Made In Canada: Home Grown Research on Canadian Women’s Health

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Health Care System in Atlantic Canada Neglects Immigrant, Refugee and Minority Women
From the Atlantic Centre for Excellence in Women’s Health

The health care system in Atlantic Canada cannot adequately help immigrant, refugee and racialized minorities if it cannot hear or see them. When it comes to access to health care for diverse populations, their current invisibility within the system is a top concern.

Recent studies sponsored by the Atlantic Centre of Excellence for Women’s Health (ACEWH) have exposed a critical knowledge gap in the region about accessibility of health care for disadvantaged sub-populations in general, and women in particular. A lack of information about the lives of women and their families—especially Aboriginals, indigenous Blacks, immigrants and refugees—forms one of the chief roadblocks to their proper care.

Research sponsored by the ACEWH demonstrates that there are three major barriers for adequate health care:

  • Medical Research: Health care systems are not well informed about the ethno-cultural diseases and medicines of minorities. Services do not investigate how various diseases affect Blacks or Asians differently, what conditions are prevalent among different ethnic groups, or what alternative therapies are available that best reflect cultural and religious beliefs.




  • Language and Communication: Minorities who lack English language skills—particularly immigrant women, who are the family caregivers —are uncertain about which health services are available to them. This, in turn, prevents them from fully using the services. Limited or insufficient social support networks and high levels of unemployment among these women further restrict their ability to maintain health.




  • Culture: Access to health services by groups such as Acadians, Blacks, Aboriginals and immigrants is increasingly difficult because the regional health system is not always sensitive to the needs of a culturally diverse clientele. In practice, this can translate into a tendency to by-pass the system. Immigrant women sometimes prefer no physician at all if they cannot see a female physician for gynecological examinations; Black women use facilities for breast cancer screening less than others, relying more on community structures to manage health; Aboriginal women prefer care delivered within their own communities.




  • Steps for the Future: The ACEWH recommends that more and better trained health care interpreters are needed to help prevent misunderstandings and to enhance communication processes respecting diagnoses.

Training in medical terminology and cultural and linguistic translation for interpreters would help immigrant encounters with doctors and nurses. A parallel need exists for more organizations to provide and deliver vital information and health education about how to use the system and about health promotion in an immigrant’s own language.

Provincial and regional health systems in Atlantic Canada should develop umbrella policies integrating sensitivity training and multicultural issues into programs for health providers. Diversity training for medical and support staff must become a matter of policy and practice before the system can become culturally responsive. Finally, culturally relevant communitybased research on social and economic inclusion is required to shape policy, professional education and service delivery.

For more information call: (902) 470-6725 or visit: http://www.medicine.dal.ca/acewh/eng/reports.html


Immigrant, Refugee and Visible Minority Women Experience Post Traumatic Stress Disorder, Study Finds
From the Prairie Women’s Health Centre of Excellence with the Immigrant Women’s Association of Manitoba and The Centre for War Affected Families

A new study authored by Judy White, and published by the Prairie Women’s Health Centre of Excellence, reports that immigrant, refugee and visible minority women often suffer from Post Traumatic Stress Disorder, and that physicians and psychiatrists do not appear to recognize symptoms of this disorder among their clients.

Immigrant and refugee women often come from war-torn countries and may have been exposed to disaster, incidents of extreme trauma and continued gender oppression. The process of migration and the experiences of settlement as an immigrant in Canada may also add to the distress and trauma.

The study of trauma, and in particular, Post Traumatic Stress Disorder, is of relevance to policy makers, health professionals and other community workers because of the ongoing arrival and settlement of immigrant and refugee women from many parts of the world. An increasing number of women are coming from war-torn countries and from countries where there has been a high risk of exposure to disaster, incidents of extreme trauma and continued gender oppression. The study also explores parallels among Aboriginal, First Nations women and other visible minority women and their experiences with Post Traumatic Stress Disorder.

Currently the Canadian health care system does not adequately address the Post Traumatic Stress Disorder experienced by immigrant, refugee and visible minority women. This study, which focuses on the experiences of women in Saskatchewan, highlights the need for policy makers, medical practitioners, mental health workers and other community providers to improve services to address immigrants and refugees who are victims of Post Traumatic Stress Disorder.

Full study details are available at: http://www.pwhce.ca/ptsd-immigrant.htm or (204) 982-6632.


$1.25 Million Study Looks at Impact of Racism, Violence on Health and Well Being of African Canadians
From the Canadian Institute for Health Research

A team of African Canadian researchers is looking at the impact of violence— including the violence of racism—on the health and well being of members of Black communities in Halifax, Toronto and Calgary. Dr. Wanda Thomas Bernard, Director of the School of Social Work at Dalhousie University is Team Leader for the five-year, $1.25 million project funded by the Canadian Institute for Health Research (CIHR) in partnership with the Atlantic Centre for Excellence in Women’s Health.

Susan Edmonds, co-chair of the Health Association of African Canadians (HAAC), is one of many community partners involved in the research. A nurse and community activist, Edmonds has been in the forefront of calling for the inclusion of racism as a determinant of health. “The repeated experience of being personally devalued coupled with a fear of speaking up takes a toll on an individual’s sense of self and can negatively impact that individual’s health,” Edmonds says.

“Academics in the past have come and gone from the Black community without creating lasting ties,” Edmonds says. “The resultant research tended to be paternalistic.” HAAC is encouraged that CIHR has supported the development of an African Canadian research team with members who live in and contribute to their communities on an ongoing basis.

Bernard says the project is action research—information is gathered and analysis is developed in order to provide community members, health professionals and policy makers with a basis for taking action on issues of concern to the communities involved. As much as possible, research assistants will be hired from the Black community and services will be purchased from Black community members. “This kind of research can only be successful if community members contribute their time, expertise and resources,” Bernard says. “An ethical approach to research requires that most of the project resources go back to those communities.”

The African Canadian researchers and their research assistants will be working with African Canadian community members to document experiences of individual, community and systemic violence. They will be meeting with people in various communities to discuss current concerns, complete a survey and engage in in-depth interviews. They will also work closely with nine families over three years, looking deeply at family members’ experience of violence, and its effects not only on their health and well being, but that of their communities and of society in general. A national conference will be held in Halifax in 2003, an internet conference in 2004 and an international conference in 2006.

In each city, annual Community Forums will be held to discuss issues that arise from different research activities and explore how to address these issues in concrete ways. Four community- based projects will occur in the final year, projects that will build on the capacity of communities to heal from and work to prevent individual, community and systemic violence. At least one of the projects will develop Africentric health education materials and workshops that focus on violence, gender and health.

General areas of investigation include the questions: How do African Canadian boys, girls, men, women and elders experience violence in their lives? How does it affect their health and wellbeing? How does it affect the health and well being of their families and communities? What actions do community members already take to counteract the effects of violence in their lives? What other actions can individuals, families and communities take that will increase their understanding of the root causes and terrifying effects of violence? How can we make sure that what we learn directly benefits members of African Canadian communities and has an impact on policy makers, program managers and frontline workers?

For more details contact: Dr. Wanda Thomas Bernard (902) 494-1190; wanda.bernard@dal.ca


Studies Highlight Differences in HIV Risks For Canadian Men and Women
From the Atlantic Centre of Excellence for Women’s Health

New studies published by the Atlantic Centre of Excellence for Women’s Health (ACEWH) reveal that there has been an overall lack of sensitivity to the differences in risk factors between men and women in HIV prevention and treatment strategies in Canada, and that these omissions have profound implications for the health of all Canadians.

Health Canada estimates that 1 in 500 Canadians has been infected with the HIV virus, with 35,000 currently diagnosed cases of HIV/AIDS and an estimated 15,000 more who are unaware of their infection (Health Canada 2000).

In Canada, the number of women being diagnosed with HIV continues to increase. While there has been an overall drop of 25% in the number of new HIV positive infections in Canada since 1995, the current female infection rate has risen steadily, and has increased by 20% since 1997. Globally, women are becoming infected at younger ages than men, and transmission from men to women is twice as likely as from women to men.

Individual studies published by ACEWH examine the impact of HIV on diverse female populations in Canada:

HIV and Aboriginal Women
There have been dramatic and rapid increases in HIV and AIDS rates among Aboriginal peoples in Canada with the patterns of HIV and AIDS cases markedly different from that observed for Canadian women in general. Epidemiological data shows that Aboriginal women constitute 49.6% of newly diagnosed HIV cases among Aboriginal people, while non- Aboriginal women comprise 20% of newly diagnosed non- Aboriginal HIV cases.

Injection drug use is the major mode of HIV transmission among Aboriginal women, followed by heterosexual contact with an HIV infected partner. HIV infection occurs at a younger age for Aboriginal women than for non-Aboriginal women. Young women constitute the largest proportion of Aboriginal AIDS cases. Consequently, the risk of HIV transmission from mother to infant among Aboriginal women is on the rise. The ACEWH published study indicates that despite these alarming trends, Aboriginal women continue to remain invisible in HIV/AIDS research and policy, and they face numerous barriers in accessing services.

HIV and Pregnant Women
Women of childbearing age (15-44 years) account for approximately 80% of total AIDS cases among adult women in Canada. Of pediatric AIDS cases, the majority (84%) can be attributed to mother-to-child transmission (Health Canada 2001). This national study examines the application and acceptability of the different Provincial approaches of providing voluntary HIV testing and counseling to reduce the rate of pediatric AIDS in Canada.

HIV and Injection Drug Use
Injection drug use continues to be a major contributing risk amongst women testing positive in Canada. The proportion of positive HIV tests among women attributable to injection drug use was 31.9% prior to 1994, rising to 53.6% in 1995, and 47.5% in 1999.

The authors of the ACEWH published study suggest that women who use injection drugs are more likely than men to use needles and syringes previously used by others, more likely to share other injection materials (water, cotton, cookers) and are more likely to report sharing of needles and syringes with a sex partner. Study findings suggest the importance of relationships and networks in HIV risk for female injection drug use.

HIV and Prostitution
Contrary to popular stereotypes, studies show that Canadian female prostitutes are no more likely to be infected with HIV or other sexually transmitted diseases than other women unless they are also injection drug users. To date, the focus of much HIV prevention work within the sex trade industry in the Canadian context has been on the female prostitute. Most prevention programs have attempted to ensure that female prostitutes have a high level of knowledge of HIV transmission and utilize condoms. Studies suggest that these programs have been effective, that many women who work as prostitutes within the North American context are relatively consistent users of condoms, and that sex-trade workers use condoms more consistently than other populations similar in age, race and sex.

However, research also indicates that when condoms are not utilized during the prostitute-client relationship, it is frequently because the client resists. Client resistance to condom use can take many different forms, from subtle coercion to more overt forms of violence. This study demonstrates that the emphasis on the female prostitute as the keeper of safer sex not only detracts attention from the contexts that make it difficult for the women to practice safer sex, but also reinforces the idea that the women, and not the men, are to blame if one or more parties becomes HIV infected.

For more information visit: http://www.medicine.dal.ca/acewh/eng/books.html or call: (902) 470-6725.