Abstract

The intersection of race, gender, sexual orientation and HIV: understanding multi-dimensional forms of stigma and discrimination experienced by women living with HIV in Ontario, Canada

Presented by Carmen Logie (Canada).

C. Logie¹, L. James², W. Tharao², M. Loutfy<sup>3

1</sup>University of Toronto, Faculty of Social Work, Toronto, Canada, ²Women's Health in Women's Hands CHC, Toronto, Canada, ³Women's College Research Institute, Toronto, Canada

Background: HIV-related stigma interacts with structural inequities and may be exacerbated for marginalized populations. The increased HIV infection rate among women in Canada, particularly among African/Caribbean and Aboriginal women, underscores the importance of understanding multi-dimensional forms of stigma and discrimination. We used a critical feminist epistemology to explore experiences of stigma and discrimination among women living with HIV from marginalized communities.
Methods: We conducted 15 focus groups with women living with HIV across Ontario, Canada including: Aboriginal, African/Caribbean, sex worker, injection drug user (IDU), lesbian/bisexual, and transgender women. Three focus groups were implemented with HIV researchers and service providers in Ottawa, Hamilton and Toronto. We used a semi-structured interview guide to explore strengths and challenges experienced by women living with HIV. Focus groups were digitally recorded, transcribed, entered into NVivo and examined with narrative thematic techniques from grounded theory.
Results: Focus group participants (n=104; mean age=38 years; 23% lesbian/bisexual; 22% transgender; 69% ethnic minority) attributed experiences of stigma and discrimination to: HIV serostatus, sexism, racism, homo/transphobia, and other marginalized identities (e.g. IDU). Participant narratives highlighted widespread stigmatization across multiple realms (e.g. familial, social, health care) that negatively impacted mental health, relationships, and treatment access. Lesbian, bisexual, and transgender women described the intersection of homo/transphobia with gender-based violence as a route of HIV infection. Ethnic minority women and IDU reported that discrimination within health care reduced utilization of health services. HIV-related stigma emerged as major reason why women living with HIV remained in situations of domestic violence.
Conclusions: Women living with HIV described interdependent and mutually constitutive relationships between social identities and social inequities such as HIV-related stigma, homo/transphobia and racism. Understanding the deleterious effect of stigma(s) on HIV risk, mental health, and access to care for women living with HIV can inform health care provision, domestic violence programs, and multi-level stigma reduction interventions.