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Gender, Place & Culture
A Journal of Feminist Geography
Volume 23, 2016 - Issue 7
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Articles

‘It’s a very isolating world’: the journey to HIV care for women living with HIV in British Columbia, Canada

‘Es un mundo muy aislante’: el viaje hacia el cuidado del VIH para las mujeres que viven con VIH en Colombia Británica, Canadá

这是个非常孤立的世界:加拿大英属哥伦比亚省中,与爱滋病共存的女性之HIV照护旅程

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Pages 941-954 | Received 15 Aug 2014, Accepted 01 Apr 2015, Published online: 07 Sep 2015
 

Abstract

HIV health services research conventionally defines place in terms of proximity to care. However, understandings of place must also include the social spaces that women living with HIV (WLWH) occupy which shape their experience of health and access to care. Drawing on focus group data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, we explored how 28 WLWH navigate geographic place and social space in attempting to access HIV-related healthcare within and across a range of urban to rural localities in British Columbia (BC), Canada. We describe how existing services, even if physically close, can be socially marginalizing as women confront HIV stigma, racism, and classism, which operate to exclude women from the places and spaces they must access for care. We also emphasize how women enact ‘geographies of resistance’ and succeed in carving out their own safe options for care and support. Finally, we share recommendations identified by women themselves towards developing local and community-driven ‘geographies of change’ that support the health and healing of diverse communities of WLWH. Our findings stress the urgent need to acknowledge and redress socio-spatial barriers to care and to work with WLWH to co-create a therapeutic landscape that reflects women’s diverse identities, localities, emotions, and experiences.

La investigación de los servicios de salud de VIH convencionalmente define el lugar en términos de la proximidad del cuidado. Sin embargo, las formas de comprender el lugar deben también incluir los espacios sociales que ocupan las mujeres que viven con VIH, los cuales dan forma a sus experiencias de salud y al acceso al sistema de salud. Basándose en datos provenientes de grupos focales del Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), exploramos cómo 28 mujeres que viven con VIH navegan el lugar geográfico y el espacio social al intentar acceder el sistema de salud, en relación con el VIH, a lo largo de un rango de localidades que van de urbanas a rurales, en Colombia Británica, Canadá. Describimos cómo los servicios existentes, incluso si se encuentran físicamente cerca, pueden crear marginalización social cuando las mujeres enfrentan el estigma del VIH, el racismo y el clasismo, lo que opera para excluir a las mujeres de los lugares y espacios que ellas deben acceder para su cuidado. También enfatizamos cómo las mujeres adoptan las ‘geografías de resistencia’ y tienen éxito en forjar sus propias opciones seguras para el cuidado y el apoyo. Finalmente, compartimos recomendaciones identificadas por las mujeres mismas para el desarrollo de ‘geografías del cambio’ locales impulsadas por la comunidad, que apoyen la salud y la curación de las diversas comunidades de mujeres viviendo con VIH. Nuestros resultados subrayan la urgente necesidad por reconocer y reparar las barreras socioespaciales al acceso a la salud y por trabajar con las mujeres viviendo con VIH para co-crear un paisaje terapéutico que refleje las diversas identidades, localidades, emociones y experiencias.

HIV的健康服务研究,传统上以获得照护的邻近性来定义地方。但对地方的理解,必须同时包含与HIV共存的女性所佔据的社会空间,该空间形塑了她们的健康经验,以及获得照护的管道。我们运用取自加拿大爱滋病毒妇女的性与生殖健康群组研究 (CHIWOS) 的焦点团体数据,探讨二十八位与HIV共存的女性,如何在地理地方与社会空间中航行,以试图在加拿大英属哥伦比亚省 (BC) 城市至乡村的一系列地点之中及之间,取得HIV相关的健康照护。我们描绘既有的服务——即便在物理上是邻近的——仍然有可能在社会上具排除性,因为女性面临了HIV的污名化、种族主义以及阶级歧视,将之排除于她们必须取得照护的地方及空间之外。我们亦强调女性如何採取‘反抗地理’,并成功地刻划出自身获得照护与支持的安全选项。最后,我们分享由女性自身所确认的建议,该建议迈向建立由地方与社群所驱动的‘改变地理’,支持与HIV共存的女性的多元社群的健康及疗癒。我们的研究发现,强调认清并矫正健康照护的社会—空间藩篱、以及与HIV共存的女性共同致力于创造反映女性多样的身份认同、地点、情绪与经验的疗癒地景之急迫需求。

Acknowledgments

The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) Research Team would like to thank all of the women living with HIV who participate in the research and entrust CHIWOS with their stories. We also thank the national team of Peer Research Associates, Co-Investigators, and Collaborators, and gratefully acknowledge the national Steering Committee, national Aboriginal Advisory Board, three provincial Community Advisory Boards, and all our partnering organizations for supporting the study. The following organizations partnered with CHIWOS to provide space to conduct the BC focus groups: Positive Women’s Network, Vancouver Island Persons with AIDS Society, Simon Fraser University, and the BC Centre for Excellence in HIV/AIDS. We also thank the three BC Peer Research Associates for their invaluable contributions to this qualitative research. Lastly, we gratefully acknowledge the reviewers for their critical feedback on this manuscript. A full list of members of the CHIWOS Research Team who have contributed to the research process can be found here: http://www.chiwos.ca/chiwos-collaborators-and-co-investigators/?lang=en.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

CHIWOS has been made possible through funding from the Canadian Institutes of Health Research (CIHR) [grant number MOP-111041]; the CIHR Canadian HIV Trials Network (CTN 262); the Ontario HIV Treatment Network (OHTN); the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund.

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