Kristen Beausoleil and Jessica Halverson.pdf - Canadian AIDS ...

1Population-Specific HIV/AIDS Status Report: Women in CanadaSummary of Key FindingsPresentation at women’s ancillary event to develop a coordinatednational research agenda for women, transwomen, girls andHIV/AIDS in Canada, April 13-14, 2011By: Kristen Beausoleil and Jessica HalversonCentre for Communicable Diseases and Infection Control

A population-specificapproach

3A population-specificapproach• The Public Health Agency of Canada is looking at howeight populations in Canada are affected by HIV:– People living with HIV/AIDS– Aboriginal Peoples– Women– Youth at-risk– Gay, two-spirit, bisexual, and other men who have sexwith men– People who use drugs– People in prison– People from countries where HIV is endemic• Allows for a more effective and targeted HIV response

The first step:knowledge synthesis andexchange

5A tool for knowledgeexchange: the status report• A detailed synthesis of what is currentlyknown about HIV and AIDS among eachpopulation in Canada• Provides an evidence-base to inform futuredirections of policy, programs and research• Developed with guidance of expert workinggroup• Meant to be used by everyone

Status report on womenand HIV/AIDS in Canada:overview of findings

HIV among womenin Canada:surveillance highlights

8Proportion of HIV reports bysexProportion of positive HIV test reports by sex, 1985-2009Percent100.0%90.0%80.0%70.0%60.0%50.0%40.0%30.0%20.0%10.0%0.0%19851987198919911993199519971999Year of test20012003200520072009MalesFemalesData source: Public Health Agency of Canada, Surveillance and Risk AssessmentDivision. HIV/AIDS in Canada surveillance report to December 31, 2009. 2010.

10Exposure categoriesProportion of Positive HIV Test Reports among Adult Women (> 15 yrs) byExposure Category, 1985-20093.8% 4.9%37.3%53.9%Heterosexual contact* Injection drug use (IDU) Blood / blood products Other*Data source: Public Health Agency of Canada, Surveillance and Risk AssessmentDivision. HIV/AIDS in Canada surveillance report to December 31, 2009. 2010.

11Ethnic/racial breakdown of HIV casereports in CanadaFigure 5: Percentage of positiveHIV reports among women byrace/ethnicity 1998-2008White0.8%0.5%Black2.1%33.3% Asian42.9%WOMENAboriginal3.8%6.6%16.9% 2.5%66.4%MENFigure 6: Percentage of positiveHIV reports among men byrace/ethnicity 1998-20083.1%0.6%WhiteBlackAsianAboriginal1.6%18.8%South/WestAsian/ArabLatinSouth/WestAsian/ArabLatinOtherOtherData source: Public Health Agency of Canada, Surveillance and Risk AssessmentDivision. HIV/AIDS in Canada surveillance report to December 31, 2009. 2010.

12Other surveillance findings• From 1985-2009, the largest proportion of HIV positivetest reports occurred in women aged 30-39• In 2009, HIV prevalence rates for women in federalprison (7.9%) were higher than rates for men in federalprison (4.5%)*• Research studies indicate that women involved in sexwork have higher HIV prevalence rates than the generalfemale population• Limited data indicate that transwomen have particularlyhigh HIV prevalence rates*Source: Correctional Service of Canada. Research report: summary of emerging findingsfrom the 2007 National Inmate Infectious Diseases and Risk-Behaviours Survey. 2010.

Women, HIV risk and thedeterminants of health

14Women’s vulnerability andresilience to HIV/AIDSHIV RiskData source: Modified from a diagram prepared by Women’s Health in Women’sHands. Permission sought by personal communication, March 2010.

15Gender, race and culture• Gender is the key determinant which intersects andinfluences the other determinants• Two most common exposure categories for HIVtransmission in women involve risk behaviour relatingto power relationships and gender inequalities• Other factors related to race and culture intersect withgender to increase women’s vulnerability to HIV:– Racism and discrimination– Culturally-specific stigmatizing attitudes– Certain cultural practices– Culturally-specific norms and values

16Social and physicalenvironments• Clear link between homelessness, drug use and HIV riskbehaviour• Repeated physical and sexual violence is strongly associatedwith a positive HIV test report• Lack of power to negotiate safer sex is significantlyassociated with increased vulnerability to HIV• Substance use also increases women’s vulnerability to HIV ina number of ways:– Directly (women are more likely to share injection equipmentthan men)– Indirectly (as a result of physical, mental and economiceffects of dependency)

17Healthy childhooddevelopment• Childhood physical, emotional or sexual abuse maycontribute to risk behaviours in later life which mayfacilitate the acquisition of HIV– injection drug use significantly associated withchildhood sexual abuse• Studies indicate that HIV and HCV prevalence are alsohigher among those who have experienced sexualabuse• Childhood sexual violence is also significantlyassociated both with sex work and with sharing ofcontaminated needles

Research and response

19Current HIV/AIDS Research• 87 Canadian time-limited research projects underway between 2006-2009 that focused on HIV/AIDS among women in Canada• General areas of research included prevention, interventions andtreatment strategies and focus on capacity building• Many projects focused on specific groups of women:– Women living with HIV/AIDS– Women involved in sex work– Women from countries where HIV is endemic– Female youth at-risk– Aboriginal women– Women who use injection drugs– Lesbian, bisexual women and transwomen– Women in prison settings• Gaps on certain cross-populations remain and there is a need formore evidence about what interventions work

20Current response toHIV/AIDSDistribution of Women-Centred Projects on HIV/AIDS by Category(N=114)Youth9%11%2%Women in prisons7%WHAs21%19%AboriginalEndemicSex workersTrans women20%11%Women who injectdrugs

How do we better addressHIV among women inCanada?

22Status report findingsApproaches, interventions and projects need to:‣ Be aimed at distinct groups of women most affected by HIV‣ Be gender- and culturally-specific‣ Consider the underlying inequalities present in women’s lives‣ Focus on empowering women to redress gender powerimbalances‣ Be evaluated to determine their effectiveness and resultsshared‣ Address underlying causes that render women vulnerable toinfection

Where do we go fromhere?

24Research implications (1)• Focus on women most affected and underresearchedpopulations:• Aboriginal women• Black women• Women who use injection drugs• Cross-populations of women most atriskof HIV infection (e.g., femaleyouth at risk, women who are coinfectedwith another STBBI)• Women involved in sex work• Transwomen

25Research implications (2)• Focus on evaluative research• Take a closer look at what works: i.e., factors thatcontribute to women’s resilience against HIV• Emphasize the systematic generation and exchange ofknowledge• Integrate research with program delivery• Promote collaboration and strengthen partnerships

26AcknowledgementsSincere appreciation to National Expert Working Group members for theirexceptional commitment:• Louise Binder, Canadian Treatment Action Council and Blueprint forAction on Women and Girls and HIV/AIDS (Toronto, ON)• Hélène Chalifoux, Québec Region, PHAC (Montréal, QC)• Anne Marie DiCenso, Prisoner's AIDS Support and Action Network(Toronto, ON)• Lynne Leonard, University of Ottawa, Epidemiology and CommunityMedicine, HIV Prevention Research Team - Ontario Women's Study(Ottawa, ON)• Sharon Milewski, YouthCO AIDS Society (Vancouver, BC)• Darlène Palmer, Cactus Montréal (Montréal, QC)• Doris Peltier, Canadian Aboriginal AIDS Network (Wikwemikong, ON)• Mary-Beth Pongrac, Correctional Service of Canada (Ottawa, ON)• Pascale Robitaille, Eve Robinson, Stella (Montréal, QC)• Marcie Summers, Positive Women’s Network (Vancouver, BC)• Wangari Tharao, Women’s Health in Women’s Hands (Toronto, ON)• Kim Thomas, Canadian AIDS Society (Ottawa, ON)• Tree Walsh, AIDS Cttee of Newfoundland and Labrador (St. John’s, NL)• Sophie Wertheimer, Canadian AIDS Society (Ottawa, ON)

27AcknowledgementsSincere appreciation to staff from the Public Health Agency of Canada,Centre for Communicable Disease and Infection Control for their hardwork:• Geneviève Tremblay, HIV/AIDS Policy and Programs Division• Jocelyne Guay, HIV/AIDS Policy and Programs Division• Kristen Beausoleil, HIV/AIDS Policy and Programs Division• Jessica Halverson, Surveillance and Risk Assessment Division• Kristina Lalonde, Surveillance and Risk Assessment Division

28For more informationv Women’s status report targeted forpublication this summerKristen BeausoleilSenior Policy AnalystKristen.Beausoleil@phac-aspc.gc.ca613-954-1008

AppendixWomen in Canada:demographic highlights

30Demographic profile• Over half of Canada’s population are women or female children (2006Census data)• Almost half a million women (3.7% of the total female population)self-report as being First Nations, Inuit or Métis (2006 Census data)• 80.1% of all lone-parent families are headed by women (2006 Censusdata)• Fewer women than men report having good mental health (2002Canadian Community Health Survey)• 12.7% of Canadian women lived in households with core housingneeds as compared to 10.3% of men (Canada Mortgage and HousingCorporation, 2001)• More than one-third of street youth are female (E-SYS surveillance data 1999-2003)