Download PDF Voices of Resilience: Stigma, Discrimination and Marginalisation of Indian Women Living with HIV/AIDS

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Birth in the Age of AIDS is a quick, compelling read that will appeal to readers working in a number of related fields.

This fine ethnography fits well under the rubrics of Asian studies, global health, medical anthropology, gender studies, and the anthropology of reproduction. Van Hollen proves that careful ethnographic research is indispensable to understanding the actual, lived effects of infectious disease control programs, an insight that will surely resonate with public and global health practitioners and other readers outside of anthropology.

This support structure has helped them deal with cultural stigmatization and gender inequalities and seek social justice. Lucidly documented research findings along with discussion on policy insights make this book an important reading for all who are directly or indirectly engaged in the field of reproductive and child health.

The author situates her work firmly within the growing annals of medical anthropology that document how discourses of global health intersect with local realities. There is insightful analysis of how global health techniques—such as of informed consent—are implemented in Tamil Nadu hospitals. While acknowledging some of the problematic reasons for the centrality of informed consent procedures, she nonetheless focuses on them in order to highlight the gap between global policy on the one hand and local practice on the other hand.

But the analysis of informed consent does more work than just highlighting the gap between policy and practice. In choosing to study a practice that is central to the global health vernacular, the author renders the Indian epidemic recognizable across countries, inserting the experience of the women in Tamil Nadu into frameworks that can be understood beyond India.

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Van Hollen's compassionate, humanizing account sheds light on women's strength and resilience in the midst of a cruel epidemic. Customer Reviews. Write a review. See any care plans, options and policies that may be associated with this product. Email address. Please enter a valid email address. Walmart Services. Get to Know Us. Customer Service.

In The Spotlight. Shop Our Brands. All Rights Reserved. Cancel Submit. How was your experience with this page? Although all gendered groups are affected by social and economic factors, women are particularly affected by the way in which gender interacts with the other determinants of health. The compounding and intersecting nature of sex, gender, race, sexual orientation, age, class, and disability impacts how individuals negotiate health through intrapersonal, interpersonal, community, and institutional mechanisms.

S ocial mechanisms produce gender-based inequities and disparities e. These inequalities and disparities are apparent in the public health, social and behavioural sciences, and medical fields as exposures, risk factors, and biological properties. For example, gendered roles of masculinity and femininity may support a stereotyped sexuality, whereby gendered norms associated with masculinity encourage men to have multiple sexual partners either concurrent or not and encourage men to have sexual relationships with younger women [7].

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For some women, gendered norms contribute to an inability to negotiate safer sex practices and increase risk of sexual assault. Gendered norms lie at the root of all of these behaviours, which facilitate HIV exposure and transmission in women. Recent literature has also identified a strong association between requiring help injecting and HIV seroconversion in women who use injection drugs [].

Challenges and opportunities in examining and addressing intersectional stigma and health

Consequently, beyond increased risk of HIV transmission as a result of sharing contaminated needles, this group of women is further made vulnerable to HIV as a result of behaviour linked to gendered norms. Gendered roles of masculinity and femininity also strongly impact transgender people.

Emerging data on transgender people suggest that this population is at a heightened risk of HIV infection as a result of institutional factors that reinforce a bi-gendered culture. The basic biology and organic make-up of the human body are a fundamental determinant of health. Genetic endowment provides an inherited predisposition to a wide range of individual responses that affect health status. Although socio-economic and environmental factors are important determinants of overall health, in some circumstances, genetic endowment appears to create predispositions to particular diseases or health problems [2].

For instance, when considering heterosexual sex, the risk of contracting HIV through penile-vaginal intercourse is greater for women than it is for men [5;]. Male-to-female HIV transmission has been shown to be two to four times higher than female-to-male HIV transmission [24]. While unprotected penile-anal intercourse is considered to be of higher risk for HIV transmission than penile-vaginal intercourse, the former is rarely reflected in the literature or discourse in the context of heterosexual HIV exposure or sexually transmitted infections STIs [19;26;27].

Although similar data were not available for Canada, research from the American National Survey of Family Growth [28] reported that 5. An American study, which examined heterosexual intercourse in young adults aged years, significantly associated the practice of anal intercourse with being forced to have sex, living with a partner, and having two or more partners [27].

Voices Of Resilience Stigma Discrimination And Marginalisation Of Indian Women Living With Hiv Aids

The study also found that some women may practise anal sex as an alternative to vaginal intercourse to avoid risk of pregnancy. For women the situation is further complicated by the fact that STIs, such as gonorrhoea, chlamydia, syphilis, herpes simplex virus HSV types 1 and 2, and human papilloma virus HPV , may remain asymptomatic in women, and may, therefore, go undiagnosed. As a result, the full impact of treatment is often unknown and may pose health risks to, or impede the sustainable care of, women living with HIV.

For example, a study comparing the side effects of HAART in women and men found that metabolic toxicities associated with treatment occur more frequently in women than in men [30]. Sex-based differences in body masses, fat composition, hormonal secretion and drug metabolism may explain these differences [30;31].

Living With The Stigma Of HIV

These findings contributed to an international review of the drug for use in pregnant women living with HIV. The inventory of published research included in this report identified a single study that indicated better HIV treatment outcomes for women than men [33]. A study on fragility fractures and bone mineral density BMD in women living with HIV reveals that they report a significantly higher risk of bone fragility compared to women in the general population, despite having normal BMD.

The study identifies the need for additional research to assess bone fragility in women living with HIV and for a risk assessment tool on fractures [34]. Health status improves with level of education. Education is closely tied to socio-economic status, and effective education for children and lifelong learning for adults are key contributors to health and prosperity for individuals, and for the country. Education contributes to health and prosperity by equipping people with knowledge and skills for problem solving, and helps provide a sense of control and mastery over life circumstances.

It increases opportunities for job and income security, and job satisfaction. It also improves people's ability to access and understand information to help keep them healthy [2]. Studies show that women with limited education are hindered in their ability to access and understand HIV prevention and treatment information.

One study found that women with limited education may have trouble communicating their needs to health providers, a disadvantage when it comes to accessing health services. Further, this group of women may not be able to obtain and fully comprehend health education and health promotion materials [].

Limited language skills can also prevent women from accessing or understanding HIV prevention and treatment information [38]. Diminished educational opportunity combined with abuse, lack of economic opportunity, and experiences with child welfare system, make certain groups of women, such as Aboriginal women, more vulnerable to sexual exploitation [39] and, as a result, to infections such as HIV.


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Lack of information about sexual and reproductive health is common to all populations. Another study, conducted among undergraduate university students women, 85 men, and 4 students sex and age not indicated; mean age, Only 3.

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Health status improves at each step up the income and social hierarchy. High income determines living conditions such as safe housing and ability to buy sufficient good food.


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  • The healthiest populations are those in societies which are prosperous and have an equitable distribution of wealth. Unemployment, underemployment, stressful or unsafe work are associated with poorer health. People who have more control over their work circumstances and fewer stress- related demands of the job are healthier and often live longer than those in more stressful or riskier work and activities [2].

    Low income and poverty are associated with increased risk of HIV infection and disease progression [41]. As demographic data from Chapter 2 reveal, more women are involved in less stable work than men, more women have part-time jobs than men, and women continue to earn less than their male counterparts and are required to do more unpaid labour than men [19;42]. Gender disparities tend to be masked among those with higher incomes. As data from Chapter 2 indicate, women are disproportionately affected by poverty and certain groups of women fall to the outer ends of the socio-economic hierarchy.

    For instance, Aboriginal women and women from racial minority groups are faced with the double discriminatory effects of gender inequality and racial inequality, which ultimately impacts their socio-economic status [41;45]. Studies show that male-to-female transgender persons MTF also deal with multiple layers of discrimination and generally less than the overall population [47]; accordingly, transgender women also experience low socio-economic status [48].

    Women involved in street-level sex work are one of the most vulnerable groups in Canadian society. Society has always looked down on working women. You should be able to tell doctors so you are medically safe and the police so you can be protected physically Woman, Sex worker [49]. Several studies involving survival or street-level sex workers highlight the intrinsic relationship between survival sex and substance use. Combined, these behaviours may leave women few options for condom negotiation, as money for drugs or shelter may take precedence over self-protection [52;56;57;60].

    A Vancouver study highlighted the correlation between drug market prices and the amount which street-level sex workers charge for sexual acts [61]. Studies have identified certain risk factors, such as drug use and incarceration, which put street-level sex workers at greater risk of HIV infection. For example:. One of the prostitutes, Line, said to me: come with me. To do that, I needed to get stoned two or three times more than usual. Literature shows that while the majority of sex workers consistently use condoms with clients, sex workers have unprotected sex with their regular partners.

    Additional research indicates that regular sexual partners of sex workers may themselves be using injection drugs or participating in other high-risk activities. Some HIV-positive women live below the poverty line because their social assistance income benefits do not extend to cover their basic needs. One study reports that source of income is considered a serious concern for the majority of women living with HIV [69].

    These issues were of special concern for single parents from Aboriginal and ethnic communities, as women from these communities make up a high number of people living in low- income situations [69]. According to a British Columbia study, risk factors for inadequate food security and hunger include being female, having a low income, having a low education, and being Aboriginal [72]. Other risk factors include living with children, having a history of injection drug and alcohol use, and unstable housing [72].