Course:SOWK551/2021/ HIV/AIDS, Women, and Social Work Practice
Literature review informing healthcare social workers on how they can improve the quality of care to Women living with HIV.
Date: December 8, 2022
Although it has been about 40 years since HIV/AIDS was initially diagnosed in Canada many healthcare professionals still hold incorrect beliefs and misconceptions about the illness (Act, 2021). Presently, these preconceived notions lead to stigmatization, discrimination, and alienation of HIV-positive (HIV+) people, particularly among marginalized groups and women. Due to these negative societal pressures, HIV+ individuals continually face oppressive systematic barriers which generate extraordinary strain within the healthcare system, that is ill-equipped in meeting their needs. To put the public health issue into perspective “women represent 50% of the 33.3 million people living with HIV globally” (Carter et al., 2013, p.1). As a result, social workers often become part of the interdisciplinary team to lend guidance, education, and support to navigating these complex structures. An overview of the struggles and implications which are unique to women living with HIV (“WLWH”) is needed to navigate the bureaucratic medical system. Nevertheless, parameters and theoretical perspectives become influential in forming a social worker’s practice when working with WLWH. Present and future social work interventions and theoretical frameworks will be addressed which can be utilized in addressing the potentially fragmented service delivery of healthcare to WLWH.
Keywords: HIV-positive women, services for women, healthcare, social determinants of health, healthcare, and social work.
The review of seventeen research publications occurred between 2000 to 2022. This literature review was conducted by using electronic online databases by searching the UBC library and google scholar to find peer-reviewed articles and grey literature. The search included the following keywords “HIV-positive women”, “services for women”, “healthcare”, “social determinants of health”, “healthcare”, and “social work”. The search terms were used alone and in various combinations. A considerable number of studies involved interviews with WLWH. A critique in the literature is that there is insufficient research completed on WLWH in Canada. As a result, the scope of the findings was examined globally to identify relevant literature. A thematic analysis was completed and resulted in three themes: (1) barriers to healthcare, (2) theoretical framework, and (3) practice recommendations. This literature review will inform healthcare social workers on how they can improve the quality of care to WLWH.
Barriers to Healthcare
There are many overarching issues associated with WLWH and healthcare barriers. Carr and Gramling (2004) discussed how WLWH may experience stigma, discrimination, sexism, racism, homophobia, and transphobia while interacting with the healthcare system. Consequently, WLWH regularly encounter negative experience when seeking assistance through the healthcare system. WLWH may express concern about accessing healthcare due to violence from their perpetrator. This may further isolate WLWH, and due to their reduced coping abilities they may be further prevented from accessing healthcare (Lichtenstein, 2006). WLWH could experience substance use, mental health, and isolation which further exacerbates their need for adequate and interdisciplinary care (Gahagan & Loppie, 2001). Funding is often overlooked and prevents WLWH from accessing HIV care services (Moneyham et al., 2010). Often WLWH will have negative experiences with healthcare providers which may discourage them from receiving routine medical care (Churcher, 2013). A lack of services focusing on WLWH limits their ability to access women-specific services to address their unique needs (Csete, 2005). It is increasingly complicated for a WLWH to address her own healthcare needs when there are multiple other responsibilities such as being a mother, homemaker, paid worker, and caregiver (Stein et al., 2000; Schuster et al., 2000). These conflicting responsibilities pose a unique challenge for women when they attempt to try to address their own healthcare needs. WLWH experience a multitude of barriers to healthcare and the findings above are not an exhaustive list. These findings do not encompass all the recommendations identified in the research and additional research can be useful to further articulate additional barriers. The barriers discussed above must be dismantled and addressed in healthcare services to prevent unjust access to care.
In accordance with the Canadian Association of Social Workers (CASW), social workers need to utilize theoretical frameworks in exercising professional judgments (CASW, 2020). The curative medical model often pathologizes WLWH. To shift from this ideology practitioners will need to be more cognizant to look beyond this extent thus incorporating a more holistic and inclusive approach to one’s bio-psychosocial diverse needs. By utilizing a theoretical framework such as the social determinants of health it will help medical professionals to evaluate the intersection of social and structural factors that threaten WLWH’s health (Benoit et al., 2009). This framework acknowledges the intersections of a WLWH’s identity and their experience of social, economic, and political realities and the role that these intersections have in shaping their health outcome and experiences with healthcare services (Hankivsky & Christoffersen, 2008). The social determinants of health offer a more integrated approach when working within a multi-disciplinary medical team. The model further provides digestible language to encourage the use of open communication to discuss further ways to improve opportunities of equity, accountability, efficiency, and responsiveness of the delivery of healthcare for WLWH.
It is of utmost importance to include the voices of WLWH to influence recommendations so that healthcare services can be tailored to be women-specific which will respond to the intersectional needs of WLWH. WLWH are the experts of their own experiences and should influence what resources and services should look like for themselves which would likely address their healthcare needs more holistically and effectively. In turn, this would involve WLWH in the planning, delivery, and evaluation of services. While working with WLWH it is critical to work from a women-centered approach. The women-centered approach would include service providers providing opportunities that promote self-determination which would enhance their equity and quality of care (Vancouver/Richmond Health Board, 2001). It is further encouraged to ensure tailored programming for women (Grella, 2008). There is a need to listen to the experiences of women and provide meaningful access to care through social and supportive services (Vancouver/Richmond Health Board, 2001). Offering practical support like on-site childcare or childcare subsidies would alleviate any child-rearing stressors.
Researchers encourage healthcare providers to facilitate access to culturally sensitive information wherever possible and facilitate meaningful communication (Wisdom et al., 2008; 2009). This could look like culturally appropriate brochures in a women’s language or a peer support group to facilitate access to information. Additional recommendations for social work and healthcare practice include the need to consider the family as the unit of intervention (Schuster et al., 2000). Women consider their family in the context of decision making and therefore family and family context should be acknowledged and included. Additionally, it is crucial to involve a multidisciplinary integration and coordination of services (Vancouver/Richmond Health Board, 2001). For example, WLWH have unique experiences, and services are required to have an integrated approach to meet their unique needs to improve health outcomes. In Canada, BC Women’s Hospital has an Oak Tree Clinic which provides specialized and interprofessional care to women, children, and their families living with HIV. This program is a positive model that can be incorporated across other regions and enhanced by incorporating the practice recommendations mentioned.
WLWH have multiple social determinants of health that may need to be addressed along with their medical care like drug therapies and specialist appointments with various healthcare providers. WLWH have unique needs and a women-centered approach would include meeting the women where they are at (Shannon et al., 2005). All social workers and healthcare professionals should be encouraged to engage in gender, culture, and HIV training (Vancouver/Richmond Health Board, 2001). This would help professionals deconstruct any biases, judgments, and stereotypes which would evolve into more inclusive and women-centered care. WLWH have felt unsafe and discriminated against while interacting with the healthcare system. Therefore, there is a need to create a sense of safety, respect, and acceptance while working with WLWH (Carter et al., 2013). Lastly, the role of engaging in HIV/AIDS research will help shed light on implications for practice with the hope of improving the quality of healthcare for patients experiencing HIV/AIDS.
Literary resources attribute largely to repressive societal factors and social ideals. What becomes necessary for social workers is to be aware of the historical and political context of any crisis. There needs to be more establishment in developing empowerment, self-determination, and autonomy, so that WLWH can make independent decisions that impact the services they as women receive from the healthcare system. To achieve this, one must recognize power imbalances, so assumptions and institutional practices are challenged. Institutions are sometimes disempowering in preventing the health and well-being of individuals. As social workers, we must understand and navigate the complexities within the healthcare system. By understanding WLWH, their barriers to healthcare, the social determinants of health, and practice recommendations, social workers can adapt to change and implement strategies and resources to influence new interventions to meet the increasingly diverse and growing population of WLWH. As one tries to revise the century-old ideologies of the healthcare system, we must strive to address the social determinants of health for WLWH and work towards finding balance, equal opportunity for treatment and care, and provide resources to address the specific bio-psychosocial needs of WLWH.
Act. (2021). History. AIDS Committee of Toronto. Retrieved November 18, 2022, from https://www.actoronto.org/about-act/our-organization/history
Benoit, C., Shumka, L., Vallance, K., Hallgrimsdottir, H., Phillips, R., Kobayashi, K., Hankivsky, O., Reid, C., Brief, E. (2009). Explaining the health gap experienced by girls and women in Canada: A social determinants of health perspective. Sociological Research Online, 14(5), 1-13. https://doi.org/10.5153/sro.2024.
Canadian Association of Social Work (CASW). (2020). CASW Scope of Practice Statement. Retrieved November 19, 2022, from https://www.casw-acts.ca/files/attachements/Scope_of_Practice_Statement_2020_1.pdf
Carr, R. L., Gramling, L.F. (2004). Stigma: A healthcare barrier for women with HIV/AIDS. The Journal of the Association of Nurses in AIDS care, 15(5), 30.
Carter, A.J., Bourgeois, S., O’Brien, N., Abelsohn, K., Tharao, W., Greene, S., Margolese, S., Kaida, A., Sanchez, M., Palmer, A.K., Cescon, A., Pokomandy, A., Loutfy, M.R., & CHIWOS Research Team. (2013). Women-specific HIV/AIDS services: Identifying and defining the components of holistic service delivery for women living with HIV/AIDS. Journal of the International AIDS Society, 16(1), 17433-n/a. https://doi.org/10.7448/IAS.16.1.17433
Csete, J. (2005). ‘Vectors, Vessels and Victims’: HIV/AIDS and women’s human rights in Canada. Canadian HIV/AIDS Legal Network.
Churcher, S. (2013). Stigma related to HIV and AIDS as a barrier to accessing healthcare in Thailand. A review of recent literature. WHO South-East Asia Journal of Public Health, 2(1), 12-22. https://doi.org/10.4103/2224-3151.115829
Gahagan, J.C., & Loppie, C.J. (2001). Counting pills or counting on pills? What HIV+ women have to say about antiretroviral therapy. Canadian Woman studies, 21(2), 118.
Grella, C.E. (2008). From generic to gender-responsive treatment: Changes in social policies, treatment services, and outcomes of women in substance abuse treatment: California substance abuse research consortium (SARC) meetings 2007. Journal of psychoactive Drugs, 327-343.
Hankivsky, O. & Christoffersen, A. (2008) Intersectionality and the determinants of health: A Canadian perspective. Critical Public Health, 18(3): 271-283.
Lichtenstein, B. (2006). Domestic violence in barriers to healthcare for HIV-positive women. AIDS Patient Care and STDs, 20(2), 122.
Moneyham, L., McLeod, J., Boehme, A., Wright, L., Mugavero, M., Seal, P., Norton, W.E., & Kempf, M. (2010). Perceived barriers to HIV care among HIV-infected women in the deep south. The Journal of the Association of Nurses in AIDS Care, 21(6), 467-477. https://doi.org/10.1016/j.jana.2010.03.00.
Stein, M., Crystal, S., Cunningham, W., Ananthanarayanan, A., Andersen, R., Turner, B., Zierler, S., Morton, S., Katz, M., Bozzette, S., Shapiro, M., & Schuster, M. (2000). Delays in seeking HIV Care due to competing caregiver responsibilities. American Journal of Public Health (1971), 90(7), 1138-1140. https://doi.org/10.2105/AJPH.90.7.1138
Schuster, M., Kanouse, D., Morton, S., Bozzette, S., Miu, A., Scott, G., & Shapiro, M. (2000). HIV-infected parents and their children in the United States. American Journal of Public Health (1971), 90(7), 1074-1081. https://doi.org/10.2105/AJPH.90.7.1074.
Shannon, K., Bright, V., Duddy, J., & Tyndall, M.W. (2005). Access and utilization of HIV treatment and services among women sex workers in Vancouver’s downtown eastside. Journal of Urban Health, 82(3), 488-497. https://doi.org/10.1093/jurban/jti076.
Vancouver/Richmond Health Board. (2001). A Framework for women centred health: Vancouver/ Richmond Health Board.
Wisdom, J.P., Hoffman, K., Rechberger, E., Seim, K., Owens, B. (2008;2009;). Women-focused treatment agencies and process improvement: Strategies to increase client engagement. Women & Therapy, 32(1), 69-87. https://doi.org/10.1080/02703140802384693.