Research has demonstrated that women face not only biological susceptibility to HIV, but also amplified vulnerability due to social factors such as poverty, marginalization, violence, and gender inequity. Women who are HIV-positive have unique care needs, but frequently face inattention to their specific social circumstances and health needs, particularly those of a sexual, reproductive and mental health nature, and may experience diverse challenges in accessing care. While there is limited literature and research about how women use HIV/AIDS health and social services, these factors indicate that many women could benefit from women-specific services that would more fully address their unique needs in a supportive, inclusive, and accessible manner.
The Canadian HIV Women’s Sexual & Reproductive Health Cohort Study, or CHIWOS, was developed to address these issues, and will roll out in Ontario, Quebec, and British Columbia. Affiliated with CANOC, this prospective cohort study operates within community based research and GIPA (greater involvement of people with HIV/AIDS) approaches, prioritizing the leadership, and valuing the experiences, of the diverse women who are themselves living with HIV. CHIWOS is further guided by a Critical Feminist framework and a continuous analysis of the Social Determinants of Health over a woman’s lifespan, and seeks to put its research into action in order to further social change and justice and to improve lives and care for women living with HIV in Canada. This research and approach aims to further social change for all women living with HIV around the world. The overall study aims to:
- Assess the proportion, distribution and patterns of use and uptake of women-specific HIV/AIDS services, and factors associated with service uptake among HIV-positive women living in Canada.
- Estimate the effect of women-specific HIV/AIDS services uptake on the sexual and reproductive and mental health outcomes and women’s health outcomes and screening of women living with HIV in Canada.
CHIWOS has brought together a national, multi-disciplinary research team, drawing expertise and experience from various fields and areas of the country. Mona Loutfy, Alexandra de Pokomandy, Bob Hogg, and Angela Kaida, the principal investigators, are leading the Core Research Team. Advised by the National Steering Committee and by three provincial Community Advisory Boards (CABs), supported by administrative staff and provincial coordinators, and implemented by community Peer Research Assistants (PRAs), the study brings in a rich diversity of perspectives and specialities. CHIWOS is being run through and is supported by the Women’s College Research Institute, Simon Fraser University, McGill University Health Centre, Women’s Health in Women’s Hands, the British Columbia Centre for Excellence in HIV/AIDS, the University of British Columbia, and Providence Health Care. The study is funded by the Canadian Institutes of Health Research, the Ontario HIV Treatment Network (OHTN) and supported by CIHR Canadian HIV Trials Network (CTN 262).
1) Formative Phase
Before the usage and impact of ‘women-specific HIV/AIDS services’ can be assessed, CHIWOS must determine how HIV-positive women define and envision these services. Two sets of focus groups will be conducted as part of this initial phase: 1) one to determine community definitions and perceptions of women-specific HIV/AIDS services, and 2) one to collect feedback and input on the preliminary survey instrument before it is employed on a larger scale.
2) National Survey Phase
The full cohort will recruit and enroll 1250 HIV-positive women living in the three study provinces. Participants will complete a PRA-administered survey at baseline and two years, with a phone call and brief survey at one year to ensure continuity of contact. This study will yield critical information which will help to fill knowledge gaps about women, HIV, and HIV/AIDS care, and will enable improvements in the health, care, and wellbeing of HIV positive women in Canada.