Critical Feminist Framework
A critical feminist framework looks at the overlapping and intersecting issues of gender, racism, homophobia, classism, sexuality, ableism, and HIV-related stigma, and how these issues intersect at individual and structural levels to create oppression; thus, there is an interdependent and mutually constitutive relationship between social identities and social inequities. These structural factors put women at increased risk of gender inequity, violence, poverty, and HIV transmission. A critical feminist approach examines how women are affected by patriarchal systems and structures that affect their social status in relation to men, and intersect with systemic inequality related to women’s many other identities. This also involves looking at how the role of women in society is culturally limited and impacted by legal, financial, religious, and economic discrimination against women. This type of systemic and structural inequality has meant that women are not provided with opportunities to participate meaningfully in society or be involved in decisions that directly impact on their lives. Critical feminism draws on principles of social justice, anti-racism, and anti-oppression, which seek to challenge rather than perpetuate systems of oppression.
Anti-oppression, Intersectionality, and Social Justice
The integration of principles of anti-oppression into our critical feminist framework means that we recognize the systemic gendered oppression that women face without homogenizing the experiences of women. An anti-oppressive approach acknowledges that women throughout the world are situated differently, experience oppression in a multitude of ways, while other women experience privileges based on their social locations or identities. Through an understanding of anti-oppression, we are able to deepen our analysis in understanding the complexities of power relations, and how these power relations have an influence on the ways in which women experience their lives.
Intersectionality should be at the core of any conceptual framework that seeks to understand the multiple issues and concerns that face HIV-positive women in Canada. Intersectionality moves beyond the assumption that health outcomes may be caused by a number of contributing causes, by asserting that numerous factors are always at play and that “intersectionality examines gender, race, class and nation as systems that ‘mutually construct one another’” (Patricia Hill Collins, 1998:63). Intersectionality encourages a contextual analysis that probes beneath single identities, experiences and social locations to consider a range of axes of difference to better understand any situation of disadvantage (Yuval-Davis in Hankivsky, 2005). Researchers who are committed to social justice and working toward creating change in health and social care prevention policies can view intersectionality as more than merely a concept, but a term that can be enacted on to address social inequalities. “Intersectionality can inspire political action and policy development…by understanding how individual stories are politically embedded and have political consequences” (Pheonix and Pattynama, 2006, p.189).
The use of a social justice framework, particularly within research is connected to emancipatory resistance with the objectives of confronting oppression, and demanding – or creating – social justice. In order to achieve social justice, research must support communities through collaborative approaches that demand radical social change. Thus, community-based research approaches and practices are often used because they involve incorporating and informing community members, and having them guide the research. Research that is working towards social change should have an impact on policies and practices in Canada in order to improve the lives and health of HIV-positive women in Canada.
Social Determinants of Health Framework
A social determinants of health (SDoH) framework, as established by the World Health Organization (WHO) in 2005, acknowledges that many interacting social factors have a large impact on health outcomes and service use. The premise for addressing the SDoH in a broad sense is that while good medical care is a vital component of good health, the underlying social causes that undermine people’s ability to access these services must be addressed in order to have an opportunity for good health and well-being. Poverty and gender inequity are SDoH, given that these factors impact the lives of women and children on a global scale, affect access to secure housing, food security, health care, services, resources, and susceptibility to HIV.
However, this more traditional notion of SDoH does not go far enough in recognizing the unique and intersectional social positionings that women occupy in Canadian society. As such, we have recognized the need to understand the experiences of HIV-positive women within a ‘social determinants of women’s health’ framework. A ‘social determinants of women’s health’ framework recognizes the importance of differences between women, men and other gender groups, as well as differences between and within groups of women based on social factors, identity statuses, geographical locations and access to key material and ideological resources. It also recognizes that although women play multiple roles in our society, including mothering, they continue to have unequal access to power suggesting that a social determinants of women’s health framework is necessary when engaging in applied research aimed at developing more effective practice and policy based outcomes.
The principle of GIPA (or Greater Involvement of People living with HIV/AIDS) demands the meaningful and emancipatory participation of people living with HIV (PHAs) in every stage of research and knowledge translation. GIPA recognizes the rights of PHAs to a voice in directing the decisions that impact their lives, and to self-determination and autonomy. The absence of meaningful participation of PHAs, as well as violating these rights, will render the research project, service-delivery or support program, or policy initiative significantly less effective. CHIWOS is striving to embody this principle in a genuinely transformative way, benefiting women living with HIV as well as researchers, and to avoid the pitfalls of tokenism and a shallow commitment to meaningful engagement.
Community-Based Research Approach
Community Based Research (or CBR) is an approach which seeks to genuinely democratize research, breaking down hierarchical power relations and problematic dichotomies between the researchers and the ‘researched’. CBR moves beyond simple consultative relationships and instead tries to build collaborative ones: active co-research, by and for those to be helped. It involves all relevant parties – particularly, in this case, women living with HIV – in identifying problems, priorities and questions, shaping and implementing the research process, and actively working to change and improve conditions seen as problematic. CHIWOS seeks to bring together a radically different research community which includes PHAs, doctors, scientists, social scientists, AIDS Service Organization workers, service providers, activists, academics, and others. In and through this community, all members’ contributions and diverse experiences will be valued and respected, critical self-reflection will be prioritized, and those to be helped will be able to determine the purposes and outcomes of their own inquiry.
It is essential to the success and integrity of the CHIWOS project that all members of the Core Research Team, the Steering Committee, the peer research assistants and the Community Boards understand these principles and work within these frameworks for all their CHIWOS-related activities.