Examining Multilevel Factors Associated with the Process of Resilience among Women Living with HIV in a Large Canadian Cohort Study: A Structural Equation Modeling Approach.

OBJECTIVES: We examined how multiple, nested, and interacting systems impact the protective process of resilience for women living with HIV (WLWH). METHODS: Using data from a Cohort Study, we conducted univariate analyses, multivariable logistic regression, and a 2-step structural equation modeling for the outcome, high resilience (N = 1422). RESULTS: Participants reported high overall resilience scores with a mean of 62.2 (standard deviation = 8.1) and median of 64 (interquartile range = 59-69). The odds of having high resilience were greater for those residing in Quebec compared to Ontario (adjusted odds ratio [aOR] = 2.1 [1.6, 2.9]) and British Columbia (aOR = 1.8 [1.3, 2.5]). Transgender women had increased odds of high resilience than cisgender women (aOR = 1.9 [1.0, 3.6]). There were higher odds of resilience for those without mental health diagnoses (aOR = 2.4 [1.9, 3.0]), non-binge drinkers (aOR=1.5 [1.1, 2.1]), and not currently versus previously injecting drugs (aOR = 3.6 [2.1, 5.9]). Structural equation modeling confirmed that factors influencing resilience lie at multiple levels: micro, meso, exo, and macro systems of influence. CONCLUSION: There is a need to consider resilience as the interaction between the person and their environments, informing the development of multilevel interventions to support resilience among WLWH.

Immigration as a crisis tendency for HIV vulnerability among racialised women living with HIV in Ontario, Canada: an anti-oppressive lens.

South Asian immigrant women in Canada face unique structural barriers that influence their HIV vulnerability. Using an intersectional and anti-oppressive lens, we explored the role of immigration in bringing about changes in gender roles and the structure of gender relations and their effect on HIV risk among immigrant women as they experienced crisis tendencies in the face of hegemonic masculinity. Informed by Connell's theory of gender, the study entailed in-depth interviews with 12 self-identified South Asian immigrant women living in the Greater Toronto Area, in Ontario, Canada. A thematic analysis yielded four themes: power relations, emotional relations, gendered division of labour and social norms. Our findings revealed interdependencies between immigration and each of structural, individual and normative factors (the themes) as they pertain to crisis tendencies when patriarchy is disrupted. Given the rapid increase in global immigration, the connections between transnationalism and hegemony, and the established link between immigration and HIV, future research should extend this work to other immigrant communities.

South Asian immigrant women's suggestions for culturally-tailored HIV education and prevention programs.

Using a community-based, socialist feminist qualitative study, and an emergent research design, we explored the unique individual experiences of South Asian immigrant women living with HIV in the Greater Toronto Area (GTA) of Ontario, Canada. We assessed both the HIV risk context and the strategies for HIV education and prevention as expressed by study participants. Grounded in Connell's social theory of gender, a thematic analysis of semi-structured interviews with 12 women yielded six themes related to the power and impact of stigmatization, community's denial of HIV, infidelity, manifested in resistance to discussing sex and condom use, non-disclosure, and lack of HIV knowledge. This study validated the legitimacy of listening to the voices of South Asian immigrant women living with HIV, who communicated 20 recommendations for researchers, educators, community organizations, and service providers to culturally-tailor HIV education programs.

Exploring the use of fact-based and story-based learning materials for HIV/STI prevention and sexual health promotion with South Asian women in Toronto, Canada.

Story-based learning is well recognized as an effective strategy for adult health education. However, there is a scarcity of research on story-based health education among women in South Asian diasporic communities. To address this gap, we undertook a pilot study in Toronto to explore how South Asian women respond to the use of fact-based and story-based materials for HIV/STI prevention. A total of 78 women were recruited from across the city. We engaged nearly half of the women (n=40) using fact sheets on HIV/STIs, and the remainder (n=38) using stories written by South Asian women on HIV/STIs. Surveys and focus groups were used to explore participants' responses in terms of knowledge, attitudes and perspectives. Results indicated that both approaches were effective in increasing participants' knowledge of HIV/STIs. Participants in the fact-based sessions tended to distance themselves from the idea of personal HIV/STI risks. Participants in the story-based groups were emotionally engaged, expressing personal commitments to take a stand against HIV stigma. In summary, within-culture stories are potentially effective tools that enable women to make sense of their own life situations and contextual vulnerabilities. Story-based materials are useful for breaking the silence of taboo topics, addressing stigma and discrimination and raising awareness about collective empowerment.