Tag Archive for: HIV

Behind the Science: Exploring the Intersection of Racial Discrimination and Sexual Pleasure

Interviewee: Charity Mudhikwa, BSc Hons, MSc Student, Simon Fraser University Faculty of Health Sciences, Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: June 9th, 2023

Could you tell us more about your research?

 My research is sort of two-pronged. Firstly, it aims to examine the prevalence of perceived everyday racial discrimination among racialized women in British Columbia. Everyday racial discrimination refers to chronic, routine and relatively minor experiences of unequal treatment such as being followed around in stores and being treated with less courtesy because of your race. These experiences have been shown to be associated with poor health outcomes! And so, the second aim of my research is to evaluate the association between everyday racial discrimination and sexual health— particularly sexual pleasure.

I’ll also be looking to see if HIV status modifies that association since my work is within the BCC3 cohort of women living with and without HIV. I think women living with HIV are generally more aware of their sexuality because of the conversations they have in healthcare settings and with their peers, so we may see differences when comparing women living with and without HIV. 

Ultimately, I’m really interested in examining everyday racial discrimination, the tools used to measure it in health research, and the associations that it may have with sexual pleasure.

What motivated you to look at the intersection between racial discrimination and sexual pleasure in women?

As a racialized woman myself, I always knew what racism was and experienced it in different ways, but I began to understand it more when I moved to Canada because I grew up in Zimbabwe, where my race was not a significant part of my identity. Usually, when we think of racism we think of structural factors, like how racialized communities have lower socioeconomic status or blatant acts like racial slurs. But we don’t think about more minor everyday experiences of racial discrimination, like not being treated well in restaurants. It seems very minute and inconsequential, but it’s cumulative and there is evidence that it does impact health. Also, racialized women are often seen as ‘deviant’ when it comes to sexual behaviour. What about looking at sexual health from a positive lens like pleasure? What about the racial discrimination that women experience? How may it affect women’s opportunities to experience pleasure? 

What are some of your findings so far?

Racialized women, particularly Black and Indigenous women, are reporting significantly higher experiences of everyday racial discrimination compared to White women. When we compare by HIV status across specific groups, for example, Black women living or not living with HIV, there are no significant differences in everyday racial discrimination scores. So, we’re seeing that even after accounting for HIV status or socio-economic factors like income, education, and sexual orientation, racialized women are still experiencing very high levels of everyday racial discrimination. So, it warrants further investigation of how these experiences may be impacting priority health areas for women. 

Who have been some of your mentors in the research field?

I’m very lucky to have had really inspirational and encouraging mentors throughout my academic journey. For my undergraduate honours project, I reached out to Dr. Bob Hogg, and he welcomed me with open arms, helped me figure out a project, and connected me with other mentors such as Dr. Kalysha Closson who has also been supportive. I was grateful to have people who believed in me and encouraged me to pursue opportunities that I otherwise would not have such as working to get my honours work published. Throughout grad school, my supervisor Dr. Angela Kaida has been very instrumental in my journey as a researcher and encourages me to explore the questions that I’m interested in. I think that’s rare, unfortunately, so having supportive people has been incredible. I don’t think I’d be where I am without those mentors. I’m very grateful for them. 

What impact do you hope to see with your research?

Firstly, especially in Canada, I would like to see the recognition that racial discrimination even exists in the first place. Going through the literature, I’ve realized just how much is lacking in a Canadian context. Some people in Canada genuinely deny the existence of racism or racial discrimination, or say ‘But it’s not as bad as it is in the US.’ There’s definitely a need for the Canadian general public to recognize that racism does exist and that it has serious implications for people’s health. And it may have impacts on women’s priority health areas such as sexual health and pleasure. So hopefully the impact that my work will have is to recognize the potential links between racial discrimination and sexual pleasure and to also inspire further research that considers the influence of everyday racial discrimination on other health outcomes.

 Where can people find out more about the great work you do?

You can find out more about it on Twitter at @CharityMudhikwa or @HIV_HEAR_me. You can also find me on the BCC3 Study website. 

 

 

 

 

 

 

 

 

Behind the Science: Sexual Pleasure in Women Living with HIV

Interviewee: Kelly Mathews, MD Student, University of British Columbia Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: May 5th, 2023

Could you briefly explain what your research is about? 

I’m part of a study on healthy aging in women living with and without HIV called BCC3. It involves community members, so women living with HIV, right from the beginning. My project, in particular, is looking at sexual pleasure in women living with and without HIV, and examining if the hormone testosterone has any influence on pleasure. We also look at social variables like income, mental health, home environment, substance use, etc. to see if they have any influence on sexual health.

Why do we need more work to understand sexual pleasure in women?

HIV is not transmissible by sexual activity for people on effective antiretroviral therapy. Yet, research looking at sexual health for women living with HIV has been really pathologizing, seeing women as vectors of disease rather than sexual beings who are deserving of pleasure and satisfaction in their sex lives. 

Historically, the way we’ve studied female sexual function has been thinking that women operate in the exact same way as men do. There’s been a ton of research on the sexual response cycle in men and this has been broadly applied to women.  This doesn’t take into account how women experience pleasure and what sexual interactions are like for women. For instance, women living with HIV, have often been labeled as having sexual desire disorder, without taking into account structural factors that might be preventing them from wanting to have sex. 

I think it’s really important to emphasize these positive aspects of sexuality and the other things that give women pleasure, whether that be with a partner or on their own, and once we can figure it out then we can promote it on the frontlines to clinicians, community workers, and among community members themselves. 

Recent research suggests that a focus on pleasure can actually lead to safer sex and a reduction in chronic pain, mental health, and fatigue. So I think focusing on pleasure is really the way going forward.

Could you highlight some important findings from your research?

The biggest thing that we’ve seen so far in preliminary results is that there’s actually no difference in the prevalence of reporting ‘always’ or ‘usually’ experiencing pleasure during a sexual experience when we compare the women living with HIV and those without HIV, which was a bit of a surprise! This is something that we hope will be empowering for community members to take away from the study. We also acknowledge that it’s important to keep promoting pleasure for more people because only 60-65% of the women in our study reported ‘always’ or ‘usually’ experiencing pleasure. 

I think that this finding highlights some of the strengths of our study. We looked at pleasure not only in partnered sex, but also for women who are engaging in self-pleasure/masturbation. Not too many projects have done that in the past. I think another strength is that our control population is very similar in terms of many sociostructural factors such as housing, income, and substance use to the women living with HIV in our study. So this helps us narrow in on this pleasure piece and shows that the virus itself isn’t changing pleasure. It’s more of those social determinants of health that affect both populations.

Another important finding was that women living with HIV have lower total testosterone levels than HIV-negative women, but this was not associated with an increased or decreased odds of pleasure.

What other questions do you hope to answer next?

We’ve nearly doubled our sample size of women that we have testosterone measurements for and sexual pleasure responses. That’s going to allow us to look at a few more variables and, in particular, it’s going to allow us to do an analysis stratified by HIV status. Having spoken to some community members, a lot of people have highlighted the need for including chronic pain as well as maybe HIV medication side effects in our analysis. It would also be really interesting to look at how HIV factors like immune cell count, HIV viral load, and HIV-related stigma might impact sexual health. 

What impact do you hope to see with this work years from now? 

I think the community involvement and the design of the BCC3 study are really good and I hope that more projects will emulate that in the future and have more community members involved in every step of the project. In terms of pleasure, I really hope that there is a shift to conducting more research focusing on these positive aspects of sexuality. 
Another hope is that we can get the message out about U Equals U and reduce the stigma surrounding HIV. U Equals U, or undetectable equals untransmittable, is a saying from groundbreaking research that essentially means that there is no risk of transmitting HIV to a sexual partner if the person living with HIV is using effective HIV medication. Knowing this, my goal for the future is that more and more women living with HIV will be able to experience stigma-free sex and have the same opportunities for a satisfying sex life as someone that doesn’t have HIV.

Behind the Science: Improving the Health of Women Living with HIV

Interviewees: Tetiana Povshedna, PhD Student (University of British Columbia Department of Pathology and Laboratory Medicine); Marie-Soleil Smith, PhD Candidate (University of British Columbia Department of Pathology and Laboratory Medicine)  Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: March 10th, 2023

Could you briefly explain what your research is about?

Tetiana: My research is part of The British Columbia CARMA-CHIWOS Collaboration (BCC3) Study, which seeks to better understand the process of aging among women living with HIV by examining the interplay between biological, clinical, and socio-structural determinants of health. In my thesis, I examine the associations between latent viral infections, inflammation, markers of cellular aging, and risk of comorbidities in women living with HIV. My work also explores chronic pain, which is often referred to as an “invisible disability” by community members due to its negative effects on all aspects of life and, in the context of HIV, treatment adherence and care. By raising awareness of this important comorbidity, we hope to improve chronic pain care for women living with HIV.

Marie-Soleil: My field of study lies at the cross-section of women’s health, HIV research, and the safety of medications taken while pregnant. My main project utilizes human embryonic stem cells as a model of an early developing embryo to find the safest antiretroviral regimens for use during pregnancy.

What led you to become interested in studying HIV and women’s health?

Tetiana: Historically, the majority of HIV research has involved men, thus limiting generalizability of findings to women, who constitute >50% of people living with HIV globally. The specific needs of half of the population of people living with HIV haven’t been addressed for years, and it’s only been changing recently. After my initial interest in HIV and aging, I was lucky to join the Côté Lab and get involved with community-based women-centered research. We have an amazing team of scientists, clinicians, and community members working together to answer women-specific questions in a meaningful way. 

Marie-Soleil: My interest in HIV research stemmed from my time at the BC Centre for Disease Control working as a co-op student. During my time there, my eyes were opened to the wide world of infectious disease research, particularly the more classically stigmatized sexually transmitted infections. I was energized by my brief stint in the field and was so grateful to find an opportunity to continue this important research in Dr. Côté’s lab. Although it was not intentional, I am very lucky to have landed in a lab that puts a major emphasis on women’s health research. This is especially true as women are now disproportionately affected by HIV.

Could you talk more about why clinical and cellular research are important?

Tetiana: It takes decades of diligent basic science research to advance a field to the point when the results are tangible in a clinical setting. While my work involves human specimens and survey data, a lot of other researchers in Côté Lab work with cellular models. Both types of work provide valuable data that can often guide clinical decision-making to improve quality of life for people living with HIV. 

What does your typical day look like?

Marie-Soleil: My days vary greatly depending on upcoming deadlines and whether I have ongoing cell culture experiments. If I do not have any experiments, I spend my day on the computer analyzing data, reading papers, and working on manuscripts. Experiment days vary widely depending on if it is a day where I am starting up the experiment, a maintenance day where I change the cell culture media, or a big analysis day where I harvest and prep the cells for subsequent flow cytometry. The cell culture experiments I conduct require daily lab work, so I try my best to spread my other work out throughout the week in an attempt to avoid burnout.

What impact do you hope to see from your work in the future? 

Tetiana: A powerful message coming from the community of people living with HIV is “Nothing about us without us is for us”. I hope that research projects that meaningfully involve community, such as BCC3, will address the true needs of the people we’re trying to serve. Ultimately, I hope that our study findings will improve care and everyday life for women living and aging with HIV, and also affect the way the research is conducted in this field. 

Marie-Soleil: My research provides information on the relative toxicity of antiretrovirals in an in vitro model, which may help inform and guide future human trials and strategies for the treatment of HIV in women of reproductive age. I would like to highlight the importance of utilizing relevant preclinical models and including people who become pregnant in clinical trials that assess medications that will undoubtedly be taken during pregnancy. Ultimately, I hope there is a future where all women have access to medications with sufficient pregnancy safety data.

Where can people find out more about your work? 

Tetiana: You can learn more about the BCC3 study on our website.

Marie-Soleil: @MarieSunSmith on Twitter

 

Behind the Science: Moving the Microscopic Lens to Marginalized Populations

Interviewee: Emmanuela Ojukwu (RN, PhD), Assistant Professor of Nursing, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinators).

Published: November 18th, 2022

Could you briefly explain your career trajectory from a Registered Nurse to now an Assistant Professor?

Towards the end of obtaining my Bachelor of Science Degree in Nursing, I knew that I wanted to pursue a career in women’s health. As my journey progressed, I would eventually get accepted to a PhD program where I had the opportunity to work with a professor who was internationally recognized, with a track record of success in improving minority women’s health with a focus on social determinants of health. The decision to focus on HIV came during my RN experiences at a Perinatal HIV clinic for vulnerable populations, wherein I observed birthing parents living with HIV, to be lost to follow-up to their own care but continually engaged in their infant’s care, postpartum. Possibly due to maternal instincts, but the focus on their infants and not themselves was very apparent. This spurred the idea for what would eventually become my dissertation. So, I wanted to see what factors deterred them from engaging in their own care or factors that motivated them to go in (for those that did). Also, as a natural empath – sometimes to a fault – I would find myself really vested in their care, particularly, for the marginalized women, e.g, new immigrants/refugees, racialized populations, homeless. Most of the patients who were lost were within these categories, so it was important to note the possible intersections in their marginalized identities, which were causing their suboptimal engagement in treatment and possible impediments to their overall wellbeing. When I applied to UBC, I definitely wanted to continue with HIV research, although, I realize that HIV rates here compared to the US are relatively less, but it’s still present. And, as there is currently no treatment that completely eliminates the virus, the likelihood of transmission and/or increasing morbidity and mortality,is significantly reduced with effective treatment/management. I remain vested in this topic as a researcher, and would describe my work as focusing on health equity and social determinants of health for vulnerable populations, marginalized by race, sex, gender, disabilities such as HIV, and other psychosocial vulnerabilities.

Why did you choose to study marginalized populations and sexual health?

Asides from being such an empath, I think that I’ve had my own lived experiences of discrimination within the healthcare setting, both as a patient and a healthcare provider. I, sometimes, find that there are “sexual and reproductive health stereotypes” that follow “black women” and these often go before them upon their arrival to any hospital/clinical setting. As a patient, I can count times this has been the case for me; and not until I divulge my profession in healthcare do I get treated any differently. As a provider, the discrimination can stem from patients or colleagues with preconceived, underrated expectations of racialized peoples’ performances, and hence a lack of trust in their abilities as providers, and also unequal (or mostly, subdued) access to and opportunities for growth and development within their various units. All of these experiences, and their impacts on wellbeing demonstrate a critical need for research with and for persons on both sides of the table. By doing this work with and for patients who may fit within these identity brackets, especially for topics that could be stigmatizing such as sexually transmitted infections and HIV, I hope to amplify their voices and create an awareness of their situations. I hope that in creating such an awareness of the existing disparities and inequities; and with the development of interventions, put in place by healthcare providers, public health officers, and even the government; that there might be opportunities to rebuild some of the trust which may have seemed lost in the system, by these communities.

How does Women’s Health specifically intersect with your work at the moment?

Women’s health is at the center of everything I do in my research. A lot of my work focuses on the sexual and reproductive health of women. I currently have two ongoing studies; one, examining the impacts of COVID-19 on quality of life for African, Caribbean, and Black women living with HIV in BC; and another exploring the impacts of racism, sexism, and psychosocial vulnerabilities on access to care services for African, Caribbean, and Black women living with HIV. While I have a special interest for racialized women, I do not shy away from work focusing on the psychosocial and sociostructural factors influencing equitable care for all women. Merely existing in a patriarchal world as a woman can interfere with several aspects of wellbeing. The impacts of other layers of marginalization can have very lasting, detrimental effects on the lives of persons who fit within these identity brackets. Examining the impacts of these intersecting, underprivileged identities and unpacking the various layers and layers of vulnerabilities that surface, is at the core of my research. So in essence, the makeup of a woman’s sexual and reproductive health, and how that interferes with and/or allows them to exist inclusively in a very patriarchal system is of importance to me.

What impact do you hope to see with your work years from now?

I’m hoping that knowledge generated from my work can have lasting positive impacts in the way that care is modified/adjusted for the affected populations. Not surprisingly, there isn’t a lot of data on marginalized populations when it comes to women’s reproductive health, whether it’s rates of maternal mortality or anything else, in Canada. I’m hoping that my research can contribute to bridging those gaps and generating these data, so that researchers, community leaders, healthcare providers, the government, and others in positions of power may be alerted to these situations and help to effect change. We know that these issues exist but the paucity of data and research in this area limits the opportunities for interventions that are culturally-sensitive and -safe. I hope that my research in the short run, can be a “call to action” and in the long run can lead to sustainable “actions for change” for enhancing women’s equitable health.

Where can people find your work?

My email, usually, is the best way to contact me, at emmanuela.ojukwu@ubc.ca.