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Aboriginal Women’s Cultural Safety and Sexual Health

November 10th, 2012     by Robyn Spilker     Comments

Transcription by Vidhya Elango

On this episode of the podcast, Robyn Spilker, Coordinator of the Women’s Radio Collective at CFUV 101.9 FM in Victoria, B.C. interviews Charlotte Reading, an academic and Aboriginal women’s sexual health advocate. Reading explains how the sexual health of Aboriginal women is compromised by the lack of cultural safety many experience when accessing public healthcare. Curious to hear what she has to say?

Take a listen here:

For a transcription of ‘Aboriginal Women’s Cultural Safety and Sexual Health’ read on:
Sarah Feldbloom: Hi, I’m Sarah Feldbloom, Shameless Magazine’s Web Producer. If you haven’t picked up a copy yet, our “health” issue is still on stands at your local bookstore, and available through subscription at shamelessmag.com and on the Shameless iphone app.

The focus of our podcast today is Aboriginal women’s sexual health. If you’re interested in learning more about the topic, one resource to take a look at is this issue’s Activist Report, written by Caitlin Blennerhassett with notes from Hilary Barlow. It features the Native Youth Sexual Health Network, an organization by and for indigenous youth. There are a bunch of other great pieces in the current issue which relate to what we’re about to get into. I’ll tell you about one more, after we hear from Robyn Spilker, Coordinator of the Women’s Radio Collective at CFUV 101.9FM in Victoria, British Columbia, whose interviewing Charlotte Reading, an academic and Aboriginal women’s sexual health advocate on today’s show. So, here they are with no further adieu.

[Sound up on interview]

Robyn Spilker: Charlotte Reading is an Aboriginal health researcher who has extensive experience in areas of Aboriginal health disparities, human sexuality, and women’s health. She’s also an assistant professor with the University of Victoria’s School of Public Health and Social Policy. And right now she’s the Interim Director of the Centre for Aboriginal Health Research. I was lucky enough to get her in the studio to get her to talk about her research related to Aboriginal women’s sexual health, and the growing movement to implement practices of cultural safety within BC’s medical system.

Thanks for joining me today, Charlotte, to talk about your research relating to Aboriginal women’s sexual health and also your research related to cultural safety. How did you originally come to do this research?

Charlotte Reading: Well it really started in Halifax, when I was attending Dalhousie doing my Masters, and I got really interested in the medicalization of women’s sexual and reproductive health. And at the time, I was a mature student, so I decided that I would focus on menopause as one of women’s reproductive stages of their lives.

RS: Mhmm.

CR: And so, that’s really where it started. And the women that I interviewed were African, Nova Scotian women, and women of European descent, and also Aboriginal women. And during that research, the Aboriginal women said, you know, we really would like a study that just explores our experiences. And so I promised that if I did my doctoral degree that I would do that, and so my doctoral degree looked specifically at Aboriginal women’s experiences with menopause. And in that of course, sexuality, is, you know, a major component, because there’s lots of changes during women’s lives during that time.

RS: Mhmm.

CR: And that just led me to doing research with the Canadian Aboriginal AIDS Network, specifically looking at Aboriginal women’s experiences of HIV and risk. RS: And, I guess I just want to ask, why do you do this research, as well? What drives you to do this?

CR: Well, probably lots of different things. A good friend and mentor of mine, Madeleine Dion Stout, who is, or lives in the Tsawwassen First Nations – she’s a Cree woman – once said that we, Aboriginal women, who are scholars and researchers, she called us organic academics. And that is because we explore experiences that grow out of our own lives. And so, as an Aboriginal woman, going through menopause at the time, it was really relevant for me, and I’d seen my mother go through it, and I wondered about the cultural features of that experience. And so, what drives me now is the disparities in the health of Aboriginal women – the lack of opportunities that women have, not only to promote their own health, but to address health issues as they arise for themselves and their families. I’ve become more and more entrenched in that movement, I guess, you want to call it, since, since doing that initial research.

RS: Yeah, and what are some of the sexual health issues and disparities faced by Aboriginal women that you focus on in your research lately?

CR: Well, most of my work has been focusing on HIV, which most people are aware is becoming quite a problem in many Aboriginal communities and with some particularly disadvantaged Aboriginal people. In particular, Aboriginal women who are using IV drugs. And so, one of the primary vectors of infection for Aboriginal women that are infected with HIV is intravenous drugs. And so, those women generally come from fairly traumatized backgrounds, and so, it puts them at risk for lots of other sexually transmitted infections. But also, sexual violence plays a role in their risk of becoming infected with HIV, as well as other sexually transmitted infections. The kind of sexual violence I’m talking about sometimes begins in childhood and a lot of women are ending up in adulthood having faced multiple sexual traumas over the course of their lives, and very limited opportunities to actually address those problems.

RS: It’s already evident, it’s very hard to talk about disparities of health for Aboriginal women without talking about the structural determinants. So what are some of the structural determinants that we see in Canada that impact Aboriginal women’s health? I’m thinking maybe government policies, or the medical system, racism, poverty, those types of things?

CR: Well, yes to all those. But I think if we really want to understand those disparities, we really have to go back to the beginning, and some people suggest that we don’t need to keep looking back, but in order to understand what’s going on now, we really do have to understand how this all began. So, most folks are familiar with the term colonization. Based on the literature I’ve been able to find – and there’s not a lot in the historical records, but Indigenous people’s sexuality prior to contact was really quite healthy when we compare it to the European sensibilities around sex, particularly during the Victorian era, where people were really uncomfortable with it. What we’ve been able to discover is that Indigenous people, particularly in North America, were quite comfortable with their sexuality. Women had a lot of sexual agency, sexual assault was not tolerated in societies, and so the sexual safety of women and children was protected. So, with settlement by European, mostly men, who didn’t have the same…

RS: Values?

CR: Comfort and values around sexuality and gender equity. We saw a transition, over time, to much more patriarchal gender roles. And during that process, Indigenous women were often sexually exploited, sexually violated. And then, of course, with the imposition of the residential schools, many Aboriginal men and women – well girls and boys – suffered sexual abuse. And, not only that, were taught to feel quite shameful about their sexuality. And so, it really just changed the sexual values and practices of Indigenous people around the world, but particularly in Canada.

What we see now, is a generational effect of that, in the sense that people don’t talk about sexuality, they’re not comfortable talking about it, and, in particular, in communities, people are not at all comfortable, in most communities, talking about HIV. So aside from those things, government policies have created disparities for Aboriginal people across the board – health, education, economic development. So, those things that most of us take for granted, like access to health care, preventative programs, often don’t exist on First Nations reserves or Inuit communities. So, what we see is folks who may not have access to pregnancy tests, to HIV tests, to other STI screening, they’re not getting screened and tested as much as they should. And then, there’s a lot of stigma about HIV in the communities. A lot times, people, they don’t want to be tested, they don’t want to know, because they’re afraid that someone will find out. And so women, often, are diagnosed quite late in their infections, and this is actually similar for men, for Aboriginal men, so the treatment regimens are less successful, often.

In our research, it’s called Safe Spaces, so this was the project that we did with Aboriginal women, who are infected with HIV, looking at the role of sexual violence in their lives. They obviously talked about sexual violence, but one of the things that they talked, probably more about were things like the lack of opportunity to get an education, the lack of opportunity to get a job, the fact that if they had children at an early age – which happens in lots of different communities, but it tends to happen more often in First Nations and other Aboriginal communities, women are, tend to be younger when they’re having their kids –that puts an enormous amount of financial stress on women, if they’re not able to get a job that pays them enough money to raise their kids, well then they’re often having to rely on the welfare state.

And for some women – not all –because I don’t want to paint all Aboriginal women with the same brush, but the women that we see, who are infected with HIV, often they’re coping with some trauma, related, oftentimes, to some sort of abuse and neglect, and so, they sometimes will cope with that trauma through drug use, and they sometimes will support that drug use by working on the street. And they become quite vulnerable to not only, like, generalized violence, but also sexual violence, and to all kinds of other stigma that’s attached to not only being Aboriginal, but being an Aboriginal women and being a poor Aboriginal woman, and being an Aboriginal woman who may be using IV drugs and who is HIV positive. So, I mean, talk about, like, multiple jeopardies, right?

RS: And you think the lack of understanding about what you’re talking about, basically, all the history and the health issues and the systemic issues, combined with racism, must also be involved in that?

CR: Yeah, well, there’s still a lot of people who really don’t understand the history and who are really not able to grasp the idea of historical trauma. And so, what that term means, is that, if you think about an individual life, if a person is traumatized by something, they live with that trauma. But, they don’t live with it, it doesn’t stay inside them, it affects the other people in their lives, right? So, if you imagine an entire family being traumatized, then that family’s extended family, they’ll experience some of that, because, that, that gets shared. The coping gets shared, the trauma gets shared. So imagine a whole community of people being traumatized. Imagine a whole nation of people being traumatized. Well then, it’s not difficult to understand how that trauma is passed on from one generation to another.

People don’t mean to do it, they don’t want to do it, but it just happens. It’s pain and pain doesn’t go away unless they’re some way to address it. And if there are no supports, which there are very few for Aboriginal people, to address those things, and oftentimes, when there’s a government that will not acknowledge the trauma, or people who say “Well just get over it, we’re just so past that now”. Well, that’s, that’s an easy thing to say when it’s not you, when it’s not your family, when it’s not your community, when that’s not your nation.

So, I think there’s a lot of people who don’t understand that. I use a tree metaphor sometimes to explain it to people. It’s the social determinants of health, but I say, if you look at a tree and the leaves are healthy, you’re pretty much guaranteed, or you know, that the soil and the roots of that tree are healthy as well. If you look at a tree, and the leaves of that tree are dying, then you have to know that there’s something going on in the roots of that tree, there’s some contamination, there’s some trauma, there’s something going in. So I say, if you want to look at a population of people, like Aboriginal women, and the disparities that we often experience, you can’t stop with the person. You have to look at the circumstances and the conditions which that person lives. And then, if you look deep into the roots, well that’s history, that’s structure, that’s government policies, that’s stigma, that’s racism, that’s sexist racism, so that’s that kind of misogyny that they save just for women of colour, just for Aboriginal women. So, I mean, I don’t know that everybody understands that.

RS: Yeah, and I mean, I think for a lot of people like myself, it’s a constant learning process, too, especially when you don’t experience it yourself, or experience different things.

CR: Yeah, yeah.

RS: What needs to happen so that Aboriginal women and Aboriginal peoples can get better access to health care and health services?

CR: I think I’ve already talked about the fact that Aboriginal women don’t always have access to health services, sexual health services that they need, either prevention, or treatment, or even care and support – so for instance if they’re infected with HIV. But they also report about problems they encounter when they do go for help. So, even when they can access the help, they often encounter racism, disrespectful behavior that creates a barrier for them to accessing it again. Or, if they’ve heard of other people having experiences, and so that’s where this notion of cultural – what we used to term and some people still do, cultural competency – but we now talk more about it as being cultural safety. So, we’ve been doing some research with Aboriginal people with HIV, and particularly with women, talking to them about their experiences within the health care system, and what are some of the barriers they face in terms of their relationships with those people that they interact with, the health care professionals.

So, we hear pretty terrible stories. I mean there was one story – that’s in our report, so I can share it with you – she was a woman who was homeless, and she went to the hospital for something, I’m not sure what it was. And they lost her clothes, so she said, well, when she was going to leave, she was like, “well, where are my clothes?” and they said “are you sure you came in wearing clothes?” And she said, “I can’t imagine that they would say that to a white woman, that they would propose to be so disrespectful.” And so, stories like that, of course, the response is, “I’m never going back there again, like, I’m never going to be treated that way.” I mean, they obviously don’t need that, nobody needs that kind of treatment. But, particularly someone who’s looking for help and really might need help. So, what we’ve been trying to do, and there’s lots of folks who’ve been doing it for longer than I have, this whole movement started in New Zealand, this notion of cultural safety, is to try to develop some skills among health professionals, to not only prepare them to interact respectfully with Aboriginal people, but also to educate them about some of them historical and social determinants of those people’s lives that they might be interacting with. And one of the most important things about cultural safety is to encourage health professionals to acknowledge their own privilege.

RS: Mhmm.

CR: So some folks who often don’t encounter a lot of disadvantage in their life, don’t sometimes recognize how much privilege they have or the power dynamic that they might be participating in with an Aboriginal client.

RS: So what’s an example of that power dynamic that, maybe, wouldn’t be noticed, or that privilege that wouldn’t be noticed?

CR: Well, assumptions. So, assumptions about whether or not people have transportation, whether or not a person has cash or the resources to get medications, different therapies that might not be covered by either regular health insurance that everybody has and then there’s specific, non-insured health benefits that some First Nations people have, people who are status. So, sometimes people assume that a person is housed, or a person has childcare. If someone misses an appointment, oftentimes the inclination is to assume that person doesn’t really care about whether or not they receive the healthcare. And it might just be the person couldn’t - didn’t have money for the bus, didn’t have childcare, couldn’t get there. And again, in the case of HIV, we’re often talking – not always – but we’re often talking about women who are struggling, they’re struggling just to survive.

RS: Okay. And is that the main aspect of cultural safety…?

CR: I mean, it really does, it really does begin with the person recognizing what privilege is, how privilege affects our relationships with each other, and also though, to have a fair degree of familiarity with Aboriginal cultures. And I say cultures because it’s obviously, there’s not just one Aboriginal culture. People are often asking me, “Well can you tell me about Aboriginal culture?” I say, “Well, which one?” I mean, there’s like, hundreds and hundreds, right? And so, just understanding the diversity of Aboriginal people, understanding some of the structural determinants and some of the structural barriers. We called it relational care. We did a project with Aboriginal people with HIV and what we ended up discovering was that, it wasn’t so much whether the person they were interacting with was an Aboriginal person or not, it was about the relationship that they had with that person and if that person treated them like they cared about them and tried to understand the context within which they were approaching from.

RS: Yeah. And treated them with dignity.

CR: Yeah, it’s a pretty simple thing, and yet people don’t often get it, because there’s a lot of stereotypes out there.

RS: Yeah. Is there anything else you’d want to say about your work around cultural safety? How far have you gotten in terms of working with health professionals around this?

CR: Oh well, there are some wonderful programs that I’m not necessarily involved with, but there is a program in Vancouver Island and BC around cultural safety. The province has a great website, Cheryl Ward is the person who directs that. Health professionals can go to that websites and they can roll in these online modules to improve their cultural safety, but there’s lots of research being done and we’re still trying to figure out what the indicators of cultural safety are. So, what kind of awareness and knowledge and skills should health professionals have in order to provide appropriate care to Aboriginal people. And so, that means we just need to talk to more Aboriginal people about that.

RS: Alright, well, thank you for joining me today, Charlotte. It’s been really great learning about your research and about how cultural safety’s being implemented. CR: Well, it’s been great talking to you.

[Sound up on extro]

SF: I’m Shameless Magazine’s Web Producer, Sarah Feldbloom, and you’ve been listening to Robyn Spilker, Coordinator of the Women’s Radio Collective at CFUV 101.9 FM in Victoria, BC, interviewing academic and Aboriginal women’s sexual health advocate, Charlotte Reading.

At the top of the show I promised to share a second recommendation from our current issue, so here we go. In our She’s Shameless column, Rachel McCarthy interviews Tanesha Darby, a first year university student and rad sex-positive feminist, musician, writer, sex educator and activist. So awesome!

That’s all for me today. Wishing you a happy and cozy time as you adjust to the onset of winter! Thanks so much for listening. Talk to you again soon!

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