Leaders in Women’s Health - Ariel O’Neill
02 November 2016
Image from the Women’s HIV/AIDS Initiative
This new feature of OWHN's Online Leadership Network is intended to profile people and/or projects leading change in women’s health in Ontario. The leaders share brief highlights of their work, achievements and challenges, visions for women’s health and recommended resources, among other things in response to our brief questionnaire.
1. What women’s health issue do you work in? Can you tell us a little about your greatest successes and challenges?
I work as a community developer around women and HIV, part of a provincial strategy called the Women and HIV/AIDS Initiative (WHAI) funded though the AIDS Bureau, a program of the Ministry of Health and Long Term Care. The WHAI strategy builds community capacity to respond to HIV transmission among women with the long term goal of reducing women impacted by the illness. There are 16 of us around the province at AIDS Service Organizations where we provide education, outreach and community development based on our unique geographic characteristics. I facilitate workshops, develop resources, share best practices, consult on policy, plan events and also provide frontline service delivery at my agency.
In Ontario, we’ve seen a drop in rates of transmission of HIV among women from a peak of 26% to 17% between 2012 and 2015, which is a success partially due to increased resources including the existence of this WHAI network. There are between 5,100 and 8000 women living with HIV in Ontario as of 2015. Certain communities of women are disproportionately at risk for HIV and others have a more difficult time staying in care and managing their illness if HIV positive. These communities are problematically categorized in our sector as: African Caribbean and Black, women who use injection drugs, Indigenous women and women who engage in high risk sexual activity with risk identified men.
My community partners work in intersecting social determinants of health where women have special experience and vulnerability, including: gender-based violence, trauma, precarious housing, challenges to health, sex work as employment and survival, and so I work collaboratively with agencies who may focus in those areas. What I’m most excited about this past year is partnering with women’s shelter staff at different agencies to strive to be inclusive of harm reduction principles and learn about the gender dimensions to substance use as well as how they can shift historically zero tolerance approaches to curfews and substance use, which have historically marginalized women who use drugs and/or engage in sex work from accessing gender based violence services. We unpack our own responses to substance use and sex work also which can be transformative
Challenges can be that because I work in a small urban, large rural area, we don’t have large numbers of HIV positive women or outreach services and agencies to build momentum or garner local attention, and we have unmet needs that we can’t necessarily quantify to receive funding for. There is the challenge to get HIV prevention on the agenda for over taxed community agencies in a time and place of other urgent issues like mental health crises and enduring poverty. Furthermore, within the HIV field itself in Ontario there is a strong focus on men who have sex with men as vectors of the illness and targets of campaigns and resources.
I view my work with nursing students from Trent University as a highlight and a privilege, coaching them in their interactions with our clients who access needle exchange and safer inhalation supplies and providing them a space to grow into excellent future health care practitioners with practice and research on gendered dimensions of health care issues.
Evidence based research and lived experience are equally important means of knowledge acquisition for me and for this field which is guided by principles of ‘nothing about us, without us’ and the Greater Involvement of People Living with HIV/AIDS (GIPA).
2. Why are you passionate about women’s health?
What a challenging and great question to ask. There is the systemic view, of a care system that is reductive, compartmentalized and difficult to access. A system that calls itself universalized health care but is actually a profit driven enterprise for different levels within it, and a societal notion that is about purchasing your way to good health (supplements, gym memberships, products, clothing, etc.). Vast numbers of people are excluded from this model. Dental and eye care for example are luxuries to large numbers of people who don’t have workplace benefits or bare minimum service through social assistance and that’s a crime in my opinion which we all need to fight to change.
Then there is the personal passion: from a young age I could identify with struggles for bodily autonomy, acceptance and dare I say well-being that are distinctly gendered. I saw women around me struggling to maintain their health while being responsible for the health of men who they prioritized over themselves.
Speaking up for what women as community members and anchors in families need for good health is necessary and transforming systems of oppression can never fall off the agenda.
3. What is your favorite de-stressing activity?
I’m a single mom of a busy pre-teen guy and unstructured, unpressured, mindful, ‘me time’ is necessary to de-stress for me. So it might be at the end of the day when I walk my dogs and I don’t have to hurry to anything, so I can be very present and notice nature around me, connect to silence or conversely to neighbours who might want to chat. A new favourite activity is swimming - when I get in the pool, everything stressful disappears. My aversion to public swimming for so many years was based on body shame. Conquering that is a feminist win for my self care too.
4. What is your vision for women’s health equity in Ontario?
Women’s health and well-being have many dimensions, but the dominant gendered health issues that get mainstream attention are pregnancy and breast cancer. Now sexual violence is in the public domain too. Women’s bodies are regulated, scrutinized, shamed, pathologized, criminalized, objectified, vaunted aesthetically and treated as the only site of reproduction. Our personhood is reduced by victimization and binary notions of gender. We are pressured and frankly under attack from so many places and typically prioritize our own health last because of shame or because of competing responsibilities. My experience with midwives and nurse practitioners has given me hope that system transformation that includes women’s leadership can happen. When women support other women, in a system that critiques dominant power relationships, transformation happens.
Health equity would include women having control over their sexuality and reproductive health through free birth control, autonomy over their fertility including not being prevented from having tubal ligations when they want, gender confirming supports and surgery would be accessible to people who identify as trans. Women’s health equity includes having more support from the state for universal affordable childcare and parenting help, which might help to address large numbers of women reporting depression and anxiety and increased heart and stroke issues. Clinics would have extended hours to reach more people, street health outreach would be funded in every city, drop in physicals and pap tests could become a norm, more nurse practitioner led services where care providers are on salary and thus take their time with you, rather than the common current system of billing per head where only one issue at a time can be discussed.
Health equity would include more addiction services for women that are residential, within their communities, and community responses to addiction would have fewer profit-driven methadone clinics as the only treatment. Medical personnel in all health care settings would have universal skills in trauma informed care.
The whole lifespan, from birth through old age, including whatever nearly universal female struggle you look at, including reporting sexual violence, to accessing morning after pills, to navigating bone and breast scans, to having abortions, to having babies, to managing menstrual pain, to accessing therapy and holistic health supports, to managing life, wouldn’t be a frustrating, disempowering or expensive experience. Ultimately my vision is about community well being and it would involve implementing the feedback of people who are not being served by the existing system.
Fundamentally, health equity would involve more linkages made between poverty and core housing need, with governments stepping up with a national housing strategy and basic income supplement.
5. What resources, tools or research would you like to share with us?
- Women and HIV/AIDS Initiative, an Ontario-based network with information for general public and service providers specific to women and HIV.
- Positive Women: Exposing Injustice. Directed by Alison Duke, 2012. A 45 minute film that explains the impacts of criminalization of HIV through the experiences of a handful of women.
- Canadian HIV/AIDS Information Treatment Exchange (CATIE), Canada’s clearinghouse on HIV and Hepatitis C information.
- Trauma Matters. Guidelines for Trauma-Informed Practices in Women’s Substance Use Services. Jean Tweed Centre, 2013.
- Gendering the National Framework: Women-Centred Harm Reduction. BC Centre for Excellence in Women’s Health, 2010.
- The Trauma Toolkit Second Edition, 2013. Klinic Community Health Centre.