A program of research on optimizing trauma-informed practice in sexual, reproductive and HIV-related health services among marginalized women

Marginalized cisgender (cis) and transgender (trans) women experience high levels of gender-based violence, defined as violence perpetrated against someone based on their gender, gender expression, gender identity or perceived gender, as well as multiple forms of stigma. With the overarching aim to optimize trauma- and violence-informed approaches to enhance access to sexual and reproductive care and HIV prevention and treatment, this research program aims to work closely with marginalized cis and trans women to:

AIM 1. Launch a program of research that will i) develop an evidence base to describe complex relationships between and mechanisms linking gender-based violence and multiple forms of stigma with sexual and reproductive health access, and access to HIV treatment and care; and ii) develop innovative metrics, methodologies and tools to advance an understanding of gender-based violence and stigma and trauma- and violence informed care and practice;

AIM 2. Create a research and training platform to develop and inform innovative community-based interventions tailored for and with marginalized women to inform program and policy interventions.

Preventing and Mitigating the Impacts of COVID-19 Among Im/migrants in British Columbia: Rapid Mixed-Methods Data to Inform Policy and Programmes.

In BC, migrants make up >25% of residents and are overrepresented in crucial roles as essential workers (eg, temporary foreign workers), yet may be disproportionately impacted by COVID-19 and face barriers to healthcare access. Despite purported shifts to ‘universal’ coverage for COVID-related care, many im/migrants report severe ongoing inequities, including gaps in healthcare coverage, unsafe living/working conditions, and confusion about how changes are put in practice. Rapid transition to virtual service delivery may also compound inequities due to language or technology barriers. We will use health system data and interviews to understand migrants’ experiences with COVID-19 related care and health services coverage to ensure “no one is left behind” in the COVID-19 response and beyond.

Evaluating gender-sensitive interventions for people who use drugs in the context of British Columbia’s overdose crisis

The drug overdose crisis has been hardest felt in BC. Research has shown that gender plays a key role in shaping contexts of drug use (e.g., within sex work, intimate partnerships) and access to treatment and harm reduction services. Women access treatment with more severe drug-related profiles relative to men (e.g. violence/trauma), yet few services are women-centred. New Vancouver Coastal Health guidelines highlight grave gaps in supports and prevention for marginalized women, and several new models of care are being rolled out (e.g., women-only consumption rooms). Several randomized clinical trials (RCTs) are underway in BC to increase access to evidence-based treatments.

However, the gendered impacts of these interventions remain poorly understood and under-investigated. The proposed research will evaluate the impacts of 'naturally occurring' and clinical interventions (i.e., through prospective methods and RCTs) using a gender lens to identify gender differences in treatment outcomes and barriers to accessing services. Research findings will be widely disseminated with the aim of informing gender-specific policies and programs for people who use drugs in BC and beyond.

Adapting BC’s healthcare system for equitable and tailored service provision to sexual and gender minorities

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face judgment and discrimination on the basis of their sexualities and genders. This leads many LGBTQ people to avoid seeking treatment from the healthcare system, to hide aspects of their sexuality/gender when seeking care, or to selectively visit LGBTQ-affirming providers.

The goal of this research program is to develop a comprehensive understanding of healthcare access patterns among LGBTQ people in BC.

Objectives:

  • To describe points of healthcare access for LGBTQ people ('where')
  • To explore LGBTQ people's reasons for avoidance, concealment, and provider selection when seeking healthcare ('why')
  • To characterize the ways in which service providers in BC ensure that their services are LGBTQ-affirming ('how')

Administrative health data, surveys, and interviews with providers and LGBTQ people will produce a detailed description of where, why, and how LGBTQ individuals navigate healthcare.

Collaborators include public health clinics, community organizations, and general practitioners. This research will provide recommendations to adapt BC's healthcare system so that LGBTQ people receive the services they need, when they need them.