Recap: Responding to the SRHR Needs of Indigenous Women and Girls

The purpose of the research project—called Measuring Sexual and Reproductive Health and Rights: Responding to the Needs of Indigenous Women and Girls in a Global Context—is to develop an Indigenous framework that promotes and improves well-being. Through scoping reviews, focus group discussions, and surveys, the project aims to create an Indigenous women-specific, culturally appropriate toolkit on SRHR. The project is being implemented simultaneously alongside local Indigenous organizations in seven countries, including:

• Canada.
• Guatemala.
• India.
• Nepal.
• New Zealand.
• Nigeria.
• Peru. 

The project has three specific aims:

1. Improved understanding of barriers affecting data collection, analysis, utilization, and communications related to SRHR of Indigenous women and girls living with HIV.
2. Increased partnerships to inform SRHR care programming, planning, and learning.
3. Enhanced capacity of future Indigenous and allied researchers, civil society professionals, and in-country leaders to collect, analyze, communicate, and use data effectively.

In March and April of 2022, CAAN and The World Health Organization’s (WHO) IBP Network collaborated on a series of seven webinars (one per country). Each webinar included:

• An introduction to the research project.
• Featured Indigenous speakers who presented on context-specific challenges and opportunities in advancing SRHR of Indigenous women living with HIV.
• A discussion about ways to implement the guidelines to support SRHR of Indigenous women living with HIV.

Each webinar was unique, with speakers highlighting national plans, the status of Indigenous women living with HIV in the particular country, and rich discussions. 

• CAAN is implementing a five-year research project to develop an Indigenous framework that promotes and improves well-being. The project is working to strengthen a global network while also building local capacity in evidence-based and culturally relevant SRHR.
• The project centers Indigenous women and girls. It ensures they are equipped with the knowledge to make the best decisions about their sexual and reproductive lives. They also seek to enhance the ability of Indigenous women and girls to engage in all levels of research while strengthening global Indigenous and allied partnerships.
• The project’s research questions are:
  • What are the underlying cultural and structural issues Indigenous women and girls face in accessing safe and effective SRHR?
  • What are some cultural and structural opportunities that could increase Indigenous women and girls’ access to safe and effective SRHR?
  • What are appropriate, culturally responsive solutions to advance Indigenous women and girls’ SRHR?
  • How do we build Indigenous men’s capacity to advocate for optimizing the SRHR of Indigenous women and girls?
• The team’s overall goal is to develop an Indigenous framework that promotes and improves well-being. It plans to investigate:
  • Underlying barriers to SRHR.
  • Develop culturally informed solutions.
  • Mentor and train Indigenous women.
  • Support capacity strengthening among Indigenous self-identified men and boys as advocates for and change agents for SRHR.
• Project activities and deliverables include:
  • A scoping review specific to SRHR among Indigenous Women living with HIV.
  • Focus group discussions.
  • A survey administered by Indigenous women living with, or impacted by, HIV.
  • An Indigenous-appropriate toolkit on SRHR for Indigenous women living with HIV.
  • An evaluation of the impact of the project and the toolkit.

Listen to a recording of this segment from the first webinar (India):

• The WHO published the consolidated guideline on the sexual and reproductive health and rights of women living with HIV in 2017. It is the outcome of a broad consultative process, involving many national, regional, and global experts—including individuals and networks of people living with HIV (as well as Indigenous women living with HIV).
• This guideline was developed because, in many contexts, women living with HIV do not have equitable access to good quality health services. They are faced with multiple and intersecting forms of stigma and discrimination.
• The guideline is meant to help countries more effectively and efficiently monitor programs and services. This ensures that they are appropriate for women living with HIV.
• The guideline is grounded in the following guiding principles: women-people-centered approaches, human rights, gender equality, meaningful community engagement, and health and well-being.
• The development began with a global survey, which was conducted by and for women living with HIV. It assessed their priorities ahead of the expert working groups.
• The need for quality and respectful care within health facilities was highlighted and recommendations support a safe and supportive enabling environment. Effective implementation of the guideline needs to be context-specific, responding to the needs of local communities.
• The participatory approach used in the guideline led to the establishment of a WHO advisory group of women living with HIV. It includes representation from Indigenous communities.

Listen to a recording of this segment from the first webinar (India):

The webinar took place on March 25, 2022, and included the following:

Highlights from the discussion

If someone at the [International AIDS] conference asked you what are Canada’s top three HIV issues among Indigenous women, what would you say to them?

• “Talking about SRHR and bringing forward the rights of women to be wholly and fully sexual beings and to have that respect…” —Renée Masching
• “I want to put a call out there for all of us at how much there is to learn and benefit at understanding Indigenous approaches and ways of knowing. Research as ceremony is transformative for all of us engaged in research in the HIV space and I really hope that is something that emerges from AIDS 2022 in Montreal.” —Angela Kaida
• “The involvement of women at the table is forefront. We have to be in every little nook and cranny in order for that work to be represented in the right way.” —Claudette Cardinal
• “The importance of continued research. For us at WHO, we are dependent on that things should be based on the evidence … having that published and available to others continues to be so important.” —Manjulaa Narasimhan

This webinar took place on March 17, 2022. It was conducted in Spanish and included the following:

The webinar took place on March 10, 2022. It included the following:

Highlights from the discussion

Many of the faith-based organizations are not pro-women and [have their] own biases. What would be the most influential factor for breaking these biases?

“It’s not that we have found any of our partners who are faith-based organizations in any way biased in terms of gender. But one of the biggest problems comes when the issues of morals [come] in … what we do is we offer them a bouquet of choices: Either they just talk about preventive approaches or they act as secondary service provision points or they act as counselors … we tell them, “You decide what your congregation likes to do’ and then give them the choice to take it forward.” —G.S. Shreenivas

The webinar took place on April 4, 2022. It included the following:

This webinar took place on April 1, 2022. It included the following:

Highlights from the discussion

Why is it important for the voices of Maori people living with HIV to not only be heard but how do you see it in a way that you actually see changes being made?

• “[I] think the approach needs to come from those that know and that understand those that are going through it … knowing how they are feeling. Knowing what they are needing … having a holistic approach, a cultural approach and understanding that we are not just dealing with the individual.” —Milly Stewart, CE and founder of Toitu te Ao

Stories really matter and come easy to us as Maori. How do we make stories also occurrent in the data so [they’re] meaningful to the people with lived experience?

• “We need the stories and we also need the statistics in order to move forward. In our communities, stories are an effective way of providing information about services that are needed. But also the success stories … those stories are uplifting, positive, and very useful. But for health services, we need the health statistics to change the funds that are allocated and we need a rights-based approach.” —Alison Green, professor, Te Whāriki Takapou

This webinar took place on March 18, 2022, and included the following:

This webinar took place on March 9, 2022. It was conducted in Spanish and included the following:

Highlights from the discussion

In your experience how do we apply and institutionalize culturally relevant public health policies?

• “It requires dialogue, training, the creation of working groups, and it requires time.” —Daniel Aspilcueta, member of the Directorate of Sexual and Reproductive Health at the Peruvian Ministry of Health
• “All health services, including sexual and reproductive health, should be jointly developed through intercultural discussions, agreements, and consultations with the community.” —Pilar Montalvo, senior program officer at Planned Parenthood