>>WELCOME
>>FIRST, I WOULD LIKE TO START
WITH ACKNOWLEDGING THE LAND ON
WHICH I WORK AND THIS LAND
ACKNOWLEDGMENT SERVES AS A
REMINDER OF THE COMPLEX
HISTORIES OF WHERE WE ARE AND A
RECOGNITION OF THE HISTORICAL
AND ONGOING CONFLICTS AND
STRUGGLES AROUND LANDS, WATER
AND AIR THAT PERSIST TODAY.
THE LAND ON WHICH BROWN
UNIVERSITY IS LOCATED IS THE
ANCESTRAL HOME LAND OF THE
NARRAGANSETT INDIAN TRIBE AND
REMAINS THE HOME OF INDIGENOUS
PEOPLE ACROSS TURTLE ISLAND.
THE HISTORIES OF THIS LAND ARE
SHALED BY EXPLOITATION OF
INDIGENOUS PEOPLE NATIVE TO THIS
LAND AND THOSE WHO CAME HERE BY
FORCE AS A RESULT OF SLAVERY,
CLONISM AND IMPEERISM.
WHEN WE ENTER ANY SPACE, WE MUST
BRING THESE INTERCONNECTED
HISTORIES INTO VIEW.
WITH THIS KNOWLEDGE, WE ENTER
AND MEET HERE IN THE HOPES OF
CREATING A DIFFERENT, MORE JUST
AND EQUITABLE WORLD.
SO TODAY, FOR MY BRIEF REMARKS,
I WILL START BY DISCUSSING
GENDER, SOCIAL INEQUITIES AND
IMPLICATIONS FOR POPULATION
HEALTH, BROADLY.
I WILL THEN MOVE ON TO DISCUSS
THE MODIFIABLE FACTORS THAT
DRIVE GENDER BIAS AND
DISCRIMINATION IN CLINICAL
CONTEXT, AS WELL AS
INTERVENTIONS THAT MAY HELP
ADVANCE GENDER EQUITY IN
CLINICAL PRACTICE AND RESEARCH
AND AMONG HEALTH CARE PROVIDERS
AND SYSTEMS.
AFTER THAT, WE WILL HEAR FROM
THREE LEADING RESEARCHERS IN
THIS FIELD INCLUDING DR. A BRUME
BRUME, DR. A McMcAND DR. A
SAL SAL, WHO WILL PRESENT THEIR
WORK.
SO FIRST OF ALL, WHAT IS GENDER
AND WHY DOES IT MATTER FOR
HEALTH?
SO GENDER, AS WE HEARD ABOUT
EARLIER THROUGHOUT THE DAY, IS A
MULTI-LEVEL, MULTI-DIMENSIONAL
AND HISTORICALLY-CONTINGENT
SOCIAL CONSTRUCT.
IT CONSISTS OF VARIOUS
COMPONENTS SUCH AS GENDER
IDENTITY, ROLES, BEHAVIORS,
NORMS, NETWORKS, SYSTEMS AND
REGIMES AND OPERATES WITHIN AND
ACROSS MULTIPLE SOCIAL DOMAINS,
SYSTEMS AND INSTITUTIONS,
INCLUDING BUT NOT LIMITED TO
EDUCATION, EMPLOYMENT AND OF
COURSE HEALTH CARE, WHICH I'LL
BE FOCUSING ON TODAY.
ALSO, IT'S IMPORTANT TO NOTE
THAT GENDER VARIES ACROSS BOTH
TIME AND SPACE SUCH THAT
HISTORICAL, GEOGRAPHIC, SOCIAL,
ECONOMIC AND CULTURAL CONTEXT
ALL MATTER FOR HOW WE THINK
ABOUT AND ACT OUT GENDER.
FUNDAMENTALLY, GENDER IS ABOUT
THE COMPLEX AND DYNAMIC SOCIAL,
ECONOMIC AND POLITICAL
RELATIONSHIPS THAT EXIST AMONG
GEND ERRED SOCIAL GROUPS ACROSS
THE GENDER CONTINUUM.
AND THESE RELATIONSHIPS MATTER
BECAUSE THEY SHAPE THE UNEQUAL
AND INEQUITABLE DISTRIBUTION OF
POWER AS WELL AS SOCIAL,
ECONOMIC AND HEALTH CARE
RESOURCES AMONG MARGINALIZED AND
PRIVILEGED GENDERED GROUPS.
ADDITIONALLY, GENDER BOTH SHAPES
AND IS SHAPED BY SEXISM AND
CISGENDERRISM, WHICH ARE POWER
RELATIONS THAT DRIVE GENDER BIAS
AND DISCRIMINATION AND ARE
LINKED TO BROADER IDEOLOGYIES
AND STRUCTURES INCLUDING
HETEROPATRIARCHY AND SIS NORM
ACTIVITY.
ALSO IT'S IMPORTANT TO REMEMBER
THAT SEXISM, CISGENDERRISM AND
GENDER DON'T OPERATE IN A VACUUM
OR IN THE SAME WAY ACROSS SOCIAL
GROUPS.
RATHER, GENDER AND GENDER
DISCRIMINATION ARE
CO-CONSTITUTED BY RACE
ETHNICITIES, RACISM AND CLASS,
CLASSISM, HETEROSEXISM AND
DISABILITY AND ABLEISM AMONG
OTHER SOCIAL INEQUITY.
LASTLY, DECADES OF POPULATION
HEALTH RESEARCH SHOWS THAT
GENDER, SEXISM AND CISGENDERRISM
ARE KEY SOCIAL DETERMINANTS OF
HEALTH.
FIRST WITH REGARD TO CLINICAL
PRACTICE, RESEARCH STUDIES IN
WHICH GENDER WAS LARGELY
CONCEPTUALIZED AS A BINARY AND
THAT LARGELY FOCUSED ON
CARDIOVASCULAR DISEASE SHOW THAT
GENDER STEREOTYPES AND BIAS
UNDERMINE DIAGNOSE ACCURACY FOR
WOMEN, WHICH IN TURN LEADS TO
GENDER BIAS AND DISCRIMINATION
IN THE RECOMMENDATION OF
CLINICAL SERVICES SUCH AS
CARDIOVASCULAR DISEASE
TREATMENT.
AMONG TRANSGENDER AND NON-BINARY
PEOPLE, STUDIES INDICATE THAT
CISGENDERRISM IS PERVASIVE IN
CLINICAL SETTINGS AND LINKED TO
MEDICAL MISTRUST AS WELL AS POOR
PATIENT PROVIDER COMMUNICATION
AND DENIAL OF NEEDED CARE ALL OF
WHICH UNDERMINE THE RECEIPT OF
HIGH-QUALITY CARE AND INCREASED
DELAYS AND FOREGOING CARE IN
THIS MINORITY POPULATION.
THE NEGATIVE EFFECTS OF BOTH
SEXISM AND CISGENDERRISM IN
CLINICAL PRACTICE AMONG WOMEN
AND GENDER MY NOR TIESED PEOPLE
ARE COMPOUNDED BY RACIAL,
ETHNIC, CLASS, SEXUAL
ORIENTATION AND OTHER FORMS OF
BIAS AND DISCRIMINATION THAT
ALSO UNDER MY HIGH QUALITY
CLINICAL CARE.
SYSTEMATIC REVIEWS INDICATE
NOTABLE LIMITATION IN THE
CONCEPTUALIZATION, MEASUREMENT,
ANALYSIS AND REPORTING OF GENDER
IN CLINICAL STUDIES.
THIRD, RESEARCH ALSO SHOWS THAT
THERE ARE PRONOUNCED GENDER
INEQUITIES IN THE COMPENSATION
AND WORKLOAD, HOURS AND
EXPECTATIONS OF PHYSICIANS AND
NURSES WITH WOMEN RECEIVING
LOWER SALARIES THAN THEIR MALE
COUNTERPARTS AND ENGAGING IN
HIGHER LEVELS OF EHR AND DIRECT
PATIENT WORK.
ADDITIONALLY, STUDIES ALSO
INDICATE PERVASIVE GENDER BIAS
AND HARASSMENT OF WOMEN
PROVIDERS BY TEACHERS,
COLLEAGUES, PATIENTS AND MEDICAL
SCHOOLS AND INSTITUTIONS AS WELL
AS NOTABLE GENDER INEQUITIES IN
HEALTH CARE LEADERSHIP.
RESEARCH ALSO SHOWS ELEVATED
LEVELS OF WORK LIFE CONFLICTS
AND POOR MENTAL HEALTH AMONG
WOMEN PROVIDERS
DISPROPORTIONATELY.
LASTLY, WITH REGARD TO PROVIDERS
OWN GENDER BIAS AND
DISCRIMINATION, STUDIES SHOW
THAT PROVIDERS TEND TO LACK
KNOWLEDGE OF AND DISPLAY BIAS
TOWARDS TRANSGENDER HEALTH CARE
IN PARTICULAR.
FINALLY, RESEARCH INDICATES THAT
RESTRICTIVE GENDER NORMS AND
HEALTH CARE SYSTEMS AND
INSTITUTIONS UNDERMINE THE
HEALTH AND WELL-BEING OF WOMEN
AND GENDER MY NOR TIESED
PATIENCE AND PROVIDERS ALIKE.
IN PARTICULAR, PERVASIVE
RESTRICTIVE GENDER NORMS AND
STEREOTYPES LEAD TO THE
PRIORITIZATION OF CAROL FOCUSED
ON ONE'S SEX ASSIGNED AT BIRTH
AS WELL AS GENDER EXPECTATIONS
ABOUT THE USE AND NON USE OF
HEALTH SERVICES.
A LARGE BODY OF WORK HAS ALSO
SHOWN THAT STRUCTURAL AND
SYSTEMIC SEXISM AND
CISGENDERRISM IN HEALTH CARE
SYSTEMS AND INSTITUTIONS
INCREASE BARRIERS TO HEALTH CARE
AMONG WOMEN AND GENDER MY NOR
TIDES PEOPLE FURTHER COMPOUNDED
BY RACISM, CLASSISM, XENOPHOBIA,
AMONG OTHER QUALITIES.
LASTLY, RESEARCH ALSO INDICATES
THAT GENDER BIAS AND
DISCRIMINATION IN CLINICAL
PRACTICE AND RESEARCH AND AMONG
HEALTH CARE PROVIDERS AND
SYSTEMS ARE SHAPED AND
REINFORCED BY GENDER INEQUITIES
OUTSIDE OF THE CLINICAL CONTEXT,
INCLUDING GENDERED SOCIAL NORMS,
LAWS, POLICIES AND PRACTICES
ACROSS ALL SOCIAL SYSTEMS AND
INSTITUTIONS AND SOCIETY MORE
BROADLY.
SO IN TERMS OF CLINICAL
INTERVENTIONS, I'LL BREEZE
THROUGH THESE AND I THINK WE'LL
HAVE THE SLIDES AVAILABLE BUT I
DO WANT TO HIGHLIGHT A FEW
POINTS BEFORE WE TURN TO OUR
SPEAKERS WHO WILL PROVIDE MORE
DEPTH ON THESE TOPICS.
SO THERE IS RESEARCH SUGGESTING
THAT THE USE OF CLINICAL
DECISION AIDS AND STANDARDIZED
PROTOCOLS CAN HELP DECREASE
GENDER DIFFERENCES IN PROVIDER
CLINICAL SERVICES AS WELL AS
EVIDENCE THAT CLINICIAN
INFORMATION EXCHANGE NETWORKS
CAN HELP INCREASE DIAGNOSIS
ACCURACY AND DECREASE GENDER AND
RACIAL BIAS AND RECOMMENDATIONS.
ADDITIONALLY, THERE IS PROMISING
EVIDENCE OF THE EQUITABLE
COLLECTION AND USE OF GENDER
DATA IN CLINICAL PRACTICE CAN
HELP INCREASE DISCRIMINATION IN
CLINICAL SETTINGS.
CLINICAL TRIALS THAT EXPAND
PARTICIPATION TO GENDERED GROUPS
THAT MAY BE SYSTEMATICALLY
EXCLUDED AS WELL AS PROMOTE
GENDER EQUITY AND CLINICAL TRIAL
LEADERSHIP MAY PROVIDE AVENUES
FOR ADDRESSING GENDER BIAS AND
DISCRIMINATION IN CLINICAL
SETTINGS AS WELL AS THINKING
ABOUT WHO IS INCLUDED AND NOT
INCLUDED IN STUDIES AS WELL AS
HOW THIS GENDER CONCEPTUALIZED.
SO THINKING ABOUT
CONCEPTUALIZING GENDER AS A
MULTI-LEVEL, MULTI-DIMENSIONAL
SOCIAL CONSTRUCT MEASURING ARE
GENDER BIAS AND DISCRIMINATION
AT MULTIPLE LEVELS AND DOMAINS
AND REPORTING GENDER STRATIFIED
IN GENDER-SPECIFIC ANALYSIS.
THERE ARE ALSO PROMISING
INTERVENTIONS RELATED TO HEALTH
CARE PROVIDERS AROUND WORK
EXPECTATIONS, HOURS AND LOAD AND
SUPPORTING WOMEN AND GENDER MY
NOR TIESED PEOPLE IN CAREER
LEADERSHIP IN CLINICAL SETTINGS,
AS WELL AS IN ADDRESSING GENDER
BIAS AND DISCRIMINATION IN
CLINICAL INSTITUTIONS.
ALLOCATING RESOURCES FOR
IDENTIFYING AND RECOLLECT VYING
GENDER BIAS AND DISCRIMINATION.
AND LASTLY, GLOBAL HEALTH
RESEARCH SHOWS THAT COMMUNITY
ORGANIZATIONING AND SOCIAL
MOVEMENT THAT PROMOTE GENDER
EQUITY CAN ALSO POSITIVELY
IMPACT GENDER EQUITY WITHIN
CLINIC WALLS.
SO, WITH THAT BRIEF OVERVIEW, WE
WILL NOW TURN TO DR. AMAYA
PEREZ-BRUMER WHO WILL SPEAK
ABOUT PrEP RESEARCH MISTRUST
AND THE DILEMMA OF BEING A KEY
POPULATION AND THEN
DR. CATHERINE MCKINLEY SPEAKING
ABOUT UNDERSTANDING INDIGENOUS
GENDER RELATIONS AND STRUCTURAL
VIOLENCE AND LAST BUT NOT LEAST,
DR. ARGHAVAN SALLES WHO WILL
SPEAK ABOUT THE IMPACT OF GENDER
BIAS AND HARASSMENT: THANK YOU
VERY MUCH.
I WILL GLADLY TURN IT ON TO EYE
BRUME BRUME.
>>AMAYA PEREZ-BRUMER:
WONDERFUL, THANK YOU VERY MUCH.
GOOD MORNING OR GOOD AFTERNOON.
I'M HOP ORD TO BE HERE WITH YOU
TODAY TO SHARE MY, WHO.
MY NAME IS AMAYA PEREZ-BRUMER, A
CRITICAL GLOBAL HEALTH SCHOLAR
TRAINED IN BOTH PUBLIC HEALTH
AND SOCIOLOGY AND IN THE SYSTEM
PROFESSOR AT THE UNIVERSITY OF
TORONTO, ADDITIONALLY I'M A
CANADA RESEARCH CHAIR IN GLOBAL
HEALTH INTERVENTION JUSTICE.
THIS TALK TODAY IS GIVEN FROM
TKARONTO.
A WORD KNOWN IN ENGLISH AS
TORONTO.
TORONTO CONSISTS OF CEDDED LAND,
COVERED UNDER TORONTO TREATY
THIRTEEN AS WELL AS UNCEDED LAND
THAT CONTINUES TO BE CONTESTED.
I WOULD LIKE TO ACKNOWLEDGE THE
TRADITIONAL TERRITORIES OF THE
MISSISSAUGA OF THE NEW CREDIT
FIRST NATION INDIGENOUS PEOPLES
ON WHICH THE UNIVERSITY OF
TORONTO NOW STANDS AND ON WHICH
I'M CURRENTLY ON.
I ALSO RECOGNIZE THAT AS A
SETTLER LIVING ON STOLEN LAND, I
BENEFIT DAILY FROM THE ONGOING
VIOLENCES AND THE LEGACIES OF
COLONIALISM.
I HAVE AN ONGOING RESPONSIBILITY
TO LEARN ABOUT THE LAND ON WITH
I'M LIVING TO CEDE POWER TO
INDIGENOUS PEOPLE AND TO AMPLIFY
ONGOING PROJECTS OF INDIGENOUS
RESURGE EXPENSE IS SOVEREIGNTY.
SO, I AM VENEZUELAN, AMERICAN
AND AFTER FIVE YEARS LIVING IN
TORONTO, A CANADIAN PERMANENT
RESIDENT.
SPANISH IS MY FIRST LANGUAGE AND
I IDENTIFY AS LATINA.
IT'S TELLING I'M AFFORDED THE
HONOR AND THE PRIVILEGE TO BE
HERE WITH YOU TODAY.
I AM I CISGENDER WOMAN AND DO
NOT TAKE LIGHTLY THE PRIVILEGE
OF SHARING THESE FINDINGS AND
MOST IMPORTANTLY, LEARNINGS FROM
WHAT I HAVE BEEN TAUGHT BY
NUMEROUS TRANS WOMEN IN PERU.
IN SHARING THESE LESSONS, OUR
TASK IS TO PUSH TOWARDS
ACCOUNTABILITY.
MY WORK CENTERED ON THE MAKING
AND ANALYZING OF DATA AND ALSO
THE ANALYZING OF THE MAKING OF
THE DATA.
SO WHO GETS TO DO HEALTH EQUITY
RESEARCH?
AND WHO ARE ITS BENEFICIARIES?
SPECIFICALLY I STUDY THE WAYS IN
WHICH POWER, SEXUALITY AND
GENDER ARE ENTANGLED WITH
CONTEMPORARY APPROACHES TO HIV
SCIENCE.
ON THIS SLIDE YOU WILL SEE A
PHOTO OF VARIOUS MEMBERS FROM A
COMMUNITY-BASED ORGANIZATION IN
LIMA.
THE TEXAS -- THE TEXT IS SMALL
BUT IT READS PERUVIAN
TRANSGENDER WOMEN SAY THEY WANT
MORE LEADERSHIP ROLLS IN STUDIES
INVOLVING THEM AS SUBJECTS.
I WANT TO BE CLEAR, THAT
POLITICS AND POWER ARE CENTRAL
TO MY TALK.
UNDERSTANDING GENDER AS A SOCIAL
AND CULTURAL DETERMINANT OF
HEALTH CANNOT BE DISENTANGLED
FROM THE POLITICS AND POWER OF
WHO GETS TO DO THIS RESEARCH.
LEARNING FROM TRANS WOMEN IN
PERU WHERE I HAVE BEEN
CONDUCTING RESEARCH SINCE 2009,
THIS IS A PROVOCATION TO URGE US
ALL TO THINK ABOUT OUR OWN
SOCIAL LOCATION, OUR PRIVILEGE
AND MOST IMPORTANTLY OUR
RESPONSIBILITY AS RESEARCHERS.
SO WHY STUDY GENDER AND POLITICS
OF HIV PREVENTION?
THE FOURTH DECADE OF HIV AND
AIDS HAS USHERED IN A NEW ERA OF
HOW AND WHAT RESEARCH ON THE
VIRUS IS CONDUCTED AND IT'S
EXPLICIT FOCUS ON
PHARMACEUTICAL-BASED PREVENTION
AND THE NEW TECHNOLOGIES AT
PLAY.
THE ADVENT OF PRE-EXPOSURE
PROPHYLAXIS OR PrEP, IS A
REMARKABLE INNOVATION TO PREVENT
HIV ACQUISITION.
IT'S DEVELOPMENT HAS LED TO A
BOOM IN RESEARCH AMONG
POPULATIONS MOST AT RISK AND
THUS MOST IN NEED OF PrEP.
PEOPLE CLASSIFY AS QUOTE/UNQUOTE
AS MSM AND ESPECIALLY TRANSWOMEN
ARE CENTRAL IN THIS FOCUS.
THE SHIFT TO PREVENTION AND
EMPHASIS ON CERTAIN GROUPS OF
PEOPLE NECESSITATES A RETHINKING
OF THE POLITICS OF DATA
EXTRACTION FROM PEOPLE OF
DIVERSE GENDERS AND SEX ALTS IN
THE PURSUIT OF HIV PREVENTION
RESEARCH.
PERU IS CENTRAL TO THE TESTING
OF HIV STRATEGIES.
THE FACT THAT PERU CONTRIBUTED
MORE THAN 50% OF THE GLOBAL
SAMPLE FOR THE WATERSHED STUDY
THAT SPARKED SIGNIFICANT CHANGES
IN BOTH GLOBAL POLICY AND
ASSOCIATED SCIENTIFIC ACTIONS TO
SUPPORT PrEP FOR HIV
PREVENTION.
TODAY, MORE THAN A DECADE AFTER
PrEP, THE EVIDENCE CONTINUES
TO REFLECT A BURDEN OF HIV IN
EXCEEDINGLY HIGH BURDEN AMONG
THE VERY COMMUNITIES THAT
PARTICIPATED AND ADVANCED THIS
KNOWLEDGE.
AVAILABLE CONVENIENT SAMPLES IN
PERU REPORT THAT HIV PREVALENCE
IS ESTIMATED TO BELIEVE AROUND
15% FOR THOSE CLASSIFIED AS MSM
AND ALMOST DOUBLE THAT CLOSE TO
30% FOR TRANSWOMEN.
SO WHILE THIS STARK HIV --
PREVALENCE EVIDENCES THE URGENT
NEED FOR TREATMENT AND
PREVENTION, PREVENTION SCIENCE
SPECIFICALLY ON PrEP AND AMONG
CERTAIN POPULATIONS DOMINATES
RESEARCH AGENDAS AND RESEARCH
DOLLARS.
SO LET'S TALK A LITTLE BIT MORE
ABOUT PrEP AND SOME OF THE
CHALLENGES THAT WE'RE FACING IN
THE GLOBAL ARENA AND WHY GENDER
IS CRITICAL TO THINK ABOUT.
PRE-EXPOSURE PROPHYLAXIS IS THE
LEADING STRATEGY TO PREVENT HIV.
YET WITH THE EXCEPTION OF THE
GLOBAL NORTH, PrEP UPTAKE
REMAINS SUBOPTIMAL WORLDWIDE.
PRESENT DAY PrEP RESEARCH
CONTRIBUTES AND INTERACTS WITH A
PROBLEMATIC LEGACY OF HIV
EXPERIMENTATION ON MARGINALIZED
COMMUNITIES IN RESOURCE-LIMITED
SETTINGS.
MORE RECENTLY, PrEP HAS
SPURRED THE SEEMINGLY ENDLESS
SERIES OF ISOLATED, SHORT-TERM
TRIALS NOT SUBSEQUENTLY
INTEGRATED INTO EXISTING HEALTH
CARE SYSTEMS.
EVEN WHEN INTERVENTIONS ARE
SHOWN TO WORK, WITHIN THIS
CONTEXT KEY POPULATIONS
CLASSIFIED AS THE HIGHEST-RISK
FOR HIV AND THE HIGHEST NEED FOR
PREVENTION, ARE OFTEN THE
INTENDED AUDIENCE YET WE CANNOT
FORGET THAT FOR MANY KEY
POPULATIONS, MEDICAL
INSTITUTIONS ARE A SIGHT OF
VIOLENCE AND TRAUMA.
THIS IS PARTICULARLY IMPORTANT
AS PrEP CONSTITUTES A PARADIGM
SHIFT FROM CONDEMN-BASED
PREVENTION TO SYSTEMS THAT
REQUIRE SIGNIFICANT TRUST TO
PROMOTE THE USE OF PrEP AS A
BIOMEDICAL INTERVENTION FOR
PEOPLE WHO ARE NOT YET LIVING
WITH HIV.
WHILE OBSTACLES GLOBALLY FOR
PrEP INCLUDE COST, CHALLENGES
WITH HEALTH CARE SYSTEM
INTEGRATION AND POLITICAL WILL,
MERGING SCHOLARSHIP HAS ALSO
HIGHLIGHTED MISTRUST AS A
CRITICAL BARRIER TO PrEP
ACCEPTABILITY.
IN THE AFTERMATH OF THE -- AND
THE NUMEROUS PrEP
IMPLEMENTATION CHALLENGE THAT IS
FOLLOWED, EMERGING RESEARCH
AMONG PERUVIAN TRANSWOMEN
HIGHLIGHTED THE EXISTENCE OF
MISTRUST OF INTERNATIONAL DRUG
TRIALS, FOREIGN INVESTIGATORS
AND PERUVIAN INSTITUTIONAL
ACTORS IMPLEMENTING THE STUDIES
AS OBSTACLES TO WIDESPREAD
PrEP ACCEPTABILITY AND USE.
SO HERE I'M DRAWING ON FINDINGS
FROM OUR MULTI-METHOD
QUALITATIVE STUDY THAT IS
EMBEDDED WITHIN A LARGER TRIAL
WHICH EXPLORED MISTRUST AND ITS
IMPACT ON RESEARCH
PARTICIPATION.
AS REPORTED BY TRANSWOMEN WHO
PARTICIPATED IN THE PrEP
ADHERENCE TRIAL AND ALSO THOSE
WHO REFUSED INVOLVEMENT IN THE
STUDY.
AND THAT MEANS THOSE WHO
VOLUNTARILY WITHDREW AND ALSO
THOSE WHO WERE LOST FOR
FOLLOW-UP.
OUR ANALYTIC SAMPLE IS COMPRISED
OF TRANS, TRANSGENDER WOMEN WHO
PARTICIPATED IN THE FORMATIVE
AND THE EVALUATIVE STAGES OF THE
STUDY.
OF NOTE, A TERM TOL DESCRIBE
TRANSFEMININE IDENTITIES THAT
ARE CLOSELY ASSOCIATED WITH
STREET-BASED SEX WORK AND EROTIC
ECONOMIES AND OFTEN REFLECT A
LORER CLASS WITHIN THE PERUVIAN
CONTEXT.
IN THE FORMATIVE STAGE, WE
CONDUCTED FOUR FOCUS GROUPS AND
20 INTRODUCE AND IN THE
EVALUATIVE STAGE WE CONTACTED 34
INTERVIEWS WITH FOUR PEER
FACILITATORS, EIGHT WITH
PARTICIPANTS WHO SCREENED BUT
NEVER ENROLLED.
SIX APPROXIMATE PARTICIPANTS
ENROLLED AND LATER DROPPED OUT
AND ALSO 16 INTERVENTION
COMPLETERS.
THREE PARADOXES OF TRANSWOMEN'S
INVOLVEMENT IN PrEP SCIENCE AS
MEMBERS OF A KEY POPULATION
EMERGE.
THE FIRST UNDERSCORES THE
DISCORDANCE BETWEEN THE
INCREASED FREQUENCY OF PrEP
RESEARCH TARGETING TRANSWOMEN
AND THE LIMITED ACTUAL
IMPROVEMENT IN HIV OUTCOMES
AMONG TRANSWOMEN.
THE SECOND ILLUSTRATES THE
CONTINUED DISMISSAL OF
PARTICIPANTS REPORTS OF
PREP-RELATED SIDE EFFECTS BY
RESEARCH STAFF, DESPITE THEIR
STATUS AS A KEY POPULATION.
AND THE THIRD HIGHLIGHTS THE
CONTRADICTION THAT PrEP IS
TESTED ON TRANSWOMEN BUT
SUBSEQUENTLY IS NOT READILY
AVAILABLE TO THEM.
FOSTERING FEELINGS OF THE
COMMUNITIES USE AS GUINEA PIGS
TO ADVANCE PrEP SCIENCE.
SO, ALL TRANSWOMEN WHO
PARTICIPATED IN OUR STUDY HAVE
PRIOR EXPERIENCE WITH RESEARCH
PARTICIPATION EITHER AS A
PARTICIPANT OR KNEW A CLOSE
ACHAINS PARTICIPATED IN HIV
PREVENTION RESEARCH.
THIS IS THE ANTIBODY STUDIES,
VACCINE AND PrEP TRIALS.
THE CHOICE TO PARTICIPATE IN AN
HIV STUDY WAS COMPLICATED BY THE
LIMITED HIV PREVENTION AND CARE
OPTIONS FOR TRANSWOMEN AND THE
EXISTING HEALTH CARE SYSTEM.
STUDIES WERE OFTEN DESCRIBED AS
PROVIDING FIRST-LINE HIV
TREATMENT AND PREVENTION.
FOR EXAMPLE, LOUISA WHO IS 19
YEARS OLD, TOLD US, I FOUND OUT
ABOUT THE STUDY BECAUSE I NEEDED
TO GET AN HIV TEST AND A FRIEND
TOLD ME THAT THE EASIEST WAY TO
GET A FREE TEST IS THROUGH A
STUDY.
I DID.
THEN I LEARNED ABOUT PrEP AND
I WANTED TO PARTICIPATE.
HOWEVER, EVEN THOSE WHO NOTED
THE IMPORTANCE OF HIV RESEARCH
FOR ACCESS TO CARE WERE WARY OF
THE SURGE OF CLINICAL TRIALS AND
NOTED THAT THE HEALTH IMPACT FOR
TRANSWOMEN IN LIMA SEEMED
LIMITED.
CARE WAS DESCRIBED AS A FEMORAL
AND HIV ACQUISITION FREQUENTLY
AS INEVITABLE.
FOR EXAMPLE, I PARTICIPATE IN
STUDIES NOW SO I CAN GET CARE.
WHAT HAPPENS ONCE I GET SICK?
THESE STUDIES END.
27-YEAR-OLD DANICA TOLD US.
WHILE MANY PARTICIPANTS SAID
THEY VALUED THE CARE PROVIDED IN
STUDIES, THEY QUESTIONED THE
LACK OF LONG TERM BENEFITS FOR
TRANSWOMEN AND THIS WAS FURTHER
COMPLICATED BY THE WARINESS OF
FOREIGN INVESTIGATORS PERCEIVED
TO BE DRIVING PREP RESEARCH
AGENDAS.
FOR EXAMPLE, MARIA NOTES, HOW
LONG HAVE GRINGOS BEEN
RESEARCHING US?
WHY ARE WE STILL GETTING SICK?
WHAT WILL I DO IF I GET HIV?
THE SECOND PARADOX IDENTIFIED
CENTERS ON TRANSPHOBIC
MISTREATMENT OF PARTICIPANTS AND
THE DISMISSAL OF PrEP RELATED
SIDE EFFECTS BY RESEARCH
PHYSICIANS AND STAFF.
EVEN IN STUDIES DESIGNED TO
ENSURE THAT PrEP IS ATTUNED TO
TRANSWOMEN'S NEEDS.
PARTICIPANTS TAKING PREP
DESCRIBED BEING DISMISSED WHEN
TELLING RESEARCH STAFF ABOUT
SIDE EFFECTS.
I DIDN'T WANT TO KEEP GOING TO
THE CLINIC.
I KNOW I SAID I WOULD AS PART OF
THE STUDY.
BUT PrEP MADE MY HEAD HURT AND
THAT ONE DOCTOR DIDN'T BELIEVE
ME.
AND HE KEPT MAKING ME FEEL BAD.
THEY WERE OBVIOUSLY ONLY GIVING
ME MEDICAL ATTENTION BECAUSE
THEY HAD TO.
THE THIRD PARADOX HIGHLIGHTS THE
CONTRADICTION THAT PrEP HAS
BEEN TESTED REPEATEDLY ON
TRANSWOMEN BUT IS NOT READILY
AVAILABLE TO THEM.
FURTHERING THE BELIEF THAT THEIR
COMMUNITY IS BEING USED AS
GUINEA PIGS RATHER THAN PrEP'S
INTENDED USERS.
AS NOTED IN A FOCUS GROUP IN THE
GREEN BUBBLE, WHY ARE WE,
TRANSWOMEN, BEING USED LIKE
GUINEA PIGS EVERY SINGLE ONE OF
US?
PrEP MISTRUST WAS FURTHER
AMPLIFIED BY THE CONFLICT
BETWEEN SHORT TERM REWARDS BEING
PROVIDED FINANCIAL INCENTIVES
AND TEMPORARY ACCESS TO NEW
MEDICATIONS, AGAINST THE
LONG-TERM PUBLIC HEALTH FAILURES
LEADING TO LIMITED ACCESS FOR
SUCCESSFUL THERAPIES AND CARE.
AS DESCRIBED BY ANGELICA, WHAT
CAN I TELL YOU?
DO I HAVE A PROBLEM WITH MY
COMMUNITY TREATED LIKE AN
EXPERIMENT?
YES.
BUT WE CONTINUE TO PARTICIPATE
AND WORK FOR THESE STUDIES
BECAUSE WE ARE SEEN.
WE AT LEAST GET SOME HIV CARE.
SOMETIMES WE GET PrEP AND WE
EVEN GET PAID.
FURTHER CONTRIBUTING TO THE
PERCEPTION THAT TRANSWOMEN WERE
SIMPLY GUINEA PIGS WERE
FRUSTRATIONS REPORTED OVER THE
PHYSICAL BURDEN OF REPEATED
BEHAVIORAL AND BIOLOGICAL
MEASURES AND STUDIES EMPHASIS ON
OBTAINING A DIVERSE CLINICAL
SAMPLE.
ONE FOCUS GROUP PARTICIPANT
NOTED: I WON'T PARTICIPATE IN
ANOTHER STUDY THAT TAKES MY
BLOOD.
WE DON'T TRUST WHAT THEY DO WITH
OUR BLOOD.
THESE SENTIMENTS HIGHLIGHT
SUSPICIONS ABOUT AND MOTIVATIONS
FOR BIOSPECIMEN'S COLLECTION
THAT WERE COMMONLY ECHOED BY
PARTICIPANTS ACROSS ALL STAGES
OF OUR DATA COLLECTION PROCESS
PROCESSES.
SO WE INTERVIEWED 86 TRANSWOMEN
ACROSS TWO TIME POINTS TO
UNDERSTAND THE EXPERIENCE AND
THE PERCEPTIONS OF TRANSWOMEN
WHO INTERACTED WITH PrEP
PREVENTION TRIAL.
WHAT INITIALLY BEGAN AS AN
ATTEMPT TO APPROVE OUR OWN STUDY
DESIGN RESULTED IN REVEALING A
CRITICAL TENSION RELEVANT TO THE
BROADER PROJECT OF HIV
PREVENTION GLOBALLY.
OUR FINDINGS SUGGEST AN URGENT
NEED TO BETTER UNDERSTAND MIGS
TRUST, NOT AS A TRAIT OF
TRANSWOMEN TO BE ADDRESSED
INDIVIDUALLY, SOLELY THROUGH
EDUCATION ABOUT THE RESEARCH
PROCESS.
BUT AS A JUSTIFIED RESPONSE TO
SYSTEMIC INEQUITIES REP CALLED
BY AND MANIFESTED THROUGH THE
RESEARCH.
NARRATIVES HIGHLIGHT THE WISDOM
INHERENT IN PrEP MISTRUST AS A
REFLECTION OF LEARNED COMMUNITY
INSIGHTS THAT UNDERSCORE THE
BROKEN BONDS OF TRUST BETWEEN
COMMUNITIES, RESEARCHERS AND THE
RESEARCH ENTERPRISE.
PrEP MISTRUST IS AMPLIFIED
THROUGH PERCEIVED PARADOX THAT
IS SUGGEST TRANSWOMEN THAT THEY
ARE KEY EXPERIMENTAL
PARTICIPANTS BUT NOT TARGET
PrEP USERS OUTSIDE OF RESEARCH
SETTINGS.
TODAY I BRIEFLY DISCUSS YOUD HOW
THE SPOTLIGHT SHINED ON
TRANSWOMEN HAS RAISED QUESTIONS
ABOUT THE ETHICS OF RESEARCH
THAT MAKES MANY VULNERABLE
COMMUNITIES SUCH AS TRANSWOMEN,
FEEL AS THOUGH THEY ARE KEY TEST
SUBJECTS OR GUINEA PIGS BUT NOT
KEY BENEFICIARIES.
ACADEMIC RESEARCH BEE GETS MORE
RESEARCH.
PRODUCING SCIENTIFIC KNOWLEDGE
AS A GLOBAL CONCEPT.
THIS IS TRUE FOR 50s
RESEARCHERS LIKE ME WHO REALIZE
THAT THE ABILITY TO SECURE
FUNDING AND PROGRESS THROUGH THE
RANKS OF ACADEMIC PROMOTION
DEPENDS ON PARTICIPATING IN THIS
RESEARCH ECONOMY.
AND THUS IT IS OUR
RESPONSIBILITY AS RESEARCHERS TO
ACTIVELY RECTIFY BROKEN BONDS
AND BUILD AND SUSTAIN RESPECT.
SO WHAT'S OUR CALL?
WHEN WE DO NOT NAME CAPITALISM,
CLONEIAMISM AND OTHER
INTERSECTING MODES OF
OPPRESSION, HARMS EXPERIENCED BY
RESEARCH PARTICIPANTS ARE EASILY
IGNORED.
OUR CALL FOR A HEIGHTENED FOCUS
ON GENDER AS A SOCIOCULTURAL
DETERMINANT OF HEALTH CANNOT BE
DIVORCED FROM AN EXAMINATION OF
THE ROLE OF POWER AND POLITICS
PLAY IN THE PERPETUATION OF
EXTRACTIVE DATA PRACTICES.
THERE IS SIMPLY TOO MUCH AT
STAKE AND IT IS TOO EASY TO
ABSOLVE OURSELVES AS RESEARCHERS
IN THE ROLE WE PLAY IN THIS
SYSTEM.
SO, THE TWO PHOTOS PRESENTED
HERE HIGHLIGHT THE STRENGTH,
POWER AND ONGOING SOLIDARITY
ENACTED BY TRANS AND GENDER
NON-BINARY NEME PERU.
THIS IS MY REMINDER OF WHO I'M
ACCOUNTABLE TO.
LET'S PUSH AND FIGHT AND
ADVOCATE FOR GINNEDDER AS A
SOCIAL CULTURAL DETERMINANT OF
HEALTH TO BE A PRIORITY FOR NIH.
IN OUR DEMANDS, LET'S NOT FORGET
THIS WORK IS POLITICAL AND
DEPENDS ON AUTHENTIC COMMUNITY
RELATIONSHIPS.
THIS REQUIRES FUNDING AND NOT
SOLELY AS PEER RECRUITERS OR AS
MEMBERS IN COMMUNITY ADVISORY
BOARDS.
BUT REAL MONEY TO ACKNOWLEDGE
THE PARTNERSHIPS WITH GRASSROOTS
COMMUNITY ORGANIZATIONS AND
COMMUNITY MEMBERS THAT MAKE THIS
RESEARCH POSSIBLE.
LEARNING FROM MY TEACHERS IN
PERU, I WOULD BE REMISS TO NOT
ASK, WHAT DO WE DO WITH THESE
DATA?
WHO BENEFITS FROM THEM?
WHO IS RESPONSIBLE FOR
ADDRESSING THE OPPRESSIONS THAT
YIELD PERVASIVE AND GROWING
HEALTH DISPARITIES?
THANK YOU AND I LOOK FORWARD TO
CONTINUING TO THINK THROUGH
THESE ISSUES AND ENGAGING WITH
YOUR QUESTIONS AND COMMENTS.
>>FANTASTIC, THANK YOU VERY
MUCH, DR. PEREZ-BRUMER.
NOW WE WILL TRANSITION TO
DR. CATHERINE MCKINLEY.
>>CATHERINE MCKINLEY: HELLO,
EVERYONE.
IT'S AN HONOR TO BE RECOMMENDED
WITH THESE AMAZING PEOPLE HERE
TODAY AND TODAY I'M GOING TO BE
TALKING TO YOU ABOUT
UNDERSTANDING INDIGENOUS GENDER
RELATIONS AND STRUCTURAL
VIOLENCE BECOMING GENDER AWAKE.
I WANT TO ACKNOWLEDGE INDIGENOUS
PEOPLE'S LANDS IN NEW ORLEANS
AREA AS WELL AS TRIBES IN
MONTANA.
THANK YOU.
AS WELL AS THE NIH BIRCWH
FUNDING THAT SUPPORTED THIS
HIGHLIGHT PROGRAM THAT INFORMED
CLINICAL TRIAL BY NIAAA FOR THE
PROGRAM I'M GOING TO TALK TO YOU
ABOUT AT THE END OF THIS
PRESENTATION.
WHAT IS ALSO PUT FORWARD IS
DIRECTLY CONTRIBUTED TO THIS AND
DEVELOP THIS PROGRAM.
OVER 60 COMMUNITY HEALTH
REPRESENTATIVES THAT FACILITATE
THIS PROGRAM, COMMUNITY ADVISORY
BOARD CENTER AND THE PERSON ON
THE RIGHT WHO DEDICATE THIS
PROGRAM TO, HE RECENTLY PASSED
AWAY BUT HIS VISION IS REALLY
EMBODIED THROUGHOUT THIS PROGRAM
AND WE HONOR HIM.
I WANT TO SAY A HELLO TO MY
INDIGENOUS AND NON INDIGENOUS
ELDERS WHO SET ME ON A GOOD PATH
AND HELPED ME TO DO THIS IN A
GOOD WAY.
TO THE I'M GOING TO TALK TO YOU
ABOUT HOW TO BECOME GENDER AWAKE
IT'S AN EXTENSION OF THE
FRAMEWORK OF HISTORICAL
OPPRESSION THAT WAS DEVELOPED
THROUGH RESEARCH WITH INDIGENOUS
PEOPLES.
THIS IS A TRIBAL INDIGENOUS
RELATIONAL WORK AT RISK
PROTECTED AND PROMOTED ACROSS
LEVELS AND HOW THEY INTERACT TO
GIVE RISE TO GREATER DEGREES OF
WELLNESS ACCORDING TO THE
SPIRITUAL AND MENTAL AND
PHYSICAL AND EMOTIONAL FACTORS.
AND TODAY I'M FOCUSING ON
TRANSCENDENTS OR BECOMING A
LITTLE BIT RATED FROM THE
COLONIAL MINDSET PRESCRIPTIVE
AND MARGINALIZED WITH THESE
ASCRIBED GENDER ROLES THAT
INHIBIT OUR AUTHENTIC SELVES AND
OUR ABILITY.
AND TO DO THAT WE NEED TO
UNDERSTAND WHAT IS THIS MINDSET
WE MAY OR MAY NOT BE AWARE OF?
LARGELY CONUNCONSCIOUS AND
INFILTRATES THE WAY WE ARE,
RESEARCH, AND COMMUNITIES AND
STRUCTURE.
BECAUSE WE KNOW THAT EVERY PART
OF THE WORLD HAS NOT BEEN
UNTOUCHED BY COLONIZATION.
PEOPLE COME HERE IN THE U.S. FOR
INSTANCE TO MAKE THIS PLACE
THEIR OWN AND THEY HAVE TO DO
THAT BY ELIMINATING INDIGENOUS
PEOPLES, INTRODUCING A APARTHEID
SLAVES TO DO THE WORK AND
PERPETUATING STRUCTURES WHICH
CONTINUE TOO PRESS.
COLONIAL OPPRESSION IS
HETEROPATRIARCHAL AND MALE
CENTERED HEAD OF HOUSEHOLD,
WHITE SUPREMACY, RACISM, SEXISM
IN A PERSPECTIVE IS INCLUSIVE
AFFECTING ALL OF US IN DIFFERENT
WAYS.
WITH THAT WE NEED TO THINK ABOUT
OUR OWN CONDITIONALITY, MINE
INCLUDING.
I COME FROM A SETTLER COLONIAL
BACKGROUND.
MY ANCESTORS CAME FROM IRELAND
AND SWEDISH AREAS.
WE HAVE A STATUS OF WHITE THINKS
THAT STRUCTURES THE WAY THAT
THEY ARE TREATED OVER TIME THAT
DIFFERENTIALLY EFFECTS MY
TRAJECTORY AND WHAT I CAN DO IN
THE WORLD.
BECAUSE OF THAT, AND THE WAY I
GREW UP AND HOW I HAVE BEEN
SOCIALIZED, I BRING INTO THE
WORLD A WAY OF WHAT I THINK IS
NORMAL STRUCTURED BY THE
IDEOLOGY OF THE COLONIAL
MINDSET.
SO THE IDEA TO LIVE AWAKE FOR
GENDER AWAKENESS DISMANTLE THE
IDEOLOGY OF A COLONIAL
SUPERIORITY THAT PRIVILEGES
DOMINATING THOUGHT IN RESEARCH.
INSTEAD OF READDRESSING THIS
MARGINALIZATION AND IN VIS
BILLIZING TO UNDERSTAND WHAT IS
GOING ON WITH THE DOMINANT ROLE
WE ALSO NEED TO CENTER
INDIGENOUS ROLES, THEY ARE VERY
DIFFERENT AND HAVE BEEN
INTENTIONALLY SET ASIDE
THREATENING THE STRUCTURES OF
OUR SOCIETY.
HEEL HISTORY IS IMPORTANT TO
ENABLE THESE STRUCTURES TO
PERSIST.
SO YOU FIND THESE COLONIAL
MINDSETS ARE INFILTRATED INTO
RESEARCH AND PRACTICE PROTOCOLS
AND PARADIGMS AND PRINCIPLES AND
THESE THINGS ARE DOMINANT OVER
THE INDIGENOUS CULTURAL
PROTOCOLS, PARADIGMS AND
PRACTICES AND PRINCIPLES.
WHAT DO WE DO?
WE NEED TO LIFT UP INDIGENOUS
WORLD VIEWS.
HAVING A RECKENING AND
ACKNOWLEDGMENT OF THE PAST AND
FINDING BALANCE WHICH INVOLVES
POWER AND HOPEFULLY FOR A FUTURE
OF HARMONIZATION, RESPECTFUL,
RECIPROCAL AND REFLEXIVE
RELATIONS FOR ALL WHERE THINGS
CAN BE COMP TERRY AND NOT THE
ADVERSARIAL DOMINATION THAT WAS
BROUGHT ON.
SO FROM DECOLONIAL TO PRE
COLONIAL TRANSCENDENCE.
MY OWN WORK IS REALLY AFFECTED
BY AN ELDER RECOMMENDING TO ME
WHAT DO I DO AND HOW SHOULD I DO
THIS?
EMILY CELT ME ON A GOOD PATH AND
SAID DO RESEARCH ABOUT RESEARCH
AND WHY THERE IS SO MUCH
DISTRESS.
AND I DID DO THAT.
INDIGENOUS AND NON INDIGENOUS
RESEARCH.
MY BACKGROUND IS SOCIAL WORK.
AND I FOUND OUT ABOUT HOW
RESEARCH IS USED AS A TOOL OF
COLONIAL EXTRACTION FOR THE
PURPOSE OF COLONIZATION.
AND SOCIAL WORK HAS BEEN VERY
MUCH EMBEDDED IN A PROCESS IN
THE BOARDING SCHOOL AREA AND THE
INDIAN ADOPTION ACT WHERE
CHILDREN WERE REMOVED AND PLACED
WITH WHITE FAMILIES.
MY OWN PERSON AND PROFESSIONAL
AND SCHOLARLY HISTORY IS
INTERLINKED WITH STRUCTURES OF
COLONIAL SETTLER HISTORICAL
OPPRESSION AND I NEED TO KNOW
THAT AND BE AWARE OF THAT AND
HAVE LOTS OF CHECKS AND BALANCES
WITH THAT.
SO THIS TOOLKIT DOES THAT.
IT COMMITS LONG TERM USING
COMMUNITY-BASED RESEARCH IN
THINGS SO STRUCTURES RESEARCH IN
A GOOD WAY THAT I WAS DRIVEN BY
COMMUNITIES IN THAT ACTUALLY
PROVIDES THE IMPLICATIONS OF THE
RESEARCH DIRECTLY.
SO THE COMMUNITY IS CENTERED AND
HAS WORKED REALLY WELL.
THAT WENT ON TO COLLABORATING
WITH THE CHOCTAW WOMEN INVITED
TO DO WORK IN MISS SIP WHOA
ASKED ME TO DO THIS WORK AS
WELL.
AND THAT INVITED ME TO WORK WITH
HIM ON WHY VIOLENCE AGAINST
WOMEN IS SO HIGH GIVEN THAT PRE
COLONIAL STATUS OF WOMEN WAS A
RESPECTED EGAL TARYN AND
CENTERED STATUS.
WHY DO WE HAVE THE HIGHEST RATE
OF VIOLENCE AGAINST INDIGENOUS
WOMEN THAN ANY OTHER GROUP GIVEN
THIS PRE-COLONIAL STATUS OF
RESPECT AND SACREDNESS?
THAT LED ME TO LISTEN TO LIFE
HISTORY INTERVIEWS OF WOMEN WHO
EXPERIENCED VIOLENCE AS WELL AS
PROFESSIONALS WHICH LED TO THE
DEVELOPMENT OF THE FRAMEWORK OF
HISTORICAL OPPRESSION.
ALL OF THAT 10 YEARS OF RESEARCH
HAS BEEN IMPLEMENTED AND
INTEGRATED INTO WHAT WE HAVE AS
A HEALTHY FAMILIES PROGRAM.
A SUBSTANCE ABUSE AND VIOLENCE
PREVENTION PROGRAM.
IT'S ADAPTED FROM OF THE
CELEBRATING FAMILIES PROGRAM
THAT WE DEVELOPED OVER THIS LAST
DECADE WITH THE TRIBES WE ARE
WORKING WITH.
THE LAST QUESTION IS TO THINK
ABOUT TODAY IS WHO AND WHAT IS
THE INTERVENTION FOR?
IS THERE A LOT OF
DAMAGE-CENTERED RESEARCH THAT
REDEFINES THE DEHUMANIZATION OF
A LOT OF GROUPS THAT HAVE BEEN
STRUCTURALLYO PRESSED AND MANAGE
FESTATIONS OF THAT OPPRESSION
THROUGH VIOLENCE AND SUBSTANCE
ABUSE AND LOTS OF OTHER THINGS.
IF THE STRUCTURES EVER COLONIAL
ECOLONNIZATION IMPAVED IN
OURSELVES AND INSTITUTIONS, IF
THEY ARE CAUSING THEM, THEN WHO
AND WHAT NEEDS THE INTERVENTION
ITSELF?
THINK ABOUT THAT AS WE KEEP
MOVING THROUGH.
WE HAD A LOT OF PEOPLE TALK
ABOUT STRUCTURAL SEXISM.
I'M NOT GOING INTO THAT OTHER
THAN TO SAY IT HURTS EVERYONE TO
SOME EXTENT.
IT BENEFITS OTHER PEOPLE
INTERPERSONALLY ESPECIALLY WHEN
IT COMES TO RELATIONSHIPS AND
WORK.
MOST WOMEN ARE AFFECTED IN
DIFFERENT WAYS BY VIOLENCE
EITHER PSYCHOLOGICAL, PHYSICAL,
SEXUAL AND ACROSS ALL OF THESE
NORMATIVE WAYS WOMEN ARE
UNDERMIND AND IT DRIVES
DISTRESS, ANXIETY AND
DEPRESSION.
THE CRITICAL FRAMEWORK I USED IS
INSPIRED BY THOSE WHO TALK ABOUT
DEHUMANIZATION MARKS NOT ONLY
THOSE WHOM HUE MANAGITY HAS BEEN
STOLEN BUT THOSE WHO HAVE STOLEN
IT.
IT'S A DISTORTION TO BE MORE
FULLY HUMAN.
WE HAVE TO BE BEYOND THE
COLONIAL MINDSET AND KNOWING
WHAT THAT IS, WHICH IS ABOUT
COMPETITIVE SEEKING AS MUCH AS
YOU CAN WHICH REQUIRES THE
EXPLOITATION OF OTHER PEOPLE.
GETTING A BIGGER PIECE OF THE
PIE.
BUT INDIGENOUS WOULD SAY THE PIE
IS THE PROBLEM.
THIS KIND OF COMPETITION AND
ADVERSARIAL RELATION.
THAT'S THE PROBLEM ITSELF.
WE ARE SET ON THINGS THAT ARE
NOT SATISFYING OR ULTIMATELY
FULFILLING AND THE HIGHER YOU
GET UP, THE SICKER YOU CAN
BECOME.
SO EVEN THOUGH WE THINK THAT THE
HIGHEST THING TO ATTAIN IS
GREATER WEALTH AND HOUR, THAT IS
ACTUALLY NOT SUSTAINABLE AND
DOESN'T REALLY HELP PEOPLE IN
THE LONG RUN.
I'M ALSO NOT GOING TO GO TOO
MUCH INTO THE GENDER IMBALANCES
WHICH HAVE BEEN COVERED IN
DETAIL IN CREDIBLE WAYS.
BUT I WILL CENTER THE PART OF
INDIGENOUS WORK ON THIS WHICH
STATES PATRIARCHY ISN'T JUST
INTERTWINED WITH THE SYSTEM
SYSTEM OF COLONNISM AND
CAPITALISM.
THEY NEED PATRIARCHY TO WORK.
WOMEN'S WORK IS THE ORIGINAL
SUBSIDY OF CAPITALISM.
REPRODUCTIVE LABOR IS NECESSARY
FOR SOCIAL REPRODUCTION.
SO THE STRUCTURES REQUIRE UNPAID
AND UNDER VALUED WORK OF WOMEN
BECAUSE THEY NEED MORE FOR LESS
TO EXTRACT AND EXPLOIT AND WORK
UPON.
IF WOMEN ACROSS GENDER AND
RACIAL IDENTITIES, WHITE WOMEN
SEEK RACIAL JUSTICE AND THESE
THINGS, THE SYSTEM IS IN
TROUBLE.
AND THEY ARE INTERLINKED.
WE NEED TO WORK IN A COLLECTIVE
WAY TO DISMANTLE INTERSEABLITING
STRUCTURES THAT ARE PERPETUATED
ALL THE TIME.
THE HISTORICAL OPPRESSION
CONCEPT IS BROADER AND INCLUSIVE
OF HISTORICAL TRAUMAS.
IT INCLUDES THE CONTEMPORARY
FORMS OF OPPRESSION THAT
CONTINUE AND PERSIST IN THE
FORMS OF MICRO-AGGRESSION,
SEXISM, RACISM.
IT'S INCLUSIVE BUT A LOT OF WHAT
I FOUND IS THAT PEOPLE ARE
REALLY AWARE OF WHAT IS
HAPPENING TODAY, THE ECONOMIC
INEQUALITIES.
SO IT'S NOT JUST PATH.
IT'S STRUCTURES THAT ARE
PRESENT, IN CLUESIVELY OF THOSE
THINGS THAT HAVE BEEN EMBODIED
AND IMPOSED, NORMALIZED AND
INTERNALIZED ACROSS THE LEVELS.
AND IT'S MANIFESTATIONS ARE
GENDER IMBALANCES AND STRUCTURAL
VIOLENCE WHICH NOW 2-3 TIMES
CREATES VIOLENCE FOR INDIGENOUS
PEOPLES.
AND PHYSICAL VIOLENCE OR ANY
LIMITATION BY ANO PRESSOR ON TO
THEO PRESSED OF FREEDOM.
ALTHOUGH THE TYPES OF VIOLENCE
MIGHT CHANGE BASED ON THE NEEDS
OF THE STRUCTURAL SYSTEM AT THE
TIME, MIGHT BE MORE OVERT VERSUS
MORE UNCONSCIOUS FOR INSTANCE OR
MORE INSTITUTIONAL AND HARDER TO
SEE, WHATEVER THE FORMS ARE, THE
FUNCTION IS THE SAME.
SO THESE FORMS OF VIOLENCE HAVE
CHANGED OVER TIME, THEY HAVE THE
SAME EFFECT.
SO WHETHER IT'S VIOLENCE IN THE
FORM OF RACISM OR SEXISM, THESE
THINGS ARE ALL DOING THE SAME
THING AND THEY PIT PEOPLE
AGAINST EACH OTHER BECAUSE IT
DISTRACTS FROM THE STRUCTURES
THAT ARE PERPETUATING THE
PROBLEM.
SO IN ADDITION TO LOOKING AT
HISTORICAL OPPRESSION, THIS
FRAMEWORK ALSO CENTERS
RESILIENCE.
AND THESE ARE SOME OF THE
PROTECTED THAT WE FOUND IN OUR
RESEARCH THAT ARE AFFIRMED IN
MUCH OF THE OTHER RESEARCH.
INDIGENOUS IS AFFIRMING
THEMSELVES AND CANADIAN
GOVERNMENT AND ALLOCATING A LOT
OF GOVERNMENTAL FUNDING TO
CENTER INDIGENOUS WORLD VIEWS,
TO REDRESS THE COLONIZATION THAT
CONTINUES INTO THE PRESENT.
THIS IS SOMETHING THAT WE NEED
TO DO INSTITUTIONALLY BUT IT HAS
BENEFITS FOR ALL PEOPLE BECAUSE
THEY ARE PROTECT AND I HAVE
EXPANSIVE AND ALSO CAN HELP US
UNDERSTAND WHAT IS THE DOMINANT
SYSTEM AND WHY ISN'T IT WORKING?
INDIGENOUS PROTECTIONS INCLUDES
GENDER, FLUID AND FLEXIBLE
GENDER ROLES COMMON IN PRE
COLONIAL INDIGENOUS SOCIETIES.
2-4 GENDER IDENTITIES WERE
COMMON.
THESE WERE SACRED STATUSES.
NOT UNDERMIND.
PEOPLE WHO WERE DIFFERENT WERE
LOOKED TO BE HONORED AND THEY
HAD SPECIAL PERSPECTIVES OTHERS
COULDN'T PROVIDE.
SO DIFFERENCES WERE LOOKED AT
COMPLEMENTARY AND PROVIDING A
BROADER PIECE OF THE PUZZLE WE
CAN'T HAVE ON OUR OWN.
FAMILY AND EXTENDED FAMILY KIN
SHIP BONDS ARE CENTERED AS WELL
AS CONNECTION TO LAND AND PLACE,
FOOD, CULTURAL HEALING AND
TRADITIONS, THESE ARE CENTRAL
PROTECTIVE FACTORS THAT ARE
REALLY SUPPRESSED OVER TIME.
AND TO CONTRAST THE WESTERN
EUROPEAN VERSUS INDIGENOUS
MODELS WITH KNOWLEDGE, WE ARE
STRUCTURED BY THIS WESTERN
EUROPEAN VIEW OF POSITIVISM,
SCIENCE, COMPARTMENTALIZE,
REMUTUAL THE CONTEXT,
MEASURABLE, QUANTITY VERSUS
QUALITY.
LINEAR.
AND THIS IS VERY DIFFERENT THAN
THE INDIGENOUS WORLD WITH
CYCLICAL, PATTERNS AND IT'S ALSO
WITH SEEN IN THE PERSPECTIVE OF
LAND ACQUISITION, POSSESSION OR
HUMAN USE, DISTRACTION VERSUS
LAND AS SACRED, TAKE ONLY WHAT
HE IS NEEDED, INTERCONNECTION,
RESPECT FOR ALL HUMAN AND
NON-HUMAN LIFE.
HARMONY, BALANCE.
THESE THINGS ARE VERY DIFFERENT.
THE FAMILY LEVEL WE HAVE IN THE
WESTERN WORLD VIEW PATRIARCHAL,
NUCLEAR, HIERARCH ALIX
ADVERSARIAL, DIRECT.
VERSUS THE INDIGENOUS WE HAVE
FEMALE-CENTERED KIN SHIP
FOCUSED, CIRCUMSTANCIAL,
RELATIONSHIP ORIENTED.
AND THE INDIVIDUAL VERSUS
COLLECTIVE LEVEL, WE HAVE
INDIVIDUAL FOCUS ON PERSONAL
ACHIEVEMENT AND COMPETITION,
HIERARCHY, CONFLICT.
VERSUS PROCESSING THE INDIGENOUS
WORLD VIEW, COMMUNITY WELLNESS,
INTERDEPENDENCE, COLLECTIVE.
THESE REALLY CLASH AND THE
INDIGENOUS WORLD VIEW HAS BEENO
PRESSED ON PURPOSE BECAUSE IT
REALLY THREATENS THESE
OPPRESSIVE WORLD VIEWS.
IT UNDERMINES THEM.
THE ONLY WAY TO KEEP THESE
EXSTANCIVE WORLD VIEWS DOWN IS
TO SUPPRESS AND DEHUMANIZE OVER
TIME BUT THEY PERSISTED.
SO WHAT HAPPENS?
ONE OF THE THINGS I HAVE DONE IN
MY RESEARCH IS TO SEE HOW THE
PRE COLONIAL DIE LOGIC OR LIB
TORY TYPES OF WORLD VIEWINGS
WERE UNDERMIND AND HOW THAT
EFFECTED VIOLENCE AND PEOPLE
ACROSS THESE ECOLOGICAL LEVELS.
WHAT I FOUND WAS THAT THIS IS
PAULA'S COLONIAL ANTI-DITA LOGIC
AND DIE LOGIC WORLD VIEWINGS.
THE PRE COLONIAL WORLD VIEWS OF
COOPERATION, THE ORGANIZATION,
CULTURAL SYNTHESIS.
PRESENT AND STILL PRESENT
THROUGH COMP TERRY COHESION AND
INTERRELATEDNESS.
WITH THE ENTRANCE OF CELTLER
COLONIZERS, THEY USED ANTI-DIZZ
LOGIC TACTICS, CONQUEST, WAR,
DIVIDE AND RULE, FRAGMENT
COMMUNITIES AND TRIBAL MEMBERS,
INTRODUCE ALCOHOL AND VIOLENCE
AND TREATIES.
MANIPULATING POWER THROUGH FALSE
GENEROSITY AND MISSIONARIES
THROUGH CULTURAL INVASION AND
CHANGING THE WORLD VIEW,
RELIGIOUS OPPRESSION AND
ASSIMILATION.
IN THE SAME ANTI-DILOGIC TACTICS
HAVE BEEN USED ACROSS MORE
CONTEMPORARILY SOCIETAL
COMMUNITY AND FAMILY RELATIONAL
LEVELS.
SO, THROUGH BOARDING SCHOOLS,
SHARE CROPPING, DISCRIMINATION,
YOU CAN SEE THE SAME CONQUESTS,
DIFFERENT FORMS, DIFFERENT FORMS
OF VIOLENCE BUT THE SAME
FUNCTION.
SAME THING WITH DIVIDE AND RULE.
FRAGMENTING COMMUNITIES.
IT'S THIS TRIBE AGAINST THAT
TRIBE.
FEMALES AGAINST MALES.
IT'S DIFFERENT RACIAL GROUPS.
IT'S FRAGMENTATION.
THE PEOPLE WORK TOGETHER THEY
ARE MUCH MORE POWERFUL.
THERE IS A FEAR OF FREEDOM
BECAUSE OF REAL VIOLENCE IF YOU
SPEAK OUT WHICH IS LED TO THE
CULTURAL OF SILENCE OR
DIFFICULTY IN HAVING A VOICE
BECAUSE IT'S BEEN SUPPRESSED.
PEOPLE DON'T FEEL LIKE THEY ARE
LIBERATED TO STRIKE OUT AGAINST
THE STRUCTURAL VIOLENCE.
THERE SAY LOT MORE UNTOLD
VIOLENCE FOR PEOPLE OF LOWER
LEVELS, WOMEN AND CHILDREN,
SUBOPPRESSION IMPOSED THROUGH
THE U.S. GOVERNMENTAL STRUCTURE
AND BEING IMPOSED TRIBAL
GOVERNMENT.
SO, THAT SAME SYSTEM HAS BEEN
REPLICATED SOMETIMES.
CORPORATE INTERESTS HAVE COME IN
AND RUN A LOT OF THE ECONOMIC
MATTERS IN TRIBAL COMMUNITIES.
AND THEN ALSO THIS
DEHUMANIZATION OF GENDER ROLES
AND USING WOMEN AND CHANGING
THEIR STATUS, THE HIGH RATES OF
VIOLENCE, HIGH RATES OF OVERLOAD
FOR INDIGENOUS WHIPSES IS
OPPOSITE OF WHAT WE FOUND BEFORE
AS WELL AS PEOPLE COPING WITH
THIS OPPRESSION THROUGH
SUBSTANCE ABUSE AND VIOLENCE.
AT THE RELATIONAL LEVEL, YOU CAN
SEE THIS IN THE POWER CONTROL
WHEEL VERY SIMILAR HERE.
WE SEE THE SAME COLONIAL TOOLS
OF CONQUEST AT THE SOCIETY
LEVEL, INTERPERSONAL LEVEL USING
CONTROL, THREATS, STOCKING.
SAME IN THE SETTLER COLONIAL
TACTICS.
WE SEE PEOPLE I GUESS LATING
EACH OTHER FROM FAMILIES, EWING
LAW AND POLICY, ECONOMIC
MANIPULATION AND MINIMIZING.
THE INVASION OF THE INVASION OF
LOSS OF SELF.
PEOPLE LOSING THEMSELVES,
FEELING INTERNALIZED OPPRESSION
AND ACCUMULATIVE VILE EXPENSE IS
SUBSTANCE ABUSE.
WHAT I FOUND IN RESEARCH THESE
SAME TACTICS CAN BE FOUND AT ALL
LEVELS AND THEY DO RELATE TO
VILE EXPENSE IS THEY ARE THESE
INTERNAL STRUCTURES OF COLONIAL
SETTLER HISTORICAL OPPRESSION.
HOWEVER, DESPITE THAT, WHAT I
STILL SEE IN THE WORK IS THAT
PEOPLE HAVE THESE DILOGIC
QUALITIES STILL EMERGENT IN THE
THREE Rs AND THAT GROUNDED
DIALOGUE CANNOT EXIST EXCEPT IN
PROFOUND LOVE.
AND GROUNDED IN RESPONSIBILITIES
TO COMMUNITIES IN RELATIONS WITH
FAMILY, EXTENDED FAMILY IN
RELATION TO COME FROM GENDER
BACKGROUNDS.
SO HOW PEOPLE ACROSS 500 YEARS
OF INJUSTICE CAN HAVE THESE SAME
SPRAWLS WORLD VIEWS?
THAT IS AMAZING IT'S
TRANSCENDENT.
SO THERE IS SO MUCH FREEDOM THAT
CAN BE FOUND BY CENTERING THESE
WORLD VIEWS THAT ARE PERSIST
ONLY FOR CENTURIES.
THIS ALL IN FORMS THE RESEARCH
OF THE HEALTHY FAMILIES PROGRAM
THAT CENTERS THESE FACTORS TO
SEE WHETHER IT PREVENTS AND
REDUCES SUBSTANCE ABUSE.
WE USED IMPLEMENTATION SCIENCE
TO SEE WHAT IS HELPING AND
HURTING.
THE BARRIERS OF THE FACILITATORS
TO BE USED IN THE COMMUNITY.
WE USED mHEALTH TO HELP
REINFORCE THE TEACHINGS IN THIS
THROUGH OUR COVID SETTLEMENT.
THIS 10-SESSION PROGRAM STARTS
WITH THE FAMILY MEAL WHERE WE
INTEGRATE TRIBAL FOOD WAYS AND
THE FRAMEWORK OF HISTORICAL
OPPRESSION AND RESILIENCE.
PEOPLE SHARE MEALS AND HAVE
POSITIVE RITUALS BEFORE THEY GO
OFF INTO DEPARTMENTALLY TAILORED
GROUPS WHERE THEY LEARN THE SAME
LESSON IN TAILORED WAYS AND KEY
COVER THINGS LIKE RESILIENCE,
COMMUNICATION, SUBSTANCE ABUSE,
HEALTHIER RELATIONSHIPS, THE
FRAMEWORK I MENTIONED.
AND WE INFUSED, STARTING WITH
TALKING CIRCLES AND THROUGHOUT
WE HAVE TRIBAL VALUES.
MEDICINE WHEEL, FAMILY FOCUS.
SO THESE PARTS ARE CENTERED AND
WE ALLOW THAT RELATIONSHIP AND
NOT SO MUCH OF THE CONTENT.
SO WE FOUND THAT EVEN -- WE ARE
CURRENTLY TESTING OVER 100
FAMILIES.
EVEN THE PILOT STUDY WHICH WE
USED CULTURALLY RELEVANT
MEASURES OF HISTORICAL
OPPRESSION IN RESILIENCE, WE
FOUND REDUCTIONS AFTER THE PILOT
ALREADY.
WE FOUND FEELINGS OF
CONNECTEDNESS WITH OUR
COMMUNICATEDY AND SOCIAL SUPPORT
INCREASED.
FAMILY RESILIENCE AND FAMILY
POSITIVE PARENTING INCREASED.
THE ABILITY TO MANAGE COMPLEX
THROUGH COMMUNICATION INSTEAD OF
VIOLENCE INCREASED.
RESILIENCE AND HEALTH PRACTICES
ANDEE MOTIONAL REGULATION AND
PSYCHOPATHOLOGY WERE IMPROVED
AFTER THE INTERVENTION.
WE FOUND THAT SUBSTANCE ABUSE,
ALCOHOL WAS REDUCED 3 FOLD FOR
PEOPLE AND THERE WAS A GENDER
DIFFERENCE WITH MEN HAVING A
GREATER REDUCTION LIKELY BECAUSE
OF THE -- WE FOUND INTERESTINGLY
THAT PEOPLE WHO REPORTED HIGHER
LEVELS OF HISTORICAL OPPRESSION
FOUND GREATER REDUCTIONS ON A
LOT OF THESE SYMPTOMS INDICATING
WHEN PEOPLE UNDERSTAND THEIR
SOCIAL OR MENTAL OR PHYSICAL
PROBLEMS, RELATED TO STRUCTURAL
CLASSES, THEY FIND RELIEF JUST
FROM THAT.
KNOWING IT WASN'T THEM THE WHOLE
TIME THAT OF COURSE THEY FEEL
THIS WAY BECAUSE LOOK AT THE
STRUCTURES MAKING YOU DO THAT OR
CAUSING THAT.
IT HELPS THEM HEAL BECAUSE THEY
CAN DISMANTLE THE INTERNAL
STRUCTURES OF DEHUMANIZATION
THAT WERE IMPOSED.
WE SAW PHYSICAL, PSYCHOLOGICAL
VIOLENCE REDUCED AS WELL AS
ANXIETY AND DEPRESSION AS WELL.
SO IMPORTANTLY, TO END HERE, WE
HAVE A TON OF COMMUNITY
SUSTAINABILITY I.
WE PAY HALF FUNDING GOING
DIRECTLY TO PEOPLE WHO ARE
CHEFS, COMMUNITY HEALTH
REPRESENTATIVES, STIPENDS FOR
FAMILIES, PEOPLE ARE GETTING
TRAINED AND HIGHER EDUCATION.
WE HAVE COMMUNITY ADVISORY BOARD
THAT LEADS THIS.
WE ARE WORKING WITH INSTITUTIONS
IN THE COMMUNITIES THAT ARE
TAKING THIS FORWARD.
WE HAVE PLANS AND HAVE TRAINED
PEOPLE IN ALL OF THE AGENCIES
WHO WILL CONTINUE THIS AFTER THE
GRANT RUNS OUT.
OVER ALMOST 90% OF THE FAMILIES
WHO START STAY IN THE PROGRAM
WHICH IS 560 PEOPLE WHICH IS
REALLY, REALLY HIGH.
ABOUT TWICE AS HIGH AS USUAL.
AND WE INVITE PEOPLE BACK FOR
FAMILY AND COMMUNITY HEALTH
REPRESENTATIVES TALKING CIRCLES.
SO CONTINUE THE DIALOGUE OF NOT
ONLY JUST ABOUT THE PROGRAM AND
THEMSELVES BUT THIS DECOLONIZING
DIALOGUE.
WE DO THE RESEARCH LEVEL IN OUR
TEAMS TO UNDERSTAND HOW OUR
COLONIAL MINDSET
INSTITUTIONALIZING OUR LIVESES
AND IN OUR PROCESS.
SO WE TRY TO DISMANTLE THOSE IN
OUR RESEARCH PROCESS.
WE USE TEXT MESSAGE REMINDERS TO
AFFIRM EDUCATIONAL MESSAGES THAT
THEY GET IN THE SESSIONS AND
IT'S BEEN REALLY GROWING AND
WILL CONTINUE TO GROW.
WE DO OFFER VIRTUAL OPTION
WHEN'S IT COMES TO COVID BUT WE
HAD A REALLY GREAT SUCCESS AND
IT'S BEEN REALLY GREAT.
I WANT TO END TODAY WITH, AFTER
HAVING HEARD WHAT WE HEARD
TODAY, AND WHO AND WHAT IS THIS
INTERVENTION REALLY FOR AND WHAT
IS CAUSING IT?
SO ASKING OURSELVES HOW HAVE
INSTITUTIONS AND PROFESSIONALS
AND ACADEMIA RESEARCH BEEN
COMPLICIT IN THE PER PET
ALLIESING?
HOW DOES IT AFFECT SOCIETY AND
THE WORLD AND THE IT'S PEOPLE?
IS THIS THE TYPE OF WORLD WE
WANT TO LIVE IN?
AND IF SO, IF IT'S WORKING FOR
WHO?
AND WHO IS IT NOT WORKING FOR
AND WHAT ACTIONS AM I DOING TO
BE COMPLICIT IN DRIVING DOMINANT
VERSUS LIBERATING STRUCTURES?
WE HAVE TO LOOK AT OUR HISTORY.
YOU CAN E-MAIL ME.
I HAVE A WORKSHOP ON DISMANTLING
COLONIAL MINDSET FOR SELF CARE
AND MORE ON WORLD VIEWS.
THANK YOU VERY MUCH FOR YOUR
TIME AND I REALLY ENJOYED
SPENDING TIME WITH YOU.
THANK YOU.
>>THANK YOU VERY MUCH,
DR. CATHERINE MCKINLEY FOR THAT
POWERFUL TALK.
NOW I WILL TURN IT OVER TO
DR. ARGHAVAN SALLES.
>>ARGHAVAN SALLES: IT LOOKS
LIKE SOMEBODY IS SHARING.
KATHLEEN, I CAN SHARE FROM HERE
IF THAT'S OKAY.
THANK YOU.
THANK YOU VERY MUCH FOR THE
OPPORTUNITY TO BE HERE.
MY TALK IS A LITTLE BIT
DIFFERENT FROM THE OTHER TWO IN
THIS SESSION.
SO HOPEFULLY PEOPLE WILL GET
SOMETHING OUT OF IT.
I JUST HAVE SOME QUICK DIGS
CLOSURES.
I DO CONSULTING WORK WITH THE
INTUITIVE FOUNDATION AND
SURGICAL ROBOTIC COMPANY AND I'M
A COLLABORATOR WITH EXPONENTIAL
TALENT, DIVERSITY EQUITY AND
INCLUSION CONSULTING FIRM.
I ALSO LIKE TO START WITH SOME
POSITIONALITY AS OTHER FOLKS
HAVE DONE.
I'M A CISGENDER WOMAN, MY
PRONOUNCE ARE SHE/HER.
I HAPPEN TO HAVE A HETEROSEXUAL
ORIENTATION.
I COME TO YOU FROM THE -- LAND
AND RECOGNIZE THAT THOSE ARE THE
FOLKS TO WHOM THIS LAND BELONGS
AND REPARATIONS NEED TO BE MADE.
I ALSO AMMAN IMMIGRANT.
USUALLY THIS ISN'T A BIG PART OF
MY TALK BUT I'M FROM IRAN AND
TODAY ESPECIALLY I FEEL THAT I
JUST NEED TO MAKE A COMMENT ON
THAT.
TODAY IS THE 40th DAY AFTER
THE MURDER OF -- BY THE POLICE
THAT LED TO NOW COMING UP ON TO
SIX WEEKS OF PROTESTS IN IRAN AS
PEOPLE FIGHT FOR PRE DOMESTIC.
AND ANYWAY, JUST WANT TO
ACKNOWLEDGE THAT AND SHARE THAT
THAT IS THE SPACE THAT I'M IN.
SO I'M GOING TO TALK ABOUT
DIFFERENT FROM WHAT OTHER FOLKS
HAVE TALKED ABOUT.
I'M A PHYSICIAN BY TRAINING AND
SO I SPEND A LOT OF TIME
THINKING ABOUT PATIENT CARE.
MY RESEARCH IS ALL ON THE
WORKFORCE.
SO WHO IS PROVIDING THAT CARE TO
PATIENTS AND WHAT ARE THE
CIRCUMSTANCES IN WHICH WE ARE
WORKING?
AND THESE TWO ARE LINKED.
SO OUR PATIENT CARE OUTCOMES ARE
LINKED TO WHAT IS HAPPENING WITH
THE WORKFORCE.
USUALLY I START OUT BY JUST
SHARING SOME DATA TO SUPPORT
THAT SUPPOSITION.
SO ONE, THERE ARE STUDIES THAT
SHOW THAT PATIENTS PREFER TO BE
CARED FOR BY PEOPLE WHO LOOK
LIKE THEM.
THEY ARE MORE LIKELY TO ADHERE
TO TREATMENT PLANS AND THEY ARE
MORE CERTIFIED WITH THEIR
INTERACTIONS.
AND THEN I WANT TO HIGHLIGHT A
COUPLE OF STUDIES THAT LOOK
SPECIFICALLY AT OUTCOMES SUCH AS
MORTALITY, READMISSIONS,
ET CETERA.
SO ONE IS LOOKING AT WOMEN WHO
PRESENT TO EMERGENCY DEPARTMENTS
WITH SYMPTOMS OF A HEART ATTACK.
AND BASICALLY THIS STUDY WHICH
CAME OUT A COUPLE OF YEARS AGO,
FOUND THAT WOMEN WERE MORE
LIKELY TO DIE, IN OTHER WORDS
LESS LIKELY TO SURVIVE IF THE
PHYSICIAN CARING FOR THEM WAS A
MAN THAN IF IT WERE A WOMAN.
AND ADMITTEDLY PRETTY MUCH ALL
THE RESEARCH I'M GOING TO
PRESENT TO YOU AROUND THIS TOPIC
USES A BINARY GENDER FRAMEWORK
WHICH I THINK THOSE OF US HERE
CAN AGREE IS INADEQUATE BUT THAT
IS CURRENTLY WHAT WE HAVE TO
WORK WITH.
THE OTHER REALLY INTERESTING
THING FROM THAT STUDY IS THAT
NOT ONLY DID WOMEN PATIENTS HAVE
BETTER OUTCOMES IN THE HANDS OF
WOMEN PHYSICIANS BUT MORE WOMEN
PHYSICIANS BEING PRESENT IN AN
EMERGENCY DEPARTMENT BEING ON
STAFF IN AN EMERGENCY DEPARTMENT
LED TO BETTER OUTCOMES FOR WOMEN
PATIENTS OVERALL WHEN THEY CAME
TO THAT EMERGENCY DEPARTMENT
EVEN IF THEY WERE CARED FOR
DIRECTLY BY A MAN INSTEAD OF A
WOMAN.
THERE SEEMS TO BE SOME DIFFUSIVE
BENEFIT TO HAVING MORE WOMEN
AROUND.
AND THEN WITH REGARD TO RACE,
MULTIPLE STUDIES I'M GOING TO
JUST HIGHLIGHT ONE, WHICH HAS TO
DO WITH NEWBORN MORTALITY.
SO THERE IS A RACIAL DISPARITY
THERE, BLACK INFANTS IN THIS
COUNTRY ARE MORE LIKELY TO DIE
THAN WHITE INFANTS.
THIS IS ANOTHER STUDY THAT WAS
DONE LOOKING AT THE CONCORDANCE.
BUT INSTEAD OF LOOKING BY
GENDER, THEY LOOKED BY RACE.
AND THEY FOUND FOR WHITE
NEWBORNS, THEY WERE EQUALLY
LIKELY TO SURVIVE, EQUALLY
LIKELY TO DIE REGARDLESS OF THE
RACE OF THEIR PHYSICIAN.
BUT BLACK NEWBORNS WERE MUCH
LESS LIKELY TO DIE IF THE
PHYSICIAN CARING FOR THEM WAS
BLACK RATHER THAN WHITE.
SO IT IS A SIGNIFICANT SHRINKING
OF THAT RACIAL DISPARITY IN
NEWBORN OUTCOMES WHEN THERE WAS
RACIAL CONCORDANCE.
I SHARE THESE THINGS BECAUSE A
LOT OF TIMES WHEN I GIVE TALKS
TO OTHER AUDIENCES, THEY THINK
THIS IS ALL FLUFF.
THAT CARING ABOUT WHO IS IN THE
WORKFORCE IS IRRELEVANT AND WE
NEED TO FOCUS ON THE SCIENCE.
AND OF COURSE YOU ALL KNOW THAT
THIS IS ALSO SCIENCE.
AND WHAT SCIENCE IS TELLING US
IS THAT WE NEED TO DO BETTER BY
OUR PATIENTS AND PART OF THAT IS
BY DOING BETTER BY OUR WORKFORCE
WORKFORCE.
SO JUST STEPPING BACK A LITTLE
BIT AND LOOKING AT OUR PHYSICIAN
WORKFORCE.
THERE ARE DATA FROM THE AAMC
THAT SHOW US BASICALLY
THROUGHOUT THE RANKINGS AS
SOMEONE GOES UP THROUGH THE
CAREER, WHAT IS THE
REPRESENTATION OF WOMEN?
AND A LOT OF TIMES THESE DAYS
PEOPLE THINK THAT WE KIND OF
HAVE MADE IT, THAT WE HAVE
PARITY IN MEDICINE BECAUSE WE
HAVE A LOT OF WOMEN IN MEDICAL
SCHOOL AND WE HIT NOW MORE THAN
JUST OVER 50% OF MEDICAL
STUDENTS BEING WOMEN.
BUT, DATA LIKE THESE SHOW THAT
AS WE GO UP THROUGH THE RANKS,
AT EVERY LEVEL WE ARE LOSING
WOMEN.
IN OTHER WORDS, THERE IS LESS
AND LESS REPRESENTATION AT THE
HIGHEST LEVELS.
AND THERE IS MANY REASONS FOR
THIS.
BUT OFTEN PEOPLE WILL SAY, IT'S
JUST GOING TO TAKE TIME FOR
WOMEN TO KIND OF MAKE THEIR WAY
UP THROUGH THE RANKS.
AND I THINK THAT IS A REASONABLE
THING TO THINK EXCEPT FOR WE
KNOW THAT WOMEN HAVE BEEN VERY
CLOSE TO BEING HALF OF MEDICAL
SCHOOL STUDENTS SINCE THE 1990S.
SO, 45% OR MORE OF MEDICAL
STUDENTS SINCE THE LATE 1990S.
SO THAT SHOULD BE ENOUGH TIME,
CERTAINLY, FOR WOMEN TO MAKE IT
UP TO THE RANKS OF KNACK TEE,
MAYBE EVEN DIVISION CHIEF AND SO
ON.
THAT JUST ISN'T THE CASE.
SO THERE ARE MULTIPLE FACTORS AT
PLAY.
I'M JUST GOING TO TALK A LITTLE
BIT ABOUT BIAS AND SEXUAL
HARASSMENT, WHICH SENATOR TWO
OBSTACLES.
I ALSO WANT TO NOTE THAT JUST AS
I MENTIONED, THE DATA I'M
SHARING ARE REALLY USING A
BINARY GENDER FRAMEWORK.
A LOT OF THE DATA LOOKING AT
GENDER DISPARITIES ON THE
WORKFORCE SIDE ALSO DO NOT TAKE
INTO ACCOUNT RACE OR OTHER
ASPECTS OF IDENTITY.
SO EVEN THOUGH I THINK WE ALL
PROBABLY UNDERSTAND HOW
IMPORTANT IT IS TO APPROACH
THESE PROBLEMS WITH AN
INTERSECTIONAL LENSE, THE DATA
ARE NOT QUITE THERE YET.
SO, IMPLICIT BIAS, I'M SURE MOST
OF THE FOLKS IN THIS AUDIENCE
ARE FAMILIAR WITH THE IAT WHICH
USES REACTION TIMES TO ASSESS
HOW LIKELY WE ARE TO ASSOCIATE
DIFFERENT THINGS WITH EACH
OTHER.
SO I'M GOING TO SHARE DATA FROM
WHAT WAS PUBLISHED A COUPLE
YEARS AGO ON HEALTH CARE WORKERS
AND THEIR IMPLICIT GENDER
BIASES.
SO WE DID TWO THINGS HERE.
ONE WAS WE LOOKED AT THE DATA
FROM PROJECT IMPLICIT ON THEIR
GENDER CAREER IAT LOOKING AT
MAN/WOMAN AND THEN
CAREER/FAMILY.
DO PEOPLE ASSOCIATE MEN MORE
WITH FAMILY OR CAREER AND DO
THEY ASSOCIATE WOMEN MORE WITH
FAMILY OR CAREER?
AND WE PULLED OUT THE FOLKS WHO
HAD TAKEN THAT OVER AN 11-YEAR
PERIOD WHO SELF IDENTIFIED AS
WORKING IN HEALTH CARE.
AND THEN WE DEVELOPED A NOVEL
IAT SIMILAR TO THE GENDER CAREER
IAT EXCEPT FOR INSTEAD OF FAMILY
AND CAREER, WE HAD FAMILY,
MEDICINE AND SURGERY.
AND WE ADMINISTERED THAT ONE TO
A SAMPLE OF SURGEONS.
SO THOSE OF YOU WHO LOOKED AT
DATA FROM IAT KNOW A VALUE OF
ZERO HERE IS NO PREFERENCE ONE
WAY OR THE OTHER AND YOUR
REACTION TIMES ARE JUST AS FAST
WHEN YOU'RE CONNECTING MAN WITH
CAREER AS YOU ARE MAN WITH
FAMILY AND WOMEN WITH CAREER AS
YOU ARE WOMEN WITH FAMILY.
AS YOU SEE, NONE OF OUR SUBSETS
HERE WERE AT ZERO.
SO ON THE LEFT IS THE DATA FROM
THE GENDER CAREER IAT SHOWING
THAT BOTH MEN AND WOMEN WHO WORK
IN HEALTH CARE ARE MORE LIKELY
TO ASSOCIATE MEN WITH CAREERS
AND WOMEN WITH FAMILY.
AND ON THE RIGHT, WE HAVE DATA
FROM SURGEONS SHOWING BOTH MEN
AND WOMEN SURGEONS ARE MORE
LIKELY TO ASSOCIATE MEN WITH
SURGERY AND WOMEN WITH FAMILY
MEDICINE.
AND THESE DATA, WHILE MAYBE
INTUITIVE, HELP EXPLAIN WHY IT
IS THAT WHEN PHYSICIANS SEE
PATIENTS, FOR EXAMPLE, IN THE
HOSPITAL, PATIENTS WILL SAY,
WHEN AM I GOING TO SEE THE
DOCTOR?
OR WHEN I AS A WOMAN SURGEON
TALK TO A PATIENT ABOUT THE
RISKS AND BENEFITS OF SURGERY
AND WHAT THEIR PROBLEM IS AND
HOW WE WOULD ADDRESS IT, AT THE
END OF THE VISIT, THEY'LL
SOMETIMES ASK, WHO IS GOING TO
DO THE SURGERY?
BECAUSE IT DOESN'T LIKE COMPUTE
FOR THEM THAT I WOULD BE THE
PERSON WHO WOULD DO THAT
PROCEDURE.
AND THESE BIASES NOT ONLY EFFECT
OUR ONE-ON-ONE INTERACTIONS WITH
PATIENTS OR WITH PEOPLE ON OUR
TEAMS BUT THEY ACTUALLY EFFECT
OUR CAREER OPPORTUNITIES.
BECAUSE EVERY TIME THAT PEOPLE
ARE THINKING ABOUT WHO SHOULD BE
NOMINATED FOR AN AWARD OR WHO
SHOULD BE ASKED TO SPEAK OR WHO
SHOULD BE APPOINTED TO A
LEADERSHIP POSITION, ALL THESE
BIASES AND ALL THE DIFFERENT
TYPES OF BIASES THAT EXIST ARE
ENGAGED.
SO FOR WOMEN AND IN PARTICULAR
WOMEN WHO HAVE OTHER
MARGINALIZED IDENTITIES WHETHER
THAT BE THEIR RACE, ETHNICITY,
ABILITY, ET CETERA, THIS CAN BE
REALLY DAMAGING BECAUSE WE NEED
PEOPLE TO KIND OF GIVE US
OPPORTUNITIES IN ORDER TO BE
ABLE TO ADVANCE IN OUR CAREERS.
NO MATTER HOW SMART OR
HARDWORKING YOU ARE, THERE IS
ONLY SO FAR YOU CAN GET ON YOUR
OWN.
WE LOOKED AT DATA FROM A NUMBER
OF SURGICAL SPECIALTIES, A FEW
YEARS AGO, JUST TO SEE WHO WAS
BEING SEEN AS AN EXPERT.
WHO WAS BEING INVITED TO SPEAK
ON THE STAGES OF THE ANNUAL
MEETINGS?
WE LOOKED AT 14 DIFFERENT
SURGICAL SOCIETIES AND WE LOOKED
AT FOR EACH ONE, TWO DIFFERENT
YEARS OF THEIR ANNUAL MEETING.
AND WE LOOKED AT TWO CATEGORIES
OF SPEAKERS.
WE LOOKED AT PLENARY SPEAKERS.
I LIKE THE ONES WE HAD THIS
MORNING.
AND WE LOOKED AT PANELISTS ANY
TIME THERE ARE TWO OR MORE
PANELISTS OR PEOPLE IN A SESSION
PRESENTING IN A SESSION, WE
CONSIDERED THAT A PANEL.
SO, THE BASIC TAKEAWAYS HERE ON
THE LEFT LOOKING AT THE PLENARY
SPEAKERS, THE BLUE PORTIONS OF
THOSE BARS ARE REPRESENTING MEN
SPEAKERS AND THE BLACK MARKS
REPRESENT THE MEMBERSHIP OR
PROPORTION OF WOMEN MEMBERS IN
THAT SOCIETY IN THAT GIVEN YEAR.
AND I SHOULD NOTE THAT ON THE
WHOLE, ABOUT ONE FOURTH OF THE
MEMBERS ACROSS ALL THE SOCIETIES
WERE WOMEN.
SO, WE HAVE NOT REACHED PARITY
IN SURGERY.
BUT IT'S ALSO NOT AT 0% OR 5% OR
EVEN LIKE ORTHOPAEDIC SURGERY AT
6%.
THESE ARE DIFFERENT GENERAL
SURGERY SPECIALTIES AND WHAT WE
FOUND IS 1/3 OF THE SOCIETIES
HAD ZERO WOMEN PLENARY SPEAKERS
IN BOTH OF THE YEARS THAT WE
LOOKED AT.
SO, WE LOOKED AT TWO DIFFERENT
YEARS, 5 YEARS APART FROM EACH
OTHER AND THEY COULD NOT
IDENTIFY A SINGLE WOMAN IN
EITHER YEAR.
AND WHEN WE LOOKED AT THE
MANTELS, WE FOUND THAT ALMOST
HALF OF THE PANELS WERE MANTELS.
MINUTED ELSE ARE TWO OR MORE
SPEAKERS, ALL OF WHOM WERE MEN.
ALMOST HALF OF THE PANELS WERE
MANTELS.
THERE WAS A WIDE RANGE FROM 0%
TO SOME BEING AT 100%.
SO SOCIETY B HAD 100% MANTELS IN
BOTH YEARS AND 0% WOMEN IN
PLENARY SPEAKING ROLLS IN BOTH
YEARS.
SO THIS TELLS US THAT THERE IS
AGAIN FACTORS AT PLAY INCLUDING
BIAS WHEN PEOPLE ARE DETERMINING
WHO IS SUITABLE FOR THESE
OPPORTUNITIES AND OF COURSE
THESE OPPORTUNITIES ARE REALLY
IMPORTANT FOR ESTABLISHING ONES
SELF AS A -- SOMEONE WHO HAS A
NATIONAL REPUTATION OR
INTERNATIONAL REPUTATION, WHICH
IS THEN USED AS PART OF THE
DECISION-MAKING PROCESS FOR
PROMOTIONS.
AND I JUST WANT TO NOTE HERE
THAT OFTEN PEOPLE THINK THAT
THESE ISSUES ARE FOCUSED ON
ENTRY-LEVEL LIKE IF WE CAN GET
WOMEN PAST THE FIRST RUNG OF A
LADDER FOR EXAMPLE, THAT THESE
PROBLEMS WILL GET BETTER.
OR THAT WHEN YOU SEE WOMEN IN
LEADERSHIP ROLES THAT THEY MADE
IT AND THEY ARE NOT EXPERIENCING
THESE CHALLENGES ANYMORE.
AND DATA FROM THE WOMEN IN THE
WORKPLACE REPORT THAT COMES OUT
EVERY YEAR ARE REALLY HELPFUL IN
UNDERSTANDING WHAT ACTUALLY
HAPPENS.
SO THESE ARE DATA FROM LAST
YEAR.
THE REPORT FROM THIS YEAR JUST
CAME OUT BUT I HAVEN'T HAD A
CHANCE TO LOOK THROUGH IT YET.
IT CAME OUT LAST WEEK.
THIS IS FROM LAST YEAR.
THESE DATA TELL US THAT
BASICALLY WHEN WOMEN GO FROM
ENTRY-LEVEL TO SENIOR ROLES,
THEY ARE MORE LIKELY TO BE
INTERRUPTED OR BE SPOKEN OVER.
MORE LIKELY TO HAVE THEIR
JUDGMENT QUESTIONED.
AND MORE LIKELY TO HAVE PEOPLE
COMMENT ON THEIR EMOTIONAL
STATE.
I'M GOING TO SKIP THIS IN THE
INTEREST OF TIME.
AND I'M GOING TO SHIFT GEARS TO
SEXUAL HARASSMENT.
SO FAR I REALLY HAVE BEEN
TALKING ABOUT IMPLICIT GENDER
BIAS AND AS I SAID, I WANT TO
TALK ABOUT BOTH OF THESE IDEAS
ACKNOWLEDGING THAT THERE IS A
LOT MORE THAT GOES INTO THESE
DYNAMICS AND HOW WE NAVIGATE OUR
CAREERS THAT I'M NOT GOING TO
HAVE TIME FOR TODAY.
SO SEXUAL HARASSMENT IS REALLY
BASED ON A FOUNDATION OF POWER
DIFFERENTIAL.
SO SEXUAL HARASSMENT IS ABOUT
POWER.
IT'S NOT ABOUT SEX.
AND THERE ARE THESE THREE
CATEGORIES OF SEXUAL HARASSMENT
THAT HAVE BEEN DEFINED BY MANY
PEOPLE AND MOST FAKE USUALLY IN
RECENT YEARS BY THE NATIONAL
ACADEMIES OF SCIENCE ENGINEERING
AND MEDICINE.
GENDER BASED HARASSMENT ARE
VERBAL AND NON VERBAL BEHAVIORS
THAT ESSENTIALLY INDICATE SECOND
CLASS STATUS TO PEOPLE OF A
PARTICULAR GENDER.
THEN THERE IS UNWANTED SEXUAL
ATTENTION WHICH IS AS IT SOUNDS
AND THEN COORGANIZATION OR QUID
PRO QUO.
CONDITIONING EITHER
OPPORTUNITIES OR GRADES OR
TITLES ON SEXUAL FAVORS.
AND THESE ARE INTENTION ALLEY
SMALLER IN SIZE BUT HIGHER UP ON
THE PYRAMID BECAUSE THEY ARE
LESS AND LESS FREQUENT AS WE GO
UP BUT ALSO MORE AND MORE
DAMAGING.
AND SO THIS GRAPHIC WAS PUT OUT,
I'M SURE YOU HAVE SEEN THIS FROM
THE NATIONAL ACADEMIES A FEW
YEARS AGO.
THE KEY POINT IS JUST THERE IS
SO MUCH THAT HAPPENS IN THE
COURSE OF WOMEN'S CAREERS THAT
IS UNDER THE WATER, IF YOU WILL.
SO THINGS THAT PEOPLE DON'T
REALLY THINK ABOUT LIKE UNWANTED
SEXUAL DISCUSSIONS.
I'M GUESSING THAT HAPPENED TO --
CERTAINLY ANYONE WHO WORKS IN A
HOSPITAL.
THAT HAPPENS ALL THE TIME.
PRESSURE FOR DATES.
OFFENSIVE SEXUAL TEASING.
SEXIST INSULTS LIKE WOMEN DON'T
BELONG IN SCIENCE.
THOSE ARE THE THINGS UNDER THE
WATER.
AND THEN UNWANTED SEXUAL
ATTENTION AND COERCION ARE AT
THE TOP.
I WANTED TO HIGHLIGHT THE THINGS
THAT I PERSONALLY HAVE
EXPERIENCED IN MY CAREER WITH
THESE RED BOXES.
AND THIS IS NOT BECAUSE MY
EXPERIENCE IS UNUSUAL IT'S
ACTUALLY I THINK VERY
REPRESENTATIVE.
SO EVEN THOUGH WE THINK SOME OF
THESE THINGS NEVER HAPPEN OR
WE'D LIKE TO THINK THEY DON'T,
THEY HAPPEN ALL THE TIME.
AND THESE THINGS ARE REALLY,
REALLY CONSEQUENTIAL FOR
CAREERS.
SO THIS IS FROM THE NATIONAL
ACADEMY'S REPORT WHERE THEY SAY
THE ACCUMULATIVE EFFECT OF
SEXUAL HARASSMENT IS A
SIGNIFICANT AND COSTLY LOSS OF
TALENT IN ACADEMIC SCIENCE,
ENGINEERING AND MEDICINE.
AND WE KNOW EVEN JUST LOOKING AT
PATIENT CARE THAT THAT IS REAL
REDAMAGING TO OUR PATIENTS.
AND BEYOND THAT IF YOU THINK
ABOUT RESEARCH AND WHAT PROBLEMS
WOMEN STUDY AND WHAT OTHER
MARGINALIZED PEOPLE WILL STUDY
AND HOW THOSE FOLKS GET PUSHED
OUT AND THEN THOSE TOPICS AREN'T
STUDIED, IT'S REALLY
CONSEQUENTIAL FOR OUR HEALTH.
AND, ON TOP OF ALL OF THAT,
DESPITE THESE BARRIERS OF
EXPERIENCING BIAS AND
HARASSMENT, THERE IS A NUMBER OF
STUDIES OUT THERE, HIGH-QUALITY
STUDIES WITH LARGE NUMBERS OF
PATIENTS, THAT SUGGEST THAT
WOMEN PHYSICIANS PROVIDE BETTER
CARE FOR PATIENTS THAN DO MEN.
SO THIS IS SAY PIECE THAT A
COLLEAGUE AND I WROTE FOR THE
WASHINGTON POST THAT CAME OUT, I
THINK IT WAS STILL THIS YEAR.
BUT, BASED ON A STUDY THAT CAME
OUT IN JAMBA SURGERY LAST YEAR
LOOKING AT PATIENTS WHO ARE
SHOWING UP FOR SURGERY.
AND WHILE THE HEADLINE FOR THAT
PARTICULAR ARTICLE OR WHAT A LOT
OF PEOPLE WROTE ABOUT IS WOMEN
PATIENTS FAIRED BETTER IF THEIR
SURGEON WERE A WOMAN THAN IF
THEIR SURGEON WERE A MAN.
IT WAS TRUE THAT ALL PATIENTS
FAIRED BETTER IF THEIR SURGEON
WAS A WOMAN.
AND SO I SHARE THIS BECAUSE EVEN
THOUGH WE'RE EXPERIENCING SO
MUCH BIAS AGAINST US, THERE IS
SO MANY OBSTACLES IN OUR PATH
AND EXPERIENCING SEXUAL
HARASSMENT IN A NUMBER OF OTHER
THINGS AND SOME OF US ARE
EXPERIENCING RACISM AND ZONEO
PHOBIA AND FATPHOBIA AND ALL
THESE OTHER REALLY NEGATIVE
FORCES ON US, WE ARE STILL ABLE
TO PROVIDE BETTER CARE.
SO JUST IMAGINE WHAT OUR WORLD
WOULD BE LIKE.
HOW OUR HEALTH CARE WOULD BE IF
WE DIDN'T HAVE TO OVERCOME THESE
OBSTACLES.
THERE IS THE LAST SLIDE.
JUST WANTING TO MAKE A CLEARER
LINK HIRE TO WHAT ALL THIS MEANS
FOR THE NIH.
SO OBVIOUSLY I AS WE ALL KNOW,
NIH SETS STANDARDS FOR A LOT OF
OTHER FUNDERS, ESPECIALLY IN THE
AREAS OF HEALTH.
THIS IS ALL MY PERSONAL OPINION.
THE NIH HAS A RESPONSIBILITY TO
RECOGNIZE HOW ALL OF THESE
ISSUES I TALKED ABOUT AND THE
ONES THAT I DEPENDENT GET TO
TALK ABOUT, AFFECT PUBLIC
HEALTH.
RESEARCH ON PATIENT OUTCOMES
WHICH THEY SUPPORT TO SOME
DEGREE, IS OBVIOUSLY IMPORTANT
BUT SO IS RESEARCH ON THE
WORKFORCE.
WITH RESEARCH AND CLINICAL
WORKFORCES.
AND WHAT WE REALLY NEED IS
RESEARCH ON EFFECTIVE
INTERVENTIONS.
AND I SHOULD JUST PAUSE HERE AND
THAT IS THE END OF MY TALK BUT I
WANT TO NOTE THAT I'M VERY
GRATEFUL TO BE FUNDED TO DO WORK
ON SEXUAL HARASSMENT BY NIH AND
THE OFFICE OF RESEARCH ON
WOMEN'S HEALTH AND I THINK THAT
IS LIKE NOT JUST MAJOR FOR ME
AND MY CAREER BUT IT'S MAJOR
THAT YOU ALL ARE INVESTING IN
THAT WORK.
SO THAT IS IT FOR ME.
THIS IS MY CONTACT INFORMATION
IF ANYONE WANTS TO BE IN TOUCH
AND I'LL BE HERE FOR THE
QUESTION AND ANSWER.
>>EXCELLENT.
THANK YOU VERY MUCH FOR YOUR
IMPORTANT TALK DR. ARGHAVAN
SALLES AND FOR BRINGING UP THE
IMPORTANCE OF ADDRESSING GENDER
BIAS AND DISCRIMINATION IN ALL
FORMS AND CLINICAL CONTEXT.
SO DR. TIM KIN F IT'S OKAY WITH
YOU, I THINK WE CAN GO AHEAD AND
OPEN IT UP FOR QUESTIONS FROM
THE AUDIENCE.
>>I DON'T KNOW IF YOU HAD ANY
QUESTIONS YOU WANTED TO ASK?
>>YES, I WAS GOING TO SAVE MINE
FOR AFTERWARDS OR FOR A LULL
JUST TO GIVE A CHANCE TO FOLKS
WHO HAVE BEEN APPARENTLY
LISTENING TO ASK ANY QUESTIONS
THEY MIGHT HAVE.
>>I HAVE ONE QUESTION THAT CAME
UP THAT IS AROUND GENDER AND
CROSS-CULTURAL MEASUREMENTS OF
GENDER.
I THINK DR. ARGHAVAN SALLES
MENTIONED VIOLENCE AGAINST WOMEN
IN IRAN.
WE HEARD ABOUT GENDER ROLES AND
TRANSFOLKS IN PERU AND WE HEARD
ABOUT INDIGENOUS GENDER ROLES AS
WELL.
AND I WAS WONDERING IF EACH OF
OF THE SPEAKERS COULD JUST MAKE
A COMMENT ON WHETHER YOU THINK
THERE ARE ANY UNIVERSE ALTS
RELATED TO GENDER ROLES ACROSS
VARIOUS CULTURES.
>>IT'S OKAY IF THERE ARE.
WE THINK OF -- WE DEFINE GENDER
AS A CULTURAL AND SOCIAL
VARIABLE.
AND SO, I THINK IF FOLKS THINK
THAT THEY ARE INTENDED UNIVERSE
ALTS THAT'S AN APPROPRIATE
ANSWER ALSO.
>>I DON'T KNOW IF THERE ARE
UNIVERSE ALTS BUT IT'S IMPORTANT
TO BE INCLUSIVE OF HAVING SOME
ONES THAT ARE CULTURALLY
RELEVANT FOR PEOPLE LIKE
INDIGENOUS, BLACK PEOPLE,
FEMALE, MALE, THESE KINDS OF
THINGS AND DIFFERENT TRIBES HAVE
2-4 DIFFERENT IDENTITY STATUSES
AND IT'S VERY MUCH TRIBAL
SPECIFIC AS WELL.
IT'S REALLY IMPORTANT TO BECOME
GROUNDED IN THE PEOPLES THAT
YOU'RE WORKING WITH AND USE
CULTURALLY RELEVANT INFORMATION
FROM THE COMMUNITY TO DRIVE
THOSE QUESTIONS AND MEASURES.
AND I DO THINK THAT INVESTING
THAT TIME AT THE OUTSET PROVIDES
THE ABILITY TO HAVE PRECISE AND
ROBUST FINDINGS WITH LESS DATA.
SO IT'S VERY IN A WAY EFFICIENT
BECAUSE WE FOUND REALLY ROBUST
FINDINGS, BECAUSE OUR MEASURES
ARE GROUNDED IN THE CONCEPTS
THAT MAKE SENSE THAT ARE
RELEVANT TO THE PEOPLE WE ARE
WORKING WITH.
>>SO THE IDEA OF UNIVERSALITY
MAKES THE CRITICAL SCIENTIST IN
ME GO, WHAT DO YOU MEAN?
WHAT DO YOU MEAN BY THIS?
I THINK WE HAVE ANOTHER
OPPORTUNITY TO TALK ABOUT THIS.
SO, WHAT WE DO IN PERU AND
SIMILAR STUDIES IN THE STATES
AND NOW IN CANADA IS, AS A FIRST
STEP VERY BASIC, IS A TWO-STEP
MEASURE.
WE SHOULD BE ASKING EVERYONE SEX
ASSIGNED AT BIRTH AND GENDER
IDENTITY.
AND THEN THERE ARE BEAUTIFUL
SCHOLARSHIP OUT THERE THAT TELLS
US ABOUT THE NEXT STEPS.
SO GENDER IDENTITY THROUGHOUT
THE LIFE COURSE.
GENDER PERFORMANCE AND GENDER
EXPRESSION.
LIKE THERE REALLY IS A HUGE BODY
OF LITERATURE TO GUIDE US ON
THAT BUT AS BEAR MINIMUM, WE GOT
TO BE ASKING, SEX AND GENDER AS
SEPARATE DOMAINS AND SEPARATE
DOMAINS TO BE RECORDED ACROSS
OUR GRANT MECHANISMS AS WELL.
AND THAT HAS WORKED FOR US VERY
WELL IN PERU.
AND WHAT HASN'T WORKED SO WELL
FOR US IS THE NECESSARY DIVISION
BETWEEN SEXUAL ORIENTATION AND
GENDER IDENTITY.
SO THAT IS SOMETHING THAT WE
STRUGGLE WITH IN OUR CONTEXT,
BUT WE'RE ABLE TO TALK ABOUT IT
WITH REGARDS TO DIFFERENT
CONTEXT STARTING WITH WHEN WE
ASK PEOPLE ABOUT SEX AND GENDER
AND THEN WHERE DO THE CONFUSIONS
OR TENSIONS COME.
>>I WOULD JUST ADD, I AGREE
WITH EVERYTHING THAT'S BEEN SAID
AND I WOULD ADD THAT IN IRAN,
IT'S REALLY NOT ACCEPTABLE FOR
FOLKS TO EVEN IDENTIFY AS A
DIFFERENT GENDER THAN THE SEX
THAT THEY WERE ASSIGNED AT
BIRTH.
AND THAT PEOPLE WHO HAVE ANY
IDENTITY THAT IS RELATED WITH
ANY OF THE LGBTQIA IDENTITIES
ARE PERSECUTED HEAVILY AND THE
PUNISHMENT IS DEATH.
SO THERE IS NOT REALLY FREEDOM
OF EXPRESSION THERE ABOUT GENDER
OR SEX OR SEXUAL ORIENTATION OR
ANYTHING BECAUSE THERE ARE JUST
RAMPANT HUMAN RIGHTS VIOLATIONS
THERE EVERY DAY.
>>THANK YOU ALL FOR AN ENGAGING
FIRST QUESTION.
AND BUILDING OFF OF THAT AND NOT
SEEING ANY QUESTIONS IN THE CHAT
YET, ALTHOUGH I'M STILL KEEPING
MY FINGERS CROSSED AND ACTIVELY
ENCOURAGING FOLKS TO ADD THEM.
SO YOU ALL TALKED ABOUT
INTERSECTION AT TOW SOME EXTENT,
RIGHT?
IN DIFFERENT WAYS.
ONE THING THAT THE QUESTION THAT
DR. TIM KIN IS MAKING ME WONDER
ABOUT IS F WE'RE GOING TO TAKE
THIS IDEA OF COCONSTRUCTION OF
MULTIPLE FORMS OF OPPRESSION
SERIOUSLY, HOW CAN WE GET AT
CAPTURING IN OUR STUDIES THE
GENDER IS RACIALIZED, GENDER IS
CLASSED, SIMILARLY SEXISM AND
CISGENDERRISM ARE COCONSTRUCTED
AS YOU ALL SAID, WITH RACISM AND
PHOBIAS.
SO WHAT ARE THE TOOLS AT OUR
DISPOSAL AS RESEARCHERS TO KIND
OF CAPTURE THOSE INTERSECTIONS
AND HOW HAVE YOU BEEN ABLE TO DO
THAT?
AND ALSO WHAT CHALLENGES AND
WAYS FORWARD DO YOU SEE FOR
DOING SO?
>>I MEAN THIS IS SUCH AN
IMPORTANT QUESTION.
I CAN TAKE A STAB AT IT AND SAY
THAT A LOT OF THE WORK THAT IS
DONE THAT IS NOT AS
SOPHISTICATED AS SOME OF THE
STUFF WE HAVE SEEN PRESENTED
TODAY, THE TYPE OF STUFF LIKE
THE SPEAKERS AT MEETINGS THAT I
PRESENTED.
WE HAVE VERY LIMITED INFORMATION
AND IN FACT, I WANTED TO DO
SOMETHING LIKE THAT TO SEE WHO
LIKE JAMA AND NEW ENGLAND
JOURNAL, LANCET SEE AS EXPERTS.
BECAUSE NOVEMBERS LIKE A YEAR
AGO I HAD A IDEA LET'S LOOK AT
THE FIRST YEAR OF THE PAN DEMIC
AND WHO DID THEY INVITE ON TO
THEIR COVID PODCASTS.
BECAUSE THEY ALL STARTED WEEKLY
PODCASTS THEY DIDN'T HAVE WITH
REGULARITY BEFORE.
ALL YOU CAN MAYBE GUESS AT AND
GARNER FROM WHAT IS AVAILABLE ON
THE INTERNET IS GENDER AND EVEN
THAT, LIKE OBVIOUSLY IS SOMEWHAT
FLAWED.
THAT METHODOLOGY.
BUT YOU CAN KIND OF GET AT IT IF
YOU CAN FIND PRONOUNCE BUT THERE
IS NO ANALOGUE FOR THAT FOR RACE
OR ETHNICITY OR ANY OTHER ASPECT
OF IDENTITY.
THEN YOU'RE THROAT CONTACT
PEOPLE AND WE ALL KNOW THAT WHEN
YOU CONTACT PEOPLE, THE RESPONSE
RATES ARE LOW AND SOY I THINK
THAT'S, FOR THAT TYPE OF WORK
WHICH IS A VERY SPECIFIC
CATEGORY OF WORK, I THINK THAT
IS A LIMITATION.
AND THEN I'LL LEAVE IT TO THE
OTHER FOLKS TO ADDRESS WHAT I
SEE OR MAYBE NOT -- ADDRESS
WHATEVER YOU WANT, BUT ANOTHER
QUESTION I HAVE IS AROUND WHEN
WE'RE TRYING TO DO STUDIES LIKE
DOT PATIENT PHYSICIAN CONCORDANT
STUDIES, IF WE WANT TO LOOK AT
RACE AND GENDER AND WE HAPPEN TO
HAVE A DATASET THAT HAS BOTH,
IT'S MUDDY.
THAT STUDY ON NEWBORNS, THEY
JUST COMPARED BLACK AND WHITE.
THERE WERE NO OTHER RACES OR
ETHNICITIES REPRESENTED IN THAT
DATA.
AND SO HOW DO YOU LOOK AT BOTH
GENDER LIKE -- YOU CAN
ANALYTICALLY LOOK AT EVERY
SINGLE LEVEL BUT IT STARTS TO BE
SO FEW NUMBERS WITHIN EACH OF
THESE CATEGORIES THAT IT'S HARD
TO SAY SOMETHING MEANINGFUL IT'S
ANOTHER THING THAT I PERCEIVE AS
A METHODOLOGICAL CHALLENGE.
>>I THINK THE WAY THAT --
CHALLENGING THE THINKING IN A
SITUATION, WHEN I FIRST STARTED
THIS WORK, IS THERE NATIONAL
DATASETS FOR -- AND THERE ARE
BUT THEY ARE NOT GOOD AND ALSO
TRIBES UNDERSTOOD - LIKE I'M
THINKING FROM A TRIBAL
PERSPECTIVE.
MARGINALIZED GROUPS UNDERSTAND
WHEN THEY RESIST BEING
HOMOGENIZED AND HAVING THESE
PRESCRIBED CATEGORIES THAT FEEL
DEHUMANIZING IN MANY WAYS.
I RECOMMEND TAKING A STEP BACK
AND ASKING HOW PEOPLE WANT TO
DEFINE THEMSELVES AND GIVE THAT
VOICE.
BECAUSE SOMETIMES WHAT
INFORMATION ARE WE GOING TO GET
AND WHO IS IT GOING TO HELP?
AND WHAT TYPES OF INFORMATION OR
RESEARCH DO WE NEED TO DO DO
MAKE MORE SYSTEMIC CHANGES WHICH
MIGHT BE IN THE WAY WE THINK
ABOUT AND ASK QUESTIONS.
AND WHO OWNS THE DATA?
THESE KIND OF THINGS.
WHO IS CREATING KNOWLEDGE AND
FOR WHOM?
AND IT REALLY DOES TAKE A STEP
BACK, AN INVESTMENT IN LETTING
PEOPLE WHO HAVE EXPERIENCED THIS
HAVE THAT POWER TO CONSTRUCT
THEIR RESEARCH.
YOU SEE THIS, IN CANADA I WAS
REVIEWING SOME BILLIONS OF
DOLLARS THEY ARE GIVING TO
UNIVERSITIES AND INSTITUTIONS
THAT ARE SIGNIFICANT PROPORTION
IS GOING FOR INDIGENOUS
RESEARCH.
SO I REALLY THINK WE NEED TO
SAY, WHAT DO YOU WANT TO DO?
AND LET AND PROVIDE THAT TRUST
AND PROVIDE THAT GOVERNANCE AND
THAT SOVEREIGNTY FOR PEOPLE TO
DEFINE THEMSELVES BECAUSE WE
HAVE THESE VERY DEHUMANIZING
SEPARATING TYPES OF STATUSES
THAT PEOPLE MAY OR MAY NOT BE
ALIGNED WITH.
THEY ARE IMPORTANT BECAUSE THEY
EFFECT HOW YOU WOULD EXPERIENCE
OPPRESSION IN THE WORLD BUT THEY
MAY NOT FEEL REFLECTIVE TO YOU
AND MAY REFINE THIS
DAMAGE-CENTERED RESEARCH.
WE NEED TO STEP BACK AND REALLY
PUT SOME RESOURCES, SOME
INFRASTRUCTURE AND LETTING
PEOPLE DEFINE THEMSELVES AND
THEN HOW CAN WE COME TOGETHER IN
A RELATIONAL WAY?
I REALLY LOVE INTERSECTIONAL AS
WELL.
THAT'S RELATIONAL.
SO WE AREN'T THIS ONE THING.
SO HOW CAN WE LOOK AT THINGS
MORE HOLISTICALLY?
WHAT TYPES OF RESEARCH ISSUE
LENDING THEMSELVES FOR THAT?
>>I HAVE BEEN REALLY PUMPED
ABOUT THE NEW METHODS THAT ARE
COMING FORWARD.
SO WHEN YOU SAY LIKE WHAT ARE
THE TOOLS THAT WE HAVE
AVAILABLE?
FOLKS ARE DOING IT.
AND FOLKS ARE DOING IT ACROSS
DIFFERENT DOMAINS.
WE HAVE GRETA AND IMAN PUSHING
US TO THINK THROUGH
QUANTITATIVELY HOW DO WE MEASURE
INTERSECTIONALITY.
AND THEN WE HAVE FOLKS LIKE RYAN
THROWING POLITICAL EPIDEMIOLOGY
AT US AND LIKE BRINGING IN
POETRY INTO METHODS AND ALL OF A
SUDDEN IT'S LIKE WHEN WE WERE
TALKING ABOUT ACTIVE
OPPRESSIONS, LIKE HOW ARE WE
LIMITING OURSELVES AND OUR
THINKING AND OUR METHODS?
AND SO FOR ME PERSONALLY, I'VE
TRIED TO REALLY GO DOWN A PATH
WITH LATIN-AMERICAN SOCIAL
MEDICINE AND SO FOR THAT, FOR
ME, THAT MEANS EPIDEMIOLOGY
WITHOUT NUMBERS AND POLITICAL
INCIDENCE.
WHAT DOES THAT MEAN AND HOW DO
WE CHANGE?
AND I KNOW IT'S GOING TO SOUND
VERY POLYANISH, BUT LIKE TEAMS.
TEAMS DO THIS.
AND FUNDING FOR LARGER TEAMS
DOES THIS.
SO ON ONE OF OUR CLINICAL TRIALS
THAT WE HAVE FUNDED NOW, LIKE WE
BROUGHT IN A PHOTO JOURNALIST
BECAUSE WHAT WE ARE SEEING WITH
TRANSWOMEN MIGRATING FROM
VENEZUELA TO PERU, THAT PRE CARE
US LIFE, WE ARE NOT CAPTURING IN
OUR SCALES, IN OUR QUALITATIVE
INTERVIEWS, OR IN OUR FOCUS
GROUPS.
LIKE IT'S TOO COMPLEX AND SO WE
WILL GET THERE, RIGHT?
LIKE I HAVE HOPE.
LIKE I HAVE CRITICAL HOPE WE
WILL GET THERE BUT WE DON'T HAVE
THE METHODS YET.
AND SO, IN PARTNERING WITH OTHER
FOLKS, IT'S NOT MY AREA BUT
THERE IS BODY MAPPING AND PHOTO
VOICE AND THERE IS -- I MEAN IF
WE'RE THINKING ABOUT INDIGENOUS
WAYS OF STORY TABLE TALKS AND
DREAMS OF STORYTELLING, THERE IS
SO MUCH LEARNING THERE.
BUT IT'S NOT AN INDIVIDUAL
EFFORT.
>>I LOVE THAT EVEN AS LIKE
EVERYTHING HAS BECOME MORE
VISUAL THAT THE WAY THAT WE
EXPERIENCE THE WORLD, I THINK
ALL OF OUR COMMUNICATION METHODS
HAVE CHANGED AND IT'S REALLY
INTERESTING TO THINK ABOUT THAT.
>>AND JUST TO SAY THAT THAT WAS
A FANTASTIC NOTE TO KIND OF END
OUR PANEL ON BECAUSE I THINK YOU
ALL REMIND US OF THE
COMPLEXITIES OF STUDYING THESE
TOPICS AND REALLY THINKING ABOUT
NEW WAYS TO INTEGRATE DIFFERENT
PERSPECTIVES SO WE CAN CAPTURE
PEOPLE'S FULL HUMANITY WITHIN
CONTEXT.
SO THANK YOU VERY MUCH FOR
OFFERING YOUR INSIGHTS, YOUR
CRITICAL IMPORTANT WORK.
I JUST WANT TO GIVE YOU A ROUND
OF APPLAUSE FOR REALLY ENGAGING
US TO THINK STRUCTURALLY, TO I
THINK INTERSECTIONALY AND AS YOU
SAID IT DR. McKINLEY, TO THINK
RELATION ALLEY.
THANK YOU VERY MUCH.
>>THANK YOU VERY MUCH.
WONDERFUL JOB.
>>I'M JUST GOING TO REMIND
FOLKS OF A COUPLE OF THINGS.
THAT THIBLE STRADDLE ARE ALL
AVAILABLE IF PEOPLE DIDN'T HAVE
A CHANCE TO TAKE A LOOK AT THEM
SO FAR.
BOTH ON THE EVENT WEB PAGE AND
THE V FARES PLATFORM AND THAT
WE'RE GOING TO HAVE A REPORT
BACK FROM ALL THREE SESSIONS AND
THEN CLOSING REMARKS AND THANK
YOU ALL FOR PARTICIPATING TODAY.