financial, structural forms of inaccessibility that prevails over African women in sustaining behaviours that contribute to HIV prevention strategies. Also, at the multiple levels of socio-structural marginalization are manifold with segregation experiences in acquisition of jobs () in the work place or even exclusion or deskilling () that are very common in Canada; intersecting discriminations () still occurs. All these border on homophobia, social exclusion, helplessness, as major social problems and with serious health effects, particularly for African women. The HIV-related stigma, a health inequity, can be classified as key driver and barrier that affect African women; it affects her level of accessibility of services as majority of health and social workers would not want to associate with her; a reduced likelihood of retention in care for her comprehensive health management; a lowered quality of medical and clinical care, a lessened chance of disclosure to family with a heightened possibility of HIV transmission to sexual partners; a low to a decreased uptake of preventative behavior; and reduced uptake of pre-exposure prophylaxis (Fletcher et al, 2016). As Logie et al, surmised their finding in Eastern Canada, “social and structural factors; such as HIV-related stigma, gender discrimination, and racial discrimination converge to increase vulnerability to HIV infection among SSA women by reducing access to HIV prevention services; also, stigma and discrimination also present barriers to treatment, care, and support and may contribute to mental health problems”. Recognizing the existence of these multiple intersecting identities is one step in appreciating the social and health complexities associated with populations who have been historically marginalized in Canada.
The complexities for African women in their reproductive years may affect the vulnerability of her next generation. More so, African women has been found to be strengthened more by her family and to a large extent her children. Their children are not just as succor or a fulfillment of reproductive duties, but hope for their future sustenance: Children are seen as social safety nets and supports in their culture. African women, especially those in their reproductive years, have the possibility of maternally transferring the HIV virus to their children; hence a need for effective and comprehensive preventive family health services ( ). An inability of the mother to access wholesome determinants of health, due to social exclusion from societal systemic oppressions, can affect their children with translations to poor developmental domains in the children’s physical, emotional, cognitive and social life. The manifestations, on her children in their adult years, can be seen as malnutrition – stunted growth or obesity; emotional involvement can shape strength or develop vulnerability stances; mental health issues from early childhood trauma can result to depression, poor opinions about life or possible criminal activities; and challenges to their economic participation. As the African tradition view children, as social safety nets; a potentiality for further disintegration and exclusion of African women at the micro and meso-levels. These, in itself, constitutes a hierarchical oppressive identity of structural drivers as a first-generation migrant and “contributes to a downward spiral of socio-economic status” (Okeke-Ihejirika, Salami & Karimi, 2016) for African women. As Anthias, (2012) surmised, “we use must pay attention to how different nations are hierarchically positioned and how actors (first and second generations) themselves are positioned hierarchically through these global dimensions of power. This also includes ascriptions and attributions given to actors because of their provenance or country of origin, as well as forms of discrimination on the basis of “race” or cultural difference” (p.103).
As care-givers, African women will prefer to spend and/or save for their progenies and not always for their self-sustenance; their health are invariably linked to the health of their children and family. Life course approach is reflected as processes of socially defined events and roles that has come across a person over their life time with interconnections to the historical and socio-economic contexts that have shaped the person’s life (). Inequitable access to social and health goods are experienced due to culturally inappropriate and/or insensitive approaches to care. Woodgate et al (2017) in their qualitative study in Manitoba by Woodgate et al (2017) shows the response of a refugee”,
“When I remember it…I become emotional and I cry, so for three days without eating and without drinking, I was in hospital. I gave birth and I didn’t eat or drink. Not because they didn’t offer me food but the food they gave me was foreign and I didn’t know how to eat it or how it will be like and my husband cannot bring me food because there is no one to leave the children with” (p. 6).
Even when linked to the right care and treatment services, the assessment of care for services and social supports are socio-culturally determined and cuts across institutional, community and intra personal services that expose them to discrimination. The socio-economic hardships that ensues are manifold on her health status. The untoward outcome of the virus to these women is worsened with the manifestation as AIDS; the socio-structural and biological determinants of HIV make it pertinent that these drivers must be substantially addressed for any visible impact.
Assessing and intervening for a healthy start of the progeny of African women become critical for targeted needs due to the population health significance. The Barkers hypothesis of 1986 with early environmental influences on health and establishment of cohort studies, proposes the inputs during fetal life and early childhood may result to increased potentials of risk of diseases and social outcomes in adulthood. Apart from maternal stressors that are associated with HIV and attendant pregnancy complications that may extends to the unborn child; ineffective pre-natal, antenatal, natal, post-natal care, and early years of childhood life care can bring developmental challenges in later years. Early childhood development (ECD) is an important period for the child as it determines the life-course and trajectory of the child in later years of life. Developmental trajectories and health outcomes in adulthood be affected by intergenerational influences, exhibiting the impact of combined genetic and environmental over time (Vaghri lctures ppt, 2017). A life course interventional approach looks at the family of this group from the concept of services that target the child and adolescent, healthy ageing, maternal and newborn health; and their sexual and reproductive health (NAP, 2018). In a qualitative research in Ontario (Logie et al, 2011), a Francophone African woman described that with regard to HIV services”,
“The African community, for example, we are not informed about anything; nothing at all”.
This shows a narrowed health promotional opportunity for African women; a pointer to institutionalized and internalized form of racism in HIV services that is meant to be comprehensive and all-inclusive. Missed opportunities on educational approaches can impact on family health and well-being. This also reveals a need for building capacity of service providers in the health, psychosocial, education, police, justice and peace-building sectors of institutions through program at either formal or informal community level structures for multi-responsive services (NAP, 2018). In essence, there is need for equity based interventional approaches from the start and is all-inclusive of different social dimension of health.
The role of African women with certain intersecting identities demonstrates that, “gender intersects with ethnicity among other identities (Anthias, 2012); and men and women often play different roles (also in intersection with class and life-cycle) in the reproduction and transmission of ethnic culture and socially constructed issues. Women are central transmitters of ethnic culture in their child-rearing role and in migration (p. 106) despite other systemic actors such as schools, religious organization, family or community; they reproduce cultural and traditional norms (having a special role to play in ceremonial and ritual activities, keeping in touch with families and others) through processes of learning such as influence, discipline and mentoring (NAP, 2018) of familial structures and ideologies. They not only reproduce the group biologically but are also used as symbols of the nation or ethnic group. They are important as “mothers” of patriots, and represent the nation” (Anthias, 2012, p.106). In essence, the transmission of socio-cultural norms leads to acceptance of appropriate behaviours or continuing of inappropriate behaviours necessary for continuity of their progeny. In essence, promotional influences can reduce barriers against ill-health while the level of the knowledge of the mother is reflected on her progenies.