The HIV Endgame conference logo stands beside a drawing of several people linking arms

Strategies for responding to colonization and oppression

Resilience after colonization

Speaking on a panel about resilience, Janet Smylie, of St. Michael’s Hospital, explained that, while resilience models are a step forward from problem and illness-based approaches, “If the adverse situation is oppression, maybe it’s not so good to be adaptive. Maybe we should try to change the adverse situation.”

This sentiment was echoed by other presenters over the course of the conference, and Smylie explained that Indigenous scholars have done work to redefine resilience in ways that envision thriving Indigenous communities.

“I guess most racialized and Indigenous people in the audience won’t be surprised to hear that racism is alive and well in Canada… but it hit the national news, so it shows that there’s not a lot of talk about it.”

Noting that racism and colonization are two factors informing health disparities for Indigenous peoples, Smylie urged attendees to read the recommendations in the Truth and Reconciliation report, noting that, among other things, the recommendations encourage us to:

  • see the links between health disparities and public policies
  • recognize and address the distinct health needs of Inuit, Métis, and off-reserve Aboriginal people
  • fund Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools
  • recognize Aboriginal healing practices
  • ensure health professionals have cultural competency training.

Smylie explained that there is a reluctance to talk about discrimination, bias, and stereotyping as contributors to health disparities, noting that the focus has often been on treatment effectiveness across different groups. “Racial groups are socially constructed,” she said, “So, to say that we have more H1N1 or HIV because of some weird Indigenous gene is kind of different than saying, well, maybe it’s about the determinants of health.”

Definitions of racism

Smylie delivered an overview of the definition(s) of racism, starting with a quote from Yin Paradies and colleagues which defined racism as “avoidable and unfair actions that further disadvantage the disadvantaged or further advantage the advantaged.” Subcategories include:

  • systemic racism, enacted through societal systems and institutions
  • attitudinal or interpersonal racism
  • epistemic racism, positioning the knowledge of one group as superior to another.

Epistemic racism involves deciding not only which knowledge is superior, but also which knowledge is considered to be knowledge in the first place. This has led some scholars to argue that using Western “scientific” frameworks to demonstrate the inferiority of Indigenous peoples or Indigenous ways of knowing is an act of epistemic racism.

Strategies to overcome racism

Noting that explicit racism is easier to identify and respond to, Smylie explained that several studies and practices have found ways to overcome implicit racism as well.

“The good news is that, as human beings all across the world, we usually have wise people… who actually have helped us build social systems to challenge [our biases].”

Cultural safety training – which goes beyond awareness, sensitivity, or competence by including critical reflection – has been used to move learners past in-group and out-group stereotypes through an understanding of power differentials. St. Michael’s Hospital is also conducting a randomized controlled trial of explicitly anti-racist adult education.

Smylie recommended building Indigenous-led partnerships to implement system-level change, and learning from jurisdictions that have found appropriate and consistent ways to collect information on race and ethnicity on health forms.

Resources referenced in Janet Smylie’s presentation

Critical race theory in health care

Leo Wilton of Binghamton University discussed ways in which healthcare can integrate theoretical work from the humanities. Wilton argued that, while interdisciplinarity is sometimes understood to mean creating teams made up of individuals from different disciplines, it also involves integrating different knowledge frameworks.

Drawing on examples including Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present and No Tea, No Shade: New Writings in Black Queer Studies, Wilton explained that approaches grounded in critical race theory are better able to interrogate and challenge power dynamics and frameworks that harm black communities. By way of a brief overview, he explained that the key dimensions of critical race theory are:

  • a critique of liberalism (e.g., colour blindness)
  • storytelling and counter-storytelling (including Black people telling their own stories)
  • intersectionality
  • challenging essentialism.

Like Smylie, Wilton emphasized the importance of asking what constitutes legitimate knowledge rather than assuming the answer is limited to randomized controlled trials.

“We can’t be doing work on Black communities… without talking about exclusion and marginalization within sociological… political, [and] historical contexts. It just doesn’t make sense.”

Wilton urged attendees to think about using African diaspora and queer studies to build knowledge and critique structural and health inequalities. He also urged attendees to engage with the real concerns of Black communities, including police brutality.

Anti-Oppression Psychotherapy and intersectional violence

Roberta Timothy, of Continuing Healing Consultants, provided an overview of anti-oppression psychotherapy, a therapeutic approach designed to support people experiencing intersectional violence.

Timothy outlined a history of violence against Indigenous, Black, and Asian communities, Jewish and Muslim communities, LGBTTIQ communities, women, and people living with disabilities, beginning in the 1800s and continuing to the present day. She noted that, between 2009-2010, 54% of police-reported hate crimes in Canada were motivated by race, 29% by religion, and 13% by sexual orientation. There is a higher prevalence of post-traumatic stress disorder among people living with HIV than in the general population and, especially for women living with HIV, there is a link between PTSD and experiences of rape and domestic violence.

Anti-Oppression Psychotherapy supports clients dealing with the effects of oppression, trauma, and intersectional violence. The essential concepts of Anti-Oppression Psychotherapy include:

  • Factors of identity, including race, class, gender, sexual orientation, age, (dis)ability, Indigeneity, spirituality, immigration status, language, and educational attainment.
  • Oppressions, including racism, classism, sexism, homophobia or heterosexism, transphobia, ableism, ageism, colonialism, cultural imperialism, oppression based on spirituality or religion, anti-semitism, Islamophobia, and anti-Indigeneity.
  • Intersectional violence or trauma
  • Transnational and transgenerational contexts that impact service providers’ and clients’ locations, experiences of intersectional violence, and therapeutic or organizational practices.

Timothy also reviewed three of the eight principles of Anti-Oppression Psychotherapy.

  1. Dedication to addressing intersectional violence and oppressions in the therapeutic process. This involves building anti-oppression competencies, acknowledging different worldviews, and translating anti-oppression principles into action.
  2. Understanding that systemic oppression and practices of exclusion contribute to trauma and violence against the body, mind, and spirit. This involves the use of coping techniques and tools to relieve distress stemming from oppression.
  3. Examining and determining clients’ and therapists’ identities. This involves examining fixed notions of identity, developing therapeutic alliances, negotiating understandings, and using identities for change.

Timothy explained that, in Anti-Oppression Psychotherapy, therapists challenge their own beliefs and question how notions of identity manifest in their work – a challenge she extended to attendees by asking them to consider how to dismantle fixed notions of identity and make change happen personally, organizationally, and systemically.

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