Legislation of Structural Violence, Inequities, and Social Injustices? An Institutional Ethnography of the social organization of HIV Healthcare and Treatment for African, Caribbean, and Black (ACB) People Living with HIV in Canada
Bibliographic record
Abstract
Biomedical HIV discourses demonstrate that people living with HIV on antiretroviral treatment (ART) can achieve undetectable viral load or a state of undetectability, which is fundamental for optimizing health outcomes, decreasing mortality and morbidity, and preventing HIV transmission. Despite the biomedical breakthroughs and the global and national commitment to end HIV/AIDS, African, Caribbean, and Black (ACB) people remain structurally disadvantaged, marginalized and experience disproportionate burden of HIV. The way that HIV healthcare and treatment are organized has significant implications for ACB people. This dissertation research draws on institutional ethnography (IE) to explore how ACB people access HIV healthcare and treatment given the social context and their actualities. Through the lens of structural violence, this IE illuminates invisible and taken-for-granted harmful effects of laws, policies and institutional practices organizing and regulating healthcare access and delivery in Ontario, Canada. The research explicates how laws, policies, and institutional practices shape Black people’s day-to-day lives in ways that constrain their ability to access and engage in HIV healthcare, adhere to ART, and reach undetectability. This research uses data obtained through semi-structured interviews with Black people living with HIV (n=20) and fifteen health workers (n=15), including physicians, nurses, pharmacists, frontline workers, and health policy actors, and textual analysis of biomedical HIV/AIDS discourses, and legislative and human right frameworks. The inquiry begins from the experiences of ACB people seeking HIV healthcare and explores the struggles they encounter accessing care within Canada’s healthcare system. This inquiry demonstrates that standardized biomedical HIV discourses, which are presented as “best practices,” ignore and obscure forms of structural violence that perpetuate inequities and violate individual and population right to health. The dissertation unmasks a multi-axial model of violence, inequities, social injustices, and suffering that constrain Black people’s ability to enter the healthcare system, access HIV healthcare, adhere to ART, reach undetectability, and achieve optimal health outcomes and quality life, and therefore undermining public health and global HIV response efforts of ending HIV and contributing to the pathologization of Black people. Actioning Black Health provides a human rights, equity and social justice informed operational framework for facilitating HIV healthcare and treatment interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.024 | 0.024 |
| Scholarly communication | 0.007 | 0.003 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".