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Why focus on women from minority ethnic groups?

In general people from minority ethnic groups experience worse health compared with the general population. The differences in health and wellbeing outcomes between people or groups are known as health inequalities.

While the reasons for these ethnic health inequalities are complex and multifactorial, they can mostly be explained by the social and economic disadvantage experienced by minority ethnic groups and their experiences of racism and discrimination1. Thus inequalities in health exist because of inequalities in society.

Given the importance of socioeconomic status to health, woman from minority ethnic groups who are vulnerable to financial instability and low income may find it even more difficult to maintain their health and wellbeing. Furthermore, many women from ethnic minorities face social isolation and communication barriers which negatively impacts on their health.

What does minority ethnic mean?

get informed graphic_web2You may have heard the terms “minority ethnic” , “black Asian and minority ethnic groups(BAME)” and more recently “people of colour” and confusingly seen that they have different meanings in different contexts. We understand that ethnicity is a complex concept. We understand that just because you look white doesn’t mean you are not from a minority ethnic group and just because you look black doesn’t mean you are like everyone else with the same skin colour as you. We understand that these terms lack nuance and they don’t define who you are. However, we use the term minority ethnic cautiously to refer to all white and non-white ethnic minorities, not in an attempt to reduce ethnicity to a simple construct and lump all minorities together under one banner, but to provide a starting point for discussions.

Why focus on mental health, HIV and sexuality?

Mental health

There is a large body of evidence examining the worse mental health outcomes experienced by ethnic minority communities2. In particular, this is with regard to rates of mental ill-health, mental health service experience and service outcomes. For example, in 2014/2015, of people in contact with mental health services, black and black British people had the highest proportion of people who had spent time in hospital in the year and was double the rate compared with those of a white ethnic group3. Women from ethnic minority groups face additional risk factors for mental ill-health such as socioeconomic deprivation and gender-based violence.

HIV

HIV disproportionally affects minority ethnic groups. In 2014 in the UK, 45% of people accessing HIV- related care were a non-white ethnic minority4 despite making up just 13% of the UK population5. This disparity becomes further emphasised when we consider women affected by HIV, with 79% of women accessing HIV-related care in the UK from a non-white ethnic minority6. HIV is the leading cause of death globally among women of reproductive age7. Biologically women are more susceptible to HIV. However, the unequal power relationship between men and women renders women at higher risk of acquiring HIV through intimate partner violence, transactional relationships and the inability to negotiate safe sex. Trans women are even more vulnerable to acquiring HIV with global estimates suggesting that trans women are 49 times more likely to be living with HIV compared with the general population8.

Lesbian and bisexual women

Evidence suggests that lesbian and bisexual women experience worse mental health compared with heterosexual women. This includes higher levels of self-harm, suicide, and substance misuse. For example, one in five lesbian and bisexual women have deliberately harmed themselves compared with 0.4% in the general population9. This is largely attributed to homophobic stigma and discrimination, Being a minority within a minority with regard to sexual orientation and ethnicity leads to further challenges. Public services fail to understand that individuals can have more than one identity which results in poor service delivery and inappropriate service response. 10

What is stigma?

Stigma is when people have negative beliefs, views or attitudes about individuals or groups.

Stigma can be internalised or enacted and these two kinds of stigma are linked and reinforce one another. Internalised stigma or self-stigma is when individuals have negative thoughts or feelings about themselves, which are constructed on the negative stereotypes that are linked to people or certain groups. Enacted stigma refers to experiences of discrimination.

Stigma erodes an individual’s dignity, morale and self-worth. Stigma leads to social exclusion and impairs people’s ability to lead fulfilling and flourishing lives. Importantly, stigma prevents individuals from seeking help and results in disengagement with healthcare services and treatment regimes.

Stigma towards people living with HIV, people who experience mental health problems and those from a sexual minority is widespread. For example, in a survey of people who have experienced mental health problems, 9 out of 10 people reported the negative impact of stigma and discrimination on their lives11. However, people can also be stigmatised due to other factors such as their gender and ethnicity. This results in layers of stigma. Therefore for example women from ethnic minorities who are living with HIV will experience stigma in a different way to a white man living with HIV. This may help to explain why in a survey, twice as many people from non-white ethnic minorities living with HIV had never told anyone about their HIV status compared to respondents form non-ethnic minorities12.

This corresponds to a theory called intersectionality which explores how oppression and discrimination intersect and overlap across different social identities such gender, ethnicity, sexuality, class etc.

get informed graphic_webSources
1. Parliamentary Office of Science and Technology (2007) Ethnicity and health
2. Mental Health Providers Forum and Race Equality Foundation (2015) Better practice in mental health for black and minority ethnic communities
3. Health and Social Care Information Centre (2015) Mental health bulletin
4. Public Health England (2015) National HIV surveillance data tables
5. Office for National Statistics (2011) Census
6. Public Health England (2015) National HIV surveillance data tables
7. World Health Organisation (2013) Women’s Health
8. UNAIDS (2014) The gap report
9. Stonewall (2008) Prescription for change
10 Gusap, A and Kibrigie, H. One Minority at a time
11 Mental Health Foundation. Stigma and Discrimination
12 Stigma survey UK 2015(2016)Black, Asian and minority ethnic participants