Abuse of power in relationships and sexual health

Abstract

STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.

Perspectives on restoring health shared by Cree women, Alberta, Canada

“…Cree, and many other First Nations communities, have a tradition of using the medicine wheel to talk about and conceptualize health (Dapice, 2006;Gesink et al, 2016). Nehiyaw iskwêwak worldview was grounded in the belief that we are not just physical, but also mental, emotional and spiritual beings-core aspects of the medicine wheel-and so used the medicine wheel to conceptualize health, both directly and indirectly.…”

“…Sexual health is complex and involves physical, mental, emotional, spiritual and social well-being (Edwards and Coleman, 2004;World Health Organization, 2006). Threats to sexual health are insidious and ubiquitous, rooted in social conditioning, gender discrimination (Hayon, 2016), sexual discrimination, sexual abuse and violence, sexual coercion (Williams et al, 2013), abuse of power (Gesink et al, 2016), economic insecurity (Breiding et al, 2017), stigma (Hood and Friedman, 2011) and the limitation and restriction of sexual and reproductive rights, choice and freedom (Fortenberry, 2013). Human immunodeficiency virus (HIV), and other sexually transmitted infections (STIs), are one sign that sexual health is out of balance (Cedar Project et al, 2008;Gesink et al, 2016).…”

“…Article and current relationships (Gesink et al, 2016). Thus, there was a need to restore balance to health holistically before sexual health could be address specifically.…”

Social Ecological Factors of Sexual Subjectivity and Contraceptive Use and Access Among Young Women in the Northwest Territories, Canada

“…Feelings of shame and stigma about sexuality coupled with a perceived general lack of intrapersonal and interpersonal accountability while using alcohol have created a climate within communities where many young women have a difficult time exerting sexual self-efficacy regarding contraception. The co-occurrence of alcohol and sexual activity in Northern communities is a complicated relationship (Gesink, Whiskeyjack, Suntjens, Mihic, & McGilvery, 2016; Government of the Northwest Territories, 2010). Many youth in the NWT who want to have sex in their stigmatized sociocultural environment use alcohol to have sex-not only because alcohol has a disinhibiting effect but also possibly because the "shame" of sexual activity can be shared with being in an altered state.…”

“…The latter is suggested by the repeated statements youth make about friends explaining their sexual activity as a consequence of being drunk yet continuing to use alcohol in highly sexually charged contexts and settings. Problematic alcohol use also has an early start in many remote communities (Government of the Northwest Territories, 2010), and alcohol can have a much darker role in sexual activity when young women who are intoxicated are sexually assaulted by individuals or groups of intoxicated men (Gesink et al, 2016).…”