APPLYING INTERSECTIONALITY TO RESEARCH METHODS: EXAMPLES FROM A QUALITATIVE STUDY OF HIV DISCRIMINATION

Dr Sara Paparini

Terrence Higgins Trust

What’s all this?

• Findings from PhD research • A qualitative study of the experiences of discrimination of 35 PLWH

• Carried out between 2008-2013• After previous years of research across voluntary, clinical and academic sectors

Why HIV?

• HIV is helpful to think ‘with’• HIV disproportionally affects ‘marginalised’ groups in the UK

• HIV is transmitted through behaviours that are morally ‘charged’

• HIV thrives where there is prejudice, ignorance and inequality

• HIV affects people in different ways: same illness but not the same story

Estimated number of people living with (both diagnosed and undiagnosed) HIV infection in the United Kingdom: 2012

Social research on HIV in the UK

(Mostly):• Quantitative• Behaviour/prevention oriented• Psycho-social studies• Focuses on the two majority groups in the epidemic (gay men/MSM and black Africans)

• With little or no research on any other groups

Analytical lenses for HIV in the UK

• (Black) Ethnicity

• (Homo) Sexuality

• Sometimes ethnicity + sexuality

• Sometimes ethnicity + gender

• (More recently) age

HIV discrimination• Is a social process• Takes place at different levels (individual, interpersonal,

structural)• Takes different forms in different contexts (think of HIV as

a global pandemic made up of lots of different epidemics)• Is inseparable from pre- and co-existing forms of

discrimination (against drug use, against sexual minorities, against foreigners etc.)

• Is inherently MULTIPLE

Why not try intersectionality?• An analytical framework to understand multiple and

simultaneous forms of oppression…• …and of opportunity• Originally developed (by K. Crenshaw, P. Collins et al) as a

critique of feminist and anti-racist discourses that privileged gender over race and vice-versa

• Individuals (and groups) are socially located (in different contexts and at different points in time)

• Social locations are shaped by intersecting axes of oppression (and opportunity) aka axes of domination, categories of difference etc.

• Main axes of interest are race, class and gender…• But also sexuality, disability, seropositivity and so on

Key principles of intersectional categories

• Time, place and subject-specific• Mutually constituting (rather than commensurable)

• Non-hierarchical (rather than primary)• Internally heterogeneous (rather than representing group identity)

• Operationalised simultaneously in analysis• Used reflexively throughout research studies

How did I use it?

In theory…• By asking: what does it mean to take an intersectional

approach to the entire research process?

In practice….• Reviewing the literature for multiple categories and for

methodologies• Recruiting • Sampling• Analysis• Presentation of findings

Choosing categories

(1) Should be universally relevant to any social structure

Race/ethnicity; sex/gender; class

(2) Should be of particular relevance to the context under study

Sexuality; citizenship

(3) Should be applicable to all participants

BASED ON:• Broader knowledge of social science and health research• Established use in the social science of HIV in UK and

comparable settings• Relevance in relation to current policies that affect PLWH

KEY CHALLENGES -1

• How many categories (the list is endless?)• What subcategories?• What definition (for each category)?

Intersectional matrix (basic)Sex/gender Sexuality Class Citizenship Race/

ethnicity

Male Gay/Lesbian Professional UK Born White British

Female Bisexual Skilled UK Resident /Refugee

White Other

Transgender Heterosexual Elementary Work/Study Visa

Black African

MSM Student Asylum seeker

Black Other

Unemployed (current)

FAS; HLTR; Disc LTR

Minority Ethnic

Unemployed (long term)

FAS (no right of appeal); Over-stayer; Undocum.

Other

Recruitment• Aiming to include people at different ‘intersections’ • Contacting organisations for PLWH that serve different

groups of clients – most orgs are for all PLWH but in reality the client-base is made up mostly of people from certain backgrounds

• Recruiting through the NHS

KEY CHALLENGE

Obtaining NHS ethics approval !!!

Intersectional matrix (final/complex)Sex/Gender

Sexuality Class Residency/Citizenship

Race/Ethnicity

Male Gay Middle Full UK Black African

Female Heterosexual Working Migrant Black Other

Welfare Precarious White Other

Destitute? Non -citizen White British

Minority Ethnic

KEY CHALLENGES

•Assigning categories: whose choice is it?

•Detailed measurements (i.e. class, citizenship)

•And what about the missing intersections?

Intersectional analysis & key challenges

• A (nightmare!) version of thematic analysis• Coding for negative/discriminatory events and

positive/neutral ones• Coding for categories (one or more) involved in

discrimination• Coding for who did what to whom

But then?• Cannot divide participants by types such as all women, all

UK-born, all African working class men etc. (too many cases)

• Cannot draw on similarities/differences (too much variation)

Presentation of findings• Descriptive findings that pertain to the definition of stigma

and discrimination, the main actors involved, the main contexts

Then• Findings presented via each category (not ideal!) but

showing each category in interaction with the others – as available in the data

• Suggesting ‘meta-categories’ that can encompass the range of the interplays of the categories in intersection

• Reflecting on emerging categories and on methodological experiment

Key findings – in brief!

• Time-dimension of stigma and discrimination and connections between the intensity of the relationship and the severity of the impact

• Emerging categories of salience (age, LTSD, employment status)

• Advantage/disadvantage with regards to discrimination on the basis of each category in interaction with the others

• Security/insecurity in different life domains: material, emotional, health-related

• Policy ramifications and recommendation based on more complex approach to the issue

Dilemmas for discussion• Do you see any contributions?• Do you see any further limitations? (I do!) • Do you have any different suggestion for resolution of key

challenges?

KEY CHALLENGE AREAS:

Choosing and measuring categories

Recruiting for variation and avoiding bias

Assigning ‘identities’

Analysing and presenting findings intersectionally

Thanks to all participants and staff at:

CARA LIFE

HOPE GATEPLWHA working for PLWHA