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1. Universal access to antiretroviral treatment has resulted in an increased prevalence of HIV infection in Canada. The number of individuals involved in HIV-serodiscordant relationships has also likely increased. However, we know little about how HIV disclosure is negotiated in the context of serodiscordant relationships, particularly to external social networks, and the ways in which disclosure may influence the overall quality of the relationship. Preliminary research with partners in serodiscordant relationships has pointed to a need to better understand these processes of HIV disclosure through more in-depth analysis. The objective of the present proposal is to understand the perceived risks and benefits of, and barriers to, disclosure of the relationship by serodiscordant couples (n=15) in Canada. With assistance from participating clinics and AIDS Service Organizations (ASOs), we will aim to purposively recruit HIV-positive and seronegative partners belonging to heterosexual and same-sex couples for private, individual qualitative interviews. Data will be analyzed using a grounded theory approach. Findings will be used to identify program-level recommendations for ASOs, people living with HIV, their sexual partners and families. Knowledge translation will include production of a scientific abstract for conference presentation, a manuscript for peer-reviewed publication, and direct dissemination of findings to Canadian ASOs.
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In the past decade there has been a significant amount of research emerging around the biology of HIV transmission and biomedical HIV prevention technologies. Even though some of this research has generated clear scientific consensus (e.g., that HIV transmission is unlikely when one’s blood viral load is undetectable), there are other pieces of research that may appear contradictory or unclear (e.g., the efficacy of PrEP). Amidst the swirling discourse, even when scientific consensus is clear, we have observed that many frontline community-based service providers are unconfident in how to digest and distill these scientific findings. Even if HIV service providers are able to make sense of the scientific findings, many are unsure whether or how to pass the information on to people most affected by HIV (in this case people from African, Caribbean and Black – or ACB – communities) in ways that will resonate. Thus, service providers and their organizations can act as guides, conduits, filters and/or bottlenecks of the latest HIV prevention information. This study is based on the premise that service providers play an important gatekeeper role in provision of HIV prevention information: their judgments regarding the validity, relevance and importance of scientific findings will influence the availability, content and framing of information they decide to pass on to their clients, and in turn influence the prevention options considered by ACB community members. This project will address three core questions:
• What are the perceptions, understandings, discourses, values, and readiness of ACB service providers in regards to biomedical aspects of HIV risk, transmission and prevention?
• Are community-based organizations and service providers who work with ACB communities acting as gatekeepers of new biomedical knowledge of HIV within their existing (and evolving) social, structural and behavioural prevention efforts?
• How can ACB service providers best be supported to integrate new biomedical knowledge of HIV within their existing (and evolving) social, structural and behavioural prevention efforts?
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Canada has a long history of research and action on rehabilitation and disability in the context of HIV. But what might these Canadian lessons have to offer people living with HIV in Sub-Saharan Arica (SSA)? A growing number of Canadian researchers and advocates are asking this question, but efforts to date have been uncoordinated and non-strategic. This study explores strengths and gaps in the current approach to inform a more intentional, harmonized and impactful programme of action between Canada and SSA. Furthermore, this study explores lessons learned in SSA that can be applied in Canada, as well as capacity-building experienced by Canadian researchers engaged in this work (such as enhanced insight regarding colonial power relations). In other words, instead of Canadians researching people living with HIV in SSA, this is a study of Canadian researchers in which members of the research and advisory teams are HIV community members from SSA.
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In 2011 a team comprising researchers, service providers and policy makers from organizations affiliated with the African and Caribbean Council on HIV/AIDS in Ontario (ACCHO) implemented the iSpeak study to understand the HIV-related need, challenges and priorities of heterosexual African, Caribbean and Black (ACB) men in Ontario. The subsequent KTE activities have included publication of a community report, organizing a stakeholder consultation to share the results and determine next steps, and numerous presentations to program practitioners, policy makers and researchers. A subset of the original iSpeak team is now proposing to develop a series of 3-4 short videos to disseminate the priority findings and inspire critical reflection and action on HIV and health among heterosexual ACB men in Ontario. The videos (6-8 minutes each) will be disseminated through YouTube and the websites of ACCHO and its affiliated agencies throughout Ontario,; as well, a small number will be available on DVD for use in community settings. The video series is consistent with some the recommendations that emerged from iSpeak, namely, to institute deliberate initiatives to engage ACB men in community responses to HIV, and to reflect men’s issues and potential contributions in the efforts to address HIV among ACB communities.
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The aim of this project is to engage in systematic preparatory research and team building that will lead to the completion of a CIHR operating grant. The project asks: What is the significance of immigration status and racialization in relation to the criminalization of HIV non-disclosure in Canada? The relevance and role that a person’s immigration status plays in contributing to vulnerability to HIV-related criminal prosecution has not been scientifically explored. This study fills this knowledge gap. Anecdotal and scientific findings support the claim that it is necessary and timely to examine the intersections between immigration, racialization and HIV-related criminalization in Canada. A12-month pilot study with four empirical research activities explores answers to the research question. Activities include a) interviews with racialized persons who have faced criminal charges related to their HIV status in Canada from African, Caribbean, and Black communities, and interviews with community workers and service providers who have experience with the latter; b) analysis of criminal case files; c) analysis of media representation of immigration status in criminal non-disclosure cases; and, d) consolidation of a multidisciplinary, multilingual, and multi-sited research team. We intend the knowledge produced through this project to directly contribute to public policy dialogue and reform in Canada. To this end, a strategic three-point knowledge transfer and exchange strategy is outlined. This project fits within the Centre’s central focus on holistic approaches to HIV prevention, and in particular the thematic intersections of HIV prevention and health systems, service and policy, and determinants of health. This project will shed new and valuable light on the processes and consequences of criminalization for a racialized and socially marginalized group of people with HIV.
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To better understand and address the high rates of HIV infection among people who use injection drugs (PWUID) in Ottawa, this study seeks to develop and pilot-test a novel research methodology for investigating the social determinants and root causes of injection drug use initiation among PWUID in the capital. Building on the success of the PROUD (Participatory Research in Ottawa; Understanding Drugs) Cohort Study in developing capacity, ownership and meaningful participation of PWUID in community-based research, the PROUD Community Advisory Committee (CAC) will lead the development and implementation of a new qualitative research project that seeks to investigate the relationships between experiences of trauma and initiation of injection drug use in their community. As a next step in their community-based research activities, the CAC identified experiences of trauma, mental health and stigma within health and social services as key issues in their community to explore in more depth. To overcome some of the challenges of traditional talk-based qualitative interviews, including barriers of power, trust and comfort when talking about difficult topics and experiences, this project will adapt and pilot test a new visual narrative interview tool: the Vidaview Life Story Board (LSB). The Vidaview LSB is an innovative visual interview tool with a play board, cards and notation system that facilitates the co-construction of a visual lifescape that represents the personal, relational and temporal aspects of a person`s lived experience. The application of this novel interview tool within a community-based research project constitutes a new social science research methodology for investigating themes of risk, resilience and vulnerability among communities affected by HIV. A comprehensive process evaluation will be conducted concurrently with the primary research to evaluate the utility of the LSB tool for improving data quality, and to assess the experiences of both interviewers and participants in the CBPR process. This evaluation will support further development of this novel visual interview methodology, as well as contribute to the advancement of community-based research methods among people who use drugs. The primary aim of this research is to develop and pilot test a new qualitative research methodology while enhancing our understanding of the relationship between experiences of trauma and initiation of injection drug use among people who use drugs in Ottawa. This new knowledge will empower the CAC to advocate for improved services and develop anti-stigma messaging that responds to the complex realities of trauma and drug use faced by their community.
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The 6th South African AIDS Conference (SA AIDS) was held in Durban, South Africa on 18-21 June 2013. The conference attracted well over 3000 researchers, professional and lay health care workers, policymakers, activists and persons living with HIV. The conference theme was ‘Building on Successes: Integrating Systems’, with a special emphasis on tackling the dual epidemic of HIV and tuberculosis (TB) co-infection through “Getting to Zero – zero new HIV and TB infections, zero discrimination & stigma and zero AIDS related deaths”.
Under a CIHR KTE grant, we hosted a symposium at SA AIDS to call attention to the social and ethical challenges of HIV-TB co-infection, particularly in light of the global shift to integrate HIV and TB health care services within high-burden settings. We aimed to broaden scientific discourse around co-infection beyond prevailing clinical and operational spheres, to encompass a wider sociomedical perspective. Our panel was accordingly diverse and interdisciplinary to stimulate knowledge transfer and exchange around the integration of HIV and TB health care, stemming from operational research, evidence-based practice and theoretical debate. Panelists included Dr. Francesca Conradie (Right to Care, Sizwe Tropical Diseases Hospital), Dr. Liesl Page-Shipp (The Aurum Institute), Thabile Lihle Dlamini (AIDS Foundation of South Africa), Dr. Jennifer Zelnick (Touro College Graduate School of Social Work), and Dr. Amrita Daftary (ICAP, Columbia University); panelist presentations and relevant publications of interest may be accessed below. The symposium was moderated by Dr. Nesri Padayatchi (CAPRISA). Over 120 delegates attended, and the interactive discussion gave voice to local and international experiences, including those arising from health care policy, program planning, treatment advocacy, providers and community members.
The event facilitated networking between Canadian and international researchers, helped build capacity to address social and ethical challenges related to HIV-TB health care practice, and complemented ongoing biomedical efforts to mitigate the burden and impact of HIV-TB co-infection.
Links:
Panelists’ publications of relevance
Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital. Voss De Lima Y, Evans D, Page-Shipp L, Barnard A, Sanne I, Menezes CN, Van Rie A. PLoS One. 2013;8(1):e49140. doi: 10.1371/journal.pone.0049140. Epub 2013 Jan 16. PMID: 23341869 [PubMed - indexed for MEDLINE] Free PMC Article
Health-care workers' perspectives on workplace safety, infection control, and drug-resistant tuberculosis in a high-burden HIV setting. Zelnick JR, Gibbs A, Loveday M, Padayatchi N, O'Donnell MR. J Public Health Policy. 2013 Aug;34(3):388-402. doi: 10.1057/jphp.2013.20. Epub 2013 May 30. PMID: 23719292 [PubMed - in process]
Integrating patients' perspectives into integrated tuberculosis-human immunodeficiency virus health care. Daftary A, Padayatchi N. Int J Tuberc Lung Dis. 2013 Apr;17(4):546-51. doi: 10.5588/ijtld.12.0714. Epub 2013 Feb 11. PMID: 23407149 [PubMed - indexed for MEDLINE]
Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa. Daftary A, Padayatchi N. AIDS Care. 2012;24(12):1480-6. doi: 10.1080/09540121.2012.672719. Epub 2012 Apr 24. PMID: 22530855 [PubMed - indexed for MEDLINE]
HIV and tuberculosis: the construction and management of double stigma. Daftary A. Soc Sci Med. 2012 May;74(10):1512-9. doi: 10.1016/j.socscimed.2012.01.027. Epub 2012 Mar 7. PMID: 22444460 [PubMed - indexed for MEDLINE]
Natural killer cell activation distinguishes Mycobacterium tuberculosis-mediated immune reconstitution syndrome from chronic HIV and HIV/MTB coinfection. Conradie F, Foulkes AS, Ive P, Yin X, Roussos K, Glencross DK, Lawrie D, Stevens W, Montaner LJ, Sanne I, Azzoni L. J Acquir Immune Defic Syndr. 2011 Nov 1;58(3):309-18. doi: 10.1097/QAI.0b013e31822e0d15. PMID: 21826013 [PubMed - indexed for MEDLINE]
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The Sharing the Lay of the Land project is a community based research project implemented by CAAN and the University of Victoria in collaboration with the CAAN APHA Caucus, which is composed entirely of APHAs, and allied researchers. At CAAN’s annual general meeting in 2007, the caucus passed a resolution that directed CAAN to develop an APHA Leadership Development Strategy. CAAN and its APHA Advisory Committee initiated this project to better understand how to maximize an APHA leadership process. It is hoped that the project will increase the APHA response to HIV & AIDS and identify ways to formalize APHA peer-to-peer mentorship as leaders in Canada.
Current reports confirm that HIV & AIDS continue to disproportionately impact Aboriginal peoples in Canada (PHAC, 2012). Intervention research represents a promising methodology through which this critical health disparity might be addressed. Peer education, mobilization and support have emerged as integral components of prevention efforts as well as campaigns aimed at improving the health of those living with HIV & AIDS (Collins et al., 2007; Dann, 2009; Roy, 1995; Tangelder, 2010). Over the past 13 years, the Canadian Aboriginal AIDS Network (CAAN) has evolved from the initial National Aboriginal People living with HIV/AIDS Network (NAPHAN) to a leader in research, prevention and health promotion activities for Aboriginal Peoples living with or affected by HIV & AIDS.
In December 2011, CAAN and U Vic were awarded CIHR catalyst grant funds to initiate the Sharing the Lay of the Land research project. The project is designed to investigate how to respond to the CAAN Aboriginal People living with HIV & AIDS (APHA) Caucus and APHA Advisory Committee prioritization of the development of a long term, strategic Leadership Initiative that emphasizes peer education, mobilization and support. At this time, additional resources are required to further develop a solid foundation for a larger operating grant submission by organizing current knowledge and uniting key stakeholders.
Proposal development activities funded by CIHR have resulted in a literature review and funding for a small meeting of APHAs. Activities proposed to SRC will produce substantial impact by further developing the recommendations of CAAN’s APHA Advisory Committee’s experience of more than a decade of formal organizing in conjunction with the extensive body of knowledge internationally generated in response to the Greater Involvement of People with AIDS (GIPA) Principle. Grant funds are sought to support the Principle Investigators, team members and APHA Leadership Development sub-committee members to meet with APHA stakeholders, community and academic researchers; to continue to strengthen partnerships relevant to this specific initiative and to increase consultation related to the preparation of a full application to undertake a community-based intervention research project. This will ultimately assist CAAN in developing the knowledge necessary to carry out our HIV & AIDS work by effectively engaging and supporting APHA Leadership
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Recent reports point to the growing urbanization of Aboriginal peoples; however, a paucity of research has been conducted to determine the social and structural conditions shaping migration patterns between urban and on-reserve communities. This Community-Based Participatory Action Research (CBPAR) study, based on an Indigenous Critical Theory approach will serve as a pilot for a national investigation of the effects of migration from Mi’kmaq communities to urban centers and vice versa on the health and wellbeing of individuals, families, and communities. Participants’ perceptions of factors that contributed to their resilience or vulnerability to health risks such as HIV or Hepatitis C, and to their general health and wellbeing more broadly will be explored. This study will have the following components:
- A substantive review of the literaturewill be conducted focused on the following subjects: (a) health of Canadian Aboriginal peoples, (b) their worldviews and understanding of health and health practices, (c) effects of migration on Indigenous people’s health, including the impact of the migration experience on Indigenous people’s vulnerability to HIV, HCV, STIs, addiction, mental illness, and trauma as well as (d) program-level recommendations derived from similar studies developed to address the health of Aboriginal people who have migrated from or to reserves.
- The development of a broader research partnership including the creation of a Community Advisory Committee (CAC) to work closely with the research team to refine study methodologies, implement the study, and advise and approve the research.The CAC will include an Elder, an Aboriginal health care worker, and another community member, all of whom have spent time in a city but returned to a reserve.
- Aboriginal research methodologies will inform the qualitative study design and guide the data collection process. Data will be collected through: (a) five individual/family unstructured interviews with First Nations participants who have migrated from their home reserve to an urban center and five such interviews with participants who have returned to the reserve after living in an urban setting for more than a year and (b) three group interviews using a talking circle approach; one with clients of a Native Friendship Center who have lived in the city for at least a year and two with participants who have moved back to the reserve.
- Consensual group process honouring the Aboriginal perspective will guide the coding and analysis of data and the formulation of recommendations.Thefindings of this study will be used to inform the programming of the Aboriginal communities for youth and members who have migrated to the city or returned, and to design a national study on the impact of migration of Aboriginal Canadians.
- Knowledge transfer and dissemination will involve close collaboration with the Native Friendship Centers and Union of New Brunswick Indians research team members to make recommendations for subsequent health promotion and prevention programs to support Mi’kmaq people in the urban center and to help them prepare for such a transition. Study findings will be reported in culturally congruent and accessible written and oral reporting styles to the participating communities, the Union of New Brunswick Indians, the Atlantic Policy congress of First Nations Chiefs, the Canadian Native Friendship Centers Association, the NB Aboriginal Peoples` Council, Aboriginal Health Conferences and academic health and social sciences conferences, and peer-reviewed journals.
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People who use illicit drugs (PWUIDs) have been subjects of HIV research since the beginning of the epidemic. Indeed, in several Canadian communities we know anecdotally that many people who use injection drugs use research participation as a source to occasionally supplement income. Community-based research has become a prominent form of research with people who use injection drugs and other vulnerable populations. Our research team, comprised of CBR and IDU researchers, students, and community members, will conduct a scoping review of the CBR ethics and injection drug use research literatures to examine best practices when conducting CBR with people who use injection drugs. Using the results of the scoping review and a process of community consultations, we plan to create a community-friendly document to assist people who use injection drugs to understand their rights and responsibilities when participating in CBR, as well as a parallel “Best Practices Guide” for nascent researchers as well as those who are more experienced. We will also produce a manuscript for a peer reviewed publication. We are requesting funds for a graduate research assistant to assist us with the scoping review process, approximately 8 (2 from each of 4 the sites) peer researchers, and funding to support community consultations in Toronto, Ottawa, St. John’s and Victoria, as well as support for two one-day team meetings to develop and finalize the project products and deliverables.
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A “red zone”, often imposed on people who use drugs, legally bars an individual from being within a specific geographical area for a specific period of time. In the case of a person who is accused of drug related offences, red zones include areas known for drug consumption and trafficking. In Ottawa, the most common red zone areas are also home to the majority of Ottawa’s health and social service organizations. Restricting access to necessary
services puts people who use drugs at risk and makes them increasingly vulnerable to violence, homelessness, poor health, and diseases, including HIV. Harm reduction approaches are more effective than legal restrictions in protecting and promoting the health of people who use drugs and public health more broadly. Further research into red zones is needed in order to better understand red zones and their role in the production of risk. To date, there is very little research on the practice of red zoning people who use drugs in Ottawa and elsewhere, with previous research largely focusing on red zones and sex work. This study aims to fill a gap in the existing literature by engaging people who use drugs in an exploratory study of red zones in the Byward Market area of Ottawa, Ontario.
The study aims to understand how red zones impact access to harm reduction, health and social services and the impact that this has on HIV prevention, care and treatment for people who use drugs in Ottawa. The study hypothesizes that the use of red zones by criminal justice actors adversely affects the health of people who use drugs by limiting their access to health, social and harm reduction services and that red zone restrictions can lead to increased risk of HIV infection. Incorporating a participatory and collaborative approach to the research design, data collection and analysis, community members, community-based organizations and academic researchers will bring their diverse knowledge, experience and expertise to the research.
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The Positive Sex project is an arts-based, health intervention designed and executed by and for people living with HIV. The project includes skills-building workshops and corresponding Facilitator’s Guide focusing specifically on disclosing HIV to potential sexual partners. The workshop was developed in response increasing cases of criminal prosecution of PHA, as well as an absence of such a training, knowledge transfer activities, tools and/or resources in the Canadian context.
Positive Sex is a participatory action research project with three main objectives: 1) contribute to evidence on prevention and HIV disclosure; 2) provide capacity-building opportunities to reduce the vulnerability of people living with HIV to criminalization for HIV non-disclosure; and 3) increase social knowledge and acceptance of HIV. Focus groups will be held with workshop participants for the purpose of collecting data on experiences of HIV disclosure among people living with HIV. The workshops will contribute to HIV prevention efforts by fostering skills among people living with HIV to discuss sexual health with their potential sexual partners and foster safer sex choices. Furthermore, this project provides opportunities for successful prevention programming to be replicated and reproduced in the future.
In partnership with CTAC, the Positive Sex Project is seeking supplementary funding sources for 6 additional workshops, as well as to conduct a literature review on HIV disclosure and criminalization. Positive Sex aims to produce a snapshot of the current evidence on disclosure and prevention in Canada, while providing opportunities for PHAs to enhance their knowledge and skills for disclosing to sexual partners for people living with HIV thereby reducing PHA vulnerability to criminalization and contribute to social change.
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Objectives: To understand the research needs and assets of MSM populations across Canada in 2013
Methodology: Utilizing a web-based platform (Survey Monkey) a questionnaire will be made available to AIDS Service
Organizations (ASOs), Community AIDS Organizations (CAOs), and/or members of the Canadian AIDS Society (CAS) which
deal with men’s issues. The study will look for responses from persons within these organizations responsible for sexual
health promotion for MSM. The information obtained will be primarily quantitative and descriptive in nature.
Sample Size: The previous Research Needs Assessment (2005) targeted 130 organizations, we aim to target a similar
number of organizations.
Community Engagement Plan: Collaboration will be sought from both the CAS and CATIE. CAS member organizations will
also be engaged, either directly by the team or through a contact at CAS. CATIE will help facilitate knowledge exchange and
community engagement with the results.
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The limited research that exists suggests that lesbian, bisexual and queer (LBQ) women are at similar risk for sexually transmitted infections (STI) as heterosexual women. This is a particularly salient area to address, as literature highlights the convergence of sexual stigma and gender-based sexual violence as elevating LBQ women’s risk for HIV infection. However, recent Statistics Canada data indicated that: lesbians reported significantly lower rates of Pap testing than heterosexual or bisexual women; lesbians and bisexual women had higher odds of not having a regular doctor than heterosexual women; and bisexual women had higher reported unmet health care needs than lesbian and heterosexual women. These differences highlight the importance of implementing and evaluating interventions to address HIV/STI risk among LBQ women; however, no published study exists of this nature.
A group-level HIV/STI prevention intervention will be utilized to engage a sample size of 40 participants in 2 locations (Calgary, Toronto). Group sessions will focus on individual, social and structural determinants that influence HIV/STI vulnerability and resilient coping among LBQ women and WSW. A survey will be conducted at pre and post-intervention to evaluate the impact of the intervention on: safer sex practices, HIV/STI knowledge and testing, internalized sexual stigma, social capital and resilient coping. The inclusion criteria will include women who self-identify as lesbian, bisexual, queer or a woman who has sex with women (WSW). We will hold focus groups to adapt and tailor the Many Men, Many Voices (3MV) evidence-based group-level intervention for HIV/STI prevention among men who have sex with men (MSM) for LBQ women and WSW. Peer-driven sampling techniques will be employed to facilitate inclusion of a diverse (e.g. age, ethnicity) range of LBQ women in Toronto and Calgary. We will use paired-sample t-tests to asses pre- and post- intervention differences in sexual risk behaviour outcomes (safer sex practices, safer sex self-efficacy), protective factors (resilient coping, HIV/STI knowledge and testing) and social-structural determinants (social capital, internalized sexual stigma) directly following the intervention and 3 months post-intervention. We will use logistic and linear generalized estimating equation (GEE) regression models to asses intervention effects for the follow-up period of 3 months to control for repeated within-subject measurements. The proposed 12-month timeline includes: intervention development and ethics submission (Months 1-3); recruitment, focus groups and intervention implementation (Months 4-6); follow-up data collection (Months 6-9); data analysis (Months 9-10); report writing, community forums, dissemination of results and preparation of additional funding proposals (Months 11-12).
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Community-based participatory research (CBPR) explores social, structural, and physical environmental inequities through the active involvement of community members, organizational representatives, and academic researchers in all aspects of the research process, calling for a more comprehensive and integrated approach to research and practice. There has been a growing recognition of the need to meaningfully engage people who use drugs in public health research, in order to better understand a community that outsiders know little about, and this principle has been adopted by many drug user advocacy groups through the expression “Nothing About Us Without Us”. With this in consideration, the overall aim of this project is to engage current and former illicit drug users in a CBPR project to develop and design a prospective cohort study examining the HIV and HCV risk environment of people who use illicit drugs in Ottawa, Canada, referred to as the Ottawa Cohort Study. To accomplish this, the research team has partnered with the Drug User Advocacy League (DUAL), a peer-led advocacy group in Ottawa, Ontario, to recruit community members into a Community Advisory Committee (CAC), made up of current and former drug users and key stakeholders. The CAC will contribute to all aspects of the research development, including helping to establish research themes, developing research questions, analyzing and validating study findings, and creating a plan for KTE. Peer researchers will also be actively involved in recruitment and data collection. This project provides a new opportunity to engage marginalized current and former drug users and key stakeholders in community-based HIV research. While we have been successful in engaging a diverse group of people for the Community Advisory Committee, most members of this group have limited research knowledge or experience. In order to increase their engagement with the project and their ability to participate as informed decision-makers, CAC members will receive training in CBPR skills, research ethics, interviewing skills, data analysis, and KTE. What separates this project from other CBPR initiatives is the active engagement of drug users, including people who are HIV and HCV positive in a prospective cohort study, the integration of Peer Researchers at multiple stages of the research process, and a clear plan to evaluate the impact of this CBPR strategy on the CAC and Peer Researchers themselves. An evaluation of the CBPR process undertaken in this project will be conducted and it is expected that the CBPR methods developed and evaluated here will be used to inform models of CBPR with drug using communities in other settings across Ontario, and Canada.
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In Canada the burden of HIV remains disproportionate among immigrant, refugee and non-status (IRN) groups from HIV endemic countries.1 IRN-PHAs are affected by sociocultural and economic factors making them more susceptible to HIV infection while creating systemic barriers to accessing preventative healthcare, HIV screening, treatment support and care programs.1,2 Effective interventions geared to assisting IRN-PHAs achieve optimal mental health and well-being must take an intersectional perspective toward addressing the needs of this diverse group, acknowledging the impact of social determinants of health (SDOH) and attending to the transnational experiences of trauma experienced by many IRN-PHAs. Many therapeutic interventions facilitate coping with trauma symptoms, failing to take into account the impact of oppressions experienced as traumatic incidents.3 Effective tailored interventions supporting IRN-PHA mental health must be holistic, taking into account not only the impact of the SDOH, which may be experienced more negatively across this group in comparison to other populations, but the impact of multiple traumatic incidents which may have been the motivation for migration, and part of the migration experience for IRN-PHAs. This scoping review and stakeholder consultation is a first step toward creating a therapeutic intervention targeted to this group’s specific needs.
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Literature indicates that DBACC women face greater disparities across the social determinants of health and confront considerable barriers in achieving optimal health status compared to their white Canadian counterparts. Despite the growing number of DBACC women living with HIV (DBACC WLWH) in Canada, little current research has been conducted to determine the social and structural factors driving these health inequities and there remains a gap in knowledge pertaining to effective stigma and discrimination (S/D) reducing interventions that attend to diversities across race, gender, sexuality, and culture for populations such as DBACC WLWH. The project will respond to this gap through a 3-phase project. Phase 1, funded by the SRC, involves undertaking a systematic review to generate the necessary knowledge and establish relevant partnerships to support the development of a stigma reduction intervention that addresses multiple forms of oppression – race, HIV-related stigma and sexism simultaneously, targeted to DBACC WLWH in Canada. Phase 2 will involve piloting the identified/developed S/D reducing intervention, while phase 3 will involve full scale roll out of a national clinical trial assessing the effectiveness of the intervention. Phase 2 and 3 will require funding from other sources e.g. Canadian Institutes of Health Research.
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The African and Caribbean communities living in Canada have been seriously affected by the HIV epidemic. While many HIV infections in these communities were likely acquired before they came to Canada, a substantial and probably growing number were acquired since arriving here. The patterns of HIV transmission in this context are completely unknown and no research has addressed this issue anywhere in Canada. The case-control design in this study will provide rich and important data to better understand the context in which transmission is occurring and how to target and adapt preventive messages and programs to this important population.
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There are an estimated 65,000 people living with HIV in Canada, over a quarter of which (approx. 18,000) live in the GTA. Despite a large and increasing number of infected and affected men and women, we know little about the dynamics of HIV serodiscordant relationships and the social and political constraints on these relationships. A preliminary literature review identified a small number of current US and UK studies that provide in-depth information on needs, experiences and management of HIV in serodiscordant relationships. The extent to which their findings are reflective of the Canadian context and their recommendations applicable is unknown.
This study includes the development of a research proposal to conduct a qualitative study to understand the needs and experiences of heterosexuals and gay/bisexuals in Canada who are in serodiscordant relationships. The study will utilize a social determinants of health framework to examine the individual, relationship, and broader community/societal level impact on the lives of serodiscordant couples. Findings will be used to identify program-level recommendations relevant to those working to improve the health and well-being of people living with HIV (PHAs), their sexual partners and families. As part of the protocol development phase, we will: (1) conduct a systematic review of the literature; (2) conduct consultations with key informants and 4 focus groups with serodiscordant couples; (3) prepare a full-study protocol for spring-2013 submission; (4) produce scientific abstracts for presentation at upcoming conferences, an SRC synthesis paper, and potentially a manuscript.
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This international, interdisciplinary research workshop on the public health implications of criminalizing HIV exposure/transmission will be the first of its kind. It will bring together the world’s leading researchers in the area and connect them with emerging researchers, criminologists, graduate students, lawyers, community members, decision makers, advocates, and people living with HIV/AIDS with an interest in HIV prevention and the criminal law. The workshop will: (1) produce new international research and scholarship on the public health impact of criminalizing HIV exposure; (2) document and respond to key challenges faced by this area of research; (3) attract new investigators to the field; (4) develop a collaborative international research agenda; and (5) catalyze an international interdisciplinary research network. The proceedings of the workshop will be published as a special journal issue or edited book collection.
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One of the key issues that has come up in conversations at SRC meetings, as well as meetings of other research centres (CTN, REACH) – particularly from AIDS service organizations working with rural/remote populations (e.g., in BC outside the lower mainland, Saskatchewan and Manitoba, Northern Ontario, Atlantic Canada) – has been the need for information on promising and proven HIV prevention programs and interventions that would be useful for services development for agencies with rural/remote regions in their catchment area. As there is little in the literature on effective HIV prevention services for people living in rural/remote areas (at least in the industrialized world), the purpose of this study is to learn from community – and to document programs that are being developed and delivered for rural/remote populations in different regions of Canada to provide a foundation for information sharing and future implementation and intervention research.
The study includes data collection (organizational document review, and phone/face-to-face interviews) with ASOs and community-based organizations (CBOs) that serve non-urban populations, generation of a report/compendium (including program descriptions and theory foundations, if any; implementation information; and successes and challenges to date), and a webinar for interested participants, other CBOs, and clinics for information sharing.
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This Emerging Team Grant application in Maternal Health targets women infected and affected by HIV (WIAHIV) and proposes an integrated research, education, mentoring, and knowledge translation and exchange (KTE) program to undertake policy-relevant research regarding the care of HIV-positive women and HIV-negative women with HIV-positive male partners during pre-conception, and HIV-positive women during pregnancy and motherhood in Ontario. This is an important area of research within the realm of maternal health which to date has been understudied. Our provincial Team, entitled the “Interdisciplinary HIV Pregnancy Research Group” (IHPREG), began to link over the last two years through a Canadian Institutes of Health Research (CIHR) Infection and Immunity Catalyst Grant. The multidisciplinary team consists of over 50 clinical and health services (HS) researchers, basic scientists, social scientists, Infectious Diseases (ID) specialists, Obstetricians/Gynecologists (OB/Gyns), Maternal Fetal Medicine (MFM) specialists, Fertility specialists, Paediatricians, policy makers, community organizations, and people living with HIV (PLWHIV). This program will 1) carry out high quality clinical, HS, and basic scientific evaluations of WIAHIV through pre-conception and HIV-positive women through pregnancy and motherhood, 2) enable collaboration of stakeholders in various disciplines whose work focuses on maternal health and HIV by allowing for cohesive enrolment of this small population of women across Ontario, 3) assist in the training and mentoring of new health practitioners and researchers, and 4) disseminate research findings to improve current practice guidelines for maternal health care of WIAHIV. By fulfilling these objectives, we hope to foster research collaborations between researchers, clinicians, policy-makers, and community members; to enhance research and training opportunities for undergraduate and graduate students and clinician and community researchers; and to inform policy-makers, clinicians and the community on how our findings may impact the current status of maternal health in the context of HIV in Canada.
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The beginnings of the HIV epidemic were marked by significant and celebrated contributions from scholars using critical social science and humanities perspectives. However, more recently these perspectives have become characterised as lacking applied value in settings that emphasise ‘evidence-based’ interventions. Fortunately, there are growing attempts to revive the use of critical perspectives in HIV in Canada and beyond.
The meeting provided a much needed opportunity to bring together junior, middle, and senior level HIV researchers, people living with and/or affected by HIV, services providers, clinicians, community advocates, and activists interested in advancing critical social science and humanities perspectives in Canadian HIV studies and practice.
Specific objectives:
- To bring together HIV scholars using critical approaches to share and discuss their work in relation to emerging intervention, policy, and research trends in the Canada.
- To establish a program of research that will address the social, political, legal, ethical, and cultural implications of the Canadian HIV response and identify research questions that should be explored using critical social science and humanities perspectives.
Participants included HIV researchers and graduate students from various academic disciplines and interested knowledge users (people living with and/or affected by HV, service providers, clinicians, and community advocates). The following researchers delivered presentations: Viviane Namaste, Eric Mykhalovskiy, Cindy Patton, and Carol Strike. In addition, Randy Jackson, Barry Adam, and Mary Petty were rapporteurs.
Visit vimeo.com/channels/thinkinghiv to view a series of videos coming out of the conference including a main conference video and individual teaching moments!
Visit the New Directions website for more information about the conference: http://www.thinkinghiv.ca/
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African, Caribbean and Black (ACB) people account for a disproportionately high share of the numbers of people in Ontario living with HIV. ACB men are particularly affected, accounting for 60% of ACB people infected with HIV up to 2008 (not including ACB men infected through sex with other men). Moreover, men are obviously implicated in the rapid spread of heterosexually transmitted HIV among African and Caribbean women in Ontario since the mid-1990s. Yet, women and gay and bisexual comprise the majority of ACB service users and others involved in HIV/AIDS issues. In addition, AIDS service organizations, researchers and policy makers have continued to focus their efforts on ACB women and gay and bisexual men. Clearly, understanding and addressing the HIV-related needs and challenges of heterosexual ACB is an urgent priority. The overall goal of this project is to engage ACB heterosexual men in the response to HIV, and engage researchers, service providers, policy makers and other stakeholders to address the HIV- related needs and circumstances of ACB heterosexual men. The objectives are to: (1) understand the HIV- related needs, challenges and priorities of ACB heterosexual men, and possible strategies to address them; (2) understand the current program environment, identify gaps in the knowledge base, and determine research needs to support programs and policy; (3) develop a research team representing primary stakeholder interests; (4) develop at least one research study to address the most pressing priority; and (5) initiate a process to strengthen program and policy responses related to ACB heterosexual men among ACCHO members.
Read the report from their latest consultation with members of the community.
Talking Black - Straight Black Men and HIV - the iSpeak Report
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The Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) has been in Canada for three decades. Over this period of time, only a few surveys have been conducted to gain a better understanding of Canadians’ attitudes, knowledge and perceptions of HIV and AIDS. This research entails a descriptive study to identify and explore trends in public attitudes, knowledge and perceptions of HIV and AIDS popular among Canadians today. As Canada finds itself at a crossroad in HIV prevention and care the timing for this initiative is critical. On the one hand, modern treatment has transformed HIV into a manageable infection and prevention strategies have steadily reduced the rates of new HIV infections. On the other hand, evidence is emerging that proven prevention strategies are lagging in some populations and that complacency and disinterest have become common. Therefore, the primary objectives of this study include: (1) to describe the attitudes, perceptions and knowledge regarding HIV and AIDS and existing policies of people living in Canada; (2) to describe actions that people living in Canada have taken to increase their awareness of HIV and AIDS, and steps taken to assess and prevent transmission; and (3) to identify opinions on charitable giving for HIV and AIDS relative to other causes/diseases and the current and intended charitable giving behaviour of Canadians. These findings will inform and support strategies at CANFAR and the SRC to best address gaps in public information, better target funding priorities and awareness efforts among policy makers, the general public and the Canadian donor community, and improve HIV prevention interventions and other research initiatives overall.
Press Release and Fact Sheet.
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Two of the populations disproportionately affected by HIV – Aboriginal Peoples and African, Caribbean and Black (ACB) communities – bring to the research arena distinct worldviews, perspectives and histories on research and research methodologies. In order to conduct successful research with a strong focus on the social drivers of HIV for these communities, it is important for us as researchers and community members to develop a shared understanding of what research is, what research means, and how research is enacted/practiced from different lenses. Our group, composed of Aboriginal community members and researchers, ACB community members and researchers, and allied researchers, will conduct a scoping review of decolonizing, indigenous, and “Southern[1]” research methodologies to provide a foundation for our research work together on HIV prevention within the SRC. The products of this review will include a working paper for use by SRC members in the development of proposals and which could be shared more widely with others engaged in HIV/AIDS research. We also anticipate that the review process will inform a model(s) of cross-cultural collaborative engagement in research. We are requesting funding for a graduate research assistant to assist us in the scoping review process, 2 peer researchers, and funding to support 2 face-to-face day-long meetings for team members to come together and work at establishing an inclusive, respectful conceptual framework to inform methodological decisions.
[1]“Southern” research refers to knowledge production methods that are distinct from dominant Western philosophies.
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The Canadian Aboriginal AIDS Network (CAAN) is seeking to learn how to maximize the positive impact of current information communication technologies (ICT) to strengthen our membership and conduct our core business more efficiently and effectively. Engagement in new media and ICT will strengthen our ability to conduct business; perform research and disseminate findings; develop innovative interventions that enhance HIV prevention and harm reduction messaging; expand the reach of HIV/AIDS efforts to include new methods of community engagement; and provide a platform for communication of program outcomes. Effective communication strategies within the HIV/AIDS community will improve the health and wellbeing of Aboriginal peoples living with and affected by HIV/AIDS in Canada. Engagement with new technologies and the use of free networking tools among marginalized populations is a new and emerging topic for exploration. The team proposing this research initiative represents excellence in community engagement, academics and ICT. This project will advance our research agenda through the use of innovative ICT fostering new areas of collaboration, partnership, and opportunity for community engagement. This project will further strengthen the knowledge translation and exchange (KTE) work central to CAAN's commitment to community-based research (CBR) by offering new and innovative ways to share research findings with our broad target audience made up of individuals, organizations, policy makers and Aboriginal leadership.
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There is great interest in biomedical technologies for HIV prevention which may empower individuals in sexual encounters to protect themselves, regardless of the desires and wishes of their sexual partner. An often touted promise of NPTs is that they will act as biomedical tools not only for prevention of HIV transmission, but will also act as tools for women to take control over their own sexual health (and in some cases reproductive health) decisions. Despite the touted benefits of empowerment through female-controlled prevention products, there have been numerous critical views. These perspectives suggest that female-controlled prevention products may not be the panacea for women’s equality and empowerment that they are purported to be. However, they may be a catalyst for longer-term, broader structural change to the extent that female-controlled interventions stimulate and are introduced within multi-level interventions that address women’s vulnerabilities, such as gender inequality, poverty, and other forms of discrimination. There is a need for a revitalized prevention research agenda to understand how NPTs make personal calculations of risk more complex, and could influence personal agency. This Formulation project will lay the groundwork for a more comprehensive research project to explore the implications of new prevention technologies (NPTs) on women’s sexual autonomy and empowerment.
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Previous research with African, Caribbean and Black (ACB) communities in Toronto has shown that stigma is a salient factor in people’s ideas about and response to HIV affecting ACB communities. Moreover, ACB people have identified faith communities as integral to how those communities may address stigma. The proposed initiative is a 1-day consultation with ACB faith leaders, researchers, service providers and people living with HIV/AIDS to develop research that may reduce stigma. Specifically, the consultation will facilitate the formation of a multi-stakeholder team and community agreement to develop intervention research to reduce stigma, focusing on ACB faith leaders, their congregations and affiliated communities.
