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ObjectivesUnderstanding who uses internet-based sexually transmitted and blood-borne infection (STBBI) services can inform programme implementation, particularly among those most impacted by STBBIs, including gender and sexual minority (GSM) men. GetCheckedOnline, an internet-based STBBI testing service in British Columbia, Canada, launched in 2014. Our objectives were to assess reach, identify factors associated with use of GetCheckedOnline 5 years into implementation and describe reasons for using and not using GetCheckedOnline among GSM men.MethodsThe Sex Now 2019 Survey was an online, cross-sectional survey of GSM men in Canada administered from November 2019 to February 2020. Participants were asked a subset of questions related to use of GetCheckedOnline. Multivariable binary logistic regression modelling was used to estimate associations between correlates and use of GetCheckedOnline.ResultsOf 431 British Columbia (BC) participants aware of GetCheckedOnline, 27.6% had tested using the service. Lower odds of having used GetCheckedOnline were found among participants with non-white race/ethnicity (adjusted OR (aOR)=0.41 (95% CI 0.21 to 0.74)) and those living with HIV (aOR=0.23 (95% CI 0.05 to 0.76)). Those who usually tested at a walk-in clinic, relative to a sexual health clinic, had greater odds of using GetCheckedOnline (aOR=3.91 (95% CI 1.36 to 11.61)). The most commonly reported reason for using and not using GetCheckedOnline was convenience (78%) and only accessing the website to see how the service worked (48%), respectively.ConclusionOver a quarter of GSM men in BC aware of GetCheckedOnline had used it. Findings demonstrate the importance of social/structural factors related to use of GetCheckedOnline. Service promotion strategies could highlight its convenience and privacy benefits to enhance uptake.

Objectives: Métis people experience health inequities and often face discrimination when accessing health services. Métis-specific services are limited, and pan-Indigenous approaches to health services fail to acknowledge heterogenous identities and distinct health needs of the Métis. This study explored a Métis response to HIV and other sexually transmitted and blood borne infections to inform public health services development for Métis people. Methods: As part of the DRUM & SASH Project, this study used a community-based research approach which privileged Métis knowledges and processes. Three gathering circles were held in Alberta, Canada, with self-identified Métis individuals who had lived experience or intimate knowledge of HIV/hepatitis C or worked in HIV/HCV service provision. The gathering circle process integrated Métis cultural practices in discussions about Métis understandings of health. Gathering circles transcripts were used to inform the description of the model emerging through the dialogue. Results: Twelve diverse Métis people participated in gathering circles. Participants identified 12 determinants of health and well-being grounded in Métis culture and imagery, including Métis medicine bag, fiddle, cart tarp, flag, Capote coat, sash, York boat, moccasins, grub box, weapons, tools, and stove. The Red River Cart Model, a Métis-specific model of health to guide service planning, was created from these discussions. Conclusion: The Red River Cart Model provides a holistic view of the determinants of Métis health and has potential as a collaborative client assessment resource for STBBI community health service providers. Additionally, this model may be helpful to other health service providers for developing Métis-specific/informed services and improving cultural safety for the Métis.

ObjectivesWe assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada.MethodsWe administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available.ResultsOf 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%).ConclusionsOf BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.

Objectives: Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic. Methods: In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p< 0.01). Results: Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex). Conclusion: Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.

ABSTRACTStable Homes, Strong Families (SHSF) is a community-based research project that sought to investigate the connection between HIV, housing and Indigenous cultures and identify strategies to ensure culturally appropriate housing programs and policies for Indigenous peoples living with and affected by HIV. The impetus for this research stems from a body of knowledge that recognizes the inextricable link between housing and health, as well as growing momentum in Canada to reimagine the relationship between Indigenous and non-Indigenous peoples through decolonizing approaches and reconciliation. This paper outlines a number of solution-focused social policy recommendations that emerged from SHSF research findings to Indigenize the creation and management of housing for Indigenous peoples living with and affected by HIV. Recommendations include creating spaces for ceremonial practices and cultural traditions; integrating processes for community engagement and consultation; breaking down silos that exist between health, housing, and urban development stakeholders; and providing wrap around support services from an Indigenous perspective. In advocating for these recommendations, we aim to stimulate a dialog regarding how, and by whom, housing policies and practices can be developed, implemented, and mandated to best support Indigenous peoples living with and affected by HIV and AIDS across Canada and around the world.

r: HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16–64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing. Methods: A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex. Results: Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age <60 years, female sex, sexual minority status, perceived HIV knowledge, casual sex partner in previous year, and living in a higher-prevalence jurisdiction. For men, the strongest factor related to testing was sexual minority status (OR = 5.15, p < 0.001); for women, it was having a casual sex partner in the previous year (OR = 2.57, p = 0.001). For both men and women, residing in a jurisdiction with lower HIV prevalence decreased odds of testing. Discussion: Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further.

The second edition (2010) of the Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans (TCPS2) prescribes a set of principles and provisions for engagement with Aboriginal communities. The objective of this study was to explore research ethics board (REB) stakeholder perspectives on the principles and processes of reviewing and conducting public health research with Aboriginal populations and communities. Twenty-four semi-structured qualitative interviews were conducted with REB staff, chairs, members (academic, community and student), and ethics policy key informants with knowledge of the ethics review process, including four Aboriginal participants. Interviews were professionally transcribed verbatim and thematically analyzed using NVivo 8 qualitative data management software. Three dominant themes emerged specific to ethical research practices with Aboriginal communities: 1) the importance of understanding Aboriginal research as a distinct form of research; 2) the unique nature and complexity of negotiating community consent; and 3) the importance of trust and relationship-building in the research process. Thematic results highlight the most prominent issues that REB participants encountered in reviewing research involving Aboriginal peoples. Continued attention needs to be paid to acknowledging and respecting issues of diversity in research involving diverse First Nations, Inuit and Métis peoples. While specific to Aboriginal peoples, the TCPS2 guidelines also illustrate processes and practices that may assist in the development of respectful, collaborative public health research relationships with other historically marginalized populations. Dans la deuxième édition (2010) de l’Énoncé de politique des trois Conseils: Éthique de la recherche avec des êtres humains(EPTC 2), on prescrit un ensemble de principes et de dispositions pour traiter avec les communautés autochtones. Nous avons voulu étudier les perspectives des membres des comités d’éthique de la recherche (CÉR) sur les principes et les processus d’examen et de conduite de la recherche en santé publique auprès des populations et des communautés autochtones. Vingt-quatre entretiens qualitatifs semi-directifs ont été menés avec le personnel, les présidents et les membres (universitaires, grand public et étudiants) de CÉR et avec des spécialistes des politiques en matière d’éthique pouvant nous informer sur le processus d’examen de l’éthique, dont quatre participants autochtones. Les entretiens ont été professionnellement transcrits, mot à mot, et analysés par thème à l’aide du logiciel de gestion de données qualitatives NVivo 8. Trois grands thèmes se sont dégagés en ce qui a trait aux pratiques éthiques dans la recherche avec les communautés autochtones: 1) l’importance de considérer la recherche autochtone comme une forme de recherche distincte; 2) la singularité et la complexité de la tâche de négocier le consentement communautaire; et 3) l’importance d’établir la confiance et de tisser des relations au cours du processus de recherche. Les résultats par thème font ressortir les principales difficultés rencontrées par les participants des CÉR lors des examens d’études de recherche auprès des Autochtones. Il faut poursuivre nos efforts pour reconnaître et respecter l’enjeu de la diversité dans la recherche impliquant diverses populations inuites, métisses et des Premières Nations. Bien qu’elles soient axées sur les Autochtones, les lignes directrices de l’EPTC 2 illustrent un processus et des pratiques qui peuvent aider à tisser des relations respectueuses et collaboratives lorsqu’on fait de la recherche en santé publique avec d’autres populations longtemps marginalisées.

As part of a larger case study exploring physician retention factors and strategies employed by rural communities, the objective of this analysis was to explore the community factors that promoted physician retention. A qualitative, collective case study design was employed to study four rural communities (cases) in Alberta that retained family physicians for four years or longer. Participants included physicians, staff members, spouses and community members (all were patients from the communities studied). Communities were selected through a retention-specific matrix; each quadrant represented a particular community typology. Case data collected from interviews, documents and observations were analyzed, and similarities and differences among cases were assessed. A range of community factors that could influence physicians’ decisions to stay in a particular community were described by participants. Four themes, Appreciation, Connection, Active Support and Physical/Recreational Assets, were positively related to physician retention in the four communities studied. These community factors existed to different degrees but were present in all communities. Reciprocity was a fifth factor that emerged in three of the four communities studied. Physicians, policy-makers, community members and health care professionals are encouraged to consider the community domain when planning and implementing strategies to retain rural physicians and other health care professionals. The four communities studied were able to promote retention of their primary care physicians by showing appreciation to them, building connections with them and their families, actively supporting their physicians and local health facilities, maintaining and improving local physical/recreational amenities, and nurturing reciprocal rapport with physicians. Dans le cadre d’une vaste étude de cas sur les facteurs et les stratégies de fidélisation des médecins en milieu rural, nous avons voulu analyser les facteurs communautaires qui favorisent le maintien en poste de ces médecins. Nous avons mené une étude qualitative et collective dans quatre communautés rurales de l’Alberta (les « cas ») ayant conservé leurs médecins de famille quatre ans et plus. Les participants étaient des médecins, des membres du personnel, des conjoints et des résidents (tous des patients des communautés à l’étude). Les communautés ont été choisies selon une matrice portant spécifiquement sur la fidélisation; chaque quadrant représentait une typologie communautaire particulière. Nous avons recueilli les données au moyen d’entretiens, de documents et d’observations, analysé ces données, puis évalué les similitudes et les différences entre les cas. Les participants ont cité divers facteurs communautaires ayant pu influencer la décision des médecins de rester dans une communauté donnée. Quatre thèmes (appréciation, relations, soutien actif et équipements physiques/récréatifs) étaient positivement liés à la fidélisation des médecins dans les quatre communautés étudiées. Ces facteurs étaient présents à différents degrés dans toutes les communautés. Un cinquième facteur, la réciprocité, était présent dans trois des quatre communautés. Nous encourageons les médecins, les stratèges, les résidents et les professionnels de la santé à tenir compte de l’aspect communautaire lorsqu’ils planifient et mettent en œuvre des stratégies pour fidéliser les médecins et autres professionnels de la santé en milieu rural. Les quatre communautés à l’étude ont réussi à fidéliser leurs médecins de premier recours en leur montrant leur appréciation, en tissant des relations avec eux et leurs familles, en appuyant activement leurs médecins et leurs établissements de santé locaux, en entretenant et en améliorant les équipements physiques et récréatifs locaux et en entretenant des rapports de réciprocité avec les médecins.

To examine differences in health risks, health outcomes and health services use of Calgary street-involved youth by level of street involvement to inform services planning. 355 street-involved youth (61% male, 26% Aboriginal) completed surveys at a variety of outdoor and agency locations: 46% currently lived on the street, 33% had lived on the street in the past, and 20% were street-involved but had not lived on the street. Odds Ratios (OR) adjusted for sex, ethnocultural group, and age group were calculated for each health/health risk and health service factor by level of street involvement. With the exception of condom use, significant health and health risk outcome differences were seen by level of street involvement. Use of hospitals and walk-in clinics did not differ significantly by level of street involvement; however, youth living on the street were less likely (OR 0.2) than those who had not lived on the street to use a physician during office hours, and those who had lived on the street were more likely (OR 10.1) to use mobile clinics, services that are targeted to street-involved people. Street-involved youth who had not lived on the street showed better health/health risk outcomes than those who currently or had lived on the street, and health services use showed some differences by level of street involvement. Public health and other service providers need to be cognizant of their role in providing prevention, safety or stabilization services for youth at different stages of street life. Examiner les écarts dans les risques sanitaires, les résultats cliniques et l’utilisation des services de santé par les jeunes de la rue de Calgary selon leur niveau d’itinérance, afin d’étayer la planification des services. Trois cent cinquante-cinq jeunes de la rue (de sexe masculin à 61 %, autochtones à 26 %) ont répondu à un sondage à divers endroits à l’extérieur et à l’intérieur d’organismes: 46 % vivaient actuellement dans la rue, 33 % y avaient déjà vécu, et 20 % n’y avaient pas vécu, mais fréquentaient le milieu. Nous avons calculé des rapports de cotes (RC) rajustés selon le sexe, le groupe ethnoculturel et le groupe d’âge pour chaque facteur de santé/de risque sanitaire et de service de santé selon le niveau d’itinérance des jeunes. À l’exception du port du condom, nous avons observé des écarts significatifs dans les résultats de santé et les risques sanitaires selon le niveau d’itinérance. La fréquentation des hôpitaux et des cliniques sans rendez-vous ne différait pas significativement selon le niveau d’itinérance, mais les jeunes vivant dans la rue étaient moins susceptibles (RC 0,2) que ceux qui n’avaient pas vécu dans la rue de consulter un médecin pendant les heures de bureau, et ceux qui avaient déjà vécu dans la rue étaient plus susceptibles (RC 10,1) de fréquenter les unités sanitaires mobiles (un service qui cible les personnes de la rue). Les jeunes qui n’avaient pas vécu dans la rue affichaient de meilleurs résultats sur le plan de la santé et des risques sanitaires que ceux qui vivaient actuellement ou qui avaient déjà vécu dans la rue, et l’utilisation des services de santé variait quelque peu selon le niveau d’itinérance. Les intervenants en santé publique et autres fournisseurs de services doivent être conscients de leur rôle lorsqu’ils offrent des services de prévention, de sécurité ou de stabilisation aux jeunes à différents stades d’itinérance.

This paper follows from a previous paper which described the basic approaches to economic evaluation of health programs. The discussion in this paper builds and discusses the theoretical and practical concerns felt by practitioners and analysts about economic evaluations in mental health care. Two examples of economic evaluations that compare the costs of hospital care and community-based care are presented to illustrate some of the limitations of economic evaluation. Discussion also focuses on the difficulties involved in developing and conducting economic analyses in the mental health field, as well as problems faced in trying to generalize from one study setting to others.

Economic evaluation is becoming an increasingly important part of the evaluation of health and mental health services. Current models for conducting economic evaluation, including cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, have great potential for improving the quality of decision-making and for making mental health programs more effective and efficient. This paper presents the basic economic theory underlying the various forms of economic evaluation and provides general guidelines for developing and conducting an economic analysis of a health program.

ABSTRACTAlthough Indigenous Elders were traditionally involved in cross-generational health promotion and education, colonisation disrupted this role. Little research examines the role of Elders in contemporary health promotion for Indigenous youth and few strategies have been identified to engage Elders in health promotion or sexual health education. We explored engagement of Elders through participatory filmmaking in a sexual health and HIV education workshop for youth. Eleven youth and five Elders participated in this 3.5-day workshop. During the workshop, Elders indicated they wanted to make a film and attend a sexual health and HIV education session. Four Elders were interviewed about their experiences. Interview transcripts and the Elders’ film were analysed using content analysis. Although Elders initially felt hesitant to engage, the process of participatory filmmaking allowed Elders to co-create an environment for their “comfortable” workshop engagement. Elders’ feelings of comfort were created by having control and sense of ownership over their engagement; the presence of youth; peer-based dialogue; inclusion of traditional items; and an Indigenous sexual health educator. Findings suggest participatory filmmaking is a promising approach for engaging and empowering Elders to reclaim traditional roles in sexual health education and health promotion with Indigenous youth.