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Some older gay men (50+) experience diminished quality of life (QOL) due to historical and ongoing discrimination in addition to living through a collective trauma—the pre-HAART era of the HIV/AIDS epidemic—characterized by the absence of treatment and rampant discrimination targeting gay men. A growing body of literature, however, illustrates that older gay men demonstrate remarkable resilience but little is known about how QOL is conceptualized and how these conceptualizations are potentially shaped by pre-HAART experiences. The current study drew on constructivist grounded theory methods to examine how QOL is conceptualized in light of the sociohistorical relevance of pre-HAART. Twenty Canadian based gay men aged 50+ participated in semi-structured interviews via Zoom. Ultimately, QOL is understood as experiencing contentment, which is made possible by the development and implementation of three key processes: (1) developing and cultivating meaningful connections, (2) growing into and embracing identity, and (3) appreciating the capacity to do what brings joy. QOL for this group is greatly informed by a context of disadvantage, and the demonstrated resilience warrants further investigation to meaningfully support the overall well-being of older gay men. [ABSTRACT FROM AUTHOR]

Increased sexually transmitted and blood-borne infections (STBBI) testing can reduce the burden of disease among Two-Spirit, gay, bisexual, transgender, and other queer Black, Indigenous, people of colour (2SGBTQ+ BIPOC). However, this population encounters barriers, such as discrimination, when accessing in-person STBBI testing services. Digital STBBI testing, such as self-testing/collection kits ordered online and digital requisitions, may address some of these barriers. Our aim was to understand acceptability of free digital STBBI testing among 2SGBTQ+ BIPOC living in Ontario, Canada. We approached this analysis using Implementation Science and Critical Race Theory. We conducted interviews and focus groups with 21 2SGBTQ + BIPOC individuals from 2020–2021. Participants were asked about their perceptions of the benefits and drawbacks of digital STBBI testing, populations that would benefit from using these services, and recommendations for how these services may be implemented in Ontario. Interviews and focus groups were transcribed verbatim and analyzed using reflexive thematic analysis. Six themes emerged. Digital STBBI testing services: (1) May reduce oppression experienced by 2SGBTQ + BIPOC when testing in-person; (2) Should address the unique needs that 2SGBTQ + BIPOC experience due to other intersecting identities they possess; (3) Should adapt their services to suit the varying cultural contexts and living circumstances of 2SGBTQ + BIPOC; (4) Should be accessible to 2SGBTQ + BIPOC who hold diverse or no documentation; (5) Should be offered in multiple languages; (6) May be inaccessible to those without Internet access or devices. Digital STBBI testing is one strategy that may reduce discrimination experienced by 2SGBTQ + BIPOC when getting tested in-person. However, digital STBBI testing services may not address all the needs of 2SGBTQ + BIPOC. Racism and other forms of oppression embedded into in-person and digital testing services will need to be addressed to meet the needs of this diverse population. [ABSTRACT FROM AUTHOR]

About 50% of people living with HIV will develop HIV-associated neurocognitive disorder (HAND) during their lifetime, and we know that cognitive issues are a concern for people living with HIV. However, limited information exists regarding how HAND is managed and coped with, or how cognitive issues are discussed with others, including health care professionals. Following a community-based research approach, we conducted 25 interviews in 2016 aimed to (1) build the capacity of people living with HIV, (2) facilitate participant recruitment and data collection, (3) increase the validity and reliability of our data analysis results, and (4) facilitate knowledge transfer and exchange regarding HAND. After thorough training, we engaged a number of peer researchers living with HAND in the analysis and knowledge transfer and exchange (KTE) phases of the study. This engagement prompted a number of tensions between the clinicians and the peers that we learned to navigate and make productive. We conclude that it is possible to engage patients and providers only if careful attention, time and human resources are provided to navigating the emerging tensions. The outcomes of our study suggest that engaging an interdisciplinary team across multiple sites with PRAs is a valuable method for comprehensively exploring the lived experience of a complex chronic condition such as HAND.

OBJECTIVE: 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 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. KEY WORDS: HIV; testing; anonymous testing; Canada Can J Public Health 2015;106(2):e4-e9 doi: 10.17269/CJPH.106.4625 OBJECTIF: Le depistage du VIH demeure une strategie centrale en matiere de prevention du virus, car il permet d'aiguiller les personnes seropositives vers les traitements et le soutien disponibles. Au Canada, les lignes directrices nationales ont change recemment dans le cadre des soins primaires normalises, et l'on recommande maintenant le depistage volontaire du VIH pour les 16 a 64 ans. A l'aide des resultats d'une enquete representative nationale, nous avons examine les facteurs individuels et les facteurs lies a la region administrative associes au depistage volontaire. METHODES: En tout, 2 139 participants ont ete echantillonnes selon un processus de recrutement en deux etapes, stratifie selon la region. Des entretiens en anglais ou en franpais (par telephone ou en ligne) ont ete menes en mai 2011. Le depistage volontaire etait defini comme etant un depistage au moins une fois pour une raison autre que pour donner du sang, a des fins d'assurance ou decontrole des immigrants ou pour participer a une etude de recherche. Des analyses de regression logistique ponderees (incluant les facteurs sociodemographiques, d'activite sexuelle, de connaissance du VIH et du sida et les facteurs de prevalence du VIH et de disponibilite du depistage anonyme selon la region administrative) ont ete menees pour l'echantillon global, puis stratifiees selon le sexe. RESULTATS: Vingt-neuf p. cent (29 %) des participants de l'enquete ont declare avoir subi au moins un depistage volontaire du VIH au cours de leur vie. Pour le modele utilisant l'echantillon entier, les facteurs suivants ont ete associes a une probabilite de depistage accrue : l'age DISCUSSION: Il faudrait tenir compte des differences entre les sexes lorsqu'on conpoit des interventions pour accroftre le recours au depistage. Les facteurs comme la prevalence du VIH et les modalites de depistage dans la region administrative devraient faire l'objet d'etudes plus poussees. MOTS CLES: VIH; depistage; depistage anonyme; Canada, Despite a range of educational campaigns and policies designed to increase voluntary human immunodeficiency virus (HIV) testing in Canada, one in four Canadians living with the disease are unaware of [...]

Public health scholarship is increasingly attuned to the structural determinants of health, such as the associations between macro-level policy and population health outcomes. Yet the ways public healthcare services are specifically made available through political and legislative decisions remain relatively under-explored. Using the critical research strategy of institutional ethnography, this study charts how political leadership transitions and legislative processes animate local public health service implementation activities. We investigated the feasibility of introducing an online sexually transmitted and blood-borne infections (STBBI) testing service to improve sexual healthcare access for gay, bisexual, queer, and other men who have sex with men in Ontario, Canada. Data were collected between June 2019 and June 2020. We conducted interviews with healthcare providers, sexual health program developers and managers, and other public health professionals with expertise in STBBI testing (n = 23), stakeholder meeting observations, and analyses of key texts (e.g. provincial policies and legislation). We uncovered that interpretations of provincial legislation posed a barrier to the online STBBI testing model, and we explicated the work of gaining decision-maker support for this new service during a period of austerity. In response to the election of political leadership who de-funded local public health, participants strategically framed arguments in favour of online testing using discourses of evidence, equity, and cost savings. Our article provides an empirical case study of the mechanisms by which political and legal dimensions direct the implementation of health services, shaping population health outcomes, and health equity in turn. [ABSTRACT FROM AUTHOR]

Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada - a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants' service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants' structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants' subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP. Keywords: HIV/AIDS; integrated service model; treatment as prevention; structural vulnerability; qualitative; Canada, Introduction The negative impact of social-structural inequities, such as poverty, homelessness and drug criminalization on HIV treatment and care among people living with HIV (PLHIV) who use drugs is well [...]