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Persson T, Löve J, Tengelin E, Hensing G. Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study. BMC Health Serv Res 2023; 23:535. [PMID: 37226171 DOI: 10.1186/s12913-023-09508-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.
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Affiliation(s)
- Tommy Persson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden.
- Knowledge Center for Sexual Health, Region Västra Götaland, Gothenburg, Sweden.
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden
| | - Ellinor Tengelin
- Department of Health Sciences, Rehabilitation Science, Mid Sweden University, Sundsvall, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, Gothenburg, SE-405 30, Sweden
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Factors Influencing the Acceptability of Nominal, Non-nominal, and Anonymous HIV Testing Options Among Young Men Living in Vancouver, Canada: A Qualitative Study. J Assoc Nurses AIDS Care 2023; 34:15-23. [PMID: 36656091 DOI: 10.1097/jnc.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ABSTRACT Individuals unaware of their HIV seropositive status continue to represent a key "driver" of the HIV epidemic. Strategies to improve initiation into the HIV treatment cascade, including among young men, are required. This study assesses the acceptability of three HIV testing options among young cisgender men living in Vancouver, British Columbia. Using a modified grounded theory approach, we conducted semi-structured interviews with 45 young cisgender men ages 18-30 years to identify the factors influencing the acceptability of diverse HIV testing approaches. Participants ascribed value to non-nominal testing as a means of providing a secure pathway to HIV-related care for those who test positive while also safeguarding privacy. Anonymous HIV testing was problematized by participants as potentially creating difficulty in accessing ongoing HIV-related care. Most participants preferred non-nominal testing. Nevertheless, based on principles of equity, we argue that anonymous access to one's serostatus should be available, especially within a criminalized context.
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Persson T, Löve J, Tengelin E, Hensing G. Notions About Men and Masculinities Among Health Care Professionals Working With Men's Sexual Health: A Focus Group Study. Am J Mens Health 2022; 16:15579883221101274. [PMID: 35726805 PMCID: PMC9218462 DOI: 10.1177/15579883221101274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health care professionals’ (HCPs) notions about gender may influence the provision and quality of care. If care-seeking men are met by HCPs holding idealized and stereotypical notions of masculinity, this could reinforce barriers to adequate care. This study explored notions about men and masculinities among HCPs working with men’s sexual health in Sweden. Focus group interviews with 35 HCPs from primary health and sexual health clinics were analyzed using qualitative content analysis. The analysis resulted in three descriptive themes: (a) Contradictory masculinity—elusive but clear. Notions of masculinity as a phenomenon or concept were elusive, but masculine and un-masculine traits, behaviors, and qualities were clear. (b) Sexual health care is a social place where men and masculinities can be challenging. Male patients were associated with unwanted sexual tensions. Masculinity could challenge professionality. Seeking sexual health care was perceived as doing un-masculinity. (c) Regarding masculinity as irrelevant—a difficult ambition to achieve. Participants strived for gender-neutrality by regarding patients as humans, individuals, or patients rather than as men and masculine. The analysis also identified a theme of meaning: Notions of masculinity are situated relationally. HCPs situate masculinity in real and hypothetical relationships. Romantic and sexual preferences were used to define preferred masculinity. This study identified themes that showed how HCPs balanced professional and private notions of men and masculinity in their patient encounters. Increased gender awareness and training are needed to professionalize the management of gendered notions in encounters with men who seek care for sexual health problems.
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Affiliation(s)
- Tommy Persson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Knowledge Center for Sexual Health, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ellinor Tengelin
- Department for Health Sciences, University West, Trollhättan, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kumar V, Atre S, Jain R, Bhanushali N, Singh S, Chaudhari S. Include-integrate-involve: Deciphering oral healthcare providers' professional demeanor towards sexual and gender minority cohorts in a metropolitan city of western India. J Oral Biol Craniofac Res 2021; 11:149-157. [PMID: 33537187 DOI: 10.1016/j.jobcr.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives The Sexual and Gender Minorities (SGM) have been subject to disparities in healthcare. This study gauges and compares the demeanor of oral health task force in privately-funded and government-funded dental schools of India towards SGM cohorts. Study design A descriptive, cross-sectional, point prevalent study was conducted following standard statements of the STROBE guidelines and using the Medical Condition Regard Scale (MCRS). It was conducted among the clinical oral health taskforce hailing from private-funded and government-funded institutes. Methods One-way ANOVA test computed differences in mean MCRS scores among the undergraduates, postgraduates and faculty. Independent t-test compared responses of participants from private institutions and government institutions using SPSS version 17 statistical software. Results All the respondents were mostly but not completely satisfied to work with SGM patients (MCRS score = 4.55 ± 1.114) indicative of some underlying hesitance. Though everyone had a positive regard, undergraduates and those from private institutions felt more compassionate and showed greater willingness to put in extra efforts to help them feel at ease (P-value <0.05). This is interpretive of more receptiveness towards specialized training and policy reforms of these individuals. Conclusion The significant differences between institutes and designations highlight disparities in knowledge and training resulting in the underlying hesitation. Health education urgently needs a targeted and focused SGM-related training program to deconstruct these disparities and provide equitable oral and general health for all individuals irrespective of their sexual orientation.
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Affiliation(s)
- Vaibhav Kumar
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | - Swarali Atre
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | - Romi Jain
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
| | | | - Shishir Singh
- T.P.C.T's Terna Dental College & Hospital, Navi Mumbai, India
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Handlovsky I, Bungay V, Johnson J, Oliffe J. Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1566-1580. [PMID: 32579289 DOI: 10.1111/1467-9566.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.
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Affiliation(s)
| | | | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
| | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
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Boroughs MS, Provenzano DA, Mitchell AD, O'Cleirigh C. Developing HIV Prevention Interventions for Emerging Adult MSM With a History of Being Bullied: A Qualitative Study. Am J Mens Health 2020; 13:1557988319852447. [PMID: 31117857 PMCID: PMC6537256 DOI: 10.1177/1557988319852447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The experience of being bullied in childhood or adolescence affects health into adulthood and is a public health crisis. Particularly affected are sexual minority young adults who are at the greatest risk for severe and violent bullying, HIV seroconversion, and onset of a substance use disorder. Although the scholarly work in the area of bullying victimization has made great gains over the past few years via improved sampling and methodological rigor, most of the focus of health research in this area has been on prevention efforts. The purpose of the current study was to inform the development of a transdiagnostic integrated treatment platform that will focus on mental and physical health outcomes that include sexual risk taking and substance abuse. This study involved conducting four focus groups with HIV-uninfected gay and bisexual men, aged 18 to 26 years, in order to examine treatment needs and preferences and further develop an evidence-based intervention. Four themes emerged from the analysis of transcripts: (a) learning about bullying and psychopathology, (b) coping with bullying, (c) experiencing psychopathology as a consequence of bullying, and (d) tailoring psychosocial interventions to address health sequelae linked with bullying. These themes provided a solid foundation to develop and test an intervention to address key health risks among men who have sex with men (MSM) with a history of being bullied and recent sexual risk taking and substance abuse.
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Affiliation(s)
- Michael S Boroughs
- 1 Department of Psychology, University of Windsor, Canada.,2 The Fenway Institute at Fenway Health, Boston, MA, USA
| | | | - Avery D Mitchell
- 3 Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Conall O'Cleirigh
- 2 The Fenway Institute at Fenway Health, Boston, MA, USA.,4 Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,5 Harvard Medical School, Boston, MA, USA
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Taylor TN, DeHovitz J, Hirshfield S. Intersectional Stigma and Multi-Level Barriers to HIV Testing Among Foreign-Born Black Men From the Caribbean. Front Public Health 2020; 7:373. [PMID: 31998675 PMCID: PMC6965168 DOI: 10.3389/fpubh.2019.00373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/21/2019] [Indexed: 01/08/2023] Open
Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
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Affiliation(s)
- Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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Handlovsky I, Bungay V, Oliffe J, Johnson J. A qualitative investigation of mental health promotion among aging gay men. J Ment Health 2019; 29:321-327. [PMID: 31682541 DOI: 10.1080/09638237.2019.1677874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Gay men, particularly middle aged and older men (over 40 years of age) experience a disproportionate burden of mental health issues compared to heterosexual men. Despite ample evidence that chronic exposure to structural and interpersonal discrimination negatively affect their mental health, little is known from gay men's perspectives how they understand mental health or their strategies to address their mental health concerns.Aim: This study's aim was to investigate how middle aged and older gay men experience their mental health and the mitigation strategies used to promote mental health.Method: Semi-structured interviews were conducted with 25 men who self-identified as gay. Data were analyzed using an interpretive descriptive approach.Results: Three overarching themes that best illustrate how men perceived their mental health and manage their mental health concerns were identified: gaining perspective, engaging with health services, and promoting and maintaining mental health.Conclusions: This study provides insight into how gay men come to acknowledge the validity of their mental health concerns, engage with health services, and their participation in other activities deemed essential for mental health promotion. These findings are ideally poised to inform development of health resources to promote and protect the mental health of aging gay men.
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Affiliation(s)
| | - Vicky Bungay
- Canada Research Chair Tier III, UBC School of Nursing, Vancouver, Canada
| | - John Oliffe
- Research, UBC School of Nursing, Vancouver, Canada
| | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, Canada
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Ferlatte O, Oliffe JL, Salway T, Broom A, Bungay V, Rice S. Using Photovoice to Understand Suicidality Among Gay, Bisexual, and Two-Spirit Men. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1529-1541. [PMID: 31152366 DOI: 10.1007/s10508-019-1433-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 05/24/2023]
Abstract
This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men's education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention.
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Affiliation(s)
- Olivier Ferlatte
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alex Broom
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Victoria Bungay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Simon Rice
- Orygen, The National Centre for Excellence in Youth Mental Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Closson K, Chown S, Armstrong HL, Wang L, Bacani N, Ho D, Jollimore J, Olarewaju G, Moore DM, Roth EA, Hogg RS, Lachowsky NJ. HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada. BMC Public Health 2019; 19:429. [PMID: 31014296 PMCID: PMC6480620 DOI: 10.1186/s12889-019-6744-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young gay, bisexual, and other men who have sex with men (YGBM) may have reduced engagement and knowledge of HIV care and biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and Treatment as Prevention (TasP), compared with adult GBM. We sought to understand differences in HIV prevention awareness, health care access, and service utilization between youth (16-29 years) and adult (≥30 year) GBM, as well as factors associated with attendance in HIV leadership programming among YGBM living in the publicly funded PrEP setting of Vancouver, Canada. METHODS Sexually-active GBM were recruited using respondent-driven sampling (RDS) from February 2012 to February 2015. Participants completed an in-person computer-assisted self-interview every 6 months, up to February 2017, with questions on sociodemographic factors, awareness of biomedical HIV prevention strategies, and an HIV treatment optimism-skepticism scale. Participants were asked if they had ever attended either of two HIV-leadership programs designed for YGBM. Both programs involve multiple GBM-led education and social networking sessions operated by community-based organizations in Vancouver. Multivariable Glimmix confounder models assessed differences between youth and adult GBM. Among younger men, bivariate analyses examined factors associated with HIV-leadership program attendance. RESULTS Of 698 GBM who enrolled in the longitudinal study, 36.8% were less than 30 years old at the first study visit. After controlling for gender identification, sexual orientation, HIV status, and income in the past 6 months, younger GBM (n = 257/698) had lower awareness of biomedical HIV prevention strategies and less HIV treatment optimism compared with older GBM (n = 441/698). Among younger GBM who attended HIV-leadership programs (n = 50), greater awareness of biomedical HIV prevention strategies and higher HIV treatment optimism were reported, compared with non-attendees. CONCLUSION Younger GBM, who are disproportionately affected by the HIV epidemic, are less aware of new prevention technologies than older GBM, but attending peer-based HIV-leadership programs ameliorates age-disparities in HIV-prevention knowledge and treatment optimism.
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Affiliation(s)
- Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Sarah Chown
- YouthCO HIV & Hep C Society, 205-568 Seymour St., Vancouver, BC V6B 3J5 Canada
| | - Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
| | - Darren Ho
- Community-Based Research Centre for Gay Men’s Health, 1007-808 Nelson St., Vancouver, BC V6Z 2H2 Canada
| | - Jody Jollimore
- Community-Based Research Centre for Gay Men’s Health, 1007-808 Nelson St., Vancouver, BC V6Z 2H2 Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Eric A. Roth
- Department of Anthropology, University of Victoria, Cornett Building B228, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada
- School of Public Health and Social Policy, University of Victoria, Human and Social Development Building B202, 3800 Finnerty Road, Victoria, BC V8P 5C2 Canada
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11
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Armas A, Meyer SB, Corbett KK, Pearce AR. Face-to-face communication between patients and family physicians in Canada: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:789-803. [PMID: 29173960 DOI: 10.1016/j.pec.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.
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Affiliation(s)
- Alana Armas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Alex R Pearce
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Karamouzian M, Shoveller J, Dong H, Gilbert M, Kerr T, DeBeck K. Perceived Devaluation and STI Testing Uptake among a Cohort of Street-Involved Youth in a Canadian Setting. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2165-2172. [PMID: 28643100 PMCID: PMC5548595 DOI: 10.1007/s10508-017-1002-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/28/2017] [Accepted: 05/08/2017] [Indexed: 06/15/2023]
Abstract
Perceived devaluation has been shown to have adverse effects on the mental and physical health outcomes of people who use drugs. However, the impact of perceived devaluation on sexually transmitted infections (STI) testing uptake among street-involved youth, who face multiple and intersecting stigmas due to their association with drug use and risky sexual practices, has not been fully characterized. Data were obtained between December 2013 and November 2014 from a cohort of street-involved youth who use illicit drugs aged 14-26 in Vancouver, British Columbia. Multivariable generalized estimating equations were constructed to assess the independent relationship between perceived devaluation and STI testing uptake. Among 300 street-involved youth, 87.0% reported a high perceived devaluation score at baseline. In the multivariable analysis, high perceived devaluation was negatively associated with STI testing uptake after adjustment for potential confounders (Adjusted Odds Ratio = 0.38, 95% Confidence Interval 0.15-0.98). Perceived devaluation was high among street-involved youth in our sample and appears to have adverse effects on STI testing uptake. HIV prevention and care programs should be examined and improved to better meet the special needs of street-involved youth in non-stigmatizing ways.
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Affiliation(s)
- Mohammad Karamouzian
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616911320, Iran
| | - Jean Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- School of Public Policy, Simon Fraser University, Suite 3271 - 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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Ferlatte O, Salway T, Hankivsky O, Trussler T, Oliffe JL, Marchand R. Recent Suicide Attempts Across Multiple Social Identities Among Gay and Bisexual Men: An Intersectionality Analysis. JOURNAL OF HOMOSEXUALITY 2017; 65:1507-1526. [PMID: 28885100 DOI: 10.1080/00918369.2017.1377489] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study draws from intersectionality to describe variations in recent suicide attempts (RSA) among gay and bisexual men (GBM) across sociodemographics. Using survey data, logistic regression modeling explored RSA in two analytical stages: (1) the individual effects of each sociodemographic were measured; (2) two-way interaction terms between sociodemographics were tested and added to the models created in stage A. In stage A, only education and income achieved significance. In stage B, the study found that (a) education and income interacted significantly such that the odds of RSA increased for those with a lower income and a lower education; (b) sexual orientation and partnership status interacted, resulting in decreased odds among bisexual men in heterosexual partnerships; and (c) income and education interacted with geography; the effects of these variables were significant only among urban men. These findings suggest that GBM are at unequal risk of RSA according to intersecting sociodemographics.
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Affiliation(s)
- Olivier Ferlatte
- a Men's Health Research Program , University of British Columbia , Vancouver , British Columbia , Canada
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
| | - Travis Salway
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
- c Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada
| | - Olena Hankivsky
- d School of Public Policy , Simon Fraser University , Vancouver , British Columbia , Canada
| | - Terry Trussler
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
| | - John L Oliffe
- a Men's Health Research Program , University of British Columbia , Vancouver , British Columbia , Canada
| | - Rick Marchand
- b Community-Based Research Centre for Gay Men's Health , Vancouver , British Columbia , Canada
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Datta J, Reid D, Hughes G, Mercer CH, Wayal S, Weatherburn P. Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study. Sex Transm Infect 2017; 94:46-50. [PMID: 28778980 PMCID: PMC5800331 DOI: 10.1136/sextrans-2016-052983] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives To explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics. Methods Qualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted. Results Attending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental. Conclusions A range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.
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Affiliation(s)
- Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David Reid
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Catherine H Mercer
- Department of Infection and Population Health, University College London, London, UK
| | - Sonali Wayal
- Department of Infection and Population Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Lee C, Oliffe JL, Kelly MT, Ferlatte O. Depression and Suicidality in Gay Men: Implications for Health Care Providers. Am J Mens Health 2017; 11:910-919. [PMID: 28103765 PMCID: PMC5675322 DOI: 10.1177/1557988316685492] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 01/18/2023] Open
Abstract
Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men's health has often been defined by sexual practices, and poorly understood are the intersections of gay men's physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual identities, social cohesion and belonging, internalized stigma, and victimization. Barriers to gay men's help seeking are also discussed in detailing how health care providers might advance the well-being of this underserved subgroup by effectively addressing depression and suicidality.
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Affiliation(s)
- Carrie Lee
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary T. Kelly
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- University of British Columbia, Vancouver, British Columbia, Canada
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16
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Ng CK, Haines-Saah RJ, Knight RE, Shoveller JA, Johnson JL. "It's not my business": Exploring heteronormativity in young people's discourses about lesbian, gay, bisexual, transgender, and queer issues and their implications for youth health and wellbeing. Health (London) 2017. [PMID: 28629224 DOI: 10.1177/1363459317715776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Canada, the issue of creating safe and inclusive school environments for lesbian, gay, bisexual, transgender, and queer students has been in the spotlight. Several researchers and advocates have pointed out the positive effects of lesbian, gay, bisexual, transgender, and queer-positive policy frameworks on the health and wellbeing of all young people. In this article, we take a critical approach to analyzing narrative findings from qualitative interviews conducted with youth in three communities in British Columbia, Canada: "the North," Vancouver, and Abbotsford. Using a Foucauldian Discourse Analytic Approach and Butler's concept of Citationality, our analysis suggested that although explicit homophobia was largely absent from youth discussions, young people discursively constructed lesbian, gay, bisexual, transgender, and queer identities and "communities" in ways that reified heteronormativity. Youth made references to sociopolitical discourses of libertarianism and liberalism and to homonormative stereotypes regarding gay masculinity. A few young people also alluded to egalitarian, queer-positive discourses, which appeared to interrogate structures of heteronormativity. Since studies suggest a connection between the existence of institutional supports for lesbian, gay, bisexual, transgender, and queer students in schools and their mental and physical wellbeing, we conclude by considering the limitations and possibilities of these sociopolitical discourses in the struggle for sexual and gender equity, and how they might help frame future health-related, anti-homophobia policy frameworks in educational settings.
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Stewart K, O'Reilly P. Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review. NURSE EDUCATION TODAY 2017; 53:67-77. [PMID: 28448883 DOI: 10.1016/j.nedt.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/27/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore current literature surrounding the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients and their influence on equal and non-discriminatory care for LGBTQ individuals. DESIGN Systematic integrative review. DATA SOURCES CINAHL, MEDLINE, PubMed, InterNurse. REVIEW METHODS This integrative review used Wakefield's (2014) framework to establish the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of LGBTQ patients. Qualitative, quantitative and mixed methods primary studies carried out between 2006 and 2015 from 7 countries were included. Four databases were searched and 98 studies were screened for eligibility by two researchers. Level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (SIGN, 2010) criteria and quality was assessed by a screening tool adapted from Noyes and Popay (2007) for qualitative papers and Quality Assessment Tool for Quantitative Studies adapted from the Effective Public Health Practice Project (EPHPP, 2010). Following PRISMA guidelines, this integrative review analysed and synthesised evidence using thematic analysis to generate themes. RESULTS 24 papers were included in the final synthesis which revealed four primary themes: Heteronormativity across Healthcare; Queerphobia; Rainbow of Attitudes; Learning Diversity. CONCLUSIONS Nurses and midwives possess a wide spectrum of attitudes, knowledge and beliefs which impact the care received by LGBTQ patients. Many issues of inadequate care appear to be due to a culture of heteronormativity and a lack of education on LGBTQ health. Further research is needed on interventions which could facilitate disclosure of sexual orientation and interrupt heteronormative assumptions by staff. It is recommended that LGBTQ issues be included within undergraduate nursing and midwifery education or as part of continued professional development.
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Affiliation(s)
- Kate Stewart
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Ireland.
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Knight R, Falasinnu T, Oliffe JL, Gilbert M, Small W, Goldenberg S, Shoveller J. Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study. BMJ Open 2016; 6:e011209. [PMID: 27566628 PMCID: PMC5013347 DOI: 10.1136/bmjopen-2016-011209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Surveillance data frequently indicate that young men and women experience high-yet considerably different-reported rates of sexually transmitted infections (STIs), including bacterial infections such as chlamydia. We examined how several sex-based (eg, biological) and gender-based (eg, sociocultural) factors may interact to influence STI surveillance data trends. METHODS Employing ethno-epidemiological techniques, we analysed cross-sectional qualitative data collected between 2006 and 2013 about young people's experiences accessing STI testing services in five communities in British Columbia, Canada. These data included 250 semistructured interviews with young men and women aged 15-24 years, as well as 39 clinicians who provided STI testing services. RESULTS The findings highlight how young women are socially and medically encouraged to regularly test, while young men are rarely offered similar opportunities. Instead, young men tend to seek out testing services: (1) at the beginning or end of a sexual relationship; (2) after a high-risk sexual encounter; (3) after experiencing symptoms; or (4) based on concerns about 'abnormal' sexual anatomy. Our results illustrate how institutions and individuals align with stereotypical gender norms regarding sexual health responsibilities, STI testing and STI treatments. While these patterns reflect social phenomena, they also appear to intersect with sex-based, biological experiences of symptomatology in ways that might help to further explain systematic differences between young men's and women's patterns of testing for STIs. CONCLUSIONS The results point to the importance of taking a social and biological view to understanding the factors that contribute to the gap between young men's and women's routine engagement in STI care.
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Affiliation(s)
- Rod Knight
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
| | - Titilola Falasinnu
- Health Research and Policy, Stanford University, School of Medicine, Stanford, California, USA
| | - John L Oliffe
- University of British Columbia, School of Nursing, Vancouver, BC, Canada
| | - Mark Gilbert
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shira Goldenberg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jean Shoveller
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
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Gahagan J, Colpitts E. Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research. JOURNAL OF HOMOSEXUALITY 2016; 64:95-121. [PMID: 27043161 DOI: 10.1080/00918369.2016.1172893] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.
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Affiliation(s)
- Jacqueline Gahagan
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Emily Colpitts
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
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20
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Knight R, Small W, Thomson K, Gilbert M, Shoveller J. Implementation challenges and opportunities for HIV Treatment as Prevention (TasP) among young men in Vancouver, Canada: a qualitative study. BMC Public Health 2016; 16:262. [PMID: 26975718 PMCID: PMC4791765 DOI: 10.1186/s12889-016-2943-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite evidence supporting the preventative potential of HIV Treatment as Prevention (TasP), scientific experts and community stakeholders have suggested that the success of TasP at the population level will require overcoming a set of complex and population-specific implementation challenges. For example, the factors that might influence decisions to initiate 'early' treatment have yet to be thoroughly understood; neither have questions about the factors that enhance or impede their ability to achieve long-term adherence to ARVs or the social norms regarding various treatment regimens been examined in detail. This knowledge gap may hamper opportunities to effectively develop public health practices that are informed by the various challenges and opportunities related to TasP implementation and scale up. METHODS Drawing on 50 in-depth, individual interviews with young men ages 18-24 in Vancouver, Canada, this study examines young men's perspectives regarding factors that might affect their engagement with TasP. RESULTS While findings from the current study indicate young men generally have a high receptiveness to TasP, our findings also identify key social and structural forces that will warrant ongoing consideration for TasP implementation. For example, participants described how an enhanced awareness regarding treatment (including awareness of the universal availability of treatment in Vancouver) would be a necessary, but not sufficient, condition to decide to endorse TasP. Their decisions about engaging in HIV care in the context of TasP (e.g., HIV testing, treatment initiation, long-term adherence) also appear to be contingent on their ability to negotiate or 'balance' the risks and benefits to themselves and others. The findings also offer insight into the complex and sometimes controversial narratives that continue to emerge regarding risk compensation practices in the context of TasP. CONCLUSION Based on the results of this study, we identify several areas that hold promise for informing the effective scale up of TasP, including new information regarding implementation adaptation strategies.
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Affiliation(s)
- Rod Knight
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kim Thomson
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.,Ontario HIV Treatment Network, Toronto, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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21
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Knight R, Small W, Carson A, Shoveller J. Complex and Conflicting Social Norms: Implications for Implementation of Future HIV Pre-Exposure Prophylaxis (PrEP) Interventions in Vancouver, Canada. PLoS One 2016; 11:e0146513. [PMID: 26756474 PMCID: PMC4710521 DOI: 10.1371/journal.pone.0146513] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/19/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV Pre-Exposure Prophylaxis (PrEP) has been found to be efficacious in preventing HIV acquisition among seronegative individuals in a variety of risk groups, including men who have sex with men and people who inject drugs. To date, however, it remains unclear how socio-cultural norms (e.g., attitudes towards HIV; social understandings regarding HIV risk practices) may influence the scalability of future PrEP interventions. The objective of this study is to assess how socio-cultural norms may influence the implementation and scalability of future HIV PrEP interventions in Vancouver, Canada. METHODS We conducted 50 interviews with young men (ages 18-24) with a variety of HIV risk behavioural profiles (e.g., young men who inject drugs; MSM). Interviews focused on participants' experiences and perceptions with various HIV interventions and policies, including PrEP. RESULTS While awareness of PrEP was generally low, perceptions about the potential personal and public health gains associated with PrEP were interconnected with expressions of complex and sometimes conflicting social norms. Some accounts characterized PrEP as a convenient form of reliable protection against HIV, likening it to the female birth control pill. Other accounts cast PrEP as a means to facilitate 'socially unacceptable' behaviour (e.g., promiscuity). Stigmatizing rhetoric was used to position PrEP as a tool that could promote some groups' proclivities to take 'risks'. CONCLUSION Stigma regarding 'risky' behaviour and PrEP should not be underestimated as a serious implementation challenge. Pre-implementation strategies that concomitantly aim to improve knowledge about PrEP, while addressing associated social prejudices, may be key to effective implementation and scale-up.
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Affiliation(s)
- Rod Knight
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Anna Carson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- * E-mail:
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22
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Knight R, Small W, Shoveller JA. HIV stigma and the experiences of young men with voluntary and routine HIV testing. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:153-67. [PMID: 26382632 PMCID: PMC4713278 DOI: 10.1111/1467-9566.12345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As routine HIV testing approaches are implemented to enhance participation rates in HIV testing, it is often widely believed that these approaches are socially and ethically justifiable given the underlying assumption that these practices will result in the widespread reduction of HIV-related stigma. Nonetheless, a variety of empirical and theoretical gaps on how HIV testing practices may impact on HIV stigma remain, raising questions about the social underpinnings of the public health rationale. We draw on 50 interviews with 18-24 year-old men to determine how HIV-related stigma is experienced differentially across subgroups of young men in relation to both voluntary and routine testing practices. The men's experiences with routine testing highlight how (mis)interpretations of universal, routine testing practices may serve to (unintentionally) burden disadvantaged subgroups of men; however, when these practices are adequately explicated, the universal dimension of a routine offer greatly diminished these concerns. These findings also show that, under the right conditions, a routine offer can provide transformative opportunities for individuals to reconceptualise their expectations over HIV and HIV-related stigma.
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Affiliation(s)
- Rod Knight
- School of Population and Public Health, University of British Columbia, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jean A. Shoveller
- School of Population and Public Health, University of British Columbia, Canada
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Knight R, Small W, Shoveller J. How do 'Public' Values Influence Individual Health Behaviour? An Empirical-Normative Analysis of Young Men's Discourse Regarding HIV Testing Practices. Public Health Ethics 2015; 9:264-275. [PMID: 27790291 DOI: 10.1093/phe/phv031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Philosophical arguments stemming from the public health ethics arena suggest that public health interventions ought to be subject to normative inquiry that considers relational values, including concepts such as solidarity, reciprocity and health equity. As yet, however, the extent to which 'public' values influence the 'autonomous' decisions of the public remains largely unexplored. Drawing on interviews with 50 men in Vancouver, Canada, this study employs a critical discourse analysis to examine participants' decisions and motivations to voluntarily access HIV testing and/or to accept a routine HIV test offer. Within a sub-set of interviews, a transactional discourse emerged in which the decision to test features an arrangement of 'giving and receiving'. Discourses related to notions of solidarity emphasize considerations of justice and positions testing as a 'public' act. Lastly, 'individualistic' discourses focused on individual-level considerations, with less concern for the broader public 'good'. These findings underscore how normative dimensions pertaining to men's decisions to test are dialectically interrelated with the broader social and structural influences on individual and collective health-related behaviour, thereby suggesting a need to advance an explicit empirical-normative research agenda related to population and public health intervention research.
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Affiliation(s)
- Rod Knight
- Simon Fraser University, University of British Columbia, and British Columbia Centre for Excellence in HIV/AIDS
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University
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O'Byrne P, Phillips JC, Campbell B, Reynolds A, Metz G. "Express testing" in STI clinics: extant literature and preliminary implementation data. Appl Nurs Res 2015; 29:177-87. [PMID: 26856511 DOI: 10.1016/j.apnr.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 01/20/2023]
Abstract
In an era of stagnant resources for sexually transmitted infection (STI) and HIV testing clinics, and at a time of ongoing-and in some cases increasing-STI and HIV transmission, it is important to trial and evaluate novel STI/HIV testing strategies. Based on the extant literature, one such approach is express testing, which includes full STI/HIV testing (as per clinical indication and client request), altered pretest counseling, and no physical examination for both men and women. In this paper, we overview the available research about express testing, including the literature on less-invasive testing, the effects of risk reduction counseling HIV testin/HIV testing, available research on various HIV testing modalities, and the reasons people undergo such testing. Thereafter, we overview our express testing program, which includes a detailed review of our clinical processes (which are unique within the published literature). Lastly, we provide some preliminary pre-implementation data to support the proposed efficacy of express testing.
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Affiliation(s)
| | | | | | | | - Gila Metz
- Ottawa Public Health, Ottawa, Canada
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O'Byrne P, MacPherson P, Ember A, Grayson MO, Bourgault A. Overview of a gay men's STI/HIV testing clinic in Ottawa: clinical operations and outcomes. Canadian Journal of Public Health 2014; 105:e389-94. [PMID: 25365275 DOI: 10.17269/cjph.105.4471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 09/02/2014] [Accepted: 08/15/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To 1) create a space where men who have sex with men (MSM) feel comfortable accessing sexually transmitted infection/human immunodeficiency virus (STI/HIV) testing, and 2) reduce STI/HIV incidence. PARTICIPANTS Gay men in Ottawa and its surrounding regions. SETTING A preponderance of diagnoses of sexually transmitted infections and HIV continue to occur among MSM. Meanwhile, other literature identifies that many MSM are reluctant to access STI/HIV testing services or to disclose their sexual practices to primary care practitioners. INTERVENTION In Ottawa, in an effort to surmount these issues and decrease STI/HIV incidence among MSM, the local public health unit in collaboration with community partners created "GayZone", a three-hour-per-week STI/HIV testing and STI treatment clinic for gay men. In this paper, we report on the uptake and STI/HIV diagnosis outcomes for this clinic from January 2010 through December 2013. OUTCOMES GayZone is a well-utilized clinic that yields a number of STI/HIV diagnoses per year. Overall, the positivity rates of the STI/HIV tests at this clinic are above-average, although lower than what might be expected by local epidemiological data. While the results of this clinic validate anonymous HIV testing, they bring into question the utility of pharyngeal swabs to test for gonorrhea and chlamydia. CONCLUSION The results of our study demonstrate the utility of a gay men's STI/HIV testing clinic and highlight some areas for improvement. Public health practitioners, frontline clinicians, and community workers in other regions who wish to implement such an STI/HIV clinic would do well to consider our results beforehand.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences School of Nursing University of Ottawa.
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Knight RE, Shoveller JA, Carson AM, Contreras-Whitney JG. Examining clinicians' experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. HEALTH EDUCATION RESEARCH 2014; 29:662-70. [PMID: 24412811 PMCID: PMC4101184 DOI: 10.1093/her/cyt116] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 12/02/2013] [Indexed: 05/13/2023]
Abstract
Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency-either implicitly (e.g., by describing heteronormative practices) or explicitly (e.g., by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable.
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Affiliation(s)
- R E Knight
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada V6T 1Z3 and School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - J A Shoveller
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada V6T 1Z3 and School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - A M Carson
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada V6T 1Z3 and School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - J G Contreras-Whitney
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada V6T 1Z3 and School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
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Brown S, Shoveller J, Chabot C, LaMontagne AD. Risk, resistance and the neoliberal agenda: young people, health and well-being in the UK, Canada and Australia. HEALTH RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.796346] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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