STICK IT TO THE                  STRUCTURES!  New approaches to social and structural drivers             of HIV among MSM...
STICK IT TO THE          STRUCTURES!     Let’s get a move on to address HIV among     folks in the masculine realm of the ...
SPECIAL EDITIONHIV in Men who have Sex with Men          July 20, 2012
AWESOME ARTICLE               7   13174                        (Millett et al., 2012)
THE CLEAR AND PARADOXICAL            PATTERN  Black MSM were more likely than other MSM toreport any preventive behaviour ...
BLACK MSM ALSO HAD……a   three-fold greater odds  of testing HIV positive……a   six-fold greater odds of   having undiagnose...
AHA!   Disparities in HIV clinical care access and use, low  income, unemployment, incarceration, low education           ...
THEY STUCK IT TO THE    STRUCTURES
 aids2031 is a consortium of partners who have come  together to look at what we have learned about the AIDS  response as...
THINKING BROADLY ABOUT         WHERE WE’RE AT Behavioural interventions can work (Sullivan et al., 2012)  Biomedical inter...
“After 25 years of AIDS it has become abundantly clear that the epidemic thrives on socialinequality and marginalization, ...
TWO MAJOR ISSUES
TWO MAJOR ISSUES
IfGAY SEX/LOVE → DANGER        does   DANGER = SEXY?               (Carballo-Diéguez et al., 2011)
NEW APPROACHES1. Re-orienting our approaches to social and   structural drivers: four key concepts2. Nurturing AIDS Resili...
Re-orienting ourapproaches to social   and structural      drivers:    FOUR KEY   CONCEPTS
#1: RE-ORIENTING OURUNDERSTANDING OF SOCIALAND STRUCTURAL DRIVERS       •   Complex       •   Fluid       •   Non-linear  ...
EXAMPLES  Links between:    • Depression and ‘risky sex’    • Gender inequality and HIV incidence (Auerbach et al., 2011)...
#2: FROM THE INDIVIDUAL TO          THE COLLECTIVE “Individual capacities are intimately tiedto the enabling (or disabling...
#3: RE-VISIONING GOALS FROM        SHORT-TERM HIV-FOCUSED     TARGETS TO LONG-TERM SOCIAL            TRANSFORMATIONS• Impo...
#4: COMBINATION APPROACHES:BIOMEDICAL AS BEHAVIOURAL AS          STRUCTURAL
Structural: Policies that require enhanced sex ed in           high school curricula            Community:Community activi...
Not  either / or      But  and / also /all of the above
AIDS RESILIENCE“a point at which individuals are effectively able to manage the risks present in their environment”      (...
AIDS RESILIENT INDIVIDUALS• have the ability to increase the safety of their  practices• can access services such as testi...
3 GUIDING OBJECTIVES
AIDS-COMPETENT               COMMUNITIES (1 OF 2) The knowledge and skills to prevent AIDS and a means  of translating th...
AIDS-COMPETENT              COMMUNITIES (2 OF 2) A sense of solidarity and common purpose that  allows people to work tog...
SEROADAPTATION STRATEGIES
FOSTER INDIVIDUAL AGENCY (1                          OF 2)“the capacity of individual humans to actindependently and to ma...
FOSTER INDIVIDUAL AGENCY (2                               OF 2) is intimately tied to the definition of enabling environm...
BUILD HEALTH-ENABLING            ENVIRONMENTS Access to appropriate health and social  services Economic empowerment Fr...
SO WHAT CAN WE ACTUALLY DO?
SIX STRATEGIC ACTIONS           (aids2031 Social Drivers Working Group, 2010)
STRATEGIC ACTION #1 “Know your epidemic” by including routinesociological assessments to identify and explore those dimens...
STRATEGIC ACTION #1 Most of the research is focused in the three urban   centres of Canada Introduce an MSM stream into ...
STRATEGIC ACTION #2     Devolve planning and priority-setting      processes to ensure local relevance and  involvement of...
STRATEGIC ACTION #2 Provincial gay men’s health summits & meetings Ontario’s GMSH Alberta Community Council on HIV Gay...
STRATEGIC ACTION #3Link the integration of structural approaches tobudget lines that are sufficiently robust for supportin...
STRATEGIC ACTION #3 Current funding structures are… not conducive to an up-stream, community-based approach to gay  men’...
STRATEGIC ACTION #4     Develop a monitoring and evaluation      framework that will account for multi-dimensional changes...
STRATEGIC ACTION #4 Statistics Canada Canadian Community Health Survey Census M-Track Sex Now Male Call Canada
STRATEGIC ACTION #5Strive toward and adhere to a minimum legal standard and introduce processes to ensure  effective imple...
STRATEGIC ACTION #6 Establish inter-sectoral AIDS coalitions tointegrate HIV efforts with broader health and          deve...
LOVE EACH OTHER
THANK YOU     Community-Based Research CentreProfessor Dan Allman (University of Toronto)         Chi Chung Lau, Colleague...
REFERENCES aids2031 Social Drivers Working Group. (2010). Revolutionizing the AIDS Response: Building AIDS Resilient   Co...
REFERENCES Kippax, S. (2012). Effective HIV prevention: the indispensable role of social science. Journal of the Internat...
Len Tooley-stick it to the structures!
Len Tooley-stick it to the structures!
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  • Wow, Sarah! That was amazing. Thank you so much for that work – it’s something our movement really needs and good to start looking for consensus. My name is Len Tooley and I come to this conference wearing a few different hats. I work at a national HIV organization called CATIE doing capacity building and knowledge translation, I do HIV testing and STI counselling with guys who love/do guys through Hassle Free Clinic in Toronto, and I just finished a degree in public health at the University of Toronto. Fortunately for me, I submitted a very academic abstract to the community-based research centre and – yay! – they accepted it. This presentation is actually baed on a paper I wrote to complete my degree. Unfortunately for the CBRC…
  • I’m also known as Lenora Ramona Lovelace the Second. To be honest, I think I’m actually the first, but I always like to hedge my bets and I figure if someone else says they claimed the title first second is still OK with me. My real presentation is called Stick it to the Structures! Let’s get a move on to address HIV among folks in the masculine realm of the gender multiverse who do and/or love each other. And while I’m being a bit facetious, I wanted to re-name my title because, well, I have a big, catholic, confession to make. That’s that I don’t actually identify as gay or as a man. I’m queer. And to me that means the sexual possibilities are so much more endless and for me that really works. I also don’t really like how the things I do are often either considered manly or feminine – because I think they’re actually just sorta gay. Or queer. So I really prefer the term genderqueer. That being said, I have a lot of sex with gay men. I work with gay men, I work for gay men. I even have had the words “gay men” in my job title. But I wanted to reflect the diversity of sexuality and gender orientations that sometimes we don’t really get to explore all that much, particularly in professional settings.
  • Now on to business…. So a few months ago, around the time of the international AIDS conference, there was this special edition of the lancet that specifically focused on HIV in Men who have sex with men. If you haven’t seen it, I highly suggest reading through it. It’s online so you can GOOGLE it.
  • In the issue, there was this awesome article called “ Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and the USA: a meta-analysis” So a meta-analysis is basically where you take a bunch of studies, combine and compare them, and by looking at them all together come to new conclusions. Basically, they wanted to ask the question – why, in many parts of the world, are we seeing higher rates of HIV in black MSM than in other MSM? They basically looked at articles that had words relevant to race like black, african, caribbean, afro-, african-american. <Click> So they looked at Canada, the UK, and the USA and ended up including 174 studies from the US, 13 from the UK and…..7 from Canada. Waawaa. So, the funny thing is that Canada was actually different from the US and UK. They actually didn’t find much interesting stuff in Canada, so the data I’m going to be talking about is actually focused on the US and UK. But I promise, it’s worth looking at.
  • <CLICK> for CHECK MARK
  • So despite all their preventive behaviours, why do black MSM seem to be at higher risk of HIV?
  • Social Drivers Working Group: A number of leading social scientists who have been collaborating to revise and enhance our understanding of how social and structural drivers impact our experience of HIV as well as think about how we can address those drivers BASICALLY WHAT I AM GOING TO DO IS PRESENT THE KEY CONCEPTS THAT HAVE BEEN DEVELOPED THROUGH THIS INITIATIVE AND TALK ABOUT HOW THEY ALIGN WITH GAY MEN’S HEALTH.
  • But we know that some things DO WORK. But why haven’t they been sufficient? We’ve been exploring many different answers at this summit. <click> Is it that we just don’t have enough funding to make it work? <click> Is it that these things work but we just haven’t brought them up to the required scale? <click> Is it that they work but only for a period of time, and then they lose their effectiveness? <click> Is it that they work but just not well enough? We know that it’s actually probably a combination of all of these things.
  • OK, so we have to do better. But Lenora, you say, we *know* this already – we have already been talking about all these structural issues!
  • So let’s back up and look at one of the more commonly used models to think about HIV risk. This is called the socio-cultural model. Basically the model starts with Individual behaviour. But then it acknowledges that behaviours occur in a context. <Click> Relationships <Click> Community <Click> Social/Structural <Click> But the problem that some have levelled at this model is that, in the end, it all comes back to the individual. And that can have to major consequences. <click>
  • The first is shame. <CLICK> So as I mentioned I’m an HIV tester, and I do testing in a bathhouse in Toronto. I actually do the rapid test with the client sitting beside me, so we see the results together. And more often than not, when we move to exploring their feelings, a common theme of shame emerges. In other words, I should have known better and this is what I get for doing what I did. They say you only have 30 seconds to get information in to someone before they blank after getting a positive diagnosis. The one message I always try to convey is that HIV IS NOT YOUR FAULT. But there are many people who might not agree with me. <<MOVING ON>>
  • A second concern is the consequence of focusing on individual, RISKY behaviours. In a society where heterosexual unions are really priveleged and idealized <CLICK> When we have sexual or romantic thoughts for other men, often that is <CLICK> DANGEROUS. Socially dangerous. And so a few academics have picked up on the idea that…. <click>
  • <CLICK> for BB
  • So I’m going to talk about ways of moving forward in three sections. <READ SECTIONS>
  • First, how can we re-think or re-orient our approachs to social and structural drivers?
  • Note that I mentioned DRIVERS and I am not using the word DETERMINANTS any more.
  • Condoms are a great example of a biomedical tool that has seen interventiosn at all levels.
  • Condoms are a biomedical, behavioural, and structural intervention all at the same time Obviously condoms have not been the solution to HIV among gay/bi/MSM men – so it is probably arguable that even when all three are combined they are not sufficient That doesn’t mean things are hopeless, it just means we need more options at every level – biomedical, behavioural, and structural You can choose where you want to act and how you want to spend you time – but I would challenge everyone to question how they can support one another rather than rip each other’s approaches to shreds.
  • A further implication, and requirement of, structural interventions is how they “[highlight] the need for more prevention options” (de Wit et al., 2011, p. 3) both within and across different epidemic scenarios. Disrupting the distinctions between biomedical, behavioural and structural interventions is an important conceptual shift that provides the flexibility to tailor multi-faceted interventions that address the complex nature of different HIV epidemics. In order to do this effectively Hayes et al. (2010) emphasize that it is social sciences and community experience which are integral to tailoring programmes to local epidemics, such that interventions “be attuned to people’s life conditions, address all the interacting barriers to prevention and be delivered with the intensity and quality necessary to achieve intended effects” (p. S85). ny options open to me as possible when I think about managing HIV risk in my daily life.
  • Rather than a quality, a point.
  • AIDS resilience is cultivated by attempting to achieve three guiding objectives.
  • Compare last point to idea of syndemics and multi-sectoral collaboration
  • Ever since the introduction of HIV/AIDS, communities of GBMSM have picked up on the science of HIV and its transmission and utilized this to modify their sexual behaviours (translating information into action). Sullivan (2012) argues that historic examples of group-level behaviour change, such as the adoption of condoms by GBMSM in the 1980s, “…show that community-initiated strategies can have an important role in shaping of epidemics” (p. 390). Increasing amounts of research are beginning to acknowledge and study the practices that gay men are adopting with the hope that these practices will reduce their HIV risk (Mao et al., 2011; Philip, Yu, Donnell, Vittinghoff, & Buchbinder, 2010; Zablotska et al., 2009). These practices are generally called seroadaptation strategies, and an increasing number of them revolve around condomless sex.
  • GASP – Is Lenora talking about INDIVIDUALS in a SOCIAL STRUCTURAL DRIVERS presentation??
  • GASP – Is Lenora talking about INDIVIDUALS in a SOCIAL STRUCTURAL DRIVERS presentation??
  • In an analysis of representation of MSM over five years of annual Canadian Association for HIV/AIDS Research conferences (the largest HIV/AIDS research conference in Canada), Tooley (2012a) found that only 12% of abstracts made any mention of MSM, with 7% exclusively addressing MSM . Further, only 1.2% of all abstracts exclusively addressed HIV positive MSM (Tooley, 2012a) , who have accounted for 55.4% of all HIV positive test reports in Canada since 1985 (Public Health Agency of Canada, 2012a). MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • iN an analysis of representation of MSM over five years of annual Canadian Association for HIV/AIDS Research conferences (the largest HIV/AIDS research conference in Canada), Tooley (2012a) found that only 12% of abstracts made any mention of MSM, with 7% exclusively addressing MSM . Further, only 1.2% of all abstracts exclusively addressed HIV positive MSM (Tooley, 2012a) , who have accounted for 55.4% of all HIV positive test reports in Canada since 1985 (Public Health Agency of Canada, 2012a). MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • iN an analysis of representation of MSM over five years of annual Canadian Association for HIV/AIDS Research conferences (the largest HIV/AIDS research conference in Canada), Tooley (2012a) found that only 12% of abstracts made any mention of MSM, with 7% exclusively addressing MSM . Further, only 1.2% of all abstracts exclusively addressed HIV positive MSM (Tooley, 2012a) , who have accounted for 55.4% of all HIV positive test reports in Canada since 1985 (Public Health Agency of Canada, 2012a). MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • iN an analysis of representation of MSM over five years of annual Canadian Association for HIV/AIDS Research conferences (the largest HIV/AIDS research conference in Canada), Tooley (2012a) found that only 12% of abstracts made any mention of MSM, with 7% exclusively addressing MSM . Further, only 1.2% of all abstracts exclusively addressed HIV positive MSM (Tooley, 2012a) , who have accounted for 55.4% of all HIV positive test reports in Canada since 1985 (Public Health Agency of Canada, 2012a). MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  •  There’s not much I can say about this, other than, as always, we need to get creative. And we need to be honest about a number of things: • First, we need to be honest about what the law now clearly requires for consent • Second, we need to be honest about the fact that HIV transmission has a HUGE grey zone and that it’s almost impossible to say for any particular sexual encounter whether HIV has been transmitted or not, although we do have a very good idea of what the most likely outcome is • Thirdly I would suggest that we as individuals need to practice something different: if you want to know, ASK. If you don’t ask, don’t blame.
  • iN an analysis of representation of MSM over five years of annual Canadian Association for HIV/AIDS Research conferences (the largest HIV/AIDS research conference in Canada), Tooley (2012a) found that only 12% of abstracts made any mention of MSM, with 7% exclusively addressing MSM . Further, only 1.2% of all abstracts exclusively addressed HIV positive MSM (Tooley, 2012a) , who have accounted for 55.4% of all HIV positive test reports in Canada since 1985 (Public Health Agency of Canada, 2012a). MOST OF THE RESEARCH IS FOCUSED IN THE THREE URBAN CENTRES OF CANADA INTRODUCE AN MSM STREAM INTO THE CIHR HIV/AIDS COMMUNITY-BASED RESEARCH PROGRAM INTEGRATE SOCIOLOGIAL ASSESSMENTS INTO M-TRACK
  • Len Tooley-stick it to the structures!

    1. 1. STICK IT TO THE STRUCTURES! New approaches to social and structural drivers of HIV among MSM in CanadaLen Tooley, MPHDalla Lana School of Public Health, University of Toronto2012 BC Gay Men’s Health SummitNov. 2, 2012
    2. 2. STICK IT TO THE STRUCTURES! Let’s get a move on to address HIV among folks in the masculine realm of the gender multiverse who do and/or love each otherLenora Ramona Lovelace II2012 BC Gay Men’s Queer Utopia
    3. 3. SPECIAL EDITIONHIV in Men who have Sex with Men July 20, 2012
    4. 4. AWESOME ARTICLE 7 13174 (Millett et al., 2012)
    5. 5. THE CLEAR AND PARADOXICAL PATTERN Black MSM were more likely than other MSM toreport any preventive behaviour against HIV infection condom use HIV testing fewer sex partners less amphetamine use less drug use before or during sex disclosure of HIV status to sex partners (Millett et al., 2012)
    6. 6. BLACK MSM ALSO HAD……a three-fold greater odds of testing HIV positive……a six-fold greater odds of having undiagnosed HIV infection compared with other MSM… (Millett et al., 2012)
    7. 7. AHA! Disparities in HIV clinical care access and use, low income, unemployment, incarceration, low education access“rather than disparities in sexual and substance-use risk behaviours”affect availability and choice of sex partners and localize sexual networks to neighbourhoods with a high background HIV prevalence and community viral load, raising infection risks (Millett et al., 2012)
    8. 8. THEY STUCK IT TO THE STRUCTURES
    9. 9.  aids2031 is a consortium of partners who have come together to look at what we have learned about the AIDS response as well as consider the implications of the changing world around AIDS. Numerous working groups (Costs and Financing, Leadership, Programmatic Response, and more) Social Drivers Working Group • Judith Auerbach, Dave Bell, Carlos Cáceres, Caitlin Chandler, Ellen Foley, Anne Hendrixson, Kimberly Keller, Anne Murenha, Jessica Ogden, Justin Parkhurst, Barbara Thomas-Slayter, and Ann Warner
    10. 10. THINKING BROADLY ABOUT WHERE WE’RE AT Behavioural interventions can work (Sullivan et al., 2012) Biomedical interventions can work (de Wit et al., 2011)But our efforts to date, while essential, have not been sufficient.
    11. 11. “After 25 years of AIDS it has become abundantly clear that the epidemic thrives on socialinequality and marginalization, at the root of which are imbalances in power relations.” aids2031.org
    12. 12. TWO MAJOR ISSUES
    13. 13. TWO MAJOR ISSUES
    14. 14. IfGAY SEX/LOVE → DANGER does DANGER = SEXY? (Carballo-Diéguez et al., 2011)
    15. 15. NEW APPROACHES1. Re-orienting our approaches to social and structural drivers: four key concepts2. Nurturing AIDS Resilience3. Strategic Actions
    16. 16. Re-orienting ourapproaches to social and structural drivers: FOUR KEY CONCEPTS
    17. 17. #1: RE-ORIENTING OURUNDERSTANDING OF SOCIALAND STRUCTURAL DRIVERS • Complex • Fluid • Non-linear • Contextual • Interact with biological, psychological, behavioural, and other social forces
    18. 18. EXAMPLES  Links between: • Depression and ‘risky sex’ • Gender inequality and HIV incidence (Auerbach et al., 2011) • Criminalization of same-sex behaviour and HIV incidence (Altman, et al, 2012)  Syndemics and resilience (Stall et al., 2008)  Positive marginality (Meyer et al., 2011)Auerbach et al. (2011) conclude that language must shift to “discussinghow, in what circumstances, and for whom particular combinations of factors contribute to HIV vulnerability (or, conversely, resilience)”
    19. 19. #2: FROM THE INDIVIDUAL TO THE COLLECTIVE “Individual capacities are intimately tiedto the enabling (or disabling) character of social norms, practices and institutions” (Kippax, 2012)
    20. 20. #3: RE-VISIONING GOALS FROM SHORT-TERM HIV-FOCUSED TARGETS TO LONG-TERM SOCIAL TRANSFORMATIONS• Importance vs. urgency• Are there measures other than HIV prevalence and incidence, community viral load, etc. that we can take into account?
    21. 21. #4: COMBINATION APPROACHES:BIOMEDICAL AS BEHAVIOURAL AS STRUCTURAL
    22. 22. Structural: Policies that require enhanced sex ed in high school curricula Community:Community activism & group-level norms around safer sex strategies Organizational:Outreach works at ASOs trained to reach out & educate specific populations & distributing condoms Behavioural:Condom use and other safer sex strategies Biomedical: Insertive/receptive condoms and lube
    23. 23. Not either / or But and / also /all of the above
    24. 24. AIDS RESILIENCE“a point at which individuals are effectively able to manage the risks present in their environment” (aids2031 Social Drivers Working Group, 2010).
    25. 25. AIDS RESILIENT INDIVIDUALS• have the ability to increase the safety of their practices• can access services such as testing and treatment• assert their own desires and preferences• can claim their rights without threat to themselves, their partners or their families
    26. 26. 3 GUIDING OBJECTIVES
    27. 27. AIDS-COMPETENT COMMUNITIES (1 OF 2) The knowledge and skills to prevent AIDS and a means of translating this information into action in their own lives; Social spaces for dialogue and critical thinking so that people can collectively renegotiate individual and social norms that negatively impact the health and well-being of the community; A sense of agency, ownership and responsibility about the response to the epidemic; (Campbell, 2009)
    28. 28. AIDS-COMPETENT COMMUNITIES (2 OF 2) A sense of solidarity and common purpose that allows people to work together despite potentially competing interests and to tackle the problem collectively; Access to bridging social capital that allows people the ability to connect with and access resources from outside communities or organizations that can support them in their efforts against the epidemic. (Campbell, 2009)
    29. 29. SEROADAPTATION STRATEGIES
    30. 30. FOSTER INDIVIDUAL AGENCY (1 OF 2)“the capacity of individual humans to actindependently and to make and act upon their own decisions” (aids2031 Social Drivers Working Group, 2010)
    31. 31. FOSTER INDIVIDUAL AGENCY (2 OF 2) is intimately tied to the definition of enabling environments in the sense that those environments must allow for people to have “high levels of self-confidence, perceived self-efficacy, and some sense of freedom and choice over one’s personal well-being and welfare” (aids2031 Social Drivers Working Group) it does not allow for one social goal to be placed too far above others, it prevents the “sacrifice of broader social development goals for the sake of HIV prevention calls for “social valuation, which must be transparent and open to debate” (Parkhurst, 2012)
    32. 32. BUILD HEALTH-ENABLING ENVIRONMENTS Access to appropriate health and social services Economic empowerment Freedom from discrimination and harassment Gender equality Human rights Social capital
    33. 33. SO WHAT CAN WE ACTUALLY DO?
    34. 34. SIX STRATEGIC ACTIONS (aids2031 Social Drivers Working Group, 2010)
    35. 35. STRATEGIC ACTION #1 “Know your epidemic” by including routinesociological assessments to identify and explore those dimensions of social context that lead to HIV vulnerability and risk; and as a matter ofurgency, invest in building the necessary capacityfor undertaking these assessments and analysing the findings (aids2031 Social Drivers Working Group, 2010)
    36. 36. STRATEGIC ACTION #1 Most of the research is focused in the three urban centres of Canada Introduce an MSM stream into the CIHR HIV/AIDS Community-Based Research Program Integrate sociologial assessments into M-track
    37. 37. STRATEGIC ACTION #2 Devolve planning and priority-setting processes to ensure local relevance and involvement of affected communities and civil society organizations and networks, especiallythose that include HIV positive persons and young people. (aids2031 Social Drivers Working Group, 2010)
    38. 38. STRATEGIC ACTION #2 Provincial gay men’s health summits & meetings Ontario’s GMSH Alberta Community Council on HIV Gay men’s focused health promotion organizations (HiM)
    39. 39. STRATEGIC ACTION #3Link the integration of structural approaches tobudget lines that are sufficiently robust for supporting substantial, long-term action and project cycles of five to fifteen years or more. (aids2031 Social Drivers Working Group, 2010)
    40. 40. STRATEGIC ACTION #3 Current funding structures are… not conducive to an up-stream, community-based approach to gay men’s health or HIV prevention. limiting the types of knowledge we need to acquire preventing us from doing upstream, structural research not reflective of the nature of the work that is being done not sustainable, leading to short-lived programs that need to re-invent themselves regularly in order to continue functioning (CATIE, 2010)
    41. 41. STRATEGIC ACTION #4 Develop a monitoring and evaluation framework that will account for multi-dimensional changes in the social, economic and political environment alongside assessments of HIV prevalence and incidence. (aids2031 Social Drivers Working Group, 2010)
    42. 42. STRATEGIC ACTION #4 Statistics Canada Canadian Community Health Survey Census M-Track Sex Now Male Call Canada
    43. 43. STRATEGIC ACTION #5Strive toward and adhere to a minimum legal standard and introduce processes to ensure effective implementation, enforcement and awareness of laws that reduce stigma and protect human rights and equity. (aids2031 Social Drivers Working Group, 2010)
    44. 44. STRATEGIC ACTION #6 Establish inter-sectoral AIDS coalitions tointegrate HIV efforts with broader health and development approaches.
    45. 45. LOVE EACH OTHER
    46. 46. THANK YOU Community-Based Research CentreProfessor Dan Allman (University of Toronto) Chi Chung Lau, Colleague Uncle Danny
    47. 47. REFERENCES aids2031 Social Drivers Working Group. (2010). Revolutionizing the AIDS Response: Building AIDS Resilient Communities (Synthesis Paper). aids2031. Auerbach, J. D., Parkhurst, J. O., & Cáceres, C. F. (2011). Addressing social drivers of HIV/AIDS for the long-term response: Conceptual and methodological considerations. Global Public Health, 6(sup3), S293–S309. doi:10.1080/17441692.2011.594451 Campbell, C. (2009). Building AIDS Competent Communities: possibilities and challenges. aids2031 meeting. Salzburg. Carballo-Diéguez, A., Ventuneac, A., Dowsett, G., Balan, I., Bauermeister, J., Remien, R., Dolezal, C., et al. (2011). Sexual Pleasure and Intimacy Among Men Who Engage in “Bareback Sex.” AIDS and Behavior, 15, 57 –65. CATIE. (2010). New Directions in Gay Men’s Health and HIV Prevention in Canada: Pan-Canadian Deliberative Dialogue Report, 2010 (p. 32). Retrieved from http://www2.catie.ca/en/resource/new-directions-gay-mens- health-and-hiv-prevention-canada-pan-canadian-deliberative-dialogu-0 de Wit, J. B. F., Aggleton, P., Myers, T., & Crewe, M. (2011). The rapidly changing paradigm of HIV prevention: time to strengthen social and behavioural approaches. Health Education Research, 26(3), 381–392. doi:10.1093/her/cyr021
    48. 48. REFERENCES Kippax, S. (2012). Effective HIV prevention: the indispensable role of social science. Journal of the International AIDS Society, 15(17357), 1–8. doi:10.7448/IAS.15.2.17357 Meyer, Ilan H., Ouellette, S. C., Haile, R., & McFarlane, T. A. (2011). “We’d Be Free”: Narratives of Life Without Homophobia, Racism, or Sexism. Sexuality Research and Social Policy, 8(3), 204–214. doi:10.1007/s13178-011-0063-0 Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries 4th, W. L., Wilson, P. A., Rourke, S. B., et al. (2012). Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. The Lancet, 380(9839), 341–348. doi:10.1016/S0140-6736(12)60899- X Stall, R, Friedman, M., & Catania, J. A. (2008). Interacting Epidemics and Gay Men’s Health: A Theory of Syndemic Production among Urban Gay Men. In R. Wolitski, R. Stall, & R. O. Valdiserri (Eds.), Unequal opportunity : health disparities affecting gay and bisexual men in the United States (pp. 251–274). New York: Oxford University Press. Sullivan, P. S., Carballo-Diéguez, A., Coates, T., Goodreau, S. M., McGowan, I., Sanders, E. J., Smith, A., et al. (2012). Successes and challenges of HIV prevention in men who have sex with men. The Lancet, 380(9839), 388–399. doi:10.1016/S0140-6736(12)60955-6
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