Day 2   1530 - mark gilbert
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  • Provincial workplan:Joint government/community leadership; all levels of drivers; clear goals, objectives, commitments, timelines; appropriately funded and resourcedProvincial health strategy:HIV prevention as key component; broader focus on overall health and wellness; focus on community, social, structural determinants; partnership with community; sustained programmatic support & funding accessible to community agencies
  • Testing: Expand/adapt successful testing models (low-barrier testing, dedicated clinics, outreach testing, routine testing; expand pooled NAAT; develop innovative approaches (internet-based testing, home testing, couples-based testing); provincial testing guidelines for MSMBiomedical approachesCondom distribution; support starting/staying on treatment (peer navigators); PEP; PrEP; maintain summary of evidence and recommendations re potential benefits/limitationsSexual healthExpand STI testing; HPV vaccination; include gay/bi men in provincial STI strategy; school-based sexual health education
  • HIV positive men:Support active adoption of prevention behaviours; aging with HIV; mental health; reduce HIV stigma within gay communitiesCampaigns:Multi-pronged (multiple media, multiple sectors, adapted regionally); responsive to current trends, evaluated, and evolveMental health/substance useAligned with provincial Health Minds, Healthy People 10-yr plan; dedicated services and increased cultural competency/capacity existing services; across BC (self-management, peer counselors/support groups, online/tele-health)Aboriginal/ethnocultural minority:Among Aboriginal/Two-spirited men (greater risk, rural/remote communities) recognize impact of colonization, inter-generational trauma, residential schools; support initiatives aiming to reduce racism among gay/bi men; recent immigrants; English as a second language; homophobia within ethnocultural minority populations
  • Health system: Consider specific inequities on basis of sexual orientation/gender identity; respectful and responsive health services (gay-friendly, organizational policies, professional practice standards); provider training; improve capacity of gay/bi men to navigate health system Reduce stigma and discrimination:Prosecutorial guidelines based on best available evidence and public health legislation preferred; public programs or campaignsEnvironments:Importance of family acceptance (support for parents of youth of all sexual orientation/gender identity); support for coming out process; foster social and community engagement (e.g., leadership skills for youth, intergenerational); school policies/programs that address discrimination/harassment/bullying on basis of sexual orientation and gender identity; programs that foster supportive school environments, connections, resilience of youth (e.g., GSA, community programs); discrimination/harassment in workplace
  • Monitoring:Use and resource community-based surveys and knowledge generation; size and membership of population and how changing over time; capacity-building for program evaluation and knowledge disseminationResearch:Partner with community organizations to identify priorities/support CBR; implementation science approaches (maximize impact different interventions); social science methods (e.g., life-course, intersectionality); data linkage initiatives- Includes list of current research priorities identified by advisory groups

Day 2   1530 - mark gilbert Day 2 1530 - mark gilbert Presentation Transcript

  • Renewing HIV Prevention for Gay Men in British Columbia Mark Gilbert, MD, FRCPC Clinical Prevention Services Presentation to BC Gay Men’s Health Summit November 2013
  • Background • Provincial Health Officer will be releasing a report in 2014 entitled “The Current State of the HIV Epidemic among Gay and Bisexual Men in BC: Renewing HIV Prevention” • Includes and endorses recommendations from Community and Public Health/Clinical Advisory Groups Number of new HIV diagnoses by exposure group, BC, 2003-2012
  • Conceptual approach
  • Key messages • Is a complex epidemic, no simple solutions • Fundamental differences to other populations, and specific focus on gay/bi men warranted • Not a uniform population but diverse social/sexual groups • Traditional public health response no longer sufficient: remain essential strategies, but need more comprehensive, multi-level approaches • Concerted, focused effort and partnership among government, health agencies, community organizations, researchers • Gay/bi men first population affected, first to mobilize, with demonstrated resiliency in face of legacy of a devastating epidemic and social marginalization that continues to this day • Gay/bi men need to be empowered and meaningfully involved in the continued response to the epidemic
  • Best practices for implementation • Meaningful involvement & leadership by gay/bi men, which must involve HIV positive men • Use positive, assets- or strengths-based approaches • Online program/outreach models which are linked to regional onthe-ground services • Need for services specific to gay/bi men as well as working with other sectors to improve reach and engagement of existing health services • Tailored to the epidemiology of the epidemic, reflect regional differences, evolve over time in response
  • Sub-populations facing additional vulnerability • • • • • • HIV positive men Aboriginal and Two-spirited men Other ethnocultural minority men Young gay and bisexual men Men in suburban, rural and remote regions Gay and bisexual men in active sexual networks
  • 1. Recommendations at a Policy Level • Develop, implement and monitor a provincial HIV prevention workplan for gay and bisexual men in BC, integrated within the provincial STOP HIV/AIDS program • Develop a long-term provincial health strategy for gay and bisexual men
  • 2. Addressing individual and network level drivers • Expand HIV testing to increase uptake and frequency of testing among gay and bisexual men, using targeted and routine approaches in a variety of settings • Continue to support biomedical approaches to HIV prevention • Promote sexual health by using a sexual health framework that goes beyond HIV, STIs and behaviour to incorporate physical, social and mental aspects of sexual health (e.g., relationships, intimacy, pleasure)
  • 3. Addressing Community & Relationship Drivers • Support central role of HIV-positive men in HIV prevention • Implement regular, periodic health promotion and education campaigns for gay/bi men across BC • Better meet the mental health and substance use needs of gay/bi men in BC • Engage and support communities of Aboriginal, Two-spirited, and other ethnocultural minority gay and bisexual men to reduce disparities in health and HIV prevention
  • 4. Addressing social and structural Drivers • Improve the capacity of policies, programs and services within the BC health system to reduce existing health inequities for gay/bi men, in alignment with existing provincial policies for improving health equity and quality • Support initiatives that aim to reduce stigma and discrimination associated with HIV at a societal level • Promote positive mental health and wellbeing for gay and bisexual men of all ages by fostering safe and supportive environments
  • 5. Monitoring, evaluation, and research • Establish ongoing monitoring to identify changes in trends and population dynamics • Address key gaps in research, both in terms of specific knowledge gaps as well as prioritization of research, related to HIV prevention for gay/bi men in BC
  • Acknowledgements • My profound thanks for the support and thoughtful contributions of many people here today • If you have any SFW images (photos, posters, campaigns) for the report please send them my way mark.gilbert@bccdc.ca Tel: 604-707-5615