This document summarizes a presentation on renewing HIV prevention efforts for gay and bisexual men in British Columbia. The presentation discusses recommendations from advisory groups to release a provincial report in 2014 on the current state of the HIV epidemic among gay and bisexual men in BC. It emphasizes the need for a comprehensive and partnership-based approach that meaningfully involves gay and bisexual men. This includes expanding HIV testing, promoting sexual health, addressing social determinants, and monitoring trends through ongoing research.
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Day 2 1530 - mark gilbert
1. 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
2. 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
4. 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
5. 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
6. Sub-populations facing additional vulnerability
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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
7. 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
8. 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)
9. 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
10. 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
11. 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
12. 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
Editor's Notes
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