Closing Presentation CAHR 2006

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Closing Presentation CAHR 2006 Powered By Docstoc
					                                     Closing Presentation
                                         CAHR 2006

Diapo 1

Hi, it’s a pleasure for me to present you a summary of the social sciences track presentations.

Diapo 2

This year, the following themes represented the main concerns of researchers in the social
sciences track: quality of life, coping strategies, sexuality and treatment among people living
with HIV; HIV prevention among MSM, sex workers and injection drug users; cultural issues
among different populations and challenges pertaining to community-based research.

Diapo 3

People living with HIV: Quality of life, coping strategies, sexual behaviours and
treatment

With a significant improvement in life expectancy of people living with HIV since the advent
or antiretroviral therapies, the question of quality of life is now considered an important
research topic for many researchers of the social sciences track. For example, Dr. Mark
Vosvick, during his lecture, proposed a promising conceptual framework offering a new
comprehension of the interrelations between quality of life, coping strategies, HIV stigma,
self efficacy, social support and forgiveness. A great number of researchers shared interest in
these interrelations.
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Jorge Flores-Aranda spoke about the interdependence between perceptions of quality of life in
light of side effects of medications among people living with HIV who live outside of
Montreal. His qualitative results showed that side effects - mainly bodily changes such as
lipodystrophy, negatively influence psychological well-being, functioning in daily life and
social functioning. Nadia Campanelli and colleagues’s findings on men’s body image and
lipodystrophy were similar as she also highlighted the importance of better understanding this
phenomenon and to adapt health and social services accordingly.

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Kelly O’Brien also discussed another aspect of quality of life. In her rigorous qualitative study
she proposed an exhaustive framework demonstrating that people living with HIV perceive
disability as episodic and multi-dimensional. In fact, level of disability may be influenced by
support, living strategies, etc. These temporary and not foreseeable disability episodes may be
triggered by HIV diagnosis, experiencing illness, etc.

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Disabilities certainly affect the capacity of people living with HIV to keep working or
returning to work. In Montreal, only thirty-nine percent of participants in the MAYA
longitudinal study were said to be currently working. The multivariate results presented by
René Lavoie also showed that, compared to people living with HIV who were not currently


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working, working participants had a greater level of quality of life, mainly concerning
physical and social functioning. However, having a job does not seem to be related to lifespan
with HIV and with treatment. It would be of interest to further explore the question of whether
work is an antecedent of improved quality of life or whether a consequence of it.

Diapo 7

Mylène Fernet, through a unique qualitative study conducted among adolescents living with
HIV since birth, reported that after learning their HIV status, these adolescents adopted
coping strategies oriented towards the regulation of emotional distress and the actions which
will give themselves the possibility to live longer.

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Gregory Harris’s presentation reminded us that high risk behaviours following the moment of
discovering one’s positive serologic status sometimes represent ways to cope with this new
situation. For example, unsafe sexual behaviours, refusal of self care, and suicidal attempts
could be ways to numb the pain, to deny the situation or to seek help.

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Having an active sexual life is another important dimension of quality of life. Results from the
MAYA study demonstrated that a little over half of participating people living with HIV
reported sexual intercourse in the past six months. Among these, more than a third reported
unprotected sexual intercourse with an HIV negative partner or a partner of unknown
serological status. Findings also showed that sexual intercourse is associated with many
quality of life dimensions such as physical, sexual and social functioning.

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On the other hand, participants who have had unprotected sexual intercourse were less likely
to use active coping strategies and emotional support of friends and more likely to use drugs
or alcohol as a way to deal with their condition.

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Furthermore, Karène Proulx-Boucher reported that for adolescents living with HIV since
birth, interpersonal responsibilities, avoiding certain types of sexual activities and disclosure
management are ways identified to prevent HIV transmission to their partner. Disclosure does
not only play a role in the sexual lives of individuals living with HIV, it also transcends all
aspect of their lives.

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In this respect, the study by Heidi Olson and colleagues on HIV disclosure and discrimination
attitudes of people living with HIV and medical students clearly stated that the perceived
barrier to disclosure lies more in the health provider’s failure to ask about HIV status rather
than HIV positive patient’s fear surrounding disclosure. Thus, it seems important to maintain
and reinforce training for HIV in the medical and hospital settings.




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Diapo 13

Health care providers must also develop tools to help people living with HIV manage
medication intake. In this respect, the team of José Côté and Pilar Ramirez Garcia proposed a
virtual and direct support program aiming to help people living with HIV in the management
of their medication. This program is based on concepts demonstrated as predictors of
adherence to treatment, such as self-motivation, self-observation, management of side effects,
management of emotions and other social aspects.

Diapo 14

Medication was also addressed under an ethical perspective by Timothy Christie who, with
his colleagues, proceeded to undertake an ethical examination of the program of special
access to experimental medication. He notes clear shortcomings which warrant for an
improvement of the current structure of the special access program.

Diapo 15

HIV Prevention: Continuing prevention efforts among vulnerable populations: MSM

The question of prevention, especially for men who have sex with men, is still an extremely
important question.




Diapo 16

The presentation of Dennis Haubrich reporting qualitative data from the Polaris longitudinal
study conducted in Toronto among HIV negative and positive MSM demonstrated how sexual
risk behaviours are in confluence with substance use, non disclosure of the positive status and
non consensual removal of condom by partners.

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Moreover, the results from the Sex Now project, presented by Terry Trussler, in British
Columbia, indicated that social pressure from peers to practice unsafe sex seems to be one of
the most important predictors of unprotected anal intercourse. They stated that the permissive
attitude towards unsafe practices seems to open the door to risk taking behaviour among gay
populations in Vancouver.

Diapo 18

On his part, Jeffrey Aguinaldo suggested that social norm of dishinibition caused by
substance use in the gay community tends to excuse MSM who do not practice safe sex.

Diapo 19



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 Instead of generalizing the experience of disinhibition to all gay men and normalize this
behaviour, he recommended that prevention campaigns should stress that unsafe sex while on
substances is neither acceptable nor inevitable and that research efforts should attempt to
identify successful safer sex strategies that gay men already use.

Diapo 20

As indicated by Sandra Bullock, MSM who are users of Crystal meth are particularly
vulnerable to HIV. In the same vein, the presentation of Thomas Lampinen further pursued
this line of research, by explaining the reasons why MSM start using crystal meth. This study
suggested that depression and other mental illness’s are major reasons why MSM begin to use
this type of drug. Furthermore, he stated the difficulty of health services to face this problem
as well as the reluctance of users to disclose their drug consumption.


Diapo 21

HIV Prevention: Continuing prevention efforts among vulnerable populations: Sex
workers

The challenge of prevention among vulnerable populations requires the use of original
methodology to better understand the characteristics of the population and the environment in
which it progresses. Kate Shannon’s presentation is a great example of an innovative
methodology.

Diapo 22

 In the context of the MAKA Project in Vancouver, the use of social mapping provided a
geographic picture of sex work that gives a structural understanding of HIV vulnerability and
may help identify pockets of high-risk in this community. Findings also highlighted some of
the structural barriers to HIV prevention and health care access and a need for increased
support for safety initiatives for female sex workers.
Diapo 23

HIV Prevention: Continuing prevention efforts among vulnerable populations: Injection
drug users

Diapo 24

In a descriptive study conducted by Steven Petrar and colleague among injection drug users
who frequent the InSite supervised injection site in Vancouver, the majority of participants
reported that their injection behaviour had changed since using InSite. Among them, sixty-
two percent of users felt less rushed to inject and fifty-five percent injected less outside of the
site.

Diapo 25

However, many fundamental questions are raised concerning the roles of workers in injection
sites. For instance, Richard Pearshouse highlighted the legal questions related to physical



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assistance to injection drug users. He maintained that current laws criminalize such assistance
and highlighted the importance of legal reforms.

Diapo 26

On his part, Ralph Jurgens (408) shared with us the experience of syringe exchanges in
prisons in Ukraine, highlighting the importance of adequate intervention planning as well as
training.

Unfortunately, we notice that the lack of coordination between social structures and laws
hinder effective interventions. It would be of great relevance to concentrate future research
efforts on the apparent contradictions of interventions undertaken by different actors, on the
limits of legal and social structures with which we have to deal with. The reason for the
ineffectiveness of some of our interventions may perhaps be due to the behaviour of users, or
perhaps due to certain social and political limitations that are imposed.

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Multiple stigmatisation and cultural issues

Some studies discussed the presence of multiple stigmatization and discrimination among
people living with HIV of ethno-cultural background.

Diapo 28

Judy Mill reported that many persons living with HIV are victim of diverse forms of
stigmatisation. For example, not only are they stigmatized because of their belonging to a
minority group (First Nations, women, ethno-cultural community, poverty, etc), but they are
also stigmatized by society or the members of their families because of their serologic status.

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On their part, MSM of asian origin are also plagued by multiple difficulties. In this respect,
Shimpei Chihara reported that these men are victims of racism among the gay community and
of homophobia among their cultural community. Moreover, they hesitate to consult health and
social services because of language barriers and obstacles to cultural understanding.
Consequently, they feel more and more isolated.

Diapo 30

Furthermore, Roy Cain presented preliminary results of a qualitative study on depression as a
lived experience in the cultural context of First Nation people living with HIV, considering
the high prevalence of depression in these communities. The results demonstrated the
existence of a complex relation between depression, HIV and social connections which may
also be influenced by frequent alcohol or drug use.

Diapo 31

When considering the population of seropositive women living in South Africa, Erin Rogers
presented to us the specificities of the reality of these women with respect to accessing health


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and social services. In this respect, case stories from these women highlighted an
unsatisfactory experience in public, the importance of access to quality and specific
medications and also the importance for these women to be treated with respect and dignity.

Diapo 32

On her part, Sarine Lory Hovsepian with the data obtained from the MAYA study, suggested
that it is perhaps not necessary to target psychosocial interventions for women living with
HIV originating from high endemic countries that currently reside in Montreal. However, she
specified that religion represents for these women an important tool for them to better cope
with their serologic status. The dimension of spirituality should therefore be considered within
all interventions for these women –whether they be medical follow-ups or community
interventions.


Diapo 33

Reinforcing Community-Based Research: Importance of Change in Individual,
Organizational and Structural Capacities

The concept of community-based research is a fairly recent concept. However, this is a
subject that elicited much research and evaluation in order to better understand the
phenomenon and particularly the necessary pre-requisites to quality community-based
research.

Diapo 34

Following a vast consultation to document the community-based research projects in Ontario,
Rob Travers identified the challenges of community-based research. These challenges mainly
concerned competing demands, lack of physical or human resources, access to ethical
reviewing, etc. He proposes concrete strategies to respond to these issues on the level of
infrastructures, capacity building and knowledge transfer.




Diapo 35

On her part, Paula Migliardi reported a similar experience from Manitoba and Saskatchewan.
She recommended changes in individual, organizational or structural capacities to reinforce
community-based research.

Diapo 36

Finally, René Masching gave a concrete example of knowledge translation in aboriginal
community-based HIV research. In the context of the project “The diagnosis and care of HIV
infection in Canadian aboriginal youth”, she stated that effective knowledge translation
requires significant planning in advance; that direct community involvement throughout the



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project leads to deeper investment in the results with greater capacity to take action through
ongoing learning and that working, in-person, with the support of Elders, is key to success.

Diapo 37

Closing statement

We would like to take this opportunity to congratulate all those who presented their work in
the social sciences track. It is imperative to pursue this line of research to improve our
knowledge on the quality of life of people living with HIV, on HIV prevention strategies of
vulnerable populations, on cultural issues and community-based research. However, we have
to reinforce our efforts to translate this knowledge into action if we want to observe real
changes in the epidemic and in the lives of people living with HIV. Therefore, we need to
develop more effective interventions and conduct more intervention research and evaluative
research.

Finally, I want to take the time to thank Roger Leclerc, Marie-Eve Girard et Sarine Lory
Hovespian who until the last minutes, helped me with the enormous job that is reporting for
the social sciences track at CAHR. A special thank to all the students who also gave a hand in
this: Nadia Campanelli, Mélanie Gagnon, Sarah Raymond, Marianne Beaulieu et Joanie
Heppel.




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