6 projects that highlight the imperative to “Let communities lead” on World AIDS Day

Posted on November 28, 2023
Categories: Carmen Logie, David Brennan, Faculty, Peter Newman, Research

Ending AIDS is withing our reach, but to achieve this goal, communities need to be leading the way. That’s a key message from UNAIDS during World AIDS Day 2023. The need to look beyond a biomedical approach in the global response to HIV has also long been a key message from leading researchers at the University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW).

“We live in a world where a biomedical response to disease is often prioritized above the well-established upstream social and structural factors that put people at greater risk of infection,” says Professor Peter A. Newman, whose global research focuses on HIV risk & prevention, vaccine hesitancy, LGBTQ+ health and human rights, and the social determinants of health. “More attention must be focused on intervening in the social-structural conditions that both produce disease and create systemic barriers to healthcare access in order to accelerate the effectiveness of new prevention technologies.”

In honour of World AIDS Day, here are 6 studies from FIFSW researchers that center community voices in the effort to end AIDS.

Phi-Nong project

Thailand continues to see high rates of new HIV transmission among sexual and gender minority youth. The Phi-Nong Project led by Professor Peter A. Newman in collaboration with VOICES-Thailand uncovered the multiple layers of challenges faced by young people, including young gay men and trans people between the ages of 16 to 18, in accessing HIV prevention and care.

Findings from the community-based project reveal the pervasive structural and systemic barriers in healthcare system practices and policies, a lack of comprehensive sexuality education that is inclusive of sexual and gender minority populations, and rampant stigma, which explains the very low uptake of HIV pre-exposure prophylaxis (PrEP) — a once daily pill that prevents HIV infection — among young key populations. The study also identified young people’s motivations to seek information, the great potential of peer interventions, and the critical importance of scaling up youth-friendly and gay- and trans-affirmative healthcare settings in Thailand to achieving UNAIDS targets of ending the AIDS epidemic by 2030.

Read the study published in the Journal of the International Association of Providers of AIDS Care

Reference: Newman, P. A., Tepjan, S., Fongkaew, K., Akkakanjanasupar, P., de Lind van Wijngaarden, J. W., & Chonwanarat, N. (2023). Multilevel factors impacting PrEP engagement among young gay men and young transgender women in Thailand: A qualitative analysis. Journal of the International Association of Providers of AIDS care, 22.

Uncovering the connections between HIV and climate change

A new research program on climate change and pathways to HIV, led by Professor Carmen Logie, includes newly funded CIHR Project Grants in Kenya, Uganda, and Tanzania that aim to elucidate the pathways from climate change’s impacts on food and water insecurity to HIV prevention and care outcomes. This work builds on Logie’s role as an Affiliate Professor at the United Nations University Institute for Water, Environment & Health and her research on climate change and sexual health, including food and water insecurity, in Northern Canada, Uganda, and Kenya.

Logie received the 2023 CAHR-CANFAR Excellence in Research Award in the social sciences category for her contributions to HIV/AIDS research in Canada and internationally. She was also recently announced co-chair of the Canadian Association for HIV Research (CAHR) 2024 annual conference.

References:
Logie, C., Van Borek, S., Lad, A., Gittings, L., Kagunda, J., Evelia, H., Gachoki, C., Oyugi, K., Chege, M., Omondi, B., Okuto, M., Taing, L. (2023). A creative approach to participatory mapping on climate change impacts among very young adolescents in Kenya. Journal of Global Health Reports, 7, e2023036.

Logie, C.H., Lys, C., Sokolovic, N., Malama, K., Mackay, K., McNamee, C., and Kanbari, A. (2023). Examining pathways from food insecurity to safer sex efficacy among Northern and Indigenous adolescents in the Northwest Territories, Canada. International Journal of Behavioral Medicine.

Task Shifting in HIV care

“Task shifting” in HIV care (i.e. having community organizations take on some healthcare tasks to increase access to healthcare when providers are limited) has been shown to provide quality and cost-effective HIV health services, but it’s more common in low-and middle-income countries than in Canada. In 2020, researchers led by Professor David Brennan interviewed clinicians and community health workers in Ontario and held a community consultation with key stakeholders to get their take. Most felt that rapid HIV testing could and should be provided by community health workers and that AIDS service organizations could be ideal sites for clients to obtain and use self-testing kits for sexually transmitted and blood bourne infections. The study’s authors argued that creative solutions are required to meaningfully reduce the impact of HIV and that non-regulated community health workers should be allowed to provide certain HIV prevention services, such as rapid HIV testing, with adequate training and supervision.

Read the study, published in Sexuality Research and Social Policy.

Reference: Brennan, D.J., Charest, M., Turpin, A. et al. “It’s a win for the clinic, it’s a win for the frontline, but, most importantly, it’s a win for the client”: Task Shifting HIV Prevention Services from Clinicians to Community Health Workers in Ontario, Canada. Sex Res Soc Policy 20, 780–792 (2023).

Project VOICES

Work from Project VOICES led by Professor Peter A. Newman, with Professor Charmaine Williams and Suchon Tepjan, among others, has revealed challenges and opportunities faced by people living with HIV, and various marginalized populations, around COVID-19 vaccination.

An extensive scoping review conducted by the researchers underscored the understandable concerns that people living with HIV have about how the COVID-19 vaccine may interact with current HIV medications and potential limitations based on one’s immune system. The review points to the importance of having these concerns respectfully addressed by knowledgeable healthcare providers who work with people living with HIV. The researchers also revealed the unique strengths among people living with HIV who have a trusting relationship with a healthcare provider. They concluded that COVID-19 vaccine information and recommendations from a trusted healthcare provider who is aware of the issues, concerns and intersectional challenges faced by people living with HIV who are gay, bisexual, transgender, and/or BIPOC is a key intervention to promote informed decision-making about vaccination.

Read the scoping review published in PLoS One.

Reference: Newman, P. A., Reid, L., Tepjan, S., Fantus, S., Allan, K., Nyoni, T., Guta, A., Williams, C. (2022) COVID-19 Vaccine hesitancy among marginalized populations in the U.S. and Canada: Protocol for a scoping review. PLoS One 17(3): e0266120.

HIV self-testing with urban refugees in Uganda

New developments in HIV prevention often do not reach humanitarian settings, and a recently finished CIHR-funded Project Grant “Tushirikiane (Supporting one Another)” by Professor Carmen Logie and team marked the first time HIV self-testing was conducted in one. Findings from this research, published in the Journal of the International AIDS Society, show the feasibility and promise of increasing HIV self-testing with urban refugee youth. This aligns with research that Logie does as part of the WHO Guideline Development Group on Self-Care for Sexual and Reproductive Health and Rights. More recently Logie and her team finished another HIV self-testing trial, this time in a rural refugee settlement at the Ugandan border with South Sudan. The findings, which are forthcoming, also show that HIV self-testing is well accepted, feasible and effective in increasing HIV testing in humanitarian settings.

Read the study published in the Journal of the International AIDS Society.

Reference: Logie, C., Okumu, M., Berry, I., Hakiza, R., Kibuuka Musoke, D., Nakitende, A., Baral, S., Mwima, S., Kyambadde, P., Loutet, M., Batte, S., Lester, R., Neema, S., Newby, K., Mbuagbaw, L. (2023). Findings from the Tushirikiane mobile health (mHealth) HIV self-testing pragmatic randomized trial with refugee adolescents and youth living in informal settlements in Kampala. Journal of the International AIDS Society, 26, e26185.

Bullying 2SLGBTQ+ people living with HIV

On November 16th, Professor David Brennan and his colleagues, Tsegaye Bekele, Kristen O’Brien, Abigail Kroch, gave a talk at the Community-Based Research Centre’s 2023 Annual Summit in Vancouver. This year’s summit focused on the long-term effects that childhood bullying has on 2SLBGTQ+ people living with HIV.

In 2019, the Ontario HIV Treatment Network Cohort Study included a 6-item survey tool to assess childhood bullying experiences among 2SLGBTQ+ people living with HIV due to their gender and sexual orientation. Of the 1,645 2SLGBTQ+ participants who provided information, 55.7% reported experiencing at least one form of childhood bullying. The most common forms of childhood bullying reported were verbal bullying or harassment, physical bullying or harassment, and “having a family member stop talking to me for a long time or ending the relationship.” 2SLGBTQ+ who experienced childhood bullying reported were more likely to report at least one diagnosed mental health condition and higher level of depressive symptoms when compared to 2SLGBTQ+ who did not report childhood bullying.

In their presentation, Brennan and his colleagues argued that this research study’s findings can be used to advocate against the implementation and advancement of recent stark and dangerous anti-2SLGBTQ+ policies that further harm and stigmatize 2SLGBTQ+ youth. The study supports calls to encourage more robust 2SLGBTQ+-positive policies, better interventions, and, thus, better health outcomes for 2SLGBTQ+ people.

Read the abstract in the CBRC’s Summit program.

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