Our Youth, Our Response

Building Capacity for Effective HIV/HCV Policy and Programming

Responses Across the Atlantic Region

Anik Dubé, Jacqueline Gahagan, Greg Harris, Lois Jackson, Jo-anne MacDonald, Kathleen Hare, Pamela Hudson, Jocelyne Maurice,

Maryanne Tucker, Sally Walker

3-year project, started June, 2011 Funded by Nova Scotia Health

Research Foundation Analyzes policies and programs

related to HIV/HCV prevention in youth in four Provinces and makes recommendations for change.

Uses information from all 4 provinces

The Project

Led by Dr. Jacqueline Gahagan, Dalhousie University

12 researchers from the 4 Atlantic provinces

Part-time coordinator and 4 Research Assistants

Community Advisory Committee with 11 members from all 4 Atlantic provinces

Youth Advisory Committee with 7 members

The Team Collaboration

Youth are at risk of HIV/HCV infection through:

Unprotected sexual intercourse with infected partner

Injection drug use Unsafe tattooing practices Lack of accurate knowledge of HIV/HCV

transmission risk factors

Background

Social Determinants of Health influence likelihood of contracting HIV/HCV:

Income and social status Age Gender Culture Health Services Social and physical environments

Background (cont’d.)

HIV & HCV share many features in common:

Prevalence among youth Stigma Negative impact on lives of infected

and affected individuals Preventable with proper knowledge of

transmission and ways to prevent transmission

Background (cont’d.)

Determines programs & services and methods of delivery

Provides restrictive measures for reporting and testing

Should address determinants of health Policies from several sectors have impact

Health Education Justice

Policy framework needed to integrate multiple sectors

Role of Policy

1. Analyze existing HIV/HCV primary and secondary prevention policies and programs for youth in the Atlantic Region

2. Determine with our stakeholders how well these address the needs of youth and social determinants of health

1. Policy advisors2. Youth3. Youth workers

Objectives of Study

3. Identify gaps in the effectiveness of the policies and programs

4. Develop multi-sectoral policy recommendations for Nova Scotia

5. Provide opportunities for policy capacity building through knowledge exchange

Objectives of Study (2)

1. What HIV/HCV primary and secondary prevention policies related to youth exist in the Atlantic Provinces?

2. Do these policies (and programs) adequately address the needs of youth?

3. How do the prevention approaches differ for each province? How fractured or cohesive are the approaches?

Research Questions

4. What, if any, gaps exist in current policy approaches to primary and secondary prevention?

5. How can these gaps be used to refine policies and policy frameworks?

6. How can such policy refinement help inform best practices in HIV/HCV prevention among youth in Nova Scotia?

Research Questions (Cont’d.)

Based on a multidimensional approach to HIV/HCV prevention;

Used a sex, gender, diversity, and equity lens; gender identity gender roles gender relations institutionalized gender

Sex and gender-based analytic framework

Research Assistants (R.A.s) in each province worked with university librarian to develop systematic search terms and most appropriate databases

R. A.s contacted community organizations and government departments to find “grey” literature

R.A.s categorized documents in terms of types of documents, target populations, types of prevention addressed, and sector

Policy Scan: Methods

Scan of policies, programs, services completed in each province

Total number of documents coded New Brunswick 81 Newfoundland and Labrador 149 Nova Scotia 132 Prince Edward Island 63

Policy Scan: Methods

More documents related to programs than those related to policy

More documents related to primary prevention than secondary prevention

Most documents came from the health sector and government, while others came from community-based ASO and research reports

Types of Documents Found

Lack of youth framework : documents in many different organizations and departments

Different structures of government departments in different provinces

Search terms and databases searched specific to each province

Difficulty in obtaining unpublished documents

Challenges in conducting Interprovincial Policy Scan

Coding scaleRanked on a scale from 1 to 3

1: highly featured2: not fully explored3: absent from document

Research coding

OYOR coding focused on health, education, community, and justice

Coding and cross-coding across sectors Of the 62 grey literature documents:

Five documents scored 1* 29 scored 2 28 scored 3

Research coding grey literature

The health sector captured most of the coding within the sex and gender-based framework

Of the 19 academic literature articles: No article scored 1 13 articles scored 2 Six articles scored 3

Research coding academic literature

Analysis of documents showed that few are highly sensitive to multidimensional gender-based and youth-specific issues in HIV/HCV prevention Most integrate the needs of men and

women together Most are income directed to increase

awareness (i.e. gender gap in provincial wages)

Only one provincial gender-based analysis guide exist for the province and it dates back to 2003

Most do not address the determinants of health

Findings

Conduct interviews with key stakeholders and analyze results

Use results as basis for developing youth focus groups and survey for year 3

Knowledge Exchange Event: “Spread information, not disease”

Year 2

Focus groups with youthSurvey of youth (400)Analysis of all results Identification of gaps and prioritiesDevelopment of recommendations for public health policy and for program interventions

Year 3

Final Report and published papers

Meetings with youth advisory members

Meetings with provincial policy makers

Presentations at government and professional meetings/conferences

Year 3 Dissemination

For more information, contact:Dr. Jacqueline Gahagan Anik Dubé, RN, PhD (c)Professor & Chair Health Professor

promotion Université de Moncton

Dalhousie University Jacqueline Bouchard Building

6230 South Street Moncton, NBHalifax, NS B3H 3J5 506.858.4256902.494.1155 anik.dube@umoncton.cajgahagan@dal.ca

Thank you!