HIV/AIDS research in Canada extends to behavioural, biomedical, clinical, economic, epidemiological, legal and psychosocial fi elds of studies.
A review of the priorities of HIV/AIDS research funding bodies revealed that the CIHR and the OHTN had identifi ed people from countries where HIV is endemic and Black communities as a priority.
A review of funded research specifi c to HIV/AIDS and Black communities in Canada identifi ed 19 research projects. Of the 19 projects identifi ed, most are taking place at the municipal level in Alberta, Ontario and Quebec. The research taking place in Alberta focuses on newcomers/recent immigrants from countries where HIV is endemic, particularly those from Africa. Only two research projects explicitly focus on people living with HIV/AIDS – one on women living with HIV/AIDS in Quebec, the other on recent immigrants living in rural Alberta. Three research projects focus on women and two focuses on Black gay, bisexual and other Black MSM. In the majority of cases, collaboration between academics and community service providers was identifi ed. In general, the research projects identifi ed are conducting psychosocial and behavioural research, which will allow for the description of experiences and the identifi cation of needs, issues, challenges and solutions by community members, and, in some situations, service providers. The following are general areas of investigation:
The following is an annotated listing of currently or recently funded research projects referenced above.
Researchers: Ruthann Tucker (University of Toronto), Saara Green (York University, Toronto), Steve Byers (AIDS Niagara), James R. Dunn (Centre for Research on Inner City Health [CRICH], St. Michael’s Hospital, University of Toronto), Dale C. Guenter (McMaster University), Stephen W. Hwang (CRICH, St. Michael’s Hospital, University of Toronto), Jay Koornstra (Bruce House, Ottawa), Laverne E. Monette (Ontario Aboriginal HIV/AIDS Strategy, Toronto), Lea A. Narciso (Ontario AIDS Network, Toronto), Sean B. Rourke (CRICH, St. Michael’s Hospital, University of Toronto), Michael Sabota (AIDS Thunder Bay).
Description: Security and quality of housing is an important determinant of health, although its impact remains poorly understood. There is little information about the housing status of people living with HIV/AIDS (PHAs) in Ontario; about the housing-related supports that are required by PHAs to ensure safety, health and dignity; and the effect of housing situation on health and on health and social service utilization. We propose to expand and enhance the work of a 2-year study (start Apr. 2005) that explores the housing status and issues for PHAs, in order to achieve the following main objectives: 1) to understand factors that affect housing status of PHAs; 2) to understand quality of housing, level of housing security, and related supports impact the mental and physical health of PHAs; 3) to understand how these factors impact the access to and utilization of health and social services; and 4) to highlight similarities and differences between particular groups of PHAs including aboriginals, ethnic minorities, women, sexual minorities, youth, and ex-prisoners with regard to their experiences of housing and homelessness. Our overarching hypothesis is that good housing quality and security is an important factor contributing to the mental and physical health of PHAs, and to their access to health and social services. We also hypothesize that good quality and security of housing decreases unnecessary health and social service utilization, and results in cost savings. Finally, we hypothesize that there are risk factors, including demographic characteristics and health status that play a role in the housing and homelessness of PHAs. We will collect both qualitative and quantitative data in a longitudinal, province-wide study design in which PHAs will be followed for up to three years. Changes in housing status will be observed, along with factors that play a role in these changes, and outcomes resulting from these changes.
Funder: Canadian Institutes of Health Research (CIHR), 2005 – 2008
Description: The goal of this three year research program is to conduct a series of collaborative and interdisciplinary research projects to improve HIV health services for specifi c groups, including HIV prevention and care needs of newcomers to Calgary from HIV-endemic countries in sub-Saharan Africa. This collaborative study will benefi t from the direct participation of service providers and members of the populations under study to ensure knowledge exchange and timely uptake of research results.
Funder: Alberta Heritage Foundation for Medical Research (AHFMR), 2005 – 2008
Researchers: Patricia O’Campo (Centre for Research on Inner City Health [CRICH], St. Michael’s Hospital, University of Toronto), Richard H. Glazier (CRICH, St. Michael’s Hospital, Institute for Clinical Evaluative Sciences [ICES], Toronto), Ahmed Bayoumi and Kamran Khan (CRICH, St. Michael’s Hospital, Toronto), Donald Wasylenki (Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto), Blake Poland (University of Toronto), James Lavery (CRICH and Centre for Global Health Research [CGHR], St. Michael’s Hospital, University of Toronto), Rosane Nisenbaum, (CRICH, Applied Health Research Centre [AHRC], St.. Michael’s Hospital, Toronto), Stephen W. Hwang, James Dunn and Janet Smylie (CRICH, St. Michael’s Hospital, University of Toronto), Kelly Murphy (Ministry of Health and Long-Term Care, Toronto)
Description: As we enter the 21st century, there are major challenges to improving the health of those Canadians who are disadvantaged and underprivileged: those with HIV/AIDS, Aboriginal peoples, new immigrants, those with mental illness, substance abuse or low socioeconomic status, amongst others. The goal of this CIHR program is to train a new generation of health researchers who will undertake a true transdisciplinary approach, using a variety of methods to understand and impact on the health issues of marginalized populations. We seek to train young investigators with the values and skills to build their own research programs designed to ultimately improve the health of marginalized Canadians.
Funder: Canadian Institutes of Health Research (CIHR), 2003 – 2009
Researcher: Vinh-Kim Nguyen (Lady Davis Institute, Jewish General Hospital Montreal)
Description: This project aims to respond to the challenges raised by expanding access to antiretroviral therapy (ART) in Africa and the growing epidemic in women from endemic countries in Canada. Specifi cally, we are concerned with providing knowledge to more effectively sustain treatment effectiveness and improve prevention measures in patients on treatment, particularly for women in or from endemic countries. Our study will be a prospective multicentre cohort study in 6 sites prescribing ART in Burkina Faso and Mali. We will enroll 800 patients starting ART. In this cohort, we will (1) Describe treatment effectiveness using immunologic and clinical outcome measures (CD4 response, AIDS defi ning illness and death); (2) Describe adherence to Highly Active Antiretroviral Therapy, using questionnaires we have previously validated in this population, by calculating time to nonadherence; (3) Describe adherence to sexual behaviours that reduce HIV transmission risk by calculating time to consistent condom use for people with regular sexual partners and time to notifi cation of sexual partners for those patients who have not yet notifi ed partners of their HIV+ status. Gender-specifi c models will be developed to identify factors that infl uence adherence and preventive behaviour for women and men separately.
Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2009
Researchers: Tam Donnelly, Daniel W.T. Lai, Paul Schnee and Catherine A. Worthington (University of Calgary)
Description: Over the past few years, Alberta has had an increase in the number of immigrants with HIV or AIDS, who came from countries with high numbers of people with HIV/AIDS. The purpose of this study is to (a) fi nd out how recent immigrants living in small towns in Alberta seek help to manage their HIV/AIDS, prevent the spread of HIV, and deal with social stigma; and (b) fi nd out how to be effective in meeting the needs of recent immigrants living with HIV/AIDS, and in promoting the use of HIV prevention activities. This study asks fi ve questions related to the purpose, as well to what kinds of things infl uence how recent immigrants access health care and social support services, and what or who encourages them to seek the right kinds of help for their HIV/AIDS and prevent its spread. The research questions will be addressed from both the immigrant and the health care provider’s perspectives using interviews. We want to recommend ways to strengthen Alberta’s health delivery system and create supportive environments for recent immigrants to seek care and to prevent HIV/AIDS.
Funder: Canadian Institutes of Health Research (CIHR), 2007 – 2009
Researchers: Anita J. Gagnon (McGill University), Geoffrey Dougherty (McGill University, The Montreal Children’s Hospital), Anne M. George (Centre for Community Child Health Research, Vancouver), Jacqueline Oxman-Martinez (Université de Montréal), Jean-François Saucier (Hôpital Ste-Justine, Université de Montréal), Elizabeth A. Stanger (Vancouver Coastal Health), Donna E. Stewart (University Health Network, Toronto General Hospital), Olive Wahoush (McMaster University, Hamilton)
Description: In Canada, as in other countries, successful resettlement of newcomers varies based on bio-psycho-social, migration and resettlement factors. Most vulnerable are: women who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the offi cial languages, are visible minorities, and are in precarious immigration categories (e.g., asylum-seekers, participants in the “live-in caregiver” program, or “mail-order brides”). The relationship of migration to reproductive health has been relatively neglected. Effective and acceptable family planning and post-abortion care, STI/HIV prevention, and optimal pregnancy and childbirth, and postpartum outcomes are vital to the health of these women and society at large. Studies meant to examine the extent to which characteristics of migration-related vulnerability affect reproductive health and health care, as well as the relative effect of these characteristics when compared to Canadian-born women, have begun. Two pan-Canadian (Montreal, Toronto, and Vancouver) studies are underway. In one, a broad range of reproductive health determinants and outcomes have been identifi ed, questionnaires to measure them located or developed, and extensive translation procedures into 12 different languages begun. In the other, the health and social care needs of mothers and infants at one week postpartum and whether these needs are being addressed in the context of short postpartum stays is being assessed. Both studies are being informed by national and community (based in each city) advisory groups composed of policy-makers, service providers (licensed professionals and non-governmental organizations), and researchers to ensure study relevance to policy development and knowledge transfer. Follow-up studies needed include, “Pregnancy and Childbirth in Newcomers” and “Needs of Newcomer Families One Year after Birth”.
Funder: Canadian Institutes of Health Research (CIHR), 2003 – 2004
Researchers: Alix Adrien (Direction de la santé publique Montréal Centre), Valérie Lépine (Direction de la santé publique, Agence de la santé et des services sociaux de Montréal), Joseph Jean- Gilles (GAP-VIES, Montréal), Riyas Fadel (COCQ-sida, Montréal), Carole Morissette (Direction de la santé publique, Agence de la santé et des services sociaux de Montréal)
Description: A knowledge transfer project on sexually transmitted and blood borne infections among Quebecers of Haitian origin is currently underway. It began with the identifi cation of the key needs and issues encountered by workers in these areas. Data from scientifi c studies was used, semi-structured interviews were conducted with key actors and workshops were held with our partners. The following phases consisted of documenting the state of knowledge and identifying tools for more effective intervention. The project is aimed at developing and disseminating appropriate, culturally adapted tools for preventing sexually transmitted and blood borne infections in this population and caring for people with these infections.
Funder: Ministère de la santé et des services sociaux du Québec – Quebec Ministery of Health and Social Services, 2007–2008
Description: This community-based research project is being undertaken by AIDS Calgary and research partners at the University of Calgary to investigate 1) the HIV/AIDS service needs and priorities of African newcomers, 2) how these needs can be met in conjunction with other African newcomer service priorities, and 3) the most appropriate ways for AIDS service organizations in Calgary to engage African newcomer communities in the design and delivery of HIV/AIDS services. The emphasis in this study will be on relationship building and mutual learning among HIV service providers, members of the African newcomer communities, and academic partners. Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2008
Description: Few studies in Canada and Quebec in particular, have focused on the representations of antiretroviral treatments for HIV and their impact on the daily lives of women who have the infection. Even fewer studies have involved women from African, Haitian or Aboriginal backgrounds in a situation of migration (Gallant, 2000; Lévy et al., 2000; Rogers et al., 2000; Sendi et al., 1999). The experience of maternity, which few studies have considered, seems key to constructing the relationship with HIV infection, adherence to treatment and secondary prevention. Given the scarcity of studies aimed at understanding the experiences of women with HIV/AIDS who are on antiretroviral treatment, including their relationships with children (desire to have children, pregnancy, childbirth, maternity, vertical transmission), this study will help advance knowledge which is currently limited. Once the study is completed, we will be able to identify secondary HIV/AIDS prevention strategies and better understand the issues related to adherence to retroviral treatments in the ethno cultural communities targeted by the project.
Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2009
Researcher: Françoise Guigne (Simon Fraser University, Vancouver)
Description: no abstract provided
Funder: Social Sciences and Humanities Research Council (SSHRC), 2006 – 2007
Researchers: Clemon George and Sean Rourke (St. Michael’s Hospital, Toronto), Winston Husbands (AIDS Committee of Toronto), Joseph Beyene (Hospital for Sick Children, Toronto), Robert Remis (University of Toronto), Barry Adam (University of Windsor)
Description: Canadian studies of sexual behaviour and determinants of HIV infection among homosexual men have included Black men who have sex with men, but the results and service implications are in determinant for two main reasons: (1) researchers have found it diffi cult to recruit large enough numbers of Black MSM for studies that are designed for mainstream gay populations; and (2) recruitment is normally done from gay environments that may not be frequented by nongay- identifi ed Black men. This leaves us with an incomplete understanding of the risk behaviours and sexual relationships of Black MSM. Further, HIV prevention activities that are designed for gay, Caucasian men and target Black MSM may not be particularly well informed. The study seeks to: (1) describe the risk behaviour of Black MSM and variables associated with these behaviours; (2) understand how lived experiences and everyday decision-making are associated with (un)protected sex; and (3) understand how Black MSM interpret and assess the role of AIDS service organizations in their networks or communities.
Funder: Ontario HIV Treatment Network (OHTN), 2005 – 2007
Description: The purpose of this study is to explore and understand the experiences of HIV-positive Alberta women who are from Sub-Saharan Africa.
The objectives of this study are: to understand how women experience their HIV diagnosis, treatment and support in their community; and to understand how women’s HIV illness impacts their social and familial relationships. There are a number of women from Sub-Saharan African countries living and working in Alberta who may be infected with, or affected by, HIV. The literature shows relatively few studies which explore HIV/AIDS among immigrants to Canada from Sub-Saharan Africa. With evidence showing increased number of positive HIV tests and AIDS diagnoses in Sub-Saharan African Canadians, there is still little known of the experiences of women who are HIV positive and who are living outside of large metropolitan communities.
Funder: Canadian Institutes of Health Research (CIHR), 2007-2010
Researcher: Kristi Kenyon (University of British Columbia)
Description: Although often categorized separately as the outcome of armed confl ict and a health crisis, the forced migration of people and the HIV/ AIDS pandemic interact in a number of ways, each with the potential to feed the other through direct or indirect means. People living with HIV/AIDS additionally have their rights and their quality of life affected profoundly by their ability or inability to access and afford medical treatment that can slow this deterioration and, by the unprecedented social reactions to HIV which, in their extreme negative can result in stigma, discrimination, harassment, loss of employment, ostracization, physical assault and death. The 1951 Convention on the Status of Refugees defines a refugee as someone who is outside of their country of nationality or habitual residence, “owing to a well-founded fear of being persecuted,” on the basis of one of fi ve grounds: race, religion, nationality, political opinion or membership in a particular social group. The last of these grounds is the least precise and most controversial. Decisions such as Ward in Canada and Islam and Shah in the United Kingdom have disputed the initial proposition that the group must be cohesive, and emphasized instead a shared unchangeable characteristic. People living with HIV “form a cognizable social group” and, similarly, the community “responds to [them] on the basis of their HIV status, forming and acting upon stereotyped notions about what the illness signifi es.” I intend to examine the extent to which persecution on the basis of HIV status could potentially fi t the ‘particular social group’ provision through an examination of case law from the United Kingdom, the United States, Canada, Australia and New Zealand with reference to this provision, as well the small but growing body of case law examining HIV–based persecution specifi cally. The aim is to discern both actual and potential practices with references to persecution on the basis of HIV status.
Funder: Social Sciences and Humanities Research Council (SSHRC), 2006 – 2009
Reference: http://www.hivresearch.ca/index. asp?navid=17&csid1=1616, Personal communication, Kristi Kenyon (May 2008)
Researchers: Alix Adrien (Public Health Branch - Montréal-Centre), Witnisse Mereus (Public Health Branch, Montreal Health and Social Services Agency), Joseph Jean-Gilles (GAP-VIES, Montréal), Riyas Fadel (COCQ-sida, Montréal), Carole Morissette (Public Health Branch, Montreal Health and Social Services Agency)
Description: The need for effective sexually transmitted and blood borne infection prevention programming that is genuinely adapted to the situation of ethno cultural communities has been well documented. This programming should be guided by targeted knowledge transfer and exchange among researchers and decision makers. Our goal is to bring about knowledge transfers and exchange among researchers and decision makers who are responsible for improving the health of ethno cultural communities by: defi ning the terms of this partnership; determining the type of research data that will be most useful to decision makers; and systematically identifying the results of research and experience with sexually transmitted and blood borne diseases in ethno cultural communities and explaining and contextualizing these results in a comprehensible way for groups working with these communities. Finally, we will conduct knowledge transfer activities with these communities. The partnership structure and process will be evaluated. The partnership proposed for the project is made up of three organizations: the Coalition des organismes communautaires Québécois de lutte contre le sida, the Groupe d’Action pour la Prévention de la transmission du VIH et l’Éradication du Sida and the Direction de la santé publique de Montréal. There are several categories of expected benefi ts and likely implications and repercussions: a) the strengthening and establishment of a sustainable partnership; b) the involvement of actors in concrete, realistic and feasible actions within a reasonable time frame; and c) the sustainable integration of knowledge at all levels of government, especially in the local health care and policy environments.
Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2007
Researchers: Winston Husbands (AIDS Committee of Toronto/African and Caribbean Council on HIV/AIDS in Ontario, Toronto), Clemon George (St. Michael’s Hospital/ African and Caribbean Council on HIV/AIDS in Ontario, Toronto), Barry Adam (University of Windsor), Robert Remis (University of Toronto), Sean Rourke (St. Michael’s Hospital, Toronto), Joseph Beyene (Hospital for Sick Children, Toronto)
Description: A study of factors that may make Black/African/Caribbean gay and bisexual men and other Black men who have sex with men (Black MSM) in Toronto vulnerable to HIV/AIDS. The study will include key informant interviews, a survey, and in-depth interviews with Black/African/Caribbean gay and bisexual men and other Black MSM. MaBwana will examine sexual behaviour, relationships, dating, homophobia, racism, community issues and other factors. MaBwana was designed to provide information that would improve HIV prevention programming for Black/African/Caribbean gay and bisexual men and other Black MSM in Toronto and elsewhere in Ontario. The study is a partnership between the AIDS Committee of Toronto, the African and Caribbean Council on HIV/ AIDS in Ontario (ACCHO), and researchers from the University of Toronto, St. Michael’s Hospital, the University of Windsor and the Sick Kids Hospital. A community advisory committee assists and advises the research team.
Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2008
Researchers: Wangari Esther Tharao (Women’s Health in Women’s Hands Community Health Centre, Toronto), Stan Read (Hospital for Sick Children, Toronto), Dr. Lindy Samson (Children’s Hospital of Eastern Ontario, Ottawa), Mark Yudin (St. Michael’s Hospital, Toronto), Dr. Andree Gruslin (Ottawa General Hospital), Dr. Lynne Leonard (University of Ottawa), Frank McGee (AIDS Bureau, Ontario Ministry of Health and Long -Term Care, Toronto), Notisha Massaquoi (Women’s Health in Women’s Hands Community Health Centre, Toronto)
Description: This study is targeted to African and Caribbean women living in Ontario who have had a pregnancy since 1999 when the Ontario Prenatal HIV Testing Program was initiated. The study will examine their opinions and experiences with the program and the Information obtained will be used to build scientifi c knowledge around prenatal HIV testing and related issues for African and Caribbean women, and identify programming and policy issues in order to make the necessary changes to improve and optimize the delivery of the Ontario Prenatal HIV Testing Program. Funder: AIDS Bureau, Ontario Ministry of Health and Long-Term Care, 2006 – 2008
Reference: Personal correspondence, Wangari Esther Tharao (May 2008)
Researchers: Peter S. Tugwell (University of Ottawa), Raywat S. Deonandan, Ronald Labonte, Wendy L. Muckle, Victor R. Neufeld, Caroline Nyamai, Jeffrey M. Turnbull
Description: The specifi c aim of this pilot project is to investigate narrative as a tool for ensuring that best evidence leads to improved health for vulnerable populations. This project will examine narrative methodologies in health intervention programming, evaluation and knowledge translation. The project builds on a global health network (ACANGO) and key initiatives in Ottawa and Kenya. The Ottawa Inner City Health Initiative (OICHI) has proven highly effective in engaging patients, stabilizing and treating health problems of homeless populations and promoting adherence to treatment. Narrative represents a potential tool to engage the client population, as well as the general public and city offi cials. In Kenya, AfriAfya has demonstrated the effective use of information communication technology for informing vulnerable Kenya communities about HIV/AIDS prevention and treatment strategies. Narrative represents a tool to evaluate current programming and inform planning, as well as continue to engage communities in additional health topics, such as tuberculosis and malaria. Using a combination of methods including critical review, learning forums, and online dialogue, the project will identify key literature and best practices in narrative. Facilitators will be trained in Ottawa and Kenya on the design, implementation and assessment of narrative best practices. The pilot project will be used to design a second study phase in which best practices will be tested and compared in Ottawa and Kenya. We believe narrative methods improve relevance, timeliness and accessibility of knowledge for communities, organizations as well as policy-makers.
Funder: Canadian Institutes of Health Research (CIHR), 2006 – 2007
Researchers: Peter A. Newman and Charmaine Williams (University of Toronto), Notisha Massaquoi (Women’s Health in Women’s Hands Community Health Centre, Toronto)
Description: Centre for International Health, University of Toronto in collaboration with Women’s Health in Women’s Hands Community Health Centre, this multi-method study explores the acceptability of future HIV vaccines and present HIV/AIDS prevention services among Black women of African and Caribbean descent in Toronto. Assessments include knowledge, attitudes, barriers and motivators regarding hypothetical HIV vaccine acceptability, intentions to change HIV risk behaviours in response to hypothetical vaccines, and preferences for HIV prevention. The purpose is to support the design of empirically-based interventions, in collaboration with vulnerable communities, to ensure appropriate and equitable dissemination of, and access to, future HIV vaccines, as well as to facilitate availability and access to culturally competent HIV prevention services.
Funder: Canadian Institutes of Health Research (CIHR), 2004 – 2007
Researchers: Liviana M. Calzavara (University of Toronto), Wangari Tharao (Women’s Health in Women’s Hands), Ann Burchell (McGill University), Ted Myers (University of Toronto), Robert Remis (University of Toronto), Carol Swantee (Ontario Ministry of Health and Long Term Care), Catherine Chalin (University of Toronto), Kimberly Gray (Study Coordinator), and the EAST Community Advisory Committee.
Description: The East African Health Study in Toronto (EAST), a community-academic partner ship, is the fi rst large-scale Canadian survey of African communities from countries where HIV is endemic. EAST was conducted in response to the lack of population-based data necessary to assess HIV-related issues in these communities, and to assist in the development of intervention programs and strategies. The purpose of EAST was to examine HIV/AIDS issues and concerns in the context of general health issues and behaviour present in fi ve East African communities. The survey covered an extensive range of HIV and health-related issues such as immigration and mobility, social support, attitudes and beliefs, screening and testing, health conditions, risk behaviour, and health care utilization. The study, conducted between 2004 and 2006, included 456 participants from the Greater Toronto Area (GTA) who identifi ed as members of the Ethiopian, Kenyan, Somali, Ugandan, and Tanzanian communities. The cross-sectional survey consisted of an interview and HIV screening component. EAST has made contributions in several key areas, including the generation of new research knowledge and provision of a platform on which to base programs, services, policy decisions and further research.
Funder: Ontario HIV Treatment Network (OHTN), 2003 – 2008