Chris Sanders

Conceptualizing the integration of HIV treatment and prevention: findings from a process evaluation of a community-based, national capacity-building intervention

Objective:This paper responds to a gap in knowledge about the conceptualization of integration in community-based AIDS organizations (CBAOs).Methods:A community-based process evaluation was conducted of a national intervention, developed by the Canadian AIDS Treatment Information Exchange (CATIE), to enhance treatment information provision in CBAOs and encourage its integration with prevention services. Our study involved 13 interviews with intervention participants in 6 CBAOs across Canada, CATIE staff, and funders, as well as a 25-person verification exercise.Results:Intervention participants conceptualized integration as linking front-line HIV treatment, health promotion and prevention services, emphasizing mediation between scientific and lay knowledge, the political context of integration and the role of social determinants in clients’ health and access to services. Challenges to integration include high staff turnover and inflexible funding structures. Complex health education related to the relationship between viral load and HIV transmission is a critical area of integrated service delivery.Conclusion:Study findings help distinguish a community-based concept of HIV-related integration from alternative uses of the term while pointing out key tensions associated with efforts to integrate HIV prevention and treatment in a community-based context.

Beyond buzzwords: toward a community-based model of the integration of HIV treatment and prevention.

Abstract Propelled by increased global access to Highly Active Anti-Retroviral Therapies, the integration of HIV treatment and prevention has emerged as an important organizing concept of pandemic response. Despite its potential significance for community-based AIDS organizations (CBAOs) little research on integration has been done from a community-based perspective. This paper responds to that gap in the literature. With a view to moving what can be an abstract concept to the level of concrete practice, we offer a community-based model of the integration of HIV treatment and prevention. The model is based on research conducted in 2006–2007 with front-line staff from CBAOs across Canada carried out in partnership with the Canadian AIDS Treatment Information Exchange. The model is grounded in three central dimensions of a community-based perspective on integration deriving from our research: the phenomenological primacy of front-line service work, a comprehensive notion of treatment and prevention, and the importance of social context. The model is intended as a conceptual resource that can assist CBAOs in formulating practical responses to new demands for integrated service provision.

“HIV Is Not Going to Kill Me, Old Age Is!”: The Intersection of Aging and HIV for Older HIV-Infected Adults in Rural Communities

Older adults with HIV/AIDS living in rural areas face unique challenges to accessing HIV care and medications, and suffer greater mortality than non-rural HIV-infected individuals. This qualitative study examined the intersection of aging and HIV to identify factors that affect overall health, engagement in care, and medication adherence among this understudied population. Qualitative interviews were conducted by phone with 29 HIV-positive adults over the age of 50 living in U.S. rural counties and analyzed using thematic content analysis. Individuals reported complex medical needs in addition to their HIV and noted difficulty discerning whether symptoms were associated with HIV or aging. Although reported medication adherence rates were high, participants also cited several barriers to maintaining adherence. Given the increase in rural individuals living with HIV, interventions are needed to address the complex intersection of aging and HIV, especially for those in rural environments.

The Impact of Shared Location on the Mental Health of Military and Civilian Adolescents in a Community Affected by Frequent Deployments: A Research Note

Preliminary results of our survey of 1066 adolescent members of a Canadian Forces (CF) community, comparing the mental health and well-being of CF and civilian youth in a secondary school adjacent to an army base, yielded surprising results. The data were collected in 2008 with an instrument that replicated parts of the National Longitudinal Survey of Children and Youth (NLSCY). Our findings suggested that there are few statistically significant differences between CF and civilian youth on mental health and well-being measures. On the other hand, both the CF and civilian youth scored lower on crucial health and well-being measures than their peers in the national NLSCY sample. This research note attempts to explain these complementary findings, using data from follow-up semi-structured interviews we conducted in 2009/10 with 60 of the CF adolescents. It also considers the possibility of a ‘‘spillover effect’’ of military life stressors on civilian youth.