Daniel Grace

An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity

IntroductionIn the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts – an Intersectionality-Based Policy Analysis (IBPA) Framework.MethodsDeveloped over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies.ResultsThe analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks.ConclusionThe aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

Examining local processes when applying a cumulative impact policy to address harms of alcohol outlet density.

One approach to addressing the negative health and social harms of excessive drinking has been to attempt to limit alcohol availability in areas of high outlet density. The Licensing Act (2003) enables English local authorities the power to implement a Cumulative Impact Policy (CIP) in order to tackle alcohol challenges. More than 100 English local authorities have implemented a CIP in one or more designated areas. We examined local licence decision-making in the context of implementing CIPs. Specifically, we explored the activities involved in alcohol licensing in one London local authority in order to explicate how local decision-making processes regarding alcohol outlet density occur. Institutional ethnographic research revealed that CIPs were contested on multiple grounds within the statutory licensing process of a local authority with this policy in place. CIPs are an example of multi-level governance in which national and local interests, legal powers and alcohol licensing priorities interface. Public health priorities can be advanced in the delivery of CIPs, but those priorities can at times be diluted by those of other stakeholders, both public sector and commercial.

Transnational Institutional Ethnography: Tracing Text and Talk Beyond State Boundaries

Purpose: In this article I provide a rich account of how I utilized and critically applied the research strategy of institutional ethnography to investigate transnational processes of legislative standardization. The text at the center of this inquiry is a model law that was funded by the United States Agency for International Development (USAID) to create omnibus HIV/AIDS laws across West and Central Africa (2005-2010). Expanding upon the sociological approach of institutional ethnography, my research method is best understood as a transnational institutional ethnography (TIE). This article provides a case study of TIE for those interested in ethnographically exploring transnational processes across diverse institutional settings. Design/Methodology/Approach: The complex legislative process being investigated was made visible through the use of participant observation, archival research, textual analysis, and informant interviews with national and international stakeholders (n=32). This research strategy involved ethnographic data collection in Canada, the United States, Switzerland, Austria, South Africa, and Senegal (2010-2011). Findings: In this article a methodological discussion is offered focusing upon the everyday actualities of conducting transnational research in diverse environments, including cafes, conferences, courtrooms, and activist gatherings. I provide an account of (a) the complex institutional sites from which a research problematic may emerge; (b) challenges and opportunities when conducting interviews and identifying informants; (c) the importance of accounting for matters of geography and interview location in ones study design; and (d) the work of knowing where to look, what to read, and who to talk with during the iterative process of research and discovery. Originality/Value: Moving beyond state-based organizational relations, a focus which is predominant in most institutional ethnographies, in this article I explicate the research process undertaken to ethnographically interrogate complex processes of transnational social organization and translocal text-mediated relations. Methodological insights and lessons learned regarding the experience of conducting transnational ethnographic research are provided.

… it's almost therapeutic, right? Because it's almost like that session that I never had: gay men's accounts of being a participant in HIV research.

ABSTRACT Limited research has explored how gay, bisexual and other men who have sex with men describe the impact of their involvement in HIV and sexual health research. We enrolled 166 gay and bisexual men who tested HIV-negative at a community sexual health clinic in Vancouver, British Columbia, into a year-long mixed methods study. Thirty-three of these participants who reported recent condomless anal intercourse were purposively recruited into an embedded qualitative study. Analysis revealed rich accounts of the self-described, interrelated impacts of study participation: (1) pride in contribution and community involvement (e.g., as a rationale for enrolment and an outcome of participation); (2) how one thinks about sexual behaviours and partnerships (e.g., encouraging reflection on the types and amount of sex they have had; in some cases the methods of quantitative data collection were said to have produced feelings of guilt or shame); and (3) experiencing research as a form of counselling (e.g., qualitative interviews were experienced as having a major therapeutic component to them). Our analysis underscores the importance of researchers being reflexive regarding how study participation in HIV research may impact participants, including unintended emotional and behavioural impacts.

Need for robust and inclusive public health ethics review of the monitoring of HIV phylogenetic clusters for HIV prevention

www.thelancet.com/hiv Vol 3 October 2016 e461 suggested that decriminalisation of sex work could avert 33–46% of HIV infections worldwide. In Nigeria, another context on which the study draws, legislation criminalising samesex sexuality resulted in increased avoidance of health care among men who have sex with men. The modelling of prevention scaleup without addressing the legal environment omits a crucial part of the picture.

Linking ad views to test results: Assessing the impact of a social marketing campaign on program outcomes for users of an internet-based testing service for sexually transmitted and blood-borne infections (Preprint)

Background While social marketing (SM) campaigns can be effective in increasing testing for sexually transmitted and blood-borne infections (STBBIs), they are seldom rigorously evaluated and often rely on process measures (eg, Web-based ad click-throughs). With Web-based campaigns for internet-based health services, there is a potential to connect campaign process measures to program outcomes, permitting the assessment of venue-specific yield based on health outcomes (eg, click-throughs per test). Objective This study aims to evaluate the impact of an SM campaign by the promotional venue on use and diagnostic test results of the internet-based STBBI testing service GetCheckedOnline.com (GCO). Methods Through GCO, clients create an account using an access code, complete a risk assessment, print a lab form, submit specimens at a lab, and get results online or by phone. From April to August 2015, a campaign promoted GCO to gay, bisexual, and other men who have sex with men in Vancouver, Canada. The campaign highlighted GCO’s convenience in 3 types of promotional venues—location advertisements in print or video displayed in gay venues or events, ads on a queer news website, and ads on geosocial websites and apps. Where feasible, individuals were tracked from campaign exposures to account creation and testing using venue-specific GCO access codes. In addition, Web-based ads were linked to alternate versions of the campaign website, which used URLs with embedded access codes to connect ad exposure to account creation. Furthermore, we examined the number of individuals creating GCO accounts, number tested, and cost per account created and test for each venue type. Results Over 6 months, 177 people created a GCO account because of the campaign, where 22.0% (39/177) of these completed testing; the overall cost was Can

Confronting comorbidity risks within HIV biographies: gay men’s integration of HPV-associated anal cancer risk into their narratives of living with HIV

118 per account created and Can

P4.113 Reach and acceptability of an online hiv/sti testing service (getcheckedonline) among gay, bisexual, and other men who have sex with men living in british columbia, canada

533 per test. Ads on geosocial websites and apps accounted for 46.9% (83/177) of all accounts; ads on the news website had the lowest testing rate and highest cost per test. We observed variation between different geosocial websites and apps with some ads having high click-through rates yet low GCO account creation rates, and vice versa. Conclusions Developing mechanisms to track individuals from Web-based exposure to SM campaigns to outcomes of internet-based health services permits greater evaluation of the yield and cost-effectiveness of different promotional efforts. Web-based ads with high click-through rates may not have a high conversion to service use, the ultimate outcome of SM campaigns.

O02.2 Syphilis and sexual geographies: mapping the sexual travels, networks, and knowledge of gay, bisexual and other men who have sex with men in toronto, canada

HPV-associated anal cancer is one of the most prevalent non-AIDS defining cancers affecting gay men living with HIV. Drawing on interviews with 25 HIV-positive gay men living in Toronto in 2017, we explored their responses to anal cancer as a comorbidity risk and the necessity of preventative screening. These participants had previously been screened for anal cancer through a clinical trial. The majority of our sample did not initially consider anal cancer a health priority. They relied on narratives of living with HIV – that is, on their HIV biographies – to make sense of anal cancer’s significance given their self-described lack of knowledge. This included references to personal-level narratives of the biographical disruption and revision associated with a HIV diagnosis, as well as reflections on community-level and socio-historical trends in the HIV epidemic. Drawing on these narratives, some started to accept anal cancer as a significant comorbidity risk, while others remained ambivalent. Those who began to accept anal cancer as significant integrated it into their HIV biographies to present anal cancer as a threat to the ontological security they have gained managing HIV in an era of effective treatment and to position themselves as pragmatic, responsible health-seekers. Others drew on their HIV biographies to vocalise resistance to chronic risk and medicalisation. Our analysis points to the fundamental role narratives play on everyday risk perception practices, health decision-making and, for those managing a chronic illness, on securing ontological security and presenting a coherent self-identity under conditions of expanding risks and prevention possibilities.

Becoming “Undetectable”: Longitudinal Narratives of Gay Men's Sex Lives After a Recent HIV Diagnosis

Introduction Gay, bisexual, and other men who have sex with men (MSM) in British Columbia (BC) have a high incidence of HIV/STI, with many reporting barriers to accessing testing. An online HIV/STI testing service, Get Checked Online (GCO), was launched in 2014 to reduce these barriers. In this study we examined reach and acceptability of GCO within the MSM community. Methods We surveyed MSM living in BC over 6 months in 2016. Participants were recruited at local pride events, bars, on the street, in sexual health clinics, through social media, and on gay hook-up apps and websites. Survey questions were analysed descriptively and included questions about the service itself, sexual health, technology use, and demographic characteristics. Results Of 1272 participants completing the survey, 78% identified as gay and 16% as bisexual, 73% identified as White, 52% reported being single, and 55% reported living in the city of Vancouver. 32% were aware of GCO, 13% had visited the website and 3% had tested through the service (10% among the 411 men aware of GCO). Among GCO-aware participants, 50% intended to test through the service in the future (vs. 47% among GCO-unaware), 51% reported talking about GCO with others and 22% knew someone who has used it. 46% reported that at times they would use GCO over their usual place of testing. The most common benefits reported by participants were testing without waiting for an appointment (50%), getting results online (46%), and saving time (38%). The most common drawbacks were not speaking with a doctor or nurse (39%), not being sure how the service works (26%), and worrying about the privacy of one’s online information (20%). Conclusion Approximately 2 years after GCO’s launch, a third of MSM in the region are aware of the service with 1 in 10 GCO-aware men testing through the service. Given high intention to use GCO, these findings highlight the importance of continuing promotion efforts to raise awareness of the service among MSM.