Godelive Ndayikengurukiye 1 , Ciro Alex Bisignano 1 , Alan Li 1,2 , Christian Hui 1 ,

1. Newcomer Sexual Health Promotion Project (NSHP):An innovative peer driven model to promote sexual health amongst racialized newcomers at risk for STIs and HIV in Toronto Godelive Ndayikengurukiye1, Ciro Alex Bisignano1, Alan Li1,2, Christian Hui1, Maureen Owino1, Henry Luyombya1,3 1-Committee for Accessible AIDS Treatment; 2- Regent Park Community Health Centre; 3-Universities Without Walls April 12, 2013 , 3:45-4:00 pm CAHR Conference Vancouver – British Columbia

2. No Conflict of Interest to Declare

3. Acknowledgements Funder: AIDS Prevention Community Investment Program (APCIP) NSHP Advisory Committee members and Contributing & Founding partners APAA : Africans in Partnership Against AIDS ACAS: Asian Community AIDS Services ASAAP: Alliance for South Asian AIDS Prevention Black-CAP: Black Coalition for AIDS Prevention Canadian HIV/AIDS Legal Network CATIE : Canada Treatment & Information Exchange CSSP : Centre for Spanish Speaking People Toronto Public Health OCASI : Ontario Council of Agencies Serving Immigrants PWA : Toronto People With AIDS Foundation

4. Outline of Presentation • Context: Changing Demographics of HIV • Key challenges affecting immigrants, refugees and newcomers • Strategies to address those challenges • Newcomer Sexual Health Promotion project • Project Activities • Project Findings & Lessons Learned • Recommendations and Conclusion

5. A coalition formed in 1999 to reduce barriers faced by people living with HIV/AIDS (PHAs) who are immigrants, refugees or with precarious status in Canada Coalition of over 40 health, legal and social service organizations plus individual immigrant/refugee PHAs Focuses on Empowerment Education, Research, Service Coordination and Advocacy on issues related to HIV, Immigration and Access Newcomer Sexual Health Promotion Project developed by CAAT in 2010 to address barriers affecting newcomers’ access to services. Committee for Accessible AIDS Treatment (CAAT)

6. Context: Demographics • Toronto receives close to 30% of Canada’s population of new immigrants each year (CIC, Facts and figures , 2011) • Newcomers are 10 times at increased risk for STIs and HIV • Among HIV case reports with ethnic or race information in 2009, racialized new immigrants and refugees comprised 22.5% of new HIV cases (PHAC, 2009) • Over 40% of the people living with HIV/AIDS (PHAs) from endemic countries contracted HIV after their arrival in Canada (Remis et al., 2006)

7. Key Challenges

8. Summary of Key Challenges & Gaps • Complexity of system & difficulty to understand/negotiate access • Multiple dimensions of systemic discrimination compound vulnerabilities • Marginalized status, Stigma and Fear preventing access to information & services & self advocacy • Lack of cultural competent and appropriate legal, settlement & health services • Barriers that lead to differential and major negative health impact on both physical and mental health

9. Our Project Model • Train the trainer approach : to engage and train newcomer/racialized PHAs to become peer educators to deliver educational workshops • Outreach to where newcomers are at (undisclosed/ disclosed) • HIV prevention and sexual health education to a general newcomer population • Outreach to non-ASO agencies which are not connected with ASOs and serve a lot of newcomers • Access point for HIV at risk/affected newcomers to get connected with ASOs, legal and healthcare services

10. Activities & Strategies

11. Workshop facilitation

12. HIV Disclosure Skills Sexual Health Service-access info & awareness Peer-based learning Workshop and Forums Topics STIs/STDs/ HIV Facts HIV Testing facilities Stigma reduction strategies HIV prevention, support & care HIV Criminalization & Legal Issues

13. Target Populations: Inclusive Outreach African Caribbean Latino/Spanish Speaking NEWCOMERS REFUGEES IMMIGRANTS South Asian East & Southeast Asian

14. Evaluation Tools To measure NSHP’s outcomes systematically, we use indicators like: • Attendance sheet • Follow up sheet • Participants Feedback forms • Facilitator’s Activity Report • Facilitators’ debriefing forms • A “Take Home Info” report

15. Results/ Lessons Learnt • Sexual health promotion approach is an effective and better way of engaging communities on sensitive issues like HIV and homosexuality that often carry huge stigma and discrimination in the target populations • Sexual health-centered workshops and forumsmotivate newcomer PHAS to break their isolation and access social services, various types of support from AIDS Service Organizations and Peer Support Networks. • Peer-led workshops and forums on sexual health significantly encourage newcomer PHAs to disclose their status. After hearing positive life stories from PHA facilitators, newcomer PHAs feel safe and ready to access specific services

16. Conclusion • NSHP provides an innovative peer-based model to effectively address newcomers’ vulnerabilities to HIV and STIs to facilitate service access. • NSHP provides peer support and empowerment for greater capacity building for newcomers • NSHP model is highly replicable in other regions and can be adapted to address various social and mental health issues

17. Thank You! Godelive Ndayikengurukiye NSHP Project Coordinator GodeliveN@regentparkchc.org Tel. 416.364.3030 ext 2277 www.hivimmigration.ca www.facebook.com/HIVimmigration Twitter: @HIVimmigration