Inequities in Responding to HIV and Hepatitis C in Atlantic Canada

1. Inequities in Responding to HIV and Hepatitis C in Atlantic Canada Susan Kirkland PhD, C Marshall MPA, M Dykeman PhD, G Mugford PhD, J MacDonald MN, I Sketris PhD, L Jackson PhD, K Peltekian MD, S Taylor MN, T Dutchyn MA, A Myles MSc CPHA June 2008

2. What is AIRN? • A network of government, community, academic, and other stakeholders with an interest in HIV/AIDS and Hepatitis C • Originated with a core group of researchers from a variety of disciplines based at four Atlantic universities (UPEI, UNB, Dalhousie, Memorial) • Funded by Canadian Institutes of Health research (CIHR) Interdisciplinary Capacity Enhancement Grant 2005 – 2009 • Work collaboratively with community and government stakeholders to reduce inequities, create an evidence base to support the development of effective strategies, policies, programs, and services

3. Rationale • Although unique, HIV/AIDS and Hepatitis C share features in common • Emerging prevalence among marginalized populations • High risk behaviours associated with transmission • Stigma and negative impact on the lives of infected and affected individuals • Symptoms can be debilitating, treatment can be toxic • Chronic, serious and potentially fatal health consequences for individuals • Major public health burden for society

4. Health Inequities in HIV/HCV • Increased prevalence in marginalized groups: IDU, MSM, incarcerated, youth at risk, immigrant population • Social determinants of health related to health outcomes: those with less access to resources have poorer health outcomes • Large geographic distances, fewer resources and services, sparse concentration of researchers/practitioners • Stigma, discrimination

5. Positive HIV Test Reports(Nov 1, 1985 – Dec 31, 2006) * HCV 3107 PHAC HIV and AIDS in Canada Surveillance Report to Dec 31, 2006

6. Objectives • Contribute to a research agenda in HIV and HCV prevention strategies, interventions, and policy. • Enhance interdisciplinary collaboration and promote cross fertilization for the prevention and enhancement of care of both diseases. • Train a new generation of researchers to build capacity for social research on HIV/HCV in the region. • Ultimately, shape policy and program responses to prevent the transmission of HIV and HCV, and to improve the quality of life of those infected and affected by HIV and HCV.

7. Building Capacity Through Cross-fertilization • Cross fertilization occurs at multiple levels • Across diseases • Across disciplines • Across methodologies • Across sectors • Across provinces • Across CIHR’s pillars of research (biomedical, clinical, health systems and services, and the social, cultural factors that affect the health of populations) • Coordinating efforts across the Atlantic region will have a much greater impact, particularly with respect to information dissemination, uptake and policy development

8. Social Determinants Research Agenda • Social influences that require greater research attention: • the intermediate social context or social networks • the macro-level social influences or conditions • Macro-level forces have been found to be especially important in determining rates of transmission of HIV and HCV: • gender, racial, and economic inequities; • power imbalances within communities, regions, across countries, and globally • Differential access to health services

9. Environmental Scan • Identified the range of policies, programs, services and research in the region – to serve as a foundation to guide future research and planning • Highlights: • Significant service gaps in prevention and harm reduction approaches across the region • More initiatives in HIV/AIDS than HCV, although greater integration is occurring • NS only province to have AIDS strategy, standards for blood borne pathogens • Research and policy activities not coordinated across the region • Mechanisms to support coordination of effort do not exist

10. Benefits, models, for working together Access to best practices Sharing resources, responsibility (take risks) Avoid duplication United voice Value, validity Defining a research agenda for the future Aging Labour force participation Income support Cross issue services Why prevention not working Housing, mobility, urban/rural Regional WorkshopFrom Research to Policy to Action!

11. Community Consultations • Consultations in 8 communities across Atlantic Canada – Fall 2007 • 100 participants from multiple sectors • Key issues: • Access to harm reduction strategies (needle exchanges, MMT) • Prevention education and outreach (sexual health) • Access to treatment • Access/promotion of early testing and diagnosis • Services, supports for youth, youth at risk

12. AIRN Atlantic Advisory Committee • Raise the profile of prevention and management of HIV/AIDS and Hepatitis C in Atlantic Canada • Exchange information, knowledge, and ideas • Enhance partnerships and promote networking • Enhance knowledge uptake and utilization of research findings into policy, programs, practice, and further research • Contribute to defining an Atlantic Canada research agenda of the future

13. Summary Observations • Much research work underway by various players – government, community, academia • Greater recognition of the value of research and of working together • Challenges • using evidence to change policy & practice (barriers, resource constraints, leadership, philosophical beliefs) • KTE, sharing information, integration to avoid duplication

14. Are we making a difference? • Increasing awareness of the inequities and issues related to the prevention of and response to HIV/HCV in the region • Increasing the evidence base upon which to make sound public policy • Influencing policy change – through consultation/ collaboration, through AAAC as a direct conduit to policymakers, and through development of an action plan to follow-up on the consultations • Ensuring research conducted is responsive to regional needs and priorities and involves key stakeholders in its design and execution

15. Thank you! To contact us: susan.kirkland@dal.ca cmarshall@ns.sympatico.ca Website: www.med.mun.ca/AIRN