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In March 2020, COVID-19 shuttered access to many healthcare settings offering HIV testing and there is no licensed HIV self-test in Canada.A team of nurses at the University of Ottawa and Ottawa Public Health and staff from the Ontario HIV Treatment Network (OHTN) obtained Health Canada's Special Access approval on April 23, 2020 to distribute bioLytical's INSTI HIV self-test in Ottawa; we received REB approval on May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in an HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits.In the first 6 weeks, 637 persons completed our eligibility screener; 43.3% (n = 276) were eligible. Of eligible participants, 203 completed a baseline survey and 182 ordered a test. These 203 participants were an average of 31 years old, 72.3% were white, 60.4% were cis-male, and 55% self-identified as gay. Seventy-one percent (n = 144) belonged to a priority group for HIV testing. We have results for 70.9% (n = 129/182) of participants who ordered a kit: none were positive, 104 were negative, 22 were invalid, and 2 "preferred not to say"; 1 participant reported an unreadiness to test.Our results show that HIV self-testing is a pandemic-friendly strategy to help ensure access to sexual health services among persons who are good candidates for HIV testing. It is unsurprising that no one tested positive for HIV thus far, given the 0.08% positivity rate for HIV testing in Ottawa. As such, we advocate for scale-up of HIV self-testing in Canada.RéSUMé: CONTEXTE: En mars 2020, la COVID-19 a empêché l’accès à de nombreux établissements de santé offrant des tests de dépistage du VIH et il n’existe pas d’autotest du VIH autorisé au Canada. INTERVENTION: Une équipe d’infirmières de l’Université d’Ottawa et de Santé publique Ottawa et le personnel du Réseau ontarien de traitement du VIH (OHTN) ont obtenu l’approbation d’accès spécial de Santé Canada le 23 avril 2020 pour distribuer l’autotest VIH INSTI de bioLytical à Ottawa; nous avons reçu l’approbation du Comité d’éthique de la recherche (CER) le 15 mai 2020. À partir du 20 juillet 2020, les participants admissibles (≥18 ans, séronégatifs, ne prenant pas de PPrE, ne participant pas à un essai de vaccin contre le VIH, vivant à Ottawa, ne souffrant pas de troubles de la coagulation) pouvaient s’inscrire via www.GetaKit.ca pour commander une trousse d’autotest. RéSULTATS: Au cours des six premières semaines, 637 personnes ont rempli notre questionnaire d’admissibilité; 43,3 % (n = 276) étaient admissibles. Parmi les participants admissibles, 203 ont répondu à l’enquête de référence et 182 ont commandé un test. Ces 203 participants avaient en moyenne 31 ans, 72,3 % étaient blancs, 60,4 % étaient hommes-cis et 55 % s’identifiaient comme gays. Soixante et onze pour cent (n = 144) appartenaient à un groupe prioritaire pour le dépistage du VIH. Nous avons les résultats pour 70,9 % (n = 129/182) des participants qui ont commandé une trousse : aucun n’était positif, 104 étaient négatifs; 22 étaient invalides; 2 « préféraient ne pas le dire »; et un seul a indiqué qu’il n’était pas prêt à subir le test. CONCLUSION: Nos résultats montrent que l’autodépistage du VIH est une stratégie adaptée à la pandémie pour aider à garantir l’accès aux services de santé sexuelle aux gens qui sont de bons candidats au dépistage du VIH. Il n’est pas surprenant que personne n’ait été testé positif pour le VIH jusqu’à présent, étant donné le taux de positivité de 0,08 % pour le test de dépistage du VIH à Ottawa. C’est ce qui nous incite à préconiser l’intensification du recours à l’autotest du VIH au Canada.

Background: The Public Health Agency of Canada estimates that about 87% of persons living with human immunodeficiency virus (HIV) in Canada have been diagnosed, which is well below the Joint United Nations Programme on HIV/AIDS target to have 95% of HIV-positive persons diagnosed. Research has shown that HIV self-testing may help increase such diagnoses, especially among the populations who are most affected by HIV. The objective of the study was to determine the uptake and diagnosis outcomes associated with free HIV self-testing. Methods: We developed the first online mailout free HIV self-testing program in Canada and implemented it in Ottawa. This project ran through the website, www.GetaKit.ca. We intended to recruit 150–400 participants over a 6–12-month period, estimating that this number would yield between 0–1 positive test results (expected positivity rate of 0.08%). Results: Between July 20, 2020 and April 1, 2021, 1,268 people accessed the GetaKit website and verified their eligibility. In total, 600 persons were eligible and 405 ordered an HIV kit. Of those who ordered a kit, 399 completed a baseline survey. Overall, 71% of these participants were members of HIV priority groups. For test results, 228 persons reported test results, with one being positive, for a positivity rate of 0.24% overall and 0.44% of reported results. These rates exceed that normally observed in Ottawa. Conclusion: Self-testing of HIV can be effectively delivered through a website. Such an intervention will also be used by persons with undiagnosed infections and appears to do so at a rate higher than that observed by other means of testing. Self-testing of HIV may therefore help Canada achieve the United Nations 95-95-95 targets.

Whereas public health efforts to prevent HIV transmission used to focus exclusively on HIV diagnosis and reductions in the practices that transmit HIV, they now include the provision of HIV medicat...

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

Background In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients – the majority of whom are men who have sex with men. Aims To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Methods Qualitative interviews were conducted and interpreted using thematic analysis. Results This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates – and led patients to simultaneously want to evade, and be assisted by, public health nurses. Conclusions Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients’ experiences of receiving an HIV diagnosis.

Syphilis has increased in recent years, causing difficulties for clinicians and public health practitioners alike. While one issue with the current management of syphilis is that it has both a myriad of presentations and complicated laboratory results, another issue relates to the current case definitions used to define and track syphilis in public health surveillance. One item that is missing is a "probable" case definition, which could help capture the number of likely cases of syphilis that were appropriately treated clinically, but which failed to reach public health case definition based on serologic markers. This approach could produce a more accurate picture of the breadth of syphilis transmission in North America and help better appreciate the groups most affected by syphilis change. We put forward and argue this position herein.

As part of examining the public health effects of media releases about HIV-status nondisclosure, a semi-structured interview technique was employed to collect data about gay men's perceptions of and experiences with HIV-status disclosure, nondisclosure, and prevention. In this article, participants' (N=27) narratives about their expectations of how and when HIV-status disclosure and discussions about STI histories should occur are presented, and then contrasted against stated (hypothetical) expectations with the stories they recounted about discussing HIV-status during previous sexual contacts (actual practices). These data highlight that the overwhelming socio-sexual norm among gay men in Ottawa is not to discuss HIV-status, and, instead, to perform HIV risk assessments based on the characteristics of their sexual partners and their relationships with these men. A small subset of participants, however, noted they used condoms to maintain what was called the code of silence (i.e., the norm not to discuss HIV), and to simultaneously minimize HIV transmission during sexual contacts with casual or anonymous partners. In light of the extant literature about STIs, HIV, and prevention among gay men, these data provide important insights for HIV prevention workers, who should consider how to tailor prevention efforts to local communities.

While pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, its uptake is limited. To address barriers, we piloted a nurse-led PrEP clinic in an STI clinic and had public health nurses refer patients during STI follow-up. We recorded the number of PrEP offers and declines and clinic uptake. We conducted a thematic analysis of patients’ responses from nursing notes written at the time patients declined PrEP. From August 6, 2018 to August 5, 2019, nurses offered a PrEP referral to 261 patients who met our criteria; only 47.5% accepted. Qualitative analysis identified four themes: (1) perceptions of risk, (2) lack of interest, (3) inability to manage, and (4) concerns about PrEP. Our patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless “other”. This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.

Sexually transmitted infections (STIs) have been explored in various sexual subgroups. While excellent, these analyses have primarily occurred from uniquely biologic, epidemiologic, or sociologic perspectives. Missing from these discussions has been in-depth presentations of the dynamics of STI transmission from all three viewpoints simultaneously. In this paper, I present information about STI transmission for each STI, including considerations of prevalence, and then review the STI research and of the concept of risk. I then apply these three considerations to a fictitious case study to show their importance and utility. I close by arguing that this information could strengthen future sociologic reviews of STIs and sexual health by helping such researchers include more nuanced understandings about STIs.

Routine HIV surveillance cannot distinguish between recent and older infections: HIV-positive individuals reported soon or long after infection are both considered new diagnoses from a surveillance perspective, notwithstanding the time since infection. This lack of specificity makes it difficult to understand the jurisdiction-specific trends in HIV epidemiology needed for prevention planning. Previous efforts have been made to discern such timing of infection, but these methodologies are not easily applied in a public health setting. We wished to develop a simple protocol, using routinely collected information, to classify newly diagnosed infections as recent or older, and to enumerate and characterize recent versus older infections. Applying our methodology to a review of HIV cases reported between January 2011 and December 2014, we classified 62% of cases; one-third of these were recent infections. Although men who have sex with men (MSM) and persons from HIV-endemic countries (HEC) disproportionally accounted for new HIV diagnoses, the dynamics of HIV transmission within these groups differed dramatically: MSM accounted for the majority of recent infections, whereas persons from HEC accounted for the majority of older infections. Among older infections, one-quarter were previously unaware of their infection. Categorizing cases in this manner yielded greater, jurisdiction-specific understanding of HIV, and guides subpopulation-specific interventions.

Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy involving the use of once daily antiretroviral medications to prevent HIV infection. Available research supports that PrEP, when used as prescribed, can prevent HIV transmission by upwards of 96%. Such findings have led to the development of research publications and guidelines supporting PrEP for individuals at high risk for HIV acquisition, such as men who have sex with men (MSM). Despite its benefit, current use of PrEP in clinical settings has been undermined by false impressions of poor efficacy of PrEP and concerns about increased risk-taking among MSM should PrEP be readily available. Furthermore, guidance for the role of public health units in PrEP access has not been well defined. While we maintain that PrEP should be available to any person who requests it, we feel that public health units should focus on those at highest risk for HIV acquisition, and, in doing so, possibly reduce local HIV rates.

Background HIV PEP is an intervention to prevent HIV seroconversion among HIV-negative persons after they have come into contact with the virus. The literature suggests PEP is greater than 80% effective at reducing HIV seroconversion. To expand access to this prevention strategy, we established a nurse-led PEP program in two STI clinics. Aims We sought to explore why people seek PEP, and their experiences using it. Materials & methods We invited participants who used our PEP program to engage in semi-structured qualitative interviews. These were audio-recorded, transcribed verbatim, and analyzed using the techniques of thematic analysis. Results Twelve men who initiated PEP through our program participated in an interview. Thematic analysis of the data identified three themes: (1) assessing risk, (2) euphoria and distress, and (3) reducing distress. Discussion Based on our findings, it appears as though instances of condomless sex were atypical and unplanned, they occurred due to contextual factors (e.g., consent, desire to explore, sexual chemistry/intensity), and they resulted in a state of temporary euphoria, which, afterward, transformed into distress (i.e., "feel[ing] stupid"). The participants used PEP not only for HIV prevention, but also (and perhaps more so) to address their emotional state. PEP used seemed to primarily occur to address situations of atypical sexual contact with partners they did not "know" or "trust". Conclusion We feel these results help contextualize how potential PEP users view HIV risk assessments, and how they determine their need for this intervention.

A total of 27 gay and bisexual men were interviewed about how they perceived the criminal prosecution of persons living with HIV who do not disclose their HIV status. The stories that emerged from the interviews raise questions about the nature of the gay community. The findings centre on the participants' descriptions of (1) the heterosexual meta-culture, (2) the locales of gay life, and (3) unsupportive elements in the gay community. Analysis of the interview data situates the gay community as a place of both inclusion and exclusion and as a heterogeneous environment.Des entrevues ont été menées auprès de 27 hommes gais et bisexuels afin de sonder leurs perceptions à l'égard des poursuites criminelles intentées contre les personnes vivant avec le VIH/sida qui n'ont pas divulgué leur état. Les récits qui en découlent soulèvent des questions sur la nature de la communauté gaie. Les données touchent aux descriptions des participants concernant 1) la méta-culture hétérosexuelle; 2) les lieux de la culture gaie; 3) les éléments non solidaires au sein de la communauté gaie. L'analyse des données d'entrevue situe celle-ci comme un espace à la fois d'inclusion et d'exclusion et comme un milieu hétérogène.

Patrick O’Byrne, RN, PhD, is an Associate Professor, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Alyssa Bryan, RN, MScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Cory Woodyatt, BA, BScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. In 1998, the Supreme Court of Canada ruled that people living with HIV had a legal obligation to disclose their serostatus prior to the onset of activities that posed a ‘‘significant risk’’ for HIV transmission. As part of this ruling, the Supreme Court (1998) indicated that nondisclosure prosecutions would not undermine HIV-prevention efforts. This ruling, however, was made without any research on the effect of the law on HIV prevention. Accordingly, because the number of nondisclosure prosecutions is increasing in Canada (Mykhalovskiy, 2011), self-identifying gay, bisexual, and other men who have sex with men (MSM) in Ottawa were given self-administered surveys about their sexual practices and sexually transmitted infection (STI) and HIV testing practices. In total, 441 surveys were collected to help better tailor sexual health services for gay, bisexual, and other MSM in this region. In this paper, we present results detailing the relationships between perceptions about nondisclosure prosecutions and STI/HIV testing practices. We also provide comparisons of the self-reported sexual practices of the survey respondents. While this paper presents and discusses data that are Canada-specific, nondisclosure prosecutions are common in the United States as well (American Civil Liberties Union, 2008).

The potential for antiretroviral therapy to reduce HIV transmission, a strategy known as “treatment as prevention,”[1][1]–[4][2] is important in light of unrelenting HIV transmission. The Public Health Agency of Canada has estimated that the number of new cases of HIV infection in Canada in

In Canada, nondisclosure prosecutions against people living with HIV/AIDS (PHAs) have increased. Nurses who provide services to PHAs could become involved in such criminal cases because they (a) elicit sensitive information about their clients’ sexual practices, and (b) adhere to documentation standards. Currently, HIV documentation policies do not exist for clinicians working with PHAs in Canada or abroad. Sexual assault nursing, which includes documentation guidelines, may offer guidance in the creation of a PHA care policy because sexual assault nursing and PHA care both intersect with the justice system. A PHA care policy may have several benefits: It can increase clinician confidence in patient interactions and documentation by clarifying roles and scope of responsibilities, reduce inconsistencies in practice, diminish conflict among professionals, and reduce the stress involved in clinical practice. The outcome of these improvements could be an increase in PHAs’ level of comfort with nurses knowing that policies exist.

Recently, health care workers (researchers, academics, policy writers, clinicians) have begun to view ethnography as an acceptable research methodology for informing public health work. This corresponds with a change in public health practice toward population health, wherein identifiable groups are examined to identify the group-level and contextual factors that affect their health statuses. Although population health-based methodological and outcomes-focused examinations have already occurred regarding ethnography, no extant literature scrutinizes the incorporation of ethnography into mainstream public and population health work from a sociopolitical viewpoint. Consequently, such an investigation occurs here using Foucault’s concepts of discipline and Lupton’s advancement of Foucault’s ideas about the imperative of health. The outcome of this investigation is the assertion that ethnography is a strategic method for disciplining populations that do not respect the imperative of health. In other words, ethnography helps generate the data that can be used to normalize large groups of people.

Over the last few years, the number of people living with HIV who have been convicted for not disclosing their HIV status to sexual partners in Canada has been steadily increasing. Whilst these laws are criminal in nature, and not public health-based, it is important to examine their effect on public health HIV prevention efforts. To undertake such an analysis, the impact fraction model was used to structure and examine the extant literature about HIV transmission, HIV status awareness and HIV testing practices. The findings of this analysis indicate that although these laws might prevent HIV transmission in a few isolated cases, it is unlikely that they would influence overall population-level rates of HIV transmission. Some evidence even suggests that these laws could exacerbate HIV transmission.

Over the last few years, the rates of certain sexually transmitted infections (STIs) have again begun to rise in Canada, the United Kingdom, and the United States. Paradoxically, these increases are occurring at the same time that greater numbers of researchers are publishing reports about highly successful safer sex interventions. Research that investigates this phenomenon reveals that the majority of new STIs management initiatives never reach day-to-day practice after the research period has terminated. In reaction to this, it is suggested here that researchers should begin developing their STIs management interventions in practice-based settings, with a strong emphasis being placed on ensuring target group input from the outset. While such an approach may not be able to discern precise cause-and-effect relationships, it has the benefit of enhancing use after researchers have withdrawn their support. The benefits that arise from long-term and widespread use of this approach may therefore outweigh the advantages that can occur from developing highly efficacious, but unused, STIs management strategies.

A literature review that addressed the possible reasons sexually transmitted infection (STI) rates are increasing indicated that self-directed STI testing for gonorrhea and chlamydia should be trialed. As such, a self-directed STI testing kit was developed and piloted for 6 months, during which 182 bathhouse patrons accessed services from both an on-site nurse and through the self-directed kits. In total, 127 of these individuals presented for testing from the nurse, with the remaining using the self-directed testing kits. Community/Participant feedback indicated that this testing method was a welcome adjunct to traditional services, thus suggesting that self-directed testing should be further explored.

The aim of this paper is to discuss how public health/epidemiological surveillance of sexually transmitted infections (STIs) contributes to and reinforces the subjugation of self, body and sexual pleasures, and thus acts as an apparatus of capture. Surveillance, which carries the connotation of policing, is validated, structured and supported by power/knowledge; indeed, infectious disease surveillance, particularly that of HIV and STIs is a powerful disciplinary technology that monitors the ‘ill’, the ‘transgressors’ and the ‘deviants’. In economic terms, it is the reconnaissance of information about the unproductive or pending ‘burden’ on power. Therefore, we posit that mechanisms of epidemiological surveillance of HIV/STIs inscribe and subjugate the self, the body and sexual pleasures into governed ‘practices’, not just of the self, but of social and cultural communities and places.

Normal.dotm 0 0 1 143 817 Queen's University 6 1 1003 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} While Michel Foucault asserted that the sovereign style of rule had disappeared, instead replaced by a disciplinary society (wherein individuals were trained/domesticated in a variety of social institutions), years later, Gilles Deleuze recounted how this social structure had again changed. Within this new system, which Deleuze labelled the society of control , social networks have become so densely intertwined that it no longer matters whether or not someone is disciplined in accordance with social rules because now they are entrapped within a web that would more often than not ensure that socially appropriate trajectories are maintained. Using Deleuze's framework about the society of control, in this paper, we explore the current public health STI/HIV surveillance system. The outcome of this exploration is the suggestion that the system is, in fact, an example of a densely intertwined ( rhizomatic ) control society, and that it is maintained through the desires of the people.

In Canada, there have been recent increases in HIV infections among men who have sex with men (MSM), making HIV transmission among MSM a continuing public health concern. In this paper, we explore ...

Over the last two decades, the incidence/prevalence rates of Hepatitis C virus have increased; this has resulted in the development of novel approaches to disease control, with many of these strategies taking a harm reduction approach. In Canada, one response has been crack pipe distribution (CPD). This article presents the results of a case study that compares CPD implementation in two Canadian cities: Ottawa and Toronto. The consequent analysis uses a systems perspective and thus, the implementation of CPD is examined within the larger context of social change that is necessary for public health services to transform their underlying philosophy from abstinence-based to harm reduction.

Aim. This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background. The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health worker's mandate. Method. Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings. As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the client's subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion. Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services.

During the past few years, the popularity of “bareback sex” within male homosexual communities in Western countries has increased, despite increased attention to health promotion campaigns in the era of AIDS and HIV. To address the issue of HIV and its legal ramifications, this article focuses on the important issue of serological status disclosure prior to sexual contact. It should be noted that the social, cultural, economic, and gender differences that lead to the creation of HIV laws are beyond the scope of this article. Instead, our goal is to present a brief overview of particular sexual practices—bareback sex and two of its derivatives: “bug chasing” and “gift giving”—as they relate to HIV sero-status and unprotected sexual contacts, as exemplified through current Canadian HIV laws. Because the legalities of HIV reporting, disclosure, and surveillance vary worldwide, it would be impossible to address more than one country’s HIV laws within the scope of a single article; therefore, we chose to focus on the legal aspects of bareback sex mainly from a Canadian perspective. However, our overall intent is to inform nurses of the legal and clinical implications of working with individuals who engage in bareback sex practices. It is hoped that through this article, additional questions for clinical practice and research will emerge.

Due to a recent increase in the rates of reportable sexually transmitted infections (STI) across Canada and the movement of public health nursing initiatives to a health promotion/ illness prevention model this paper proposes alternative strategies to current public health initiatives to encourage individuals who are labelled as at-risk by public health discourses such as teens and males who have sex with males (MSM) to undertake preventative screening. To undertake this task we approached Health Canadas (2002) determinants of health utilizing Luptons (1995) poststructuralist work on public health to suggest that for some members of these groups health is not an imperative. As such we propose that increasing anonymous testing and its advertisement would provide one means of providing population-sensitive care and could thus increase the screening rates of individuals within groups who reject the public health "healthy" disquisition. (authors)

Objectives HIV prevention efforts, particularly among men who have sex with men (MSM), have not achieved maximum effectiveness. A survey of MSM in Ottawa, Canada was completed to ascertain whether there were differences in how the perceived HIV status of participants and their partners influenced sexual practices. Methods Self-directed surveys were administered to a convenience sample of 721 MSM in Ottawa, Canada from November 2011 through May 2012. Data collection occurred at 14 sites. The survey identified whether participants identified as HIV positive, negative or unsure of their HIV status. Results The findings indicated variation between HIV-negative MSM and those who are unsure of their HIV status. Men who were unsure of their HIV status were less likely to report that they asked sexual partners or have had their partners ask about HIV status. Conclusions The results of this study indicate that some MSM may base decisions about HIV prevention on discussion about HIV status with their partners, rather than condom use. These practices may increase, rather than decrease, HIV transmission. Survey findings and extant literature demonstrate a need to inform MSM about the limitations of serosorting as a prevention strategy, and to provide facilitated access to sexually transmitted infection testing and treatment to further reduce onward HIV transmission.

OBJECTIVES: To 1) create a space where men who have sex with men (MSM) feel comfortable accessing sexually transmitted infection/human immunodeficiency virus (STI/HIV) testing, and 2) reduce STI/HIV incidence. PARTICIPANTS: Gay men in Ottawa and its surrounding regions. SETTING: A preponderance of diagnoses of sexually transmitted infections and HIV continue to occur among MSM. Meanwhile, other literature identifies that many MSM are reluctant to access STI/HIV testing services or to disclose their sexual practices to primary care practitioners. INTERVENTION: In Ottawa, in an effort to surmount these issues and decrease STI/HIV incidence among MSM, the local public health unit in collaboration with community partners created “GayZone”, a three-hour-per-week STI/HIV testing and STI treatment clinic for gay men. In this paper, we report on the uptake and STI/HIV diagnosis outcomes for this clinic from January 2010 through December 2013. OUTCOMES: GayZone is a well-utilized clinic that yields a number of STI/HIV diagnoses per year. Overall, the positivity rates of the STI/HIV tests at this clinic are above-average, although lower than what might be expected by local epidemiological data. While the results of this clinic validate anonymous HIV testing, they bring into question the utility of pharyngeal swabs to test for gonorrhea and chlamydia. CONCLUSION: The results of our study demonstrate the utility of a gay men’s STI/HIV testing clinic and highlight some areas for improvement. Public health practitioners, frontline clinicians, and community workers in other regions who wish to implement such an STI/HIV clinic would do well to consider our results beforehand.

This clinical concept paper overviews a program to facilitate access to postexposure prophylaxis (PEP) for gay, bisexual, and other men who have sex with men. The project, which was a collaborative initiative involving the local School of Nursing, public health unit, AIDS service organization, hospital-based HIV clinic, and an outpatient pharmacy, was implemented to circumvent common barriers to care identified in the literature. In this project, persons who present to one of the two participating clinics after having come, or likely having come, into contact with HIV within the previous 72 hr, are offered rapid HIV testing, also known as point-of-care (POC) testing, to rule out existing HIV infection, and provided with a follow-up appointment booked at the HIV clinic. Clients are also offered comprehensive STI testing, and HIV prevention counseling. The implementation of this collaborative community-based access-to-PEP project demonstrates the application of research to a real-world health care setting, and it is hoped that others will adapt this model to their local setting, enabling ease of access to PEP for members of groups that are disproportionately affected by HIV.

Objectives To review the extant literature on HIV criminal laws, and to determine the impact of these laws on public health practice. Methods The available research on this topic was obtained and reviewed. Results The extant literature addressed three main topics: people’s awareness of HIV criminal laws; people’s perceptions of HIV criminal laws; and the potential effects of HIV criminal laws on people’s sexual, HIVstatus disclosure and healthcare-seeking practices. Within these categories, the literature demonstrated a high level of awareness of HIV criminal laws, but a poor comprehension of these laws. For perceptions, on the whole, the quantitative research identified support for, while the qualitative literature indicated opposition to, these laws. Lastly, the behavioural effects of HIV criminal laws appear to be complex and non-linear. Conclusions A review of the extant literature from a public health perspective leads to the conclusion that HIV criminal laws undermine public health.

Although communicable disease public health practice has traditionally been based on numbers (e.g., incidence, prevalence), in the domain of HIV prevention and control qualitative research has recently become a more commonly employed data collection strategy. Of particular benefit, this approach can supplement the numbers which typically underpin public health strategies by generating in-depth understandings about how specific populations define, describe, and perceive their health and the factors that affect it. However, the use of qualitative research in public health must be explored; it cannot simply be accepted without reflection or analysis. To guide such an investigation, the work of Michel Foucault and Michael Hardt and Antonio Negri is used to examine two previous research projects that were undertaken by the author. The outcome of this analysis is the somewhat paradoxical conclusion that although qualitative research can enhance public health work, it may also be a strategy that generates the information that can be used for capturing and normalizing marginalized populations. Qualitative research, in other words, may be a technique that can be used to achieve biopolitical goals. Keywords: critical analysis; health inequities; HIV; public health; qualitative research According to Last (2001), public health "is the combination of sciences, skills, and beliefs that [are] directed to the maintenance and improvement of health of all people through collective or social actions" (p. 145). Public health is therefore a combined effort to optimize the health status of entire populations in educated and informed ways (Last, 2001). As part of executing informed initiatives in the domain of HIV care and management, public health practitioners collect population level data, which often requires laboratories, nurses, and physicians to report information about persons newly diagnosed with HIV to local public health departments; these reportable details typically include the age, sexual orientation, and sex of the individual diagnosed with HIV (Sullivan, Levine, McKena, & Weinstock, 2008). With these data, public health workers identify the groups burdened by HIV, the places where transmission occurs, and the methods by which transmission takes place. Thereafter, public health workers design targeted interventions that aim to diminish HIV transmission (Sullivan et al., 2008). In recent years, public health workers have begun to supplement conventional public health measures (e.g., incidence, prevalence, etc.), with additional data about the distribution of these indicators among disparate populations (Osborne, 1997). Underpinning this new philosophy of practice is the belief that identifiable subpopulations should not be disproportionately burdened by the negative sequelae associated with any illness, disease, or condition, including HIV. Each person, consequently, whether a member of a visible or identifiable minority group or not, deserves the right to equal health status, enjoyment of life, and ability to pursue his or her dreams. Evidently, the principles of social justice and fairness, with the corresponding ideas of inequalities and inequities, frame current public health practice.1 Although the importance of research which aims to diminish inequities cannot be overstated, missing from current discussions about the public health research that examines such health inequalities, disparities, and inequities are sociopolitical analyses about the role and purpose of qualitative2 research. To address this gap, the work of Michel Foucault and Michael Hardt and Antonio Negri was used to examine previous research that was undertaken by the author. Specifically, the foregoing theories framed a critically self-reflective examination of two interrelated projects: One that was an exploratory qualitative study; a second, which was an intervention project based on the first study. In this article, therefore, the author's previous work functioned as "results," which were examined using the foregoing sociopolitical theoretical framework. …

Background During the past decade, the intersection of HIV and criminal law has become increasingly discussed. The majority of studies to date have approached this topic from a sociological or legal perspective. As a result, the potential effect of nondisclosure prosecutions on population health and HIV prevention work remains mostly unknown. Methods A descriptive quantitative-qualitative study was undertaken to examine HIV testing, HIV diagnoses, and the attitudes of men who have sex with men following regional media releases about a local nondisclosure prosecution. As part of this study, first, we reviewed the trends in HIV testing and HIV diagnoses from 2008 through 2011 in Ottawa, Canada. Second, we explored the attitudes and beliefs of local MSM about HIV, HIV prevention, HIV serostatus disclosure, nondisclosure prosecutions, and public health. Results Quantitatively, the findings of this study revealed that, in comparison to the period preceding the media releases about a local nondisclosure prosecution, HIV testing and HIV diagnoses among men who have sex with men did not significantly change after the media releases of interest. Qualitatively, a subgroup of 27 men who have sex with men (12 HIV-positive, 15 HIV-negative) noted their beliefs that the local public health department openly shares information about people living with HIV with the police. Moreover, some HIV-positive participants stated that this perceived association between the local public health department and police services caused them to not access public health department services, notwithstanding their desires to seek assistance in maintaining safer sexual practices. Conclusions Nondisclosure prosecutions likely undermine HIV prevention efforts.

In May 2010, a local police force released the details of an HIV-transmission-related criminal investigation. This involved the publication of the name and photograph of, and charges against a man who the police allege did not disclose his HIV status prior to engaging in sexual activities that pose a “significant risk” for HIV transmission. Presently, however, there are no public health analyses of this situation. Consequently, the available literature on Canadian criminal laws, HIV transmission within this jurisdiction, and HIV prevention are presented and discussed herein. The outcome of this analysis is the conclusion that the act of publicizing an HIV-related criminal investigation more likely inhibits than encourages STI/HIV testing among HIV-negative and HIV-positive men who have sex with men. It is the assertion here that this undertaking thus conflicts with the overall public health goals of HIV prevention, and should likely not occur in the future.

In this article, an argument is put forth that clinic-based HIV testing can function as an important aspect of public health HIV prevention. This assertion is not an outright declaration that all HIV testing is beneficial. Instead, it is the conclusion that the individual-focused initiative of HIV testing could, if structured properly, induce population-level HIV prevention benefits. This analysis was informed using the impact fraction model, the Anderson-May equation, current epidemiological information about HIV from Canada, the United States, and England, and the extant literature on the dynamics of HIV transmission. This conclusion could help inform the development of public and population health HIV testing and HIV prevention policies/practices.

This paper provides an overview of HIV viral loads in blood and genital fluids and how these relate to HIV transmission during sexual activity. Current knowledge around HIV viral loads and transmission are then discussed in relation to HIV disclosure laws in Canada. HIV counsellors and health care workers should ensure that their clients/patients are aware that blood viral load is not necessarily equivalent to genital tract viral load and that the development of drug resistance within the two compartments may be unrelated. This is an important factor in preventing the spread of HIV as well as for HIV-positive individuals in not unintentionally exposing themselves to potential legal repercussions.

Amidst fiscal constraint and burgeoning health care demands, an innovative response to sexually transmitted infections was piloted in Quebec (Canada). This response arose out of the relationship of man and machine and resulted in the creation of 'cyborgs' as a communication medium for the dissemination of safer sex messaging. These 'cyborgs' physically carried the prevention message to a traditionally ‘at-risk’ audience, engaged their attention, and elicited an observable response. This paper proposes that at least a small portion of the resources allocated to re-creating old technologies may be diverted to researching and developing original and highly artistic prevention campaigns in Public Health.