Search

As part of a study on the social consequences of the criminal justice system on people living with HIV or AIDS (PHAs) in Canada, this article focuses on how heightened public identification of HIV with criminal matters is having wide ranging effects on perceived personal security and in particular on negotiating potential romantic and sexual interactions. As articulated by the Supreme Court of Canada, the courts have been enforcing a requirement that HIV-positive people disclose their sero-status to prospective partners, relying on the notion that “through deterrence it [the Criminal Code] will protect and serve to encourage honesty, frankness and safer sexual practices.” Nevertheless an accumulating set of evidence in the social and health sciences is pointing toward the difficulties of carrying out this directive in everyday life and toward the ways in which the application of law creates counter-productive or unanticipated consequences that can run contrary to the ostensible objective of discouraging behaviour likely to transmit HIV.

An intervention to address stigma directed toward HIV-positive men and to enhance the sexual health of gay and bisexual men was developed through a community-based process involving HIV prevention workers, public health, government, and researchers. The intervention aimed to diminish stigma, create greater support for HIV-positive men, make disclosure safer and easier, discourage reliance on disclosure to prevent transmission, and encourage testing. The question, “If you were rejected every time you disclosed, would you?” was widely disseminated in the gay community and supported by the website, hivstigma.com, to encourage participation in blog-based discussions. Eight bloggers moderated lively discussions over 5 months. There were 20,844 unique visitors to the site averaging more than 5 minutes each; 4,384 visitors returned more than 10 times. 1,942 men answered a pre-test survey on a popular gay dating site and 1,791, a post-test evaluation. Results show a statistically significant shift among those aware of the intervention toward reduced stigma-related attitudes and behaviors, and toward recognition that HIV positive gay men face stigma in the gay community and that stigma reduces the likelihood of HIV disclosure.

This paper reports on the creation, implementation, and evaluation of a life skills and HIV prevention program for Spanish-speaking gay, bisexual, and other men who have sex with men (MSM) who are within three years of arrival in Canada. The Mano en Mano program consists of an initial day-long session followed by four two-hour evening sessions addressing HIV prevention, social isolation, social service, and migration issues. Evaluation showed a significant shift toward safer sex practice and decreased sense of social isolation as expressed in exit interviews. The Mano en Mano intervention shows movement in the right direction in HIV prevention and sexual health promotion and shows considerable potential to be effective and well liked by participants. Interventions of this type that build social networks and peer bonds in a sexual health context likely have potential to be useful and effective beyond the Latino newcomers who participated in this pilot.

Background: Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. Objective: To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). Methods: A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Results: Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. Conclusions: There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease. [J Med Internet Res 2013;15(2):e35]