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In industrialized countries where HIV infection is becoming a chronic, episodic condition, rehabilitation services have the potential to play an expanded role for people living with HIV/AIDS (PLHAs). However, little is known about rehabilitation in the context of HIV. This paper documents the development of an enhanced, multidisciplinary conceptual framework of rehabilitation in the context of HIV, using the perceptions of PLHAs and rehabilitation professionals. Rehabilitation, broadly defined, is a dynamic process that includes all prevention and/or treatment activities and/or services that address body impairments, activity limitations and participation restrictions for an individual. The framework was developed through broad consultation and interviews with thirteen key informants. Themes that emerged from analysis of interviews related to concepts of rehabilitation in the context of HIV, rehabilitation professionals' roles in the context of HIV, and barriers to access and delivery of rehabilitation services. While there was some variation, key informants generally viewed rehabilitation as a goal-oriented and client-centered process with the potential to impact a range of life domains. Themes were presented to members of a national advisory committee (including PLHAs and health care providers), who produced the foundation of the HIV rehabilitation framework. The framework uses the perspective of the person living with HIV/AIDS, and includes individual life domains that may be affected by HIV, drawing and expanding upon the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health.

In this paper, we examine the challenges of defining the boundaries of outreach work using the example of needle exchange programs. In particular, we examine the multiple and inter-related factors that extend needle exchange outreach work beyond its official mandate. Using semi-structured interviews, 59 workers at 15 programs in Ontario, Canada were asked questions about operational policies and routines. An iterative and inductive analytic process was used. Over time, most outreach workers develop a well-defined sense of the activities they consider to be consistent with a harm reduction approach and the types of conduct that are considered to be acceptable and professional. Workers conceptualize their roles to encompass education and support but are reluctant to impose a rigid definition of their roles. A pragmatic and humble stance combined with strong beliefs in social justice encourages workers to find informal solutions to meet client needs that extend beyond the program mandate. As a result, doing 'extra' is the norm. These extra efforts are informal, but often regular, expansions of the service complement. Construction of flexible boundaries provides opportunities to meet many client needs and unexpected situations; however, going the extra-mile strains resources. A minority of workers blur the boundaries between private and professional lives. Further, a variety of personal, social and socio-political forces encourage outreach workers to continually redefine the boundaries of their roles and service complements. Keywords: Outreach; Client helper relationships; Needle exchange; prevention; Canada

This article discusses the the relationship between sexual aggression, unsafe sex, and HIV transmission among street youth. Topics include sexual orientation, substance use, relationship obligations, guilt, and vulnerability.

Objective: This article describes the self-reported use of substances, participation in unprotected intercourse and differences in sexual risk-taking behavior with state of inebriation among a group of aboriginal (First Nations) people in Ontario. And, in so doing, attempts to answer some of the questions about the association between the use of alcohol and sexual risk taking in this population. Method: The project was developed in a partnership between an aboriginal steering committee and university researchers. Data were collected via interview from 658 randomly selected status First Nations people living within 11 reserve communities in the province. Results: Of the 426 individuals included in the within subject analysis 9.6% reported variation in their participation in sex, 13.8% variation in their participation in intercourse and 10.3% variation in their participation in unprotected intercourse with inebriation. An examination of individual behavior across 'sober' and 'drunk or high' states showed that there were almost equal proportions of respondents who only participated in unsafe sex when sober and respondents who only participated in unsafe sex when drunk or high. Where significant differences occurred, individuals were more likely to report a shift towards no sex or no intercourse with inebriation, not towards unprotected intercourse. Conclusions: Since a large proportion of individuals in this study engage in unprotected intercourse, the small proportion of individuals reporting different sexual behavior were more likely to report participation in a safe activity rather than an unsafe activity while 'drunk or high.' Stereotypes and assumptions may lead educators and researchers to feel the need to focus their messages on the relationship between drug and alcohol consumption and unsafe sex; however, the amount of unsafe sexual intercourse that occurs only while individuals are inebriated suggests that this focus is not of principal concern. (J. Stud. Alcohol 58: 312-322, 1997), Interviews with 426 Native American men and women reveal that their level of inebriation from alcohol has no significant effect upon their willingness to engage in unprotected sexual intercourse. The data gathered shows that more than 66% of the subject population either never uses condoms during sexual intercourse or uses them inconsistently. This indicates a very high level of risky sexual behavior existing in this population regardless of sobriety level. Those who varied their sexual behavior when inebriated were actually more likely to avoid sex at that time than attempt it., SLIGHTLY MORE than 1 million of Canada's 27 million people identified themselves as aboriginal (First Nations) people in the 1991 national census and 24% of these individuals live within the [...]

This article explores bisexual behavior in men and disease transmission risk in the United States and Canada. The authors maintain bisexual men in both countries demonstrate that they are more likely to practice safe sex than homosexual men, are less likely to wear a condom when with a woman, approximately 35% are at high risk for HIV infection, and bisexual men have high rates of drug abuse.

A survey of community pharmacies in Canada reveals that they use a harm reduction approach to deal with the AIDS epidemic. Study of the role of policy and practices of these pharmacies indicates that they promote safer sex practices, counsel, and provide safer-drug-use equipment and site for the disposal of used needles. The support from the federal government, regulatory bodies and professional associations enhances the effectiveness of the role of these pharmacies.

Low and stable seroprevalence can be maintained in cities where HIV has been introduced into the population of injecting drug users (IDUs) by instituting early community outreach and education. Researchers identified for further study five cities that had maintained seroprevalence rates of less than 5% for five years or more. These were Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Washington; and Toronto, Ontario. Prevention efforts were conducted early and sterile injection equipment was made available in the cities studied. Community outreach programs were implemented that distributed AIDS information and supplies for risk reduction, in addition to developing trust between IDUs and health care workers. In Toronto, Tacoma, and Sydney, bleach was distributed to disinfect injection equipment. The low seroprevalence was maintained even though a large number of IUDs still participated in some risky behavior., Objectives.-To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUS), but where seroprevalence has nevertheless remained low Design and Setting.-a literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUS. Participants.-Injecting drug users recruited from both drug treatment and nontreatment settings in each city. interventions.-A variety of HIV prevention activities for IDUS had been implemented in each of the five cities. Results.-There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low,(2) provision of sterile injection equipment, and (3) community outreach to IDUS. Moderate levels of risk behavior continued with one third or more of the IDUS reporting recent unsafe injections. Conclusions.-In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUS, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUS are at risk for rapid spread of HIV. (JAMA. 1995;274:1226-1231)

Objectives. This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. Methods. A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. Results. Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to he tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. Conclusions. Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value. (Am J Public Health. 1993;83:701-704), There is no one predominant reason why gay or bisexual men decide to be tested for the human immunodeficiency virus (HIV). HIV is the virus that causes AIDS. Analysis of questionnaires distributed in bars and bathhouses in Toronto, Canada, indicates that one of the strongest predictors of test taking was location. Residents of metropolitan areas were more likely to be tested for HIV. The availability of anonymous testing also seemed to be an important variable in the men's decision to be tested. Not wanting one's name reported to health authorities was cited as the most common reason for not being tested. Anonymous testing only became widely available in Toronto in 1992. Prior to that time, positive test results and diagnoses of AIDS had to be reported. More research on testing policies needs to focus on the individual in order to implement policies that encourage testing.

Abstract Background HIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth. Methods A community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years). Results Average age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test. Conclusion It is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.