Our Youth, Our Response Building Capacity for Effective HIV/HCV Policy and Programming Responses Across the Atlantic Region Anik Dubé, Jacqueline Gahagan, Greg Harris, Lois Jackson, Jo-anne MacDonald, Kathleen Hare, Pamela Hudson, Jocelyne Maurice, Maryanne Tucker, Sally Walker

 3-year project, started June, 2011  Funded by Nova Scotia Health Research Foundation  Analyzes policies and programs related to HIV/HCV prevention in youth in four Provinces and makes recommendations for change.  Uses information from all 4 provinces The Project

 Led by Dr. Jacqueline Gahagan, Dalhousie University  12 researchers from the 4 Atlantic provinces  Part-time coordinator and 4 Research Assistants  Community Advisory Committee with 11 members from all 4 Atlantic provinces  Youth Advisory Committee with 7 members The Team Collaboration

Youth are at risk of HIV/HCV infection through:  Unprotected sexual intercourse with infected partner  Injection drug use  Unsafe tattooing practices  Lack of accurate knowledge of HIV/HCV transmission risk factors Background

Social Determinants of Health influence likelihood of contracting HIV/HCV:  Income and social status  Age  Gender  Culture  Health Services  Social and physical environments Background (cont’d.)

HIV & HCV share many features in common:  Prevalence among youth  Stigma  Negative impact on lives of infected and affected individuals  Preventable with proper knowledge of transmission and ways to prevent transmission Background (cont’d.)

 Determines programs & services and methods of delivery  Provides restrictive measures for reporting and testing  Should address determinants of health  Policies from several sectors have impact  Health  Education  Justice  Policy framework needed to integrate multiple sectors Role of Policy

1.Analyze existing HIV/HCV primary and secondary prevention policies and programs for youth in the Atlantic Region 2.Determine with our stakeholders how well these address the needs of youth and social determinants of health 1.Policy advisors 2.Youth 3.Youth workers Objectives of Study

3.Identify gaps in the effectiveness of the policies and programs 4.Develop multi-sectoral policy recommendations for Nova Scotia 5.Provide opportunities for policy capacity building through knowledge exchange Objectives of Study (2)

1.What HIV/HCV primary and secondary prevention policies related to youth exist in the Atlantic Provinces? 2.Do these policies (and programs) adequately address the needs of youth? 3.How do the prevention approaches differ for each province? How fractured or cohesive are the approaches? Research Questions

4.What, if any, gaps exist in current policy approaches to primary and secondary prevention? 5.How can these gaps be used to refine policies and policy frameworks? 6.How can such policy refinement help inform best practices in HIV/HCV prevention among youth in Nova Scotia? Research Questions (Cont’d.)

 Based on a multidimensional approach to HIV/HCV prevention;  Used a sex, gender, diversity, and equity lens;  gender identity  gender roles  gender relations  institutionalized gender Sex and gender-based analytic framework

 Research Assistants (R.A.s) in each province worked with university librarian to develop systematic search terms and most appropriate databases  R. A.s contacted community organizations and government departments to find “grey” literature  R.A.s categorized documents in terms of types of documents, target populations, types of prevention addressed, and sector Policy Scan: Methods

 Scan of policies, programs, services completed in each province  Total number of documents coded  New Brunswick 81  Newfoundland and Labrador 149  Nova Scotia 132  Prince Edward Island 63 Policy Scan: Methods

 More documents related to programs than those related to policy  More documents related to primary prevention than secondary prevention  Most documents came from the health sector and government, while others came from community-based ASO and research reports Types of Documents Found

 Lack of youth framework : documents in many different organizations and departments  Different structures of government departments in different provinces  Search terms and databases searched specific to each province  Difficulty in obtaining unpublished documents Challenges in conducting Interprovincial Policy Scan

 Coding scale  Ranked on a scale from 1 to 3  1: highly featured  2: not fully explored  3: absent from document Research coding

 OYOR coding focused on health, education, community, and justice  Coding and cross-coding across sectors  Of the 62 grey literature documents:  Five documents scored 1*  29 scored 2  28 scored 3 Research coding grey literature

 The health sector captured most of the coding within the sex and gender-based framework  Of the 19 academic literature articles:  No article scored 1  13 articles scored 2  Six articles scored 3 Research coding academic literature

 Analysis of documents showed that few are highly sensitive to multidimensional gender- based and youth-specific issues in HIV/HCV prevention  Most integrate the needs of men and women together  Most are income directed to increase awareness (i.e. gender gap in provincial wages)  Only one provincial gender-based analysis guide exist for the province and it dates back to 2003  Most do not address the determinants of health Findings

 Conduct interviews with key stakeholders and analyze results  Use results as basis for developing youth focus groups and survey for year 3  Knowledge Exchange Event: “Spread information, not disease” Year 2

 Focus groups with youth  Survey of youth (400)  Analysis of all results  Identification of gaps and priorities  Development of recommendations for public health policy and for program interventions Year 3

 Final Report and published papers  Meetings with youth advisory members  Meetings with provincial policy makers  Presentations at government and professional meetings/conferences Year 3 Dissemination

For more information, contact: Dr. Jacqueline GahaganAnik Dubé, RN, PhD (c) Professor & Chair Health Professor promotionUniversité de Moncton Dalhousie UniversityJacqueline Bouchard Building 6230 South StreetMoncton, NB Halifax, NS B3H 3J Thank you!