Exploring the Health and Wellness of Long-Term HIV-positive Two-Spirit Men in Ontario
Amount: $99,131
Duration: 2012-2013
Funding Source: CIHR Catalyst Grant – HIV/AIDS and Aboriginal Health
Role: Co-Principal Investigator, with Art Zoccole
Abstract: Aboriginal peoples living with HIV face numerous obstacles to health and wellness. Despite these obstacles, many two-spirit and/or gay/bisexual HIV-positive Aboriginal men who have been living with HIV for a long time (10 years or more) report that they are doing well. Little is known about the factors that impact the resiliency, health and wellness of two-spirit and/or gay/bisexual HIV-positive Aboriginal men who have been living with HIV long term. This study is designed to bring together a team of researchers comprised of Aboriginal and non-Aboriginal community members and academics to review existing research about resiliency among those living with HIV. Once we have summarized the research, we will conduct focus groups that have been modified to work similarly to Aboriginal sharing circles with HIV- positive two-spirit Aboriginal men who have had HIV for 10 years or more to obtain their input into how the summary of the research is relevant to their lives. Additionally, we will ask them what other areas we should be looking at for future research. The research team will then submit a grant for a larger study on resiliency among two-spirit and/or gay/bisexual HIV-positive Aboriginal men. We will summarize our findings and present them to communities and academics. This grant will result in three specific outcomes: (1) a substantial review of current academic literature on resiliency among those who have been living with HIV long term, (2) written and verbal community and academic reports of the sharing circle findings, and (3) a new research partnership of academics and community members will be strongly poised to submit a larger CIHR operating grant for future research funding focused on enhancing and sustaining the health and wellness of two-spirit and/or gay/bisexual HIV-positive Aboriginal men who have been living with HIV long term.
Protective Factors Against HIV Risk Behaviour Among Gay and Bisexual Men: A Longitudinal Study
Amount: $325,356
Duration: 2011-2014
Funding Source: CIHR Institute of Infection and Immunity, HIV/AIDS CBR Progra
Role: : Co-Investigator, with Dr.'s Barry Adam and Trevor Hart as Principal Investigators
Abstract: Gay, bisexual, and other men who have sex with men (MSM) bear a disproportionate burden of the epidemic in Canada, and HIV incidence appears to be rising among Canadian MSM. There is therefore clearly a need for new thinking to improve HIV prevention efforts for HIV-negative MSM. The research literature tends to use a risk factor/deficit model. This model does not adequately explain why most MSM manage to consistently practice protected sex. The lack of knowledge on protective factors limits the ability of public health agencies and AIDS service organizations to prevent the spread of HIV. The present study aims to examine how HIV- MSM rely on to reduce their sexual risks. Using a mixed-methods approach, the study will identify protective factors and sexual strategies among MSM that lead to higher or lower sexual risk outcomes. The research team includes university researchers from multiple disciplines, researchers from the AIDS Committee of Toronto and OHTN-based researchers. This study intends to build capacity of AIDS service organizations (ASOs), support evidence-based practice, support research, and build, support, and enhance community-academic-policy partnerships.
Resiliencies and Risks: Addressing HIV and Other Health Disparities among Marginalized Men Who Have Sex with Men
Amount: $260,000
Duration: 2011-2016
Funding Source: OHTN Scholarship Award
Role: Principal Investigator
Abstract: The goal of my program of research is to work with community partners and academic colleagues to develop knowledge and interventions that will enhance the resiliencies and reduce the risks of HIV and other health disparities among men who have sex with men (MSM). It is focused on five related areas: 1) health disparities (particularly sexual risk, but also body image, eating disorders, substance use and mental health) among MSM who are marginalized due to sexual orientation identity (gay/bisexual vs. MSM), HIV status, age, socio-economic status and ethnoracialized identities; 2) The identity of factors which protect marginalized MSM from HIV and other health outcomes; 3) The relationship between eating risks, body image and sexual risk among marginalized MSM; 4) The influence of age on the resiliencies from and risks for HIV; 5) The development of interventions and policies that can enhance resiliency and reduce risk among these populations. Examples of projects that are part of this program of research include: the "Imagine Men's Health" study which focuses on body image and sexual risk among ethnoracialized MSM; "A Profile of Older Adults Living with HIV in Ontario" examining the resiliencies and risks of those over 50 living with HIV/AIDS; "Are Gay Men Really Men Who Have Sex with Men?" examining if there are different health outcomes based on how we measure sexual orientation. I am also working on projects focused on issues of HIV risk among lesbian, gay, bisexual and transgendered (LGBT) youth; and a test of a new model of community-based group Motivational Interviewing (MI) to reduce drug use and sexual risk for MSM.
Double Jeopardy? A Salon on the Joys and Discontents of Aging with HIV
Amount: $3,000
Duration: 2011-2012
Funding Source: Ryerson University, Office of Research Services Health Science Fund
Role: Principal Investigator
Abstract: Since the advent of highly active antiretroviral therapy (HAART) in the 1990s, people with HIV are now living longer and HIV has evolved from a fatal disease to a more manageable long-term illness. Since 1998, the percentage of total reported AIDS cases in Canada among those 50 and over has increased from approximately 12% to nearly 20% in 2006 (PHAC, 2007) - a phenomenon known as the "graying" of HIV/AIDS. According to current research, older adults living with HIV/AIDS are affected physically, psychologically and socially in ways that may be exacerbated by age. For example, data from both the U.S. and Canada have consistently shown that older adults living with HIV/AIDS are significantly more likely to receive a late diagnosis than their younger counterparts diagnosis (Centers for Disease Control and Prevention, 2008b; Kohli et al., 2006), possibly as a result of the impact of aging on the immune system and lack of clinical suspicion for HIV among health care providers (CDC, 2009; Hall, 2009). Psychologically, older adults with HIV disease have higher rates of depression and social isolation than younger adults(Karpiak, 2006). HIV stigma has been shown to be an important issue facing older adults living with HIV (Emlet, 2007) that can be a barrier to care (Desquilbet, 2009). Despite this demographic trend and its impacts, the issue of aging with HIV has received little media and research attention and has been "insufficiently taken into account by policies and the Canadian health system" (Wallach, 2008, p. 1). The 2010 View from the Front Lines (the annual report on the activities of Ontario community-based AIDS service organizations) highlighted both the growing number of older clients and the need for more information to meet their needs.
A profile of older adults living with HIV in Ontario
Amount: $6,590
Duration: 2010-2012
Funding Source: The Canadian Embassy in Washington, DC.
Role: Co-Principal Investigator, with Dr. Charles Emlet, University of Washington, Tacoma.
Abstract: The project seeks to answer two primary research questions: 1) What is the socio-demographic profile of older adults (50+) living with HIV/AIDS in the Greater Toronto Area (GTA) who are members of the OHTN Cohort study (OCS)? 2) What are the differences in HIV Stigma and mental health quality of life based on gender and sexual orientation among the sample?
Are Gay Men Really Men who have Sex with Men (MSM)? Methodological Issues in Measuring Male Sexual Orientation in Health Research
Amount: $42,790
Duration: 2010-2011
Role: Co-Principal Investigator, with Dr. Greta Bauer
Abstract: Health studies on sexual minority men have used a wide variety of measures of sexual orientation. Different dimensions of sexual orientation - attraction, behaviour and identity - are measured in diverse ways. Behavioural measures of men who have sex with men (MSM) may define this group according to sexual activity during different timeframes (Ever? Past six months?) and may define "sex" variably or not at all. Identity measures may involve scales or categories, including culturally specific categories, or options such as "unsure" or "something else," and may combine categories (e.g. gay and bisexual vs. heterosexual). Despite varying measures, researchers and policy makers combine data across studies, formally and informally, assuming that results obtained using one measure are comparable to those that would be obtained using another. This assumption had been found to be invalid for women, but has not been evaluated for men. If it is not, there are serious policy implications. For example, in the consideration of Canadian blood donor deferral criteria, data from studies of gay- and bisexual-identified men have been used to evaluate whether changes should be made to the current policy excluding potential male donors who have had sex with another man, even one time, since 1977. The proposed study draws on population data from the U.S. National Health and Nutrition Examination Study, which contains multiple measures of sexual orientation not available in Canadian data sets, to assess whether different measures and categorizations of sexual orientation in men will produce similar outcomes in the same large group of adult men. Outcomes include obesity, physical activity, current alcohol and tobacco use, sexually transmitted disease prevalence, and recent sexual risk-taking. Based on a literature review and results of this analysis, recommendations will be made for measuring male sexual orientation in health research studies, and a guide for researchers will be created.
Eating Disorders, Body Image Satisfaction, and Physical, Mental, and Sexual Health Among Gay and Bisexual Men Who Identify With Ethno-racialized Communities
Amount: $152,483
Duration: 2009-2012
Funding Source: Social Sciences & Humanities Research Council of Canada
Role: Co-Investigator, with Dr. David Brennan as Principal Investigator
Abstract: Gay and bisexual men (GBM), particularly men who identify with ethnoracialized communities, are at disproportionately high risk for a variety of health disparities. There is a vital need for research that explores the relationship between ethnoracialized identity and issues of sexual identity, eating pathologies and other behaviours that put GBM at risk for a host of health issues. Building upon previous work of the principal applicant showing higher rates of body image dissatisfaction among ethnoracialized GBM in Toronto (Brennan, 2008), the objectives of the proposed research are:
1. To explore the relationship between ethnoracialized identity, resiliencies and risks for body image dissatisfaction, and associated eating behaviours and attitudes among ethnoracialized GBM;
2. To further examine the applicability of syndemic theory by examining the association between experiences of racism, homophobia and internalized ethnocultural attitudes and beliefs associated with body image satisfaction, and eating attitudes and behaviours, among ethnoracialized GBM; and,
3. To develop socioculturally relevant tools for assessing 1) body image satisfaction, and 2) eating attitudes and behaviours for ethnoracialized GBM both in clinical practice and research that will advance understanding of the role of body image satisfaction, eating attitudes and behaviours in the overall health of ethnoracialized GBM.
Universities without walls: A CIHR Training Grant in HIV/AIDS Health Research
Amount: $1,790,000
Duration: 2009-2015
Funding Source: CIHR Institute of Infection and Immunity
Role: Co-Investigator, with Dr. Sean B. Rourke as Nominated Principal Investigator and multiple Principal Investigators
Abstract: Universities without Walls is an innovative model for learning, mentorship, training and research. UWW will build a national interdisciplinary learning network -- connecting faculty in six major academic training hubs (Dalhousie, Queen's, St. Michael's Hospital, University of Windsor, University of Calgary, and Simon Fraser University) as well as faculty in 20 other universities across the nation -- 14 front-line organizations and 7 policy makers. UWW will provide a dynamic academic and service learning environment that will attract outstanding students across a wide range of disciplines and develop 60 to 70 new social science researchers skilled in interdisciplinary research, community-based research, ethics, and knowledge translation who are able to work collaboratively with other researchers, community and policy makers to have a national and global impact on the HIV/AIDS epidemic. Major Aims and Objectives of UWW: 1) Establish a National Training Network; 2) Build an Interdisciplinary Training Model and Approach; 3) Broaden Content Learning Opportunities; 4) Offer Practical Training Opportunities; and 5) Monitor and Evaluate the Success of UWW.
Centre for REACH (Research Evidence into Action for Community Health) in HIV/AIDS
Amount: $ 2,500,000
Duration: 2009-2014
Funding Source: CIHR Institute of Infection and Immunity
Role: Co-Investigator, with Dr. Sean B. Rourke as Nominated Principal Investigator and multiple Principal Investigators
Abstract: The CIHR Centre for REACH in HIV/AIDS is a collaborative, national partnership among leading health researchers in Canada in a wide array disciplines from over 20 academic institutions, people living with HIV, front-line service providers, knowledge translation and exchange (KTE) specialists, and federal, provincial and regional policy makers. OUR VISION is to bring together critical practice, research, and policy skills as well as the lived experience of people with HIV to enhance the health of individuals and communities disproportionately affected by HIV. OUR MISSION is to provide the core infrastructure support required to: engage community, policy makers and researchers in interdisciplinary teams; break down geographical, theoretical, and conceptual barriers; and solve problems in the use, uptake and implementation of research evidence. OUR WORK will strengthen policy, programs and practices, and make a measurable difference in the health and well-being of people with HIV and communities most vulnerable to HIV. Using an interdisciplinary approach and working collaboratively at the intersections of social science, population health and health services research, the Centre will use an interdisciplinary approach to focus on three thematic areas: (1) UNDERSTANDING THE PROBLEMS AND FACTORS DRIVING THE EPIDEMIC - reaching beyond individual behaviour to explore the impact of broader structural and cultural factors as well as the social determinants of health (i.e., poverty, stigma, discrimination, racism and gender inequality) on risk, resilience, behaviour and access to health services within communities; (2) FIND INNOVATIVE AND PRACTICAL SOLUTIONS - taking an integrated approach to prevention and treatment, developing evidence-based interventions and strategies; and (3) MOVE RESEARCH EVIDENCE INTO ACTION - developing effective KTE strategies, relationships and networks and having a measurable impact on policy and practice.