Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study

Collins, Alexandra B.; Parashar, Surita; Closson, Kalysha; Turje, Rosalind Baltzer; Strike, Carol; McNeil, Ryan

doi:10.1016/j.healthplace.2016.06.005

Cited by 38 publications

(21 citation statements)

References 49 publications

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“…23 The potential for differential patterning of inequalities is likely. For example, residents already encountering the negative effects of poverty related 24 or racial prejudice, 25 or groups at risk of discrimination due to their health status, 26 could have their health further compromised by the associated stigma of place of residence.…”

Section: Why Spatial Stigma Matters For Health Inequalitiesmentioning

confidence: 99%

The elephant in the room? Why spatial stigma does not receive the public health attention it deserves

Halliday

Popay

Cuevas

et al. 2018

Journal of Public Health

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Section: Why Spatial Stigma Matters For Health Inequalitiesmentioning

confidence: 99%

The elephant in the room? Why spatial stigma does not receive the public health attention it deserves

Halliday

Popay

Cuevas

et al. 2018

Journal of Public Health

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“…Filling out questionnaires, providing blood samples, and participating in interviews and clinical trials figure in alongside street vending, panhandling, and binning as a supplemental income source to offset stagnating social assistance rates (DeBeck et al, 2011). Vancouver’s Downtown Eastside, the site of some of the earliest and most effective advocacy around the “Nothing About Us Without Us” principles (Boyd et al, 2009), now offers a unique opportunity to study how peer researchers experience participation within CBPR projects and their perspective on the impact that CBPR methods have had on the intense stigma and socio-economic marginalization faced by their community (Boyd and Kerr, 2016; Collins et al, 2016). …”

Section: Introductionmentioning

confidence: 99%

Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers

Damon

Callon

Wiebe

et al. 2017

Social Science & Medicine

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113

146

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Community based participatory research (CBPR) has become an increasingly common approach to research involving people who use(d) drugs (PWUD), who are often employed as Peer Researchers on these projects. This paper seeks to understand the impact of CBPR on PWUD, particularly those living in heavily researched and stigmatized neighbourhoods where CBPR projects are often located. This study draws on 14 in-depth interviews with PWUD who had previous experience as both peer researchers and research participants in CBPR projects conducted between July 2010 and February 2011. The study employed a CBPR approach in its study design, recruitment, interviewing, and analysis. Our analysis indicates that participants were supportive of CBPR in principle and described the ways in which it helped contest stigmatizing assumptions and researcher bias. Participants also reported positive personal gains from participation in CBPR projects. However, many participants had negative experiences with CBPR projects, especially when CBPR principles were implemented in a superficial or incomplete manner. Participants emphasized the importance of inclusiveness and active deconstruction of hierarchy between researchers and community members to successful CBPR among drug using populations. CBPR has been widely adopted as a research approach within marginalized communities but has often been implemented inconsistently. Still, CBPR can empower communities to contest forms of social stigma that are often reproduced through academic research on marginalized communities. Our findings describe how the benefits of CBPR are maximized when CBPR principles are consistently applied and when community based researchers are supported in ways that reduce hierarchies of power. This suggests a need for capacity building within affected communities to develop independent support, training, and grievance processes for peer researchers.

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“…HIV, mental health, hepatitis C) within one facility [28,29], have demonstrated potential to mitigate the effects of individual structural vulnerabilities on HIV care by creating a person-centred continuum of care tailored to the needs of specific populations. To date, the limited research on integrated HIV care services has primarily focused on clinical outcomes [30][31][32][33][34], highlighting their potential to improve HAART-related outcomes [10,[35][36][37]. However, as Christopoulos and colleagues note, competing priorities (e.g.…”

Section: Introductionmentioning

confidence: 99%

Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community‐wide treatment as prevention initiative: a qualitative study in Vancouver, Canada

Collins

Parashar

Hogg

et al. 2017

Journal of the International AIDS Society

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Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada – a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants’ service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants’ structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants’ subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP.

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Navigating identity, territorial stigma, and HIV care services in Vancouver, Canada: A qualitative study

Abstract: This study examines the influence of

Cited by 38 publications

References 49 publications

The elephant in the room? Why spatial stigma does not receive the public health attention it deserves

The elephant in the room? Why spatial stigma does not receive the public health attention it deserves

Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers

Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community‐wide treatment as prevention initiative: a qualitative study in Vancouver, Canada

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