"We Cause a Ruckus": Exploring How Indigenous Youth Navigate the Challenges of Community Engagement and Leadership.

Using qualitative data from an interdisciplinary research project about mental health and community engagement with Indigenous youth in Kasabonika Lake First Nation (Ontario, Canada), this paper explores the factors that constrain and facilitate their ability to contribute to the well-being of their community. Case studies are employed to demonstrate how the youth navigate complex social and structural conditions within the context of on-going colonization through federal and provincial governance arrangements, to make a difference in the place they call home and forge unique in-roads that reflect their generational realities and aspirations. The paper contributes to ongoing discussions related to mental health, self-determination, and resilience research.

Balance, Capacity, and the Contingencies of Everyday Life: Narrative Etiologies of Health Among Women in Street-Based Sex Work.

There is an abundance of health research with women in street-based sex work, but few studies examine what health means and how it is practiced by participants. We embrace these tasks by exploring how a convenience sample of sex workers (n = 33) think about and enact health in their lives. Findings reveal pluralistic notions of health that include neoliberal, biomedical, and lay knowledge. Health is operationalized through clinic/hospital visits and self-care practices, which emerge as pragmatic behaviors and ways to resist or compensate for exclusionary treatment in health care systems. Participants also use symbols of biomedical authority to substantiate their lay interpretations of certain conditions, revealing complex forms of moral reasoning in their health etiologies. We conclude that doing health and constructing rich narratives about it are constituent elements of the women's everyday praxis and subjectivities in relation to the broader socioeconomic and political worlds of which they are a part.

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers' Perspective.

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers' perspective of gaps in services for male CSA survivors. "Limited Male CSA Programs", "Institutional Barriers", "Attitudinal Barriers", and "Systemic Gaps" emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.

"People like us": spatialised notions of health, stigma, power and subjectivity among women in street sex work.

Most spatially-oriented studies about health, safety and service provision among women in street sex work have taken place in large urban cities and document how the socio-legal and moral surveillance of geographical spaces constrain their daily movements and compromise their ability to care for themselves. Designed to contribute new knowledge about the broader socio-cultural and environmental landscape of sex work in smaller urban centres, we conducted qualitative interviews and social mapping activities with thirty-three women working in a medium-sized Canadian city. Our findings demonstrate a socio-spatial convergence regarding service provision, violence, and stigma, which is common in sex trading spaces that double as service landscapes for poor populations. Women in this study employ unique agential strategies to navigate these competing forces, many of which draw upon the multivalent uses of different urban spaces to optimise service access, reduce the propensity for violence, and manage their health with dignity. Their use of the spatialised term 'everywhere' as an idiom of distress regarding issues of power, agency and their desire to take part in wider civic discourse are also explored. These data contribute new insights about spatialised notions of health, stigma, agency, and subjectivity among women in sex work and how they manage 'risky' environments.

Barriers and facilitators affecting self-disclosure among male survivors of child sexual abuse: The service providers' perspective.

Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates, with males less likely to disclose their abuse compared to females. CSA can have lasting impact on a children's emotional, physical, and psychological wellbeing. While service providers play an instrumental role in providing care and support for male CSA survivors, little is known about their perceptions and experiences related to disclosure among these men. The aim of this qualitative study was to explore service providers' perceptions and awareness of disclosure-related barriers and facilitators amongst male CSA survivors. Individual interviews were conducted with eleven service providers. Study findings reveal four key themes related to the disclosure process among male CSA survivors: (a) personal characteristics, (b) interpersonal relations, (c) institutional elements, and (d) societal norms. Findings indicate that service providers understand and respond to complex challenges associated with disclosure of CSA among this marginalized population. Study findings demonstrate the need for additional research on the specific issues of gender bias and stigma associated with male sexual abuse. Along with their empirical significance, these findings can be used to develop more tailored public health and social service-related programming for male CSA survivors, their families, and the broader community to promote a safer and more supportive environment in which to discuss these sensitive and important issues. Recommendations to service providers are discussed.

Vets, denialists and rememberers: social typologies of patient adherence and non-adherence to HAART from the perspective of HIV care providers.

For many people living with HIV/AIDS taking highly active antiretroviral therapy (HAART) is difficult due to various individual and social factors, including the side effects of these medications, HIV/AIDS stigma and poor patient-provider relationships. Most studies that examine barriers to and facilitators of adherence to HAART have been conducted with people on these medications, which is critical to improving adherence among various HIV-affected groups. Less attention has been paid to the experiences of HIV care providers, which is an important gap in the literature considering the key role they play in the delivery of HAART and the management of patient treatment plans. This paper presents findings from a qualitative pilot study that explored how HIV care providers assess adherence and non-adherence to HAART among their HIV-positive patients in Vancouver, British Columbia. Drawing upon individual interviews conducted with HIV physicians (n = 3), social service providers (n = 3) and pharmacists (n = 2), this discussion focuses on the social typologies our participants use to assess patient success and failure related to adherence. Eleven unique categories are featured and the diversity within and across these categories illustrate a broad spectrum of adherence-related behaviours among patients and the social meanings providers attribute to these behaviours. As one of the first explorations of the social typologies used by HIV care providers to assess patient performance on HAART, these data contribute valuable insights into the experiences of providers within the context of adherence-related care delivery.

Understanding safety culture in long-term care: a case study.

OBJECTIVES: This case study aimed to understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care (LTC) facility. Specific objectives included the following: diagnosing the present level of safety culture maturity using the Patient Safety Culture Improvement Tool (PSCIT), examining the barriers to a positive safety culture, and identifying actions for improvement. METHODS: A mixed methods design was used within a secured unit for cognitively impaired residents in a Canadian nonprofit LTC facility. Semistructured interviews, a focus group, and the Modified Stanford Patient Safety Culture Survey Instrument were used to explore this topic. Data were synthesized to situate safety maturity of the unit within the PSCIT adapted for LTC. RESULTS: Results indicated a reactive culture, where safety systems were piecemeal and developed only in response to adverse events and/or regulatory requirements. A punitive regulatory environment, inadequate resources, heavy workloads, poor interdisciplinary collaboration, and resident safety training capacity were major barriers to improving safety. CONCLUSIONS: This study highlights the importance of understanding a unit's safety culture and identifies the PSCIT as a useful framework for planning future improvements to safety culture maturity. Incorporating mixed methods in the study of health care safety culture provided a good model that can be recommended for future use in research and LTC practice.

Identifying self-perceived HIV-related stigma in a population accessing antiretroviral therapy.

This study identifies factors associated with self-perceived HIV-related stigma (stigma) among a cohort of individuals accessing antiretroviral therapy in British Columbia, Canada. Data were drawn from the Longitudinal Investigations into Supportive and Ancillary Health Services study, which collects social, clinical, and quality of life (QoL) information through an interviewer-administered survey. Clinical variables (i.e., CD4 count) were obtained through linkages with the British Columbia HIV/AIDS Drug Treatment Program. Multivariable linear regression was performed to determine the independent predictors of stigma. Our results indicate that among participants with high school education or greater the outcome stigma was associated with a 3.05 stigma unit decrease (95% CI: -5.16, -0.93). Having higher relative standard of living and perceiving greater neighborhood cohesion were also associated with a decrease in stigma (-5.30 95% CI: -8.16, -2.44; -0.80 95% CI: -1.39, -0.21, respectively). Lower levels of stigma were found to be associated with better QoL measures, including perceiving better overall function (-0.90 95% CI: -1.47, -0.34), having fewer health worries (-2.11 95% CI: -2.65, -1.57), having fewer financial worries (-0.67 95% CI: -1.12, -0.23), and having less HIV disclosure concerns (-4.12 95% CI: -4.63, -3.62). The results of this study show that participants with higher education level, better QoL measures, and higher self-reported standards of living are less likely to perceive HIV-related stigma.

Identity management, negotiation and resistance among women in the sex trade in London, Ontario.

Sex work, and ideas about women in the trade, have long been represented as tragic and/or threatening. However, such portrayals tell us very little about how women think about themselves and the kinds of work they do. The data for this paper come from an ethnographic, community-based study in London, Ontario, that involves women in street-based, indoor and transactional sex work. This discussion focuses on how women develop different individual identities, including the management of multiple selves, their sexual identities and what we have termed the 'good junkie' identity. We also examine how these women employ aspects of dominant representation of sex workers, namely the low status accorded to those in street-based work and the defamatory term 'whore' or 'ho', when negotiating the moral hierarchies that exist within various kinds of sex work (i.e., stripping, massage parlours) and making sense of their professional and personal lives. The work that goes into the creation and maintenance of the women's divergent identities sheds important light on this complicated and tremendously demanding, yet inadequately understood, aspect of life as women in the sex trade.

Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Factors behind HIV testing practices among Canadian Aboriginal peoples living off-reserve.

The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15-44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and "good" or "fair/poor" self-rated health increased the odds of HIV testing. Completion of high-school education, rural residency, and less frequent alcohol and cigarette consumption decreased the odds of HIV testing. A number of differences emerged when the sample was analyzed by gender, most notably females who self-reported "good" or "fair/poor" health status were more likely to have had an HIV test, yet males with comparable health status were less likely to have had an HIV test. Additionally, frequent alcohol consumption and less than high-school education was associated with an increased odds of HIV testing among males, but not females. Furthermore, while younger age was associated with an increased odds of having an HIV test in the overall model, this was particularly relevant for females aged 15-24. These outcomes provide evidence of the need for improved HIV testing strategies to reach greater numbers of Aboriginal peoples living off-reserve. They also echo the long-standing call for culturally appropriate HIV-related programming while drawing new attention to the importance of gender and age, two factors that are often generalized under the rubric of culturally relevant or appropriate program development.

'It's like the treasure': beliefs associated with semen among young HIV-positive and HIV-negative gay men.

This paper examines cultural and social meanings associated with semen, along with related issues of unprotected receptive anal intercourse, HIV seroconversion, treatment optimism and viraemia. The findings are derived from qualitative interviews conducted with 12 HIV-positive young gay men and 12 HIV-negative counterparts who participated in a prospective cohort study in Vancouver, Canada. Focussing on the narratives of young gay men, the analysis reveals a diverse range of knowledge, values and functions of semen, especially in relation to its exchange. Beliefs about semen appeared to differ by HIV serostatus and were linked with intimacy, identity and pleasure, particularly among the HIV-positive men. Against dominant representations of semen in relation to issues of loss, anxiety and infertility, this unique study sheds much needed light on its role within the cultural construction of sexuality among gay men. As such, these narratives are of direct importance to primary and secondary HIV prevention, including condom promotion and the development of rectal microbicides.

Best practices in intercultural health: five case studies in Latin America.

The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.

Girl, woman, lover, mother: towards a new understanding of child prostitution among young Devadasis in rural Karnataka, India.

The emotive issue of child prostitution is at the heart of international debates over 'trafficking' in women and girls, the "new slave trade", and how these phenomena are linked with globalization, sex tourism, and expanding transnational economies. However, young sex workers, particularly those in the 'third world', are often represented through tropes of victimization, poverty, and "backwards" cultural traditions, constructions that rarely capture the complexity of the girls' experiences and the role that prostitution plays in their lives. Based on ethnographic fieldwork with girls and young women who are part of the Devadasi (servant/slave of the God) system of sex work in India, this paper introduces an alternative example of child prostitution. Demonstrating the ways in which this practice is socially, economically, and culturally embedded in certain regions of rural south India underlies this new perspective. I argue that this embeddedness works to create, inform, and give meaning to these girls as they grow up in this particular context, not to isolate and produce totally different experiences of family, gender identity, and moral character as popular accounts of child prostitution contend. Data pertaining to socialization, 'positive' aspects of being a young sex worker in this context, political economy, HIV/AIDS, and changes in the Devadasi tradition are used to support my position. Taken together, this alternative example presents a more complex understanding of the micro- and macro-forces that impact child prostitution as well as the many factors that affect the girls' ideas of what they do and who they are as people, not just sex workers.

Understanding the social and cultural contexts of female sex workers in Karnataka, India: implications for prevention of HIV infection.

BACKGROUND: The objective of the present study was to compare the sociodemographic characteristics and sex work patterns of women involved in the traditional Devadasi form of sex work with those of women involved in other types of sex work, in the Indian state of Karnataka. METHODS: Data were gathered through in-person interviews. Sampling was stratified by district and by type of sex work. RESULTS: Of 1588 female sex workers (FSWs) interviewed, 414 (26%) reported that they entered sex work through the Devadasi tradition. Devadasi FSWs were more likely than other FSWs to work in rural areas (47.3% vs. 8.9%, respectively) and to be illiterate (92.8% vs. 76.9%, respectively). Devadasi FSWs had initiated sex work at a much younger age (mean, 15.7 vs. 21.8 years), were more likely to be home based (68.6% vs. 14.9%), had more clients in the past week (average, 9.0 vs. 6.4), and were less likely to migrate for work within the state (4.6% vs. 18.6%) but more likely to have worked outside the state (19.6% vs. 13.1%). Devadasi FSWs were less likely to report client-initiated violence during the past year (13.3% vs. 35.8%) or police harassment (11.6% vs. 44.3%). CONCLUSION: Differences in sociobehavioral characteristics and practice patterns between Devadasi and other FSWs necessitate different individual and structural interventions for the prevention of sexually transmitted infections, including human immunodeficiency virus infection.

Dhandha, dharma and disease: traditional sex work and HIV/AIDS in rural India.

This paper discusses the results of two ethnographic studies with female sex workers in rural areas of Karnataka and Rajasthan, India. In particular, we focus on women whose socio-economic status, and religious and occupational practices, are part of sex work systems that have historical precedents such that they can be termed "traditional" sex workers. The approach taken in the ethnographic work was informed by current critical approaches in medical anthropology and public health. The paper argues that in the context of an expanding HIV/AIDS epidemic in rural areas of India, understanding the historical and structural factors that operate to perpetuate female sex work as a culturally "sanctioned" occupation is critical if interventions intended to reduce the risk of HIV transmission are to succeed. We conclude that interventions designed to empower women collectively in these communities that are consistent with cultural traditions are needed to lead to healthier sexual behaviours and reduced risk of HIV/AIDS infection.