Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study.

BACKGROUND: Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45389.

"Make sure I hear snoring": Adolescent girls, trans, and non-binary youth using sound for sexual wellbeing boundary-making at home during COVID-19.

To understand how COVID-19's stay-at-home orders impacted youths' sexual and social development, we conducted five virtual focus groups (n = 34) with adolescent girls', trans', and non-binary youths' aged 16-19 between April-June 2021 in the GTA. We queried experiences of home, privacy, and sexual wellbeing during Canada's third wave. Auto-generated zoom transcripts were coded using an inductive framework with NVivo. Field notes and team discussions on the coded data informed the analysis. This paper explores how sexual wellbeing during the pandemic is practiced in relation to, dependent upon, and negotiated at home. Using intersectionality theory and embodiment theory, this research analyzes how youth's diverse identities shape their understandings and experiences of sexual wellbeing. We found youth needed spaces where they were not only unseen, but importantly, unheard. We argue sound as an important piece of boundary-work that reveals the way youth construct space during precarious times. Youth primarily negotiated sonic privacy through (a) sound-proofing, (b) sound warnings and (c) "silent reassurance", a term we coined to describe the precursor of silence from other household members in order for youth to feel safe enough to practice sexual wellbeing. We found that white youth cited the bedroom as the best space for sexual wellbeing practices, but BIPOC youth felt the bedroom was only their best available option and still found they had to negotiate privacy. Attending to intersectionality theory, we expand on McRobbie and Garber's (1976) bedroom culture concept and widen Hernes' (2004) concept of physical, social and mental boundary-work to include sound as a fourth type, which straddles among them. This research shows how privacy, gender and sexual identities were negotiated at home in times of extreme uncertainty, highlighting how implications of home as a 'place' during the pandemic, constructs sexual wellbeing. Mapping how and where youth practice embodied sexual wellbeing exposes the ways that private and public understandings of identity relate to sexuality and geographies of home. We understand the home as a complex space that can not only determine sexual wellbeing, but where health promoting boundaries can be negotiated. We conclude with suggestions for supporting adolescent sexual wellbeing, inside and outside the home, during and after COVID-19.

'This is what's going to heal our kids': bringing the Sexy Health Carnival into Indigenous cultural gatherings.

The Sexy Health Carnival is a peer-developed Indigenous health initiative designed to provide culturally-relevant health information for Indigenous youth. The Carnival takes a strengths-based, holistic approach to address topics in fun and interactive ways. As part of the study described here, the Carnival was taken to 6 First Nations, 3 Métis, and 2 Inuit cultural gatherings in Canada. Due to complex histories of colonialism, bringing sexual health and harm reduction programming to cultural gatherings remains controversial. Interviews were conducted with 10 Carnival leaders. Transcripts were transcribed verbatim and inductively coded using NVivo. There was strong support for bringing the Carnival into cultural spaces because (a) teachings on health, sexuality, and reproduction are sacred and belong in cultural spaces, (b) doing so was requested by the communities themselves, (c) the Carnival holds potential to challenge harmful stigma, and (d) the Carnival supported a peer-led initiative. Facilitators also described several challenges encountered including (a) resistance to discussing stigmatised subjects, (b) issues of safety and (c) the intensive physical and emotional demands of the Carnival's implementation. The Carnival aids in re-imagining what culturally safe health promotion can look like when it is led by and for Indigenous youth. While the Carnival contributes to Indigenous cultural resilience and resurgence, further support is needed to enhance sustainably.

Modelling prevalent cardiovascular disease in an urban Indigenous population.

OBJECTIVE: Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. METHODS: The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. RESULTS: The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. CONCLUSION: Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.

RéSUMé: OBJECTIF: Des études ont souligné les iniquités entre les populations autochtones et non autochtones en ce qui a trait au fardeau des maladies cardiovasculaires et à la prévalence des risques prédisposants qui résultent des impacts historiques et continus de la colonisation. Nous avons voulu étudier les facteurs associés aux maladies cardiovasculaires (MCV) au sein des populations autochtones vivant à Toronto (Ontario) et spécifiques à ces populations, puis évaluer la fiabilité et la validité du modèle ainsi obtenu dans une population semblable. MéTHODE: L'étude Our Health Counts Toronto a mesuré l'état de santé de départ de membres de communautés autochtones vivant à Toronto, au Canada, à l'aide d'un échantillonnage en fonction des répondants. Une approche itérative, valorisant à la fois les données d'études scientifiques, l'expérience clinique, le vécu de personnes autochtones et les mesures statistiques, a été employée pour évaluer les candidats prédicteurs des MCV (expérience autodéclarée de discrimination, identité ethnique, affections médicales, revenu, instruction, âge, genre et taille) avant la modélisation multivariée. Le modèle ainsi obtenu a ensuite été validé à l'aide d'un échantillon distinct, mais géographiquement similaire, de personnes autochtones vivant à Hamilton (Ontario), au Canada. RéSULTATS: Le modèle multivarié des facteurs de risque associés aux MCV prévalentes incluait l'âge, le diabète, l'hypertension artérielle, l'indice de masse corporelle et l'exposition à la discrimination. La présence combinée du diabète et de l'hypertension artérielle était associée à un risque accru de MCV comparativement à l'une ou l'autre de ces deux affections médicales; c'était aussi la plus forte variable prédictive des MCV. Les personnes ayant déclaré des expériences passées de discrimination étaient aussi plus susceptibles d'être atteintes de MCV. D'autres études sont nécessaires pour déterminer l'effet de la taille sur le risque de MCV dans la population autochtone urbaine. Le modèle final avait un bon pouvoir discriminant et une calibration adéquate lorsqu'il a été appliqué à l'échantillon de Hamilton. CONCLUSION: Notre modélisation a cerné l'hypertension artérielle, le diabète et l'exposition à la discrimination comme facteurs associés aux maladies cardiovasculaires. La discrimination est un risque modifiable qui doit être abordé pour améliorer la santé cardiovasculaire au sein des populations autochtones.

Staying safe: how young women who trade sex in Toronto navigate risk and harm reduction.

Celling Sex was a community-based participatory research project that used a strengths-based approach to explore the agentic harm reduction practices employed by young women who trade sex and learn about their experience accessing health and social services. Fifteen racially diverse young women participated in interviews. They described how they tried to stay safe and advice for others. Each participant also individually made a brief digital video (cellphilm) to tell their story. Participants were invited to a private screening at which cellphilms were screened and common themes identified. The interviews and cellphilms were subsequently coded according to these themes. Participants identified a number of trading risks including: physical risks (unwanted pregnancy, STIs, and violence), social risks (racism and fetishisation), and mental health risks. To mitigate these concerns, participants detailed the harm reduction strategies they used which included use of technology, screening measures, boundary setting, and actively incorporating sexual health protections. Young women who trade sex are keenly aware of the risks inherent in transactional relationships and proactively negotiate and navigate harm reduction strategies in the context of deep systemic barriers. Further intervention may be necessary for them to actualise these strategies and access important forms of health and social support.

Quilted cellphilm method: A participatory visual health research method for working with marginalised and stigmatised communities.

The use of participatory visual methods and integration of cellphone technology is expanding in global public health research. Cellphilm method capitalises on these trends by inviting participants to use mobile devices to create short videos about health topics. This paper presents the quilted cellphilm method, which supports the participation of stigmatised populations to engage in research. We present the method with reference to the Celling Sex project, which worked with young women who have transactional sex experience. Four key steps in our unique model are discussed: (a) individual cellphilm-making; (b) participatory analysis; (c) creating a composite video; (d) publicly screening the work. We consider how working individually with participants in the cellphilm-making process built trust. We unpack how offering participants opportunities to engage in either group or one-on-one activities promoted participation in collaborative analysis. We outline how creating a composite video of the cellphilms and organising screenings facilitated knowledge translation and exchange. Overall, the quilted cellphilm method created a supportive community for vulnerable participants to generate products that challenged social stigma. Increased reliance on mobile media, especially during the COVID-19 pandemic, makes the quilted cellphilm method an opportune, exciting and accessible approach for participatory public health research.

Exploring Audience Engagement and Critical Narrative Intervention With the Celling Sex Film.

Young women who trade sex experience high rates of stigma that exacerbate existing health inequities. The products of participatory visual methodologies show promising potential for challenging stigma. In total, 15 young women who trade sex created individual brief videos to share their experiences. Following a participatory analysis, the videos were edited into one composite movie to highlight key messages. Eight facilitated screenings (cohosted by participant filmmakers and research team members) were organized with diverse community and health organizations. Audiences were led through a series of interactive writing, drawing, viewing, and discussion activities. Sessions were audio recorded, transcribed verbatim, and inductively analyzed to assess the impacts of the film on audiences. Audience reactions were categorized into four overarching themes to describe main impacts: consciousness raising, commitments to practice and organizational change, effectiveness of the approach, and limitations. Audience responses demonstrated that facilitated screenings can challenge harmful stereotypes and help viewers consider pathways to enact positive change in their personal and professional lives. However, changing deep-rooted patterns of stigma takes time, dedication, and accountability.

Visualizing DEPICT: A Multistep Model for Participatory Analysis in Photovoice Research for Social Change.

As a critical narrative intervention, photovoice invites community members to use photography to identify, document, and discuss issues in their communities. The method is often employed with projects that have a social change mandate. Photovoice may help participants express issues that are difficult to articulate, create tangible and meaningful research products for communities, and increase feelings of ownership. Despite being hailed as a promising participatory method, models for how to integrate diverse stakeholders feasibly, collaboratively, and rigorously into the analytic process are rare. The DEPICT model, originally developed to collaboratively analyze textual data, enhances rigor by including multiple stakeholders in the analysis process. We share lessons learned from Picturing Participation, a photovoice project exploring engagement in the HIV sector, to describe how we adapted DEPICT to collaboratively analyze participant-generated images and narratives across multiple sites. We highlight the following stages: dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, and collaborative analysis and translation, and we discuss how participatory analysis is compatible with creative, interactive dissemination outputs such as exhibitions, presentations, and workshops. The benefits of Visualizing DEPICT include feelings of increased ownership by community researchers and participants, enhanced rigor, and sophisticated knowledge translation approaches that honor multiple forms of knowing and community leadership. The potential challenges include navigating team capacity and resources, transparency and confidentiality, power dynamics, data overload, and streamlining "messy" analytic processes without losing complexity or involvement. Throughout, we offer recommendations for designing participatory visual analysis processes that are connected to critical narrative intervention and social change aims.

A review of reported network degree and recruitment characteristics in respondent driven sampling implications for applied researchers and methodologists.

OBJECTIVE: Respondent driven sampling (RDS) is an important tool for measuring disease prevalence in populations with no sampling frame. We aim to describe key properties of these samples to guide those using this method and to inform methodological research. METHODS: In 2019, authors who published respondent driven sampling studies were contacted with a request to share reported degree and network information. Of 59 author groups identified, 15 (25%) agreed to share data, representing 53 distinct study samples containing 36,547 participants across 12 countries and several target populations including migrants, sex workers and men who have sex with men. Distribution of reported network degree was described for each sample and characteristics of recruitment chains, and their relationship to coupons, were reported. RESULTS: Reported network degree is severely skewed and is best represented by a log normal distribution. For participants connected to more than 15 other people, reported degree is imprecise and frequently rounded to the nearest five or ten. Our results indicate that many samples contain highly connected individuals, who may be connected to at least 1000 other people. CONCLUSION: Because very large reported degrees are common; we caution against treating these reports as outliers. The imprecise and skewed distribution of the reported degree should be incorporated into future RDS methodological studies to better capture real-world performance. Previous results indicating poor performance of regression estimators using RDS weights may be widely generalizable. Fewer recruitment coupons may be associated with longer recruitment chains.

Picturing Participation: Catalyzing Conversations About Community Engagement in HIV Community-Based Organizations.

Community engagement is considered a cornerstone of health promotion practice. Yet engagement is a fuzzy term signifying a range of practices. Health scholarship has focused primarily on individual effects of engagement. To understand the complexities of engagement, organizations must also consider relational, structural, and/or organizational factors that inform stakeholders' subjective understandings and experiences. Community engagement processes are not neutral; they can reproduce and/or dismantle power structures, often in contradictory or unexpected ways. This article discusses diverse stakeholders' subjective experiences and understandings of engagement within the HIV sector in Toronto, Canada. In our study, a team of community members, service providers, and academics partnered with three HIV community-based organizations to do this work. We used photovoice, a participatory and action-oriented photography method, to identify, document, and analyze participants' understandings at respective sites. Through collaborative analysis, we identified seven themes that may catalyze conversations about engagement within organizations: reflecting on journey; honoring relationships; accessibility and support mechanisms; advocacy, peer leadership, and social justice; diversity and difference; navigating grief and loss; and nonparticipation. Having frank and transparent discussions that are grounded in stakeholders' subjective experiences, and the sociopolitical and structural conditions of involvement, can help organizations take a more intersectional and nuanced approach to community engagement. Together, our findings can be used as a framework to support organizations in thinking more deeply and complexly about how to meaningfully, ethically, and sustainably engage communities (both individually and collectively) in HIV programming, and organizational policy change. The article concludes with questions for practice.

Journeying together: A visual exploration of "engagement" as a journey in HIV programming and service delivery.

The experiences of people living with, or impacted by HIV, who participate in research and programming are relatively-well documented. However, how stakeholders within the HIV sector understand engagement, or how it functions discursively, is undertheorized. We used a comparative case study design and photovoice to explore engagement in three community-based organizations providing HIV programs or services in Toronto, Canada. We invited stakeholders to photograph their subjective understandings of engagement. We employ a visual and thematic analysis of our findings, by focusing on participants' use of journey metaphors to discuss engagement within and across sites. Visual metaphors of journey were employed by participants to make sense of their experience, and demonstrated that for many, engagement was a dynamic, affective and relational process. Our findings illustrate how journey may be an apt metaphor to explore the relational, contingent and socio-spatial/political specificities of engagement within and across HIV organizations. We conclude with a discussion on implications for practice.

The Impact of Indigenous Youth Sharing Digital Stories About HIV Activism.

INTRODUCTION: This article reports on the micro-, meso-, and macro-level impacts of sharing digital stories created by Indigenous youth leaders about HIV prevention activism in Canada. METHOD: Eighteen participants created digital stories and hosted screenings in their own communities to foster dialogue. Data for this article are drawn from individual semistructured interviews with the youth leaders, audio-recordings of audience reflections, and research team member's field notes collected between 2012 and 2015 across Canada. Data were coded using NVivo. A content analysis approach guided analysis. RESULTS: The process of sharing their digital stories had a positive impact on the youth themselves and their communities. Stories also reached policymakers. They challenged conventional public health messaging by situating HIV in the context of Indigenous holistic conceptions of health. DISCUSSION: The impact(s) of sharing digital stories were felt most strongly by their creators but rippled out to create waves of change for many touched by them. More research is warranted to examine the ways that the products of participatory visual methodologies can be powerful tools in creating social change and reducing health disparities.

Reflections on Teaching, Learning and Doing Participatory Research in a Graduate Seminar.

BACKGROUND: To improve training for the next generation of researchers to engage in community-based participatory research (CBPR), we reflect on our experience offering an applied participatory research methodologies graduate seminar. METHODS: This article is written from the perspective of a university professor/course director, a community partner, and a master's student who took the course. First, we describe our unique context. Second, we provide a general overview of the planning and implementation. Third, we illustrate what happened from our three perspectives. We conclude with recommendations. RESULTS: We each shared our unique perspectives on the strengths, opportunities and challenges associated with teaching/learning through engaging an applied CBPR project. There was consensus that our timelines were tight, the workload was heavy, communication was tricky, and we could have used more resources. Nevertheless, we all appreciated everyone's deep engagement and investment in the collaborative processes, the development of new skills and our success in gathering important evaluative feedback with efficiency and expediency. We agreed that this was a rewarding experience that we would repeat. CONCLUSIONS: Mounting a course in this fashion requires a strong community-university partnership, that is supported with substantial preparatory work, human and financial resource commitments, and contingency planning. We recommend transparency, communication and managed expectations.

Writing peer-reviewed articles with diverse teams: considerations for novice scholars conducting community-engaged research.

Given the growth of interdisciplinary and community-engaged health promotion research, it has become increasingly common to conduct studies in diverse teams. While there is literature to guide collaborative research proposal development, data collection and analysis, little has been written about writing peer-reviewed publications collaboratively in teams. This gap is particularly important for junior researchers who lead articles involving diverse and community-engaged co-authors. The purpose of this article is to present a series of considerations to guide novice researchers in writing for peer-reviewed publication with diverse teams. The following considerations are addressed: justifying the value of peer-reviewed publication with non-academic partners; establishing co-author roles that respect expertise and interest; clarifying the message and audience; using the article outline as a form of engagement; knowledge translation within and beyond the academy; and multiple strategies for generating and reviewing drafts. Community-engaged research often involves collaboration with communities that have long suffered a history of colonial and extractive research practices. Authentic engagement of these partners can be supported through research practices, including manuscript development, that are transparent and that honour the voices of all team members. Ensuring meaningful participation and diverse perspectives is key to transforming research relationships and sharing new insights into seemingly intractable health problems.

Governing Well in Community-Based Research: Lessons from Canada's HIV Research Sector on Ethics, Publics and the Care of the Self.

In this paper, we extend Michel Foucault's final works on the 'care of the self' to an empirical examination of research practice in community-based research (CBR). We use Foucault's 'morality of behaviors' to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves-and others-in ways that often resist the propensity for domination through public health research. '…there are different ways to "conduct oneself" morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.' (Foucault, 1985: 26).

Research Done in "A Good Way": The Importance of Indigenous Elder Involvement in HIV Community-Based Research.

OBJECTIVES: We examined the role that Indigenous Elders can play in ensuring that community-based research (CBR) is conducted ethically. METHODS: We present data from a larger qualitative study exploring ethical issues that occur in HIV-related CBR through the experiences of researchers engaged in CBR. Between May 2010 and July 2011, we interviewed 51 academic and community research team leaders of federally funded HIV CBR studies. We used thematic analysis techniques to identify themes. RESULTS: Participating researchers engage Elders in research because Elders are keepers of Indigenous knowledge, dynamic ethical consultants, community protectors, and credible sources of information who are able to counsel and support, mediate conflict, provide local context and history, and conduct ceremonial roles. Potential challenges cited by participants to engaging Elders in research include finding the right "fit," approaching Elders in a culturally appropriate way, and bureaucratic environments that do not honor Indigenous processes. CONCLUSIONS: Culturally appropriate Elder engagement in HIV CBR with Indigenous communities is vital for promoting positive relationships and culturally safe research that respects ceremony and Indigenous ways of knowing.

'Women are supposed to be the leaders': intersections of gender, race and colonisation in HIV prevention with Indigenous young people.

Focusing on gender, race and colonialism, this paper foregrounds the voices of Indigenous young people, their histories of oppression, their legacies of resistance and the continuing strengths rooted in Indigenous peoples, their cultures and their communities. Exploring the relationship between gender and colonialism, the paper speaks to the lived realities of young people from Indigenous communities across Canada. Over 85 young people participated in six different Indigenous community workshops to create artistic pieces that explored the connections between HIV, individual risk and structural inequalities. In the course of the research, Indigenous young people, and young Indigenous women in particular, talked about how gender intersects with race and colonisation to create experiences that are, at times, especially difficult for them. In this paper, young people discuss the ways in which colonialism has demeaned women's roles and degraded women's sexuality, and how continuing cultural erasure and assimilationist policies impact on their lives and on their bodies.

The DEPICT model for participatory qualitative health promotion research analysis piloted in Canada, Zambia and South Africa.

Health promotion researchers are increasingly conducting Community-Based Participatory Research in an effort to reduce health disparities. Despite efforts towards greater inclusion, research teams continue to regularly exclude diverse representation from data analysis efforts. The DEPICT model for collaborative qualitative analysis is a democratic approach to enhancing rigour through inclusion of diverse stakeholders. It is broken down into six sequential steps. Strong leadership, coordination and facilitation skills are needed; however, the process is flexible enough to adapt to most environments and varying levels of expertise. Including diverse stakeholders on an analysis team can enrich data analysis and provide more nuanced understandings of complicated health problems.

Governing through community-based research: lessons from the Canadian HIV research sector.

The "general public" and specific "communities" are increasingly being integrated into scientific decision-making. This shift emphasizes "scientific citizenship" and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian "governmentality" the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of "scientific citizenship" to implicate both researchers and communities in a process of governance.

Factors associated with access to sexual health services among teens in toronto: does immigration matter?

This manuscript explores predictors of access to sexual health services among urban immigrant adolescents who live in Toronto, Canada. Surveys (n = 1216) were collected from pre-existing youth groups in community settings. A binary logistic multivariate model was developed to examine associations between access to sexual health services and a series of individual, interpersonal, and structural variables. Sexual activity, age, race, and social resources each had significant partial impact on access to sexual health services. Among young women, those with more social resources had significantly accessed services more often than those with fewer resources, but among men there was no difference as a function of social resources. Although immigration predicted access to sexual health services on its own, it was not statistically significant in this model when other variables were included. Immigration status, in and of itself, was not a predictor of youth's access to sexual health services. The impact of immigration status appears to occur because of its association with other variables, such as race. Implications for practice are discussed.