Negotiating Safety and Wellbeing: The Collaboration Between Faith-Based Communities and Public Health During the COVID-19 Pandemic.

The COVID-19 pandemic led to lockdown measures where congregational faith-based activities were prohibited. With time, the collateral impacts of confinement emerged as priorities, and impositions had to be balanced with the collaboration of the population. In this process, faith-based organizations played a key role in encouraging their congregations to adhere to lockdown measures while fostering their mental wellbeing and resilience. This paper describes the process of establishing a collaborative negotiation among the Montreal Regional Public Health Unit, the police, and the Muslim and Jewish communities, examining the role of mediation in this context. Despite some obstacles, such as communication difficulties and decision-making limitations, the collaborative approach seems to buffer the escalation of intercommunity tension and to promote communities' commitment to physical distancing measures and should be considered in times of pandemic for a more inclusive public health approach.

Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale.

BACKGROUND: Although stigmatization has long been recognized as a major obstacle to HIV prevention. The lack of a valid and reliable measurement tool for stigmatization is a major gap in the research. This study aimed to: 1) develop a scale of stigmatizing attitudes towards people living with HIV (SAT-PLWHA-S) and 2) demonstrate its reliability and validity. METHODS: French and English-speaking experts (n = 21) from different professional communities (academics, practitioners) assessed the clarity and relevance of the proposed items. The psychometric properties of the SAT-PLWHA-S were assessed with a random digit dial population based telephone survey (n = 1,500) of respondents in Quebec, Canada. Analyses included exploratory and confirmatory factor analyses, correlations, multiple linear regressions, t-tests, hypothesis testing of factorial structure invariance, and Cronbach's alpha. RESULTS: Confirmatory factor analysis (CFA) supported a 27-item structure with seven factors: 1) concerns about occasional encounters; 2) avoidance of personal contact; 3) responsibility and blame, 4) liberalism, 5) non-discrimination, 6) confidentiality of seropositive status, and 7) criminalization of HIV transmission. Cronbach's alphas indicate satisfactory internal consistency. An assessment of concurrent validity using Pearson's correlation and multiple linear regression shows that homophobia and HIV transmission knowledge are significant determinants of stigmatizing attitudes toward PLHIV. Discriminant validity (t-test) results suggest that the SAT-PLWHA-S can differentiate attitudes between different groups and indicates invariant factor structure across language. CONCLUSIONS: The results of this study suggest that the SAT-PLWHA-S is a reliable and valid tool for measuring stigmatizing attitudes toward PLHIV and that it can contribute to a deeper understanding of HIV stigma.

Charitable giving for HIV and AIDS: results from a Canadian national survey.

BACKGROUND: For the first time, a national survey of adults in Canada posed questions on charitable giving for HIV and AIDS. The objective of this analysis was to explore the behaviour and attitudes of this population in terms of charitable giving. METHODS: In 2011, individuals in Canada 16 years of age or older were recruited for a survey from an online panel supplemented by random digit dial telephone interviewing. The margin of error was +/-2.1 percentage points (95%). Chi-square tests were used to detect bivariate associations. A multivariate logistic regression model was fit to compare those who had donated to HIV and AIDS in the past 12 months with those who had donated to other disease or illness charities. RESULTS: 2,139 participated. 82.5% had donated to a charitable cause in the past 12 months. 22.2% had ever donated to HIV and AIDS, with 7.8% doing so in the past 12 months. Individuals who had donated to HIV and AIDS versus other disease or illness charities tended to be younger (p<0.05), single (p<0.005), more highly educated (p<0.001) and to self-identify as a member of a sexual minority group (p<0.001). Multivariate analysis revealed individuals who self-identified as a member of a sexual minority group were significantly much more likely to have donated to HIV and AIDS than to other disease or illness charities in the past 12 months (OR, 7.73; p<0.001; CI 4.32-13.88). DISCUSSION: Despite a generally philanthropic orientation, relatively few respondents had ever been involved in charitable giving for HIV and AIDS. Those who had could be understood relationally as individuals at closer social proximity to HIV and AIDS such as members of sexual minority groups.

Trends in attitudes toward people living with HIV, homophobia, and HIV transmission knowledge in Quebec, Canada (1996, 2002, and 2010).

People living with HIV (PWHIV) face negative attitudes that isolate and discourage them from accessing services. Understanding negative attitudes and the social environment can lead to more effective health promotion strategies and programs. However, a scale to measure attitudes has been lacking. We developed and validated attitudes toward PWHIV Scale to examine trends in attitudes toward PWHIV in Quebec in 1996, 2002, and 2010. We also examined the relationship between negative attitudes toward PWHIV, homophobia, and knowledge about HIV transmission. The scale included 16 items and had a five-factor structure: F1 (fear of being infected), F2 (fear of contact with PWHIV), F3 (prejudicial beliefs toward groups at high risk of HIV), F4 (tolerance regarding sexual mores and behaviors), and F5 (social support for PWHIV). The validity and reliability of the scale were assessed and found to be high. Overall, Quebecers had positive attitudes toward PWHIV, with more negative attitudes observed in subgroups defined as male, ≥50 years of age, <14 years of education, higher levels of homophobia, and below-average knowledge about HIV transmission. Scores were stable between 1996 and 2002, and increased in 2010. Negative attitudes were correlated with higher levels of homophobia and lesser knowledge about HIV transmission. The lowest scores for each factor were observed in the same subgroups that had low overall scores on the Attitudes Scale. The findings from this study can be used to intensify interventions that promote compassion for PWHIV, address attitudes toward homosexuality, and encourage greater knowledge about the transmission of HIV in these subgroups.

Translating knowledge from Pakistan's second generation surveillance system to other global contexts.

BACKGROUND: From 2004 to 2011, a collaborative project was undertaken to enhance the capacity of the Government of Pakistan to implement an effective second-generation surveillance system for HIV/AIDS, known as the HIV/AIDS Surveillance Project (HASP). In four separate rounds, behavioural questionnaires were administered among injection drug users, and female, male and hijra (transgender) sex workers. Dried blood spots were collected for HIV testing. METHODS: Through interviews with project staff in Pakistan and Canada, we have undertaken a critical review of the role of HASP in generating, using and translating knowledge, with an emphasis on capacity building within both the donor and recipient countries. We also documented ongoing and future opportunities for the translation of knowledge produced through HASP. RESULTS: Knowledge translation activities have included educational workshops and consultations held in places as diverse as Colombia and Cairo, and the implementation of HASP methodologies in Asia, the Middle East and sub-Saharan Africa. HASP methodologies have been incorporated in multiple WHO reports. Importantly, the donor country, Canada, has benefited in significant ways from this partnership. Operational and logistical lessons from HASP have, in turn, improved how surveillance is performed in Canada. Through this project, significant capacity was built among the staff of HASP, non-governmental organisations which were engaged as implementation partners, data coordination units which were established in each province, and in the laboratory. As is to be expected, different organisations have different agendas and priorities, requiring negotiation, at times, to ensure the success of collaborative activities. Overall, there has been considerable interest in and opportunities made for learning about the methodologies and approaches employed by HASP. CONCLUSIONS: Generally, the recognition of the strengths of the approaches and methodologies used by HASP has ensured an appetite for opportunities of mutual learning.

The descriptive epidemiology of male sex workers in Pakistan: a biological and behavioural examination.

OBJECTIVES: There is a dearth of published information on the characteristics of sex workers in Pakistan. This study sought to characterise and compare hijra and non-hijra sex workers from eight large cities in Pakistan. DESIGN: χ(2) and Kruskal-Wallis tests, and multivariable logistic regression were used where appropriate. METHODS: Study respondents were described on demographic, sex-work, and risk behaviour variables using a cross-sectional integrated biological and behavioural quantitative survey. RESULTS: A total of 3350 respondents were surveyed, of which 2694 were included in the study. The average age of respondents was 24.1 years (SD 6.3), and the average duration of sex work was 7.5 years (SD 5.9). Respondents averaged 30.9 (SD 2.7) paid receptive anal sex acts in the month prior to their interview, while 21.5% reported using a condom during their last occurrence of paid anal sex. Of those surveyed, HIV prevalence was 5.4 per 1000; notably, no HIV-positive respondents reported any injection drug use. Finally, intercity heterogeneity was observed on demographic, sex work and risk behaviour characteristics, with almost all characteristics differing at the p < 0.01 level. CONCLUSIONS: Low levels of education, high volume of sex acts and suboptimal condom use makes for a potentially volatile situation. Information provided by this study can play an important role in designing effective prevention programmes, particularly in capturing heterogeneity in sex work between cities, and as evidence is accumulating that a shift in epidemic phase, as well as affected populations is occurring in Pakistan.

Behavioural risks for HIV infection among Quebec residents of Haitian origin.

Quebecers of Haitian origin (QHO) have the highest HIV prevalence of all immigrant groups in the province. We conducted a study among QHO to document the behavioural risk factors for HIV transmission. Male respondents were significantly more likely than female respondents to have at least one casual heterosexual partner in the past 12 months (39.7 vs. 18.8%, p < 0.001). Males were more likely to have used a condom at last sexual intercourse with a casual partner (78.9 vs. 53.7%; p = 0.002). However, among men who never, casually, or rarely used condoms with their regular female partner, 27.3% did not use a condom at last sexual intercourse with a casual partner. In the multivariable logistic regression analysis, having at least one casual heterosexual partner in the past 12 months was associated with being younger than 29 years, being male, being single, and being a second-generation QHO. This study allows us to identify subgroups whose behaviours can result in greater vulnerability to HIV infection and other STIs.

[Ethical considerations of a public health intervention aimed at reducing the risk of HIV transmission in HIV-seropositive-populations who are unwilling to take precautions]. / Gestion des conflits et incertitudes éthiques des intervenants oeuvrant auprès des personnes vivant avec le VIH et qui ont des contacts sexuels non protégés à Montréal.

OBJECTIVES: 1) To describe a public health intervention aimed at reducing the risk of HIV transmission by seropositive people who are unwilling or unable to take precautions to counter HIV transmission; 2) To document ethical principles that help front-line health care professionals arrive at justifiable decisions and actions. PARTICIPANTS: Front-line health care professionals dealing with these cases. LOCATION: Intervention developed by la Direction de la santé publique de l'Agence de la santé et des services sociaux de Montreal. INTERVENTION: A comité d'aide aux intervenants (CAI) was struck to advise health care professionals. To document the ethical principles that help front-line health care professionals in these situations, we undertook a multiple case study based on the committee's approach to counselling care providers for each of the 26 cases dealt with by the CAI between November 1996 and January 2003. RESULTS: We identified 7 ethical pitfalls: expecting immediate ideal results; simplification of complex situations; generalizing uncritically from a particular case; uncritical ethical bias against coercive measures; inability or refusal to recognize and accept limits; failure to anticipate unintended consequences of an action; acting on incomplete, unvalidated, or unverifiable information. CONCLUSION: A process of mutually exercised critical reflection can help health care professionals to identify and avoid ethical pitfalls and arrive at justifiable decisions and actions.

Risky sexual behavior, knowledge of sexually transmitted infections and treatment utilization among a vulnerable population in Rawalpindi, Pakistan.

As a part of a second generation surveillance, we investigated the sociodemographics, risky sexual behavior, knowledge of HIV and sexually transmitted infections (STIs) and treatment seeking behavior among a vulnerable population. A cross-sectional study preceded by mapping, was conducted in Rawalpindi, Pakistan during 2005. Subjects were recruited through snowball, time location cluster and cluster sampling techniques. Behavioral interviews were conducted with 203 female sex workers (FSWs), 101 male sex workers (MSWs), 101 Hijras (transgender men) and 200 injecting drug users (IDUs), who were deemed a vulnerable population for STIs. Among this population 136 (67%) FSWs were illiterate, 145 (71.4%) were married and entertained on average 23 clients per month. Consistent condom use during one month was reported by 34 (17%) FSWs. One hundred thirty-three (66%) FSWs had a knowledge of STIs, 69 (34%) suffered from STIs. MSWs and Hijras had the youngest average ages at 24.4 (+/- 6.8), 25.8 (+/- 5.9) and started sexual activity even at age 14.7, and 13.9 years, respectively. Consistent condom usage was as low as 3 (3.1%) and 4 (4%) among MSWs and Hijras. IDUs had lowest monthly income of US$ 69 (+/- 41) and had a predominant migratory pattern. Fifty (25.2%) IDUs shared a needle with the last injection. Though knowledge of STIs was lowest among IDUs, 61 (30.7%), however, all utilized the public health facility for their treatment. Difference between knowledge of STIs and educational levels among IDUs and Hijras were found to be statistically significant (p=0.015 and p=0.04, respectively). The present study indicates the knowledge of HIV/STIs is high among the vulnerable population but condom usage is very low.

AIDS-related knowledge, attitudes, beliefs, and practices in Haiti

AIDS constitutes an important public health problem in Haiti, where it appears to be spread mainly through heterosexual encounters. The study reported here employed in depth interviews, focus group discussions, and a national cross-sectional survey of 1 300 men and 1 300 women 15 to 49 years old to assess AIDS-related knowledge, attitudes, beliefs, and practices in Haiti. According to criteria established for the study, 38.1 percent of the 1 118 sexually active male survey respondents were found to engage in high-risk behavior. In general, the women were found to have better knowledge of AIDS than the men. Significant obstacles to condom use included the inability of women to choose whether condoms would be used and a belief that condom lubricant could cause health problems. The study also found a tendency to ostracize people with AIDS, especially in areas outside Port-au-Prince, and a belief that AIDS was imposed on people by fate- which could partially explain the tendency to persist in high-risk behavior

This article will also be published in Spanish in the Bol. Oficina Sanit. Panam. Vol. 116, 1994

AIDS-related knowledge, attitudes, beliefs, and practices in Haiti

AIDS constitutes an important public health problem in Haiti, where it appears to be spread mainly through heterosexual encounters. The study reported here employed in depth interviews, focus group discussions, and a national cross-sectional survey of 1 300 men and 1 300 women 15 to 49 years old to assess AIDS-related knowledge, attitudes, beliefs, and practices in Haiti. According to criteria established for the study, 38.1 percent of the 1 118 sexually active male survey respondents were found to engage in high-risk behavior. In general, the women were found to have better knowledge of AIDS than the men. Significant obstacles to condom use included the inability of women to choose whether condoms would be used and a belief that condom lubricant could cause health problems. The study also found a tendency to ostracize people with AIDS, especially in areas outside Port-au-Prince, and a belief that AIDS was imposed on people by fate- which could partially explain the tendency to persist in high-risk behavior

Experiencias Canadienses con el SIDA y la infeccion por el VIH / Canadian experiences with AIDS and HIV infection

Since Canada's first AIDS case was reported in 1978, a total of 1 775 cases have been recorded. Most of these (90 percent) have occurred in three provinces (Ontario, Quebec, and British Columbia); most (89 percent) have occurred among adults 24 to 49 years old; and most (95 percent) of these adult cases have occurred in males. Nationwide, 82 percent of those afflicted have been homosexual of bisexual men, 5 percent have been immigrants from endemic regions, and 4.6 percent have been recipients of blood or blood products. However, the distribution differs in the different provinces-especially in Quebec, where a substantial share of all cases (17 percent) have occurred among immingrants from endemic regions. Regarding levels of HIV infection, information is limited. The authors estimate that roughly 30 000 Canadians were probably infected as of early 1988, but the true number could be as low as 10 000 or as high as 50 000. HIV tests are available free of charge to any Canadian who requests them. At present, a system of voluntary testing of individuals for personal or clinical reasons, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. In seven of Canada's 10 provinces, HIV seropositivity is reportable to public health authorities. One of these provinces conducts a contact tracing programs based on traditional sexually

Experiencias Canadienses con el SIDA y la infeccion por el VIH / Canadian experiences with AIDS and HIV infection

Since Canada's first AIDS case was reported in 1978, a total of 1 775 cases have been recorded. Most of these (90 percent) have occurred in three provinces (Ontario, Quebec, and British Columbia); most (89 percent) have occurred among adults 24 to 49 years old; and most (95 percent) of these adult cases have occurred in males. Nationwide, 82 percent of those afflicted have been homosexual of bisexual men, 5 percent have been immigrants from endemic regions, and 4.6 percent have been recipients of blood or blood products. However, the distribution differs in the different provinces-especially in Quebec, where a substantial share of all cases (17 percent) have occurred among immingrants from endemic regions. Regarding levels of HIV infection, information is limited. The authors estimate that roughly 30 000 Canadians were probably infected as of early 1988, but the true number could be as low as 10 000 or as high as 50 000. HIV tests are available free of charge to any Canadian who requests them. At present, a system of voluntary testing of individuals for personal or clinical reasons, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. In seven of Canada's 10 provinces, HIV seropositivity is reportable to public health authorities. One of these provinces conducts a contact tracing programs based on traditional sexually