Rethinking ASOs? Literature Review Resource Page

AIDS exceptionalism grew out of the response to the pandemic in the late 1980s. AIDS activists advocated for both special resources and increased funding as a way to ensure the HIV/AIDS response was not subject to traditional top-down public health methods of disease control that could discourage people at risk from participating in HIV prevention, testing and treatment programs. Since that time, and especially since the introduction of highly active antiretroviral treatment (around 2006), debates about exceptionalism have surfaced. Recently, the discussions in Canada have centred around “service integration” — a the term being used to describe the integration of services around viral hepatitis, STIs and other health concerns into services that have been traditionally focused on HIV/AIDS prevention and care.

In order to set the stage for the Rethinking ASOs? Deliberative Dialogues in Halifax and Vancouver on November 24, 2014, we conducted a literature review around AIDS exceptionalism and the integration of AIDS services. On this page you will find:

  • A 20-minute video presentation of the findings from the literature review (please view prior to the event),
  • A link to a PDF of the presentation slides for your reference,
  • A link to a table of summaries from the literature considered in the review,
  • Links to additional optional readings, and
  • A comments section, where you can add thoughts, questions and ideas related to the video.

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We gratefully acknowledge that the above video was recorded on the traditional, unceeded territories of the Coast Salish peoples.

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Slides video 1 image

 

Click the image to the left to download the slides from Video 1: Review of the Literature: AIDS Exceptionalism & the Integration of AIDS Service Delivery.

 

 

 

 

 

Click the imagLiterature Summaries Imagee to the left to download a PDF of the entire list of literature reviewed as well as summaries of each. (Participants in the event are not required to review this, it is provided in case it is of interest.)

 

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Additional resources of interest (not required reading for participation in the event, listed here for your interest):

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Other Re-Thinking ASOs? resource pages:

3 Responses to Rethinking ASOs? Literature Review Resource Page

  1. Janice Duddy says:

    I wonder about the idea of doing “more with less”. As we are in a phase of seeing decreases in the number of new HIV infections in the province, if this trend continues I wonder if it is thinking more about doing “different with the same” (or possibly less depending on funding trends)?

  2. Janice Duddy says:

    Are integration and AIDS exceptionalism intrinsically linked? or can you have service integration and keep important aspects of exceptionalism at the same time?

  3. Another great piece to help us prepare for our day together on November 24th! Thank you!! A few comments and reflections that watching this piece generated in me, that I wanted to share (in no particular order):

    1. The feminist in me just has to put out there, that the initial grassroots and activist response to HIV/AIDS included a tremendous number of women, particularly lesbian/queer women – they played a huge role alongside of gay men and people living with HIV/AIDS

    2. In terms of the origins and perceptions of the need for an exceptional response…just to more explicitly state this…was the fact that initially there was so much fear, apathy, homophobia/hatred and stigma associated with this disease, that in addition to the bio-medical reasons for treating this epidemic differently, an exceptional response simply HAD to happen in order to counteract the lack of action and political will that was so obviously present (in supporting and treating people living with HIV we were starting not from ground zero, but from a tremendous deficit)

    3. I think you do a great job of drawing out the nuances about the increasing professionalization of the sector, the pro’s and the con’s. One of the nuances not articulated, was the way in which the grassroots/activist response was able to attract and mobilize the “talent” that was needed (medical professionals, lawyers,people with communications and media savvy, celebrities, and yes dare i even say it, administrators) to effect some tremendously valuable transformations in terms of access to treatment, care and support as well as related areas such as access to housing, income security, and the other social determinants of health

    4. Part of the reason we have lost activists and volunteers, is that many of them passed on – or grew tired – or became engaged in other work/life interests/etc – and since then we have not seen the same kind of mobilizaton of folks including “the next generation”. I think in the next 10 years, this will have huge implications at least here in BC at the community-based level

    5. In the BC context, one of the most significant developments was adoption by the provincial government of the Treatment as Prevention (TasP) approach – and the creation of the STOP (Seek and Treat for Optimal Prevention of HIV/AIDS) Pilot project – which was ultimately expanded into a province-wide, ongoing funded program. STOP provides for $42 million in dedicated HIV/AIDS related funding annually across all of the health authorities
    >>Throughout STOP’s lifespan, there has been a significant emphasis on short-term project funding – which many have praised as it allowed more room for “trial and error” and for innovation and allowed both primary health care providers as well as community-based groups to be more nimble in service response
    >>While STOP has always been infused with an “integrated” approach to some extent and there is a stated desire to do more, taken as a whole, it stands as a fairly significant example of an “exclusive” response
    >>Embedded within STOP, we have seen significant aspects of “non exclusivity” such as the routine offer of HIV tests in clinical settings/hospitals/doctors, etc. And then aspects very much of “exclusivity”, such as the peer navigator program for people newly diagnosed with HIV (but within which also works to provide supports and referrals for people living with HIV that are holistic such as housing, income security, etc.)
    >>STOP therefore provides a tremendous amount of information and food for thought, about HIV “exclusivity” – it is extremely textured!
    >>Ultimately, given the great progress we have seen in BC in terms of declines in infection and incidence rates, one has to ask – how has STOP (with its complex blend of “exclusive” and “non-exclusive” approaches) contributed to this? And how much has the decline in rates been attributable to access to harm reduction services and supplies (including the “integration” of HR services at AIDS Service Organizations and in primary health)? And what lessons could be learned from looking at the parallel evolution of harm reduction services, policies, programs – what might that have to teach us?

    6. Stigma figures so prominently as a theme that must infuse our discussions regarding the future of ASO’s. The literature review seems to be non-definitive in terms of what people’s experiences of stigma are in contexts that “integrated” such as co-location – versus when accessing “stand alone” HIV specific services. I am very excited that in this province, we will soon be launching “Speaking My Truth”, the BC arm of the national stigma index, the first ever national study to document experiences of stigma and discrimination from the perspective of people living with HIV. I think it will add so much to this conversation about “exclusivity” of services, to know where, when and what service contexts, people living with are experiencing stigma

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