Part 2 Learning from OHTN Conference 2016: HIV Endgame II – Stopping the Syndemics that Drive HIV (November 21-22, 2016) by Mona Lee, PAN’s Greater Vancouver Site Coordinator of PLPH; CBR/Evaluation Support Coordinator; Administrative Coordinator
I had the privilege of attending this year’s OHTN Conference that discussed the challenges and factors associated with the HIV syndemics as well as tips and best-practices on how to move forward to end syndemics. Here, I will highlight some of my key learnings, in hopes that this blog can be of value to BC in sharing national and cross-provincial information related to HIV syndemics. Please click here for Part 1 of this blog post, where I set the scene by sharing the definition of syndemics and associated factors.
Much of the current research and programs focus on deficits, and there is a need for a shift towards resiliency- and strength-based approach. This allows us to go from what not to do to what to do, and from risk projection to risk reduction. For example, presented research on gay men and drug use focused on 16% of those who regularly and consistently used speed (or methamphetamine). The research can strive to learn from what the other 84% are doing to quit on their own (FYI, we know they are quitting on their own because there are no treatment options available for methamphetamine addiction). This presentation was called “Syndemics, Resiliencies and Successful Aging Among Gay Men” by Ron Stall.
Common themes that spoke to me loudly around successful harm reduction and people living with HIV who use drugs were: capacity building, autonomy, and self-directed decisions. These themes are key to successful harm reduction and increased adherence to anti-retroviral therapies post-hospitalization. For example in Molly Bannerman’s presentation “Transformative Justice & Harm Reduction,” service providers and organizations can reduce barring practices (i.e. clients who did not follow the organization’s drug use policy or rules can no longer access services) and guide active learning and plans around conflict resolution for their members and clients. This is seen as transformative justice with regards to drug policy and harm reduction. Creative solutions and service providers’ willingness to create space for these are key to success.
In What’s hot with PRAs session, tips on working with peers were shared. Key learning included: do not underestimate the importance of check-ins and debriefs (take time to do them); key values that facilitate the relationship and capacity building are trust, respect and non-judgement; no one-size-fits-all in that it’s important to ask each peer research associate (PRA) what their expectations of involvement are (e.g. roles in the research), preference is around financial compensation, etc.; and ensure that peer involvement is equitable.
Seth Kalichman presented on “Where community meets clinic: How to improve engagement, retention and adherence” and shared insights on our current Treatment as Prevention model. We currently test someone repeatedly until they test positive, who then ideally would go on and adhere to treatment. There are gaps in this model. We need to increase prevention efforts in keeping people negative. Further, for those folks who test positive and do not go on treatment (by choice or not), other kinds of services need to be available that may reduce population-level transmissions (e.g. cognitive behavioural therapy, risk reduction counselling and support). For those who do not have suppressed viral loads due to treatment non-adherence, barriers to adherence need to be addressed (e.g. looking at changing behaviours/risk activities, support, etc.). Conclusively, Treatment as Prevention model is only as effective as efforts accompanied with regards to behavioural changes, counselling, and support.
Lastly, a cool tool called Resiliency Map was shared by an Indigenous team (including Renee Masching). It is a visual, culturally safe and sensitive tool that facilitates story telling, particularly useful in Indigenous and other ethnocultural communities. The map is flexible and can be translated into different languages, and the person who uses this can be in control of telling their own story.
Overall, OHTN HIV Endgame Conference was informative and diverse (with regards to programs/presentations, as well as audience). I also noticed that the patterns and key ingredients for success for various programs were closely linked to CBR principles and values.
Key take home messages were
1) Resilience is already a part of people, and thus we need to be a tool to facilitate the process for folks to recognize and bring out their own strengths; and
2) Community- and individual-centred approach is critical for success, so ask the community or individual directly about what their needs or wants are.
Presentation slides and video with media release are now online and will be available for reference until June 30, 2017. At that point, OHTN hopes to share a more structured report.
Questions? Feedback? Get in touch! Mona Lee, Greater VAncouver Site Coordinator of PLPH; CBR & Evaluation Support Coordinator; Administrative Coordinator