Barcelona 2013
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| Abstract #524 - E-Posters English | ||||
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Session: 50.49: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Mr Michel Martel - Chaire de recherche du Canada en éducation à la santé, Canada |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: To determine whether an effective and accessible combined approach to HIV prevention for MSM can be operationalized in the Montreal context. | ||||
| Method / Issue: Background: In Montreal as in other locations, MSM continue to account for the largest proportion of new HIV infections despite several decades of HIV prevention work. A combined approach to prevention could be more effective in controlling the epidemic. This approach consists of integrating new biomedical prevention technologies with prevention strategies (behavioral and structural) that are already in place. A range of HIV prevention services, programs, and technologies are currently available or may soon become available in Montreal, but it is unclear to what extent these are actually being made accessible to MSM as part of a combined approach. Method: Grounded theory and ethnomethodology were used as methodological frameworks to identify issues related to access to HIV prevention services and programs for MSM in Montreal from the point of view of the user. Data was gathered through an environmental scan of 78 prevention services or programs (41 biomedical, 29 behavioral, 9 structural), interviews with key informants, participant observation, and notes taken during 4 meetings of an ad hoc intersectoral committee comprised of 22 stakeholders (clinicians, researchers, representatives from community organization and community health agencies). Lévesque?s Theoretical Model of access to health services was used (2013) for data analysis, with an emphasis on five dimensions of accessibility from the point of view of the user:1) Approachability - Ability to perceive, 2) Acceptability - Ability to seek 3) Availability and accommodations - Ability to reach 4) Affordability ? Ability to pay, 5) Adequacy - Ability to engage. | ||||
| Results / Comments: A number of general issues were identified with regards to the accessibility of HIV prevention services for MSM: inadequate allocation of funding and other resources; few partnerships; stakeholders working in silos; inconsistent procedures for referrals between services and programs. Specific issues were also identified in relation to various stakeholders: Health agencies: obtaining information about available services is difficult, limited interest in the MSM community on the part of the agencies, few services, restricted hours, limited staff; Medical clinics: expensive services and lack of transparency regarding the cost of services, overcrowding, little promotion of some services (e.g. PEP); Community organizations: inadequate access to services for some sectors of the MSM population (youth and ethnocultural minorities), complex websites that contain extensive information about some aspects of HIV prevention and little information about other aspects; MSM as service users: lack of knowledge of about the acceptability of new prevention technologies (e.g. PREP, self-testing) within this population; homogenizing approaches to prevention that fail to account for diverse lifestyles and identities. | ||||
| Discussion: The implementation of an operational, effective, and accessible combination prevention approach is not currently possible in the Montreal context. The various stakeholders involved in HIV prevention need to collaborate more directly and effectively to improve the coordination and integration of service and program delivery, in particular to increase accessibility. Affected populations need to be more directly involved in the development of combined prevention approaches to ensure that they are effective and accessible. | ||||
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