Part of REACH 2.0’s work involves focusing on some of the populations most affected by HIV and HCV. There are solid reasons for framing research and prevention activities around certain groups.

First, HIV and HCV disproportionately affect marginalized groups, including:

  • Gay men and other men who have sex with men
  • African, Caribbean and Black communities
  • Transgender and transsexual people
  • Indigenous communities, and
  • People who use drugs.

Second, many of the populations most affected by HIV are coping with what are known as “syndemics” – meaning the combination of multiple illnesses at once. Syndemics tend to develop in conditions of health disparity, social disadvantage and structural inequality.

Reducing the burden of HIV and associated illness requires interventions that address each population’s needs. To further explore the needs of—and find interventions best suited for—each population, REACH 2.0 plans to undertake the following projects.

For gay men and other men who have sex with men

Gay men and other men who have sex with men (“MSM”) account for more than 60% of HIV infections overall in Canada and more than 50% of new infections. The incidence of HIV among MSM is relatively stable or is increasing slightly; the incidence of other sexually transmitted infections and HCV is on the rise.

REACH has already established a strong track record in gay men’s health interventions. For example, REACH 1.0 supported work that resulted in CIHR funding to apply interventions developed in Ontario and Quebec to other parts of the country.

REACH 2.0 plans to:

  • Identify changing sexual cultures and risk perceptions among young gay men
  • Understand how HIV and STI messaging from the media, medicine, and AIDS service organizations influence gay men’s risk practices and sexual cultures
  • Identify MSM networks most at risk of transmitting and acquiring HIV
  • Measure the effectiveness of interventions and health promotion programs in ways that are meaningful to the community, and
  • Identify barriers that gay men and LGBT people face in accessing health services.

For African, Caribbean and Black communities

African, Caribbean and Black (“ACB”) people make up less than 3% of the Canadian population but account for 14% of HIV infections. Within the ACB population, HIV affects men who have sex with men, heterosexual women, and heterosexual men.

Work has already begun to develop effective interventions to address syndemic factors such as stigma, racism, past trauma, violence, and power imbalances in relationships. Work has also begun on developing effective and culturally congruent models of care.

REACH 2.0 will continue this work, and will also focus on:

  • Scaling up a disclosure intervention for ACB women
  • Developing trauma-informed practices and interventions for immigrant, refugee and non-status people living with HIV
  • Conducting preliminary work to develop faith-based and other interventions to reduce stigma and create more supportive communities, and
  • Developing safer pregnancy guidelines and conducting preliminary work to develop and test a pilot intervention for safer conception, contraception, and reproductive health in ACB communities.

For transgender and transsexual people

High HIV rates have been found for some trans women, while low HIV rates have been found among some trans men. However, these rates have been taken from small sample groups (ranging from 15 to 123 participants). Lack of research, particularly for trans men, is a significant problem affecting this community.

The research that does exist suggests that trans men and women may face unique vulnerabilities to HIV infection. REACH 2.0 is committed to addressing the specific issues confronting transgender and transsexual people.

After national and regional consultation processes are completed, REACH 2.0 could explore:

  • The development and evaluation of cultural competency training for students and educators in medical schools and other professional health schools
  • HIV, STI, and HCV prevention strategies for sexual and gender minority populations
  • The development and evaluation of policy frameworks to maximize pathways to health for trans populations living with HIV, and
  • The development of national indicators of sexual health for sexual and gender minority populations.

For Indigenous communities

Indigenous people make up only 3.8% of the Canadian population, but account for approximately 8% of people living with HIV in Canada. Rates of HIV among Indigenous people are 3.6 times higher than among other Canadians. Indigenous people are also more likely than other Canadians to be diagnosed later in the course of infection and to face barriers along the prevention, engagement, and treatment cascade.

REACH 2.0 plans to work closely with partners such as the Canadian Aboriginal AIDS Network to identify regional priorities and to assess the workability of program science within an Indigenous context. Right now, program science remains untested within Indigenous research and settings, and we will be guided by the wisdom and preferences of our Indigenous colleagues in this area.

Building on CIHR-funded projects such as Stable Homes, Strong Families, REACH 2.0 will aim to develop strengths-based and culturally appropriate Indigenous HIV housing policies. REACH 2.0 will also aim to identify family and kinship features that can be woven into interventions to support all members of a family affected by HIV.

For people who use drugs

People who use drugs account for roughly 17% of all new HIV infections in Canada, and roughly 80% of all Hepatitis C infections. Although the number of HIV infections attributed to drug use has fallen in most Canadian cities since 2008, the number of Hepatitis C infections continues to rise. The harm reduction strategies that have proven effective in preventing HIV and Hepatitis C (eg., needle exchange programs and supervised injection sites) have not been scaled up.

REACH 2.0 will work with the communities most impacted by drug use. Initial priority areas of research include:

  • Identifying barriers to HIV and Hepatitis C testing and developing strategies to scale-up testing programs that work in a variety of communities
  • Developing and implementing clinical programs that can engage HIV-positive drug users in care and treatment
  • Developing networks of front-line workers, clinicians, public health experts, and decision makers to encourage a more health-focused approach to addiction, mental illness and HIV/HCV care, and
  • Promoting capacity building among the people most affected by drugs through community-based research approaches.

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