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Nathaniel Lewis

‘Placing’ HIV risk and prevention among gay men and MSM in Nova Scotia: Intersectional and ecological approaches

Date: December 12, 2013
Times: 13h00 to 14h15 Eastern Time (Montréal)
Presenter: Nathaniel Lewis
Abstract: HIV/AIDS continues to be major epidemic in Canada, particularly among marginalized and stigmatized populations. Yet existing and emerging public health approaches to HIV/AIDS prevention, such as treatment-as-prevention (i.e., antiretroviral therapy to reduce viral load and risk of onward transmission), tend to focus on categorical ‘at-risk’ individuals and populations in specific high-prevalence locales (Montaner 2011). This soon-to-be completed case study of HIV risk and prevention among gay-identified men and men who have sex with men (MSM) in the province of Nova Scotia, uses interviews with both HIV/AIDS-related service providers and individual male service users to examine how (1) men’s intersectional identities (2) social and institutional ecologies of Nova Scotia may influence the transmission and prevention of HIV/AIDS in this population. These two approaches, often described as elements of the ‘new public health’, are not often used in HIV/AIDS research but may be useful for revealing risk factors not captured in purely epidemiological approaches. Intersectionality acknowledges that multiple characteristics (e.g., gender, sexuality, location) influence individual health outcomes—not just sometimes but always (Hankivsky and Christofferson 2007). Meanwhile, ecological approaches emphasize the social, cultural, and institutional structures embedded in particular places that contribute to population health outcomes (McLaren and Hawe 2005). The objective of this webinar is to introduce a critical social science approach to defining and interrogating HIV/AIDS risk and prevention in a lesser-studied, categorically low-prevalence province. Part 1 of this discussion examines how socially constructed masculinities among men in Nova Scotia, both across the life course and across places, create distinct risk contexts and experiences both inside and outside of the province. Part 2 examines how the ecological factors, such as rurality, dense social linkages, HIV/AIDS education, and health service constraints, interact with individual, intersectional identities, to shape both HIV risk and the uptake of prevention strategies. The findings suggest that earlier- in-life identity formation processes, initial encounters with risk in Nova Scotia and elsewhere, limited HIV/AIDS messaging and services, stigma, lack of anonymity, and understandings of the region as ‘low-prevalence’ all contribute to distinct contexts of risk and require more innovative prevention strategies.
Hankivsky, O., and A. Christofferson. 2007. Intersectionality and the determinants of health: A Canadian perspective. Critical Public Health 18 (3): 271–283.
McLaren, L., and P. Hawe. 2005. Ecological perspectives on health research. Journal of Epidemiology and Community Health 59 (1): 6–14.
Montaner, J.S.G. 2011. Treatment as Prevention: A double hat-trick. Lancet 378: 208–209.
What types of interventions might be most appropriate and effective for preventing HIV/AIDS and other sexually transmitted infections (STIs) in peripheral and low- prevalence regions such as the Atlantic Provinces, and moreover, would they be considered necessary and/or worthwhile of public health funding?
What are some of the other Canadian populations (aside from gay-identified men and MSM) in which ongoing gaps in HIV prevention have led to continued transmission? How might intersectional and ecological approaches bridge, or at least bring attention to these gaps?
From a health equity perspective, should gay-identified men and MSM in places like Nova Scotia have access to the same type of population-specific services (e.g., gay men’s HIV testing nights, the Hassle Free Clinic and other gay-specific AIDS service organizations) available in Toronto, Montreal or Vancouver? Given financial and ‘critical mass’ constraints, what are the ways that safe and appropriate services could be delivered to this population?