Developing Resilience: Gay Men’s Response to Systemic Discrimination

Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination

Divided and Disconnected — An Examination of Youths’ Experiences with Emotional Distress within the Context of their Everyday Lives

This paper is based on a qualitative study conducted in a rural community in British Columbia, Canada. Ethnographic methods were used to: (1) to bring youth voice to the literature on emotional distress; and (2) to capture the ways in which context shapes young peoples’ experiences of emotional distress within their everyday lives. Our findings demonstrate how socio-structural contextual factors such as the local economy, geographical segregation, racism, ageism, and cutbacks in health and social service programming operate to create various forms of disconnection, and intersect in young peoples’ lives to shape their experiences of emotional distress

Nursing practice in sexually transmitted infections and HIV in British Columbia : report of survey findings

During 2009-2010 investigators from the BC Centre for Disease Control (BCCDC) and the School of Nursing at the University of British Columbia, in collaboration with regional health authorities, First Nations communities and private service organizations undertook a project aimed at understanding the nature and scope of public health nursing practice in the area of sexually transmitted infection including HIV prevention and control. The final data set included responses from 314 public health nurses. Data sources consisted primarily of census data from the College of Registered Nurses and a self-administered 62-item questionnaire. A total of 576 public health nurses working in STI including HIV prevention and control were identified through analysis of employing agencies identified within the CRNBC census data. The questionnaire was designed to assess the demographic characteristics of public health nurses, the client populations served, workload distribution, clinical practice activities, nursing practice resources, and continuing education needs. The majority of nurses were baccalaureate-prepared women with an average age of 44. The nurses, had been practicing for an average of 18 years, nine of which were in STI and HIV prevention and control. Approximately half of the nurses worked on a full-time basis. Community/public health centres in urban settings were the most common site of employment. On average, nurses spent 28% of their work in the area of STI and HIV care. Women were reported as recipients of nursing care more frequently than any other client population. The majority of nurses (76%) provided care in both STI and HIV prevention and control and spent at least half of their time in direct client care activities. Approximately 78% of nurses undertook STI and HIV testing. Seventy-four percent of the nurses provide clients with medication as part of STI treatment and oral antibiotics were the most commonly administered and dispensed medications. Emergency contraceptives and oral contraceptives were also administered by over 70% of the nurses. Referrals to other health service providers was common practice with physicians, abortion services, mental health care, and community organizations identified as the most common sources of referrals. Nurses were active in the reporting process for reportable infections and regularly engaged in health education activities primarily at the level of individual clients, although community-based education practice was reported by half the participants. Public health nurses were predominantly satisfied with many elements of their work, particularly in relation to direct client care interactions. Nurses were less satisfied with the amount of administrative support they obtained in their work setting, the physical space in which they worked, and their limited opportunities for continuing education and professional development activities. This project represents a detailed analysis of nursing practice in STI prevention and control in British Columbia and will provide an essential baseline for future investigations pertaining to the outcomes associated with legislated changes in nursing practice in the field of STI prevention and control.Applied Science, Faculty ofNursing, School ofUnreviewedFacult

2022 Research & Teaching Scholarship Report

Applied Science, Faculty ofNursing, School ofUnreviewedFacultyUndergraduat

Controlling Chaos: The Perceptions of Long-Term Crack Cocaine Users in Vancouver, British Columbia, Canada

People who smoke crack cocaine are described as chaotic and more likely to engage in risky sex, polysubstance use and contract infectious diseases. However, little is known about how individuals perceive smoking crack as compared to other forms of cocaine use, especially injection. We explored the lived experience of people who smoke crack cocaine. Six gender-specific focus groups ( = 31) of individuals who currently smoke crack in Vancouver, Canada, were conducted using a semi-structured interview guide. Focus groups were transcribed and analyzed by constant comparative methodology. We applied Rhodes' risk environment to the phenomenological understanding that individuals have regarding how crack has affected their lives. Subjects reported that smoking rather than injecting cocaine allows them to begin "controlling chaos" in their lives. Controlling chaos was self-defined using nontraditional measures such as the ability to maintain day-to-day commitments and housing stability. The phenomenological lens of smoking crack instead of injecting cocaine "to control chaos" contributes a novel perspective to our understanding of the crack-smoking population. This study examines narratives which add to prior reports of the association of crack smoking and increased chaos and suggests that, for some, inhaled crack may represent efforts towards self-directed harm reduction

The process of safer crack use among women in Vancouver’s Downtown Eastside

In this article we discuss the findings from a grounded theory study in which we explored how women residing in Vancouver’s Downtown Eastside (DTES) minimized some of the physical, psychological, and interpersonal harms associated with crack cocaine use, and identify the social, economic, and political factors that influence safer use. Data were collected over a 3-month period and involved group interviews with 27 women at an agency run by drug users in the DTES. A preliminary theory of safer crack use is discussed, consisting of the central phenomenon of caring for self and others. In addition, four thematic processes are described: (a) establishing a safe physical space, (b) building trusting relationships, (c) learning about safer crack use, and (d) accessing safer equipment. Implications of the findings are discussed in relation to supporting women’s efforts and improving health outcomes.Applied Science, Faculty ofNursing, School ofReviewedFacultyGraduat

"It gets people through the door": a qualitative case study of the use of incentives in the care of people at risk or living with HIV in British Columbia, Canada

Background: There has been growing interest in the use of incentives to increase the uptake of health-related behaviours and achieve desired health outcomes at the individual and population level. However, the use of incentives remains controversial for ethical reasons. An area in which incentives have been not only proposed but used is HIV prevention, testing, treatment and care—each one representing an interconnecting step in the "HIV Cascade." Methods: The main objective of this qualitative case study was to document the experiences of health care and service providers tasked with administrating incentivized HIV testing, treatment, and care in British Columbia, Canada. A second objective was to explore the ethical and professional tensions that arise from the use of incentives as well as strategies used by providers to mitigate them. We conducted interviews with 25 providers and 6 key informants, which were analyzed using applied thematic analysis. We also collected documents and took field notes. Results: Our findings suggest that incentives target populations believed to pose the most risk to public health. As such, incentives are primarily used to close the gaps in the HIV Cascade by getting the "right populations" to test, start treatment, stay on treatment, and, most importantly, achieve (and sustain) viral suppression. Participants considered that incentives work because they "bring people through the door." However, they believed the effectiveness of incentives to be superficial, short-lived and one-dimensional—thus, failing to address underlying structural barriers to care and structural determinants of health. They also raised concerns about the unintended consequences of incentives and the strains they may put on the therapeutic relationship. They had developed strategies to mitigate the ensuing ethical and professional tensions and to make their work feel relational rather than transactional. Conclusions: We identify an urgent need to problematize the use of incentives as a part of the "HIV Cascade" agenda and interrogate the ethics of engaging in this practice from the perspective of health care and service providers. More broadly, we question the introduction of market logic into the realm of health care—an area of life previously not subject to monetary exchanges.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult

Information and Communication Technologies in Commercial Sex Work: A Double-Edged Sword for Occupational Health and Safety

Over the previous decade, there has been a notable shift within sex work marketplaces, with many aspects of the work now facilitated via the internet. Many providers and clients are also no longer engaging in in-person negotiations, opting instead for communications via technological means, such as through mobile phones, email, and the internet. By analysing the qualitative interviews of indoor-based providers, clients, and agency managers, this paper addresses the occupational health and safety concerns that indoor sex workers experience in the digital age, as well as how technology use can both support and hinder their capacity to promote their health and safety. Using thematic analysis, we arrived at three salient and nuanced themes that pertain to the intersection of sex work, technology use, and occupational health and safety: screening; confidentiality, privacy, and disclosure; and malice. As socio-political context can affect the occupational health and safety concerns that providers experience, as well as their capacity to prevent or mitigate these concerns, we highlight our findings in light of prevailing societal stigma and a lack of legal recognition and protections for sex work in Canada.Applied Science, Faculty ofNursing, School ofReviewedFacult