Chapter 1: Population-specific status report: HIV/AIDS and other sexually transmitted and blood borne infections among youth in Canada – Introduction

Chapter 1 – Introduction

The transition from childhood to adulthood is marked by many changes, including physical maturation, increased independence, completion of high school and entry into post-secondary education or the labour force. It is a time when youth^{Footnote i} begin to explore their sexuality and establish attitudes and patterns of sexual behaviour which set the stage for their future sexual health and wellbeing. While most youth make this transition smoothly, some face challenges and obstacles along the way.

Significant attention in public health has focused on the negative outcomes of this transition, including infection with HIV and other sexually transmitted and blood borne infections (STBBIs). These outcomes have typically been accounted for by individual behaviours or by being part of an “at-risk” group. Undoubtedly, individual behaviours such as inconsistent condom use or use of unsafe drug injection equipment increase risk of infection with HIV and other STBBIs. However, an emphasis on these behaviours in isolation of other factors assumes that all youth have equivalent knowledge, capacities and opportunities to make fully informed choices about their sexual health and behavior. This assumption ignores the different conditions and possibilities that youth experience in their everyday lives, which affect both directly and indirectly their vulnerability to infection. In addition, emphasizing “at-risk” youth stigmatizes specific groups and can contribute to the discrimination these youth face in their everyday lives.^{Footnote 1}

This report takes a different approach by exploring how health outcomes are affected by key determinants of health including education, income, employment, living conditions and social environments. It examines how HIV and other STBBIs affect youth in Canada while focusing on the social context and key determinants of their vulnerability to infection. It also looks at determinants of vulnerability to infection among youth, but highlights the positive impacts these determinants have on the resilience of youth against infection. The purpose of this report is to provide research evidence and information that supports communities, governments, researchers, public health practitioners, non-governmental organizations and others in helping all youth to maintain their health and transition to adulthood in healthy ways. It outlines existing policies, programs and initiatives that can be built upon and learned from in future responses to HIV and other STBBIs among this population. 

1.1 Methodology

To support the development of this report, the Public Health Agency of Canada (the Agency) formed a working group made up of community representatives, academics, and youth living with HIV/AIDS, along with government officials with expertise in research, epidemiology, community development, public health policy and program development. This working group acted as an advisory body, providing guidance and feedback on the report’s themes and drafts. Working group members were selected based on their expertise and represented diverse geographic, demographic and linguistic profiles.

This report is a “scoping review” or literature review, developed and adapted to map out the literature and evidence on youth and HIV/AIDS in Canada. The methodology for each Chapter was designed to synthesize and present the most current and relevant evidence. Demographic data were extracted from various sources, including both census and national survey data collected by Statistics Canada. Epidemiological information and surveillance data were gathered from reports published by the Agency, in addition to data from other published sources.

Data and information on the vulnerability of youth to and resilience against HIV/AIDS were collected from peer-reviewed publications and grey literature. The information identified for inclusion in the report met the following criteria: focused on HIV/AIDS; published between 2003 and 2010; focused on youth in Canada; addressed one or more of the 12 health determinants related to HIV or AIDS, or characterized HIV or AIDS in the context of prevention, care, treatment, support or diagnosis for youth populations; and was written in English or French. Appendix A describes the key words and search terms, as well as the databases used in this search. Additional information and some studies published after 2010 were also included in the report to provide context and address gaps identified by the working group.

Information on current research (underway between 2008 and 2011) was gathered from the following national and provincial organizations: Alberta Innovates Health Solutions; British Columbia Centre for Excellence in HIV/AIDS (BC-CfE); Canadian Association for HIV Research (CAHR); Canadian Foundation for AIDS Research (CANFAR); Canadian Institutes of Health Research (CIHR); Fonds de recherche du Québec–Société et culture (FRQSC); Michael Smith Foundation for Health Research (MSFHR); Ontario HIV Treatment Network (OHTN); Prairie Community-Based HIV Research Program; and the Social Sciences and Humanities Research Council of Canada (SSHRC).

To gather information on the current response to HIV/AIDS among youth underway between 2009 and 2011 (including strategies, coalitions, networks, organizations and time-limited projects), governmental and non-governmental organizations were contacted through a number of mechanisms, such as: the Federal/Provincial/Territorial Advisory Committee on AIDS (F/P/T-AIDS); Health Canada’s First Nations and Inuit Health Branch; the Federal/Provincial/Territorial Heads of Corrections Working Group on Health; and The Public Health Agency of Canada’s national and regional HIV/AIDS program consultants. Projects funded by the Toronto Public Health AIDS Prevention Community Investment Program were included. The working group was also instrumental in identifying additional activities for the report. Private sector organizations were not included in the information-gathering process.

For ease of reading, information sources are collected in endnotes at the end of each chapter and are denoted in text with superscript Arabic numbers. Footnotes are used throughout the report to provide additional commentary and appear at the foot of the page, indicated in text with lower case roman numerals.

Endnotes