Chapter 6: Population-specific status report: HIV/AIDS and other sexually transmitted and blood borne infections among youth in Canada – Current response
Chapter 6 – Current Response to HIV/AIDS among Youth
This chapter provides an overview of the strategies, coalitions, networks, organizations and programmatic responses to the issue of HIV/AIDS and other STBBIs among youth in Canada.
To obtain information on youth-focused strategies, networks, coalitions, advisory bodies and projects in existence during the years 2009-2011, federal, provincial and territorial officials and other stakeholders were contacted through:
- the Status Report Working Group
- the former 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
- the Public Health Agency of Canada’s national and regional HIV/AIDS program consultants.
Projects funded by Toronto Public Health’s AIDS Prevention Community Investment Program in 2009-2010 and 2010-2011 were also included in the analysis but private sector organizations were not. Although efforts were made to identify as many activities as possible, this chapter may not have identified all projects, networks, coalitions and advisory bodies addressing HIV among youth in Canada.
A variety of organizations, time-limited projects and online resources were identified through the information-gathering process and organized into four categories, listed in Appendix C:
- youth-specific networks, coalitions and advisory bodiesFootnote i
- time-limited projects underway between 2009-2011 addressing HIV among youth
- organizations and online resources for youth related to HIV, STBBIs and sexual health
- organizations and online resources that address determinants of health related to HIV among youth.
Time-limited projects were included in this chapter if they focused on HIV, STBBIs and/or sexual health, specifically addressed youth, and were underway 2009-2011.Footnote ii Where available, organization websites were reviewed to determine and analyze the type of services being offered and which specific population was addressed (if any) within the youth population.
Canada’s response to HIV/AIDS has grown in scope and complexity since the infection first emerged. Governments, non-governmental and community-based organizations, researchers, health professionals and people living with and vulnerable to HIV/AIDS are taking action to manage the infection and the conditions that sustain it. In addition, these groups are increasingly recognizing the interrelationship between HIV and other STBBIs, including common transmission routes, risk factors, vulnerable populations and determinants.
Through the Federal Initiative to Address HIV/AIDS in Canada, the Government of Canada: monitors HIV cases through its national surveillance system; develops policies, guidelines and programs; and supports the voluntary sector (composed of national HIV/AIDS organizations, AIDS service organizations and community-based organizations) in the response to HIV/AIDS in communities across the country.
The provinces and territories are engaged in similar activities and, under Canada’s constitution, have the primary responsibility for providing health and social services to people living with, and at risk for, HIV/AIDS and other STBBIs.
Using public and private funding, organizations in all provinces and territories are working to reduce the impact of HIV/AIDS and other STBBIs and to provide diagnosis, prevention, care, treatment and support services to those most vulnerable. The private sector and religious communities are also involved in the response to HIV and other STBBIs in Canada, by providing funds or delivering programs. Depending on the jurisdiction, community-based organizations work through pre-defined structures to determine priorities and allocate resources. Communities and local health authorities, governments, frontline organizations, volunteers and affected populations are uniquely positioned to determine the appropriateness of the response.
This section provides an overview of existing national and provincial/territorial strategies to address HIV/AIDS and other STBBIs among youth.
The Federal Initiative to Address HIV/AIDS in Canada identifies youth at risk as one of eight key populations vulnerable to, or disproportionately affected by, HIV/AIDS.Footnote 1
This initiative was developed as the Government of Canada’s response to Leading Together, Canada Takes Action on HIV/AIDS, a stakeholder-led document that outlines a coordinated nationwide approach to HIV/AIDS in Canada. Leading Together highlights the importance of community involvement in the response, as well as the need for culture-, gender- and age-appropriate programs and services.Footnote 2
In 2010, the Canadian Aboriginal AIDS Network (CAAN) released its National Aboriginal Youth Strategy on HIV and AIDS in Canada which covers the years 2010 to 2015. The strategy was developed with the guidance of the CAAN National Aboriginal Youth Council on HIV and AIDS, as well as Aboriginal people living with HIV/AIDS, representatives from Aboriginal AIDS service organizations and community stakeholders, among others.
Most jurisdictions have strategies that address HIV and other STBBIs and deal with prevention, care, treatment and support. Increasingly, many jurisdictions have moved to an integrated approach as part of a broader STBBI strategy, or strategies for sexual health. Most provinces and territories did not have a specific strategy focused on youth, but many of them identify youth as a population particularly affected by and vulnerable to HIV and other STBBIs.
British Columbia’s Priorities in Action in Managing the Epidemics – HIV/AIDS in BC: 2003-2007 has guided the health system toward sustained improvements in HIV/AIDS prevention, harm reduction, care, capacity, treatment and support, and coordination and cooperation.Footnote 3 Each regional health authority in the province develops its own strategies to complement provincial directions. The provincial strategy identifies youth (including Aboriginal youth and youth who use injection drugs) as being particularly vulnerable to HIV infection. Youth-specific objectives include: ensuring that care, treatment and support are available to vulnerable populations including homeless youth; and reducing the incidence of HIV infection by half among youth and other populations.
Alberta’s Sexually Transmitted Infections and Blood Borne Pathogens Strategy and Action Plan (2011–2016) provides provincial direction to focus and coordinate the efforts of all partners involved in sexually transmitted infections and blood borne pathogen prevention, control and management.Footnote 4 Youth-specific activities include: developing and implementing targeted sexual health information and interventions to help delay the age of sexual debut; promoting safer sex practices; increased testing for early detection of STBBIs; and providing relevant information on sexual health and STBBI prevention and treatment. Youth populations to be targeted include: youth in the general population; those in youth correctional centres; out-of-school youth; homeless and street-involved youth; and other vulnerable youth.
Saskatchewan’s HIV Strategy 2010-2014 identifies youth as a population experiencing increased rates of HIV infection.Footnote 5 The strategy calls for: creating peer support networks for vulnerable populations such as HIV-positive youth; and improving prevention for children and youth, “such as Kids-First programming, which focuses on areas such as home visiting, parent engagement and promoting linkages with mental health and addictions services.”Footnote 6
Manitoba Healthy Living, Seniors and Consumer Affairs continues to implement a healthy sexuality action plan that promotes holistic sexual health practices and works toward reducing the rates of STIs, increasing access to screening and testing for STIs, reducing the rates of teen and unplanned pregnancies, improving overall sexual negotiation skills and healthy relationships, and improving levels of care and treatment for those living with HIV/AIDS. The government department is also co-leading development of a new provincial Sexually Transmitted Blood Borne Infections Strategy 2012-2017, a process that has resulted from key collaborations between provincial, regional, federal, and community partners and stakeholders. This province-wide approach integrates HIV into the overall STBBI prevention, treatment and surveillance strategy and will address chlamydia, gonorrhea, syphilis, hepatitis B and C viruses, human papilloma virus and HIV. The updated strategy is intended to promote a more coordinated provincial response to STBBI prevention and control, and youth are among the primary target populations.
The Ontario Advisory Committee on HIV/AIDS developed A Proposed HIV/AIDS Strategy for Ontario to 2008. The proposal highlighted the need to “identify and implement strategies to ensure that young people in Ontario receive education about HIV and other STDs (sexually transmitted diseases)” through school curricula and non-school settings (e.g. clubs, programs, and organizations for youth) and to create a strategy for gay and bisexual youth.Footnote 7 The Ontario Aboriginal HIV/AIDS Strategy Strategic Plan for the Years 2010-2015 also identifies Aboriginal youth as a population that is particularly vulnerable to HIV.Footnote 8 The strategic plan includes this population in a range of activities, with the specific goal that “Aboriginal youth have a better understanding of the threat of HIV/AIDS and how to prevent infection.”Footnote 9 Strategies to achieve this goal emphasize working with Aboriginal youth in the design and delivery of prevention messages, and liaising with education authorities to ensure that communications are implemented in schools that have significant Aboriginal populations.
The Quebec Strategy on HIV and AIDS, HCV and Sexually Transmitted Diseases, 2003–2009 (Stratégie québécoise de lutte contre l’infection par le VIH et le sida, l’infection par le VHC et les infections transmissibles sexuellement, 2003-2009) identifies youth as one population that is particularly vulnerable to STIs, and notes that particular groups of vulnerable youth require specific interventions (i.e., youth who are MSM, those using injection drugs, youth coming from countries where HIV is endemic, vulnerable female youth, and Aboriginal youth).Footnote 10 The strategy identifies various activities that include population-specific elements, such as targeting activities to specific populations and increasing access to youth-specific sexual health clinics.
Nova Scotia’s Strategy on HIV/AIDS identifies youth aged 15 to 19 as a population that is particularly vulnerable to HIV infection and recommends creating supportive school environments as part of a coordinated to approach to HIV prevention.Footnote 11 In addition, the Framework for Action: Youth Sexual Health in Nova Scotia was produced by the Nova Scotia Roundtable on Youth Sexual Health in consultation with government and community stakeholders.Footnote 12 It “provide(s) suggested roles for youth, communities, community-based agencies, and all sectors of government in improving the sexual health of youth in Nova Scotia.”Footnote 13 The framework contains five key components: leadership and commitment; community awareness and support; school-based sexual health education; youth involvement and participation; and sexual health-related services for youth. Standards for Blood Borne Pathogens Prevention Services in Nova ScotiaFootnote 14 also identifies youth as a vulnerable population. The document highlights programs and initiatives that target provincial youth and identifies standards for prevention services addressing youth populations.
The Sexually Transmitted Infections–The Naked Truth: A Strategic Directions Document notes that youth in the territory are particularly affected by STIs.Footnote 15 Many of the document’s goals and objectives are specific to youth, and include: supporting youth-oriented healthy lifestyle initiatives; implementing STI prevention strategies for individual communities; enabling youth to make informed decisions about sexual behaviours; implementing multimedia educational campaigns on STIs for youth; and strengthening school-based sexual education.
Goals of Developing Healthy Communities: A Public Health Strategy for Nunavut 2008-2013 are to decrease the incidence of youth engaged in risk behaviours such as unprotected sex, and reducing the rate of teenage pregnancy.Footnote 16 Strategies to support these goals include providing sexual health curriculum in schools, and focusing on skills such as decision-making, assertiveness and communication.
Although Newfoundland and Labrador, Prince Edward Island, New Brunswick, and the Yukon do not have specific strategies for HIV or other STBBIs, they do include approaches to address these illnesses among youth as part of broader provincial health strategies.
This section provides an overview of youth-specific networks, coalitions and advisory bodies focused on HIV/AIDS which undertake a variety of activities such as providing advice, advocacy and research. Some of the networks listed below also deliver programs. The existence of these organizations and bodies indicates the importance of working in partnership across community, organizational and government sectors to address HIV and other STBBIs among youth.
At the national level, three organizations were identified:
- The Canadian Association for Adolescent Health (CAAH) is a national non-profit organization consisting of healthcare professionals that aims to: promote the health and wellbeing of youth, particularly those aged 10 to 19 years of age; set standards in healthcare and services for youth; and promote cooperation between healthcare professionals and organizations.
- The National Aboriginal Youth Council on HIV and AIDS (NAYCHA) is a committee of the Canadian Aboriginal AIDS Network (CAAN). NAYCHA membership consists of First Nations, Inuit and Métis youth (aged 18-29 years) representing each province and territory. NAYCHA provides youth-specific advice and leadership on HIV/AIDS issues for Aboriginal youth.
- The Native Youth Sexual Health Network (NYSHN) is a peer-based network created by Indigenous youth which focuses on sexual and reproductive health, including HIV, other STBBIs and related issues. It engages in advocacy, resource development and specific projects with Indigenous youth in Canada and the United States.
At the provincial level, one organization was identified. The Nova Scotia Roundtable on Youth Sexual Health is a group of health professionals, educators, government and non-government organizations interested in youth sexual health. The Roundtable developed the Framework for Action: Youth Sexual Health in Nova Scotia.Footnote 17 In Cape Breton, the Sexual Health Network consists of several HIV and educational partners and focuses on improving sexual health among youth in junior and senior high schools in the region.
This section provides an overview of the types of organizations and projects underway from 2009 to 2011 that relate to HIV and other STBBIs among youth in Canada. Funded projects included for discussion, were those directed at youth, had a specific youth-focused component, or targeted youth directly within a broader group. Projects and the responsible organizations are listed in Section 2 of Appendix C.
Many AIDS service organizations provide services to youth, such as educational workshops or social support groups which are part of their regular activities related to HIV prevention, care and support. Due to methodology limitations, not all of these types of activities have been captured in this analysis. It is also important to note that HIV/AIDS projects that have been integrated into regular provincial or territorial health care and social services delivery activities have not been included here. Furthermore, due to the time-limited nature of the projects and the time lapse between writing and printing this report, some projects may no longer be active.
Of the 105 projects reviewed, 44 (42%) addressed youth as part of a larger project while 61 targeted youth exclusively (Appendix C). Figure 35 shows that over half (56%) of the organizations involved in HIV and other STBBI prevention were AIDS service organizations, followed by community services, community health or sexual health services (19%) and youth-specific service organizations (12%). This analysis reveals the diversity of groups working on prevention and the complexities of youth’s specific needs.
Text Equivalent - Figure 35
Figure 35 depicts a circle with different sized segments shaded in different colours to correspond to the relative proportions of types of organizations involved in projects related to the prevention of HIV/AIDS among youth which were reviewed as part of this report. The circle is divided into six segments in total. The figure shows that AIDS service organizations comprised 56% of the projects, compared to 4% comprised by youth-specific AIDS service organizations, 12% comprised by youth-specific service organizations, 6% comprised by other non-governmental organizations, 19% comprised by community services, community health or sexual health services and 3% comprised by government organizations.
Table 8 and Figure 36 show the distribution of projects across Canada. Between 2009 and 2011, 105 projects addressing HIV and other STBBIs among youth in Canada were identified. Note that provinces with larger populations may have more funded projects.
Text Equivalent - Figure 36
Figure 36 depicts a circle with different sized segments shaded in different colours to correspond to the relative proportions of projects reviewed as part of this report, found in each of 9 regions of Canada. The figure shows that 5% of projects were national in scope, compared to 5% located in the northern region of Canada, 7% in British Columbia, 7% in Alberta, 5% in Saskatchewan, 5% in Manitoba, 34% in Ontario, 22% in Quebec and 10% in the Atlantic region of Canada.
Of the 105 projects reviewed, 7% were located in British Columbia, 7% in Alberta, 5% in Saskatchewan, 5% in Manitoba, 34% in Ontario, 22% in Quebec, 10% in the Atlantic provinces and 5% in the North. In addition, there were five projects that were national in scope.
6.5.3 Projects addressing specific populations of youthFootnote iii
Half of the projects identified (50%) targeted the general youth population (Y7, Y11, Y13-Y22, Y27, Y28, Y33, Y34, Y35, Y37, Y38, Y40, Y41, Y43, Y44, Y46, Y47, Y57, Y59, Y66, Y67, Y68, Y71, Y72, Y74, Y75, Y79, Y80- Y83, Y86, Y88-Y92, Y94, Y95, Y96, Y98-Y103), while the other half focused on specific youth populations. The specific groups included youth who were:
- sexually diverse and gender-variant
- living with HIV
- from newcomer, immigrant and racialized communities
- used drugs
- in prison or involved with the justice system
- in foster care or group homes
- involved in sex work
- living with disabilities.
As discussed in Chapter 4, these groups often experience discrimination and multiple health and social challenges rooted in racism, sexism, homophobia and socio-economic deprivation which can affect their vulnerability to HIV and other STBBIs. As a result, these populations may require individual strategies to address their distinct health and socio-economic situations.
Of the projects identified, 88 (84%) involved the provision of information to youth through pamphlets, brochures and resources, and 68 (65%) focused on education through interactive workshops, presentations or peer groups. Topics included messaging on HIV/AIDS prevention, diagnosis, care and treatment, sexual health and other STBBIs. Over half (56%) of the projects provided outreach or peer-to-peer support to prevent HIV infection and included training of peer facilitators, peer youth counselling programs, and outreach programs designed for and by youth. Twenty-seven (26%) projects focused on prevention (e.g. distribution of HIV prevention manuals, prevention campaigns targeting safer sex behaviours). Twelve (11%) included harm reduction such as needle exchange, an injection drug use outreach program, access to safer sex and harm reduction kits and referral services.
Of the targeted projects, twenty-nine (28%) focused on Aboriginal youth. Four of these were national projects that examined culturally-appropriate messaging around sexual health and harm reduction for Aboriginal young people (Y1, Y2, Y3, Y5). Many of these projects used innovative peer-based approaches. For example, in British Columbia, AIDS Vancouver Island offered electronic HIV education tools and peer-to-peer education for Aboriginal youth living off-reserve (Y6). The Chee Mamuk Aboriginal Program undertook the Star in Your Own Stories project, engaging Aboriginal youth in BC to create their own positive sexual health campaign. Through this project, Aboriginal youth were able to explore HIV/AIDS and sexual health issues while gaining skills and knowledge (Y8). The Hiiye’yu Lelum (House of Friendship) Society provided Aboriginal youth with the opportunity to develop and present materials such as workshops and theatre presentations on HIV, hepatitis C, healthy sexual behaviour (Y9) and other topics. The Okanagan Aboriginal AIDS Society offered a Youth Facilitators Boot Camp where Aboriginal youth were recruited and trained to present workshops in the community on preventing blood borne infection (Y10). In Vancouver, YouthCO AIDS Society delivered peer-driven, culturally appropriate HIV and hepatitis C prevention education through its Aboriginal Youth Program, which allows youth to use different artistic media to express their knowledge and skills (Y13). In Alberta, the First Nations and Inuit Health Branch (Health Canada) supported a DVD messaging program in which Aboriginal youth used theatre to address HIV, hepatitis C, sexually transmitted infections, sexual health, drug use (Y15) and other issues. In Saskatchewan, the Kikinahk Friendship Centre’s Sexual Health and Drug Use Awareness Program trained youth facilitators to deliver workshops on HIV and other STBBI prevention and how these infections are affecting the North (Y25).
Some projects were aimed at specific groups of Aboriginal youth, including those who injected drugs, were in prison, and/or living with HIV. For example, Battlefords Family Health Centre’s Circle of Change: Reducing Harm offered targeted HIV educational groups for Aboriginal youth who use injection drugs or who are in prison (Y24). In Winnipeg, the Nine Circles Community Health Centre conducted focus groups with Aboriginal and HIV-positive youth to explore perceptions of risk for HIV, hepatitis C and STIs as well as ways to improve engagement with youth (Y26). Similarly, in Ontario, the Aboriginal Youth Peer Prevention Project, a part of the Ontario Aboriginal HIV/AIDS Strategy, recruited HIV-positive and non-HIV youth to participate in regional peer youth networks as well as a provincial advisory committee to develop an Aboriginal youth strategy for HIV prevention (Y53). In addition, Play It Safer worked with high schools, youth centres and colleges/universities to offer peer training for youth to create and provide information on HIV/AIDS awareness and prevention through workshops (Y27).
Two projects involved Aboriginal youth HIV/AIDS conferences. In Saskatchewan, All Nations AIDS Network hosts an annual conference on HIV prevention with Aboriginal elders and youth (Y23). Similarly, in Winnipeg, the West Region Tribal Health Services and Manitoba First Nations AIDS Working Group hosted an HIV conference to bring together youth, health professionals and community members, including Elders, to discuss and promote awareness of HIV and other STBBIs (Y30).
Several projects emphasize HIV/AIDS awareness and prevention education that is developed for and by Aboriginal youth. In Toronto, the Kwesk-iniwak Project offered outreach and HIV prevention with peer educators to reach street-involved Aboriginal youth (Y51). Also in Toronto, the Native Youth Sexual Health Network’s youth messaging initiative entitled Normalizing healthy sexuality and reducing homophobia: Native youth photography produced videos and a poster campaign about homophobia (Y52). In addition, the Ontario First Nations HIV/AIDS Education Circle offered peer education training to teach youth to deliver HIV awareness and prevention education in their communities (Y54).
In Quebec, the First Nations of Quebec and Labrador Health and Social Services Commission undertook culturally adapted workshops, training and education for Aboriginal youth:
- workshops with a focus on sexual health and HIV/AIDS (Y76)
- training young people from First Nation communities to carry out awareness activities in their communities (Y77)
- adaptation of the game “Who wants to be a millionaire” with trivia on HIV (Y78).
A project of the Regroupement des centres d'amitié autochtone du Québec supported sexual health and harm reduction initiatives for Aboriginal youth, including awareness workshops (Y84).
In the Atlantic region, Healing Our Nations engaged Aboriginal youth in developing and distributing an educational video on HIV prevention, as well as hosting a series of Youth Awareness workshops and discussion groups (Y97). Another project in the region offered targeted educational groups and outreach for Aboriginal street-involved youth (Y99).
In the North, variety projects provided culturally relevant education and services including youth outreach programs (Y101), a sexual health messaging video (Y104) and workshops and information material on HIV and other STBBI transmission and prevention (Y105).
Sexually diverse and gender-variant youth
Seventeen (16%) projects focused on sexually diverse and gender-variant youth (Y4, Y6, Y13, Y31, Y32, Y33, Y39, Y40, Y48, Y50, Y56, Y60, Y68, Y69, Y79, Y85, Y93). Some of these included lesbian, gay, bisexual and transgender (LGBT) youth as part of a larger strategy to engage marginalized youth, such as:
- CATIE’s National HIV/AIDS Knowledge Exchange Fund (Y4)
- Vancouver Island AIDS Society and YouthCO, whose activities included HIV prevention outreach, presentations, workshops and peer-to-peer education among youth at increased risk of contracting HIV (Y6, Y13)
- I.R.I.S Estrie, which offered outreach and prevention activities for vulnerable populations, including gay youth, in the Eastern Townships in Québec (Y79).
In Toronto, the 519 Church Street Community Centre offered outreach to transsexual sex workers and distributed a “Trans 101” manual for service providers (Y31). Africans in Partnerships against AIDS offered outreach to gay and bisexual youth in Toronto, including monthly sexual health support groups for vulnerable gay and bisexual young men (Y32). Similarly, the AIDS Committee of Cambridge, Kitchener, Waterloo & Area hosted weekly group meetings for LGBT males and females, and offered information to increase community awareness of LGBT youth (Y33).
Some projects targeted LGBT youth from newcomer, immigrant and racialized communities, such as outreach to South Asian gay and bisexual youth (Y39), HIV and STI prevention workshops and events targeting gay, transgender and transsexual Asian youth (Y40).
In Toronto, the sprOUT sexual health information project at the Griffin Centre offered HIV and STBBI information and support to LGBT youth with developmental disabilities. This included visual aids about HIV, STI and sexual health for LGBT youth with developmental disabilities (Y48).
Other projects made use of social media and arts-based interventions to engage young LGBT populations. For example, the Malvern Family Resource Centre involved gay, bisexual and other young men who have sex with men (MSM) through the Photograph Your Thoughts project (Y50). In the national capital region, the Bureau régional d'action sida (BRAS) offered pamphlets, posters, and videos on HIV prevention for young gay men (Y69). In Montréal, Rézo developed an online HIV prevention project for young MSM that provided information on safer sex, HIV and STIs (Y85).
In Newfoundland and Labrador, the Gay Urban Youth Zone (GUYZ) project aimed to increase HIV, HCV and STI knowledge and awareness among young gay men and service providers. Through peer education, young gay men had the opportunity to develop their own prevention materials including pamphlets, posters, and videos on sexual health issues (Y93).
Few projects explicitly address homophobia. The Peterborough AIDS Resource Network offered peer education and training for gay and bisexual men, in addition to workshops on safer sex and dealing with homophobia (Y56). In Sudbury, the healthy sexuality program of the Access AIDS Network provided bilingual safer sex workshops to gay, MSM and LGBT youth, service providers, and primary and secondary school teachers. It also delivered anti-homophobia and heterosexism workshops to service providers (Y60).
A total of 15 (14%) projects identified street-involved youth as their target audience (Y4, Y6, Y13, Y14, Y26, Y45, Y49, Y62, Y64, Y65, Y68, Y70, Y73, Y79, Y92). As addressed earlier, some of these projects included street-involved youth as part of a larger strategy to engage marginalized youth (Y4, Y6, Y13, Y62, Y68).
In Alberta, the AIDS Calgary Awareness Association conducted outreach on HIV and AIDS, shared prevention messages and connected street-involved youth to resources for safety, food and shelter (Y14). In Saskatchewan, the Kikinahk Sexual Health and Drug Use Awareness program conducted focus groups with street-involved youth to understand their unique needs and their use of mobile technologies for health promotion (Y26). In Toronto, Eva's Initiatives for Homeless Youth provided safe shelter and a range of services to homeless and vulnerable youth (Y45). In addition, Street Outreach Services worked with street-involved youth at risk of or engaged in sex work, providing counselling, HIV and harm reduction education, job skills training, and school and housing support (Y49). Two other Toronto projects provided peer-facilitated workshops on HIV and other STBBI prevention and risk reduction (Y64), and HIV and harm reduction street outreach such as access to safer sex and harm reduction kits and referral services (Y65).
In Quebec three projects were identified. Cactus Montreal worked with street-involved youth to increase knowledge of HIV transmission and the harms associated with substance abuse (Y70). Coalition sherbrookoise pour le travail de rue (Y73) and I.R.I.S Estrie (Y79) provided outreach and support for street-involved youth.
In the Atlantic region, the AIDS Coalition of Nova Scotia offered prevention and promotion workshops specifically for street-involved youth (Y92).
Youth living with HIV
Projects targeting youth living with HIV represented 9% (or 10) of all projects reviewed (Y4, Y12, Y26, Y31, Y36, Y41, Y47, Y53, Y56, Y63). Many of these projects involved those living with, affected by or at risk of HIV (e.g. knowledge exchange activities to address HIV prevention, diagnosis, care and treatment, and support for HIV-positive youth (Y4)). Some projects focused on peer support for HIV-positive youth and their families. Camp Moomba, a summer camp program for children and youth affected by HIV, offered a leadership program for youth aged 15 to 17 where participants engaged in a wide variety of experiences to build self-esteem and self-confidence (Y12). In Manitoba, the Nine Circles Community Health Centre held focus groups with HIV-positive youth to explore perceptions of existing services and ways to improve youth engagement (Y26). In Toronto, the Black Coalition for AIDS Prevention provided HIV education outreach, including a Project Hope for Africa (PHA) youth support group (Y41). Similarly, the Jane/Finch Community and Family Centre hosted Positive Circles where youth who are living with HIV or an STI can have a safe space to discuss their issues (Y47).
Through the Positive Youth Outreach project (Y36), the AIDS Committee of Toronto provided support such as health promotion information and skills development opportunities to young people (aged 29 and under) living with HIV. The Toronto People with AIDS Foundation’s Speakers Bureau also provided HIV-positive youth with the opportunity to engage in HIV prevention workshops and outreach activities (Y63). In addition, Peterborough AIDS Resource Network provided support, health promotion and advocacy for people living with HIV/AIDS through peer education, outreach, and distribution of harm reduction and safer sex information, resources and services (Y56). Other projects considered the prevention needs of HIV-positive youth as part of broader outreach and prevention initiatives (Y31), e.g. involving positive youth in the development of an Aboriginal youth strategy for HIV prevention (Y53).
Youth from racialized communities
Of the projects reviewed, 8% focused on youth from racialized communities (Y32, Y38, Y39, Y40, Y41, Y44, Y61, Y83). There were several culturally specific responses, including those focused on African (Y32), African and Caribbean (Y41), Ethiopian (Y44), Somali (Y61) and South Asian (Y38, Y39, Y40) communities. One project offered outreach and peer support groups to South Asian gay and bisexual youth, in addition to HIV and STI awareness brochures, and online postings of prevention messages for South Asian and Tamil communities (Y39). Another project provided training and support to gay, transgender and/or transsexual Asian youth peer volunteers to help with prevention education outreach and workshops. This project also involved developing Asian print media to raise awareness of HIV/AIDS issues and HIV and STI testing for gay, transgender and transsexual Asian youth (Y40).
Newcomer and immigrant youth
Two projects (2%) specifically addressed newcomer and immigrant youth (Y29, Y38). The Sexuality Education Resource Centre Manitoba provided opportunities for newcomer youth in Winnipeg and Brandon to discuss sexual health in a culturally appropriate manner (Y29). In Toronto, the Alliance for South Asian AIDS Prevention held workshops and presentations to newcomer youth, promoting HIV/AIDS prevention awareness through the media, and conducted a one-day HIV/AIDS prevention forum for newcomer South Asian youth during South Asian Heritage Month (Y38).
Youth who use drugs
Six projects (6%) focused on youth who use drugs. In British Columbia, YouthCO AIDS Society provided harm reduction and HIV prevention activities targeted to youth vulnerable to HIV infection (Y13). In Saskatchewan, Battlefords Family Health Centre addressed injection drug use and harm reduction through an art, drama and music drop-in for youth (Y24). In Toronto, Breakaway addiction services for young adults offered counselling, education and related activities for individuals experiencing problems with drugs or alcohol (Y42). Also in Toronto, Youthlink provided HIV/AIDS and harm reduction street outreach for youth who inject drugs (Y65). This assistance took the form of safer sex and harm reduction kits, referral services, sexual health education workshops, HIV/AIDS and hepatitis C counselling and testing and implementation of a harm reduction survey to track significant trends in injection drug use and common issues among service users. The Sudbury Action Centre for Youth’s harm reduction program included outreach, needle exchange, counselling and information, and an outreach program for youth who inject drugs that promotes safe disposal of needles in the community (Y62). At the Labrador Friendship Centre, targeted educational programs were offered to Aboriginal people in prison and youth to promote sexual health and injection drug use harm reduction (Y99).
Youth in prison
Five projects (5%) focused on youth in prison or detention, and those who are involved with the justice system. In Saskatchewan, Battlefords Family Health Centre offered sexual health and harm reduction initiatives for vulnerable populations, including targeted educational groups and supports for youth in open custody at the Drumming Hill Youth Centre (Y24). The youth outreach and education program of the Prisoners with HIV/AIDS Support Action Network (PASAN) offered HIV prevention educational sessions, outreach and coordinated services for young people in conflict or at risk of becoming in conflict with the law (Y58). AIDS Community Care Montreal provided HIV/AIDS education and prevention services to vulnerable populations, including youth in the general population, youth in prison, and street-involved youth (Y68). In the Atlantic region, the John Howard Society of southeastern New Brunswick provided peer education to promote knowledge about hepatitis C among youth in various custodial settings of the justice system (Y98). Another project of the Labrador Friendship Centre focused on developing educational materials and providing awareness and prevention activities, including presentations on HIV prevention at the Labrador Correctional Centre and Charles Andrew Treatment Centre (Y99).
Youth in foster care or group homes
Four projects (4%) focused on youth in foster care or group homes. One project offered peer-led workshops and the development of sexual health information distributed to youth in care over the age of 13 (Y55). In Quebec, the Centre des R.O.S.É.S. de l’Abitibi-Témiscamingue addressed youth aged 12 to 17 years in youth centres or youth homes through the development of an educational graphic novel by and for these young people, to improve knowledge, attitudes and understanding of risk behaviours for HIV and other STBBIs (Y71). Another project provided sexual health education for youth aged 6 to 12 years in foster care or group homes (Y72). Additionally, Sidaction (Trois-Rivières) in Quebec provided prevention activities such as distribution of educational materials and development of training and workshops for youth in youth centres (Y87).
Youth involved in sex work
Only two projects (2%) focused on youth involved in sex work. The 519 Church Street Community Centre in Toronto provided a range of outreach activities to trans sex workers, including distribution of HIV prevention material, telephone outreach to indoor sex workers and HIV prevention workshops (Y31). In Winnipeg, the Sexuality Education Resource Centre Manitoba worked with youth aged 16 to 24 at risk of or engaged in sex work, including outreach, in-house counselling, HIV and harm reduction education and job skills training (Y29).
Youth living with disabilities
Only one project focused on youth living with disabilities (Y48). Through youth peer educators, the Griffin Centre provided HIV and STI information to LGBT youth with developmental disabilities in Toronto.
In collecting information on projects underway between 2009 and 2011, other relevant organizations and web-based resources concerning youth in Canada were identified. Although some focus specifically on HIV and other STBBIs, others deal with related issues of interest to young people such as sexual health, healthy relationships and mental health. Many organizations addressing these and related issues have websites that contain resources and information for youth on these topics, some of which have been created specifically for key populations such as street-involved youth or youth from racialized communities. A list of these organizations and online resources can be found in Appendix C, Section 3.
In addition, there are a wide range of organizations and web-based resources across Canada that relate to determinants of health that affect vulnerability and resilience among youth to HIV and other STBBIs. Some organizations and resources target the general youth population, while others address specific groups such as youth from racialized communities, sexually diverse and gender-variant youth, and homeless and street-involved youth. A list of these organizations and online resources can be found in Appendix C, Section 4.
Note that duplicates have been removed so that no initiatives are listed in both Section 2 (time-limited projects) and Sections 3 or 4 of Appendix C.
Projects reviewed for this chapter focus on HIV and other STBBIs among youth in Canada. They reveal a wide variety of strategies, coalitions, networks, organizations and projects that span the country. While the majority of projects targeted youth in general, there is a clear need for individual strategies to address the health needs and lived realities of youth who experience increased vulnerability to infection. Many projects focused on providing education and information on HIV prevention, diagnosis, care and treatment, sexual health and other sexually transmitted and blood borne infections. Many of these projects adopted a peer education model to create workshops, presentations and support groups that were designed for and by youth. This emphasizes the importance and value of having youth involved in developing and implementing projects that affect them. Several projects demonstrate innovative ways to reach the youth population such as social media or arts-based interventions. Many projects went beyond sexual risk behaviour to build capacity among youth by strengthening their knowledge, leadership and decision-making skills. However, fewer projects addressed broader determinants of health, such as increasing access to services or providing social support to youth living with HIV or vulnerable to infection with HIV and other STBBIs.
While a number of projects dealt with the needs of Aboriginal youth, sexually diverse and gender-variant youth and street-involved youth, a limited number of projects focused on youth in foster care or group homes, youth involved in sex work and youth living with disabilities. Future responses to HIV and other STBBIs among youth should continue to tailor projects for specific groups of vulnerable youth.
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