Une équipe multidisciplinaire et intersectorielle a implanté en 2009 une recherche-intervention novatrice : Spot, un service de dépistage rapide du VIH en milieu communautaire offert aux hommes ayant des relations sexuelles avec d’autres hommes de Montréal. Une étude de cas a été menée afin de décrire le processus d’implantation de Spot et les facteurs contextuels qui l’ont affecté. L’analyse par théorisation ancrée des entrevues, l’observation participante et l’analyse documentaire ont permis d’identifier un processus d’implantation dynamique en plusieurs phases. Elles sont modulées par des facteurs liés aux motivations des acteurs à s’engager dans le projet, à la complexité des dynamiques partenariales et aux défis de la coordination en contexte d’équipe multidisciplinaire et intersectorielle et à d’autres facteurs ayant affecté l’organisation de l’équipe terrain et leurs pratiques au quotidien. Des motivations telles l’occasion unique de contribuer à la mise en place d’un projet de prévention novateur et pertinent, ont eu une influence favorable constante, ralliant les acteurs autour du projet et maintenant leur implication malgré les difficultés rencontrées. Sur le plan des dynamiques partenariales, une définition floue des rôles et tâches a ralenti l’implantation du projet, alors qu’une fois clarifiée, chacun a pu se sentir légitime et participer activement à la réussite de l’implantation. Des difficultés à la coordination du projet, entre autres concernant la gestion des fonds interinstitutionnels, sont un facteur ayant ralenti le processus d’implantation. Cette étude a permis de tirer des leçons sur l’implantation et la pérennisation d’un service de dépistage rapide du VIH en milieu communautaire gai. / In 2009, a multidisciplinary and intersectoral team implemented an innovative research-intervention project: Spot, a community-based rapid HIV testing service for men who have sex with men in Montreal. A case study was undertaken to describe the implementation process of Spot and the contextual factors that affected it. Grounded theory analysis of interviews, participant-observer, and a document analysis allowed the identification of a multistage dynamic implementation process. These stages were influenced by stakeholders’ motivations, the complexity of partnership dynamics, the challenges surrounding coordination and organization of staff members, as well as factors influencing staff members’ daily practices. Motivations like the unique opportunity to contribute to the implementation of an innovative and relevant prevention project, had a constant and positive influence, which united stakeholders in the project and maintained their involvement despite the difficulties. In terms of partnership dynamics, vague definitions of roles and tasks delayed the implementation of the project, although once clarified, everyone felt legitimate and actively participated in the success of the implantation. The management of interinstitutional funds was mentioned as one of the difficulties of coordinating the project and a factor that caused delays in the implementation process. This study allowed learning about the implementation and sustainability of a gay community-based rapid HIV testing service.

Les hommes ayant des rapports sexuels avec des hommes (HSH) sont les plus touchés par le VIH. La prévention du VIH dans cette population doit aujourd'hui se diversifier grâce à divers outils visant à réduire le risque : traitement des personnes séropositives, traitement préventif chez les personnes séronégatives, et comportements de réduction des risques sexuels. Le dépistage du VIH est alors un enjeu crucial de la prévention.La diversification de l'offre de dépistage en France, notamment grâce au dépistage rapide et communautaire, est un résultat majeur de cette thèse. D'autres problématiques sont également investiguées : le recours au dépistage du VIH chez les HSH vivant au Cameroun et l'intérêt pour la recherche en prévention chez les HSH en France.Tous ces résultats sont confrontés les uns aux autres et sont mis en perspective, en termes de recherches à mener mais aussi en termes de recommandations pour les politiques de prévention à destination des HSH. / Men who have sex with men (MSM) are the most affected by HIV. In this population, HIV prevention must be diversified, using several tools aiming to reduce risks: treatment of HIV positive persons, preventive treatment among HIV negative persons and, sexual risk reduction behaviours. HIV testing thus becomes the cornerstone of HIV prevention.Diversifying HIV testing is one of the most important results of this thesis. Other questions are also addressed: access to HIV testing among MSM living in Cameroon and interest in prevention research among MSM in France.The discussion of all these results leads to several perspectives in terms of researches that should be conducted, but also in terms of recommendations for prevention policies towards MSM.

Barriers to reaching human immunodeficiency virus (HIV) testing prevent Canada from achieving The Joint United Nations Programme on HIV and AIDS (UNAIDS) target of 90 percent of undiagnosed people living with HIV knowing their HIV status by 2020 and receive treatment.(1) Fourteen percent (9,090 of 63,100) of Canadians living with HIV were unaware of their status by the end of 2016.(1)(p.9)Individuals exposed to HIV through heterosexual contact are overrepresented (28%) among the undiagnosed people living with HIV in Canada compared to other groups, such as men who have sex with men (18%) and people who inject drugs (20%).(2)(par.15)The reasons preventing this population to present themselves for testing in Ottawa, Ontario, remain poorly understood in the literature. Most of the literature on barriers to accessing HIV testing focuses on the traditional key groups who are likely to test, and limits analysis of these barriers on one or two levels. Equally, health service providers rarely understand challenges behind HIV testing for particularly young heterosexual African migrant men. These challenges may be contributing key barriers to HIV testing. On other hand, late presentation to treatment remains a global issue. Psychosocial outcomes especially after a new positive diagnosis can delay reaching early treatment and prevention services. Indeed, all test results negative or positive have consequences. Even those with a new negative test can return to risk taking behaviour if they delay accessing prevention education. Yet no systematic study exists in this area essential for quality improvement. Programming more equitable HIV testing services will require more comprehensive evidence about challenges and barriers behind accessing HIV testing and treatment to achieve UNAIDS target of 90 percent of undiagnosed people living with HIV knowing their status and receive treatment. This research aimed to contribute to this evidence through two phases. Phase 1 used the Joanna Briggs Institute methods to implement a scoping review on psychosocial outcomes and their measurements immediately following a new HIV diagnosis. This review considered all participants who tested for HIV – whether their results were positive or negative, as any test results have consequences, and regardless of age, sex, or setting – reported in published articles between 2007 -to the present date. Paper 1 presents the scoping review. Phase 2 relied on a qualitative methodology using Grounded Theory informed by a socio-ecological framework and a framework of access to healthcare to understand experiences of accessing HIV testing services in two parts: 1) to examine barriers to reaching HIV testing among young heterosexual African migrants, focusing on young men, in Ottawa (Paper 2); and 2) to identify challenges experienced by health service providers who make accessible HIV testing services to this population in Ottawa (Paper 3). There is some ambiguity in the use of the terms “first generation immigrants” and “second generation immigrants” (or children of first immigrants). In this study, the term migrants referred to both. Selecting participants from both groups (first and second generation) was important to include a wide variety of experiences and interpretations that reflect the study population. Furthermore, the term “health service providers” was used to refer to both healthcare providers and frontline service providers. Healthcare providers referred to those who conduct HIV testing in health facilities, whereas frontline service providers referred to those who provide care and support services needed by members in their communities before and after testing within AIDS organizations and community-based organizations.

Une équipe multidisciplinaire et intersectorielle a implanté en 2009 une recherche-intervention novatrice : Spot, un service de dépistage rapide du VIH en milieu communautaire offert aux hommes ayant des relations sexuelles avec d’autres hommes de Montréal. Une étude de cas a été menée afin de décrire le processus d’implantation de Spot et les facteurs contextuels qui l’ont affecté. L’analyse par théorisation ancrée des entrevues, l’observation participante et l’analyse documentaire ont permis d’identifier un processus d’implantation dynamique en plusieurs phases. Elles sont modulées par des facteurs liés aux motivations des acteurs à s’engager dans le projet, à la complexité des dynamiques partenariales et aux défis de la coordination en contexte d’équipe multidisciplinaire et intersectorielle et à d’autres facteurs ayant affecté l’organisation de l’équipe terrain et leurs pratiques au quotidien. Des motivations telles l’occasion unique de contribuer à la mise en place d’un projet de prévention novateur et pertinent, ont eu une influence favorable constante, ralliant les acteurs autour du projet et maintenant leur implication malgré les difficultés rencontrées. Sur le plan des dynamiques partenariales, une définition floue des rôles et tâches a ralenti l’implantation du projet, alors qu’une fois clarifiée, chacun a pu se sentir légitime et participer activement à la réussite de l’implantation. Des difficultés à la coordination du projet, entre autres concernant la gestion des fonds interinstitutionnels, sont un facteur ayant ralenti le processus d’implantation. Cette étude a permis de tirer des leçons sur l’implantation et la pérennisation d’un service de dépistage rapide du VIH en milieu communautaire gai. / In 2009, a multidisciplinary and intersectoral team implemented an innovative research-intervention project: Spot, a community-based rapid HIV testing service for men who have sex with men in Montreal. A case study was undertaken to describe the implementation process of Spot and the contextual factors that affected it. Grounded theory analysis of interviews, participant-observer, and a document analysis allowed the identification of a multistage dynamic implementation process. These stages were influenced by stakeholders’ motivations, the complexity of partnership dynamics, the challenges surrounding coordination and organization of staff members, as well as factors influencing staff members’ daily practices. Motivations like the unique opportunity to contribute to the implementation of an innovative and relevant prevention project, had a constant and positive influence, which united stakeholders in the project and maintained their involvement despite the difficulties. In terms of partnership dynamics, vague definitions of roles and tasks delayed the implementation of the project, although once clarified, everyone felt legitimate and actively participated in the success of the implantation. The management of interinstitutional funds was mentioned as one of the difficulties of coordinating the project and a factor that caused delays in the implementation process. This study allowed learning about the implementation and sustainability of a gay community-based rapid HIV testing service.

The study explored the factors influencing the use of voluntary counselling and testing by university students. This was done by undertaking an exploratory and descriptive qualitative study. Focus group discussions and field notes were used to collect data from the participants. Outcomes from the study revealed various factors to the uptake of Voluntary Counselling and Testing (VCT) services by university students namely: the desire to know one‟s HIV status, illness, pregnancy, blood donation, to get a reward, the influence of significant others, the influence of media, awareness campaigns, compulsion, to get a job, curiosity, to be a positive role model and the positive attitude and professional conduct of the health care provider. The study also revealed various challenges to the uptake of VCT services by university students namely: the fear of being diagnosed HIV positive, HIV/AIDS-related stigma and discrimination, the low perception of risk to HIV infection, the lack of student friendly VCT services, the shortage of human and infrastructural resources, the inaccessibility of VCT services, the long waiting period for test results, negative perceptions about VCT, the problems with pre-test counselling and ignorance. Going by the participants‟ suggestions VCT services uptake by university students could be improved by increased resource allocation (incentives, human and infrastructural resources), increased awareness campaigns, and improved counselling and making VCT services more accessible / Information Science / MA (Public Health)

A substantial number of employees in South Africa may soon be out of work as the result of their HIV-positive status. The dismissal of an infected employee may be motivated by the fact that he is considered to be incompetent or incapable of doing the work for which he was employed. Customers and fellow employees may refuse to deal with an infected employee, with the result that the employee is dismissed for economic reasons. The nature of the undertaking's activities may be such that the presence of an infected employee constitutes a health risk. For the purposes of carrying out his duty to create and maintain safe working conditions, the employer dismisses the employee. The employer may even force the infected employee to resign. Measures should be taken to improve the situation of infected employees. They include educating employers and employees about the transmission of the human immunodeficiency virus. / Mercentile Law / LL. M.

Using non-experimental descriptive exploratory survey, this study sought to find out factors associated with delayed entry into HIV medical care among HIV positive people who are aware of their status. A quantitative design was used and a structured questionnaire was used as the data collection instrument. Respondents were patients in a hospital’s Opportunistic Infection Department whose hospital records indicated that they were HIV positive during the time of the study. The study found out that as much as 71.6% (n =43) first entered HIV medical care more than 12 months after testing HIV positive while 40% (n = 24) did so as a result of illness. Low education levels, unemployment and being single are associated with delayed entry into HIV medical care. A percentage of the population uses and trusts non-biomedical approaches to dealing with HIV/AIDS. Being diagnosed HIV positive is therefore not necessarily a strong reason enough for one to immediately enter into medical care. Intensive health education needs to be done at work places, health facilities, schools, through print and electronic media, churches and other community settings to equip the population with knowledge of the advantages of early entry into HIV care. / Health Studies / M.A. (Public Health)

This qualitative exploratory study explored adolescents’ perceptions of the HIV youth friendly centre at a hospital in Lesotho in order to improve adolescent-friendly health care services in Lesotho. Data was obtained through interviewing nine purposively selected adolescents aged 18–19 years who accessed health care services at the centre, and was analysed using an adapted version of Colaizzi’s seven-step thematic analysis. Six themes emerged from this study: attributes experienced during adolescents’ visits to health care facilities, adolescents’ perceptions of the health care facility, waiting times, facts related to HIV pre-test counselling, description of services available for adolescents’ health, and challenges faced by adolescents in relation to their HIV positive status. The adolescents explained the factors that encouraged them to be tested, and to commit to HIV management and treatment. The findings showed that it is important to reserve a dedicated space for adolescents, to provide comprehensive health services at one site, to ensure adolescents’ privacy and confidentiality, to indicate patient flow clearly, to indicate the service offering clearly, to offer flexible operating hours and days, to involve youth in the service provision, to keep queues short, and to establish peer support groups. / Health Studies / M.A. (Public Health)

A quantitative, descriptive, explorative survey was conducted to explore and describe factors contributing to underutilisation of HIV testing services among tuberculosis patients and clients in Malawi. Sampled were 282 participants attending an outpatient clinic. A self administered questionnaire was used. The findings revealed that 80.5% of the respondents perceived themselves susceptible to HIV infection, 55% believed there were negative consequences of HIV Testing and Counselling (HTC), 87.6% perceived HTC had benefits, most of the respondents (76.8%) mentioned the benefit of knowing the HIV status helping one to plan life, 65% believed in themselves, that they could accept and undergo HIV testing with ease. The study recommends that all HTC providers be thoroughly trained in knowledge and skills to offer services with confidentiality and avoid stigma and discrimination of those found HIV positive. The importance and benefits of HTC should be emphasised in all behaviour communication messages / Health Studies / M.A. (Public Health)

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