Soins intégrés auprès des personnes LGBTQI+ migrantes : la place des soins psychosociaux.

INTRODUCTION: LGBTQI+ migrants are at greater risk of facing health issues, including mental health issues, especially since the arrival of COVID-19. Furthermore, they face many barriers to accessing care in Quebec. It is in this context that Clinic Mauve was implemented, which aims to remove these barriers by offering medical and psychosocial care in an integrated care setting to LGBTQI+ migrants in Montreal. PURPOSE OF RESEARCH: The purpose of this article is to identify the benefits and challenges of a model like the Clinic Mauve in addressing the psychosocial needs of LGBTQI+ migrant individuals. RESULTS: The analysis shows that the Clinic Mauve model, because of its approaches is able to remove some of the barriers to accessing care for LGBTQI+ migrants and to allow for a certain degree of empowerment of these populations. However, some challenges have been identified, which are mainly due to the lack of resources and organizational constraints. CONCLUSIONS: The article concludes that providing psychosocial care in an integrated care setting addresses some of the barriers to accessing care faced by LGBTQI+ migrants.

Using scenario videos with Theatre Testing method to adapt a peer navigation model to improve street-connected youth's access to HIV care in Kenya and Canada.

Theatre testing (TT) method demonstrates whole or portions of an evidence-based intervention to stakeholders to elicit feedback on context-specific adaptations and future implementation. The Peer Navigator Project (PNP) studied the adaptation and implementation of Peer Navigators in five urban sites to increase street-connected youth (SCY) access to HIV prevention, testing, and treatment in Canada and Kenya. TT was used with SCY, healthcare providers, and community stakeholders to collect feedback on the optimal characteristics of the PNs (e.g., social identities) and their professional activities and responsibilities in each site. Sites scripted unique scenarios of PNs supporting SCY and interacting with social service providers. Local actors were employed, and the scenarios were filmed and edited into videos alongside audience discussion questions. Videos were screened to separate audiences of SCY (n = 40), healthcare providers (n = 12), and community stakeholders (n = 59). Facilitated discussion about the scenarios were recorded as data, and transcripts were analyzed thematically by the research team. The scenario videos are presented as a unique adaptation to the TT method. The adaptations were time-consuming and limited the ability to present responsive changes while presenting the method to different audiences. They were also effective at maintaining presentation fidelity and eliciting diverse and meaningful responses from different stakeholder groups. One site successfully adapted the method for use in a physically distanced manner that complied with COVID-19 public health regulations. TT using video scenarios is an engaging approach that garners rich responses from diverse stakeholder groups about the adaptation of evidence-based interventions preparing for implementation in international settings.

Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya.

INTRODUCTION: UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. METHODS: Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). RESULTS: Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. CONCLUSION: Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

Identity, refugeeness, belonging: experiences of sexual minority refugees in Canada.

This article explores the results of a qualitative community-based research project on the intersectional experiences of sexual minority refugees living in Canada. Undertaken between 2008 and 2010, this study examines sexual minority refugees' multifaceted experiences of migration, the refugee determination process, and settlement. Through an analysis of the interrelated themes of identity, refugeeness, and belonging, we hope to further investigate the ways in which Canadian refugee policies, social institutions, and dominant discourses contribute to the sociopolitical construction of sexual minority refugees. We conclude with an exploration of strategies for increasing protection of sexual minority refugees in Canada.