Definitions of Palliative Care Terms: A Consensus-Oriented Decision-Making Process.

Background: Lack of consistency in palliative care language can serve as barriers when designing, delivering, and accessing high-quality palliative care services. Objective: To develop a consensus-driven and evidence-based palliative care glossary for the Health Standards Organization Palliative Care Services National Standard of Canada (CAN/HSO 13001:2020). Design: Content analysis of the Palliative Care Services standard was used to refine a list of terms. Environmental scan and rapid review were used for identification of concepts and definitions. Two meetings of consultation based on the modified Delphi approach took place among a working committee consisting of 12 health care providers, administrators, academics, and patient/family representatives. Results: Palliative approach to care, quality of life, pain and symptom management, caregivers, palliative care, life-limiting illness, and serious illness were defined by modification/adoption of existing definitions. Conclusion: A glossary of key palliative care terms was developed and included in the HSO Palliative Care Services standard, which will facilitate communication using consistent language across care settings.

HIV status and sexual behaviour among gay men in Ottawa: considerations for public health.

OBJECTIVES: HIV prevention efforts, particularly among men who have sex with men (MSM), have not achieved maximum effectiveness. A survey of MSM in Ottawa, Canada was completed to ascertain whether there were differences in how the perceived HIV status of participants and their partners influenced sexual practices. METHODS: Self-directed surveys were administered to a convenience sample of 721 MSM in Ottawa, Canada from November 2011 through May 2012. Data collection occurred at 14 sites. The survey identified whether participants identified as HIV positive, negative or unsure of their HIV status. RESULTS: The findings indicated variation between HIV-negative MSM and those who are unsure of their HIV status. Men who were unsure of their HIV status were less likely to report that they asked sexual partners or have had their partners ask about HIV status. CONCLUSIONS: The results of this study indicate that some MSM may base decisions about HIV prevention on discussion about HIV status with their partners, rather than condom use. These practices may increase, rather than decrease, HIV transmission. Survey findings and extant literature demonstrate a need to inform MSM about the limitations of serosorting as a prevention strategy, and to provide facilitated access to sexually transmitted infection testing and treatment to further reduce onward HIV transmission.

Social Marginalization and Internal Exclusion: Gay Men's Understandings and Experiences of Community.

A total of 27 gay and bisexual men were interviewed about how they perceived the criminal prosecution of persons living with HIV who do not disclose their HIV status. The stories that emerged from the interviews raise questions about the nature of the gay community. The findings centre on the participants' descriptions of (1) the heterosexual meta-culture, (2) the locales of gay life, and (3) unsupportive elements in the gay community. Analysis of the interview data situates the gay community as a place of both inclusion and exclusion and as a heterogeneous environment.

Des entrevues ont été menées auprès de 27 hommes gais et bisexuels afin de sonder leurs perceptions à l'égard des poursuites criminelles intentées contre les personnes vivant avec le VIH/sida qui n'ont pas divulgué leur état. Les récits qui en découlent soulèvent des questions sur la nature de la communauté gaie. Les données touchent aux descriptions des participants concernant 1) la méta-culture hétérosexuelle; 2) les lieux de la culture gaie; 3) les éléments non solidaires au sein de la communauté gaie. L'analyse des données d'entrevue situe celle-ci comme un espace à la fois d'inclusion et d'exclusion et comme un milieu hétérogène.

HIV criminal prosecutions and public health: an examination of the empirical research.

OBJECTIVES: To review the extant literature on HIV criminal laws, and to determine the impact of these laws on public health practice. METHODS: The available research on this topic was obtained and reviewed. RESULTS: The extant literature addressed three main topics: people's awareness of HIV criminal laws; people's perceptions of HIV criminal laws; and the potential effects of HIV criminal laws on people's sexual, HIV-status disclosure and healthcare-seeking practices. Within these categories, the literature demonstrated a high level of awareness of HIV criminal laws, but a poor comprehension of these laws. For perceptions, on the whole, the quantitative research identified support for, while the qualitative literature indicated opposition to, these laws. Lastly, the behavioural effects of HIV criminal laws appear to be complex and non-linear. CONCLUSIONS: A review of the extant literature from a public health perspective leads to the conclusion that HIV criminal laws undermine public health.

Nondisclosure prosecutions and population health outcomes: examining HIV testing, HIV diagnoses, and the attitudes of men who have sex with men following nondisclosure prosecution media releases in Ottawa, Canada.

BACKGROUND: During the past decade, the intersection of HIV and criminal law has become increasingly discussed. The majority of studies to date have approached this topic from a sociological or legal perspective. As a result, the potential effect of nondisclosure prosecutions on population health and HIV prevention work remains mostly unknown. METHODS: A descriptive quantitative-qualitative study was undertaken to examine HIV testing, HIV diagnoses, and the attitudes of men who have sex with men following regional media releases about a local nondisclosure prosecution. As part of this study, first, we reviewed the trends in HIV testing and HIV diagnoses from 2008 through 2011 in Ottawa, Canada. Second, we explored the attitudes and beliefs of local MSM about HIV, HIV prevention, HIV serostatus disclosure, nondisclosure prosecutions, and public health. RESULTS: Quantitatively, the findings of this study revealed that, in comparison to the period preceding the media releases about a local nondisclosure prosecution, HIV testing and HIV diagnoses among men who have sex with men did not significantly change after the media releases of interest. Qualitatively, a subgroup of 27 men who have sex with men (12 HIV-positive, 15 HIV-negative) noted their beliefs that the local public health department openly shares information about people living with HIV with the police. Moreover, some HIV-positive participants stated that this perceived association between the local public health department and police services caused them to not access public health department services, notwithstanding their desires to seek assistance in maintaining safer sexual practices. CONCLUSIONS: Nondisclosure prosecutions likely undermine HIV prevention efforts.

A documentation policy development proposal for clinicians caring for people living with HIV/AIDS.

In Canada, nondisclosure prosecutions against people living with HIV/AIDS (PHAs) have increased. Nurses who provide services to PHAs could become involved in such criminal cases because they (a) elicit sensitive information about their clients' sexual practices, and (b) adhere to documentation standards. Currently, HIV documentation policies do not exist for clinicians working with PHAs in Canada or abroad. Sexual assault nursing, which includes documentation guidelines, may offer guidance in the creation of a PHA care policy because sexual assault nursing and PHA care both intersect with the justice system. A PHA care policy may have several benefits: It can increase clinician confidence in patient interactions and documentation by clarifying roles and scope of responsibilities, reduce inconsistencies in practice, diminish conflict among professionals, and reduce the stress involved in clinical practice. The outcome of these improvements could be an increase in PHAs' level of comfort with nurses knowing that policies exist.