Feasibility and efficacy of a hospital-based violence intervention program on reducing repeat violent injury in youth: a randomized control trial.

OBJECTIVES: To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth. METHODS: One hundred and thirty youth aged 14-24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS). RESULTS: This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07-1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21). CONCLUSIONS: This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.

A multilevel analysis of risk and protective factors for Canadian youth injured or killed by interpersonal violence.

PURPOSE: The study's purpose was to determine individual-level and neighbourhood-level risk and protective factors for severe intentional injury among youth. METHODS: We conducted a multilevel case-control study using registry data to determine individual-level and neighbourhood-level social determinants associated with severe violent injury/homicide among youth from Winnipeg, Manitoba. RESULTS: The study includes 13 206 youth, aged 12-24 years (1222 cases, 11 984 controls). Individual-level risk predictors of being a victim of violence were male sex (OR 5.72 (95% CI 4.77 to 6.86)) and First Nations (OR 2.76 (95% CI 2.32 to 3.29)). Education was inversely associated with victimisation for individuals under (OR 0.36 (95% CI 0.26 to 0.51)) and over (OR 0.58 (95% CI 0.49 to 0.69)) 18 years. Ever having been in protective care (OR 1.66 (95% CI 1.39 to 1.99)), receiving income assistance from the government (OR 1.26 (95% CI 1.05 to 1.51)) or ever having criminal charges (OR 4.76 (95% CI 4.08 to 5.56)) were also significant predictors of being a victim of violence. Neighbourhood-level risk factors for victimisation included low socioeconomic status (OR 1.14 (95% CI 1.04 to 1.25)) and high levels of assault (OR 1.07 (95% CI 1.04 to 1.10)). CONCLUSIONS: This study demonstrates a complex web of risk and protective factors among youth injured by violence. It underscores the ongoing, injurious effects of historical trauma experienced by many Canadian First Nations people. Strong victim-perpetrator overlap suggests that intersectoral policies are needed to address these issues. Our findings highlight the need to improve education and family supports.

"People try and label me as someone I'm not": The social ecology of Indigenous people living with HIV, stigma, and discrimination in Manitoba, Canada.

Indigenous peoples (First Nations, Inuit, and Métis) are currently overrepresented in the HIV epidemic in Canada and are infected at a younger age than those who are not Indigenous. This article presents our findings on the stigma and discrimination (as well as related themes such as disclosure) experienced by Indigenous people who contracted HIV in their youth and live in urban and non-urban settings in Manitoba, Canada. The findings were derived from a qualitative study that sought to understand the experiences and needs of Indigenous people living with HIV (including AIDS). We situate such experiences within a social ecological framework towards developing a better structural understanding of the impacts of stigma and discrimination on the lives of Indigenous people who are HIV positive. Stigma and discrimination caused barriers for Indigenous people living with HIV through inhibiting their ease of access to supports including family, peers, community, and long- and short-term health services. Creative forms of outreach and education that are culturally appropriate and/or rooted in culture were considered to be possibly impactful ways of reducing stigma and discrimination at the community level. Learning from communities who are successfully managing stigma also showed promise for developing new programming.

A qualitative study on the intersectional social determinants for indigenous people who become infected with HIV in their youth.

BACKGROUND: Indigenous young people are currently highly overrepresented in the HIV epidemic in Canada, especially in the Prairie Provinces, such as Manitoba. Understanding HIV-vulnerability in Indigenous peoples must begin with understanding that social determinants are intersectional and linked to the historical legacy of European colonization. In this paper findings that detail the influence of the intersectional social determinants on Indigenous people who become infected with HIV in their youth are presented. METHODS: The qualitative research design of phenomenology was used as it afforded the opportunity to understand Indigenous young people from their frames of reference and experiences of reality, resulting in a phenomenological understanding of their perspectives and experiences of the early years of living with HIV. A total of 21 Indigenous young people took part open-ended interviews. RESULTS: The stories that the Indigenous young people shared revealed their deeply interconnected social worlds, and how social determinants including abuse, trauma, being part of the child welfare system, and housing and food security were connected throughout various stages of their lives. Such stages included childhood, adolescence and young adulthood (the time of HIV infection), and later adulthood for older participants with the social determinants having multiple influences on their health trajectories. CONCLUSIONS: The findings highlight the need for policies and programs that are broadly focused, addressing multiple social determinants together. Overall, there needs to be more emphasis on the multiple social determinants in the life situations of all Indigenous youth. Reducing the health and social disparities in Indigenous youth is key to reducing the number of young Indigenous people diagnosed with HIV. The findings also shed light on the importance of listening to young Indigenous people who have experienced HIV diagnosis and life following diagnosis.