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Kte Ohtn

on 1 February 2013

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Increased Access
to Services The Community Response Trends in Outreach The number of condoms distributed in 2011-12 was up 26% from the previous year.

The distribution of safer injection equipment also increased by 20%.

There was also a significant increase in both the number of programs distributing safer inhalation equipment (20 programs) and the amount of equipment distributed. Clients of community-based AIDS services continue to face complex health and social needs, including stigma, poverty, unemployment, food insecurity and mental health issues. Yet we continue to see a significant number of new diagnoses in gay/bi/MSM – particularly in men over age 40. In 2011, the total number of new HIV diagnoses in Ontario in 2011 was down about 8% from 2010. The Epidemic About 1 of every 2 new diagnoses are in gay/bi/MSM and 1 in 5 are in people in the African, Caribbean and Black communities. Gay men represent more than 50% of new diagnoses and 60% of people living with HIV; however, they account for between 8%-44% of service users depending on type of organization.

For example, ASOs report that about 44% of support service clients are gay men while CHCs- which primarily serve other populations, such as people who use substances - report that only about 8% of support service clients are gay men.

In terms of education and outreach, ASOs report that between 30% and 34% of their clients are gay men. This raises questions about the priorities for service delivery – for example, are gay men less in need of these services, getting these services elsewhere or do they face barriers accessing these services?)” Programs report serving more newcomers than in the past, and working to ensure their services are culturally competent. 50% of new infections 60% of PHAs between 8% and 44% of service users Programs report that a significant proportion of their clients (43%) have substance use issues. Rates are even higher in the Northern (62%), Ottawa and Eastern (56%) and South West (45%). 43% Despite a 5% increase in funding from the AIDS Bureau and stable ACAP funding in 2011-12, AIDS service organizations reported an almost $1 million drop in overall funding – largely due to drops in fundraising and cuts in funding from other government sources (e.g., municipal governments, local health integration networks). AIDS Bureau
increase of 5% $1 million
in funding (mostly fundraising) More programs are recognizing that education is process and a key component of larger social change. They are working with local partners to link their education programs to broader community development and social justice work that will benefit populations at risk of HIV. Increased Knowledge and Awareness In 2011-12, programs provided fewer general presentations to schools but more outreach and support for LGBT youth – which is consistent with their mission. Programs reported more requests from service providers for education related to HIV and aging – which is consistent with the “greying” of HIV that we are seeing in terms of the number of people age 40 and older being newly diagnosed and the number of older people seeking support services. The field’s capacity to evaluate education programs is increasing: almost 80% of funded programs now regularly measure changes in knowledge as a result of their education while 60% also measure intent to change behaviour. The AIDS Bureau and ACAP support outreach activities, based on evidence that when people receive education, support, and resources (e.g., condoms) in locations where they are making decisions about risk, they are likely to take steps to reduce their risk. Programs report more demand for outreach services from sex workers, women, trans youth and LGBTTQ youth, First Nations communities, detention centres and African, Caribbean and Black men. The most common locations for outreach continue to be bars and bathhouses. The number of agencies doing internet outreach is increasing, with 7 organizations accounting for 75% of internet, email and chatroom activity. Programs that provide outreach to people who use substances reported that clients are using significantly more practical support services than in the past – including housing, food bank, transportation and employment services. More contacts with people who use substances were made in drop-in centres and through mobile services than in the past, which suggests that offering these types of services may attract clients.

However, more information is required to determine whether these sites are attracting more clients or serving a small number of clients more often. 26%+ Programs continue to report providing support services to approximately 14,000 people in each half of the year – most of whom are people living with HIV (70%), people affected (14%) or people at risk (11%). The number of new support clients in 2011-12 exceeded the number of new diagnoses, which may indicate that people seek out community-based services as they need them over the course of living with HIV and not necessarily right after being diagnosed. Most people tend to use services on a episodic basis – when and as they need them. In 2011-12, OCHART asked about the age of new clients: a significant proportion are over age 40 – which is consistent with trends in new diagnoses. Support service clients use primarily practical assistance, case management and information services as well as referrals and counselling services. The financial assistance programs provided to clients – a total of $758,680 in 2011-12 – is used mainly for transportation and food. Transportation – including getting to and from medical appointments – continues to be a challenge for many clients, particularly those in more rural and remote areas. The number of women and trans people using support services increased slightly in 2011-12 – despite a drop in the number of new diagnoses in women.

They represented more than one-third of clients in all regions except Ottawa and Eastern, and more than half the support clients in the Northern and Central East regions.

Women may make more consistent use of support services. Given that many women who are infected are likely recent immigrants, their support needs may be more extensive. For the first time, programs were also asked about client deaths. They reported a total of 145 deaths; however, as clients may use the services of more than one agency (particularly in Toronto) the actual number of deaths may be slightly lower. Compared to the number of people served, death rates were particularly high in the Northern, South West, and Ottawa & Eastern regions. "...Newcomer PHAs continued to face complex barriers in accessing basic health, settlement and support services, as well as capacity building initiatives to address the many social determinant related challenges they face.” Community-based prevention programs are effective. Between 2001 and 2009, investments in community-based programs contributed to 12,087 averted cases of HIV – infections that did not happen. They also saved the health care system $3.4 billion in direct medical costs. Every $1 invested in HIV prevention saves the health care system $51. “More requests for HIV 101’s with Long-Term Healthcare providers as more HIV+ individuals are beginning to enter those residences/programs.” “Since the ruling in the Supreme Court of Canada regarding Sex Trade we have experienced a much greater demand for information from Sex Professionals. They are seeking information on Safer Sex, STI’s and HIV transmission and testing.” CenterStage display to promote the Maryland Food Bank by zizzybaloobah Increased Capacity,
Coordination and
Collaboration Programs continue to provide both paid and volunteer opportunities for people living with HIV, and they continue to attract and retain a significant volunteer workforce – which provides more than $5 million worth of time and skills. Programs continue to engage people living with and at risk of HIV in their organizations, and to develop opportunities for them to participate in more meaningful ways. In 2011-12, for the first time, 75% of programs reported employing members of their target population, and almost 90% reported having members of their target population involved in governance. In 2011-12, the list of provincial services and organizational supports that programs can use was expanded to include:

Evidence-Based Practice Unit
Gay Men’s Health Strategy
Ontario Aboriginal HIV/AIDS Strategy (OAHAS)
African and Caribbean Council on HIV/AIDS in Ontario (ACCHO)

Over 80% of programs reported using OHTN resources while between 35 and 50% reported using the resources of the population-based strategies. Questions?

Comments? page 10 page 30 page 32 page 29 page 36 page 53 page 59 page 60 Overview Increased Knowledge and Awareness Trends in Education page 38 page 31 page 42 page 52 page 57 page 46 page 56 page 55 page 64 page 75 page 65 page 68 page 76 page 72 page 86 page 104 page 40
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