Faculty Publications (Human & Social Development)

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    Stigma, the media, and pre-exposure prophylaxis for HIV prevention: Observations for enhancing knowledge translation and resisting stigma in the Canadian context
    (AIDS and Behavior, 2019) Card, Kiffer George; Hawkins, Blake W.; Mortazavi, Leili; Gregory, Aidan; Ng, Keng Hon; Lachowsky, Nathan
    Pre-Exposure Prophylaxis (PrEP) is an effective, though sometimes stigmatized, strategy for HIV prevention. With the goal of examining how PrEP stigma can be addressed, this study examined the media’s handling of stigma related to PrEP by searching the Canadian Newsstream and Daily Xtra news databases for key terms related to PrEP. Overall, 101 media articles were thematically coded in triplicate; 36.3% of which included mentions of PrEP stigma. LGBT media sources were more likely than mainstream sources to have included content coded as relating to PrEP stigma (p = 0.02). In these articles, uncertainty regarding PrEP, and neo-liberal attitudes towards sexual responsibility were major factors associated with media discussion of PrEP stigma. We discuss the role that heuristics play in shaping lay readers perceptions and interpretation of PrEP media coverage and discuss methods for overcoming stigma using evidence-based communication strategies.
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    Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming
    (AIDS Care, 2018) Closson, Kalysha; Dietrich, Janan; Lachowsky, Nathan; Nkala, Busi; Cui, Zishan; Chia, Jason; Hogg, Robert S.; Gray, Glenda; Kaida, Angela; Miller, Cari L.
    Sexual self-efficacy (SSE) – one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents’ HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14–19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16–17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.
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    Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study
    (Drug and Alcohol Dependence, 2023) Tran, Gioi Minh; Lachowsky, Nathan; Urbanoski, Karen A.; Scheim, Ayden I.; Bauer, Greta R.
    Purpose: Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. Methods: Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. Results: Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. Conclusion: The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
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    The digital era and public sector reforms: Transformation or new tools for competing values?
    (Canadian Public Administration, 2022) Lindquist, Evert Anthony
    This article considers the tools and management approaches associated with the “digital-era” public sector reform, which many observers suggest has supplanted or should supplant previous reforms such as those associated with the New Public Management. This article levers and adapts the Competing Values Framework to categorize various public service reform movements—Traditional Public Administration, New Public Management, Public Value Management, and New Public Governance—and associated value systems and cultures. It argues that not only do these prior reform movements persist as values and repertoires in public service systems, but they are also each variously receiving oxygen from “digital” as the latest wave of technological innovation affecting societies, markets, and governments. It calls for more systematic empirical work to gauge how digital tools have been affecting the mix and balance of values and repertoires associated with these reform movements in different parts of public service systems in Canada and beyond.
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    An event-level analysis of condom use during anal intercourse among self-reported human immunodeficiency virus–negative gay and bisexual men in a treatment as prevention environment
    (Sexually Transmitted Diseases, 2016) Lachowsky, Nathan; Tanner, Zach; Cui, Zishan; Sereda, Paul; Rich, Asheligh; Jollimore, Jody; Montaner, Julio; Hogg, Robert S.; Moore, David M.; Roth, Eric A.
    Background: We sought to identify factors associated with condom use during anal intercourse among self-identified human immunodeficiency virus–negative gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada following “treatment as prevention” (TasP) scale-up in 2010. Methods: Sexually active GBM were recruited using respondent-driven sampling from 2012 to 2014. We analyzed participants' most recent sexual encounter with up to their last 5 sexual partners within the past 6 months. In addition to individual- and event-level explanatory factors, we assessed potential associations with TasP awareness, TasP-related prevention practice (viral load sorting), and TasP-related attitudes (human immunodeficiency virus treatment optimism). Accounting for clustering at the respondent-driven sampling chain-level and participant-level, factors associated with event-level condom use versus nonuse were determined using a multivariable generalized linear mixed model built using backward selection and AIC minimization. Results: Of 513 participants, 436 GBM (85%) reported a total of 1196 anal sex events with 56% condom use. The proportion of condom-protected sexual events decreased monthly over the study period (odds ratio [OR], 0.95 per month, 95% confidence interval [CI], 0.92–0.98). The TasP practices and attitudes were significantly associated with lower odds of condom use at the univariate level, but were no longer significant at multivariate level. In the multivariable model, event-level partner methamphetamine use (adjusted OR [aOR], 0.18; 95% CI, 0.06–0.58), frequency of recent anal intercourse with that partner (aOR, 0.97 per act; 95% CI, 0.95–0.98) and time since first sex with that partner (aOR, 0.97 per 6 months; 95% CI, 0.95–0.99) were associated with lower odds of condom use, whereas event-level participant alcohol use (aOR, 1.41; 95% CI, 1.01–1.98) and no planned future sex with that partner (aOR, 1.56; 95% CI, 1.08–2.27) were associated with greater odds of condom use. Event-level receptive-only (aOR, 2.10; 95% CI, 1.38–3.20) or insertive-only (aOR, 2.53; 95% CI, 1.64–3.90) sexual positions were associated with greater odds of condom use compared with reporting both positions. Conclusions: The TasP-related factors were not the most salient predictors of GBM's condom use. Health promotion must consider associations between condomless anal sex and substance use and relational factors.
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    Reflecting back, looking forward: A content analysis of scientific programs from the 2013–2016 Canadian Sex Research Forum annual conferences
    (Canadian Journal of Human Sexuality, 2017) Lachowsky, Nathan; Wentland, Jocelyn J.; Kilimnik, Chelsea D.; Levere, D.D.
    The vision of the Canadian Sex Research Forum (CSRF) is to be Canada's leading organization dedicated to interdisciplinary, theoretical, and applied sexuality research. We sought to determine the composition of four previous CSRF Annual Conference (2013–2016) scientific programs. We double-coded 356 abstracts on first author region, discipline, and faculty status; presentation format (oral/poster); and several non-exclusive yes/no questions regarding study populations, topics, and methods. We calculated odds ratios (OR) to assess trends (per year) and likelihood of oral versus poster presentation. Most of authors were from psychology (86.5%), although this decreased over time (98.1% to 80.5%). Most abstracts used quantitative methods (82.9%) and there was a decrease over time in abstracts using qualitative (26.4% to 16.3%) and experimental (17.0% to 7.3%) methods. For study population and topic, there were increases over time in clinical population foci (7.6% to 23.6%) and decreases in race/ethnicity foci (3.8% to 0.8%) and methods topics (18.9% to 5.7%). Half of the abstracts were oral presentations (44.9%), which were more frequently awarded to faculty (81.1% vs. 38.6%), sexual practice topics (50.7% vs. 40.8%), relationship topics (52.3% vs. 40.7%), methodology topics (50.0% vs. 44.2%), and theory papers (71.4% vs. 43.3%). Oral presentations were less frequently awarded to single sex/gender populations (36.7% vs. 48.4%), student-only populations (35.3% vs. 51.2%), race/ethnicity foci (20.0% vs. 45.5%), and quantitative methods (43.4% vs. 52.5%). To achieve CSRF's vision of “interdisciplinary, theoretical, and applied research,” we must undertake intentional strategic action (e.g., more content from non-psychology disciplines, more qualitative methods).
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    A narrative review of internet use, interpersonal connectedness, and sexual behaviour among gay, bisexual and other men who have sex with men
    (Journal of Homosexuality, 2018) Card, Kiffer G.; Lachowsky, Nathan; Gislason, Maya G.; Hogg, Robert S.; Roth, Eric
    Researchers have often considered the impact that online dating has had on gay communities; with some arguing that changes in social behavior may impact the spread of HIV. However, these conclusions are based on the premise that the Internet has fundamentally changed the way gay and bisexual men connect with their communities. Addressing this issue, we searched the PubMed and Web of Science databases for studies examining Internet use and interpersonal connectedness among gay and bisexual men to determine whether those who used the Internet to find sexual partners exhibited different patterns of community connectedness. Though sporadic, findings suggest that Internet use may be associated with lower gay identity, community attachment, and social embeddedness. However, recent reports have suggested that online sex seeking might be associated with greater, not less, interpersonal connectedness. We conclude that additional longitudinal analyses and consistent measurement of gay men’s social behavior are needed to draw more definite conclusions.
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    Gender, sexual self-efficacy and consistent condom use among adolescents living in the HIV hyper-endemic setting of Soweto, South Africa
    (AIDS and Behavior, 2018) Closson, Kalysha; Dietrich, Janan Janine; Lachowsky, Nathan; Nkala, Busi; Palmer, Alexis; Cui, Zishan; Chia, Jason; Hogg, Robert S.; Gray, Glenda; Miller, Cari L.
    Within HIV-endemic settings, few studies have examined gendered associations between sexual self-efficacy (SSE), one’s confidence or perceived control over sexual behavior, and uptake of HIV prevention behaviors. Using cross-sectional survey data from 417 sexually-experienced adolescents (aged 14–19, median age = 18, 60% female) in Soweto, South Africa, we measured SSE using a 6-item scale (range:0–6) with ‘high-SSE’ = score > 3 (study alpha = 0.75). Gender-stratified logistic regression models assessed associations between high-SSE and lifetime consistent condom use. A higher proportion of women reported high-SSE (68.7%) than men (49.5%, p < 0.001). We observed no difference in reported consistent condom use by gender (45.5% among women, 45.8% among men; p = 0.943). In confounder models, high-SSE was associated with consistent condom use among men (aOR = 3.51, 95%CI = 1.86–6.64), but not women (aOR = 1.43, 95%CI = 0.74–2.77). Findings highlight that individual-level psychosocial factors are insufficient for understanding condom use and must be considered alongside the relational, social, and structural environments within which young women navigate their sexual lives.
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    Adaptation, feasibility and performance of a brief clinic-based intervention to improve prevention practices among sexual minority men
    (Canadian Journal of Human Sexuality, 2019) Lachowsky, Nathan; Fulcher, Karyn; Lal, Allan; Crosby, Rick
    Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs). Originally efficacious with young Black GBM in the United States, Focus on the Future (FoF) is a clinic-based, single session intervention aimed at improving prevention practices. We examined the applicability and acceptability of the program for ethnoracially diverse GBM. Participants were recruited from a GBM sexual health clinic in Vancouver. A pre-test, post-test repeated measures design was used with a single intervention arm. Twenty-five HIV-negative participants received the intervention and retention at 90-day follow-up was 92%. Mean age was 27.8 years (SD = 3.53), 54.2% were non-white. The intervention was highly acceptable: 86.9% liked it and 91.3% would recommend it to others. A number of positive outcomes were observed post-intervention such as higher scores on the correct condom-use self-efficacy scales (p = 0.03) and increased condom-use frequency with primary partners (p = 0.03). The main outcome was number of condom-protected anal intercourse events for both insertive and receptive sexual positions; there was no significant difference for either the insertive (p = 0.62) or receptive (p = 0.36) partner. However, when restricted to participants who were not using PrEP, there was a significant increase in the number of condom-protected receptive anal sex events (p = 0.02). Although not an intended effect of the intervention program, 30% (n = 6/20) of PrEP-naïve participants initiated PrEP during the 90-day follow-up. This adapted low-cost intervention was rated highly acceptable by participants and demonstrates promise for increasing STBBI prevention practices. Expanded intervention testing and implementation research is warranted.
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    Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men
    (AIDS Care, 2019) Card, Kiffer G.; Armstrong, Heather; Wang, Lu; Bacani, Nicanor; Moore, David M.; Roth, Eric; Hogg, Robert S.; Lachowsky, Nathan
    McKirnan’s Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan’s Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV-related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escape.
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    A theoretical examination using governmentality to understand gay men’s risk and sexual behaviours
    (Canadian Journal of Human Sexuality, 2019) McKie, Raymond M.; Davies, Adam W. J.; Nixon, Kevin D.; Lachowsky, Nathan
    This article explores the link between Foucault’s (1991) governmentality theory, specifically as it relates to gay men’s sexual practices and perceptions of HIV risk. Foucault’s (1991) theory of governmentality elucidates the means through which individual behaviours and norms (at a micro level) are governed through the production of disciplinary norms and structures that are instantiated at a broader structural and institutional level (the macro-level). Foucauldian theoretical conversations pertaining to what is meant by conceptions and definitions of HIV/STI risk are furthered through this paper’s theoretical contributions as they relate to gay men. From a Foucauldian perspective, we assess how gay men may alter or monitor their sexual practices through governmental scripts produced at a state level and manifested through micro- and macro-level behavioural and ideological shifts based on dominant socio-sexual norms. A model of the interrelationship between governmentality, scripting, the micro/macro levels, and the situation-specific is presented for future consideration when examining gay men’s sexual practices. Historical oppression and segregation of gay men are considered when exploring these theories from a critical social scientific lens.
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    Substance use patterns and awareness of biomedical HIV prevention strategies among sexual and gender minority men in Canada
    (AIDS Care, 2020) Card, Kiffer George; Bernard Fournier, Anabelle; Sorge, Justin T.; Morgan, Jeffrey; Grace, Daniel; Ham, David; Lachowsky, Nathan; Trussler, Terry
    Sexual and gender minority men (SGMM) who use drugs are frequently cited as at-risk for HIV. Fortunately, biomedical prevention can greatly reduce transmission, provided individuals are aware of and interested in the uptake of these strategies. We examined associations between substance use patterns and biomedical prevention among SGMM in Canada. Latent class analysis identified patterns of substance use. Demographic-adjusted logistic regression models assessed the associations between latent classes and key biomedical prevention indicators. Among 669 participants living with HIV (PLWH) and 7,184 HIV-negative participants, six substance use classes characterized “limited” (46.0%; infrequent/low use of drugs), “common” (31.9%; alcohol, cannabis, and tobacco), “club” (5.2%; alcohol, cocaine, and psychedelics), “sex” (4.8%; alcohol, crystal methamphetamine, GHB, poppers, and erectile drugs), “prescription” (11.0%; alcohol and prescription drugs), and “polydrug” (1.1%; most drugs) use. HIV-negative men in the “prescription” and “sex” substance use classes were more likely to know about the preventive benefits of HIV treatment. All non-“limited use” HIV-negative men were more likely to report interest in taking pre-exposure prophylaxis (PrEP). For PLWH, substance use patterns were not associated with detectable viral loads or treatment awareness. While PLWH exhibited high levels of undetectability and treatment awareness regardless of substance use class, a variety of substance use patterns were associated with increased awareness, interest, and uptake of risk management strategies among HIV-negative participants.
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    Community-based participatory approaches to knowledge translation: HIV prevention case study of the Investigaytors program
    (Archives of Sexual Behavior, 2020) Morgan, Jeffrey; Schwartz, Cameron; Ferlatte, Olivier; Mniszak, Caroline; Lachowsky, Nathan; Jollimore, Jody; Hull, Mark; Knight, Rod
    Approaches to knowledge translation (KT) that engage community stakeholders in the research cycle have been identified as particularly promising for addressing the “know-do” gap. Using the case study of a long-standing community-based participatory research (CBPR) project known as the “Investigaytors,” this article describes the development and implementation of a KT intervention aimed at facilitating access to HIV pre-exposure prophylaxis for gay, bisexual, and other sexual minority men in British Columbia, Canada, through a publicly funded program. In doing so, we offer a model of CBPR for KT that is highly participatory, driven by community members, and centered around capacity building. We also present findings from a focus group with eight volunteer co-researchers to capture the perspectives of community members involved in the CBPR process and to evaluate the strengths and challenges associated with the use of a CBPR framework for KT. Findings from the focus group reveal how the inclusion of multiple perspectives from community, academic, and healthcare partners contributes to the perceived strength and credibility of the KT intervention opportunities for improving the CBPR process and how the CBPR process itself can be a form of integrated KT. This work has implications for future KT that deploys a CBPR framework, including an expanded understanding of reciprocity that can include benefits such as training and professional development, as well as introducing a novel approach to KT that is driven by community and integrates multiple perspectives. We conclude with reflections on implementing CBPR practices for KT in different settings.
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    “Hedge your bets”: Technology’s role in young gay men’s relationship challenges
    (Journal of Homosexuality, 2016) McKie, Raymond M.; Millhausen, Robin R.; Lachowsky, Nathan J.
    Technology is playing an increasingly pervasive role among young gay men in the process of meeting potential romantic or sexual partners. We investigated challenges posed by technology related to young gay men’s relationships. Focus groups (n = 9) of young gay men aged 18–24 (n = 43) were transcribed verbatim, and thematic analysis was used to identify two major themes regarding challenges to relationship development and maintenance. Subthemes include unrealistic expectations of relationships, inauthentic self-presentation online, sexual primacy over romance, increased opportunities for infidelity, and jealousy. The implications of this study for sexual education and sexual health promotion are discussed.
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    Spending reviews and the Government of Canada: From episodic to institutionalized capabilities and repertoires
    (Canadian Public Administration, 2023) Lindquist, Evert A.; Shepherd, Robert P.
    Following surges of spending and staff hiring to address the COVID-19 pandemic, the Trudeau government announced a strategic policy review in the 2022 Budget to secure savings of $6 billion. There has been little apparent progress by May 2023 and opaque communications. This is surprising because Canada was once considered an international exemplar for spending reviews, needs to learn from the pandemic experience, has a worrisome medium-to-long-term federal spending trajectory, and the governance and economic context has rapidly evolved. This article identifies different kinds of spending reviews and design considerations, reviews Canada's experience with reviews since the early 1980s, considers recent OECD experience and exemplars, and argues that its spending reviews have become increasingly selective and closed. We suggest the Canadian government should institutionalize annual spending reviews, which can be scaled up or down, and that this points to more fundamental issues for reform and building a new governance culture.
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    Sexual self-efficacy and gender: A review of condom use and sexual negotiation among young men and women in Sub-Saharan Africa
    (The Journal of Sex Research, 2018) Closson, Kalysha; Dietrich, Janan J.; Lachowsky, Nathan J.; Nkala, Busiwe; Palmer, Alexis; Cui, Zishan; Beksinska, Mags; Smit, Jennifer A.; Hogg, Robert S.; Gray, Glenda; Miller, Cari L.; Kaida, Angela
    Sexual self-efficacy (SSE), one’s perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.
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    Promoting moral imagination in nursing education: Imagining and performing
    (Nursing Philosophy, 2023) Jantzen, Darlaine; Newton, Lorelei; Dompierre, Kerry‐Ann; Sturgill, Sean
    Moral imagination is a central component of moral agency and person‐centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task‐driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task‐driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation ‘on both sides’ prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de‐escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person‐centred care.
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    Event-level outcomes of police interactions with young people in three non-metropolitan cities across British Columbia, Canada
    (International Journal of Drug Policy, 2021) Card, Kiffer G.; Selfridge, Marion; Greer, Alissa M.; Hepburn, Kirk J.; Bernard Fournier, Anabelle; Sorge, Justin; Urbanoski, Karen; Pauly, Bernie; Benoit, Cecilia; Lachowsky, Nathan J.; Macdonald, Scott
    This study examines encounters between youth and police to identify individual, contextual, and social factors that predict the outcome of these encounters. Young people aged 16–30 years were surveyed between May 2017 and June 2018 in three non-metropolitan cities across British Columbia, Canada. Outcomes were analysed using multinomial logistic generalized estimating equations. A total of 675 encounters were reported by 360 participants. These outcomes resulted in participants being questioned (n = 227; 33.6%); given warnings (n = 132; 19.6%); being searched (n = 104; 15.4%); being given a ticket (n = 101; 15.0%); and being handcuffed or arrested (n = 111; 16.4%). Young Indigenous people (vs. white) were significantly more likely to be handcuffed or arrested (OR=3.26; 1.43, 7.43). Statistical significance held after adjusting for history of police encounters and contextual factors. Findings suggest that police discretion, which has the potential to benefit youth, may be undermined by discriminatory applications of discretion.
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    Exchanging a “gnawing thought for “taking a pill once a day”: Examining sexual minority men's experiences with PrEP and mental health in a universal PrEP access context
    (AIDS Education and Prevention, 2021) Gagliano, Nick; Black, Stéphanie; Mniszak, Caroline; Morgan, Jeffrey; Lachowsky, Nathan J.; Knight, Rod
    This study explores how universal access to and taking no-cost preexposure prophylaxis (PrEP), which effectively prevents HIV acquisition, may impact the mental health-related experiences of sexual minority men, including HIV-related anxiety. We employed community-based and participatory methods to conduct and analyze 27 interviews with sexual minority men in British Columbia, Canada. Before starting PrEP, participants’ experiences with sex were highly associated with HIV-related anxiety. Participants stated they did not explicitly initiate PrEP to reduce HIV-related anxiety, yet many described significant reductions of HIV-related anxiety after starting PrEP. Participants described feeling that the sex they were having was safer following their initiation of PrEP, which resulted in increased ability to access heightened experiences of pleasure, desire, and intimacy. PrEP's capacity to impact HIV stigma and health broadly should continue to be explored, particularly given the mental health inequities faced by those who may acquire HIV.
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    Digital health systems—let’s talk about sex (and gender)
    (Healthcare Management Forum, 2022) Courtney, Karen L.
    Historically, within digital health information systems, sex and gender have been conflated as a single concept and often have been limited to a binary answer. This has led to inappropriate care, erosion of client trust and avoidance of the healthcare system. Healthcare leaders can improve care for all clients with technical and clinical information practice initiatives. While procurement processes could require digital health systems that utilize modern gender, sex and sexual orientation (GSSO) terminology, for most health leaders, technical initiatives will focus on modernizing existing systems to the maximum extent possible. Terminology updates may not be immediately visible to clients, but providing the correct information to clinicians will support respectful client encounters. Simultaneously, clinical information practice initiatives can directly affect clinical encounters. Change management strategies need to include all levels of employees and redesign tools and workflows to support modernized information handling practices.
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