Indigenous health organizations,Indigenous community resurgence,and the reclamation of place in urban areas

Research around the world has been nearly unanimous about the positive impacts of Indigenous‐led health organizations on Indigenous peoples' qualitative experiences in health care, in the face of often negative experiences in non‐Indigenous‐led health care settings. Urban environments, including health care environments, are areas of increasing attention with regard to Indigenous peoples' health in Canada. In this study, which took place in the northern city of Prince George, British Columbia, 65 Indigenous community members and health services workers participated in interviews and focus groups, describing their experiences with urban Indigenous‐led health organizations—defined in this study as non‐governmental organizations that prioritize the values and practices of local Indigenous communities. Employing perspectives on place and relationships drawn from Indigenous critical theory and Indigenous community resurgence to analyze the findings of this qualitative study leads to a focus on how relationships impact and can even constitute places, enabling new understandings of the roles of Indigenous‐led health organizations in urban Indigenous community resurgence.     

‘Facing it Together’: Early Caregiving Responses to Vancouver's HIV/AIDS Epidemic

This article utilises oral history interviews with long-term survivors and caregivers in Vancouver, British Columbia to foreground the importance of gay men's early HIV/AIDS caregiving work. Caregiving was essential to the health and resilience of Vancouver's gay community and served as a political response to homophobic discourses that demonised gay men and devalued the lives of people living with HIV/AIDS. This analysis of the practical and political significance of HIV/AIDS caregiving demonstrates that historians must find better ways to recover the often-untold histories of men's caregiving and domesticity and appreciate their significance to the success of social movements.     

Une histoire de résidus : à propos des facteurs généraux et locaux de croissance régionale au Canada,de 1971 à 2001

Starting from an econometric model of local employment growth, applied to Canada (1971–2001), residuals—relative to model predictions—are analyzed over time and over space, in turn allowing us to draw a distinction between general explanatory variables and factors of a more local, cyclical or accidental nature. The model's explanatory power grows over time, founded on variables such as urban size, market access and industrial structure, allowing us to conclude that local employment growth in Canada follows an increasingly geographically predictable pattern. However, an examination of the residuals reveals more localized processes. Growth volatility is most manifest in Alberta and British Columbia, home to the most erratic local economies. Emerging patterns are visible in the last period, most notably the underperformance of Northern Ontario and of non‐metropolitan communities between Windsor and Québec City, lying along the Great Lakes and the Saint Lawrence. The over‐performance—compared to model predictions — of small and mid‐sized towns in south‐eastern Québec can, on the other hand, be interpreted as a sign of truly local social processes, generally associated with a particularly dynamic local entrepreneurial class.     

‘It’s a very isolating world’: the journey to HIV care for women living with HIV in British Columbia,Canada

HIV health services research conventionally defines place in terms of proximity to care. However, understandings of place must also include the social spaces that women living with HIV (WLWH) occupy which shape their experience of health and access to care. Drawing on focus group data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, we explored how 28 WLWH navigate geographic place and social space in attempting to access HIV-related healthcare within and across a range of urban to rural localities in British Columbia (BC), Canada. We describe how existing services, even if physically close, can be socially marginalizing as women confront HIV stigma, racism, and classism, which operate to exclude women from the places and spaces they must access for care. We also emphasize how women enact ‘geographies of resistance’ and succeed in carving out their own safe options for care and support. Finally, we share recommendations identified by women themselves towards developing local and community-driven ‘geographies of change’ that support the health and healing of diverse communities of WLWH. Our findings stress the urgent need to acknowledge and redress socio-spatial barriers to care and to work with WLWH to co-create a therapeutic landscape that reflects women’s diverse identities, localities, emotions, and experiences.     

Impact of the Ryan White CARE Act on the Availability of HIV/AIDS Services

This article assesses the extent to which the availability of HIV/AIDS services in the Baltimore and Oakland eligible metropolitan areas (EMAs) increased after receipt of funding under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. Survey data on the availability of HIV/AIDS services in each EMA were collected from samples of organizations at two points in time: 1 year before (1991) and 1 year after (1993) the Oakland and Baltimore EMAs received their first installments of CARE Act Title I funds. Cross-sectional and longitudinal analyses of the data were performed to assess changes in the availability of HIV/AIDS services. The results showed that after CARE Act Title I funding became available, the availability of ambulatory medical and social support services in the Baltimore and Oakland EMAs increased. However, the way service availability increased varied significantly, reflecting differing opportunities and constraints present in each community. In Baltimore, the increase in the availability of HIV/AIDS services was due largely to the creation of new organizations that used Title I funds to provide services (system expansion). In Oakland, relatively few new organizations were created, but existing organizations added new HIV/AIDS services (service line expansion). Our data also indicated that in both EMAs the majority of HIV/AIDS organizations receiving Title I funds expanded the capacity of their existing services to meet growing demand.     

Ethnohistorical geography and aboriginal rights litigation in Canada: memoir of an expert witness

Since the early 1950s, evidence from ethnohistorical geography has played an important role in aboriginal rights claims and litigation in North America. I became involved in Canadian aboriginal and treaty rights litigation over 35 years ago. My participation has included several landmark cases: Regina v. Horseman (treaty rights), Delgamuukw v. Regina (Comprehensive title claim), and Regina v. Powley (Métis rights). Most of the evidence that I have presented over the years has dealt with various aspects of the changing spatial economies of First Nations and Métis communities from Ontario to British Columbia. The Hudson's Bay Company's vast archive has been the primary source for this data.     

Privileging prevention,gendering responsibility: an analysis of the Ghanaian campaign against HIV/AIDS

This article focuses on the discourses around HIV/AIDS in the national Ghanaian ‘Stop AIDS Love Life!’ public health campaign, within non-governmental HIV/AIDS publications, and the Ghanaian national print media. I have used critical discourse analysis to interpret and deconstruct a range of these social texts collected between June and September of 2001 and 2003 in and around Greater Accra, Ghana. I argue, firstly, that these discourses are shaped by an international politics of funding for HIV/AIDS that privileges prevention through behaviour change over treatment action under the premise that prevention is a more cost-effective option for the Global South. I critique this stance, highlighting the emerging possibilities for integrated prevention–treatment efforts in resource-poor settings such as Ghana. Secondly, I argue that the discourses around HIV/AIDS presented in prevention campaign materials powerfully construct normative and gendered subjectivities with assigned roles and responsibilities. The fight against HIV/AIDS is constructed as a national project in which an idealized, and often very young, female citizen is positioned as educator, volunteer, carer and protector of herself and society. This discursive coding of responsibility places the many burdens of HIV upon some of the most vulnerable in society, ignoring the structural constraints of gender, generational and economic inequality. I conclude my paper by arguing that efforts to reduce transmission rates, stigma, and the burden of care for those living with HIV/AIDS in Ghana must integrate both preventative efforts and treatment action. Where prevention campaigns are utilized I suggest that these must recognize the limitations of behaviour change initiatives that primarily target women and acknowledge the gendered constraints faced by those very subjects identified as responsible for the protection and education of the nation.     

Ryan White CARE Act Title I Funding Priorities and Unmet Service Needs in Baltimore, Maryland

The analysis presented in this paper explores the similarities and differences between the services selected as priorities for funding by the Baltimore Ryan White CARE Act Title I Planning Council during the first 2 years of the program in this metropolitan area, and services perceived by HIV/AIDS service providers and people living with HIV/AIDS to be unmet needs. The data used for these analyses were collected as part of a study to assess the implementation and impact of the CARE Act legislation in the Baltimore eligible metropolitan area( EMS ). This project includes three interrelated components: (a) a case study of the legislatively mandated Planning Council, (b) a survey of providers representing HIV/AIDS service organizations, and (c) a qualitative field study of the perceptions of people living with HIV/AIDS about the service delivery system. Taken together, the data from these three sources describe the similarities and differences among these three groups involved in HIV/AIDS care in Baltimore, in terms of their perceptions of services needed by people living with HIV / AIDS. The conclusions drawn from this study can be used to strengthen needs assessments in Title I-EMAs throughout the United States.     

Preservation of old‐growth forests: a case study of Big Timber Park,Whistler, BC

This paper explores the concepts of old‐growth forests, preservation and natural disturbance and demonstrates how contemporary biogeographic theory contributes to successful preservation of old‐growth forests. The case study analyzes the composition, structure, age and growth histories of trees in Big Timber Park, Whistler, British Columbia. Composition. The structure of the forest was diverse and tree ages ranged from 122 to 305 years. The densities of large old Douglas‐fir, shade‐tolerant trees and all snags are indicative of old‐growth forests; however, maximum tree diameters and densities of large snags and logs do not meet quantitative criteria for old‐growth forests. The abundance of tree regeneration and understory vegetation are relatively low. We conclude that some aspects of Big Timber Park are transitional between the mature and old‐growth stages of forest development. In the future, fine‐scale canopy gaps caused by tree senescence and interactions among insects, pathogens and wind are expected to dominate stand dynamics. Forest structure will become increasingly complex, exemplifying the dynamic nature of old‐growth forests. To successfully preserve Big Timber Park and La préservation des forêts other old‐growth forests in Canada requires understanding of natural disturbances. Preservation and the criteria and indicators used to measure successful preservation must explicitly include elements of natural change.     

Stakeholder engagement with environmental decision support systems: The perspective of end users

Environmental decision support systems (EDSS) are designed to assist natural resource managers and stakeholders to assess problems and select options for change. EDSS that combine community engagement in developing future scenarios with computer‐based land use planning and modelling tools are widely used internationally. However, these EDSS are often not used after the research and development phase. To best understand why the EDSS are not being used in the long term, the end users of the EDSS should be consulted—a perspective that is lacking in the literature. The research reported here presents the perspectives of stakeholders involved in a community climate change adaptation project in western Canada. Evidence from the community suggests that this project was successful in instigating change. However, the EDSS was not used after the project's end. Our findings indicate that, from the end users’ perspective, the project could have had much greater and sustained success had there been ongoing engagement and communication with them, particularly in the form of continued support for the use of EDSS after the development project.     

Development of Trigger Levels to Assess Catchment Disturbance on Stream Suspended Sediment Loads in the Magela Creek Catchment,Northern Territory,Australia

Trigger levels for fine suspended sediment (FSS) load in streams are required to identify rainfall-runoff events that have significantly elevated FSS loads, compared with expected background loads, as a result of catchment disturbance. Stream FSS load data collected in the mine-impacted Magela Creek catchment in the wet-dry tropics were used to derive water quality management trigger levels for two approaches – a Before-After-Control-Impact Paired difference design (BACIP) and a regression relationship between observed FSS load and corresponding event discharge characteristics. The results indicate that both the BACIP and regression relationship approaches behave similarly, with similar FSS load events elevated above trigger levels. Notwithstanding this, it is recommended that in order to reliably assess the location and magnitude of a catchment disturbance on FSS load, a combination of BACIP and regression relationship approaches must be adopted. In this study, an event with a FSS load above trigger levels associated with both BACIP and the regression relationship fitted for the downstream site is considered to be significantly elevated as a result of a disturbance within the mine-impacted region. While this technique cannot conclusively determine whether the cause of the disturbance is mine-related or natural (such as fire or bank erosion), it is an efficient statistical method of identifying events that warrant further investigation and management action, if required.     

An Examination of the Stochastic Distribution of Spatial Accessibility to Intensive Care Unit Beds during the COVID-19 Pandemic: A Case Study of the Greater Houston Area of Texas

Sufficient and reliable health care access is necessary for people to be able to maintain good health. Hence, investigating the uncertainty embedded in the temporal changes of inputs would be beneficial for understanding their impact on spatial accessibility. However, previous studies are limited to implementing only the uncertainty of mobility, while health care resource availability is a significant concern during the coronavirus disease (COVID-19) pandemic. Our study examined the stochastic distribution of spatial accessibility under the uncertainties underlying the availability of intensive care unit (ICU) beds and ease of mobility in the Greater Houston area of Texas. Based on the randomized supply and mobility from their historical changes, we employed Monte Carlo simulation to measure ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method. We then conducted hierarchical clustering to classify regions of adequate (sufficient and reliable) accessibility and inadequate (insufficient and unreliable) accessibility. Lastly, we investigated the relationship between the accessibility measures and the case fatality ratio of COVID-19. As result, locations of sufficient access also had reliable accessibility; downtown and outer counties, respectively, had adequate and inadequate accessibility. We also raised the possibility that inadequate health care accessibility may cause higher COVID-19 fatality ratios.     

Localizing HIV/AIDS discourse in a rural Kenyan community

This paper examines the effectiveness of multimodal texts used in HIV/AIDS campaigns in rural western Kenya using multimodal discourse analysis (Kress and Van Leeuwen, 2006; Martin and Rose, 2004). Twenty HIV/AIDS documents (posters, billboards and brochures) are analysed together with interview data (20 unstructured one-on-one interviews and six focus groups) from the target group to explore the effectiveness of the multimodal texts in engaging the target rural audience in meaningful interaction towards behavioural change. It is concluded that in some cases the HIV/AIDS messages are misinterpreted or lost as the multimodal texts used are unfamiliar and contradictory to the everyday life experiences of the rural folk. The paper suggests localization of HIV/AIDS discourse through use of local modes of communication and resources.     

After the Exception: HIV/AIDS Beyond Salvation and Scarcity

Abstract: Access to treatment for HIV/AIDS became a flashpoint for global justice struggles in the late 1990s. An expanding international response, premised to a significant extent on the idea of HIV/AIDS as an exceptional global problem, has since delivered treatment, care and prevention to growing numbers of people. HIV/AIDS exceptionalism, however, has increasingly been questioned, many aspects of the response have been critiqued and donor funding has started to decline. I argue that, having been framed as an exceptional humanitarian emergency, the question of HIV/AIDS as a global problem is increasingly located within a discourse of scarcity. Tracking the growing entanglement of global HIV/AIDS relief with neoliberal governmentality and the emergence of something I term therapeutic neoliberalism, I argue that the shift from a rationality of salvation to one of administration poses new challenges for global health activism. Questioning the discourse of scarcity remains essential to an alternative global health agenda.     

HIV/AIDS and development: failures of vision and imagination

As early as the mid-1990s the US Bureau of the Census was making dire predictions as to the effect of AIDS on life expectancy, infant and child mortality and population size and structure in a number of AIDS affected countries. Despite this it was not until 1997 that the United Nations began to consider HIV/AIDS as a development issue. This article looks at how the international community (still) fails to take HIV/AIDS into account in setting development goals. The article argues that this myopic view means that in 2015, when we assess the development goals, we are certain to have 'failed' in a number of countries and, therefore, that a new realism in target setting is imperative. There is a need to understand better the impact of the disease by taking into account that it is a long-wave event with a complex current and future impact. Sustained equitable development will be essential in dealing with this impact.     

Navigating the AIDS industry: being poor and positive in Tanzania

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care — essential to the survival of many — are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.     

Measuring potential spatial access to primary health care physicians using a modified gravity model

Ensuring equity of access to primary health care (PHC) across Canada is a continuing challenge, especially in rural and remote regions. Despite considerable attention recently by the World Health Organization, Health Canada and other health policy bodies, there has been no nation-wide study of potential (versus realized) spatial access to PHC. This knowledge gap is partly attributable to the difficulty of conducting the analysis required to accurately measure and represent spatial access to PHC. The traditional epidemiological method uses a simple ratio of PHC physicians to the denominator population to measure geographical access. We argue, however, that this measure fails to capture relative access. For instance, a person who lives 90 minutes from the nearest PHC physician is unlikely to be as well cared for as the individual who lives more proximate and potentially has a range of choice with respect to PHC providers. In this article, we discuss spatial analytical techniques to measure potential spatial access. We consider the relative merits of kernel density estimation and a gravity model. Ultimately, a modified version of the gravity model is developed for this article and used to calculate potential spatial access to PHC physicians in the Canadian province of Nova Scotia. This model incorporates a distance decay function that better represents relative spatial access to PHC. The results of the modified gravity model demonstrate greater nuance with respect to potential access scores. While variability in access to PHC physicians across the test province of Nova Scotia is evident, the gravity model better accounts for real access by assuming that people can travel across artificial census boundaries. We argue that this is an important innovation in measuring potential spatial access to PHC physicians in Canada. It contributes more broadly to assessing the success of policy mandates to enhance the equitability of PHC provisioning in Canadian provinces.     

Research on human subjects,exploitation, and global principles of ethics

Abstract

In 1997, 5.8 million people became infected with HIV, 30.6 million people were living with HIV/AIDS, and infection was running at about sixteen thousand new infections a day, of which more than 90% were in low income countries. Against this background the urgency and importance of the fight against HIV/AIDS can scarcely be exaggerated. While a cure for AIDS remains elusive research to discover more effective treatment and possible vaccines is vital. It is at this crucial moment that moral criticism has emerged of some of the most promising research towards treatments and vaccines for HIV/AIDS. This criticism has focused on, and purports to be justified by, the major current international principles and protocols on the ethics of research on human subjects. If this criticism is valid and no better ways of prosecuting successful research on AIDS can be found, the consequences, as the figures above indicate, are truly bleak. This paper will attempt to provide an appropriate framework for assessing the ethics of research on human subjects generally and in doing so will assess the relevance and force of the major ethical criticisms that have been levelled at current research on human subjects in the context of HIV/AIDS therapy and vaccines.     

Forest as hazard,forest as victim: Community perspectives and disaster mitigation in the aftermath of Kelowna's 2003 wildfires

Situated within the political ecology of hazard, this article is an extended case study of the devastating 2003 wildfires in and around Kelowna, British Columbia (also known as the Okanagan Mountain Park Fire). This article reveals how compliance (or lack thereof) with fire mitigation strategies recommended by provincial, regional, and municipal agencies is complicated by differing social constructions of what constitutes ecologically sustainable forest management and community safety. Three perspectives emerge regarding the urban forests: “nature as hazard”—a volatile force to be controlled; “nature as instrumentally valuable”—a contribution to the character of one's surroundings and subsequent sense of place; and “nature as intrinsically valuable”—a distinct entity to be preserved and protected for its own sake. The article also examines how experiences of disaster influence community perceptions and result in a greater willingness to engage in fire mitigation strategies due to perceptions of heightened vulnerability. Forestry and fire mitigation agencies need to determine multiple courses of action among the varied and valid range of residents’ nature perspectives. The role of human agency in disaster mitigation must be examined, particularly as the risk of fire at the wildland‐urban interface continues to be exacerbated by encroaching human settlements and climate change.     

Exploring the associations between cooling centre accessibility and marginalization in Montreal,Toronto, and Vancouver,Canada

Cooling centres provide respite, safety, and social support during extreme heat events for populations that do not have the resources to own or operate in-home air conditioning. The objective of this study was to measure the spatial accessibility of cooling centres and analyze the associations between cooling centre access and marginalization in Montreal, Toronto, and Vancouver, Canada. The potential spatial accessibility of cooling centres within a 15-minute walk was measured at the dissemination area scale using the two-step floating catchment area method. A two-stage modelling approach was used to analyze the associations between cooling centre access and marginalization. Approximately 62%, 58%, and 54% of the populations in Montreal, Toronto, and Vancouver had access to at least one cooling centre. In Montreal and Vancouver, high marginalization areas were more likely to have cooling centre access than low marginalization areas. Of the areas with cooling centre access, smaller access scores were observed in areas with high residential instability. Approximately one-fifth of the areas in each city had no cooling centre access and high marginalization, and may be considered for future cooling centres or programs that improve accessibility to existing centres.