Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services

Oralia Gómez-Ramírez; Kinnon R MacKinnon; Sophie Bannar-Martin; Maja Karlsson; Devon Haag; Catherine Worthington; Mark Gilbert; Daniel Grace

doi:10.1016/j.healthplace.2021.102696

Caught between HIV exceptionalism and health service integration: Making visible the role of public health policy in the scale-up of novel sexual health services

Health Place. 2021 Nov:72:102696. doi: 10.1016/j.healthplace.2021.102696. Epub 2021 Nov 2.

Authors

Oralia Gómez-Ramírez¹, Kinnon R MacKinnon², Sophie Bannar-Martin³, Maja Karlsson⁴, Devon Haag⁵, Catherine Worthington⁶, Mark Gilbert⁷, Daniel Grace⁸

Affiliations

¹ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; CIHR Canadian HIV Trials Network, 588-1081, Burrard Street, Vancouver, BC, V6B 3E6, Canada. Electronic address: [email protected].
² School of Social Work, York University, 4700, Keele Street, Toronto, ON, M3J 1P3, Canada. Electronic address: [email protected].
³ Island Health Authority, 430-1900, Richmond Ave, Victoria, BC, V8R 4R2, Canada. Electronic address: [email protected].
⁴ Interior Health Authority, 505 Doyle Ave, Kelowna, BC, V1Y 0C5, Canada. Electronic address: [email protected].
⁵ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. Electronic address: [email protected].
⁶ School of Public Health and Social Policy, University of Victoria, 3800, Finnerty Road, Victoria, BC, V8P 5C2, Canada. Electronic address: [email protected].
⁷ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada. Electronic address: [email protected].
⁸ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. Electronic address: [email protected].

PMID: 34736155
DOI: 10.1016/j.healthplace.2021.102696

Abstract

The role of contextual factors for program implementation is well-documented; however, their changing function throughout implementation phases is less established. We conducted an institutional ethnography to understand how structural conditions for scaling up initiatives are shaped by public health policy. We conducted 25 interviews with implementers of a comprehensive sexual health testing service in Canada, 21 meeting observations, and textual analyses of key policies and reports. Our analysis revealed a disjuncture between implementers' task of scaling up programming and the actualities of working within the discursive and material confines of policies premised on HIV exceptionalism and underfunded integrated health services.

Keywords: HIV exceptionalism; Health service integration; Implementation and scale-up science; Institutional ethnography; Online sexual health; Public health policy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
HIV Infections* / prevention & control
Health Policy*
Health Services
Humans
Public Policy

Grants and funding

CIHR/Canada