Propelled by increased global access to Highly Active Anti-Retroviral Therapies, the integration of HIV treatment and prevention has emerged as an important organizing concept of pandemic response. Despite its potential significance for community-based AIDS organizations (CBAOs) little research on integration has been done from a community-based perspective. This paper responds to that gap in the literature. With a view to moving what can be an abstract concept to the level of concrete practice, we offer a community-based model of the integration of HIV treatment and prevention. The model is based on research conducted in 2006-2007 with front-line staff from CBAOs across Canada carried out in partnership with the Canadian AIDS Treatment Information Exchange. The model is grounded in three central dimensions of a community-based perspective on integration deriving from our research: the phenomenological primacy of front-line service work, a comprehensive notion of treatment and prevention, and the importance of social context. The model is intended as a conceptual resource that can assist CBAOs in formulating practical responses to new demands for integrated service provision.
This paper responds to a gap in knowledge about the conceptualization of integration in community-based AIDS organizations (CBAOs).
A community-based process evaluation was conducted of a national intervention, developed by the Canadian AIDS Treatment Information Exchange (CATIE), to enhance treatment information provision in CBAOs and encourage its integration with prevention services. Our study involved 13 interviews with intervention participants in 6 CBAOs across Canada, CATIE staff, and funders, as well as a 25-person verification exercise.
Intervention participants conceptualized integration as linking front-line HIV treatment, health promotion and prevention services, emphasizing mediation between scientific and lay knowledge, the political context of integration and the role of social determinants in clients' health and access to services. Challenges to integration include high staff turnover and inflexible funding structures. Complex health education related to the relationship between viral load and HIV transmission is a critical area of integrated service delivery.
Study findings help distinguish a community-based concept of HIV-related integration from alternative uses of the term while pointing out key tensions associated with efforts to integrate HIV prevention and treatment in a community-based context.