Associate Professor, Canada Research Chair - University of Toronto
Working with Excluded Populations in HIV - Hard to Reach or Out of Sight?
The term ‘hard to reach’ has been critiqued for its lack of clarity and specificity that overlooks unique distinctions between groups of people, and for its focus on the person being ‘hard to reach’ rather than the approach that is being used to reach persons. The social factors that produce marginalization and ultimately result in people choosing to not engage in research, healthcare and/or social services are not encapsulated in the concept ‘hard to reach’. Critique of the term ‘hard to reach’ has persisted for decades. For instance, Freimuth and Mettger’s 1990 article described that: “‘Hard-to-reach’ audiences have been called obstinate, recalcitrant, chronically uninformed, disadvantaged, have-nots, illiterate, malfunctional, and information poor. These labels reflect communicators' frustration in trying to reach people unlike themselves and the failure of many campaigns to change high-risk behaviors”. Researchers have identified strategies to ‘reach’ the ‘hard to reach’ to engage them in services and research, including for recruitment and communication with diverse populations. There has been less focus on the ways in which researchers and healthcare and social service providers can challenge the notion that people themselves are ‘hard to reach’ and address the social factors that result in decisions to not engage in research and care, and reflect on their own beliefs about persons disengaged from care and research.
The objectives of the project focused on during this residency include:
1. Dedicated writing time for the book “Working with Excluded Populations in HIV - Hard to Reach or Out of Sight?” (under contract at Springer) focused on interrogating and disrupting the ways in which people are conceptualized and labelled as ‘hard to reach’ to (re)focus on transforming social systems and researcher/practitioner personal values, beliefs and approaches.
2. Developing case examples for the book based on recent collaborative HIV research by the author with Indigenous youth, internally displaced women, LGBTQ communities in the Global North and Global South, and persons at the intersection of these identities, to identify successful approaches to working with marginalized and often vulnerable communities and groups: relationality, reciprocity, reflexivity, critical hopefulness, and love and solidarity. This residency will focus on two chapters: reflexivity, and love and solidarity.
3. Engaging in interdisciplinary dialogue and knowledge exchange with fellow Brocher Foundation residents, particularly those at the intersection of global and public health, medical anthropology, biomedical science, sociology, history of medicine, law, and psychology, regarding the history and current use of the concept of ‘hard to reach’ in medical research and practice.
4. To engage in collaborative conversations with World Health Organization teams that I have been working with on global health with excluded populations, including teams focused on a) point of care HIV and syphilis testing, b) self-care sexual and reproductive health interventions, to explore the ways the strategies detailed in this book may be integrated into developing normative guidance and recommendations for HIV and sexual health research and practice.
Dr. Carmen Logie is an Associate Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto and the Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. Dr. Logie’s research program advances understanding of, and develops interventions to address, stigma and other social ecological factors associated with HIV and STI prevention and care. She is particularly interested in understanding and addressing intersectional stigma and its sexual and reproductive health impacts, with a focus on HIV and STI. Her current research focuses on HIV/STI prevention, testing and care cascades in Canada, Uganda, Brazil and Jamaica with people living with HIV, refugee and other displaced youth, LGBT communities, Indigenous youth, and persons at the intersection of these identities.