1. www.cpha.ca
Welcome to the CPHA Webinar
STBBI/HIV Community Partner
webinar
We will be starting shortly.
To connect to the Audio portion of the webinar:
Toll Free: 1-877-394-5901
Local (Toronto only): 416-548-6023
Access Code: 741-9512

2. www.cpha.ca
The Canadian Public Health
Association Community Partner
Webinar
Core Competencies for STBBI
Prevention, STBBI Health Equity
Impact Assessment Tool and
Factors that Impact Vulnerability
(FIV)

3. www.cpha.ca
Project Overview
The Project Core Competencies resulted in three documents:
• Core Competencies for STBBI Prevention
• STBBI Health Equity Impact Assessment
• Factors that Impact Vulnerability (FIV) Companion resource to the HEIA
• Overall there were consultations/and or focus groups in 6 locations
• In addition key informant interviews were held with individuals whom work in
sexual health, STBBI prevention, research, treatment and care, core
competency experts and public health

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Community partners
Vancouver: AIDS Vancouver, 3 focus groups
Saskatoon: Saskatchewan HIV/AIDS Research Endeavour
Ottawa: AIDS Committee of Ottawa
Montreal:COQ-SIDA
Halifax: AIDS Coalition of Nova Scotia & AIDS Commission of Nova Scotia
Renfrew County: Ottawa Valley Health and Wellness Centre West Champlain
Healthy Community Corporation
Yellowknife: Aurora College

5. www.cpha.ca
Approach
• Each location and partner was responsible for specific task and duties and
worked with the project leads to effectively coordinate the community visits
• All of the consultations followed the same format with semi structured
sessions throughout the day facilitated by the project team and consultant
• Competency development consisted of an analysis of the data collected in
the skills, knowledge, attitudes and behaviours large group discussions and
break out sessions and also informed the HEIA and FIV tool
• Information collected through the guided focus groups with people most at
risk of STBB’s or living with an STBBI as proved to be critical to identify
specific skills for front line workers to be effective

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Approach cont
• While the STBBI tool was loosely modeled on the Ontario Health Equity
Impact Assessment Tool with significant modifications to ensure it was
STBBI Specific
• HEIA incorporated suggestions and feedback from participants at the
consultations, national reference group and key informants
• The tool was further refined and the HEIA was first piloted at the CPHA
conference and then in community with a partner organization to assess
future as well as current initiatives
• The practical opportunity to pilot the HEIA with a group provided critical
feedback both for tool content as well as facilitation style
• The FIV companion resource was also created as a parallel process

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Approach Cont
• The FIV tool was initially formulated based on a literature review and further
developed based on participant feedback and suggestions during the flip
chart rank and sort exercise and breakout sessions during consultations
• The FIV tool is not meant to be a definitive document
• It highlights some of the factors that have an impact on an individuals’ risk
of STBBIs
• Can be used to highlight factors that impact risk for all populations as well
as specific populations
• The FIV document can be used as a stand alone tool but was primarily
created to be used as a companion resource to the STBBI HEIA

8. www.cpha.ca
STBBI Core Competencies
• The STBBI Core Competencies are based on the broader Core
Competencies for Public Health
• These Competencies provide public health practitioners with the knowledge,
skills, and attitudes required to be effective in their work
• In order to best address the increasing rates of STBBIs; a targeted
approach is required
• As a result the STBBI Core Competencies have been created for front-line
providers. They are not profession specific; they are STBBI prevention
specific and focus on HIV and other sexually transmitted and blood-borne
infections

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STBBI Core Competencies
Competencies will:
• Core competencies address the need for common language, skills and
approaches for front-line providers across disciplines and sectors so that
clients receive consistent HIV prevention, health and well-being messages,
programs and services
• Increase the capacity of front-line providers to address Factors that Impact
Vulnerability (FIV) to STBBIs
• Encourage service delivery that is evidence-based, population-focused,
ethical, equitable, standardized and client-centred
• Act as an adaptable set of skills, knowledge and practices that can be used
in all prevention strategies
• At an organizational level, core competencies provide a framework and
common understanding for integrated action in tackling the complex social
factors at play when dealing with the social determinants of health that
increase vulnerability to HIV infection and other communicable diseases

10. www.cpha.ca
Development Process
• CPHA worked with communities across Canada to identify the knowledge,
skills, attitudes, and behaviours which enhance the prevention activities
• The competencies were then refined by external experts and reviewed for
plain language
Competencies were then selected on:
Measurabilty
STBBI Specific
Based on Public Health Competencies but does not duplicate them

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STBBI Core Competencies
The STBBI Core Competencies Tool is comprised of 8 Sections:
1.Why Competencies were developed
2. The Competency Statements
3. Factors that Impact Vulnerability
4. Individual level factors
5. Community level factors
6.System level factors
7. How the Competencies were developed
8. Self Assessment Tool

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STBBI Core Competencies
1. Knowledge of STBBI transmission modes, disease and infection
progression, and treatment options .
a) Can demonstrate consistent use of universal precautions
b) Can identify, share, and contextualize best practices in prevention of
STBBI transmission
c) An understanding that the presence of one STBBI may increase risk of
other infections
d) Demonstrates knowledge of bio-medical risks associated with sexual
practices (including insertive, receptive, anal, vaginal)
e) Recognizes the complex factors, including the need for intimacy and
pleasure, involved in assessing a person for risk in sexual and non -
sexual decision-making.

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2. Respect for the diverse range of beliefs, practices, and values that
influence sexual practices and decision-making
a) Can recognize how the determinants of health influence STBBI risk for
specific populations
b) Can see how culture shapes an individual’s sexual health and decision-
making
c) Understands how stigma and discrimination can lead to further
exclusion and isolation
d) Knows and appreciates the Factors that Impact Vulnerability
e) Understands how a person’s experiences affect decisions about
accessing services, getting tested, and having treatment

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3. Effective use of interventions to modify risk of STBBIs
a) Creates and maintains appropriate boundaries within the client–service
provider relationship
b) Can identify and apply harm reduction strategies
c) Applies approaches that meet the STBBI prevention needs of the client
(such as motivational interviewing and active listening)
d) Supports clients in making informed decisions while acknowledging they
are experts in their own lives
e) Can comfortably discuss sexual practices, related risks, and prevention
of STBBI
f) Can put situations in context in order to effectively meet the needs of
those at increased risk of STBBIs

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4. Advocacy on behalf of those at risk of STBBIs and living with HIV.
a) Demonstrates awareness of the impact that organizational policies and
practices have on access to STBBI prevention services
b) Ensures a safe and respectful environment that does not isolate or
marginalize client
c) Identifies appropriate referral options for clients whose complex health
needs may impact their risk of STBBI
d) Acknowledges own limitations and be able to support clients’ navigation
of systems

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5. Planning, implementation, adaptation, and evaluation of STBBI
programs and policies
a) Can apply a health equity lens to inform programs, services, and
interventions
b) Can contextualize disparity and adapt programs to ensure inequities are
not increased
c) Knows the laws and organizational policies surrounding disclosure and
confidentiality
d) Demonstrates an understanding and ability to adapt as necessary with
people from diverse backgrounds
e) Ensures that programs and services are not only culturally relevant but
also culturally safe for populations most at risk of infections
f) Can apply organizational procedures, protocols and standards to the
delivery of STBBI services

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Attitudes and Factors that
Impact Vulnerability
Factors that Impact Vulnerability :
Individual
Community
System
• It is important to note that the FIV have been linked to populations but also
at which level of impact they may reside
• So a FIV may be linked to a specific population but also identified as an
individual impact
• This helps develop and design interventions on a population as well as an
impact level

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FIV and Attitudes of Front-line
Workers
• Service providers need confidence and a level of comfort to address the
complex needs of those at risk in an unbiased, non-judgmental, and
inclusive manner
• The Factors that Impact Vulnerability (FIV) provide an initial list of factors
that can challenge the attitudes and beliefs of those working with people at
risk of STBBIs.
• They need to understand their own role in shaping a client’s experience
• Service providers should consider their personal attitudes toward the
people they work with and choices as well as the factors that impact
vulnerability

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• An understanding of the FIV is essential for front-line workers if they are
going to understand a client’s risk of STBBIs.
• At the same time, workers should not assume that the factors are relevant
to each person’s experience—they must acknowledge that people are
experts in their own lives
Individual:
- Factors that impact sexual decision making
- The role that intimacy and pleasure may play
Community:
- Attitudes towards sexual and personal practices front line workers may
posess
- Taboos and the stigmatization of certain sexual practices
System:
-Cultural orientations may influence how people discuss sex in public and in
private
- Health, legal and education systems are intrinsically adversarial and impact
how people engage

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Self Assessment Tool
• This tool is for front line providers to perform a self assessment of their
demonstrated knowledge of the Core Competencies
• It can be used in overall performance assessments and in conjunction with
learning plans to further develop their skills, knowledge and as a result
contribute to enhance organizational capacity and robustness
• The tool is helpful to identify areas where more skill development is needed
and opportunities for development
• The tool can provide the opportunity for communication between front line
providers and managers, supervisors, directors

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The self assessment tool provides a check list for each competency statement
There are three levels an individual can rate their demonstrated ability:
a) Proficient: Expert/Others consult with me
b) Knowledgeable: Comfortable; occasionally consult with others
c) Aware: Heard of it; regularly consult with others
- The tool also provides a not relevant category as some positions will not
require knowledge in all areas nor should people be expected to be experts
in all areas
- A learning plan template has also been created as part of the competency
tools but can be used as a stand-alone tool

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Implementation
The Core Competencies can be incorporated in a number of ways:
• Facilitating workshops internally with one another
• In consultation with supervisors annual learning plans can be developed
that includes ways to strengthen the competencies
• Performance appraisals can include identifying strengths and outline areas
for improvement or development
• Based on the competencies self assessment tool a team learning plan could
be developed and implemented

23. www.cpha.ca
Health Equity Impact
Assessment
• Existing Health Equity Impact Assessments (HEIAs) are generic meant to
be applied to any proposed policy, legislation or initiative and there was a
need to develop a targeted tool for organizations
• While many populations may face challenges or barriers to health some
groups are significantly impacted by systemic factors that have a deeper
impact on their opportunities to achieve equitable health and increase risk of
STBBIs
• The STBBI Health Equity Impact Assessment Tool has been designed as a
practical tool with the goal of helping to ensure that front-line initiatives do
their utmost to prevent any increase in existing health inequities and
vulnerability to HIV/STBBIs.

24. www.cpha.ca
Health Equity
Health equity has been defined as;
“ A means to reducing barriers in access to quality health care for all by
addressing the health needs of people along the social gradient, including
those most health disadvantaged…Health inequities or disparities are
differences in heath outcomes that are avoidable, unfair and are related to
social inequality and marginalization. Roots of disparities lie in the broader
social and economic inequality and exclusion…”
• Most equity or health equity approaches to health take into account the fact
that social determinants of health (SDoH) have an impact on ones’ health
and well being
• What if anything is different for sexual health?

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STBBI HEIA
• The STBBI HEIA is a practical organizational tool to embed equity into
planning and programming and prevent an increase of existing inequities in
populations that may be at risk of infections
• The STBBI HEIA can assist organizations to develop any prevention
programs, services or initiatives and provide specific examples of factors
that impact one’s general risk of infection and also in certain population

26. www.cpha.ca
Process
• An extensive literature was conducted to identify existing Health Equity
tools, equity and health equity literature as well as participation in health
equity webinars and attendance at the International Health Equity
Conference in Quebec City in 2012
• Upon final review of the collected information ,for purposes of the project
the most relevant tool to be used as a starting point was the Ontario Ministry
of Health and Long Term Care’s Health Equity Impact Assessment Tool
• The initial STBBI HEIA was loosely predicated on the Ontario tool, literature
review and combination of existing tools
• Initial edits were completed by an external editor and guided by project staff

27. www.cpha.ca
Process continued
The initial STBBI HEIA was introduced during community consultations and a
table top exercise was conducted using a hypothetical proposed policy,
program or service ( initiative)
The goal of the exercise was to determine if organizations:
- Found it useful
- Found it was relevant
- Found it user friendly
The revised STBBI Tool was work shopped:
- At the CPHA Conference
- In a community partner organization with staff
Further iterations of the Tool occurred and the Tool was translated for plain
language and a final external edit occurred

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Responses
Initial response was favourable and organizations and individuals felt that it was
a Tool that could be incorporated into their work
Examples of use:
- work planning ;
- evaluation and assessment plans to strengthen program and policy
development;
- guide strategic planning and strengthen internal capacity through team
building;
- Assist to develop and strengthen external community partnerships
Clarifications:
- It is not mandatory
- It is to be used by organizations and individuals and adapted as necessary

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Development Cycle
Optimally organizations would use it at the start of initiative development
It can still be used throughout the various stages but may be not as effective

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Types of HEIA’s
There are three main levels of assessment
1.Rapid or desk top HEIA
2.Standard HEIA
3.Comprehensive HEIA
Most assessments typically fall between the rapid or desk-top level and the
standard level. The organization needs to determine what type will best suit
their needs.

31. www.cpha.ca
STBBI HEIA Main Objectives
• Support an organization’s assessment and decision-making during the
development of STBBI prevention initiatives
• Identify and address unintended impacts, positive or negative, on priority
populations and other groups that may face challenges attaining equitable
health outcomes
• Build on an organization’s existing prevention work and enhance
consistency and transparency in how equity issues are addressed
• Strengthen work around the factors that may impact vulnerability to STBBIs
• Systematically catalogue the decision-making process to assist in the
development of future initiatives.

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Populations
• While it is important to be aware of the identified populations that are at
increased risk of STBBIs it is also important for organizations to not feel
constrained or that they are prescribed
• The suggested populations are a starting point from which to examine their
community and may raise awareness of people who may be living in the
community that they were unaware of
• Organizations can use the STBBI HEIA to identify who may be most at risk
and how to tailor the initiative to best address the risks or vulnerabilities of
people who may be most impacted by factors that may increase their risk
• It is important to note that identifying other groups that may be impacted
does not mean that an organization should serve all groups; it is to be
aware for the potential of impacts within a population that they did not intend

33. www.cpha.ca
Factors that Impact Vulnerability
(FIV)
• Most HEIA’s examine communities through a DoH lens
• While many approaches to STBBI prevention are built on a SDoH approach
and is useful many of these tools look at how factors affect overall health
and well-being and not their unique impact on risk of STBBIs
• In the course of this project Factors that Impact Vulnerability specific to
STBBI were identified, they are an evolution of the SDoH
• Overarching FIV have been identified that impact all populations and have
been further refined to specific populations
• The list is a starting point and not meant to be exhaustive or definitive but to
be used as companion resource to conduct assessing a proposed initiative

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DOH/SDoH FIV
Population-
specific FIV
STBBI HEIA
All health issues
All populations
HIV STBBI specific
All populations
HIV STBBI specific
Population specific

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Examples of some overarching FIV that are applicable to all
populations
- Culture and faith affect a person’s
decisions around prevention, medical
care, treatment and intervention
- Distrust of systems affects individual
decisions to access health services,
sexual health services and testing
- Poor mental health can influence an
individual’s decision to participate in
high-risk activities such as substance
use
- Attitudes towards sexual and personal
practices inform discussions between
a service provider and service user
- Perceptions about who is at risk of
STBBIs may have an impact on
information provided by service
providers and risk triage in the health
care system
- Lateral violence and internalized
homophobia may influence a person’s
risk-taking behaviours and how they
use community supports
- Experiences of violence and trauma
can be linked to risk-taking behaviours
(Some populations experience higher
rates of violence, such as First
Nations, Inuit and Metis, refugee
women, people with disabilities, sex
workers, LBGTQ people.)

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FIV continued
• The examples provided are to highlight the factors that were identified
through the project
• They are meant to be used to spark initial discussion
• Each organization and region should identify specific FIV and it is important
to record those as well
• It is anticipated that the list will evolve and refined over time as information
and research is conducted
• Throughout the HEIA it is important to remember FIV are the lens from
which to assess the initiative
For the present completed list you can access it @ www…cpha.ljdljjdsjadlj

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STBBI HEIA at a glance
1. Scoping
a) Populations
b) Factors that Impact Vulnerability
2. Unintended Impacts
a) Positive
b) Negative
3. Mitigation
4. Monitoring
5. Dissemination

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Sample Template
NameofInitiative:
Target
Population(s):
IntendedOutcomes:
Step1.
SCOPING
Step2.
UNINTENTIONALPOTENTIALIMPACTS
Step3.
MITIGATION
Step4.
MONITORING
Step5.
DISSEMINATION
1.a)Populations
thatmaybeimpacted
bytheinitiative:
1.b)
FactorsthatImpact
Vulnerability:
2.a)Unintendedpositive
orneutralimpacts:
2.b)Unintended
negativeimpacts:
2.c)
Moreinformation
needed:
Waystoreduce
potentialnegative
impactsand
amplifypositive
impacts:
Waysto
measure
successfor
eachmitigation
strategy:
Waystoshare
resultsand
recommendations:

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Example Scenario
• In a small to medium sized coastal town the local AIDS service organization
administers and delivers the STBBI programs, services and prevention
activities in the community.
• Local employment is limited and many people fly to the oil patch in Alberta
for term work; typically two weeks in two weeks out.
• Recently the ASO has seen a significant increase of male clients who have
tested positive for an STBBI
• Some men have disclosed that although in hetero sexual relationships; they
have had sex with other men, or with sex trade workers while away and
have shared that they have

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• Staff are concerned about the rising rates and want to determine how to
reduce rates and raise awareness in the community about risk
• In the past localized poster campaigns have worked targeting gay men; on
buses, storefronts and tv ads. Primarily promoting condom use
• The ASO has decided that since it worked in the past it may again and
decide to re launch and target hetero men between 25 and 55

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Scoping
1 a) Populations
1.Male oil patch workers
2.Spouses, monogamous partners
3.LGBQQT
4.Women at risk
5.Youth
1b) Factors that Impact Vulnerability
- Lack of confidentiality ( small
community)
- Possibility of increased use of
substances (being far away and
isolated from family, friends, new
opportunities not available at home)
- Unaware of sexual partners’
health/history
- Spouses/partners: unaware of risk that
may be present and continue to
participate in barrierless sexual activity
- LGBQQT: marginalized, unaware of
risks
- Women: unaware of risk, power
dynamics
- Youth: unaware of risk

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Unintended Impacts
Remember these can also be neutral and more information may be needed
Positive
Workers: none
Spouses/sexual partners: none
LGBQQT: none
Women: none
Youth :none
Negative
Workers: Possibly fear of stigma of testing
positive, fear of disclosing to partner(s) as
a result will not get tested, fear of
ramifications for relationships
Spouses/sexual partners: possible
increase of risk
LGBQQT: May feel further isolated in the
community, uncomfortable accessing
services or testing at the ASO due to
hetero male focus
Women: further false sense of security;
campaign doesn’t resonate
Youth: Lack of awareness

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Mitigation
• Engage members of the other identified populations to design a campaign
that they feel would be relevant and effective
• Focus groups, interviews with existing clients are a few examples of
gathering feedback
• Incorporate (if feasible) recommendations

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Monitoring examples
The organization can:
• Use client surveys or questionnaires with members of priority populations
and those impacted by the initiative
• Rates of new STBBIs
• Process evaluation to ensure that frontline service providers, developers,
planners, and decision-makers are integrating equity and the FIV into their
processes and client interactions
• Focus groups or interviews with affected populations to see if their
vulnerability has increased or decreased since the implementation of the
initiative.

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Dissemination examples
• Present a case study at a conference, In a webinar or through another
media vehicle
• Do a literature review or evidence summary
• Summarize your results for other frontline organizations in your community
• Lead a workshop or other professional development activity based on your
experience within the organization and with community partners
• Post the results of your STBBI HEIA on your website

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Other HEIA Resources
• Equity Lens in Public Health: Health Equity Tools 2013. Victoria, BC: University of
Victoria. Available from www.uvic.ca/elph
• Health Equity On-Line Course:
http://knowledgex.camh.net/health_equity/Pages/healthEquityImpactAssessment%28
HEIA%29OnlineCourse.aspx
• National Collaborating Centre for Determinants of Health: www.nccdh.ca
• Ontario Ministry of Health and Long Term Care; Health Equity Tool:
www.health.gov.on.ca/pro/programs/heia
• Wellesley Institute: www.wellesleyinstitute.com
The above links are examples of some Health Equity Tools available in Canada

47. www.cpha.ca
Conclusion
CPHA would like to thank all of you for
significant contributions to the project and
ongoing commitment and passion working to
reduce rates of new infections.
All of the tools can be accessed……..

48. www.cpha.ca
Thank you
Contact Information: