COVID-19 (and HIV) disparities are about racism, not race. This nurse explains how

The 23rd International AIDS Conference (AIDS 2020) was held virtually for the very first time and featured plenty of discussion about the current direction and future prospects for HIV prevention, diagnosis, and treatment. The conference was followed by a virtual COVID-19 summit. During the summit, a plenary session entitled, “Impact of COVID-19 in the Health Sector,” was held on July 10.

LaRon Nelson, Ph.D., RN, FNP, FNAP, FAAN, was one of the presenters at this plenary and gave a presentation entitled, “Anti-Black Racism and COVID-19 Inequities: Explaining the System, Exposing the Setup, and Exploring the Solutions.” Nelson is associate dean for Global Health and Equity and the Independence Foundation associate professor at the Yale School of Nursing. He also is the Ontario HIV Treatment Network research chair in Implementation Science with Black Communities, which is based in MAP Centre for Urban Health Solutions at St. Michael’s Hospital of Unity Health Toronto in Canada.

Nelson’s research investigates the use of multilevel interventions to optimize HIV prevention and treatment outcomes in African and African diaspora communities. Nelson’s research has been supported by the National Institutes of Health, the Centers for Disease Control and Prevention, Ontario HIV Treatment Network, Grand Challenges Canada, and the Canadian Institutes of Health Research.

Medical experts led by SickKids release new back-to-school recommendations

“Thinking about developmental impact and mental health impact has to be in the same equation as the potential harm of COVID,” said Dr. Sloane Freeman, MAP scientist and lead pediatrician for the Model Schools Pediatric Health Initiative at St. Michael’s Hospital.

SickKids has released new proposed guidelines for reopening schools in Ontario come September, including recommendations like staggered lunch times, no large assemblies, and mandatory masks for older students.

The document, which was released Wednesday in collaboration with doctors from across the province, builds on COVID-19 recommendations the organization first released last month. It suggests various health and safety protocols for schools that take a student’s age and developmental considerations into account.

CBC News has learned Ontario Education Minister Stephen Lecce will unveil the province’s plans for the upcoming school year on Thursday.

The group says it is recommending the use of masks for high school students, with consideration for middle school students, whenever physical distancing can’t be maintained. Around 61 per cent of the authors agreed masks shouldn’t be required for elementary school kids.

Opinion: We need to strengthen publicly funded homecare in time for winter

By Dr. Tara Kiran

Summer in Canada has brought fewer new COVID-19 infections and an economy that is slowly reopening. But even as many Canadians are breathing a collective sigh of relief, health-care leaders are preparing for a winter unlike any that has come before.

Every winter is difficult for hospitals in Canada, which are often over-full and under-resourced. But this year, a potential surge of COVID-19 cases could put further stress on an already stretched system.

Better publicly funded homecare needs to be part of our strategy to prepare for what may be our worst winter yet.

We’ve known for a long time that homecare needs to be improved. In Ontario alone, there have been several expert reports in the last few years calling for homecare reforms and two successive governments have made changes to homecare governance. Yet, problems remain.

In 2018, I led a study asking patients and caregivers from across Ontario about the challenges they faced when transitioning from hospital to home. Again and again, the same answer came up: patients just simply don’t get enough homecare to meet their needs.

Do hotel isolation centres work? Researchers are looking at how key COVID programs are affecting marginalized people


THE GOAL: Improving the health and well-being of people experiencing marginalization during the pandemic by evaluating programs that support these populations, and figuring out how to make these services more effective.

THE TEAM: A group of 35 scientists, as well as community partners and people with lived experience of marginalization; the principal investigators are based at MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto.

THE TIMELINE: The project, which received funding from the University of Toronto COVID-19 Action Initiative, U of T’s faculty of medicine and the St. Michael’s Hospital Foundation, launched in May. It has a budget of $450,000 and is slated to run for a year. The first phase, which will evaluate six programs that support marginalized populations, is underway now.

When the pandemic hit, and COVID-19 infiltrated Toronto’s shelter system, the city set up isolation centres in hotels, where those experiencing homelessness can safety self-isolate and recover.

But how well are these sites working? Are there any unintended harms? What can be done to improve them?

These are among the questions that a team of scientists and community partners is probing as part of a collaborative and urgent effort to improve the lives of those on the margins, who have been hit hardest by the pandemic.

“What we’ve learned during the past few months is that the current context within the pandemic often makes people who are already marginalized even more marginalized,” said Dr. Michelle Firestone, a scientist at MAP Centre for Urban Health Solutions, which is leading the project.

“It exacerbates a lot of the pre-existing or systemic issues a lot of communities face.”

Dr. Ahmed Bayoumi, a scientist at MAP and Firestone’s co-principal investigator of the project, said it grew out of the need to “think broadly about how the pandemic response, in particular, was having an effect on the lives of people in the communities we work with.”

“We recognize that COVID is going to be with us for a while — certainly for the rest of this year and into next year,” he said. “We’re looking at programs that have been initiated … to try and learn from that, in terms of how can we move forward to both improve current responses but also inform future responses.”

Four Canada Research Chairs awarded to MAP scientists

Four prestigious Canada Research Chair titles have been awarded to MAP scientists, as part of Canada’s commitment to recognize and invest in some of the world’s most accomplished and promising researchers.

MAP is now home to six Canada Research Chairs in total: new chairholders Drs. Janet Smylie, Ann Burchell, Sharmistha Mishra and Darrell Tan, as well as current Canada Research Chairs Drs. Patricia O’Campo and Nav Persaud.

The chairs announced this month focus on solutions to understand and address anti-Indigenous racism in health services, eliminate barriers to accessing sexually transmitted disease services, improve HIV-prevention strategies, and better understand the spread of disease.

Learn more about the chairholders and their outstanding work below.

Dr. Janet Smylie

Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada

Dr. Janet Smylie, appointed a Tier 1 Canada Research Chair, is a globally-recognized applied Indigenous health researcher and director of the Well Living House Action Research Centre. Tier 1 Chairs are awarded to researchers who are recognized by their peers as world leaders in their field.

“To my knowledge, I am the first self-identified Indigenous person with kin and land ties to what is now known as Canada to be granted a Tier 1 CRC in Health,” she says. “This leaves me feeling very honoured to have been recognized and at the same time very humbled by the accompanying responsibility of ensuring that this translates into some tangible benefits.”

Learn more about Dr. Smylie

Dr. Ann Burchell

Canada Research Chair in Sexually Transmitted Infection Prevention

People experiencing disadvantage are disproportionately affected by sexually transmitted infections (STIs) and face more barriers to accessing health services. Dr. Ann Burchell’s research focuses on how to eliminate these barriers and apply practical strategies to prevent STI and STI-related cancers in high-risk populations.

Dr. Burchell says this funding underscores the importance of the team’s research.

“I am deeply honoured and humbled to receive a CRC award,” she says. “I am excited to work collaboratively over the next five years with community and health-care system stakeholders to seek evidence and identify what tools will work, and how and why they will do so.”

Learn more about Dr. Burchell

Dr. Sharmistha Mishra

Canada Research Chair in Mathematical Modeling and Program Science

Dr. Sharmistha Mishra’s research focuses on the prevention gaps and pathways of disproportionate risks that sustain infectious disease epidemics, and tailored strategies that can reduce infections in a population — especially those vulnerable to STIs and HIV.

Dr. Mishra is an international leader in mathematical modelling and epidemiology of HIV and other STIs.

“I am grateful for the support to be creative and to challenge us as a lab to expand the scope and impact of our science in shifting narratives and driving meaningful change,” she says. “This CRC means we get to keep pushing the envelope and think outside the box in how we answer questions about epidemics and outbreaks and the types of questions and solutions we pursue.”

Learn more about Dr. Mishra

Dr. Darrell Tan

Canada Research Chair in HIV Prevention and STI Research

How can new HIV-prevention technologies, such as pre- and post-exposure treatments be optimized to end new HIV infections in Canada? Dr. Darrell Tan will draw from clinical training in infectious diseases, research training in clinical epidemiology and a background in influencing policy on HIV prevention in Canada, specifically around pre-exposure prophylaxis, to explore the answer.

He says that the number of new HIV infections in Canada every year continues to stagnate, despite powerful medical tools and interventions to control it.

“This award will allow us to redouble our scientific and implementation efforts to expand access to these tools in the hope of ending these epidemics,” he says. “Receiving this CRC is a huge honour not only for myself but also for my team, our institution, our community partners and our study participants.”

Learn more about Dr. Tan

New progress in the fight to end HIV in Canada by 2025

A new initiative sponsored by the CIHR Centre for REACH 3.0 and the Canadian Foundation for AIDS Research (CANFAR), and led by MAP scientist Dr. Sean Rourke, seeks to end the stigma that inhibits Canada’s progress to reaching its goal to end the HIV epidemic by 2025.

The Positive Effect – collaboratively designed by scientists, medical experts, community leaders and people with living with HIV in Canada – begins online at The initiative will connect the lived experience of those both managing and preventing HIV with facts and evidence to correct the misinformation and fear that underlies and perpetuates stigma.

The will promote authentic, ongoing and high-energy engagement across Canada of those dedicated to wiping out HIV stigma, which impedes testing, prevention efforts, and contributes to further health inequities across communities. 

The Positive Effect is much more than a website – it is about shifting mindsets and enriching lives,” said Dr. Rourke. “It is a movement to end HIV stigma by linking facts and evidence of how stigma can affect people to their core, with stories of lived experience where people navigate through challenging circumstances and vulnerability with courage, resilience and growth.

“We know stigma interferes with HIV prevention and deters people from getting tested regularly and knowing their status – this is one of the reasons why ending HIV stigma is so critical. HIV stigma arises out of fear, lack of knowledge, and prejudices, and that’s why we created The Positive Effect. We want to inspire and support people to think differently about HIV by appreciating real stories that they otherwise may never hear about – through these experiences, we will shift mindsets.”

Quick Facts

  • One in five people living with HIV are denied health services because of stigma and discrimination.
  • 9,090 Canadians live with HIV and don’t know it.
  • 10,340 people diagnosed with HIV aren’t in care and accessing life-saving treatment.
  • Reducing HIV stigma is central to ending the HIV epidemic in Canada and will mean less barriers for people to know their status and receive treatment or preventative care.

Learn More

Visit the Positive Effect website

Read the backgrounder

Protecting women and children living with domestic violence during the COVID-19 pandemic

Ten per cent of Canadian women are concerned about the potential of violence in their homes during the COVID-19 pandemic, suggests a Statistics Canada report from April 2020. Though cases of intimate partner violence during the pandemic have been hard to track, service providers have reported increased calls for support from families isolated at home.

“COVID-19 has magnified the risk factors associated with intimate partner violence,” said Dr. Patricia O’Campo, Interim Executive Director of the Li Ka Shing Knowledge Institute and scientist at MAP Centre for Urban Health Solutions.

“With millions of jobs lost, closures of services and schools that are often sources of comfort and refuge and added burden on the shelter system, women experiencing intimate partner violence have nowhere to turn.”

Dr. O’Campo has been researching intimate partner violence for more than 25 years. She has pivoted some of her research to address violence that may be occurring during the pandemic.

Before the spread of COVID-19, Dr. O’Campo’s team designed and tested two apps to support women in abusive partnerships: the WITHWomen app, which helps women and their health care providers screen for abusive behaviours; and the Pathways app, which allows women to conduct a danger assessment for themselves and their children and build a personalized safety plan.

“The limitation of these apps is that they don’t have safety planning content tailored to a public health emergency like COVID-19,” Dr. O’Campo said. “For instance, the apps are not meant to be used in close proximity to the perpetrator, and they do present recommendations that may not be appropriate at this time, such as asking someone experiencing intimate partner violence to visit a friend or family member’s house for support.”

She and her co-principal investigator, Dr. Nicholas Metheny, a Post-Doctoral Research Fellow at St. Michael’s, have set out to redesign and test the Pathways app in the context of the pandemic.

Their research will focus on four activities: rapid research around safety planning, including compiling information from and with community agencies and women with lived experience; modification of the Pathways app to swap in content that is pandemic-appropriate; a social media awareness campaign about the apps; and the development of a toolkit to help providers incorporate the app into virtual appointments with those who may be at risk.

“Once we design a COVID-19 relevant version of the Pathways app, our research will be focused on making sure this tool can truly make a difference in people’s lives,” Dr. O’Campo said. “We want women to know they’re not alone, and we want to be able to support them through this difficult time.”

Toronto’s COVID-19 divide stretches beyond regional boundaries

Toronto’s northwest corner — which has been hardest hit by COVID-19 — is part of a larger hot spot of vulnerability that extends beyond the edges of the city, suggesting a broader regional cluster of high infection rates that defies boundaries and is exploiting socioeconomic inequalities, according to experts and public health data.

Officials are still trying to puzzle out why Toronto’s northwest corner has seen the city’s highest infection rates, and who, exactly, has been impacted most.

…Experts agree that it’s right for public health resources to focus on Toronto’s northwest corner, where COVID rates have been highest, but those efforts must extend beyond the regional border.

“One question is — are we seeing just one (hot spot)? Or are we just seeing the Toronto portion of a larger hot spot?” asks Dr. Stephen Hwang, director of MAP Centre for Urban Health Solutions at St. Michael’s Hospital. “Is it truly restricted to that area?”