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Associations Between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease - Data
(2016) Crispo, James A. G.; Willis, Allison W.; Thibault, Dylan P.; Fortin, Yannick; Hays, Harlen D.; McNair, Douglas S.; Bjerre, Lise M.; Kohen, Dafna E.; Perez-Lloret, Santiago; Mattison, Donald R.; Krewski, Daniel
Background: Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population. Methods: Using the Cerner Health Facts® database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits. Results: Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (≥4) were more likely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29-1.88) and delirium (AOR: 1.61, 95% CI: 1.08-2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10-1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33) within 30-days of discharge. Conclusions: We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD.
Systematic reviews need to consider applicability to disadvantaged populations: inter-rater agreement for a health equity plausibility algorithm
(2012) Welch, Vivian; Brand, Kevin; Kristjansson, Elizabeth; Smylie, Janet; Wells, George; Tugwell, Peter
Background: Systematic reviews have been challenged to consider effects on disadvantaged groups. A priori specification of subgroup analyses is recommended to increase the credibility of these analyses. This study aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations (only relative effect measures were addressed). Methods: A health equity plausibility algorithm was developed using clinimetric methods with three items based on literature review, key informant interviews and methodology studies. The three items dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: 1) patient characteristics; 2) intervention delivery (i.e., implementation); and 3) comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. We assessed inter-rater reliability using Fleiss multi-rater kappa. Results: The proportion agreement was 66% for patient characteristics (95% confidence interval: 61%-71%), 67% for intervention delivery (95% confidence interval: 62% to 72%) and 55% for the comparator (95% confidence interval: 50% to 60%). Inter-rater kappa, assessed with Fleiss kappa, ranged from 0 to 0.199, representing very low agreement beyond chance. Conclusions: Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this need.
The Influence of Place on Weight Gain during Early Childhood: A Population-Based, Longitudinal Study
(2012) Carter, Megan A.; Dubois, Lise; Tremblay, Mark S.; Taljaard, Monica
The objective of this paper was to determine the influence of place factors on weight gain in a contemporary cohort of children while also adjusting for early life and individual/family social factors. Participants from the Québec Longitudinal Study of Child Development comprised the sample for analysis (n=1,580). A mixed-effects regression analysis was conducted to determine the longitudinal relationship between these place factors and standardized BMI, from age 4 to 10 years. The average relationship with time was found to be quadratic (rate of weight gain increased over time). Neighborhood material deprivation was found to be positively related to weight gain. Social deprivation, social disorder, and living in a medium density area were inversely related, while no association was found for social cohesion. Early life factors and genetic proxies appeared to be important in explaining weight gain in this sample. This study suggests that residential environments may play a role in childhood weight change; however, pathways are likely to be complex and interacting and perhaps not as important as early life factors and genetic proxies. Further work is required to clarify these relationships.
Local social environmental factors are associated with household food insecurity in a longitudinal study of children
(2012) Carter, Megan Ann; Dubois, Lise; Tremblay, Mark S.; Taljaard, Monica
Background Food insecurity is a significant public health problem in North America and elsewhere. The prevalence of food insecurity varies by country of residence; within countries, it is strongly associated with household socioeconomic status, but the local environment may also play an important role. In this study, we analyzed secondary data from a population-based survey conducted in Québec, Canada, to determine if five local environmental factors: material and social deprivation, social cohesion, disorder, and living location were associated with changes in household food insecurity over a period of 6 years, while adjusting for household socioeconomic status (SES) and other factors. Methods Data from the Québec Longitudinal Study of Child Development, following same-aged children from 4–10 y of age, were analyzed using generalized estimating equations, to determine the longitudinal association between these environmental factors and food insecurity over a period of 6 years. Results Of the 2120 children originally included in the cohort, 1746 (82%) were included in the present analysis. The prevalence of food insecurity was 9.2% when children were 4 y of age (95% CI: 7.8 – 10.6%) but no significant changes were observed over time. On average over the 6 year period, three environmental factors were positively related to food insecurity: high social deprivation (OR 1.62, 95%CI: 1.16 – 2.26), low social cohesion (OR 1.45 95%CI: 1.10 – 1.92), and high disorder (OR 1.76, 95%CI: 1.37 – 2.27), while living location and material deprivation were not related to food insecurity. These associations were independent of household SES and other social variables. Conclusion These results highlight the potential role of the local social environment in preventing and ameliorating food insecurity at the household level. Stakeholders providing food security interventions at the community level should consider interactions with local social characteristics and perhaps changing the social environment itself. Further intervention research also examining interactions with household-level factors could lead to the development of interventions that increase both household and community-level food security.
Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol
(2012) Jull, Janet; Stacey, Dawn; Giles, Audrey; Boyer, Yvonne; Minwaashin Lodge, the Aboriginal Women's Support Centre
Background Little is known about shared decision-making (SDM) with Métis, First Nations and Inuit women (“Aboriginal women”). SDM is a collaborative process that engages health care professional(s) and the client in making health decisions and is fundamental for informed consent and patient-centred care. The objective of this study is to explore Aboriginal women’s health and social decision-making needs and to engage Aboriginal women in culturally adapting an SDM approach. Methods Using participatory research principles and guided by a postcolonial theoretical lens, the proposed mixed methods research will involve three phases. Phase I is an international systematic review of the effectiveness of interventions for Aboriginal peoples’ health decision-making. Developed following dialogue with key stakeholders, proposed methods are guided by the Cochrane handbook and include a comprehensive search, screening by two independent researchers, and synthesis of findings. Phases II and III will be conducted in collaboration with Minwaashin Lodge and engage an urban Aboriginal community of women in an interpretive descriptive qualitative study. In Phase II, 10 to 13 Aboriginal women will be interviewed to explore their health/social decision-making experiences. The interview guide is based on the Ottawa Decision Support Framework and previous decisional needs assessments, and as appropriate may be adapted to findings from the systematic review. Digitally-recorded interviews will be transcribed verbatim and analyzed inductively to identify participant decision-making approaches and needs when making health/social decisions. In Phase III, there will be cultural adaptation of an SDM facilitation tool, the Ottawa Personal Decision Guide, by two focus groups consisting of five to seven Aboriginal women. The culturally adapted guide will undergo usability testing through individual interviews with five to six women who are about to make a health/social decision. Focus groups and individual interviews will be digitally-recorded, transcribed verbatim, and analyzed inductively to identify the adaptation required and usability of the adapted decision guide. Discussion Findings from this research will produce a culturally sensitive intervention to facilitate SDM within a population of urban Aboriginal women, which can subsequently be evaluated to determine impacts on narrowing health/social decision-making inequities.
Trajectories of Childhood Weight Gain: The Relative Importance of Local Environment versus Individual Social and Early Life Factors
(2012) Carter, Megan A.; Dubois, Lise; Tremblay, Mark S.; Taljaard, Monica; Jones, Bobby L.
Objective To determine the association between local environmental factors with child weight status in a longitudinal study, using a semi-parametric, group-based method, while also considering social and early life factors. Methods Standardized, directly measured BMI from 4–10 y of age, and group-based trajectory modeling (PROC TRAJ) were used to estimate developmental trajectories of weight change in a Québec birth cohort (n = 1,566). Associations between the weight trajectories and living location, social cohesion, disorder, and material and social deprivation were estimated after controlling for social and early life factors. Results Four weight trajectory groups were estimated: low-increasing (9.7%); low-medium, accelerating (36.2%); medium-high, increasing (43.0%); and high-stable (11.1%). In the low-increasing and medium-high trajectory groups, living in a semi-urban area was inversely related to weight, while living in a rural area was positively related to weight in the high-stable group. Disorder was inversely related to weight in the low-increasing group only. Other important risk factors for high-stable weight included obesity status of the mother, smoking during pregnancy, and overeating behaviors. Conclusions In this study, associations between local environment factors and weight differed by trajectory group. Early life factors appear to play a more consistent role in weight status. Further work is needed to determine the influence of place on child weight.
Travelling Well: Essays in Medical Tourism
(2013-02-07) Labonté, Ronald; Runnels, Vivien; Packer, Corinne; Deonandan, Raywat; Blouin, Chantal; Chanda, Rupa; Chikanda, Abel; Crooks, Valorie; Crush, Jonathon; Ferreyra Galliani, Mariella; Hopkins, Lorraine; Johnston, Rory; Maswikwa, Belinda; Snyder, Jeremy
The opening years of the 21st century have been characterized by a variety of technological, social, political and economic factors that have seen the disintegration of the meaning and importance of international borders. From the power of the Internet to link disparate populations, to the consolidation of blocs of politically intertwined nations such as the European Union (EU), and the rise of affordable international travel, forces have been combining to bring about a globalized world economy that was only theorized in decades past. An obvious facet of this new globalization is the permeability of borders to the movement of consumers seeking a variety of medical services, and providers willing to accommodate, if not also profit, from this demand. Medical tourism refers to situations wherein an individual makes a decision to physically travel to a location in another country for the purpose of obtaining medical treatment for which he or she has paid (out-of-pocket or through individual insurance plans). This book draws from the collective efforts and thoughts of a collaboration of researchers interested in the phenomenon of medical tourism. The services sought span a surprisingly diverse array of medical products, interventions and technologies and the motivations of travellers seeking these services are equally as diverse. The book reflects the diverse aspects of medical tourism and reflects on future directions for this globalized industry.
Neighburhoods and Child Adiposity: A Critical Appraisal of the Literature
(2009) Carter, Megan Ann; Dubois, Lise
This paper critically appraised the published literature to determine the relationship between physical and social environmental features of neighbourhoods with child adiposity. MEDLINE,EMBASE, PsychINFO, and SCOPUS were searched from 1999 to July 2009 using a systematic search strategy. Twenty- seven primary studies were included based on a prior eligibility criteria. Socioeconomic disadvantage was consistently shown to increase child adiposity, while there was some evidence that high social capital protected against increased adiposity. It is unclear at this time if and how other neighbourhood environmental features play a role. Heterogeneity and methodological issues across studies limits our ability to draw overall conclusions.
Folic Acid Supplement Use is the Most Significant Predictor of Folate Concentrations in Canadian Women of Childbearing Age
(2012-04-24) Colapinto, Cynthia K.; O'Connor, Deborah L.; Dubois, Lise; Tremblay, Mark S.
One-fifth of Canadian women of childbearing age (WCBA) have red blood cell (RBC) folate concentrations below those considered optimal for neural tube defect risk reduction (≥906 nmol·L(-1)). Determinants of optimal concentrations have not been examined in a nationally representative sample of Canadian WCBA since food fortification with folic acid was implemented. This study explored correlates of optimal RBC folate concentrations and characteristics of folic acid supplement users in a sample of Canadian WCBA. RBC folate concentrations from the 2007-2009 Canadian Health Measures Survey were assessed in women aged 15 to 45 years (n = 1162). Sociodemographic, behavioural, and clinical determinants of RBC folate ≥906 nmol·L(-1) were examined using univariate and separate multiple logistic regression models that controlled for age and household income. t tests were used to study differences between folic acid supplement users and nonusers. WCBA not taking folic acid supplements were less likely to achieve a RBC folate concentration ≥906 nmol·L(-1) compared with folic acid supplement users (odds ratio, 0.47; 95% confidence interval, 0.24, 0.92). Twenty-five percent of WCBA reported folic acid supplement use, and there was a higher percentage of folic acid supplement users in the highest income group. Folic acid supplement users were also more frequent consumers of supplemental vitamin B(12) and of fruit and vegetables (>3 times per day). Folic acid supplement use was the most significant predictor of WCBA achieving optimal RBC folate concentrations. These results indicate a need for targeted strategies to improve compliance with folic acid supplement recommendations among WCBA.
A Multilevel Analysis of Neighbourhood Built and Social Environments and Adult Self-Reported Physical Activity and Body Mass Index in Ottawa, Canada
(2011) Prince, Stephanie A.; Kristjansson, Elizabeth A.; Russell, Katherine; Billette, Jean-Michel; Sawada, Michael; Ali, Amira; Tremblay, Mark S.; Prud’homme, Denis
Canadian research examining the combined effects of social and built environments on physical activity (PA) and obesity is limited. The purpose of this study was to determine the relationships among built and social environments and PA and overweight/obesity in 85 Ottawa neighbourhoods. Self-reported PA, height and weight were collected from 3,883 adults using the International PA Questionnaire from the 2003-2007 samples of the Rapid Risk Factor Surveillance System. Data on neighbourhood characteristics were obtained from the Ottawa Neighbourhood Study; a large study of neighbourhoods and health in Ottawa. Two-level binomial logistic regression models stratified by sex were used to examine the relationships of environmental and individual variables with PA and overweight/obesity while using survey weights. Results identified that approximately half of the adults were insufficiently active or overweight/obese. Multilevel models identified that for every additional convenience store, men were two times more likely to be physically active (OR = 2.08, 95% CI: 1.72, 2.43) and with every additional specialty food store women were almost two times more likely to be overweight or obese (OR = 1.77, 95% CI: 1.33, 2.20). Higher green space was associated with a reduced likelihood of PA (OR = 0.93, 95% CI: 0.86, 0.99) and increased odds of overweight and obesity in men (OR = 1.10, 95% CI: 1.01, 1.19), and decreased odds of overweight/obesity in women (OR = 0.66, 95% CI: 0.44, 0.89). In men, neighbourhood socioeconomic scores, voting rates and sense of community belonging were all significantly associated with overweight/obesity. Intraclass coefficients were low, but identified that the majority of neighbourhood variation in outcomes was explained by the models. Findings identified that green space, food landscapes and social cohesiveness may play different roles on PA and overweight/obesity in men and women and future prospective studies are needed.
Reporting Guidelines for Survey Research: An Analysis of Published Guidance and Reporting Practices
(2011) Bennett, Carol; Khangura, Sara; Brehaut, Jamie C.; Graham, Ian D.; Moher, David; Potter, Beth K.; Grimshaw, Jeremy M.
Background: Research needs to be reported transparently so readers can critically assess the strengths and weaknesses of the design, conduct, and analysis of studies. Reporting guidelines have been developed to inform reporting for a variety of study designs. The objective of this study was to identify whether there is a need to develop a reporting guideline for survey research. Methods and Findings: We conducted a three-part project: (1) a systematic review of the literature (including ‘‘Instructions to Authors’’ from the top five journals of 33 medical specialties and top 15 general and internal medicine journals) to identify guidance for reporting survey research; (2) a systematic review of evidence on the quality of reporting of surveys; and (3) a review of reporting of key quality criteria for survey research in 117 recently published reports of self-administered surveys. Fewer than 7% of medical journals (n = 165) provided guidance to authors on survey research despite a majority having published survey-based studies in recent years. We identified four published checklists for conducting or reporting survey research, none of which were validated. We identified eight previous reviews of survey reporting quality, which focused on issues of non-response and accessibility of questionnaires. Our own review of 117 published survey studies revealed that many items were poorly reported: few studies provided the survey or core questions (35%), reported the validity or reliability of the instrument (19%), defined the response rate (25%), discussed the representativeness of the sample (11%), or identified how missing data were handled (11%). Conclusions: There is limited guidance and no consensus regarding the optimal reporting of survey research. The majority of key reporting criteria are poorly reported in peer-reviewed survey research articles. Our findings highlight the need for clear and consistent reporting guidelines specific to survey research.
Globalization and Its Methodological Discontents: Contextualizing Globalization through the Study of HIV/AIDS
(2011) Labonté, Ronald; Brown, Garrett W.
There remains considerable discontent between globalization scholars about how to conceptualize its meaning and in regards to epistemological and methodological questions concerning how we can come to understand how these processes ultimately operate, intersect and transform our lives. This article argues that to better understand what globalization is and how it affects issues such as global health, we must take a differentiating approach, which focuses on how the multiple processes of globalization are encountered and informed by different social groups and with how these encounters are experienced within particular contexts. The article examines the heuristic properties of qualitative field research as a means to help better understand how the intersections of globalization are manifested within particular locations. To do so, the article focuses on three recent case studies conducted on globalization and HIV/AIDS and explores how these cases can help us to understand the contextual permutations involved within the processes of globalization.
Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City
(2012-01-28) Kristjansson, Elizabeth A.; Russell, Katherine; Billette, Jean-Michel; Sawada, Michael C.; Ali, Amira; Tremblay, Mark S.; Prud'homme, Denis; Prince, Stephanie A.
In Canada, there is limited research examining the associations between objectively measured neighborhood environments and physical activity (PA) and obesity. The purpose of this study was to determine the relationships between variables from built and social environments and PA and overweight/obesity across 86 Ottawa, Canada neighborhoods. Individual-level data including self-reported leisure-time PA (LTPA), height, and weight were examined in a sample of 4,727 adults from four combined cycles (years 2001/03/05/07) of the Canadian Community Health Survey (CCHS). Data on neighborhood characteristics were obtained from the Ottawa Neighbourhood Study (ONS); a large study of neighborhoods and health in Ottawa, Canada. Binomial multivariate multilevel models were used to examine the relationships between environmental and individual variables with LTPA and overweight/obesity using survey weights in men and women separately. Within the sample, ~75% of the adults were inactive (<3.0 kcal/kg/day) while half were overweight/obese. Results of the multilevel models suggested that for females greater park area was associated with increased odds of LTPA and overweight/obesity. Greater neighborhood density of convenience stores and fast food outlets were associated with increased odds of females being overweight/obese. Higher crime rates were associated with greater odds of LTPA in males, and lower odds of male and female overweight/obesity. Season was significantly associated with PA in men and women; the odds of LTPA in winter months were half that of summer months. Findings revealed that park area, crime rates, and neighborhood food outlets may have different roles with LTPA and overweight/obesity in men and women and future prospective studies are needed.
Euthanasia: A Confounding and Intricate Issue
(2011-11-30) Marcoux, Isabelle
Euthanasia: A Confounding and Intricate Issue is a chapter in Euthanasia - The "Good Death" Controversy in Humans and Animals, edited by Josef Kuře (2011) and published online by InTech. Euthanasia is still illegal in most countries. Nevertheless it is one of the most-debated ethical issues in recent decades, as revealed by the considerable number of scientific publications, the media coverage of specific cases, and proposed legislation in many countries. One of the most significant challenge in order to have an informed debate on this issue is to define euthanasia It is often associated with “wanting to die with dignity”, “not wanting to be kept alive against one’s wishes”, “not wanting to suffer”, and “wanting to die rather than live in a certain condition”. Among members of the public and even health care practitioners, the term is used to refer to situations ranging from the last injection allowing a person to pass from life; to death in a context of incurable illness through withholding treatment that would do more harm than good (futile treatment) and withdrawing life support that keeps the person alive (mechanical ventilation, feeding and hydration tubes); to relieving the pain and other symptoms of persons at the end of life whose next breath may well be their last. This chapter delineates what is meant by the term euthanasia, and to see how the various interpretations of this term lead to confusion and misunderstanding that often render debate pointless. Part 2 describes what euthanasia is now considered to consist in, and puts it in perspectives with other types of end-of-life decisions that characteristically arise in medical practice. Part 3 lists studies that have attempted to clarify people’s understandings of euthanasia and particularly in relation to other end-of-life practices. Part 4 discusses the interpersonal, societal and political issues raised by these varied understandings of euthanasia according to various groups.
Framing International Trade and Chronic Disease
(2011-10-28) Labonté, Ronald; Mohindra, Katia S.; Lencucha, Raphael
There is an emerging evidence base that global trade is linked with the rise of chronic disease in many low and middle-income countries (LMICs). This linkage is associated, in part, with the global diffusion of unhealthy lifestyles and health damaging products posing a particular challenge to countries still facing high burdens of communicable disease. We developed a generic framework which depicts the determinants and pathways connecting global trade with chronic disease. We then applied this framework to three key risk factors for chronic disease: unhealthy diets, alcohol, and tobacco. This led to specific ‘product pathways’, which can be further refined and used by health policy-makers to engage with their country’s trade policy-makers around health impacts of ongoing trade treaty negotiations, and by researchers to continue refining an evidence base on how global trade is affecting patterns of chronic disease. The prevention and treatment of chronic diseases is now rising on global policy agendas, highlighted by the UN Summit on Noncommunicable Diseases (September 2011). Briefs and declarations leading up to this Summit reference the role of globalization and trade in the spread of risk factors for these diseases, but emphasis is placed on interventions to change health behaviours and on voluntary corporate responsibility. The findings summarized in this article imply the need for a more concerted approach to regulate trade-related risk factors and thus more engagement between health and trade policy sectors within and between nations. An explicit recognition of the role of trade policies in the spread of noncommunicable disease risk factors should be a minimum outcome of the September 2011 Summit, with a commitment to ensure that future trade treaties do not increase such risks.
The GOAL Project: University-Community Action on HIV/AIDS
(2008) Bisaillon, Laura
Refugee + Support Project
(2008) Bisaillon, Laura
The Global Ottawa AIDS Link Workshop Report
(2007) Liyanage, Sujatha; Bisaillon, Laura
Human Rights Consequences of Mandatory HIV Screening Policy of Newcomers to Canada
(2010) Bisaillon, Laura
This paper focuses on the key human rights consequences of the HIV screening policy that applies to all permanent and some temporary resident applicants to Canada. This mandatory policy was introduced in early 2002 by Citizenship and Immigration Canada after consultation with Health Canada. The policy has yet to be evaluated and, until recently, the actualities of the medical encounters where testing occurs in domestic and international settings have not been researched. There is no systematic documentation of the policy’s implications on either the lives of persons who submit to mandatory testing or on health systems. This article argues that there are sound options for responding to the human rights challenges posed by the screening policy. Data were obtained from secondary literature and findings from empirical fieldwork and research among immigrants living with HIV/AIDS in Canada. This paper adds to theoretical and applied health services and interventions work by focusing attention on avenues for addressing key human rights concerns posed by the policy. These are identified and critically explored through the framework that Lawrence Gostin and the late Jonathan Mann developed in 1999, which was later extended by Barry Hoffmaster and Ted Schrecker in 2000. The article concludes with four recommendations for addressing the central human rights consequences of the policy.
Working From Within Endemic HIV Stigma: Developing Canadian Social Workers' Understanding of the Challenges Faced by Newcomers Managing HIV
(2010) Bisaillon, Laura
HIV stigma is central to this article's discussion and analysis because of the widely documented negative social and health impacts on Canadians living with HIV in general and ethnocultural communities in particular. The goal of this theoretically and empirically informed article is to provide insight for Canadian social workers on the challenges faced by newcomers infected with or affected by HIV. This is achieved by problematizing sociocultural contexts that sustain stigmatization and exploring how these interact with people living with HIV (PHA). Increased caseloads of migrants PHAs in Canada since early 2002 means that social workers throughout Canada have had to adjust and acquire new competencies. This article is informed by field research and social work practice with newcomers in three Canadian cities. HIV stigma is endemic in Canada, and this article posits that social workers with an increased critical awareness about stigma on individual, social and translocal levels can best support migrant PHAs. This article concludes with two key messages for social workers.

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