The guiding principle of Agenda 2030 is the commitment to leave no one behind. However, as the Millennium Development Goals experience has demonstrated, there remains a rhetoric-implementation gap where local stakeholders struggle to realistically respond to policies formulated at the global level. This article proposes a way forward for NGOs seeking to translate the rhetoric of Agenda 2030 into reality. It presents an integrated and multi-sectoral approach to meet the challenges of an NGO working to ameliorate the basic needs of women who are affected by HIV/AIDS and limited WaSH provisions in the impoverished rural community of Lyantonde, Uganda.

African and Caribbean communities in Canada and other developed countries are disproportionately affected by HIV/AIDS. This qualitative study of African and Caribbean communities in Toronto sought to understand HIV-related stigma, discrimination, denial and fear, and the effects of multiple intersecting factors that influence responses to the disease, prevention practices and access to treatment and support services. Semi-structured interviews were conducted with 30 HIV-positive men and women and focus groups were conducted with 74 men and women whose HIV status was negative or unknown. We identified a range of issues faced by African and Caribbean people that may increase the risk for HIV infection, create obstacles to testing and treatment and lead to isolation of HIV-positive people. Our findings suggest the need for greater sensitivity and knowledge on the part of healthcare providers; more culturally specific support services; community development; greater community awareness; and expanded efforts to tackle housing, poverty, racism and settlement issues.

To explore how to better educate rural Africans about preventive HIV/AIDS vaccine trials, 15 semi-structured, open-ended interviews were conducted with villagers in Lyantonde, Rakai District, Uganda. This study reports on the findings by focusing on the attitudes, knowledge and questions the rural villagers had about HIV/AIDS-preventive vaccine testing. While several interviewees confused preventive vaccines with therapeutic vaccines, most were clear about the distinction and about key questions to ask about vaccine testing. In addition, some subjects manifested high levels of trust in the likely effectiveness of preventive vaccines, even in the testing stages, most subjects demonstrated the potential to be intelligently inquisitive about the likely effects. In sum, these villagers show the potential to be reliable subjects, motivated for appropriate reasons, and willing to play a role in advancing the progress of HIV/AIDS vaccine development in Africa.

Preventive vaccines are widely acknowledged as the best hope for protection against infectious pathogens such as avian flu, HIV and SARS. As a result, they have received much recent attention in the media that has exposed some of the challenges involved in optimally using vaccine technology.

This paper reports on the preliminary findings (year one) of a four-year intervention and Participatory-Action Research (PAR) project in Malawi. Project goals are to enhance the response capacity and effectiveness of Faith Community (FC) leaders to the problem of HIV/AIDS. Ethnographic interviews with FC leaders were conducted. Intercultural training sessions and theological events were also held using a participatory method called conceptual events. Preliminary results indicate a commitment on the part of faith community leaders to enter into a dialogue with other sectors and faith traditions in addressing the common, critical concern of HIV/AIDS. All FC leaders share a common feeling that they are a small moral voice in this fight against HIV/AIDS, drowned out by a 'big voice' promoting condom use by donors and government. FC leaders are expected to present themselves as having an authoritative voice with respect to protecting the soul, but at the same time are sincerely searching for ways to speak about HIV/AIDS in more practical ways. Condoms become a metaphor for resistance. For example, FC leaders wish to know how the message of condom promotion (a behavioural and technical argument) might be grafted onto what they would posit as a moral message of care, prevention and support. This challenge is made even more complex by the quiet assumption to incorporate the truths of African traditional religion (ATR) in the construction of an ecumenical theology of faith, hope and compassion.

The purpose of this qualitative study was to explore the experiences, perceptions, and needs of youth with physical disabilities in transition from adolescence to adulthood. Purposeful sampling strategies were used to select 34 study participants who lived in three regions of south-central Ontario, Canada. Data collection methods were individual and focus group interviews, and were guided by a set of open-ended questions. An editing style of analysis sorted the text into codes for description and interpretation. Themes emerged about context, the transition process, needs, and services. Participants identified a poor fit between young persons with disabilities and the adult world they were entering. They recommended that services be focused on environmental supports to enable them to "build their own bridges" to the adult world. Community-based transition services need to be planned in collaboration with youth with disabilities and their parents. Concepts of person-environment fit and health promotion can be incorporated into services to enable young persons with disabilities to experience a smooth transition from adolescence to adulthood.

End-of-life decisions regarding the withdrawal and withholding of lifesupporting technology have become commonplace within intensive careunits (ICUs). In this paper, we examine the dialogue between ICU teammembers and families regarding limitation of treatment as a therapeuticnarrative – that is, as a story which frames therapeutic events aswell as the critically ill patient's experience in a meaningful andpsychologically comforting way for families and health care providersalike. The key themes of these end-of-life narratives are discussed, aswell as the qualities that the stories share with other narratives ofthe same genre.

Children with physical disabilities encounter environmental constraints that limit their participation in daily occupations. The purpose of this qualitative research study was to work together with parents to discover environmental situations which presented substantial challenges to their children. The study took place in a city of 92,000 people in southern Ontario, Canada. Twenty‐two families who had a child with a disability between the ages of 3 to 12 years participated. Through focus groups and individual interviews, participants identified environmental factors which supported or hindered the daily occupations of their children. Social and institutional barriers were identified as the most significant environmental barriers. Although many physical barriers were identified, participants believed that attitudes or lack of knowledge prevented these barriers from being changed. The primary themes for change emerging from this study include parents' desire for more control, increased use of inclusion as a means to change attitudes, a need for a more flexible bureaucracy related to disability issues and a profound concern about the societal view of normality.

BACKGROUND The ability of many intensive care unit (ICU) technologies to prolong life has led to an outcomes-oriented approach to technology assessment, focusing on morbidity and mortality as clinically important end points. With advanced life support, however, the therapeutic goals sometimes shift from extending life to allowing life to end. The objective of this study was to understand the purposes for which advanced life support is withheld, provided, continued or withdrawn in the ICU. METHODS In a 15-bed ICU in a university-affiliated hospital, the authors observed 25 rounds and 11 family meetings in which withdrawal or withholding of advanced life support was addressed. Semi-structured interviews were conducted with 7 intensivists, 5 consultants, 9 ICU nurses, the ICU nutritionist, the hospital ethicist and 3 pastoral services representatives, to discuss patients about whom life support decisions were made and to discuss life-support practices in general. Interview transcripts and field notes were analysed inductively to identify and corroborate emerging themes; data were coded following modified grounded theory techniques. Triangulation methods included corroboration among multiple sources of data, multidisciplinary team consensus, sharing of results with participants and theory triangulation. RESULTS Although life-support technologies are traditionally deployed to treat morbidity and delay mortality in ICU patients, they are also used to orchestrate dying. Advanced life support can be withheld or withdrawn to help determine prognosis. The tempo of withdrawal influences the method and timing of death. Decisions to withhold, provide, continue or withdraw life support are socially negotiated to synchronize understanding and expectations among family members and clinicians. In discussions, one discrete life support technology is sometimes used as an archetype for the more general concept of technology. At other times, life-support technologies are discussed collectively to clarify the pursuit of appropriate goals of care. CONCLUSIONS The orchestration of death involves process-oriented as well as outcome-oriented uses of technology. These uses should be considered in the assessment of life-support technologies and directives for their appropriate use in the ICU.

The aim of this study was to understand the intention to use a condom for each instance of sexual intercourse with a new partner in three of Canada's non-dominant ethnocultural communities: Latin American (N = 346), English-speaking Caribbean (N = 358), and South Asian (N = 355). All respondents were recruited from multiple ethnocultural venues using predetermined sampling frames and quotas for each community. Anonymous questionnaires assessing culturally specific theoretical constructs were completed. This paper presents the methodology and the main findings. The high quality of the results of this study demonstrate the advantage of establishing strong partnerships with members of communities being studied.

This paper describes the survey results reporting demographic profiles, behaviours, opinions, beliefs, attitudes, and intentions related to condom use for three Canadian ethnocultural communities (Latin American, English-speaking Caribbean and South Asian) participating in the Ethnocultural Communities Facing AIDS Study. Specific recommendations are presented for HIV-prevention programming based on the research results.

This paper reports on issues identified in conversations held between one of the Ethnocultural Communities Facing AIDS Study (ECFA) investigators and five stakeholders associated with this experiment in collaborative and participatory research. The stakeholders reflect on their experiences in partnering with university-based researchers, resistance in ethnocultural communities to being researched, and the next steps implicated by the research in question. The problem of HIV/AIDS in ethnocultural communities in Canada is, relative to the mainstream, also viewed as a symbol of disadvantage in these communities. The stakeholders suggest that to address these deeper concerns, there must be vital, dynamic, and enduring communication between researchers, community representatives, and government at all levels, in the process of identifying solutions and implementing them in the present.