Aim Causal inference relies on correct background knowledge, which epidemiologists generally understand to come from academic experts. Our community-engaged study augments scientific domain knowledge with lived/living experience to co-construct the directed acyclic graph (DAG) underpinning our team's research question about ageing and HIV. We outline our team's process for co-creating the community-based DAG and describe qualitative reflections from team members regarding these methods. Our overarching goal was to expand expert knowledge to include community expertise by engaging peer researchers in DAG co-development.Methods We assembled a team of quantitative and qualitative researchers, including a diverse group of peer researchers living with HIV. The team co-constructed a DAG, illustrated by a peer researcher-artist, combining the lived/living experience of peer researchers with subject-matter expertise from academic researchers. The DAG was refined with input from epidemiologists. Qualitative researchers transcribed DAG co-development sessions to understand how peer researchers engaged with this tool.Results Qualitative reflections allowed the study team to critically analyse our process. Peer researchers found drawing the DAG intuitive. Having a visual representation of causal relationships led to active discussion and greater understanding. The complexity of the DAG enmeshed with temporal ordering humanised the research; seeing the web of covariates resonated as a reflection of a person's life journey. One peer researcher found that incorporating diverse perspectives meant upholding unique expertise and not only platforming academic expertise.Conclusions Co-constructing DAGs incorporating lived/living experience is reasonable and possible. Co-constructing DAGs may strengthen epidemiologic studies by reconceptualising the traditional epidemiologic definition of expert knowledge.

Research is needed to better understand factors promoting health and well-being with Indigenous Peoples and people with socioeconomic barriers in Canada, given they face multiple social determinants that are barriers to health. Individual dispositions, sense of purpose and conscientiousness, are known to predict health and well-being in broader samples. In a community-based approach, guided by Indigenous Elders with traditional ways of knowing, we aimed to determine whether these measures correlate with self-rated health and well-being among Indigenous (n = 149) and non-Indigenous (n = 151) Peoples in Vancouver, Canada. The majority of participants (mean age 49 years, and 58% male) had relatively low income (≤$15,000/year) and educational attainment (<high school). Factors were valid and reliable in all groups. Mean scores were similar between Indigenous and non-Indigenous groups, and lower among participants with lower than with higher income. Correlations were similar between Indigenous and non-Indigenous groups: purpose significantly correlated with health (SF-6; 0.34 and 0.28, p < .001) and life satisfaction (0.55 and 0.58, p < .001), and conscientiousness with health (0.19 and 0.18, p < .05). Correlations were similar between income groups. When exploring and promoting the health, equity, and well-being of Indigenous and low socioeconomic status communities, purpose and personal disposition are factors to consider alongside social determinants of health.

Scholarship on the place of the HIV/AIDS crisis in urban geographies of sexual minority activism has powerfully insisted on the importance of community organising as a response to state and societal failures and to their homophobic, AIDS phobic and morally conservative underpinnings. This paper extends this scholarship by examining the urban social geographies of exclusion produced by such community organising efforts. It draws on the perspectives of long-term survivors of HIV/AIDS (LTS) in Vancouver to highlight the differentiated care geographies of HIV/AIDS that resulted from the racialised, classed and gendered politics and urban imaginations enacted by gay and allied HIV/AIDS organising. Though LTS networks, spaces and politics of care and community were more extended than Vancouver’s gay community during the 1980s and 1990s, the centring of the West End gay village in many community-led responses to HIV/AIDS resulted in LTS geographies outside the West End being excluded from important systems of care and community. LTS narratives of the city at the time of the ‘gay disease’ thus tell an urban politics of sexual and health activisms as shaped not only by processes of heteronormativity and homophobia but also of racially, colonially and class-inflected homonormative urban imaginaries.

The DUDES Club is a novel men’s health and wellness organization founded in 2010 in Vancouver, BC. Since 2017, the DUDES Club has rapidly expanded in Northern BC and, with the help of a partnership with the First Nations Health Authority, has grown to include 40 sites in British Columbia and 2 sites nationally. In this study, we analyze interviews (n = 5) and 15 focus groups (n = 101) conducted as part of a program evaluation with DUDES Club members, Elders, providers, and health care professionals. We focus on men’s experiences with the DUDES Club to identify four main themes in the data: brotherhood and community, accessible health care information, disrupting colonial constructions of masculinity, and systemic and structural challenges. We conclude with policy recommendations.

Abstract Despite the availability of prevention and treatment services, the ongoing process of colonization has significantly contributed to disproportionate rates of HIV, hepatitis C (HCV), and HIV/HCV coinfection among Indigenous peoples. This inequity highlights a deficit in health care's ability to provide effective and culturally relevant services. Indigenous peoples have used land-based cultural practices to promote wellness since time immemorial, yet they have rarely been evaluated as health interventions. Given the severity of these health inequities, it is imperative that gaps in research and services be addressed quickly and in “good way,” whereby the research undertaken is a sacred endeavor that is connected to ceremony and ancestral wisdom and contributes to healing. Land-based cultural-wellness retreats represent a fruitful path toward wholistic wellness and decolonization. The purpose of this review is to understand the theoretical utility of and wise practices for conducting land-based cultural-wellness retreats for Indigenous peoples with HIV, HCV, or both.

Problem addressed In Canada, there are few health promotion programs for men, particularly programs focused on indigenous and other men marginalized by social and structural inequities. Objective of program To build solidarity and brotherhood among vulnerable men; to promote health through education, dialogue, and health screening clinics; and to help men regain a sense of pride and fulfilment in their lives. Program description The DUDES Club was established in 2010 as a community-based health promotion program for indigenous men in the Downtown Eastside neighbourhood of Vancouver, BC. Between August 2014 and May 2015, 150 men completed an evaluation survey developed using a logic model approach. Responses were analyzed based on the 4 dimensions of the indigenous medicine wheel (mental, physical, emotional, and spiritual). Evaluation results demonstrated high participant satisfaction and positive outcomes across all 4 dimensions of health and well-being: 90.6% of respondents indicated that the DUDES Club program improved their quality of life. Participants who attended meetings more often experienced greater physical, mental, and social benefits ( P < .05). Conclusion Findings indicate that this innovative model is effective in promoting the well-being of mainly indigenous men through culturally safe services in an urban community.

Problem addressed In Canada, there are few health promotion programs for men, particularly programs focused on indigenous and other men marginalized by social and structural inequities.Objective of program To build solidarity and brotherhood among vulnerable men; to promote health through education, dialogue, and health screening clinics; and to help men regain a sense of pride and fulfilment in their lives.Program description The DUDES Club was established in 2010 as a community-based health promotion program for indigenous men in the Downtown Eastside neighbourhood of Vancouver, BC. Between August 2014 and May 2015, 150 men completed an evaluation survey developed using a logic model approach. Responses were analyzed based on the 4 dimensions of the indigenous medicine wheel (mental, physical, emotional, and spiritual). Evaluation results demonstrated high participant satisfaction and positive outcomes across all 4 dimensions of health and wellbeing: 90.6% of respondents indicated that the DUDES Club program improved their quality of life. Participants who attended meetings more often experienced greater physical, mental, and social benefits (P <.05).Conclusion Findings indicate that this innovative model is effective in promoting the well-being of mainly indigenous men through culturally safe services in an urban community.