How Do Surveillance Systems How Do Surveillance Systems Organize Service Delivery?Organize Service Delivery?

Martin FrenchSociology & Anthropology

The Case of HIV Surveillance in Ontario

OutlineOutline

I.I. Scholarship on Surveillance and Work PracticeScholarship on Surveillance and Work Practice

II.II. HIV Surveillance in Ontario—How Does It Work?HIV Surveillance in Ontario—How Does It Work? Two mutually-reinforcing circuits of surveillanceTwo mutually-reinforcing circuits of surveillance

Epidemiological surveillanceEpidemiological surveillance Surveillance at the point-of-care or service deliverySurveillance at the point-of-care or service delivery

III.III. Service Providers as Surveillance Agents?Service Providers as Surveillance Agents?

IV.IV. Concluding RemarksConcluding Remarks

Scholarship on Surveillance Scholarship on Surveillance and Work Practiceand Work Practice

Classic sociologies (e.g. Karl Marx, Max Classic sociologies (e.g. Karl Marx, Max Weber) illustrated how supervision and Weber) illustrated how supervision and oversight could constrain individual oversight could constrain individual discretion in the context of organizational discretion in the context of organizational workwork

Part I

Scholarship on Surveillance Scholarship on Surveillance and Work Practiceand Work Practice

More contemporarily, social More contemporarily, social scientists (e.g. Geoff Bowker scientists (e.g. Geoff Bowker and Susan Leigh Star) have and Susan Leigh Star) have illustrated the role of illustrated the role of classification and classification and surveillance systems in the surveillance systems in the regulation not just of service regulation not just of service provision, but also provision, but also professional practice.professional practice.

Part I

HIV Surveillance in OntarioHIV Surveillance in Ontario—How Does It Work?—How Does It Work?

HIV TestingHIV Testing NominalNominal Non-nominalNon-nominal AnonymousAnonymous

Part II

HIV Surveillance in OntarioHIV Surveillance in Ontario—How Does It Work?—How Does It Work?

HIV Testing and epidemiological surveillanceHIV Testing and epidemiological surveillance Politics of classificationPolitics of classification

Part II

HIV Surveillance in OntarioHIV Surveillance in Ontario—How Does It Work?—How Does It Work?

HIV Testing and HIV Testing and Surveillance at the point-of-Surveillance at the point-of-carecare

Ideally used to guide subsequent clinical Ideally used to guide subsequent clinical interactionsinteractions

Part II

Service Providers Service Providers as Surveillance Agents?as Surveillance Agents?

HIV Testing and HIV Testing and Surveillance at the point-of-careSurveillance at the point-of-care Care—ControlCare—Control

Part III

Concluding RemarksConcluding Remarks

Part IV

AcknowledgementsAcknowledgements

Thanks to Alex McClelland for organizing this Thanks to Alex McClelland for organizing this important workshop and for inviting me to important workshop and for inviting me to participateparticipate

Thanks to Liam Michaud for acting as our Thanks to Liam Michaud for acting as our discussantdiscussant

Thanks, everyone, for participating in this Thanks, everyone, for participating in this discussiondiscussion

Thanks to SSHRC, CIHR and the US HHS for funding Thanks to SSHRC, CIHR and the US HHS for funding while conducting the research informing this while conducting the research informing this presentationpresentation

Part IV

ReferencesReferencesBowker and StarBowker and StarBergBergDodds, C., Weait, M., Bourne, A., Egede, S., Jessup, K., and Weatherburn, P. Dodds, C., Weait, M., Bourne, A., Egede, S., Jessup, K., and Weatherburn, P.

(2013). (2013). Keeping Confidence: HIV and the Criminal Law from Service Keeping Confidence: HIV and the Criminal Law from Service Provider PerspectivesProvider Perspectives. London: Sigma Research, London School of . London: Sigma Research, London School of Hygiene and Tropical MedicineHygiene and Tropical Medicine

MolMolMykhalovskiy, E. 2011. “The Problem of ‘Significant Risk’: Exploring the Public Mykhalovskiy, E. 2011. “The Problem of ‘Significant Risk’: Exploring the Public

Health Impact of Criminalizing HIV Non-disclosure,” Health Impact of Criminalizing HIV Non-disclosure,” Social Science & Social Science & MedicineMedicine 7373(5): 668-675.(5): 668-675.

Mykhalovskiy, E., Betteridge, G., and McLay, D. 2010. Mykhalovskiy, E., Betteridge, G., and McLay, D. 2010. HIV Non-Disclosure and HIV Non-Disclosure and the Criminal Law: Establishing Policy Options for Ontariothe Criminal Law: Establishing Policy Options for Ontario. Toronto: a . Toronto: a report funded by a grant from the Ontario HIV Treatment Network.report funded by a grant from the Ontario HIV Treatment Network.

O’Byrne, P. and Gagnon, M. (2012). ‘HIV Criminalization & Nursing Practice’. O’Byrne, P. and Gagnon, M. (2012). ‘HIV Criminalization & Nursing Practice’. Aporia: The Nursing JournalAporia: The Nursing Journal, , 44(2), 5-34.(2), 5-34.

SandersSanders

Part IV