Overview

Background

Historically, queer and trans communities have faced a range of health disparities in comparison to their heterosexual and cisgender counterparts. Often, many community health programs responded with deficit-based approaches that are primarily focused on the individual - what they are doing wrong, and what changes they need to make to improve their health and wellbeing. The Pivot program takes a different approach. 

Firstly, Pivot is an asset-based program. Queer and trans communities across Canada have demonstrated extraordinary resilience, time and time again stepping up and into the gaps to fight for the health, well-being, and rights of their communities. It is this resilience that Pivot aims to harness, building the capacity of and centering queer and trans communities in the development and delivery of community-driven responses to the health challenges they face.

Secondly, Pivot shifts the burden of change from the individual to the systems around them. The primary drivers of the health disparities facing queer, trans, and Two Spirit people are stigma and discrimination, including homophobia, transphobia, racism, HIV stigma, and ableism. These forms of stigma and discrimination not only create a context wherein queer and trans people are more likely to experience negative health outcomes but also create barriers to queer and trans people accessing culturally competent care and supports. Therefore, Pivot participants are equipped with the knowledge and skills they need to dig deeper and understand the root causes of the health challenges queer, trans, and Two Spirit communities face, with a specific focus on how the systems around us contribute to these challenges and what changes to those systems are necessary for improved health and wellbeing.

If you are a community member interested in disrupting the status quo and becoming a system change leader in your community (or are an organization interested in helping to develop such leaders) then Pivot is the program for you!

Pivot at a Glance

Like other community health leadership programs developed and delivered by CBRC and its partners, Pivot aims to:

• Build connections between participants – with participants establishing long-term friendships that last long beyond the end of the program
• Improve participant health literacy – with participants demonstrating increased knowledge and increased capacity to adopt positive health behaviours and access relevant health services
• Train participants in systems change skills – with participants gaining practical skills which can be applied in a variety of real-world contexts beyond the end of the program
• Empower participants to solve health challenges in community – with participants having the opportunity to lead the development and delivery of health responses to issues facing their communities

These objectives are met through a multi-pronged program pathway which includes:

A core curriculum component comprised of two domains:

Domain One: Community Health Foundations

Domain one of the program curriculum includes two core sessions:

Session One: Queer and trans community members face significant health inequities and disparities (especially when compared to the larger, primarily heterosexual/cisgender population). These disparities are influenced by a number of drivers such as minority stress, intersectionality, syndemics, and life course. Understanding these drivers is a helpful way to look beyond the surface and better understand how systems impact our health. This session delves into these drivers, providing a useful lens through which participants can assess the health issues addressed throughout the remainder of the program curriculum. 

Session Two: The second core session of the program focuses on HIV. In part this is because Pivot was funded as a sexual health intervention by the Public Health Agency of Canada. However, it is also because of the continued disproportionate impact of HIV on queer, trans, and Two Spirit populations. For example, in 2020, gay, bi, and queer men (both cis and trans) and two-spirit people (GBT2Q) continue to make up approximately 50% of all new infections each year in Canada. In addition to overrepresentation in new infections, other facets of GBT2Q men’s health (i.e. mental, social) both greatly influence and are greatly influenced by HIV. And beyond direct health impacts, GBT2Q men have also been uniquely shaped by the HIV epidemic, experiencing strong social and cultural ties (both implicit and explicit) to this shared experience.

Because of this, it is important that GBT2Q men: 

i) are aware of the fact that they may be at increased risk of contracting HIV;
ii) understand the options that are available to them to reduce risk of HIV infection for them or their partners – and how to apply/access them within their local context;
iii) understand how other facets of their health (such as mental and physical) may affect or be affected by their HIV vulnerability; and
iv) understand how HIV has impacted queer, trans, and Two Spirit culture(s), with a focus on resilience 

Domain Two: How to Change the World, One System at a Time

In the first domain of the program, participants gained knowledge about a range of health challenges and assets experienced by queer, trans, and Two Spirit communities across Canada. Participants were also equipped with the personal health and system navigation strategies necessary to apply what they’ve learned in their own lives and achieve their own health and wellness goals. Having become leaders of their own health journeys, it’s now time for participants to expand their focus and become health leaders within their communities. This is the focus of the second domain.

In the first session of the second domain, participants engage with local research(ers), community-based organizations, and individuals leading systems change work in their communities to enhance their understanding of the health gaps, assets, challenges, and opportunities local queer, trans, and two spirit people experience. With this enhanced understanding, and knowledge gained through the first domain of the program, participants identify health challenges they wish to address through the development and delivery of their own self-determined systems change projects.

The curriculum culminates with a final session wherein participants take the knowledge, strategies, and skills they’ve learned and apply them through the development of systems change project concepts that respond to the health challenges they prioritized in the previous session. These project concepts will provide the foundation for the projects that participants will further develop and then deliver to cap off the program.

By the end of the session, participants will gain a range of practical skills related to:

•  Identifying systems-level/policy challenges
•  Developing systems/policy change goals
•  Identifying key stakeholders, including audience, supporters/allies, and opponents
•  Work-planning
•  Communications

Note: Pivot’s curriculum includes a number of “core” sessions that local delivery partners are expected to deliver as a part of the program. Session materials are provided to program delivery partners and are highly adaptable to ensure they are relevant to the local context. In addition to this, there are a number of “open” sessions that partners can develop and delivery themselves based on their own strengths and local participant interests.

Community Health Intervention Development & Delivery

Pivot concludes by providing participants the opportunity to apply what they’ve learned through the development and delivery of their own systems change health intervention. This applied component of the program is crucial to ensuring that Pivot doesn’t simply impart knowledge upon participants but gives them a chance to hone their skills through practice so that they can develop into the community health leaders Pivot aims to produce.

This component of the program can look very different from site to site depending on delivery partner capacity, participant interest, program resources, and the local context. Therefore, it’s been built to be highly adaptable. Guidance on finding a community health intervention development and delivery pathway that works for a specific delivery partner’s local context is provided in the Pivot facilitator guide, which can be accessed free of charge by program partners.

Dive Deeper

If you like what you’ve read, visit the Get Involved section of the site to contact CBRC to learn more about participating in or delivering the program. Otherwise, read on below to learn more about the impact of the program and to review past community health interventions developed and delivered by existing Pivot programs.

An important note on Pivot’s audience: Pivot was initially developed as an intervention for gay and bi men (cis and trans) and Two Spirit people. However, as many of our partners have shifted their focus beyond HIV and sexual health, their programming has been accessed by a much broader cross-section of the LGBTQ2S+ community, including individuals who identify as non-binary or fem.  Many delivery partners who have adapted and delivered Pivot to a broader audience have found that the program is just as effective as when they only delivered it to gay and bi men. CBRC recognizes that different delivery partners have different needs and serve different audiences. Therefore, we leave decisions concerning expanded audiences to the discretion of local delivery partners – as long as the program centres queer, trans, and Two Spirit people.