Integrating gender and sex to unpack trends in sexually transmitted infection surveillance data in British Columbia, Canada: an ethno-epidemiological study

Human immunodeficiency virus prevention outcomes associated with arts-based sexual health workshop participation among Northern and Indigenous adolescents in the Northwest Territories, Canada

BACKGROUND

Contextually tailored, arts-based HIV prevention strategies hold potential to advance adolescent sexual health and wellbeing. We examined HIV prevention outcomes associated with arts-based sexual health workshop participation with Northern and Indigenous adolescents in the Northwest Territories (NWT), Canada.

METHODS

An Indigenous community-based youth agency delivered arts-based workshops in school settings to adolescents aged 13-18 in 24 NWT communities. Pre and post-test surveys included socio-demographic characteristics, sexually infections (STI) knowledge, HIV/STI risk perception, sexual relationship equity, condom use self-efficacy, and safer sex efficacy (SSE). Latent change score models were conducted to assess pre-post differences and factors associated with these differences.

RESULTS

Among participants (n = 344; mean age 14.3 years, SD: 1.3; Indigenous: 79%) most (66%) had previously attended this workshop. Latent change score models revealed a significant and large effect size for increased STI knowledge (β = 2.10, SE = 0.48, p < .001) and significant and small effect sizes for increased HIV/STI risk perception (β = 0.24, SE = 0.06, p < .001) and SSE (β = 0.16, SE = 0.07, p = .02). The largest increases across several outcomes occurred with first time workshop participants; yet previous workshop participants continued to report increases in HIV/STI risk perception and SSE.

CONCLUSION

Arts-based HIV prevention approaches show promise in advancing STI knowledge, risk perception, and SSE with Northern and Indigenous youth.

Prevalence of syphilis among people living with HIV who attend a large urban antiretroviral therapy clinic in Panama: a cross-sectional epidemiological study

Background

Syphilis is a serious global public health challenge. Despite prior progress in syphilis control, incidence has been increasing in recent years. Syphilis is a common coinfection among people living with HIV (PLHIV). In Panama, few data describe syphilis prevalence among PLHIV. We describe syphilis antibody and high-titer (⩾1:8) active syphilis prevalence and associated factors among individuals who attended an antiretroviral clinic.

Methods

A cross-sectional study was undertaken during February-March 2022 and September-October 2022 for adults (⩾18 year) assigned male and female at birth, respectively. Participants provided peripheral blood samples and self-administered a questionnaire. Samples were screened using immunochromatography; antibody-positive samples were tested using rapid plasma regain to 1:512 dilutions. Logistic regression was used to identify factors associated with syphilis antibody and high-titer active syphilis.

Results

In all, 378 participants gave blood samples; 377 individuals participated in the questionnaire (216 self-reported male sex [males], 158 female [females], and three intersex individuals). Median age was 36 years (interquartile range: 28-45 years). Overall, syphilis antibody prevalence was 32.3% (122/378) (males, 50.7% [108/2013]; females, 5.7% [9/158]; intersex individuals, 100.0% (3/3)], p < 0.01. High-titer active syphilis was found among 24.6% (n = 30) of samples with positive antibody test (males 27.8% [n = 30], females 0.0% [0/9], intersex individuals 0.0% [0/3]). Antibody positivity was associated in the multivariable model with males (50.7%, AOR = 24.6, 95%CI: 1.57-384.53). High-titer active syphilis was associated with younger participant age (18-30 years, 13.2%, OR = 4.82, 95%CI: 1.17-19.83); 31-40 years, 7.8%, OR = 4.24, 95%CI: 1.04-17.21 versus 3.2% >40 years), homosexual identity (16.0% OR = 34.2, 95%CI: 4.50-259.27 versus 0.6% among heterosexual identity); in the multivariable model, associated with sexual identity (bisexual 19.1%, AOR = 10.89, 95%CI: 1.00-119.06) compared to heterosexual identity (0.6%) and weakly associated with concurrency (⩾1 ongoing sexual relationships, 15.9%, AOR = 3.09, 95%CI: 0.94-10.14).

Conclusion

This study found very high prevalence of syphilis antibodies and high-titer syphilis among PLHIV in Panama. Those most affected are males, younger in age, those who practice concurrent sexual relationships, and those who reported homosexual and bisexual identity. Targeted interventions should include repetitive testing and treatment, especially among individuals who may be at increased infection risk.

Trends in pre-military sexually transmitted infections and associated risk behaviours in Canadian Armed Forces recruits

Background

Sexually transmitted infections (STIs) have historically been problematic for militaries. Recent reports indicating that rates of STIs among young male Canadian Armed Forces (CAF) members are higher than civilians prompted a need to better understand CAF members' reported rates of STIs and their behavioural risk factors for STIs. This study examined the prevalence of self-reported pre-military sexual behaviours (i.e. number of sexual partners and frequency of condom use) and history of a STI diagnosis among CAF recruits attending basic military training using data collected from the Recruit Health Questionnaire.

Methods

Data came from 50,603 recruits who participated in the survey between 2003 and 2018 (84.9% male, 78.6% Non-Commissioned Member candidates, 64.9% aged between 17 and 24 years).

Results

Among sexually active recruits, the proportions who had more than one sexual partner in the previous year increased from 30.5% in 2003 (95% CI, 27.8-33.4) to 35.5% in 2018 (95% CI, 34.0-37.0). Of recruits who were not in an exclusive relationship at the time, the proportions who reported always using a condom decreased from 50.8% in 2003 (95% CI, 46.4-55.1) to 40.2% in 2018 (95% CI, 38.3-42.2). Overall, 5.5% (95% CI, 5.3-5.7) reported ever having received a STI diagnosis. Demographic differences by age and sex were also found.

Conclusion

These observations provide an indication of the baseline, pre-enlistment STI risk behaviours, and STI history among CAF recruits, and may provide insight into avenues for targeted interventions and health promotion programming, such as education and screening initiatives.