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Antabe R, Sano Y, Amoak D, Anfaara FW, Braimah J. Factors Associated with the Uptake of HIV Testing in Canada: Evidence from a Nationally Representative Study. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:534-547. [PMID: 38801320 DOI: 10.1080/19371918.2024.2359463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
In this study, we explore the factors associated with the uptake of HIV testing at the national level in Canada. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen's behavioral model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e. 55-64), their younger counterparts (i.e. 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Compared to those in Atlantic Canada, respondents in Quebec (OR = 1.96, p < .001), Ontario (OR = 1.44, p < .001), Prairies (OR = 1.37, p < .001), British Columbia (OR = 1.99, p < .001), and the Territories (OR = 2.22, p < .001) are all more likely to have been tested for HIV. Based on these findings, we provide several important suggestions for policymakers and future research.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Ontario, Canada
| | - Daniel Amoak
- Department of Geography and Environment, Social Science Centre, Western University, London, Ontario, Canada
| | - Florence W Anfaara
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Ontario, Canada
| | - Joseph Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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2
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Luz PM, Apelian H, Lambert G, Fourmigue A, Dvorakova M, Grace D, Lachowsky N, Hart TA, Moore DM, Skakoon-Sparling S, Cox J. HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men. AIDS Behav 2024; 28:2683-2694. [PMID: 38869761 DOI: 10.1007/s10461-024-04380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.
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Affiliation(s)
- Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nathan Lachowsky
- School of Public, Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Psychology Department, University of Guelph, Guelph, ON, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
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Berlin GW, Dermody SS, Noor SW, Skakoon-Sparling S, Ghauri Y, Zahran A, Card KG, Lachowsky NJ, Cox J, Moore DM, Lambert G, Jollimore J, Grace D, Zhang H, Apelian H, Sang JM, Dvorakova M, Lal A, Hart TA. Minority Stress, Psychological Distress, Sexual Compulsivity, and Avoidance-Based Motivations Associated with Methamphetamine Use Among Sexual Minority Men Living with HIV: Examining Direct and Indirect Associations Using Cross-Sectional Structural Equation Modeling. Subst Use Misuse 2024; 59:1629-1639. [PMID: 38950280 DOI: 10.1080/10826084.2024.2369159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Sexual minority men (SMM) living with HIV report significantly greater methamphetamine use compared with heterosexual and HIV-negative peers. Greater use may be related to stressors (e.g., HIV-related stigma) faced by SMM living with HIV and subsequent psychological and behavioral sequelae. We tested an integrated theoretical model comprised of pathways between stigma, discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape in predicting methamphetamine use among SMM living with HIV. METHODS Among 423 SMM living with HIV, we tested a structural equation model examining factors hypothesized to be directly and indirectly associated with methamphetamine use. Analyses were adjusted for demographic covariates and sampling bias. RESULTS The model showed good fit (CFI = 0.96, RMSEA = 0.01). Heterosexist discrimination was associated with psychological distress (β = 0.39, p < 0.001) and psychological distress was associated with sexual compulsivity (β = 0.33, p < 0.001). Sexual compulsivity was associated with cognitive escape (β = 0.31, p < 0.001), which was associated with methamphetamine use (β = 0.51, p < 0.001). Psychological distress was associated with methamphetamine use via serial indirect effects of sexual compulsivity and cognitive escape (β = 0.05, p < 0.05). CONCLUSIONS Heterosexist discrimination contributed to psychological distress among SMM living with HIV. Psychological distress is linked to methamphetamine use via sexual compulsivity and cognitive avoidance. Interventions seeking to reduce the likelihood that SMM living with HIV use methamphetamine should include coping strategies specific to heterosexism and related psychological distress.
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Affiliation(s)
| | | | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | | | - Yusuf Ghauri
- Toronto Metropolitan University, Toronto, Canada
| | - Adhm Zahran
- Toronto Metropolitan University, Toronto, Canada
| | - Kiffer G Card
- University of Victoria, Victoria, Canada
- Simon Fraser University, Vancouver, Canada
| | | | - Joseph Cox
- McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Institute National de Santé Publique du Québec, Montreal, Canada
| | - Jody Jollimore
- Canadian AIDS Treatment Information Exchange (CATIE), Toronto, Canada
| | | | | | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada
- University of Toronto, Toronto, Canada
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Juwono S, Flores Anato JL, Kirschbaum AL, Metheny N, Dvorakova M, Skakoon-Sparling S, Moore DM, Grace D, Hart TA, Lambert G, Lachowsky NJ, Jollimore J, Cox J, Maheu-Giroux M. Prevalence, Determinants, and Trends in the Experience and Perpetration of Intimate Partner Violence Among a Cohort of Gay, Bisexual, and Other Men Who Have Sex with Men in Montréal, Toronto, and Vancouver, Canada (2017-2022). LGBT Health 2024. [PMID: 38860358 DOI: 10.1089/lgbt.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
Purpose: Longitudinal data on the experience and perpetration of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBM) are limited. We estimated the prevalence of past 6-month (P6M) physical and/or sexual IPV (hereafter IPV) experience and perpetration, identified their determinants, and assessed temporal trends, including the impact of the coronavirus disease (COVID)-19 pandemic. Methods: We used data from the Engage Cohort Study (2017-2022) of GBM recruited using respondent-driven sampling in Montréal, Toronto, and Vancouver. Adjusted prevalence ratios (aPRs) for determinants and self-reported P6M IPV were estimated using generalized estimating equations, accounting for attrition (inverse probability of censoring weights) and relevant covariates. Longitudinal trends of IPV were also assessed. Results: Between 2017 and 2022, 1455 partnered GBM (median age 32 years, 82% gay, and 71% White) had at least one follow-up visit. At baseline, 31% of participants experienced IPV in their lifetime and 17% reported ever perpetrating IPV. During follow-up, IPV experience was more common (6%, 95% confidence interval [CI]: 5%-7%) than perpetration (4%, 95% CI: 3%-5%). Factors associated with P6M IPV experience included prior IPV experience (aPR: 2.68, 95% CI: 1.76-4.08), lower education (aPR: 2.31, 95% CI: 1.32-4.04), and substance use (injection aPR: 5.05, 95% CI: 2.54-10.05, non-injection aPR: 1.68, 95% CI: 1.00-2.82). Similar factors were associated with IPV perpetration. IPV was stable over time; periods of COVID-19 restrictions were not associated with IPV changes in this cohort. Conclusion: Prevalence of IPV was high among GBM. Determinants related to marginalization were associated with an increased risk of IPV. Interventions should address these determinants to reduce IPV and improve health.
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Affiliation(s)
- Stephen Juwono
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Jorge Luis Flores Anato
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | | | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
- Department of Psychology, University of Guelph, Guelph, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
- Community Based Research Centre, Vancouver, Canada
| | - Jody Jollimore
- CATIE, Canadian AIDS Treatment Information Exchange, Toronto, Canada
| | - Joseph Cox
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, Canada
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Zhu J, Takeh BT, David J, Sang J, Moore DM, Hull M, Grennan T, Wong J, Montaner JS, Lima VD. Impact of screening and doxycycline prevention on the syphilis epidemic among men who have sex with men in British Columbia: a mathematical modelling study. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100725. [PMID: 38590322 PMCID: PMC11000203 DOI: 10.1016/j.lana.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
Background Men who have sex with men (MSM) in British Columbia (BC) are disproportionately affected by infectious syphilis and HIV. In this study, we developed a co-interaction model and evaluated the impact and effectiveness of possible interventions among different MSM subgroups on the syphilis epidemic. Methods We designed a deterministic compartmental model, which stratified MSM by HIV status and HIV pre-exposure prophylaxis (HIV-PrEP) usage into (1) HIV-negative/unaware MSM (HIV-PrEP not recommended, not on HIV-PrEP), (2) HIV-negative/unaware MSM with HIV-PrEP recommended (not on HIV-PrEP), (3) HIV-negative/unaware MSM actively on HIV-PrEP, and (4) MSM diagnosed with HIV. We estimated the effect of scaling up syphilis testing frequency from Status Quo to six-, four-, and three-months, increasing the percentage of MSM using doxycycline prevention (Doxy-P) to 25%, 50%, and 100% of the target level, and a combination of both among subgroups (2)-(4). We also assessed the impact of these interventions on the syphilis incidence rates from 2020 to 2034 in comparison to the Status Quo scenario where no intervention was introduced. Findings Under the Status Quo scenario, with the expansion of the HIV-PrEP program to improve syphilis testing, the syphilis incidence rate was estimated to peak at 16.1 [Credible Interval (CI):14.2-17.9] per 1,000 person-years (PYs) in 2023 and decrease to 6.7 (CI:3.8-10.9) per 1,000 PYs by 2034. The syphilis incidence rate in 2034 was estimated at 0.7 (0.3-1.3) per 1,000 PYs if MSM diagnosed with HIV could be tested every four months, and at 1.5 (0.7-3.0) per 1,000 PYs if HIV-negative/unaware MSM actively on HIV-PrEP could be tested every three months. By achieving 100% of the target coverage of Doxy-P, the syphilis incidence rate was estimated at 1.4 (0.5-3.4) if focusing on MSM diagnosed with HIV, and 2.6 (1.2-5.1) per 1,000 PYs if focusing on HIV-negative/unaware MSM actively on HIV-PrEP. Under the combined interventions, the syphilis incidence rate could be as low as 0.0 (0.0-0.1) and 0.8 (0.3-1.8) per 1,000 PYs, respectively. Interpretation The HIV-PrEP program in BC plays a crucial role in increasing syphilis testing frequency among high-risk MSM and reducing syphilis transmission among this group. In addition, introducing Doxy-P can be an effective complementary strategy to minimize syphilis incidence, especially among MSM diagnosed with HIV. Funding This work was funded by the Canadian Institutes of Health Research.
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Affiliation(s)
- Jielin Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Bronhilda T. Takeh
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jummy David
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Troy Grennan
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Xiu F, Flores Anato JL, Cox J, Grace D, Hart TA, Skakoon-Sparling S, Dvorakova M, Knight J, Wang L, Gatalo O, Campbell E, Zhang T, Sbihi H, Irvine MA, Mishra S, Maheu-Giroux M. Characteristics of the Sexual Networks of Men Who Have Sex With Men in Montréal, Toronto, and Vancouver: Insights from Canada's 2022 Mpox Outbreak. J Infect Dis 2024; 229:S293-S304. [PMID: 38323703 PMCID: PMC10965213 DOI: 10.1093/infdis/jiae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The 2022-2023 global mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBM). We investigated differences in GBM's sexual partner distributions across Canada's 3 largest cities and over time, and how they shaped transmission. METHODS The Engage Cohort Study (2017-2023) recruited GBM via respondent-driven sampling in Montréal, Toronto, and Vancouver (n = 2449). We compared reported sexual partner distributions across cities and periods: before COVID-19 (2017-2019), pandemic (2020-2021), and after lifting of restrictions (2021-2023). We used Bayesian regression and poststratification to model partner distributions. We estimated mpox's basic reproduction number (R0) using a risk-stratified compartmental model. RESULTS Pre-COVID-19 pandemic distributions were comparable: fitted average partners (past 6 months) were 10.4 (95% credible interval: 9.4-11.5) in Montréal, 13.1 (11.3-15.1) in Toronto, and 10.7 (9.5-12.1) in Vancouver. Sexual activity decreased during the pandemic and increased after lifting of restrictions, but remained below prepandemic levels. Based on reported cases, we estimated R0 of 2.4 to 2.7 and similar cumulative incidences (0.7%-0.9%) across cities. CONCLUSIONS Similar sexual partner distributions may explain comparable R0 and cumulative incidence across cities. With potential for further recovery in sexual activity, mpox vaccination and surveillance strategies should be maintained.
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Affiliation(s)
- Fanyu Xiu
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada
| | | | - Joseph Cox
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada
- Research Institute, McGill University Health Centre, Montréal, Québec, Canada
- Direction régionale de santé publique, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Milada Dvorakova
- Research Institute, McGill University Health Centre, Montréal, Québec, Canada
| | - Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada, Canada
| | - Oliver Gatalo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada, Canada
| | - Evan Campbell
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Terri Zhang
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Hind Sbihi
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sharmistha Mishra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada
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Marbaniang I, Moodie EEM, Latimer E, Skakoon-Sparling S, Hart TA, Grace D, Moore DM, Lachowsky NJ, Jollimore J, Lambert G, Zhang T, Dvorakova M, Cox J. Using an intersectionality-based approach to evaluate mental health services use among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver. Epidemiol Psychiatr Sci 2024; 33:e10. [PMID: 38438301 PMCID: PMC10940056 DOI: 10.1017/s2045796024000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
AIMS To cope with homonegativity-generated stress, gay, bisexual and other men who have sex with men (GBM) use more mental health services (MHS) compared with heterosexual men. Most previous research on MHS among GBM uses data from largely white HIV-negative samples. Using an intersectionality-based approach, we evaluated the concomitant impact of racialization and HIV stigma on MHS use among GBM, through the mediating role of perceived discrimination (PD). METHODS We used baseline data from 2371 GBM enrolled in the Engage cohort study, collected between 2017 and 2019, in Montreal, Toronto and Vancouver, using respondent-driven sampling. The exposure was GBM groups: Group 1 (n = 1376): white HIV-negative; Group 2 (n = 327): white living with HIV; Group 3 (n = 577): racialized as non-white HIV-negative; Group 4 (n = 91): racialized as non-white living with HIV. The mediator was interpersonal PD scores measured using the Everyday Discrimination Scale (5-item version). The outcome was MHS use (yes/no) in the prior 6 months. We fit a three-way decomposition of causal mediation effects utilizing the imputation method for natural effect models. We obtained odds ratios (ORs) for pure direct effect (PDE, unmediated effect), pure indirect effect (PIE, mediated effect), mediated interaction effect (MIE, effect due to interaction between the exposure and mediator) and total effect (TE, overall effect). Analyses controlled for age, chronic mental health condition, Canadian citizenship, being cisgender and city of enrolment. RESULTS Mean PD scores were highest for racialized HIV-negative GBM (10.3, SD: 5.0) and lowest for white HIV-negative GBM (8.4, SD: 3.9). MHS use was highest in white GBM living with HIV (GBMHIV) (40.4%) and lowest in racialized HIV-negative GBM (26.9%). Compared with white HIV-negative GBM, white GBMHIV had higher TE (OR: 1.71; 95% CI: 1.27, 2.29) and PDE (OR: 1.68; 95% CI: 1.27, 2.24), and racialized HIV-negative GBM had higher PIE (OR: 1.09; 95% CI: 1.02, 1.17). Effects for racialized GBMHIV did not significantly differ from those of white HIV-negative GBM. MIEs across all groups were comparable. CONCLUSIONS Higher MHS use was observed among white GBMHIV compared with white HIV-negative GBM. PD positively mediated MHS use only among racialized HIV-negative GBM. MHS may need to take into account the intersecting impact of homonegativity, racism and HIV stigma on the mental health of GBM.
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Affiliation(s)
- Ivan Marbaniang
- Department of Epidemiology, McGill University, Montreal, QC, Canada
| | - Erica E. M. Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Eric Latimer
- Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Trevor A. Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Disease, University of British Columbia, Vancouver, BC, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | | | - Gilles Lambert
- Institut National de Santé Publique du Québec, Montreal, QC, Canada
| | - Terri Zhang
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Milada Dvorakova
- Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Clinical Outcomes Research and Evaluation, Research Institute–McGill University Health Centre, Montreal, QC, Canada
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Solomon D, Cabecinha M, Gibbs J, Burns F, Sabin CA. How do we measure unmet need within sexual and reproductive health? A systematic review. Perspect Public Health 2024; 144:78-85. [PMID: 36127856 PMCID: PMC10916345 DOI: 10.1177/17579139221118778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Addressing health inequality with sexual and reproductive health requires an understanding of unmet need within a range of populations. This review examined the methods and definitions that have been used to measure unmet need, and the populations most frequently assessed. METHODS Five databases (PubMed, Web of Science, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Health Management and Policy Database (HMIC)) were searched for studies that described quantitative measurement of unmet need within sexual and/or reproductive health between 2010 and 2021. A narrative synthesis was then undertaken to ascertain themes within the literature. RESULTS The database search yielded 19,747 papers; 216 papers were included after screening. 190 studies assessed unmet reproductive health need, of which 137 were analyses of trends among people living in low/lower-middle income countries; 181 used cross-sectional data, with only nine analyses being longitudinal. Eighteen studies analysed unmet sexual health need, of which 12 focused on high and upper-middle income populations. 16 papers used cross-sectional analyses. The remaining 10 studies examined unmet need for a combination of sexual and reproductive health services, eight among populations from upper-middle or high income countries. All were cross-sectional analyses. 165 studies used the Demographic and Health Surveys (DHS) definition of unmet need; no other standardised definition was used among the remaining papers. DISCUSSION There is a significant focus on unmet need for contraception among women in low income countries within the published literature, leaving considerable evidence gaps in relation to unmet need within sexual health generally and among men in particular, and unmet reproductive health need in high income settings. In addition, using an increased range of data collection methods, analyses and definitions of unmet need would enable better understanding of health inequality in this area.
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Affiliation(s)
- D Solomon
- Institute for Global Health, University College London, Gower Street, London WC1E 6BT, UK
| | - M Cabecinha
- Institute for Global Health, University College London, London, UK
| | - J Gibbs
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - CA Sabin
- Institute for Global Health, University College London, London, UK
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Hart TA, Noor SW, Tavangar F, Zahran A, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Lachowsky N, Sang JM, Palma PA, Zhang T, Dvorakova M, Cox J, Moore DM. Human Immunodeficiency Virus Treatment Attitudes and Bacterial Sexually Transmitted Infections Among Gay and Bisexual Men. Sex Transm Dis 2024; 51:178-185. [PMID: 38412464 DOI: 10.1097/olq.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUNDS Positive attitudes toward human immunodeficiency virus (HIV) treatment, such as reduced concern about HIV transmissibility, are associated with sexual behaviors that may increase the risk of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM). We examined associations between HIV treatment attitudes and bacterial STI diagnoses among GBM in Canada's three largest cities. METHODS We fit a structural equation model between HIV treatment attitudes and bacterial STI diagnoses via sexual behaviors in the Engage study's baseline data. We estimated direct and indirect paths between scores on HIV treatment attitudes and STIs via number of male anal sex partners, condomless anal sex, and oral sex. We conducted sub-analyses with participants stratified by HIV serostatus. RESULTS Among 2449 GBM recruited in 2017 to 2019, there was a direct association between HIV treatment attitudes and current STI diagnoses (β = 0.13; 95% CI, 0.07-0.19; P < 0.001). The mediated model revealed a positive total indirect effect through 2 pathways: (1) engaging in condomless anal sex and (2) number of male anal sex partners and condomless anal sex. These 2 indirect pathways remained in the stratified mediation models for both HIV negative GBM and for GBM living with HIV. CONCLUSIONS The association between HIV treatment attitudes and diagnosed STIs is mediated through a higher number of male anal sex partners and condomless anal sex. The results highlight the importance of providers educating patients when providing effective STI counseling, testing, and prevention for GBM about how accurate HIV treatment attitudes may inadvertently be associated with the bacterial STI epidemic.
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Affiliation(s)
| | | | | | - Adhm Zahran
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jordan M Sang
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Paolo A Palma
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Terri Zhang
- From the Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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10
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Daroya E, Grey C, Klassen B, Lessard D, Skakoon-Sparling S, Perez-Brumer A, Adam B, Cox J, Lachowsky NJ, Hart TA, Gervais J, Tan DHS, Grace D. 'It's not as good as the face-to-face contact': A sociomaterialist analysis of the use of virtual care among Canadian gay, bisexual and queer men during the COVID-19 pandemic. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:19-38. [PMID: 37323054 DOI: 10.1111/1467-9566.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic led to the widespread adoption of virtual care-the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID-19 pandemic on health-care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportionately experiences sexual and mental health disparities in Canada. Adopting a sociomaterial theoretical perspective, we analysed 93 semi-structured interviews with GBQM (n = 93) in Montreal, Toronto and Vancouver, Canada, conducted between November 2020 and February 2021 (n = 42) and June-October 2021 (n = 51). We focused on explicating how the dynamic relations of humans and non-humans in everyday virtual care practices have opened or foreclosed different care capacities for GBQM. Our analysis revealed that the rapid expansion and implementation of virtual care during the COVID-19 pandemic enacted disruptions and challenges while providing benefits to health-care access among some GBQM. Further, virtual care required participants to change their sociomaterial practices to receive health care effectively, including learning new ways of communicating with providers. Our sociomaterial analysis provides a framework that helps identify what works and what needs to be improved when delivering virtual care to meet the health needs of GBQM and other diverse populations.
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Affiliation(s)
- Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornel Grey
- Department of Gender, Sexuality, and Women's Studies, Western University, London, Ontario, Canada
| | - Ben Klassen
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - David Lessard
- Centre for Health Outcome Research, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Ontario, Canada
| | - Joseph Cox
- Service Prévention et contrôle des maladies infectieuses, Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Jessie Gervais
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Darrell H S Tan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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11
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Yuen AWH, Sang JM, Wang L, Barath J, Lachowsky NJ, Lal A, Elefante J, Hart TA, Skakoon-Sparling S, Grey C, Grace D, Cox J, Lambert G, Noor SW, Apelian H, Parlette A, Card KG, Hull MW, Jollimore J, Moore DM. Attitudes of Gay, Bisexual, and Other Men Who Have Sex with Men (GBM) toward Their Use of Amphetamine-Type Stimulants and Relation to Reducing Use in Three Canadian Cities. Subst Use Misuse 2023; 59:278-290. [PMID: 37867395 DOI: 10.1080/10826084.2023.2269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND We explored attitudes of gay, bisexual, and other men who have sex with men (GBM) toward their amphetamine-use and associations with reduced use over time. METHODS We recruited sexually-active GBM aged 16+ years in Montreal, Toronto, and Vancouver, Canada, from 02-2017 to 08-2019, with follow-up visits every 6-12 months until November 2020. Among participants who reported past-six-month (P6M) amphetamine-use at enrollment, we used logistic regression to identify demographic, psychological, social, mental health, other substance-use, and behavioral factors associated with reporting needing help reducing their substance-use. We used mixed-effects logistic regression to model reduced P6M amphetamine-use with perceived problematic-use as our primary explanatory variable. RESULTS We enrolled 2,449 GBM across sites. 15.5-24.7% reported P6M amphetamine-use at enrollment and 82.6 - 85.7% reported needing no help or only a little help in reducing their substance use. Reporting needing a lot/of help or completely needing help in reducing substance-use was associated with group sex participation (AOR = 2.35, 95%CI:1.25-4.44), greater anxiety symptomatology (AOR = 2.11, 95%CI:1.16-3.83), greater financial strain (AOR = 1.35, 95%CI:1.21-1.50), and greater Escape Motive scores (AOR = 1.07, 95%CI:1.03-1.10). Reductions in P6M amphetamine-use were less likely among GBM who perceived their amphetamine-use as problematic (AOR = 0.17 95% CI 0.10 - 0.29). CONCLUSIONS Most amphetamine-using GBM did not feel they needed help reducing their substance use, and many reported reduced amphetamine-use at subsequent visits. Those who perceived their use as problematic were less likely to reduce their use. Further interventions to assist GBM in reducing their use are needed to assist those who perceive their use as problematic.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- University of Victoria, Victoria, BC, Canada
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, ON, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Herak Apelian
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | | | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Mark W Hull
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David M Moore
- University of British Columbia, Vancouver, BC, Canada
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12
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Lê AS, Labbé AC, Fourmigue A, Dvorakova M, Cox J, Fortin C, Martin I, Grace D, Hart T, Moore D, Lambert G. Mycoplasma genitalium infection among gay, bisexual and other men who have sex with men in Montréal, Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:477-486. [PMID: 38504874 PMCID: PMC10946590 DOI: 10.14745/ccdr.v49i1112a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background The bacteria Mycoplasma genitalium has been identified as a causative agent of urethritis in men, especially in gay, bisexual and other men who have sex with men (gbMSM). Canadian clinic-based data have identified a high prevalence of M. genitalium and resistance to antibiotic treatments. This article estimates the prevalence of M. genitalium infections among Montréal gbMSM, explores correlates for M. genitalium infection and estimates the prevalence of mutations associated with antimicrobial resistance (AMR). Methods Engage Cohort Study is a multi-site longitudinal study on sexually active gbMSM, aged 16 years and older, recruited via respondent-driven sampling in Montréal, Toronto and Vancouver. Participants completed a questionnaire on behaviour and were tested for sexually transmitted and blood-borne infections at each visit. For this sub-study, Montréal participants with a follow-up visit that occurred between November 2018 and November 2019 were included. Results A total of 2,064 samples were provided by 716 participants. Prevalence of M. genitalium infection was 5.7% at rectal and/or urethral sites, 4.0% at rectal site and 2.2% at urethral site. Correlates for M. genitalium infection were younger age and reporting six or more sexual partners in the past six months. Prevalence of macrolide resistance associated mutations (MRAM), quinolone resistance associated mutations (QRAM) and either MRAM or QRAM, was 82%, 29% and 85%, respectively. Conclusion This first population-based study among gbMSM in Canada documents a high prevalence of urethral and rectal M. genitalium infection and high levels of AMR. Our results highlight the importance of access to testing and AMR detection when indicated.
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Affiliation(s)
- Anne-Sophie Lê
- Faculté de médecine, Université de Montréal, Montréal, QC
| | - Annie-Claude Labbé
- Faculté de médecine, Université de Montréal, Montréal, QC
- Division of Infectious Diseases and Microbiology, Hôpital Maisonneuve-Rosemont, Centre intégré de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montréal, QC
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC
- Direction régionale de santé publique de Montréal, Centre intégré de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC
| | - Claude Fortin
- Faculté de médecine, Université de Montréal, Montréal, QC
- Division of Infectious Diseases and Microbiology, Centre hospitalier de l'Université de Montréal, Montréal, QC
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Trevor Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
- Department of Psychology, Toronto Metropolitan University, Toronto, ON
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
- Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC
- Institut National de Santé Publique du Québec, Montréal, QC
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13
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Sang JM, Moore DM, Wang L, Chia J, Toy J, Montaner J, Skakoon-Sparling S, Cox J, Lambert G, Grace D, Hart TA, Lal A, Jollimore J, Lachowsky NJ. Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada. BMC Public Health 2023; 23:2124. [PMID: 37904163 PMCID: PMC10614320 DOI: 10.1186/s12889-023-17049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. METHODS Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. RESULTS Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). CONCLUSION There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
- BC Centre on Substance Use, Vancouver, BC, Canada.
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Chia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Center, Montreal, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud, Montreal, Canada
- Institut national de santé publique du Québec, Quebec City, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University (formerly Ryerson), Toronto, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Nathan J Lachowsky
- Community Based Research Centre, Vancouver, Canada
- University of Victoria, Victoria, Canada
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14
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Kirschbaum AL, Metheny N, Skakoon-Sparling S, Grace D, Yakubovich AR, Cox J, Palachi A, Sang JM, O'Campo P, Tan DHS, Hart TA. Syndemic Factors and Lifetime Bidirectional Intimate Partner Violence Among Gay, Bisexual, and Other Sexual Minority Men. LGBT Health 2023; 10:S89-S97. [PMID: 37754925 DOI: 10.1089/lgbt.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Purpose: Bidirectional intimate partner violence (IPV), the reporting of both IPV victimization and perpetration, is likely the most common form of violence among gay, bisexual, and other sexual minority men (GBM) and is thought to be part of a larger syndemic of stressors. This purpose of this study was to examine associations between syndemic factors and lifetime bidirectional IPV among GBM in three Canadian cities to inform future interventions. Methods: Data from GBM (N = 2449) were used to fit three logistic regression models with lifetime bidirectional IPV as the outcome and four syndemic factors (i.e., depressive symptomatology, childhood sexual abuse [CSA], illegal drug use, and alcohol misuse) as independent variables. Model 1 examined syndemic factors individually. Model 2 employed a summative scale of syndemic exposure. Model 3 used marginal analysis to examine the relative excess risk of each potential iteration of the syndemic. Results: Thirty-one percent (N = 762) of respondents reported lifetime bidirectional IPV. Each of the syndemic factors were significantly associated with greater odds of reporting bidirectional IPV (Model 1). Model 2 exhibited a dose-response relationship between the number of syndemic factors reported and bidirectional IPV. Model 3 suggested that the specific combination of depressive symptomatology, CSA, and alcohol misuse resulted in the highest risk of lifetime bidirectional IPV. Conclusion: Bidirectional IPV was common in this sample and was associated with a complex interplay of stressors. However, there may be opportunities to target interventions to the specific syndemic issues in an effort to prevent and mitigate this form of IPV in GBM.
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Affiliation(s)
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alexa R Yakubovich
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Iîle-de-Montréal, Montréal, Canada
| | - Aaron Palachi
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Darrell H S Tan
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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15
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Grey C, Tian IL, Skakoon-Sparling S, Daroya E, Klassen B, Lessard D, Gaspar M, Sinno J, Sang JM, Perez-Brumer A, Lachowsky NJ, Moore DM, Jollimore J, Hart TA, Cox J, Grace D. Unpacking racism during COVID-19: narratives from racialized Canadian gay, bisexual, and queer men. Int J Equity Health 2023; 22:152. [PMID: 37553689 PMCID: PMC10410892 DOI: 10.1186/s12939-023-01961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/13/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined the experiences of gay, bisexual, queer, and other men who have sex with men (GBQM) of colour facing discrimination during COVID-19. DESIGN Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQM living in Vancouver, Toronto, and Montréal, Canada. We conducted two rounds of qualitative interviews (November 2020 to February 2021, and June to October 2021) with 93 GBQM to explore the evolving impact of COVID-19 on their lives. Transcripts were coded using inductive thematic analysis. Data analysis was conducted using Nvivo software. RESULTS Fifty-nine participants identified as Black, Indigenous, and/or a Person of Colour (BIPOC). These GBQM of colour described multiple experiences of discrimination during COVID-19. Although participants did not report experiences of discrimination based on their sexual identity during COVID-19, we found that experiences of racism affected how they were treated within their sexual networks. Experiences of racism were most often reported by East Asian and Black GBQM. These participants faced racism in public and online spaces, primarily in the form of verbal harassment. Several participants were also harassed because they wore face masks. Verbal abuse against GBQM of colour was largely prompted by racist discourses related to COVID-19. CONCLUSION Racism remains a pernicious threat to the well-being of GBQM of colour. CRT highlights the importance of assessing how sexualized and gendered discourses about race shape the experiences of GBQM of colour navigating multiple epidemics like COVID-19 and HIV. These pervasive discourses unevenly affect racial and sexual minorities across multiple epidemics, and negatively impact health outcomes for these populations.
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Affiliation(s)
- Cornel Grey
- Western University, London, Canada
- University of Toronto, Toronto, Canada
| | | | | | | | - Ben Klassen
- Community-Based Research Centre, Vancouver, Canada
| | | | | | - Jad Sinno
- University of Toronto, Toronto, Canada
| | | | | | | | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jody Jollimore
- Canadian AIDS Treatment Information Exchange (CATIE), Toronto, Canada
| | - Trevor A Hart
- University of Toronto, Toronto, Canada
- Toronto Metropolitan University, Toronto, Canada
| | - Joseph Cox
- McGill University Health Centre, Montréal, Canada
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16
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Caffrey N, O'Brien SF, Walsh GM, Haw J, Goldman M. Evolving the gay, bisexual and other men who have sex with men time-based deferral to sexual risk screening for all donors: The contribution of Canadian research programmes. Vox Sang 2023; 118:605-615. [PMID: 37191161 DOI: 10.1111/vox.13443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES In Canada, the time deferral for gay, bisexual and other men who have sex with men (gbMSM) to donate blood has gradually decreased. In September 2022, this deferral was replaced with sexual behaviour-based screening for all donors. We investigate how data from targeted research programmes addressed knowledge gaps to support this change. MATERIALS AND METHODS We conducted a scoping review describing the Canadian literature available before the research programmes relating to (1) behavioural indicators of HIV risk and (2) attitudes to blood donation among gbMSM, current donors and the general population. We summarize the targeted research programmes, their outputs and impact to date. RESULTS For question 1, five projects met inclusion criteria. For question 2, three articles met inclusion criteria. Knowledge gaps identified were insufficient evidence of HIV incidence in gbMSM who met other donor eligibility criteria and scant data on opinions and views of blood donation and screening criteria for sexual risk behaviours. The research programmes funded 19 projects at 11 different research sites involving over 100 individual researchers/collaborators resulting in 19 peer-reviewed publications to date. Leveraging existing gbMSM cohorts yielded relevant HIV incidence data to inform safety modelling studies. Findings indicated that sexual behaviour-based screening was acceptable to gbMSM and donors, and donor discomfort around specific questions could be mitigated with clear explanations. CONCLUSION Targeted research programmes filled critical knowledge gaps and informed a change to gender-neutral, sexual behaviour-based screening for all donors. Findings supported successful implementation of these changes with research-informed staff training.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, Calgary, Alberta, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Geraldine M Walsh
- Innovation and Portfolio Management, Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Jennie Haw
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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17
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Yeung A, Lisk R, Rana J, Guiang CB, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH, Burchell AN. Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study. J Med Internet Res 2023; 25:e40477. [PMID: 37384393 PMCID: PMC10365575 DOI: 10.2196/40477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. OBJECTIVE Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. METHODS The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ≥60% within a ±1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. RESULTS Of the community experts (CEs), 84% (43/51) completed all rounds; 19% (8/43) were living with HIV; 37% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95%), express testing (38/43, 88%), routine testing (36/43, 84%), an online booking app (36/43, 84%), online-based testing (33/43, 77%), and nurse-led testing (31/43, 72%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77% (37/48) completed all rounds; 59% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68%, to 39/39, 100%) but not for provider alerts (7/37, 19%) and provider audit and feedback (6/37, 16%). Express testing, online-based testing, and nurse-led testing were prioritized by >95% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. CONCLUSIONS Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13801.
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Affiliation(s)
- Anna Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | | | - Jayoti Rana
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, BC, Canada
| | | | | | - Darrell Hs Tan
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Ann N Burchell
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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18
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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19
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Sang JM, Gholamian B, Wang L, Barath J, Noor SW, Lachowsky NJ, Hart TA, Cox J, Lambert G, Grace D, Skakoon-Sparling S, Lal A, Parlette A, Apelian H, Jollimore J, Hogg RS, Moore DM. Examining differential success in recruitment using respondent driven sampling (RDS) in a multi-site study of gay, bisexual and other men who have sex with men. BMC Med Res Methodol 2023; 23:136. [PMID: 37296373 PMCID: PMC10251682 DOI: 10.1186/s12874-023-01886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/09/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The Engage Study is a longitudinal biobehavioral cohort study of gay, bisexual and other men who have sex with men (GBM) in Toronto, Montreal, and Vancouver. Baseline data (2,449 participants) were collected from February 2017 - August 2019 using respondent-driven sampling (RDS). Recruitment in Montreal required fewer seeds, had a much shorter recruitment period, and recruited the largest sample. METHODS To better understand why RDS recruitment was more successful in Montreal compared to other sites, we conducted an analysis to examine RDS recruitment characteristics for GBM in each of the three study sites, explore demographic characteristics and measures of homophily, that is, the tendency of individuals to recruit other study participants who are like themselves, and compared motivations for study participation. RESULTS Montreal had the greatest proportion of participants over the age of 45 (29.1% in Montreal, 24.6% in Vancouver, and 21.0% in Toronto) and the highest homophily for this age group, but homophily was high across the three cities. Montreal also reported the lowest percentage of participants with an annual income greater or equal to $60,000 (7.9% in Montreal, 13.1% in Vancouver and 10.6% in Toronto), but homophily was similar across all three cities. The majority of participants indicated interest in sexual health and HIV as the main reason for participating (36.1% in Montreal, 34.7% in Vancouver, and 29.8% in Toronto). Financial interest as the main reason for participation was low (12.7% in Montreal, 10.6% in Vancouver, and 5.7% in Toronto). CONCLUSION Taken together, although we found some differences in study demographic characteristics and homophily scores, we were unable to fully explain the different recruitment success based on the data available. Our study underlines the fact that success of RDS implementation may vary by unknown factors, and that researchers should be proactive and flexible to account for variability.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
| | | | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Syed W Noor
- Ryerson University, Toronto, ON, Canada
- School of Human Sciences, Louisiana State University Shreveport, Shreveport, USA
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Community Based Research Centre, Vancouver, BC, Canada
| | - Trevor A Hart
- Ryerson University, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Center, Montréal, QC, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | | | | | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Herak Apelian
- Research Institute of the McGill University Health Center, Montréal, QC, Canada
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
| | | | | | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
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20
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Skakoon-Sparling S, Card KG, Novick JR, Berlin GW, Lachowsky NJ, Adam B, Brennan DJ, Sang JM, Noor SW, Cox J, Moore DM, Grace D, Grey C, Daroya E, Hart TA. The relevance of communal altruism for sexual minority men in contemporary contexts. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1461-1478. [PMID: 35932490 DOI: 10.1002/jcop.22923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 05/23/2023]
Abstract
There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).
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Affiliation(s)
- Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jake R Novick
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Graham W Berlin
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Ontario, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Kinesiology & Health Science, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornel Grey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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21
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Sang JM, Wong J, Ryan V, Cumming E, Wang L, Cui Z, Bacani N, Haag D, Lachowsky NJ, Cox J, Grace D, Otterstatter M, Morshed M, Edward J, Grennan T, Arkles J, Brownrigg B, Hogg RS, Moore DM. Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:295-307. [PMID: 36156198 PMCID: PMC10036687 DOI: 10.17269/s41997-022-00690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC. METHODS We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing. RESULTS Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p < 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93). CONCLUSION gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.
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Affiliation(s)
- Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
| | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Venessa Ryan
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Emma Cumming
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Zishan Cui
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nicanor Bacani
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Devon Haag
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
| | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Direction régionale de santé publique - Montréal, Montréal, QC, Canada
| | | | - Michael Otterstatter
- BC Centre for Disease Control, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Muhammad Morshed
- BC Centre for Disease Control, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Joshua Edward
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Robert S Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
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22
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Sang JM, Wang L, Moore DM, Barath J, Lal A, Hart TA, Skakoon-Sparling S, Noor SW, Chown S, Lambert G, Cox J, Jollimore J, Parlette A, Apelian H, Grace D, Lachowsky NJ. Examining Associations Between Resilience and PrEP Use Among HIV-negative GBM in Toronto, Montreal and Vancouver. AIDS Behav 2023. [PMID: 36867322 DOI: 10.1007/s10461-023-04031-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
This study evaluated the association between resilience and PrEP use among a population-based sample of Canadian gay, bisexual, and other men who have sex with men (GBM). Sexually active GBM aged ≥ 16 years old were recruited via respondent-driven sampling (RDS) in Toronto, Montreal, and Vancouver from 02/2017 to 07/2019. We conducted a pooled cross-sectional analysis of HIV-negative/unknown GBM who met clinical eligibility for PrEP. We performed multivariable RDS-II-weighted logistic regression to assess the association between scores on the Connor-Davidson Resilience-2 Scale and PrEP. Mediation analyses with weighted logistic and linear regression were used to assess whether the relationship between minority stressors and PrEP use was mediated by resilience. Of 1167 PrEP-eligible GBM, 317 (27%) indicated they took PrEP in the past six months. Our multivariable model found higher resilience scores were associated with greater odds of PrEP use in the past six months (aOR = 1.13, 95%CI = 1.00, 1.28). We found that resilience reduced the effect of the association between heterosexist discrimination and PrEP use. Resilience also mediated the relationship between internalized homonegativity and PrEP use and mediated the effect of the association between LGBI acceptance concern and PrEP use. Overall, PrEP-eligible GBM with higher resilience scores had a greater odds of PrEP use in the past six months. We also found mixed results for the mediating role of resilience between minority stress and PrEP use. These findings underline the continued importance of strength-based factors in HIV prevention.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada.
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Syed W Noor
- School of Human Sciences, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Sarah Chown
- Engage Community-Advisory Committee, Vancouver, BC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l'Ile-de- Montréal, Montréal, QC, Canada.,Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Joseph Cox
- Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l'Ile-de- Montréal, Montréal, QC, Canada.,McGill University, Montréal, QC, Canada
| | | | | | | | | | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Community-Based Research Centre, Vancouver, BC, Canada.,University of Victoria, Victoria, BC, Canada
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23
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Harrison LB, Bergeron G, Cadieux G, Charest H, Fafard J, Levade I, Blais AC, Huchet E, Trottier B, Vlad D, Szabo J, Thomas R, Poulin S, Greenaway C, Zaharatos GJ, Oughton M, Chakravarti A, Pilarski R, Bui-Nguyen A, Benomar K, Libman MD, Vinh DC, Duggan AT, Graham M, Klein MB, Barkati S. Monkeypox in Montréal: Epidemiology, Phylogenomics, and Public Health Response to a Large North American Outbreak. Ann Intern Med 2023; 176:67-76. [PMID: 36508736 DOI: 10.7326/m22-2699] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Monkeypox, a viral zoonotic disease, is causing a global outbreak outside of endemic areas. OBJECTIVE To characterize the outbreak of monkeypox in Montréal, the first large outbreak in North America. DESIGN Epidemiologic and laboratory surveillance data and a phylogenomic analysis were used to describe and place the outbreak in a global context. SETTING Montréal, Canada. PATIENTS Probable or confirmed cases of monkeypox. MEASUREMENTS Epidemiologic, clinical, and demographic data were aggregated. Whole-genome sequencing and phylogenetic analysis were performed for a set of outbreak sequences. The public health response and its evolution are described. RESULTS Up to 18 October 2022, a total of 402 cases of monkeypox were reported mostly among men who have sex with men (MSM), most of which were suspected to be acquired through sexual contact. All monkeypox genomes nested within the B.1 lineage. Montréal Public Health worked closely with the affected communities to control the outbreak, becoming the first jurisdiction to offer 1 dose of the Modified Vaccinia Ankara-Bavarian Nordic vaccine as preexposure prophylaxis (PrEP) to those at risk in early June 2022. Two peaks of cases were seen in early June and July (43 and 44 cases per week, respectively) followed by a decline toward near resolution of the outbreak in October. Reasons for the biphasic peak are not fully elucidated but may represent the tempo of vaccination and/or several factors related to transmission dynamics and case ascertainment. LIMITATIONS Clinical data are self-reported. Limited divergence among sequences limited genomic epidemiologic conclusions. CONCLUSION A large outbreak of monkeypox occurred in Montréal, primarily among MSM. Successful control of the outbreak rested on early and sustained engagement with the affected communities and rapid offer of PrEP vaccination to at-risk persons. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Luke B Harrison
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada (L.B.H.)
| | - Geneviève Bergeron
- Direction régionale de santé publique de Montréal, Montréal, Québec, Canada (G.B.)
| | - Geneviève Cadieux
- Direction régionale de santé publique de Montréal and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada (G.C.)
| | - Hugues Charest
- Laboratoire de santé publique du Québec, INSPQ, Sainte-Anne-de-Bellevue, and Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada (H.C., J.F.)
| | - Judith Fafard
- Laboratoire de santé publique du Québec, INSPQ, Sainte-Anne-de-Bellevue, and Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada (H.C., J.F.)
| | - Inès Levade
- Laboratoire de Santé publique du Québec, INSPQ, Sainte-Anne-de-Bellevue, Québec, Canada (I.L.)
| | | | | | - Benoît Trottier
- Clinique Médicale du Quartier Latin, Montréal, Québec, Canada (B.T., D.V.)
| | - Dragos Vlad
- Clinique Médicale du Quartier Latin, Montréal, Québec, Canada (B.T., D.V.)
| | - Jason Szabo
- Clinique Médicale l'Actuel, Montréal, Québec, Canada (J.S., R.T.)
| | - Réjean Thomas
- Clinique Médicale l'Actuel, Montréal, Québec, Canada (J.S., R.T.)
| | | | - Christina Greenaway
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Department of Medicine, Division of Infectious Diseases, Jewish General Hospital, and J.D. MacLean Centre for Tropical Diseases at McGill University, Montréal, Québec, Canada (C.G.)
| | - Gerasimos J Zaharatos
- Department of Medicine, Division of Infectious Diseases, Jewish General Hospital, Montréal, Québec, Canada (G.J.Z., M.O.)
| | - Matthew Oughton
- Department of Medicine, Division of Infectious Diseases, Jewish General Hospital, Montréal, Québec, Canada (G.J.Z., M.O.)
| | - Arpita Chakravarti
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (A.C.)
| | - Robert Pilarski
- Clinique Médicale La Licorne, Montréal, Québec, Canada (R.P.)
| | | | | | - Michael D Libman
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, J.D. MacLean Centre for Tropical Diseases at McGill University, and Research Institute of the McGill University Health Centre, Montréal, Québec, Canada (M.D.L., S.B.)
| | - Donald C Vinh
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, and Research Institute of the McGill University Health Centre, Montréal, Québec, Canada (D.C.V.)
| | - Ana T Duggan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada (A.T.D.)
| | - Morag Graham
- National Microbiology Laboratory, Public Health Agency of Canada, and Department of Medical Microbiology & Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (M.G.)
| | - Marina B Klein
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, and Research Institute of the McGill University Health Centre, Montréal, Québec, Canada (M.B.K.)
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, J.D. MacLean Centre for Tropical Diseases at McGill University, and Research Institute of the McGill University Health Centre, Montréal, Québec, Canada (M.D.L., S.B.)
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Lambert G, Cox J, Fourmigue A, Dvorakova M, Apelian H, Moodie EEM, Grace D, Skakoon-Sparling S, Moore DM, Lachowsky N, Jollimore J, Lal A, Parlette A, Hart TA. HIV incidence and related risks among gay, bisexual, and other men who have sex with men in Montreal, Toronto, and Vancouver: Informing blood donor selection criteria in Canada. Transfusion 2022; 62:2555-2567. [PMID: 36197064 PMCID: PMC10092181 DOI: 10.1111/trf.17127] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND An individualized behavior-based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada. STUDY DESIGN AND METHODS Engage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent-driven-sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood-borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS-adjusted Poisson regression. RESULTS Data on 2008 (study visits 2017-02 to 2021-08) HIV-negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person-years [95%CI:0.3, 0.6]. HIV seroconversion was associated with age <30 years: adjusted rate ratio (aRR) 9.1 [95%CI:3.2, 26.2], 6-10 and >10 anal sex partners versus 1-6 aRR: 5.3 [2.1,13.5] and 8.4 [3.4, 20.9], and use of crystal methamphetamine during sex: 4.2 [1.5, 11.6]. Applying the combined selection criteria: drug injection, ≥2 anal sex partners, and a new anal sex partner, detected all participants who seroconverted (100% sensitivity, 100% negative predictive value), and would defer 63% of study participants from donating. CONCLUSION Using three screening questions regarding drug injection and sexual behaviors in the past 6 months would correctly identify potential GBM donors at high risk of having recently contracted HIV. Doing so would reduce the proportion of deferred sexually active GBM by one-third.
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Affiliation(s)
- Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Joseph Cox
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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25
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Knight J, Tan DHS, Mishra S. Maximizing the impact of limited vaccine supply under different early epidemic conditions: a 2-city modelling analysis of monkeypox virus transmission among men who have sex with men. CMAJ 2022; 194:E1560-E1567. [PMID: 36442881 PMCID: PMC9828961 DOI: 10.1503/cmaj.221232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The current global monkeypox virus (MPXV) outbreak has disproportionately affected gay, bisexual and other men who have sex with men (GBMSM). Given that many jurisdictions have been faced with limited supplies of MPXV vaccine, we aimed to explore optimal vaccine allocation between 2 linked GBMSM transmission networks over a short-term time horizon, across several epidemic conditions. METHODS We constructed a deterministic compartmental MPXV transmission model. We parameterized the model to reflect 2 representative, partially connected GBMSM sexual networks ( cities), using 2022 data from Ontario. We simulated a roll-out of 5000 vaccine doses over 30 days that started 45 days after epidemic seeding with 10 imported cases. Within this model, we varied the relative city (network) sizes, epidemic potentials (R 0), between-city mixing and distribution of seed cases between cities. For each combination of varied factors, we identified the allocation of doses between cities that maximized infections averted by day 90. RESULTS Under our modelling assumptions, we found that a limited MPXV vaccine supply could generally avert more early infections when prioritized to networks that were larger, had more initial infections or had greater R 0. Greater between-city mixing decreased the influence of initial seed cases and increased the influence of city R 0 on optimal allocation. Under mixed conditions (e.g., fewer seed cases but greater R 0), optimal allocation required doses shared between cities. INTERPRETATION In the context of the current global MPXV outbreak, we showed that prioritization of a limited supply of vaccines based on network-level factors can help maximize infections averted during an emerging epidemic. Such prioritization should be grounded in an understanding of context-specific risk drivers and should acknowledge potential connectedness of multiple transmission networks.
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Affiliation(s)
- Jesse Knight
- MAP Centre for Urban Health Solutions (Knight, Tan, Mishra), Unity Health Toronto; Institute of Medical Science (Knight, Tan, Mishra), Institute of Health Policy, Management, and Evaluation (Tan, Mishra), and Division of Infectious Diseases (Tan, Mishra), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Darrell H S Tan
- MAP Centre for Urban Health Solutions (Knight, Tan, Mishra), Unity Health Toronto; Institute of Medical Science (Knight, Tan, Mishra), Institute of Health Policy, Management, and Evaluation (Tan, Mishra), and Division of Infectious Diseases (Tan, Mishra), Department of Medicine, University of Toronto, Toronto, Ont
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions (Knight, Tan, Mishra), Unity Health Toronto; Institute of Medical Science (Knight, Tan, Mishra), Institute of Health Policy, Management, and Evaluation (Tan, Mishra), and Division of Infectious Diseases (Tan, Mishra), Department of Medicine, University of Toronto, Toronto, Ont
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26
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Sang JM, McAllister K, Wang L, Barath J, Lal A, Parlette A, Noor SW, Apelian H, Skakoon‐Sparling S, Hull M, Moore DM, Cox J, Hart TA, Lambert G, Grace D, Jollimore J, Hogg RS, Lachowsky NJ. Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017-2020. J Int AIDS Soc 2022; 25:e26017. [PMID: 36306245 PMCID: PMC9616170 DOI: 10.1002/jia2.26017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. METHODS Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM. RESULTS Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4-31.4% (p<0.001) and Vancouver 21.7-59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18). CONCLUSIONS Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.
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Affiliation(s)
- Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Kate McAllister
- School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | | | - Syed W. Noor
- Ryerson UniversityTorontoOntarioCanada,School of Human SciencesLouisiana State University ShreveportShreveportLouisianaUSA
| | - Herak Apelian
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | | | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joseph Cox
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | - Trevor A. Hart
- Ryerson UniversityTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Gilles Lambert
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada,Institut national de santé publique du QuébecMontréalQuebecCanada
| | | | - Jody Jollimore
- Community Based Research CentreVancouverBritish ColumbiaCanada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,Simon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada,Community Based Research CentreVancouverBritish ColumbiaCanada
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27
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Hart TA, Noor SW, Berlin GW, Skakoon-Sparling S, Tavangar F, Tan D, Lambert G, Grace D, Lachowsky NJ, Jollimore J, Sang J, Parlette A, Lal A, Apelian H, Moore D, Cox J. Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men. Sex Transm Infect 2022; 99:167-172. [PMID: 35701145 PMCID: PMC10176373 DOI: 10.1136/sextrans-2021-055381] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours associated with bacterial STIs. We examined associations between PrEP use, condomless anal sex (CAS), number of anal sex partners, oral sex and bacterial STI diagnoses among GBM living in Canada's three largest cities. METHODS Among HIV-negative/unknown-status GBM in the baseline of the Engage cohort study, we fit a structural equation model of the associations between any PrEP use, sexual behaviours and bacterial STI diagnosis. We estimated direct and indirect paths between PrEP use and STI via CAS, number of anal sex partners and oral sex. RESULTS The sample included 2007 HIV-negative/unknown status GBM in Montreal, Toronto and Vancouver. There was a significant direct association between PrEP use and current STI diagnosis (β=0.181; 95% CI: 0.112 to 0.247; p<0.001), CAS (β=0.275; 95% CI: 0.189 to 0.361; p<0.001) and number of anal sex partners (β=0.193; 95% CI: 0.161 to 0.225; p<0.001). In the mediated model, the direct association between PrEP use and STIs was non-significant. However, the indirect paths from PrEP to CAS to STIs (β=0.064; 95% CI: 0.025 to 0.120; p=0.008), and from PrEP to greater number of anal sex partners to CAS to STIs were significant (β=0.059; 95% CI: 0.024 to 0.108; p=0.007). CONCLUSIONS Our study adds to the growing awareness that PrEP use among GBM may be associated with bacterial STIs because PrEP users have more anal sex partners and are more likely to engage in CAS. The results underscore the importance of providing effective STI counselling and regular testing to PrEP users, adapting PrEP care and related STI testing to individual needs, and the need for effective prevention strategies for bacterial STIs.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Department of Kinesiology and Health Science, Louisiana State University in Shreveport, Shreveport, Louisiana, USA
| | - Graham W Berlin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Farideh Tavangar
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Darrell Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada.,Direction des Risques Biologiques et de la Santé au Travail, Institut national de santé publique du Québec Montréal, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathan John Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jordan Sang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Allan Lal
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - David Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.,Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada
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Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada. Vaccine 2022; 40:3690-3700. [PMID: 35577633 DOI: 10.1016/j.vaccine.2022.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Starting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline. METHODS We recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12-13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or > 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion. RESULTS Among 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged > 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged > 26 years. CONCLUSIONS We observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Coutlée F, Burchell AN. Anal Human Papillomavirus Prevalence Among Vaccinated and Unvaccinated Gay, Bisexual, and Other Men Who Have Sex With Men in Canada. Sex Transm Dis 2022; 49:123-132. [PMID: 34561370 PMCID: PMC8746886 DOI: 10.1097/olq.0000000000001560] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Starting in 2015, human papillomavirus (HPV) vaccine has been publicly funded for gay, bisexual, and other men who have sex with men (GBM) 26 years or younger in Canada. METHODS Self-identified GBM who reported having sex with another man within the past 6 months were enrolled using respondent-driven sampling (RDS) between February 2017 and August 2019 in Montreal, Toronto, and Vancouver, Canada. Men aged 16 to 30 years self-collected anal specimens for HPV-DNA testing. Prevalence was estimated using RDS-II weights. We compared the prevalence of quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types between GBM who self-reported HPV vaccination (≥1 dose) and those reporting no vaccination using a modified Poisson regression for binary outcomes. RESULTS Among 645 GBM who provided a valid anal specimen (median age, 26 years; 5.9% HIV positive), 40.3% reported receiving ≥1 dose of HPV vaccine, of whom 61.8% received 3 doses. One-quarter were infected with ≥1 quadrivalent type (crude, 25.7%; RDS weighted, 24.4%). After adjustment for potential confounders, vaccinated GBM had a 27% lower anal prevalence of quadrivalent types compared with unvaccinated GBM (adjusted prevalence ratio [aPR], 0.73; 95% confidence interval [CI], 0.54-1.00). Lower prevalence ratios were found among vaccinated participants who were vaccinated >2 years before enrollment (aPR, 0.47; 95% CI, 0.25-0.86) or received their first vaccine dose at age ≤23 years (aPR, 0.64; 95% CI, 0.42-0.99). Point estimates were similar for ≥2 or 3 doses and 9-valent types. CONCLUSIONS Human papillomavirus vaccination was associated with a lower anal prevalence of vaccine-preventable HPV types among young, sexually active GBM. Findings will help inform shared decision making around HPV vaccination for GBM and their healthcare providers.
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Affiliation(s)
- Catharine Chambers
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
| | - Shelley L. Deeks
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Health and Wellness, Government of Nova Scotia, Halifax
| | - Rinku Sutradhar
- From the Dalla Lana School of Public Health, University of Toronto
- ICES, Sunnybrook Research Institute, Toronto
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | | | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver
| | - Trevor A. Hart
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Psychology, Ryerson University, Toronto
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal
- Laboratoire de virologie moléculaire, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal
| | - Ann N. Burchell
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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