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Gilbert M, Michelow W, Dulai J, Wexel D, Hart T, Young I, Martin S, Flowers P, Donelle L, Ferlatte O. Provision of online HIV-related information to gay, bisexual and other men who have sex with men: a health literacy-informed critical appraisal of Canadian agency websites. Sex Health 2020; 16:39-46. [PMID: 30620885 DOI: 10.1071/sh18092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/06/2018] [Indexed: 01/16/2023]
Abstract
Background HIV risk and prevention information is increasingly complex and poses challenges for gay, bisexual and other men who have sex with men (GBMSM) seeking to find, understand and apply this information. A directed content analysis of Canadian HIV websites to see what information is provided, how it is presented and experienced by users, was conducted. METHODS Eligible sites provided information relevant for GBMSM on HIV risk or prevention, were from community or government agencies, and were aimed at the public. Sites were found by using a Google search using French and English search terms, from expert suggestions and a review of links. Eligibility and content for review was determined by two reviewers, and coded using a standardised form. Reading grade level and usability scores were assessed through Flesch-Kincaid and LIDA instruments. RESULTS Of 50 eligible sites, 78% were from community agencies and 26% were focussed on GBMSM. Overall, fewer websites contained information on more recent biomedical advances (e.g. pre-exposure prophylaxis, 10%) or community-based prevention strategies (e.g. seroadaptive positioning, 10%). Many sites had high reading levels, used technical language and relied on text and prose. And 44% of websites had no interactive features and most had poor usability scores for engageability. CONCLUSIONS Overall, less information about emerging topics and a reliance on text with high reading requirements was observed. Our study speaks to potential challenges for agency website operators to maintain information relevant to GBMSM which is up-to-date, understandable for a range of health literacy skills and optimises user experience.
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Affiliation(s)
- Mark Gilbert
- Ontario HIV Treatment Network, 600-1300 Yonge Street, Toronto, Ontario M4T 1X3, Canada
| | - Warren Michelow
- The University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Joshun Dulai
- Community-Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia V6Z 2H2, Canada
| | - Daniel Wexel
- Community-Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia V6Z 2H2, Canada
| | - Trevor Hart
- Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Ingrid Young
- University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom
| | - Susan Martin
- University of Glasgow, University Avenue, Glasgow G12 8QQ, United Kingdom
| | - Paul Flowers
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom
| | - Lorie Donelle
- Western University, 1151 Richmond Street, London, Ontario N6A 3K7, Canada
| | - Olivier Ferlatte
- Community-Based Research Centre for Gay Men's Health, 1007-808 Nelson Street, Vancouver, British Columbia V6Z 2H2, Canada
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Irvine MA, Konrad BP, Michelow W, Balshaw R, Gilbert M, Coombs D. A novel Bayesian approach to predicting reductions in HIV incidence following increased testing interventions among gay, bisexual and other men who have sex with men in Vancouver, Canada. J R Soc Interface 2019. [PMID: 29540541 DOI: 10.1098/rsif.2017.0849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Increasing HIV testing rates among high-risk groups should lead to increased numbers of cases being detected. Coupled with effective treatment and behavioural change among individuals with detected infection, increased testing should also reduce onward incidence of HIV in the population. However, it can be difficult to predict the strengths of these effects and thus the overall impact of testing. We construct a mathematical model of an ongoing HIV epidemic in a population of gay, bisexual and other men who have sex with men. The model incorporates different levels of infection risk, testing habits and awareness of HIV status among members of the population. We introduce a novel Bayesian analysis that is able to incorporate potentially unreliable sexual health survey data along with firm clinical diagnosis data. We parameterize the model using survey and diagnostic data drawn from a population of men in Vancouver, Canada. We predict that increasing testing frequency will yield a small-scale but long-term impact on the epidemic in terms of new infections averted, as well as a large short-term impact on numbers of detected cases. These effects are predicted to occur even when a testing intervention is short-lived. We show that a short-lived but intensive testing campaign can potentially produce many of the same benefits as a campaign that is less intensive but of longer duration.
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Affiliation(s)
- Michael A Irvine
- Department of Mathematics and Institute of Applied Mathematics, 1984 Mathematics Road, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z2 .,British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, British Columbia, Canada
| | - Bernhard P Konrad
- Department of Mathematics and Institute of Applied Mathematics, 1984 Mathematics Road, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z2
| | - Warren Michelow
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, British Columbia, Canada
| | - Robert Balshaw
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, 1984 Mathematics Road, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z2
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3
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Gilbert M, Taylor D, Michelow W, Grace D, Balshaw R, Kwag M, Lim E, Fischer B, Patrick D, Ogilvie G, Coombs D, Steinberg M, Rekart M. Sustained Reduction in Sexual Behavior that May Pose a Risk of HIV Transmission Following Diagnosis During Early HIV Infection Among Gay Men in Vancouver, British Columbia. AIDS Behav 2018; 22:2068-2078. [PMID: 28168375 DOI: 10.1007/s10461-017-1702-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increased viral load during early HIV infection (EHI) disproportionately contributes to HIV transmission among gay men. We examined changes in sexual behavior that may pose a risk of HIV transmission (condomless anal sex (AS) with a serodiscordant or unknown status partner, CAS-SDU) in a cohort of 25 gay men newly diagnosed during EHI who provided information on 241 sexual partners at six time points following diagnosis. Twenty-two (88%) participants reported ≥1 AS partner (median time to first AS 80 days) and 12 (55%) reported ≥1 partnership involving CAS-SDU (median 116 days). In hierarchical generalized linear mixed effects models, AS was significantly less likely in all time periods following diagnosis and more likely with serodiscordant partners. The likelihood of CAS-SDU decreased three months after diagnosis and was higher in recently versus acutely infected participants. Most men in our study abstained from sex immediately after diagnosis with sustained longer-term reduction in CAS-SDU, confirming the importance of timely diagnosis during EHI.
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Orchard T, Salters K, Michelow W, Lepik K, Palmer A, Hogg R. “My job is to deal with what I can”: HIV care providers’ perspectives on adherence to HAART, addictions, and comprehensive care delivery in Vancouver, British Columbia. Critical Public Health 2015. [DOI: 10.1080/09581596.2015.1088641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gilbert M, Ferlatte O, Michelow W, Martin S, Young I, Donelle L, Rootman I, McDaid L, Flowers P. P02.05 Sexual health literacy – an emerging framework for research and intervention to improve sexual health for gay men. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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6
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Bogowicz P, Moore D, Kanters S, Michelow W, Robert W, Hogg R, Gustafson R, Gilbert M. HIV testing behaviour and use of risk reduction strategies by HIV risk category among MSM in Vancouver. Int J STD AIDS 2015; 27:281-7. [PMID: 25736346 DOI: 10.1177/0956462415575424] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/22/2015] [Indexed: 11/16/2022]
Abstract
We carried out an analysis of a serobehavioural study of men who have sex with men >19 years of age in Vancouver, Canada to examine HIV testing behaviour and use of risk reduction strategies by HIV risk category, as defined by routinely gathered clinical data. We restricted our analysis to those who self-identified as HIV-negative, completed a questionnaire, and provided a dried blood spot sample. Of 842 participants, 365 (43.3%) were categorised as lower-risk, 245 (29.1%) as medium-risk and 232 (27.6%) as higher-risk. The prevalence of undiagnosed HIV infection was low (lower 0.8%, medium 3.3%, higher 3.9%; p = 0.032). Participants differed by risk category in terms of having had an HIV test in the previous year (lower 46.5%, medium 54.6%, higher 67.0%; p < 0.001) and in their use of serosorting (lower 23.3%, medium 48.3%, higher 43.1%; p < 0.001) and only having sex with HIV-positive men if those men had low viral loads or were taking HIV medication (lower 5.1%, medium 4.8%, higher 10.9%; p = 0.021) as risk reduction strategies. These findings speak to the need to consider segmented health promotion services for men who have sex with men with differing risk profiles. Risk stratification could be used to determine who might benefit from tailored multiple health promotion interventions, including HIV pre-exposure prophylaxis.
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Affiliation(s)
- Paul Bogowicz
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Steve Kanters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Warren Michelow
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Robert
- Health Initiative for Men, Vancouver, BC, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada British Columbia Centre for Disease Control, Vancouver, BC, Canada
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7
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Orchard T, Salters K, Palmer A, Michelow W, Lepik KJ, Hogg R. Vets, denialists and rememberers: social typologies of patient adherence and non-adherence to HAART from the perspective of HIV care providers. AIDS Care 2015; 27:758-61. [PMID: 25635938 DOI: 10.1080/09540121.2015.1005003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
For many people living with HIV/AIDS taking highly active antiretroviral therapy (HAART) is difficult due to various individual and social factors, including the side effects of these medications, HIV/AIDS stigma and poor patient-provider relationships. Most studies that examine barriers to and facilitators of adherence to HAART have been conducted with people on these medications, which is critical to improving adherence among various HIV-affected groups. Less attention has been paid to the experiences of HIV care providers, which is an important gap in the literature considering the key role they play in the delivery of HAART and the management of patient treatment plans. This paper presents findings from a qualitative pilot study that explored how HIV care providers assess adherence and non-adherence to HAART among their HIV-positive patients in Vancouver, British Columbia. Drawing upon individual interviews conducted with HIV physicians (n = 3), social service providers (n = 3) and pharmacists (n = 2), this discussion focuses on the social typologies our participants use to assess patient success and failure related to adherence. Eleven unique categories are featured and the diversity within and across these categories illustrate a broad spectrum of adherence-related behaviours among patients and the social meanings providers attribute to these behaviours. As one of the first explorations of the social typologies used by HIV care providers to assess patient performance on HAART, these data contribute valuable insights into the experiences of providers within the context of adherence-related care delivery.
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Affiliation(s)
- Treena Orchard
- a School of Health Studies , Western University , London , ON , Canada
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8
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Ng BE, Moore D, Michelow W, Hogg R, Gustafson R, Robert W, Kanters S, Thumath M, McGuire M, Gilbert M. Relationship between disclosure of same-sex sexual activity to providers, HIV diagnosis and sexual health services for men who have sex with men in Vancouver, Canada. Can J Public Health 2014; 105:e186-91. [PMID: 25165837 DOI: 10.17269/cjph.105.4212] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 04/22/2014] [Accepted: 01/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care. METHODS Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test. RESULTS Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as "gay" or "queer" (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all). CONCLUSIONS While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.
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9
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Orchard T, Smith T, Michelow W, Salters K, Hogg B. Imagining adherence: body mapping research with HIV-positive men and women in Canada. AIDS Res Hum Retroviruses 2014; 30:337-8. [PMID: 24697645 DOI: 10.1089/aid.2014.0021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Warren Michelow
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Bob Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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10
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Forrest JI, Stevenson B, Rich A, Michelow W, Pai J, Jollimore J, Raymond HF, Moore D, Hogg RS, Roth EA. Community mapping and respondent-driven sampling of gay and bisexual men's communities in Vancouver, Canada. Cult Health Sex 2014; 16:10.1080/13691058.2014.881551. [PMID: 24512070 PMCID: PMC4127385 DOI: 10.1080/13691058.2014.881551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Literature suggests formative research is vital for those using respondent-driven sampling (RDS) to study hidden populations of interest. However, few authors have described in detail how different qualitative methodologies can address the objectives of formative research for understanding the social network properties of the study population, selecting seeds and adapting survey logistics to best fit the population. In this paper we describe the use of community mapping exercises as a tool within focus groups to collect data on social and sexual network characteristics of gay and bisexual men in the metropolitan area of Vancouver, Canada. Three key themes emerged from analysing community maps along with other formative research data: (1) connections between physical spaces and social networks of gay and bisexual men, (2) diversity in communities and (3) substance use linked to formation of sub-communities. We discuss how these themes informed the planning and operations of a longitudinal epidemiological cohort study recruited by RDS. We argue that using community mapping within formative research is a valuable qualitative tool for characterising network structures of a diverse and differentiated population of gay and bisexual men in a highly developed urban setting.
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Affiliation(s)
- Jamie I Forrest
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Benjamin Stevenson
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Ashleigh Rich
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Warren Michelow
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jayaram Pai
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | | | - David Moore
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- Department of Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A Roth
- Faculty of Social Science, Department of Anthropology, University of Victoria, Victoria, Canada
- Centre for Addictions Research BC, Victoria, Canada
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Haley L, Wong J, Moore D, Chan K, Michelow W, Dawar M, Robert W, Hogg R, Gilbert M, Team T. Prevalence and correlates of cigarette smoking among men who have sex with men (MSM) in Vancouver, Canada: A cross-sectional survey. ACTA ACUST UNITED AC 2014. [DOI: 10.5455/jbh.20131217011519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Maung Maung T, Chen B, Moore DM, Chan K, Kanters S, Michelow W, Hogg RS, Nakamura N, Robert W, Gustafson R, Gilbert M. Risks for HIV and other sexually transmitted infections among Asian men who have sex with men in Vancouver, British Columbia: a cross-sectional survey. BMC Public Health 2013; 13:763. [PMID: 23947623 PMCID: PMC3751745 DOI: 10.1186/1471-2458-13-763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals of Asian heritage represent the largest ethnic minority in Canada. Approximately 10% of the new HIV diagnoses in men in British Columbia occur among Asian-Canadians. However, the HIV risk patterns of Asian men who have sex with men (MSM) have not been extensively studied. METHODS Participants aged ≥ 19 years were enrolled in a venue-based HIV serobehavioural survey of MSM in Vancouver, Canada. We compared the demographic characteristics, risk behaviours, and prevalence of HIV and other sexual and blood borne infections between Asian and non-Asian MSM using bivariate analysis and logistic regression confounder modelling. RESULTS Amongst 1132 participants, 110 (9.7%) self-identified as Asian. Asian participants were younger than non-Asian participants (median age 29 vs. 32 years; p < 0.001), but otherwise did not differ from other study participants. HIV prevalence was lower among Asian MSM compared to Non-Asian MSM (3.7% vs 19.0%, p <0.001). Among men who self-reported as HIV negative or unknown we found no differences in unprotected anal intercourse (UAI) with a discordant or unknown serostatus partner in the previous six months (11 vs. 13%; p = 0.503). However, Asian MSM were less likely to report ever using injection drugs (10.8% vs. 19.2%; p = 0.043) or using alcohol before having sex (52% vs. 64.4%; p = 0.017). CONCLUSIONS Asian MSM in our study reported similar rates of UAI as non-Asian MSM, but had a lower prevalence of HIV infection. Other factors, such as the use of drugs and alcohol, in relation to sex, may partly explain these differences. However this requires further investigation.
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Affiliation(s)
- Thiha Maung Maung
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Becky Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David M Moore
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Keith Chan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Steve Kanters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Warren Michelow
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nadine Nakamura
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- University of La Verne, La Verne, CA, USA
| | - Wayne Robert
- Health Initiative for Men, Vancouver, BC, Canada
| | | | - Mark Gilbert
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of STI/HIV Prevention and Control, British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Martin G, Vallance K, Macdonald S, Stockwell T, Ivsins A, Chow C, Michelow W, Duff C. Nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users. Journal of Substance Use 2013. [DOI: 10.3109/14659891.2013.784369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Gustafson P, Gilbert M, Xia M, Michelow W, Robert W, Trussler T, McGuire M, Paquette D, Moore DM, Gustafson R. Impact of statistical adjustment for frequency of venue attendance in a venue-based survey of men who have sex with men. Am J Epidemiol 2013; 177:1157-64. [PMID: 23639936 DOI: 10.1093/aje/kws358] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.
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Affiliation(s)
- Paul Gustafson
- Department of Statistics, Faculty of Science, University of British Columbia, 3182 Earth Sciences Building, 2207 Main Mall, Vancouver, BC V6T 1Z4, Canada.
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15
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O'Brien N, Palmer AK, Zhang W, Michelow W, Shen A, Roth E, Rhodes CL, Salters KA, Montaner JSG, Hogg RS. Social-structural factors associated with supportive service use among a cohort of HIV-positive individuals on antiretroviral therapy. AIDS Care 2013; 25:937-47. [PMID: 23320437 DOI: 10.1080/09540121.2012.748866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As mortality rates decrease in British Columbia, Canada, supportive services (e.g. housing, food, counseling, addiction treatment) are increasingly conceptualized as critical components of care for people living with HIV/AIDS. Our study investigates social and clinical correlates of supportive service use across differing levels of engagement. Among 915 participants from the Longitudinal Investigations into Supportive and Ancillary health services (LISA) cohort, 742 (81%) reported using supportive services. Participants were nearly twice as likely to engage daily in supportive services if they self-identified as straight (95% confidence interval [CI], adjusted odds ratio [AOR]: 1.69), had not completed high school (95% CI, AOR: 1.97), had an annual income of < $15,000 (95% CI, AOR: 1.81), were unstably housed (95% CI, AOR: 1.89), were currently using illicit drugs (95% CI, AOR: 1.60), or reported poor social capital in terms of perceived neighborhood problems (95% CI, AOR: 1.15) or standard of living (95% CI, AOR: 1.70). Of interest, after adjusting for sociodemographic and socioeconomic variables, no clinical markers remained an independent predictor of use of supportive services. High service use by those demonstrating social and clinical vulnerabilities reaffirms the need for continued expansion of supportive services to facilitate a more equitable distribution of health among persons living with HIV.
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Affiliation(s)
- Nadia O'Brien
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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16
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Chow C, Vallance K, Stockwell T, Macdonald S, Martin G, Ivsins A, Marsh DC, Michelow W, Roth E, Duff C. Sexual identity and drug use harm among high-risk, active substance users. Cult Health Sex 2013; 15:311-326. [PMID: 23311592 DOI: 10.1080/13691058.2012.754054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research shows that sexual minorities are at greater risk for illicit substance use and related harm than their heterosexual counterparts. This study examines a group of active drug users to assess whether sexual identity predicts increased risk of substance use and harm from ecstasy, ketamine, alcohol, marijuana, cocaine and crack. Structured interviews were conducted with participants aged 15 years and older in Vancouver and Victoria, BC, Canada, during 2008-2012. Harm was measured with the World Health Organization's AUDIT and ASSIST tools. Regression analysis controlling for age, gender, education, housing and employment revealed lesbian, gay or bisexual individuals were significantly more likely to have used ecstasy, ketamine and alcohol in the past 30 days compared to heterosexual participants. Inadequate housing increased the likelihood of crack use among both lesbian, gay and bisexuals and heterosexuals, but with considerably higher odds for the lesbian, gay and bisexual group. Lesbian, gay and bisexual participants reported less alcohol harm but greater ecstasy and ketamine harm, the latter two categorised by the ASSIST as amphetamine and hallucinogen harms. Results suggest encouraging harm reduction among sexual minority, high-risk drug users, emphasising ecstasy and ketamine. The impact of stable housing on drug use should also be considered.
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Moore DM, Kanters S, Michelow W, Gustafson R, Hogg RS, Kwag M, Trussler T, McGuire M, Robert W, Gilbert M. Implications for HIV prevention programs from a serobehavioural survey of men who have sex with men in Vancouver, British Columbia: the ManCount study. Can J Public Health 2012. [PMID: 22530539 DOI: 10.1007/bf03404220] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We examined HIV prevalence, awareness of HIV serostatus and HIV risk behaviour among a sample of men who have sex with men (MSM) in Vancouver. METHODS MSM > or = 18 years were recruited from August 2008 to February 2009 through community venues. Participants completed a questionnaire and provided a dried blood spot (DBS) for HIV and other STI testing. We performed descriptive statistics and bivariate analyses of key explanatory variables. RESULTS A total of 1,169 participants completed questionnaires; of these, 1,138 (97.3%) provided DBS specimens suitable for testing. The median age was 33 years (IQR 26-44). A total of 206 (18%) were HIV-positive by DBS, of whom 86% were aware they were positive. HIV seropositivity increased from 7.1% in those < 30 years of age to 19% in those 30-44 years and 34% among those > or = 45 years (p < 0.001 for test of trend). Of the 933 who self-reported as HIV-negative or unknown, 28 (3.0%) tested HIV-positive. Among those not tested for HIV in the previous 2 years, the reasons for not testing differed between participants with undiagnosed HIV infection and those who were HIV-negative. A total of 62% of study participants who self-reported as HIV-negative reported using a condom the last time they had anal sex. The use of risk-reduction measures was reported by 91.1% of all study participants (72% if excluding consistent condom use). CONCLUSION The majority of MSM in Vancouver have adopted behaviours that reduce their HIV-related risk. However, prevention programs must continue to promote condom use, increase HIV testing, and better inform MSM of the value and limitations of other risk-reduction strategies.
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Affiliation(s)
- David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC.
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Ivsins A, Chow C, Macdonald S, Stockwell T, Vallance K, Marsh DC, Michelow W, Duff C. An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme. Int J Drug Policy 2012; 23:338-40. [PMID: 22280916 DOI: 10.1016/j.drugpo.2011.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/14/2011] [Accepted: 11/21/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BC's only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures. METHODS Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n=579) in Victoria and Vancouver between late 2007 and late 2010. RESULTS Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing. CONCLUSIONS The closure of Victoria's fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure.
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Affiliation(s)
- Andrew Ivsins
- Centre for Addictions Research of British Columbia, University Victoria, PO Box 1700 STN CSC, Victoria, BCV8Y 2E4, Canada.
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Michelow W, Talany G, O'Brien N, Wang H, Forrest J, Palmer A, Montaner JSG, Hogg R. P1-S2.62 Factors associated with high-risk penetrative sex in a cohort of treatment experienced HIV-positive men who have sex with men (MSM) in British Columbia. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O'Brien N, Palmer AK, Zhang W, Michelow W, Shen A, Roth E, Rhodes CL, Montaner JSG, Hogg RS. P5-S6.22 Social-structural factors associated with supportive service use in a cohort of HIV-positive individuals on ARV therapy in British Columbia, Canada. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Michelow W, Hogg R, Moore D, Gustafson R, Trussler T, McGuire M, Gilbert M. P1-S2.60 Prevalence and correlates of giving or receiving sex for money, drugs or goods among men who have sex with men in Vancouver, British Columbia. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Duncan KC, Reading C, Borwein AM, Murray MCM, Palmer A, Michelow W, Samji H, Lima VD, Montaner JSG, Hogg RS. HIV incidence and prevalence among aboriginal peoples in Canada. AIDS Behav 2011; 15:214-27. [PMID: 20799061 DOI: 10.1007/s10461-010-9792-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.
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Affiliation(s)
- Katrina C Duncan
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Abstract
In late 2006, pilot research was initiated in two western Canadian sites (Vancouver and Victoria) to systematically monitor patterns and trends in three specific illicit drug user populations: club and rave party attendees, adolescent street involved injection and non-injection drug users, and adult injection drug users. These sentinel groups were selected because of elevated rates of alcohol and other drug use within these populations and contexts, and the high levels of associated risks and harms. Drawing from international monitoring and surveillance systems, novel research instruments were developed for each population and were administered in face-to-face interviews at each study site. This paper presents an overview of the broad research methodology for the “high risk” monitoring research as well as select findings for the “club drug” sample. The piloted research design yielded high quality data, particularly in relation to recent patterns of drug use behaviour (items on drug use “yesterday” and “last weekend”). The success of these novel items highlights the value of the present study and its relevance for similar studies across the country.
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Stockwell T, Buxton J, Duff C, Marsh D, MacDonald S, Michelow W, Richard K, Saewyc E, Hanson R, Cohen I, Corrado R, Chow C, Ivsins A, Nicholson D, Pakula B, Puri A, Rehm J, Sturge J, Tu A, Zhao J. The British Columbia Alcohol and other Drug Monitoring System: Overview and Early Progress. ACTA ACUST UNITED AC 2009. [DOI: 10.1177/009145090903600307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This pilot project is a province-wide and nationally=supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements.
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