Clemon George

Risk factors associated with HIV infection among young gay and bisexual men in Canada

Objective: To assess risk factors associated with HIV prevalence and incidence among gay and bisexual men in two prospective Canadian cohorts. Methods: The Vanguard Project and the Omega Cohort are prospective cohort studies of gay and bisexual men ongoing in Vancouver and Montreal, respectively. For this analysis, baseline sociodemographic characteristics, sexual behavior, and substance use data from these two cohorts were combined. Assessment of risk factors for HIV seroprevalence and seroconversion were carried out using univariate and multivariate analysis. Results: This analysis was based on 1373 gay and bisexual men aged 16 to 30 years. Men who were HIV‐seropositive at baseline (n = 48) were more likely to report living in unstable housing, to have had less than a high school education, and to have been unemployed than those who were HIV‐negative (n = 1325). HIV‐positive men were also more likely to report having engaged in sexual risk behavior, including having had consensual sex at a younger age, having had at least 6 partners during the previous year, ever having been involved in the sex trade, and having engaged in unprotected receptive anal intercourse. With respect to substance use, HIV‐positive men were more likely to report the use of crack, cocaine, heroin, and marijuana and to use injection drugs. Similarly, men who seroconverted during the course of the studies (n = 26) were more likely to report having less than a high school education and having lived in unstable housing at baseline. Compared with HIV‐negative men, men who seroconverted were more likely to report ever having been involved in the sex trade and engaging in unprotected receptive anal intercourse. Reports of cocaine use and injection drug use were also significantly higher for men who seroconverted compared with HIV‐negative men. Conclusions: Our data indicate that HIV‐positive gay and bisexual men are more likely to be living in unstable conditions and to report more risky sexual and substance use behaviors than HIV‐negative men.

The MaBwana Black men's study: community and belonging in the lives of African, Caribbean and other Black gay men in Toronto

In Canada, there is a paucity of research aimed at understanding Black gay men and the antecedents to risk factors for HIV. This study is an attempt to move beyond risk factor analysis and explore the role of sexual and ethnic communities in the lives of these men. The study utilized a community-based research and critical race theory approach. Semi-structured interviews were conducted with eight key informants to augment our understanding of Black gay men and to facilitate recruitment of participants. In-depth interviews were done with 24 Black gay men. Our data showed that the construction of community for Black gay men is challenged by their social and cultural environment. However, these men use their resilience to navigate gay social networks. Black gay men expressed a sense of abjuration from both gay and Black communities because of homophobia and racism. It is essential for health and social programmers to understand how Black gay men interact with Black and gay communities and the complexities of their interactions in creating outreach educational, preventive and support services.

Never reflected anywhere: body image among ethnoracialized gay and bisexual men.

A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n=61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.

Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in montreal.

Objective: To determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with men (MSM) participating in the Omega Cohort Study, 1997 through 2003. Methods: The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. Results: Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR = 1.06, 95% confidence interval [CI]: 1.04 to 1.09) and any type of partner (OR = 1.05, 95% CI: 1.03 to 1.07). There was a nonnegligible increase in UAI with casual partners (OR = 1.05, 95% CI: 1.01 to 1.09). For the analysis by calendar time, there were increases in UAI between regular seroconcordant partners (OR = 1.04, 95% CI: 1.02 to 1.05) and any type of partner (OR = 1.03, 95% CI: 1.02 to 1.04). There were nonnegligible increases in UAI with casual partners (OR = 1.03, 95% CI: 1.00 to 1.05) and with any type of partner except a regular seroconcordant partner from 15.7% to 18.8% (OR = 1.02, 95% CI: 1.00 to 1.04). Conclusions: There was a nonnegligible and consistent increase in UAI among Omega Cohort Study participants between 1997 and 2003. Continuous trend analysis is important because it allows us to follow UAI closely and to implement intervention strategies that may help to stop or reduce the present trend.

No increase in HIV incidence observed in a cohort of men who have sex with other men in Montreal

To monitor HIV incidence we tested a cohort of men who have sex with men in Montreal for HIV every 6 months. Between 1996 and 2001, 17 out of 1244 participants seroconverted, for an HIV incidence of 0.56 per 100 person-years (py) (95% CL 0.29, 0.83). The incidence decreased over the study period, from 0.75 to 0.34 per 100 py; which was not statistically significant. An in-depth evaluation of the situation in Montreal could identify useful lessons for prevention efforts elsewhere.

Challenges to the involvement of people living with HIV in community-based HIV/AIDS organizations in Ontario, Canada

The Greater Involvement of People Living with HIV/AIDS Principle (GIPA) has been a core commitment for many people involved in the community-based HIV/AIDS movement. GIPA refers to the inclusion of people living with HIV/AIDS in service delivery and decision-making processes that affect their lives. Despite its central importance to the movement, it has received little attention in the academic literature. Drawing on focus group discussions among staff members and volunteers of AIDS service organizations, activists, and community members, we explore challenges to the implementation of the GIPA principle in community-based HIV/AIDS organizations in Ontario, Canada. Our findings reveal ways in which implementing GIPA has become more complicated over recent years. Challenges relating to health, stigma and disclosure, evolving HIV/AIDS organizations, and GIPA-related tensions are identified. This paper considers our findings in light of previous research, and suggests some implications for practice.

Black gay men as sexual subjects: race, racialisation and the social relations of sex among Black gay men in Toronto

In this study of Black gay and bisexual men in Toronto, sexually active survey participants reported on their sexual behaviours with male partners of different ethnoracial backgrounds, and interview participants reflected on how their sexual relationships emerged in the context of race and interracial desire. Most survey participants reported sexual relationships with other Black men. Participants were more likely to be insertive with White and other ethnoracial men than with Black men. A significant number of participants who were receptive or versatile with Black partners switched to the insertive role when their sexual partners were not Black. Interview participants ascribed a sense of fulfilment to their sexual relationships with other Black men, but avoided relationships with White men or interpreted such relationships as either purely sexual and/or inflected by their racialised objectification. Others avoided sexual relationships with other Black men or preferred relationships with White men, sometimes in opposition to experiences of oppressive masculinity from some Black partners but mindful of the possibility of racialised encounters with their White partners. Study participants emerge as informed sexual subjects, self-conscious about their sexual relationships and variously inclined to negotiate or resist racialisation and oppression in the private and public spheres.

Everyone just keeps their eyes closed and their fingers crossed: sexual health communication among black parents and children in Nova Scotia, Canada.

BackgroundBlack Canadian youth remain disproportionally affected by an array of social and health issues, including sexually transmitted infections. While research exists in support of the involvement of parents as a key means to prevent or modify harmful behaviours among youth, less is known about how parent–child communication can serve as a prevention intervention strategy within Black families in Canada. This study explores sexual health communication between Black parents and youth in Nova Scotia and identifies facilitators, obstacles and issues that families face in dialoguing about sexual health.MethodsFocus groups and in-depth interview sessions were held with a diverse sample of parents of Black youth, health and education professionals, and Black youth in Nova Scotia, as part of a larger study aimed at exploring parent–child communication on sexual health and HIV. The research team worked in partnership with and received feedback from key informants and a community advisory committee throughout the various stages of this study. All sessions were audio-taped with permission and thematic analysis was carried out on the verbatim transcripts.ResultsSix key themes emerged from the data analysis in relation to parent–child communication within Black families in Nova Scotia: 1. the gendered nature of [sexual] health communication; 2. fear and uncertainty as obstacles; 3. open and honest dialogue from an early age as a facilitator; 4. media as both a catalyst and a barrier; 5. peers as a catalyst; and 6. time constraints as an obstacle.ConclusionsThe findings of this study reveal that parent–child communication regarding sexual health promotion within Black families in Nova Scotia remains varied and is heavily affected by a myriad of intersecting determinants of health faced by Black youth and their parents. Health promotion interventions aimed at fostering and supporting parent–child communication on sexual health must simultaneously target both parents and youth and further, such efforts must engage a high level of cultural competency in order to better meet the needs of this population.

HIV Testing by Black MSM in Toronto: Identifying Targets to Improve Testing

Surveillance data suggest that Black men who have sex with men (MSM) in Canada contribute to a higher than expected percentage of new HIV diagnoses. HIV testing is an important part of the HIV reduction strategy in Canada and the Public Health Agency of Canada recommends HIV testing as a component of periodic routine medical care. A cross-sectional survey was conducted among Black MSM in Toronto to determine the factors associated with HIV testing. One hundred sixty-five men were recruited and completed a self-administrative questionnaire. The majority of men identified as gay/homosexual. Lifetime history of HIV testing was reported at 85%, of whom 50% had tested within the last 6 months. Self-reported HIV seroprevalence was 24%. In logistic regression, variables associated with ever testing for HIV were “having friends or family with HIV” and “regularly attending religious services.” Although HIV testing appears to be common among Black MSM in Canada, young Canadian-born men were less likely to test. This observation highlights the need to examine place of birth when tailoring health interventions for Black MSM.

Sexual health determinants in black men-who-have-sex-with-men living in Toronto, Canada

Purpose – The purpose of this paper is to develop a profile of the sexual behavioural characteristics of black men who have sex with men (MSM) in the Greater Toronto Area (GTA), Canada who constitute a unique mixture in terms of background, race, ethnicity, and culture. Having a profile of the sexual health and risk taking behaviours of these men is important since it provides information on these black Canadian men in comparison other black MSM. Design/methodology/approach – Data were collected as part of a cross-sectional study of black MSM in GTA. Survey participants completed a questionnaire requesting information on socio-demographic characteristics, sexual behaviour, general and mental health, and awareness of social marketing strategies for gay men. The study was conducted in 2007-2008, through convenience sampling. Based on the data collected, the authors characterized the profile of black MSM with respect to sexual risk behaviours. Findings – The authors collected data on 168 black MSM. These men...