Joanne Otis

Regular Exercise in 30- to 60-Year-Old Men: Combining The Stages-of-Change Model and The Theory of Planned Behavior to Identify Determinants for Targeting Heart Health Interventions

The theory of planned behavior and the stages-of-change model were used to gain a clearer understanding of the factors associated with regular exercise in order to plan more effective programs in heart disease prevention. The study was conducted using a self-administered postal questionnaire sent to a sample of 2,269 men 30 to 60 years of age. Nearly a quarter (23.3%) of respondents were physically inactive, of whom 10.5% were in the precontemplation and 12.8% in the contemplation stages ; 42.1% exercised less than twice a week, of whom 22.4% were in the preparation I and 19.7% in the preparation II stages. Only 34.6% were in the action stage, exercising regularly for at least 20 minutes twice a week or more with the intention of continuing to do so. Logistic regression indicated that the variables derived from the theory of planned behavior, namely attitude, subjective norm and perceived behavioral control, were differently associated with the stages of behavior. Perceived behavioral control was strongly significant in all stages. Attitude was related with stages in which individuals have intention of exercising (contemplation and preparation II). In contrast, subjective norm seemed to be associated with stages in which individuals have no intention of doing so (precontemplation and preparation I). By identifying the specific needs of sub-groups, the results can help define programs most likely to accelerate men to the stage of regular exercise, part of an effective strategy for heart health promotion in this high-risk population.

Romantic relationships and sexual activities of the first generation of youth living with HIV since birth

Abstract HIV-infected children, now maturing into adolescence and adulthood, must cope not only with adolescent developmental issues, but also with a chronic, socially stigmatised and sexually transmittable illness. Little research on this first generation of survivors has focused on romantic involvement and sexuality. This study, which employs a mixed-method embedded strategy (qualitative supported by quantitative), describes the perspectives of youth living with HIV since birth concerning: (1) romantic involvement and sexuality; and (2) risk management including the risk of HIV transmission and partner serostatus disclosure. Eighteen adolescents aged 13–22 from Montreal, Canada, participated in individual semi-structured interviews and completed self-report questionnaires. Most youths participated in non-penetrative sexual activities. Ten participants reported having had vaginal and three anal intercourses, at an average age of 14 for girls and 15 for boys. All sexually active youth reported having used a condom at least once. Of those who reported that their first sexual relationship was protected, over half had taken risks in subsequent relationships (e.g., unprotected sex, multiple partners, etc.). Interviews conducted with sexually inactive youths illustrate the interrelatedness of romantic involvement, sexual initiation and potential serostatus disclosure. Involvement in a sexual relationship would not be conceivable unless the partner was informed of their serostatus. For sexually active participants, risk management implies HIV transmission and partner disclosure. These youths have emotional issues regarding disclosure in romantic relationships and few risked potential rejection by disclosing. Condom use acts as a reminder of the infection and a barrier to intimacy. The narratives illustrate how risk perception changes and becomes relative with time and experience, especially when the viral load is undetectable and when past experience has convinced the adolescent that his/her partner might not become infected. Findings reinforce the need to prioritise sexual health issues for young people with perinatally acquired HIV.

Association of hepatitis B virus infection with other sexually transmitted infections in homosexual men

OBJECTIVES This study determined the prevalence and factors associated with hepatitis B virus (HBV) infection among men who have sex with men. METHODS At the baseline visit of an HIV study among men who have sex with men, we asked about HBV vaccination status and tested for HBV markers. RESULTS Of 625 subjects, 48% had received at least 1 dose of HBV vaccine. Of 328 unvaccinated men, 41% had 1 or more HBV markers. HBV prevalence increased markedly with age and was associated with many sexual and drug-related behaviors. In a multivariate model, 7 variables were independently associated with HBV infection: ulcerative sexually transmitted diseases (odds ratio [OR] = 10.1; 95% confidence interval [CI] = 2.6, 54); injection drug use (OR = 5.2; 95% CI = 1.2, 26); gonorrhea or chlamydia (OR = 4.0; 95% CI = 1.9, 8.9); sexual partner with HIV/AIDS (OR = 3.6; 95% CI = 1.8, 7.1); 50 or more casual partners (OR = 3.4; 95% CI = 1.6, 7.1); received money for sex (OR = 3.0; 95% CI = 1.2, 7.8); and 20 or more regular partners (OR = 2.5; 95% CI = 1.1, 6.1). CONCLUSIONS In Montreal, men who have sex with men are at risk for HBV infection, but a substantial proportion remain unvaccinated; new strategies are required to improve coverage. Men who have sex with men and who have a sexually transmitted infection, especially a genito-ulcerative infection, appear to be at particularly high risk for HBV infection.

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.

Factors associated with hepatitis B vaccination among men having sexual relations with men in Montreal, Quebec, Canada. Omega Study Group.

OBJECTIVE To determine factors associated with hepatitis B virus (HBV) vaccination status among HIV-uninfected men who have affective and sexual relations with men (MASM) in Montreal, Quebec, Canada. METHODS The Omega Cohort is a study of the incidence and psychosocial determinants of HIV infection among MASM in Montreal. Participants complete a questionnaire and are HIV-tested every 6 months. At baseline, we also performed testing for HBV markers and collected data on HBV vaccination history. RESULTS Forty-six percent of 653 participants had received at least one dose of HBV vaccination, whereas 28% were completely vaccinated. Lack of vaccination was associated with injection drug use, having > or =20 regular lifetime partners, living outside Montreal, not having sex in bathhouses, and not having consulted a physician aware of the participants sexual orientation. Among vaccinated MASM, incomplete vaccination was associated with having <20 lifetime casual partners, trading sex for drugs, having given goods for sex, having had unprotected anal sex with regular partners, and having no history of a previous sexually transmitted disease. CONCLUSION A significant proportion of Montreals MASM, some of whom are at risk of contracting HBV through sexual and parenteral transmission, have not been vaccinated for HBV. Men who have affective and sexual relations with men should be educated about the risk of HBV transmission and the seriousness of the disease.

Determinants of condom use among HIV-positive men who have sex with men

The main objectives of this study were to identify the determinants of condom use among HIV-positive men having anal sex with HIV-negative men or men of unknown HIV status and moderators of the intention–behaviour relationship. A cohort of 237 sexually active HIV-positive men having sex with men was followed over a period of six months. The cognitive variables measured were guided by an extended version of the theory of planned behaviour. Results indicated that past behaviour (odds ratio [OR] = 9.75; 95% confidence interval [CI]: 4.48–21.26), intention (OR = 3.13; 95% CI: 1.25–7.81), self-efficacy (OR = 3.62; 95% CI: 1.40–9.37) and use of sex drugs (OR = 0.16; 95% CI: 0.06–0.45) contributed to the prediction of 100% condom use. Self-efficacy also interacted with intention as a significant moderator of the intention–behaviour relationship (OR = 20.96; 95% CI: 2.90–151.51). Interventions promoting condom use should increase self-efficacy to use condoms and target users of sex drugs.

Determinants of Hiv Seroconversion Among Men Who Have Sex With Men Living in a Low Hiv Incidence Population in the Era of Highly Active Antiretroviral Therapies

Objective: To estimate human immunodeficiency virus (HIV) incidence and associated risk factors among men who have sex with men (MSM) participating in the Omega Cohort Study in Montreal, 1996–2003. Methods: Longitudinal study of 1587 MSM seronegative at baseline with ≥1 six-month follow-up visit. Multivariate Cox regression with time-dependent variables was used for data analysis. Results: HIV incidence was 0.62 per 100 person-years (95% confidence interval: 0.41–0.84). In multivariate analyses compared with subjects not reporting any anal sex with serodiscordant or casual partners, those reporting anal sex with such partners (all P values <0.05), whether consistently protected [hazard ratio (HR) = 3.4], or unprotected exclusively receptive (HR = 12.0), exclusively insertive (HR = 4.7), or both receptive and insertive (HR = 8.3), were at increased risk of seroconversion. Sexual behaviors with seroconcordant regular partners were not associated with seroconversion. Conclusion: These results observed in a cohort of MSM with low HIV incidence provide new insights regarding the debate about harm-reduction strategies to prevent sexual HIV transmission.

Expanding access to non-medicalized community-based rapid testing to men who have sex with men: an urgent HIV prevention intervention (the ANRS-DRAG study).

Background Little is known about the public health benefits of community-based, non-medicalized rapid HIV testing offers (CBOffer) specifically targeting men who have sex with men (MSM), compared with the standard medicalized HIV testing offer (SMOffer) in France. This study aimed to verify whether such a CBOffer, implemented in voluntary counselling and testing centres, could improve access to less recently HIV-tested MSM who present a risk behaviour profile similar to or higher than MSM tested with the SMOffer. Method This multisite study enrolled MSM attending voluntary counselling and testing centres’ during opening hours in the SMOffer. CBOffer enrolees voluntarily came to the centres outside of opening hours, following a communication campaign in gay venues. A self-administered questionnaire was used to investigate HIV testing history and sexual behaviours including inconsistent condom use and risk reduction behaviours (in particular, a score of “intentional avoidance” for various at-risk situations was calculated). A mixed logistic regression identified factors associated with access to the CBOffer. Results Among the 330 participants, 64% attended the CBOffer. Percentages of inconsistent condom use in both offers were similar (51% CBOffer, 50% SMOffer). In multivariate analyses, those attending the CBOffer had only one or no test in the previous two years, had a lower intentional avoidance score, and met more casual partners in saunas and backrooms than SMOffer enrolees. Conclusion This specific rapid CBOffer attracted MSM less recently HIV-tested, who presented similar inconsistent condom use rates to SMOffer enrolees but who exposed themselves more to HIV-associated risks. Increasing entry points for HIV testing using community and non-medicalized tests is a priority to reach MSM who are still excluded.

The degree of planning: an indicator of the potential success of health education programs.

Evaluation is a major challenge in the field of health promotion and health education. Since the degree to which a project is planned often guarantees its potential success, the evaluation process should make it possible to answer different questions related to stages of project implementation. The goal of this study was to develop a planning tool to help health professionals and community workers judge the potential success of health education interventions based on the extent to which they are planned and to test the tool in real intervention evaluations. Educational interventions examined in this study were targeted primarily at the promotion and adoption of behaviour reducing the risk of human immunodeficiency virus (HIV) transmission. The conceptual framework of “intervention mapping” served as the basis for developing the tool. Experts were consulted to identify criteria that would make it possible to evaluate the extent to which different stages of the model were accomplished. The tool was tested for reliability. Data from 123 projects were then collected and analyzed. The process for the development of the tool made it possible to identify 40 planning criteria, broken down into the 19 tasks of intervention mapping model. Reliability test results were highly satisfactory. The overall average score for project planning was 12.7 out of 40. The degree to which different stages were planned varied considerably. For example, only 15% of projects had developed their objective matrices properly, whereas 80% were assured proper support for their implementation. Thirty-nine percent of the projects were satisfactorily available for evaluation. This exercise made it possible to construct an interesting tool for identifying strengths and weaknesses of intervention planning. Various promoters might find this tool useful for increasing the potential success of their initiatives.

Is the intention to quit smoking influenced by other heart-healthy lifestyle habits in 30- to 60-year-old men?

The aim of this study was to analyze whether the intention to quit smoking was associated with other lifestyle habits healthy for the heart, namely a low-fat diet and regular exercise, using variables suggested by the theory of planned behavior. Self-administered postal questionnaires were sent to 3,200 men 30 to 60 years of age residing in Laval, Quebec. With a response rate of 70.9%, 671 respondents (29.6%) were smokers. A significant proportion (43%) had all three risk behaviors--smoking, a high-fat diet, and sedentariness, and 42% had two--smoking and one of the other behaviors. The remaining had a single risk behavior, namely smoking. Regression analysis suggested that a healthy diet and exercise had no significant influence on the intention to quit smoking. However, men who had a stronger intention to quit smoking than others had a more favorable attitude toward the behavior, a stronger perception of approval in achieving it on the part of important referents, stronger perceived behavioral control, and were among those who smoked fewer cigarettes per day, but had made more attempts to quit. These results can assist in designing better heart-health intervention programs for this high-risk population.