Steve Martindale

Increasing incidence of HIV infections among young gay and biseuxal men in Vancouver

Since the beginning of the HIV epidemic in north America, the majority of HIV infections have occurred among men who engage in sexual relations with other men. As the HIV epidemic enters its third decade, gay and bisexual men continue to have among the highest rates of HIV infection. Previous studies have highlighted the decline in the incidence of HIV and risk behaviour among gay and bisexual men. However, several studies have suggested that young gay and bisexual men continue to engage in unprotected sexual behaviours and are at continued risk of HIV infection. Recent reports in the media and research literature have indicated an increase in the incidence of HIV among gay and bisexual individuals in many of the worlds major cities. The purpose of this study was to determine trends in HIV incidence using data from a prospective cohort of young gay and bisexual men.

Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews.

Willingness to participate and enroll in a phase 3 preventive HIV-1 vaccine trial.

Objectives: To assess the extent to which HIV‐negative cohort study participants would be willing to participate (WTP) in future HIV vaccine trials, to explore enrollment into an ongoing phase 3 HIV vaccine trial, and to assess changing WTP in such trials over time. Methods: The Vanguard Project is a prospective study of gay and bisexual men in the greater Vancouver region, British Columbia, Canada. Sociodemographic characteristics, sexual risk behavior, beliefs around HIV, and reasons for not participating in the AIDSVAX B/B trial were collected from self‐administered questionnaires. Contingency table analysis compared subjects who were WTP with subjects who were not WTP. Logistic regression analyses identified possible predictors of WTP. A subset analysis was conducted to assess changes in WTP in 2001 versus 1997. Results: Of 440 respondents, 214 (48.6%) were WTP, and 97 (22.0%) were not WTP. Those WTP were disadvantaged, sexually risky, and had a high‐perceived HIV risk (all p< .05). Reasons for not participating in the AIDSVAX B/B trial included fear of health problems and having missed the deadline for enrollment (all p < 0.05). Multivariate analysis revealed that having had a regular sex partner (adjusted odds ratio, 0.48 [confidence interval, 0.25‐0.92]) was a negative predictor whereas having a high‐perceived HIV risk (adjusted odds ratio, 5.35 [confidence interval, 1.57‐18.25]) was a positive predictor of WTP. Comparing WTP in 2001 with that in 1997, 24% of 100 participants who had been previously WTP were now not WTP. Conclusion: Improving community and participant knowledge about preventive HIV vaccine trials may help ensure informed consent. However, whether informing potential participants will reverse or contribute to the declining trend in WTP observed in this cohort warrants further investigation.

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.

HIV and ethnicity in Canada: is the HIV risk-taking behaviour of young foreign-born MSM similar to Canadian born MSM?

Abstract There is a dearth of information on the HIV risk-taking behaviour of foreign-born men who have sex with men (MSM) in Canada. This study focused on identifying sexual risk behaviour among MSM who immigrated to Canada and compared them to MSM who were born in Canada. Baseline data from the Omega Cohort in Montreal and the Vanguard Project in Vancouver were combined to form four ethnicity/race analytical categories (n = 1,148): White born in Canada (WBIC), White born outside of Canada, non-White born in Canada (NBIC) and non-White born outside of Canada (NBOC). Psychological, demographic and sexual behaviour characteristics of the groups were similar except: NBOC were more likely to be unemployed, less likely to be tattooed, had fewer bisexual experiences and less likely worried of insufficient funds. WBOC were more likely to report unprotected sex with seropositives and more likely to have had unprotected sex while travelling. NBIC were more likely to have ever sold sex and to have had body piercing. WBOC are at high risk of acquiring as well as transmitting HIV. It is important to consider place of birth in addition to ethnicity when developing programmes to prevent the transmission of HIV.

Longitudinal patterns of sexual behavior and condom use in a cohort of HIV-negative gay and bisexual men in Vancouver, British Columbia, Canada, 1995-2000.

Objective: To characterize longitudinal patterns of sexual behavior in a cohort of young gay and bisexual men and determine their reasons for not using condoms. Methods: Prospective data from a cohort of young gay and bisexual men aged 18 to 30 years were studied. Study participants had completed a baseline questionnaire and HIV test between May 1995 and April 1996 and four annual follow‐up questionnaires. Results: A total of 130 HIV‐negative Vanguard participants met the eligibility criteria for this analysis. The median age at baseline was 26 years (range, 24‐28). Most were white (79%), had completed high school (85%), were currently employed (82%), lived in stable housing (95%), and reported annual incomes of ≥

High-Risk behaviours among men having sex with other men (MSM) who were born in Canada compared to those who immigrated to Canada-what should we measure?

10,000 (82%). (All dollar amounts are given in Canadian dollars.) Consistently over the 5‐year study period, >70% of study subjects reported having ≥1 regular male sexual partners in the previous year. During each of the five successive 1‐year periods, between 34% and 40% of respondents reported having had unprotected receptive anal intercourse with regular partners. Slightly fewer individuals (between 29%‐39%) reported having had unprotected insertive anal intercourse with regular partners. Between 13% and 25% of participants reported having had insertive unprotected anal intercourse with casual sexual partners; and between 9% and 18% reported having had unprotected receptive anal intercourse with casual sexual partners. Reasons for engaging in unprotected anal intercourse varied depending on type of sexual partnership. Conclusion: High‐risk sexual behaviors remained fairly consistent over a 5‐year period in this study. This suggests that it is critically important to understand the motivations for unprotected sex when designing and implementing programs aimed at reducing HIV risk among young gay and bisexual men.

HIV treatments optimism among gay men: An international perspective

Results: Baseline data analyses were based on 1337 MSM between the ages of 15 and 30 years. New Canadians (n= 241 [18%]) were less likely to live in unstable housing (4.7% vs. 11.1% p= 0.008), to report a recent rupture in a relationship (3.1% vs. 6.6 % p =0.082); more likely to have a university degree (32.4% vs. 23.2% p=0.01), to have an income below 20K (67.7% vs. 61.9% p=0.1). For sensation seeking behaviours, New Canadians were less likely to be tattooed (11.8% vs. 21.9% p<0.001) or have body piercing (41.1% vs 49.0% p=0.03). Commercial sex work among New Canadians were less frequent compared to Canadian born men (18.1% vs. 28.7% p=0.001) as well as bisexuality (45.5% vs. 57.9% p=<0.001) and having sex with more than 20 female lifetime partners (12% vs. 17.1% p=0.002). However, they were more likely to have unprotected anal sex while travelling outside of their home provinces (28.5% vs. 15.9% p=0.001).