Thomas M. Lampinen

Unprotected anal intercourse associated with recreational drug use among young men who have sex with men depends on partner type and intercourse role.

Objective: The objective of this study was to measure associations of unprotected anal intercourse (UAI) and substance use by sexual partner (regular vs. casual) and role [insertive (I) vs. receptive (R)]. Goal: The goal of this study was to identify determinants of the association of specific drugs and UAI. Study: We conducted a prospective study of young men who have sex with men (MSM), 1997–2002. Odds ratios (ORs) for association of substance use and UAI during the previous year were adjusted for age and calendar year. Results: UAI was significantly associated with sexual situation-specific use of marijuana (OR, 1.43), crystal methamphetamine (OR, 1.75), ecstasy (OR, 1.88), and ketamine (OR, 2.17); global use associations were similar. Situation-specific associations with alcohol (OR, 1.93) and &ggr;-hydroxybutyrate (GHB; OR, 1.98) were not seen with global measures. GHB and ketamine were specifically associated with IUAI with regular partners, and methamphetamine with RUAI with casual partners. Conclusion: Type of drug use measure, partner, and role are important determinants of the association of specific substances and UAI.

Workplace-Based Work Disability Prevention Interventions for Workers with Common Mental Health Conditions: A Review of the Literature

Introduction To summarize evidence on workplace-based work disability prevention (WDP) interventions in workers with common mental health conditions (CMHCs). Primary outcomes of interest were work absence duration and work functioning; secondary outcomes were quality of life, and economic costs. Methods We conducted a systematic literature search in 5 electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science) for studies published from 2007 to 2009. Two reviewers screened for studies: (1) Targeting workers with CMHCs absent from, or struggling at, work; (2) evaluating workplace-based WDP interventions; (3) assessing our primary outcome(s); and (4) with controlled trials. Quality assessment (using 29 criteria) was performed by two reviewers. Results Our search yielded 671 abstracts: 8 eligible studies and of sufficient quality. We identified three main intervention elements: (a) Facilitation of access to clinical treatment; (b) Workplace-based high-intensity psychological intervention; and (c) Facilitation of navigation through the disability management system. Moderate evidence was found that facilitation of treatment improved work functioning, quality of life and economic outcomes, with limited evidence for work absence duration. Moderate evidence was found that psychological interventions, primarily cognitive-behavioral therapy, improved work functioning, quality of life, and economic outcomes. Moderate evidence indicated that facilitation of navigation through the disability management system improved work absence duration. Conclusions Workplace-based interventions could improve work disability outcomes for workers with CMHCs. Facilitation of access to clinical treatment, and workplace-based high-intensity psychological intervention were most effective in improving work functioning and quality of life, and in reducing costs.

Factors associated with sex trade involvement among male participants in a prospective study of injection drug users

Objectives: While much research to date has examined female sex trade work, little has been done to evaluate factors associated with male sex trade involvement or to assess their health service needs. This is particularly true for male sex trade workers who are also injection drug users (IDUs). Therefore, the present analyses were undertaken to evaluate factors associated with sex trade work in a prospective cohort study of male IDUs. Methods: We identified factors associated with sex trade involvement among male participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available at semiannual intervals, variables potentially associated with sex trade involvement were evaluated with adjusted odds ratios (AOR) and 95% confidence intervals (CI) computed using generalised estimating equations (GEE). Results: Between 1996 and 2003, 995 male IDUs were enrolled into the VIDUS cohort among whom 108 (11%) reported being involved in the sex trade at enrolment and 102 (10%) individuals initiated sex trade involvement during the follow up period. In multivariate analyses, factors independently associated with sex trade involvement included HIV positive serostatus (AOR: 1.77 (95% CI: 1.44 to 2.17)), daily cocaine injection (AOR: 1.37 (95% CI: 1.11 to 1.70)), daily crack smoking (AOR: 1.36 (95% CI: 1.07 to 1.72)), borrowing syringes (AOR: 1.73 (95% CI: 1.32 to 2.25)), and inconsistent use of condoms with casual sexual partners (AOR 0.66, CI 0.53 to 0.82). We also found that male sex trade workers were more likely to report having sought but been unable to access substance abuse treatment (AOR: 1.28 (95% CI: 0.98 to 1.67); p = 0.076). Conclusions: Males involved in the sex trade in this setting have higher levels of HIV infection and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded.

Determinants of Human Immunodeficiency Virus DNA and RNA Shedding in the Anal-Rectal Canal of Homosexual Men

To define the determinants of anal-rectal shedding of human immunodeficiency virus (HIV) DNA and RNA, 374 HIV-seropositive homosexual men were tested. Factors independently associated with detection of anal-rectal HIV DNA included anal-rectal inflammation and detection of anal human papillomavirus DNA; predictors of HIV RNA included detection of anal-rectal HIV DNA, anal-rectal inflammation, and high plasma HIV RNA levels. The latter (>10,000 copies/mL) was the main determinant of anal-rectal HIV RNA shedding when HIV DNA (e.g., HIV-infected cells) was not detected in the anal-rectal sample. The local presence of HIV-infected cells and local inflammation were the principal determinants of HIV RNA among those with low (<10,000 copies/mL) plasma HIV RNA load. Among those with anal-rectal HIV DNA present, increased HIV RNA plasma load did not increase the risk of shedding of HIV RNA into the anal-rectal canal.

Sexual Risk Profile of Young Men in Vancouver, British Columbia, Who Have Sex with Men and Inject Drugs

We compared sexual risk behaviors of men who have sex with men and inject drugs (MSM/IDU) with those of other men who have sex with men (MSM). Of 910 MSM surveyed, 106 (12%) injected drugs in the previous year. MSM/IDU were younger than MSM and more likely to be HIV-seropositive, Aboriginal, economically disadvantaged, engaged in the trade of sex for money or drugs, and to report having female sexual partners. MSM/IDU reported more casual sexual partners and in multivariate analyses were twice as likely to report unprotected receptive anal intercourse with casual partners. These results, combined with those from previous analyses, suggest that the higher risk for HIV seroconversion among MSM/IDU in this cohort is attributable mainly to sexual rather than injection-related exposures. Controlled assessments are needed to identify optimal sexual risk reduction strategies for MSM/IDU.

Randomized clinical evaluation of self-screening for anal cancer precursors in men who have sex with men

Background Self-collection of anorectal swab specimens could greatly facilitate the completion of prerequisite studies and future implementation of anal cancer screening among men who have sex with men (MSM). We therefore compared self- versus clinician- collection procedures with respect to specimen adequacy for cytological evaluation, concordance of paired cytological results, and concordance of cytological with biopsy results. Methods Paired self- and clinician- collected anorectal Dacron® swabs for liquid-based (Thin Prep®) cytological evaluation were collected in random sequence from a mostly HIV-1 seronegative cohort of young MSM in Vancouver. Slides were reviewed by one cytopathologist. Presence of any cytological abnormality (atypical squamous cells of uncertain significance, ASCUS, or above) prompted referral for high-resolution anoscopy and possible biopsy. Results Among 222 patient-clinician specimen pairs, most were adequate for cytological evaluation, though self-collected specimens were less likely to be so (83% versus 92%, McNemars test p < 0.001). Cytological abnormalities, noted in 47 (21%) of self-collected and 47 (21%) of clinician-collected specimens (with fair agreement, kappa = 0.414) included, respectively: ASCUS (5%, 5%), and low-grade (13%, 13%) and high-grade (3%, 3%) squamous intraepithelial lesions. Among 12 men with biopsy-confirmed high-grade neoplasia, most had abnormal cytological results (including 6 patient and 9 clinician swabs) but few (2 patient and 1 clinician swab) were high-grade. Conclusion Self-collection of anorectal swab specimens for cytologic screening in research and possibly clinical settings appears feasible, particularly if specimen adequacy can be further improved. The severity of biopsy-confirmed anorectal disease is seriously underestimated by cytological screening, regardless of collector.

Sexual risk behaviour of Canadian participants in the first efficacy trial of a preventive HIV-1 vaccine

Background: Phase I and phase II HIV-1 vaccine trials have revealed increases in risky sexual activity among study subjects during the trials, perhaps because the subjects believe that the vaccine being tested is efficacious; subjects may thus suffer harm from their participation. We evaluated the sexual behaviour of Canadian men who have sex with men (MSM) who participated in the phase III Vax004 trial of an HIV-1 vaccine. Methods: Using self-reports of sexual behaviours during the 6 months before trial entry as a baseline, we determined changes in reported sexual behaviour after 6, 12 and 18 months of participation in the trial. Results: Of 291 HIV-seronegative MSM enrolled from July to October 1999, 260 (89%) completed 18 months of follow-up, 19 (7%) experienced seroconversion, and 12 (4%) did not complete follow-up. Unprotected receptive anal intercourse during the previous 6 months with partners whose HIV-1 serostatus was positive or unknown was reported by 21% of men at enrolment and by 27% at any point during 18 months of follow-up. No increase in this behaviour from baseline was reported by participants, including among men who were motivated to enrol because of expected protection from HIV-1 infection, men who believed they had received the vaccine, men who believed that the vaccine had greater than 50% efficacy, or men who believed that they had received the vaccine and that vaccine efficacy was greater than 50%. Interpretation: MSM can be successfully enrolled in HIV-1 vaccine efficacy trials without evident increases in those sexual behaviours most associated with HIV-1 risk.

Incidence of and Risk Factors for Sexual Orientation-Related Physical Assault Among Young Men Who Have Sex With Men

OBJECTIVES We sought to determine incidence of, prevalence of, and risk factors for sexual orientation-related physical assault in young men who have sex with men (MSM). METHODS We completed a prospective open cohort study of young MSM in Vancouver, British Columbia, surveyed annually between 1995 and 2004. Correlates of sexual orientation-related physical assault before enrollment were identified with logistic regression. Risk factors for incident assaults were determined with Cox regression. RESULTS At enrollment, 84 (16%) of 521 MSM reported ever experiencing assault related to actual or perceived sexual orientation. Incidence was 2.3 per 100 person-years; cumulative incidence at 6-year follow-up was 10.8 per 100 person-years. Increased risk of incident sexual orientation-related physical assault was observed among MSM 23 years or younger (relative hazard=3.1; 95% confidence interval [CI] = 1.6, 5.8), Canadian Aboriginal people (relative hazard = 3.0; 95% CI=1.4, 6.2), and those who previously experienced such assault (relative hazard=2.5; 95% CI=1.3, 4.8). CONCLUSIONS These data underscore the need for increased public awareness, surveillance, and support to reduce assault against young MSM. Such efforts should be coordinated at the community level to ensure that social norms dictate that such acts are unacceptable.

High Prevalence of Smoking Among Urban-Dwelling Canadian Men Who Have Sex with Men

A small but consistent literature from the United States suggests increased risk for smoking among lesbians and men who have sex with men (MSM). Few studies have investigated smoking among MSM in other countries where different social norms and restrictions on smoking in public apply. We measured smoking behaviours in a convenience sample of urban-dwelling young Canadian MSM (median age 28 years). We compared the prevalence of smoking among MSM with that among other men in British Columbia (BC) using National Population Health Survey data to compute an age-adjusted standardized prevalence ratio (SPR). Independent predictors of smoking among MSM were identified using adjusted odds ratios (OR) with 95% confidence intervals (CI). Smoking during the previous year was reported by twice as many MSM (54.5% of 354) as other men in BC (25.9%) (SPR = 1.94, 95% CI 1.48–2.59), with largest differentials observed among men under 25 years of age. In multivariable analyses, smoking among MSM was significantly associated with younger age (OR 0.94, CI 0.88–1.00 per year), greater number of depressive symptoms (OR 1.12, CI 1.06–1.19 per symptom) and Canadian Aboriginal ethnicity (OR 2.64, CI 1.05–6.60). In summary, MSM in our study were twice as likely to smoke as other men in BC; the greatest differences were observed among the youngest men. The design of effective prevention and cessation programs for MSM will require identification of the age-dependent determinants of smoking initiation, persistence, and attempts to quit.

Illustrated instructions for self-collection of anorectal swab specimens and their adequacy for cytological examination.

Background: Self-collection of anorectal swab specimens would facilitate screening for anal cancer precursors and sexually transmitted rectal infections among men who have sex with men (MSM). However, pictorial guides for self-collection were not previously available. Goals: Develop and field test a set of illustrated self-collection instructions. Design: Cross-sectional study of community-recruited MSM who were naïve with regard to collection of specimens for anal cytology. Results: Among 222 self- and clinician-collected swab pairs provided by mostly human immunodeficiency virus (HIV)-1 seronegative MSM (median age, 31.5 years), most specimens were adequate for cytologic evaluation, though self-collected swabs were less likely to be so (83% versus 92%, P = <0.001). The illustrated instructions were reportedly essential, but having used them, men rated their understanding of the self-collection procedure as very high. Conclusions: Provided with illustrated instructions, most MSM who are naïve to the technique can self-collect anorectal swab specimens that are suitable for screening.