We investigated self-reported mental health during the first three months of the COVID-19 pandemi... more We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March–May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.
Wilcoxon rank-sum test for age at time of diagnosis. The natural logarithm of polA copies/uL was ... more Wilcoxon rank-sum test for age at time of diagnosis. The natural logarithm of polA copies/uL was regressed on HIV status and polA geometric mean ratios (GMR) and corresponding 95% confidence intervals (95%CI) were generated. Results Of 188 subjects with ES, 22 PLWH and 72 PWH had available polA results in blood or tissues. PLWH were more likely to be male (84% vs 50.6%, p=0.005). There were no differences in age (range 18-62) or ethnicity between PLWH and PWH. There were no differences in the proportion of patients with polA positivity between groups in blood (72% vs 55%, p=0.269), skin (64% vs 57%, p=0.763) or mucous membranes (67% vs 67%, p=1.000). There were also no differences in the geometric means of polA copies in the blood (GMR=1.8, 95%CI 0.5-6.0, p-value=0.339), skin (GMR=2.8, 95%CI 0.4-21, p-value=0.307) or mucous membrane samples (0.001, 95%CI 0-27, p=0.284). Conclusions HIV status was not associated with higher polA Tp burdens in blood or skin in subjects with early syphilis.
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papil... more INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
ABSTRACT Background Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexua... more ABSTRACT Background Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. Methods Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. Results Across the cities, 26–40%, 7–14%, 33–39%, and 13–28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06–7.62; Stage 2: aOR = 3.09, 95%CI = 1.19–8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07–2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05–1.48; Stage 2: aOR = 1.24, 95%CI = 1.05–1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13–0.71; Stage 2: aOR = 0.27, 95%CI = 0.12–0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15–0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09–0.30; Stage 2: aOR = 0.18, 95%CI = 0.09–0.35; Stage 3: aOR = 0.38, 95%CI = 0.21–0.61). Discussion Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
regarding syphilis. A convenience sample was recruited from digital platforms (e.g., Facebook ®) ... more regarding syphilis. A convenience sample was recruited from digital platforms (e.g., Facebook ®) and bars, clinics, and community-based organization events. Results Of 119 survey respondents, 90 (76%) lived in the Anchorage/Mat-Su region. Of these, 10.0% (95% confidence interval [CI]: 5.3-17.9) reported a syphilis diagnosis during the previous 12 months and having a median of 3 (interquartile range: 1-6) sex partners during the previous 6 months. High-risk behaviors commonly associated with syphilis were reported, including condomless anal sex (36.7%; 95% CI: 27.4-47.0) during the previous month, !1 episode of group sex (26.7%; 95% CI: 18.6-36.6) during the previous 6 months, and meeting sex partners online or on a geospatial mobile app (66.7%; 95% CI: 56.4-75.5) during the previous 6 months. Additionally, 44.4% (95% CI: 34.6-54.7) reported a sex partner living outside Anchorage and 31.1% (95% CI: 22.5-41.3) outside Alaska. Conclusion Large numbers of sex partners outside Alaska presents barriers to partner services among Anchorage MSM with syphilis. Opportunities include using innovative strategies (e.g., technology-based partner services and out-of-jurisdiction partnerships) to reach populations at risk for syphilis. Disclosure No significant relationships.
Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition t... more Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined the experiences of gay, bisexual, queer, and other men who have sex with men (GBQM) of colour facing discrimination during COVID-19. Design Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQM living in Vancouver, Toronto, and Montréal, Canada. We conducted two rounds of qualitative interviews (November 2020 to February 2021, and June to October 2021) with 93 GBQM to explore the evolving impact of COVID-19 on their lives. Transcripts were coded using inductive thematic analysis. Data analysis was conducted using Nvivo software. Results Fifty-nine participants identified as Black, Indigenous, and/or a Person of Co...
Background Implementation of anal cancer screening requires the procedure to be acceptable to the... more Background Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. Methods We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016–2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men’s beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by ...
BackgroundAn individualized behavior‐based selection approach has potential to allow for a more e... more BackgroundAn individualized behavior‐based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada.Study design and methodsEngage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent‐driven‐sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood‐borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS‐adjusted Poisson regression.ResultsData on 2008 (study visits 2017‐02 to 2021‐08) HIV‐negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person‐years [95%CI:0.3, 0.6]. HIV seroconversion was associated...
We investigated self-reported mental health during the first three months of the COVID-19 pandemi... more We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March–May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.
Wilcoxon rank-sum test for age at time of diagnosis. The natural logarithm of polA copies/uL was ... more Wilcoxon rank-sum test for age at time of diagnosis. The natural logarithm of polA copies/uL was regressed on HIV status and polA geometric mean ratios (GMR) and corresponding 95% confidence intervals (95%CI) were generated. Results Of 188 subjects with ES, 22 PLWH and 72 PWH had available polA results in blood or tissues. PLWH were more likely to be male (84% vs 50.6%, p=0.005). There were no differences in age (range 18-62) or ethnicity between PLWH and PWH. There were no differences in the proportion of patients with polA positivity between groups in blood (72% vs 55%, p=0.269), skin (64% vs 57%, p=0.763) or mucous membranes (67% vs 67%, p=1.000). There were also no differences in the geometric means of polA copies in the blood (GMR=1.8, 95%CI 0.5-6.0, p-value=0.339), skin (GMR=2.8, 95%CI 0.4-21, p-value=0.307) or mucous membrane samples (0.001, 95%CI 0-27, p=0.284). Conclusions HIV status was not associated with higher polA Tp burdens in blood or skin in subjects with early syphilis.
INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papil... more INTRODUCTION In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.
ABSTRACT Background Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexua... more ABSTRACT Background Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. Methods Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. Results Across the cities, 26–40%, 7–14%, 33–39%, and 13–28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06–7.62; Stage 2: aOR = 3.09, 95%CI = 1.19–8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07–2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05–1.48; Stage 2: aOR = 1.24, 95%CI = 1.05–1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13–0.71; Stage 2: aOR = 0.27, 95%CI = 0.12–0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15–0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09–0.30; Stage 2: aOR = 0.18, 95%CI = 0.09–0.35; Stage 3: aOR = 0.38, 95%CI = 0.21–0.61). Discussion Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.
regarding syphilis. A convenience sample was recruited from digital platforms (e.g., Facebook ®) ... more regarding syphilis. A convenience sample was recruited from digital platforms (e.g., Facebook ®) and bars, clinics, and community-based organization events. Results Of 119 survey respondents, 90 (76%) lived in the Anchorage/Mat-Su region. Of these, 10.0% (95% confidence interval [CI]: 5.3-17.9) reported a syphilis diagnosis during the previous 12 months and having a median of 3 (interquartile range: 1-6) sex partners during the previous 6 months. High-risk behaviors commonly associated with syphilis were reported, including condomless anal sex (36.7%; 95% CI: 27.4-47.0) during the previous month, !1 episode of group sex (26.7%; 95% CI: 18.6-36.6) during the previous 6 months, and meeting sex partners online or on a geospatial mobile app (66.7%; 95% CI: 56.4-75.5) during the previous 6 months. Additionally, 44.4% (95% CI: 34.6-54.7) reported a sex partner living outside Anchorage and 31.1% (95% CI: 22.5-41.3) outside Alaska. Conclusion Large numbers of sex partners outside Alaska presents barriers to partner services among Anchorage MSM with syphilis. Opportunities include using innovative strategies (e.g., technology-based partner services and out-of-jurisdiction partnerships) to reach populations at risk for syphilis. Disclosure No significant relationships.
Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition t... more Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined the experiences of gay, bisexual, queer, and other men who have sex with men (GBQM) of colour facing discrimination during COVID-19. Design Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQM living in Vancouver, Toronto, and Montréal, Canada. We conducted two rounds of qualitative interviews (November 2020 to February 2021, and June to October 2021) with 93 GBQM to explore the evolving impact of COVID-19 on their lives. Transcripts were coded using inductive thematic analysis. Data analysis was conducted using Nvivo software. Results Fifty-nine participants identified as Black, Indigenous, and/or a Person of Co...
Background Implementation of anal cancer screening requires the procedure to be acceptable to the... more Background Implementation of anal cancer screening requires the procedure to be acceptable to the target population. Our objective was to assess the beliefs of men living with HIV regarding anal cancer screening and identify factors associated with their willingness to participate in screening. Methods We developed a cross-sectional questionnaire using the Theory of Planned Behavior to examine beliefs regarding prevention of human papillomavirus (HPV)-related diseases, administered to men living with HIV in 2016–2017 in a multi-site HIV clinical cohort. Correspondence analysis was used to examine the interrelationships between men’s beliefs and willingness to undergo anal cancer screening. We used multivariable proportional odds models to identify factors associated with increasing willingness. Results were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 1677 male participants, the vast majority (90%) would be willing to undergo screening by ...
BackgroundAn individualized behavior‐based selection approach has potential to allow for a more e... more BackgroundAn individualized behavior‐based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada.Study design and methodsEngage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent‐driven‐sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood‐borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS‐adjusted Poisson regression.ResultsData on 2008 (study visits 2017‐02 to 2021‐08) HIV‐negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person‐years [95%CI:0.3, 0.6]. HIV seroconversion was associated...
The Oxford Handbook of Multi and Mixed Methods Research Inquiry is designed to offer a range of i... more The Oxford Handbook of Multi and Mixed Methods Research Inquiry is designed to offer a range of innovative knowledge-building perspectives and methods tools with the goal of enhancing new ways of asking and addressing complex research questions. The Handbook offers multiple quantitative and qualitative theoretical and interdisciplinary visions and practice. Each chapter is written in clear and concise language by leading scholars in the field. R. Burke Johnson, an interdisciplinarian with four graduate degrees, specializes in research methodology and philosophy of social science. He is coauthor or coeditor of six books including the following two research methods textbooks: Educational Research: Quantitative, Qualitative, and Mixed Approaches (with Christensen, Sage 2014) and Research Methods, Design, and Analysis (with Christensen and Turner, Pearson 2014).
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