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Background: Non-disclosure criminal prosecutions among gay, bisexual and other men who have sex with men (MSM) are increasing, even though transmission risk is low when effective antiretroviral treatment (ART) is used. Reduced HIV testing may reduce the impact of HIV “test and treat” strategies. We aimed to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM. Methods: MSM attending an HIV and primary care clinic in Toronto completed an audio computer-assisted self-interview questionnaire. HIV-negative participants were asked concern over non-disclosure prosecution altered their likelihood of HIV testing. Responses were characterized using cross-tabulations and bivariate logistic regressions. Flow charts modelled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure. Results: 150 HIV-negative MSM were recruited September 2010 to June 2012. 7% (9/124) were less or much less likely to be tested for HIV due to concern over future prosecution. Bivariate regression showed no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern about prosecution. Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART. Conclusions: Fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications. [ABSTRACT FROM AUTHOR]

Background: Theory suggests that perceived human immunodeficiency virus (HIV) risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk.Methods: Sexually active men who have sex with men (MSM) were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI). Actual HIV risk (primary predictor) was constructed by applying principal component analysis (PCA) to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome) was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk.Results: One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37-50 years]). Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR) 18.33, 95% confidence interval (CI) 1.65-203.45). Older age was associated with lower perceived risk but only age 40-49 compared to less than 30 was statistically significant (OR 0.12, 95% CI 0.016-0.86). The odds of having high perceived risk was significantly associated with men who used poppers in the previous 6 months compared to those who did not use poppers (OR 5.64, 95% CI 1.20-26.48).Conclusions: Perceived HIV risk increased significantly as condom use with an HIV-positive regular partner decreased. However, perceived HIV risk was not associated with condom use with casual partners or HIV unknown status regular partners, even though these behaviours could be considered risky. The relationship between perceived and actual risk in HIV studies is complex and has implications on how health care workers address the issue of risky sexual behaviour and perceived risk. [ABSTRACT FROM AUTHOR]

Background: While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. Methods: Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. Results: Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. Conclusions: Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. Methods: From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. Results: The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type. Conclusion: Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners). [ABSTRACT FROM AUTHOR]

Summary: Objective: To describe hepatitis C virus (HCV) and HIV prevalence and co-infection, and to examine variables associated with infection in a community sample of men who have sex with men (MSM). Methods: Data were from an anonymous, cross-sectional study (N =5080) in Canada. Men self-completed a questionnaire and provided an optional saliva specimen for HCV and HIV testing. Polytomous logistic regressions identified variables associated with HCV, HIV, and HCV–HIV co-infection. Results: The prevalences of HCV, HIV, and HCV–HIV co-infection were 1.9%, 9.0%, and 0.7%, respectively. The greatest contribution to HCV (odds ratio (OR) 23.66, 95% confidence interval (CI) 9.69–57.73) and HCV–HIV co-infection (OR 26.76, 95% CI 7.97–89.80) was injection drug use. Sexual behaviors and proxies were associated with HIV but not HCV infection. Conclusions: Results suggest there are subgroups of MSM at risk for HCV. While sexual transmission of HCV was not ruled out, the predominant risk was needle sharing. The greater prevalence of HCV among HIV-positive men suggests the need for greater vigilance in the detection of HCV in this group. [Copyright &y& Elsevier]

Those living with HIV may experience a range of disabilities, including body impairments, activity limitations, and social participation restrictions. The aim of this study was to examine HIV services provision in Canada by exploring practices, referrals, and service delivery challenges from the perspective of HIV health professionals (including nurses, physicians, social workers, pharmacists, psychologists, and dieticians), and to explore differences in referrals and perceived service delivery challenges by professional group, jurisdiction, community size, and practice in a Northern region. We conducted a nationwide mail survey with the population of selected HIV health professionals in Canada using the Dillman tailored design survey method. Of the 731 deliverable mailings, we received 462 (63%) responses, with 36% of eligible respondents completing the survey (n=214). The large majority (90%) of HIV professionals were located in metropolitan or urban communities and worked predominantly in hospital in-patient (42%), out-patient (50%), and HIV specialty clinic (46%) settings in one of the three provinces (Ontario, Quebec, and British Columbia) with the highest HIV prevalence. HIV health professionals referred primarily, and at relatively high levels, to AIDS service organizations (79%) and social workers (84%) to address participation restrictions and social issues; a lower percentage referred to rehabilitation professionals and other service providers to address impairments, activity limitations, or participation restrictions. Of respondents, 74% perceived barriers to care specific to HIV. Our results suggest that there is little difference in referral patterns by profession, jurisdiction, community size, or northern region of practice. There is a need for increased information and education of HIV health professionals that may refer to rehabilitation and other health services. In addition, new approaches are needed to coordinate multisectoral care and enhance the access and delivery of HIV rehabilitation health services to better meet the disablement needs of people living with HIV in Canada. [ABSTRACT FROM AUTHOR]

While condom use remains one of the most effective measures to prevent the sexual transmission of HIV, decreasing attention appears to be given to its importance and techniques of effective use relative to potential biomedical technologies. This paper focuses on delayed condom application (DCA), one practice which has been implicated in HIV transmission among gay and bisexual men. It examines the prevalence of the practice within a gay community and explores factors associated with condom use among those who practice only safer sex and those who report at least some unprotected anal sex. Data were taken from an anonymous, cross-sectional study of a self-identified sample of gay and bisexual men (N=5080). Among 2614 men who responded to relevant questions, multivariate polytomous logistic regressions were used to identify variables associated with DCA. Nearly, half of the men reported delayed condom application for insertive anal intercourse in the previous 12 months. While the majority of this group also reported episodes of unprotected anal sex, more than 25% of those who reported delayed application only reported safer sexual practices. Most socio-demographic variables found to be associated with unsafe sex in other studies were not associated with DCA. Negative condom use experiences such as tearing, splitting and slippage were associated with delayed application among the two groups. DCA, which may be considered by men as an effective harm reduction strategy requires attention. Interventions to address this behavior need to consider the physical issues of condom use along with the complex array of social, structural, psychological, and interpersonal issues. [ABSTRACT FROM AUTHOR]

Abstract: Worthington C, Myers T, O’Brien K, Nixon S, Cockerill R, Bereket T. Rehabilitation professionals and human immunodeficiency virus care: results of a national Canadian survey. Objective: To describe rehabilitation professionals’ practices, knowledge and training, professional views, and service delivery issues for people living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (PHAs) in Canada. Design: Nationwide cross-sectional postal survey. Setting: Canada. Participants: Random sample (N=2105) of occupational therapists, physical therapists, speech-language pathologists, and physiatrists who had practiced in the past year. Interventions: Not applicable. Main Outcome Measures: Survey items on current practices, HIV knowledge and training, professional views on rehabilitation and HIV, and HIV rehabilitation service delivery issues. Results: Seventy-four percent (1492/2006) of the traceable sample responded, 53% (n=1058) of whom yielded completed surveys. Sixty-one percent of survey respondents never knowingly had served an HIV-positive patient. Of this group, 27% indicated these were patients they would like to work with, 27% indicated they were unwilling, and 46% were unsure. The 39% who knowingly had served PHAs had served an average of 4 PHAs in the last year, and less than 25% of their HIV patients’ rehabilitation issues were HIV-related. Conclusions: Despite the role rehabilitation professionals have to play in the care of PHAs, only a minority serves PHAs. Results of this survey show a potential gap between the documented rehabilitative needs of PHAs and services provided by the rehabilitation professional community. [Copyright &y& Elsevier]

Background: Each year more than 56 000 adult and young offenders are admitted to Ontario's remand facilities (jails, detention centres and youth centres). The prevalence of HIV infection in Ontario remand facilities was last measured over a decade ago, and no research on the prevalence of hepatitis C virus (HCV) infection has been conducted in such facilities. We sought to determine the prevalence of HIV infection, HCV infection and HIV-HCV coinfection among inmates in Ontario's remand facilities. Methods: A voluntary and anonymous cross-sectional prevalence study of HIV and HCV infections was conducted among people admitted to 13 selected remand facilities across Ontario between Feb. 1, 2003, and June 20, 2004. Data collection included a saliva specimen for HIV and HCV antibody screening and an interviewer-administered survey. Prevalence rates and 95% confidence intervals were calculated and examined according to demographic characteristics, region of incarceration and self-reported history of injection drug use. Results: In total, 1877 participants provided both a saliva specimen and survey information. Among the adult participants, the prevalence of HIV infection was 2.1% among men and 1.8% among women. Adult offenders most likely to have HIV infection were older offenders (30 years) and injection drug users. The prevalence of HCV infection was 15.9% among men, 30.2% among women and 54.7% among injection drug users. Adult offenders most likely to have HCV infection were women, older offenders (≥30 years) and injection drug users. The prevalence of HCV-HIV coinfection was 1.2% among men and 1.5% among women. It was highest among older inmates and injection drug users. Among the young offenders, none was HIV positive and 1 (0.4%) was HCV positive. On the basis of the study results, we estimated that 1079 HIV-positive adults and 9208 HCV-positive adults were admitted to remand facilities in Ontario from Apr. 1, 2003, to Mar. 31, 2004. Interpretation: Adult offenders entering Ontario remand facilities have a considerably higher prevalence of HIV and HCV infections than the general population. [ABSTRACT FROM AUTHOR]

The article reports on a study that proves a decrease in illegal drug use and HIV risk behavior among participants who inject and also by those who do not, when involved in a low-dose methadone treatment plan. The assessment was done on opioid users 6 months after agreeing to the harm reduction based methadone treatment. The study shows the relationship between the low drug use and the reduced risk of HIV transmission. The enforcement of abstinence based policies were not incorporated.

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Continued sexual risk behavior following repeatedly testing HIV-negative in the Polaris HIV Seroconversion Study (Ontario, Canada) led to this follow-up study which identifies the impact of repeat negative testing among 64 men and women. Repeat HIV-negative testing frequently results in confusion as to what constitutes risk and occasionally to thoughts of HIV immunity. Narrative accounts include beliefs that monogamy constitutes safety from HIV, that psychosocial factors other than repeatedly testing negative leads to risk, and that sexual risk reduction is unsustainable. In conclusion, the repeat negative test experience for some neither clarifies risk behavior nor reinforces sustained risk reduction. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe gay and bisexual men's experiences of bathhouses and their perceptions of HIV risk associated with sex in this context. Face-to-face, semi-structured interviews were conducted with a purposive sample of gay and bisexual men--14 HIV-positive and 9 HIV-negative--who reported ever frequenting a bathhouse. The sample was selected from the Polaris HIV Seroconversion Study, a longitudinal open cohort study of documented recent seroconverters and HIV-negative controls in Ontario, Canada. Interview transcripts were analysed using a narrative approach. Four major themes were identified concerning views of gay bathhouse culture and environments; moral conceptions of self and others at a bathhouse; identity management at a bathhouse; and psychosocial functions of gay bathhouses. HIV transmission is a salient component of bathhouse culture; therefore, bathhouses are critical environments for the promotion of safer sex activities among gay and bisexual men. [ABSTRACT FROM AUTHOR]

The objective of this analysis was to identify risk factors for recent human immunodeficiency virus (HIV) infection among homosexual and bisexual men in Ontario, Canada, during 1998–2001. Participants were recruited through the provincial HIV diagnostic laboratory and through physicians and community organizations. HIV test results were used to identify recent seroconverters (cases). A subsample of 183 men (62 cases and 121 controls) enrolled in the Polaris HIV Seroconversion Study as of June 2001 was analyzed. This analysis focused on sexual behaviors with partners who were HIV-positive or whose HIV status was unknown. In multiple logistic regression, independent risk factors were identified. Rates of unprotected receptive oral, insertive anal, and receptive anal sex and delayed application of condoms during receptive anal sex (RAS) were significantly higher among cases (97%, 41%, 53%, and 32%, respectively) than among controls (73%, 19%, 14%, and 2%). Independent risk factors for HIV infection were RAS without condoms (odds ratio = 4.4, p = 0.0004) and delayed application of condoms during RAS (odds ratio = 5.8, p = 0.01). There was an association with condom failure (breakage or slippage) during RAS that approached significance (odds ratio = 2.9, p = 0.09). Delayed application of condoms for RAS may result in contact with preejaculatory fluid. This behavior, which to date has received little attention, may pose as much risk for HIV infection as fully unprotected RAS. [ABSTRACT FROM PUBLISHER]

OBJECTIVES. This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. METHODS. A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. RESULTS. Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to be tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. CONCLUSIONS. Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value. [ABSTRACT FROM AUTHOR]

To explore syringe access patterns and implications for HIV prevention programming, data from qualitative interviews (n=120) with injection drug users (IDU) and an evaluation of a satellite syringe-exchange program (SEP) were used. Three patterns were identified: IDUs who stockpile supplies to meet their own needs and to provide secondary distribution to friends and drug-using associates; IDUs who keep a several-days supply of syringes available, primarily for their own use; and IDUs who usually obtain equipment at the time of obtaining drugs, in some cases unsterile equipment from other injectors. The first two types of injectors are typically in stable housing, while the last group are generally in unstable housing. This analysis highlights the very direct link between adequate housing and safer injection practices for HIV prevention, and points to the need to advocate more broadly on behalf of IDUs for appropriate housing, harm-reduction and social services. [ABSTRACT FROM AUTHOR]