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Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6 months until July 2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (

Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use.Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM.Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all plt;0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (plt;0.001), Toronto 21.4-31.4% (plt;0.001) and Vancouver 21.7-59.5% (plt;0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18).Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.

The last Canadian biobehavioural surveillance study of HIV and other sexually transmitted and blood-borne infections (STBBI) among gay, bisexual and other men who have sex with men (GBM) was conducted in 2010. We designed a study to measure STBBI prevalence among GBM in metropolitan Montreal, Toronto and Vancouver and to document related preventive and risk behaviours.The Engage Cohort Study used respondent-driven sampling (RDS) to recruit GBM who reported sex with another man in the past 6 months. At baseline, we examined recruitment characteristics of the samples, and the RDS-II-adjusted distributions of socio-demographics, laboratory-confirmed HIV and other STBBI prevalence, and related behaviours, with a focus on univariate differences among cities.A total of 2449 GBM were recruited from February 2017 to August 2019. HIV prevalence was lower in Montreal (14.2%) than in Toronto (22.2%) or Vancouver (20.4%). History of syphilis infection was similar across cities (14-16%). Vancouver had more HIV-negative/unknown participants who reported never being HIV tested (18.6%) than Toronto (12.9%) or Montreal (11.5%). Both Montreal (74.9%) and Vancouver (78.8%) had higher proportions of men who tested for another STBBI in the past 6 months than Toronto (67.4%). Vancouver had a higher proportion of men who used pre-exposure prophylaxis (PrEP) in the past 6 months (18.9%) than Toronto (11.1%) or Montreal (9.6%).The three largest cities of Canada differed in HIV prevalence, STBBI testing and PrEP use among GBM. Our findings also suggest the need for scale-up of both PrEP and STI testing among GBM in Canada.RéSUMé: OBJECTIFS: La dernière étude canadienne portant sur la surveillance biocomportementale du VIH et des autres infections transmissibles sexuellement et par le sang (ITSS) chez les hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec des hommes (GBH) a été menée en 2010. Nous avons mis en œuvre une étude visant à estimer la prévalence des ITSS parmi les GBH résidant dans les régions métropolitaines de Montréal, Toronto et Vancouver ainsi qu’à documenter les comportements préventifs et à risque associés à ces infections. MéTHODES: La méthode « d’échantillonnage dirigé par les répondants » (RDS) a été utilisée pour recruter des GBH ayant eu des relations sexuelles avec un autre homme au cours des six derniers mois. Nous avons examiné les distributions, ajustées selon l’approche RDS-II, des caractéristiques socio-démographiques des répondants, et la prévalence du VIH et d’autres ITSS mesurées par des tests de laboratoire ainsi que les comportements associés. Nous avons porté une attention particulière aux différences entre les villes décelées par analyses univariées. RéSULTATS: Nous avons recruté un total de 2 449 GBH entre février 2017 et août 2019. La prévalence du VIH était plus basse à Montréal (14,2 %) qu’à Toronto (22,2 %) ou à Vancouver (20,4 %) alors que celle de la syphilis (résultat de test compatible avec une infection au cours de la vie) était similaire dans les trois villes (14 à 16 %). Vancouver comptait plus de participants de statut VIH négatif/inconnu ayant déclaré n’avoir jamais passé un test de détection du VIH à vie (18,6 %) comparativement à Toronto (12,9 %) ou à Montréal (11,5 %) alors que les proportions de répondants ayant passé un test de détection d’une autre ITSS au cours des six derniers mois étaient plus élevées à Montréal (74,9 %) et à Vancouver (78,8 %) qu’à Toronto (67,4 %). Vancouver comptait une plus forte proportion d’hommes ayant eu recours à la prophylaxie du VIH pré-exposition (PrEP) au cours des six derniers mois (18,9 %) que Toronto (11,1 %) ou Montréal (9,6 %). CONCLUSION: Les trois plus grandes villes du Canada différaient en ce qui concerne la prévalence du VIH, le dépistage des ITSS et l’utilisation de la PrEP au sein des GBH. Nos résultats suggèrent la nécessité d’intensifier le dépistage des ITSS et le recours à la PrEP chez les GBH au Canada.

Gay, bisexual, and other men who have sex with men (gbMSM) remain disproportionately affected by human immunodeficiency virus (HIV). Interaction between psychosocial factors likely plays a role in HIV acquisition risk. We aimed to analyze the association of loneliness and self-rated attractiveness with HIV acquisition risk, and determine whether these associations were mediated by gay telephone chatlines or online dating platforms.This cross-sectional study included HIV-negative gbMSM 16 years or older enrolled into the Momentum Health Study from February 2012 to February 2015. Loneliness, self-rated attractiveness (exposures) and use of gay chatlines or online dating platforms (mediators) were assessed through self-interviews. Human immunodeficiency virus acquisition risk (outcome) was assessed by the HIV Incidence Risk Index. Weighted logistic regression modeled the association and moderation effect between exposures and outcome. Mediation models estimated 3-way direct effect among exposures, mediators, and outcome.Of 542 gbMSM, those who were lonely (adjusted odds ratio [aOR], 1.54; 95% confidence intervals [CI], 1.04-2.28) and attractive (aOR, 1.69; 95% CI, 1.04-2.76) had increased odds for HIV acquisition risk. Our moderation analysis demonstrated a heightened joint effect among lonely and attractive participants (aOR, 1.70; 95% CI, 1.08-2.65). Use of gay telephone chatlines or online dating platforms mediated 30.5% of the association between loneliness and HIV acquisition risk, but did not mediate attractiveness and HIV acquisition risk.Our findings suggest that the provision of interventions focusing on mental health support and safer sex practices through gay telephone chatlines or online dating platforms is promising to help alleviate the HIV burden among gbMSM.

We developed measures of relational beliefs and expectations among single young gay and bisexual men (YGBM). Data come from an online cross‐sectional study YGBM, which ran from July 2012 until January 2013. There were 50 items on relational beliefs and 25 items on relational expectations. We used random split samples and a priori analysis to group items together and applied principal axis factoring with varimax orthogonal rotation. We had a total N = 1582 in our analytical sample and identified six constructs of relational expectations (restrictions, negative break up, masculine and gender norms, optimism, cheating, immediacy) and two constructs of relational beliefs (sex beliefs, equality). Our findings highlight specific relational cognitions among YGBM and offer insight into the beliefs and expectations that may inform their relationships. Findings may be useful for health professionals to help YGBM reflect and understand the health implications of their beliefs and expectations about same‐sex relationships to promote healthy decision-making as they seek future partners.

Sexual and gender minority youth (SGMY) are more likely to experience bullying and violence compared to the youth who do not identify as SGMY, leading to increased risk of poor mental and physical health outcomes, and poor academic performance. Few studies explore the entire range of bullying experienced by sexual and gender minority youth (SGMY). The purpose of this study was to qualitatively describe the ways in which SGMY experience bullying victimization. We conducted semi-structured interviews with a diverse sample of 20 SGMY aged 14–18 years (median age 16 years) recruited from online social media. The sample included 10 participants who identified as cisgender girls, 4 who identified as cisgender boys, 2 who identified as transgender, and 4 who identified as another gender identity. Ten participants identified as bisexual, six identified as lesbian, and four identified as gay. Findings indicated six common experiences of bullying among the participants: (a) verbal harassment; (b) gender policing; (c) physical violence; (d) sexual harassment; (e) treated as sexual perpetrators and deviants; and (f) and social exclusion. SGMY described how bullying victimization ranged from overt to concealed attitudes and behaviors, and they articulated how several forms of bullying are likely not experienced by heterosexual and cisgender youth. These results support findings from prior qualitative studies and suggest that efforts to address school-based bullying may benefit from a more complete awareness of the range of bullying victimization experienced by SGMY. Development of multi-item scales of bullying that reflect the six common experiences of bullying presented in this study would allow researchers to quantitatively explore the range of bullying behaviors experienced by SGMY, and would aid in the conceptualization and successful implementation of anti-bullying interventions.

Prevalence of HIV in Belize is high, and men who have sex with men (MSM) are disproportionately impacted by HIV. HIV testing is critical in curbing the epidemic; however, little is known about factors associated with testing among MSM in Belize. Working with a non-governmental organization in a large, urban city within Belize, snowball sampling was applied to recruit Belizean MSM to complete a self-administered survey. Multivariable logistic regression analysis was employed to understand associations with HIV screening behavior. Access to healthcare, HIV knowledge, and reporting having heard of Section 53 of the Criminal Code of Belize (once outlawing same-sex sexual behavior), but not experiencing any negative impact from Section 53 were significantly positively associated with having received an HIV test in the past six months. Healthcare maltreatment (lifetime), depression symptomology, and shame were significantly negatively associated with having received a HIV test in the past six months. Findings suggest that multiple factors associated with stigma and discrimination negatively affect testing strategies among MSM in Belize.

BackgroundDue to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression.MethodsParticipants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012–February 2015) with follow-up visits occurring every 6 months until February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale.ResultsOf the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship.ConclusionThere may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.

Introduction In 2010, British Columbia (BC) implemented HIV Treatment as Prevention (TasP) as policy. We examined trends in virologic suppression and determinants of significant viremia among a prospective biobehavioural cohort of men who have sex with men (gbMSM) in Vancouver from 2012–2017. Methods Respondent-driven sampling was used to recruit sexually active gbMSM (≥16 years) who completed biannual study visits with a computer-assisted self-interview and clinical CD4 and viral load (VL) testing. We linked participant data with the BC HIV Drug Treatment Program to obtain antiretroviral dispensing and VL data. We conducted a trend analysis of VL suppression using univariable generalized estimating equation (GEE) multi-level modelling and multivariable GEE to identify factors associated with episodes of VL ≥200 copies/mL. Results Of 774 participants, 223 were living with HIV at baseline and 16 were diagnosed during follow-up (n = 239). We observed a significant trend towards reduced levels of unsuppressed VL (>200 copies/mL) from 22% (07/2012-12/2012) to 12% (07/2016-12/2016) (OR:0.87; 95%CI:0.83–0.91 for each 6-month period). Among those with at least one follow-up visit, (n = 178, median follow-up = 3.2 years, median age = 46.9 years), younger age (aOR:0.97; 95%CI:0.94–0.99, per year), ecstasy use (aOR:1.69; 95%CI:1.13–2.53), crystal methamphetamine use (aOR:1.71; 95%CI:1.18–2.48), seeking sex via websites (aOR:1.46; 95%CI:1.01–2.12), and lower HIV treatment optimism (aOR:0.94; 95%CI:0.90–0.97) were associated with episodes of elevated viremia. Conclusions During a period when TasP policy was actively promoted, we observed a significant trend towards reduced levels of unsuppressed VL. Continued efforts should promote HIV treatment optimism and engagement, especially among younger gbMSM and those who use ecstasy and crystal methamphetamine.

While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors.We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables.In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex.Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.

Objective: Supportive social relationships can have direct positive effects on health and miti-gate the negative impact of stressors. This study investigated the main effect of perceived social support on STI/HIV risk and prevention behaviors. The buffering effect of perceived social support on the impact of proximal minority stressors, like internalized homonegativity, was also examined on one risk behavior specifically, condomless anal sex (CAS) without HIV pre-exposure prophylaxis (PrEP) use. Methods: HIV-negative gay, bisexual, and other men who have sex with men (GBM) were recruited using respondent driven sampling from three major Canadian urban centers (n = 1,409). GBM completed measures of perceived social support, proximal minority stress, and engagement in STI/HIV risk and prevention behaviors. Results: Higher perceived social support was positively associated with a several health behaviors, in-cluding recent STI and HIV testing, discussing HIV status with prospective partners, the use of behavioral HIV-risk reduction strategies during sexual encounters, and a lower likelihood of en-gaging in CAS without PrEP. There was evidence of moderation as well. Among GBM with higher perceived social support, internalized homonegativity was no longer associated with in-creased odds of engaging in CAS without PrEP. Conclusions: The results of the current study advance social support theory to GBM in the context of biomedical prevention, showing both evidence of both direct associations and buffering effects on STI/HIV risk and prevention be-haviors. This highlights the importance of promoting social support seeking in interventions aimed at improving GBM health.

HIV testing remains a critical point of entry to HIV treatment services and now biomedical prevention as well. Yet despite the high HIV prevalence among Black men who have sex with men (MSM), insufficient attention has been given to factors associated with those Black MSM in the United States who have never received an HIV test in their lifetime. Promoting Our Worth, Equality, & Resilience (POWER) is a cross-sectional observational study that recruited Black MSM at Black Pride events across six cities in the United States from 2014 to 2017. Participants completed an anonymous questionnaire and were offered free, confidential HIV testing. Of the 4174 Black MSM without a prior HIV diagnosis, 404 (9.68%) had never tested for HIV (mean age = 31.03 years). Lower education and greater internalized homophobia were associated with never having tested for HIV. Higher age (AOR = 1.05, 95%, 1.02–1.07) and assumption of HIV-positivity (AOR = 3.24, 95% CI 1.53–6.84) were both associated with increased odds of an HIV-positive test result (n = 119; 36%). To compare, HIV prevalence among Black MSM who had received at least one HIV test before study participation was 23%. While a minority of Black MSM had never received an HIV test, this group had a significantly higher likelihood of HIV infection. Alternative HIV testing strategies are needed to facilitate HIV testing initiation among Black MSM for whom conventional HIV testing modalities are insufficient.

Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014–2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p

Religious Freedom Restoration Acts and sexual minority population health in the United States ABSTRACT: Religious Freedom Restoration Acts (RFRAs) in the United States (US) potentially facilitate discrimination against lesbian, gay, and bisexual individuals (i.e., sexual minorities). This investigation explored whether a population health metric among sexual minority adults changed over time based on the presence, absence, or introduction of a state RFRA. Data are from 21 US states that gathered sexual orientation data from population-based samples of non-institutionalized adults in the 2015 Behavioral Risk Factor Surveillance System. The analytic sample included 4,911 sexual minority individuals. Time was measured in four 3-month quarters (i.e., Q1, Q2, Q3, Q4). For each state, the prevalence of sexual minority adults reporting ≥14 unhealthy days/30 days was calculated. Only Indiana (the only state in the sample that passed a RFRA in 2015) exhibited significant increasing proportions over time of sexual minority adults reporting ≥14 unhealthy days (Q1=24.5%, Q2=34.8%, Q3=41.2%, Q4=59.5%) (ß=0.50, SE=0.23, P=.037). Post hoc analyses revealed that unhealthy days did not increase for heterosexual adults in Indiana. Indiana’s RFRA could have contributed to the increasing prevalence of unhealthy days among sexual minority adults in that state during 2015. Public health surveillance tools are needed to facilitate expeditious analysis of the impact of laws on minority population health.

Introduction Treatment as prevention strategies have been variously applied across provinces in Canada. We estimated HIV care cascade indicators and correlates of unsuppressed viral load (VL) among gay, bisexual and other men who have sex with men (GBM) recruited in Vancouver, Toronto and Montreal. Methods Sexually active GBM, aged ≥16 years, were recruited through respondent‐driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer‐Assisted Self‐Interview and tests for HIV and other sexually transmitted infections (STIs). We conducted bivariate analyses comparing RDS‐adjusted proportions across cities. We used multivariable logistic regression to examine factors associated with having a measured VL ≥ 200 copies/mL with data pooled from all three cities. Results We recruited 1179 participants in Montreal, 517 in Toronto and 753 in Vancouver. The RDS‐adjusted HIV prevalence was 14.2% (95% CI 11.1 to 17.2) in Montreal, 22.1% (95% CI 12.4 to 31.8) in Toronto and 20.4% (95% CI 14.5 to 26.3) in Vancouver (p

(1) Background: Condomless anal sex and substance use are associated with STI risk among gay, bisexual, and other men who have sex with men (gbMSM). Our first study objective was to describe event-level sexual risk and substance use trends among gbMSM. Our second study objective was to describe substances associated with event-level sexual risk. (2) Methods: Data come from the Momentum Health Study in Vancouver, British Columbia and participants were recruited from 2012–2015, with follow-up until 2018. Stratified by self-reported HIV status, we used generalized estimating equations to assess trends of sexual event-level substance use and assessed interactions between substance use and time period on event-level higher risk sex defined as condomless anal sex with an HIV serodifferent or unknown status partner. (3) Results: Event-level higher risk anal sex increased across the study period among HIV-negative/unknown (baseline prevalence: 13% vs. study end prevalence: 29%) and HIV-positive gbMSM (baseline prevalence: 16% vs. study end prevalence: 38%). Among HIV-negative/unknown gbMSM, event-level erectile drug use increased, while alcohol use decreased over the study period. Overall, interactions between substance use and time on higher risk anal sex were not statistically significant, regardless of serostatus. However, we found a number of time-specific significant interactions for erectile drugs, poppers, Gamma-hydroxybutyrate (GHB), crystal methamphetamine and ecstasy/MDMA use among HIV-negative/unknown gbMSM. (4) Conclusion: Significant differences in substance use trends and associated risks exist and are varied among gbMSM by serostatus. These findings provide a more comprehensive understanding of the effects of event-level substance use on sexual risk through longitudinal follow-up of nearly six years.

We examined temporal trends and factors associated with reporting partner's serostatus and viral load among a sample of gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada. Participants were recruited using respondent-driven sampling and we collected prospective cohort data from 09/2014 to 02/2017 using a computer-assisted questionnaire and nurse-administered STI/HIV testing. Our study included 481 participants reporting on 3780 sexual events. Among HIV-negative/unknown gbMSM we found a trend towards decreased proportions of sexual events reporting an unknown HIV-status partner (42-19%; p = 0.001) and found increased proportions among gbMSM living with HIV (11-27%; p = 0.043). More participants living with HIV reported sex with undetectable partners, compared to HIV-negative/unknown participants (14.8% versus 5%). Our multivariable model found that compared with unknown status partners, undetectable partners were older, were from longer sexual relationships and were more likely to engage in condomless anal sex. Findings indicate that HIV-negative gbMSM seem more aware of the serostatus of their partners over time, but knowledge of partners' viral load over time was not significant. Further research should assess the degree to which new campaigns such as Undetectable = Untransmittable (U = U) are associated with discussions about HIV disclosure and viral load status.

Event-level studies measure substance use and sexual behaviors happening during a specific sexual encounter, ensuring that both variables are temporally paired. This study explored the event-level associations between a range of sexual behaviors (masturbation, anal sex, oral sex, rimming, fisting, sex toys, and group sex) and five sexualized substances (poppers, methamphetamine, GHB, ecstasy/MDMA, and ketamine) used during 11,582 sexual events reported by 762 gay, bisexual, and other men who have sex with men (GBMSM) in Vancouver, Canada. Data were obtained from a prospective cohort of GBMSM who self-reported their behaviors via computer-based questionnaires on their last sexual encounter with up to five of their most recent partners in the past six months. These clustered data were analyzed with multivariable generalized linear mixed models. Participants reported popper use in 16.1% of sexual encounters, methamphetamine in 8.6%, gamma-hydroxybutyrate (GHB) in 4.1%, ecstasy/3,4-methylenedioxymethamphetamine (MDMA) in 3.3%, and ketamine in 1.5%. Condomless receptive anal sex (25.0% of events) was associated with increased odds of using poppers, methamphetamine, GHB, and ecstasy/MDMA. Group sex (13.1% of events) and sharing sex toys (2.0% of events) were more likely with the use of all five substances. Receiving money/drugs/goods in exchange for sex (2.5% of events) was associated with increased odds of poppers, methamphetamine, GHB, and ecstasy/MDMA use. GBMSM living with HIV (29.9% of participants) had higher odds of using poppers, methamphetamine, and GHB, but lower odds of using ecstasy/MDMA. In conclusion, these event-level results suggest public health strategies are needed to address the possible negative impacts of sexualized substance use among GBMSM.

Background: Methamphetamine (MA) use among gay, bisexual, and other men who have sex with men (gbMSM) is a pervasive issue, associated with detrimental health outcomes. We identified factors associated with discontinuation or reduction in MA among a subset of gbMSM reporting frequent (at least weekly) use, with a specific focus on symptoms of anxiety and depression.Methods: We recruited sexually-active gbMSM aged ≥16 years in Vancouver, Canada into a prospective-cohort study using respondent-driven sampling. Participants completed study visits once every six months. We used generalized linear mixed models to identify factors associated with reductions in MA use following a visit where participants previously reported using MA at least weekly.Results: Of 584 cohort participants with at least one follow-up visit, 67 (11.5%) reported frequent MA use at baseline or in follow-up visits. Of these, 46 (68.7%) had at least one subsequent study visit where they transitioned to less frequent (monthly or less) or no MA use. In multivariable models, reduced MA use was less likely for those who spent >50% of social time with other gbMSM (aRR=0.49, 95%CI:0.28-0.85), gave or received drugs in exchange for sex (aRR=0.34, 95%CI:0.13-0.87), injected drugs (aRR=0.35, 95%CI:0.18-0.68), or used gamma-hydroxybutyrate (GHB) (aRR=0.41, 95%CI:0.21-0.78). Symptoms of anxiety or depression were not associated with reductions in MA use.Conclusions: Social connection and drug-related factors surrounding MA use were associated with reductions, but anxiety and depressive symptomatology were not. Incorporating socialization and polysubstance-related components with MA reduction may help in developing efficacious interventions towards reducing MA use for gbMSM.

The HIV epidemic among black men who have sex with men (BMSM) demands urgent public health attention. Pre-exposure prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood.A serial cross-sectional survey assessment (N = 4184 BMSM reporting HIV-negative/unsure status) and HIV testing were conducted at Black Gay Pride events in 6 US cities in 2014, 2015, 2016, and 2017.HIV prevalence was higher among BMSM self-reporting current PrEP use (1 of 3 participants) than BMSM not self-reporting current PrEP use (1 of 5 participants) [32.3%, N = 103/319 vs. 20.0%, N = 639/3,193, adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.31 to 2.15]. BMSM reporting current PrEP use (N = 380) were more likely to report having a greater number of male sex partners (aOR = 1.02, 95% CI: 1.01 to 1.03), a sexually transmitted infection diagnosis (aOR = 2.44, 95% CI: 1.88 to 3.16), and stimulant drug use (aOR = 2.05, 95% CI, 1.21 to 3.47) when compared with BMSM not reporting current PrEP use (N = 3804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR = 1.19, 95% CI: 1.13 to 1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV-positive (aOR = 2.10, 95% CI: 1.24 to 3.56).The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, sexually transmitted infection treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP is needed to guide operational and behavioral interventions that close the gap on incident infection.

The deleterious effects of HIV stigma on HIV+ Black MSM care continuum outcomes have been well-documented. How HIV stigma shapes HIV prevention for HIV- persons in this community is poorly understood. We sought to test the relationship of HIV stigma with HIV- Black MSM on HIV testing, pre-exposure prophylaxis (PrEP) awareness, and PrEP use. We recruited 772 participants at Black Pride events across five US cities in 2016. Multivariable logistic regression models assessed the association of external HIV stigma on prevention outcomes adjusting for sociodemographic variables. Stigma was positively associated with PrEP awareness (AOR = 1.34; 95% CI = 1.09, 1.66; p value = 0.005), and not associated with PrEP use or HIV testing in our sample. These findings highlight the complex nature of HIV stigma among BMSM and include results for PrEP, which can affect uptake other prevention methods. We support anti-HIV stigma efforts and advise further exploration on HIV stigma among BMSM and prevention outcomes.

Differences across the HIV care continuum between men who have sex with men and women (MSMW) and men who have sex with men only (MSMO) are emerging in recent literature but have not been comprehensively documented among black MSM. Although MSMW have lower HIV prevalence than MSMO, they are more likely to be HIV-positive unaware and be virally unsuppressed. Explanatory factors for these differences have not previously been assessed.Between 2014 and 2016, we surveyed sexually active black MSM 18 years or older at Black Gay Pride events in 6 U.S. cities (n = 3881), 1229 of whom either self-reported HIV-positive status or tested HIV-positive onsite. We compared HIV-positive MSMW (n = 196) with HIV-positive MSMO (n = 1033) by HIV-positive unaware status, HIV care uptake, and viral load suppression. We conducted multivariable logistic regressions and built a structural equation model assessing mediating effects of psychosocial comorbidities (violence victimization, depression, and polydrug use) on the relationship between MSMW status and unsuppressed virus.MSMW were more likely than MSMO to be HIV-positive unaware [adjusted odds ratio (aOR) = 2.17; 95% confidence interval (CI): 1.58 to 3.00]. Among those who were HIV-positive aware (n = 720), MSMW were more likely to report never receiving HIV care (aOR = 2.74; 95% CI: 1.05 to 7.16) and to report detectable viral loads (aOR = 2.34; 95% CI: 1.31 to 4.19). Psychosocial comorbidities significantly mediated (P = 0.01) the relationship between MSMW status and unsuppressed virus.Black MSMW were less likely than black MSMO to uptake biomedical care and secondary prevention. Biobehavioral intervention development specific to HIV-positive black MSMW will be most successful if psychosocial comorbidities are also addressed.

ObjectivesIn 2015, a publicly funded human papillomavirus (HPV) vaccination programme was implemented for gay, bisexual and other men who have sex with men (gbMSM) up to age 26 years in British Columbia, Canada. We assessed trends and correlates of HPV vaccine uptake from 2012 to 2019 in a cohort of gbMSM in Vancouver.MethodsWe recruited sexually active gbMSM aged ≥16 years using respondent-driven sampling from February 2012 to February 2015 and followed them until July 2019. We evaluated self-reported HPV vaccine trends using mixed-effects logistic regression and identified factors associated with uptake using multivariable mixed-effects Poisson regression.ResultsA total of 719 participants were recruited and completed the baseline visit, of whom 549 were unvaccinated with at least one follow-up visit. The median age was 33 years and 23% were living with HIV. HPV vaccination increased from 4% in 2012 to 28% in 2019 (p26 years, and from 9% in 2012 to 20% in 2017 (pConclusionsAlthough we observed increases in HPV vaccination uptake from 2012, by 2019 HPV vaccination still remained below 30% among gbMSM in Vancouver, BC. Additional interventions are needed to increase vaccine uptake.

Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.

Black men who have sex with men (BMSM) have the highest HIV incidence rates among all men who have sex with men (MSM) and have been less likely than other MSM to be diagnosed, linked or retained in care for HIV. The Promoting Our Worth, Equality, and Resilience (POWER) study administered a behavioral health survey and HIV test to BMSM to estimate the HIV continuum of care among a community-derived sample. Of the N = 1,680 BMSM living with HIV, n = 956 (56.9%) were aware of their HIV-positive status. BMSM who had been previously diagnosed reported progression through the care continuum at greater than 80% for linkage to medical care (97.6%), retention in medical care (97.3%), prescription of antiretroviral therapy (93.6%) and viral suppression (86.4%). Results of this analysis reveal the urgent need to ensure BMSM are being screened and diagnosed. Additionally, community-driven samples are a promising method offering the opportunity to build on the resilience of BMSM progressing though the continuum as well as engage BMSM not yet in care. Lastly, such methods can assist in communicating with those lost to retention.

Substantial literature demonstrates the influence of the neighborhood environment on health behaviors and outcomes. But limited research examines on how gay and bisexual men experience and exist in various geographic and virtual spaces and how this relates to their sexual behavior. New York City Men 2 Men (NYCM2M) was a cross-sectional study designed to identify neighborhood-level characteristics within the urban environment that influence sexual risk behaviors, substance use, and depression among men who have sex with men (MSM) living in NYC. The sample was recruited using a modified venue-based time-space sampling methodology and through select websites and mobile applications. Whether key neighborhoods of human activity, where a participant resided (termed home), socialized (termed social), or had sex most often (termed sex), were the same or different was evaluated. “Congruence” (or the sameness) of home, social, and most often sex neighborhood was reported by 17 % of men, while 30 % reported that none of their neighborhoods were the same. The largest group of men (39 %) reported that their home and sex neighborhoods were the same but their social neighborhood was different while 10 % reported that their home neighborhood was different than their social and sex neighborhood; 5 % men reported same home and social neighborhoods with a different sex neighborhood. Complete neighborhood incongruence was highest among men who were Black and/or Latino, had lower education and personal income levels, and had greater financial insecurity. In adjusted analysis, serodiscordant condomless anal intercourse and condomless anal intercourse with partners from the Internet or mobile applications were significantly associated with having the same social and sex (but not home) neighborhoods. Understanding the complexity of how different spaces and places relate to the health and sexual behavior of MSM is essential for focusing interventions to best reach various populations of interest.

There is growing evidence that blood transfusion is associated with clinical factors that can lead to transfusion-induced immunosuppression. This effect can be beneficial or deleterious.The effect of perioperative allogeneic blood transfusion on survival was studied retrospectively in 524 patients who were discharged from the hospital after esophagogastrectomy for carcinoma performed in a single unit over a 10-year period.The median operative blood loss for the series was 500 mL (range, 50 to 3,750 mL). Three hundred thirty-five patients (64%) received a perioperative allogeneic blood transfusion related to esophagogastrectomy, and 189 (36%) did not. The median perioperative blood transfusion administered was 900 mL (range, 300 to 12,950 mL). Perioperative allogeneic blood transfusion was associated with reduced survival for patients in stage III (p0.05) at 1 year, but no significant difference was found in this stage at 3 or 5 years after resection. Stage III disease accounted for 250 (48%) of the 524 patients discharged.Although perioperative allogeneic blood transfusion does not affect long-term survival after esophagogastrectomy for carcinoma, it does have a significant association with short-term survival in a group whose overall survival is often limited after resection. Attention should be directed toward minimizing operative blood loss and transfusing only for factors known to be clinically important, such as oxygen delivery and hemodynamics, not arbitrary hemoglobin levels.

Background. Esophageal carcinoma is predominantly a disease of the elderly, a group often only considered for palliative therapies. Methods. A case note review identified 31 octogenarians undergoing resection for carcinoma of the esophagus or gastric cardia over a 12-year period ending December 1994. Results. Nineteen patients made either an uncomplicated postoperative recovery (n = 12) or suffered minor complications (n = 7). Of the 12 patients who suffered moderate or severe complications, 5 died (in-hospital mortality, 16%). The deaths included 2 of 3 patients who underwent emergency operation for esophageal perforation and 3 of 28 patients who underwent elective esophagectomy (elective mortality rate, 10.7%). Nineteen of the 26 survivors (73%) experienced no further dysphagia. The 5-year survival rate was 17%. Conclusions. Elective esophageal resection can be performed safely in selected octogenarians who have no or few coexisting medical problems and present with a localized carcinoma that is technically easy to resect. Patients undergoing emergency operations or in whom moderate or severe postoperative complications develop often have poor physiologic reserve and are therefore at risk of early postoperative death.

Seventy-five patients with Graves' disease have been treated by transantral orbital decompression. In the first post-operative month the average reduction in proptosis was 3 mm. In the years following the operation this reduction increased to an average of 4.5 mm. In 32% of the patients without diplopia before surgery, the diplopia that developed afterwards did not disappear, 83% of them were successfully treated by extraocular muscle surgery. Seventy per cent of the patients experienced immediate post-operative improvement of visual acuity. Only three patients remained with anaesthesia of the infra-orbital nerve. A total of 65% of the patients found the operation procedure beneficial while 76% were satisfied with the ophthalmological result. We conclude, that transantral orbital decompression, though with moderate morbidity, gives good results in patients with the orbital complications of Graves' disease.

In 1953 Hufnagel and Harvey reported their successful treatment of aortic valve insufficiency by the implantation of a ball-valve prosthesis into the descending thoracic aorta. Since then, great advances in technology, surgery, and anesthesia have made aortic valve replacement a more common procedure with relatively low mortality. This remains true for the vast majority of prosthetic valve replacements. However, cases requiring reoperation can be difficult, leading to a much higher degree of morbidity and mortality. In selected patients who require repeated approaches to the aortic root we propose that Hufnagel's original idea may still be of value to reduce the severity of aortic insufficiency. We report our experience in 4 cases of aortic prosthetic incompetence, all of which were improved by two New York Heart Association functional classes after a modification of Hufnagel's procedure.

To determine the recurrence patterns and prognosis after resection of esophageal cancer.One hundred eighty five patients who developed recurrence after curative resection for squamous-cell carcinoma of the thoracic esophagus were analyzed retrospectively.The median recurrence time was 303 days. Recurrence pattern was catagorized into lymphatic, hematogenous, mixed and anastomotic. The number of patients in each recurrence group was 137, 11, 29, and 8, respectively. The 0.5-, 1-, 2-, 3-, and 4-year overall survival rate was 70.7%, 47.1%, 19.8%, 12.2% and 0%, respectively. Multivariate analysis showed that depth of tumor invasion, lymph node metastasis, operative procedure and different regimens of therapy were significant prognostic factors.Lymph node metastasis and the depth of invasion may reflect the biologic behavior of the tumor. Esophagectomy with cervical anastomasis is recommended, additional cervical lymphadenectomy is beneficial in a few patients. Radiotherapy combined with chemotherapy may prolong survival time of patients with recurrence.

The nuclear population in the polyspermic egg of the domestic hen was examined in whole-mount preparations of the germinal disc. The numbers of nuclei varied in groups of hens from averages of 5.9 to 26, depending on days from insemination. Changes in development from initial formation of pronuclei to the early mitoses of the zygote nucleus were staged according to the position of the egg in the oviduct. The findings substantiated earlier accounts on the timing of the apposition of the parental pronuclei towards the end of the first cell cycle. Additionally, analysis of the spatial distribution of accessory spermatozoal nuclei showed a slight, but significant, dispersal from a clustered arrangement at this time.

The prediction of requirement for, and short- and long-term outcome of, prolonged mechanical ventilation after cardiac surgery is ill-defined. The aims of this study were to isolate any predictive indices which might identify those groups of patients who may require prolonged ventilation postoperatively and to determine which factors significantly affect outcome in the prolonged-ventilation group. Following case note review of 139 consecutive cardiac surgical patients ventilated for > or = 7 days following surgery, 43 factors were recorded on each patient, including smoking, pulmonary function, chest infection, and chronic obstructive airways disease. Of 139 patients, 89 were discharged from hospital (64% survival); of these, 52 were alive at long-term follow-up (58% long-term survival). Statistical analysis identified urban residence, chronic obstructive airways disease, prolonged operation, and bypass time as significant predictors of requirement for prolonged ventilation postoperatively. On multivariate analysis five factors were predictive of increased intensive care mortality, including urban residence, inotrope days, sepsis, perioperative cerebrovascular accident and coagulopathy requiring fresh frozen plasma transfusion postoperatively. Following discharge from hospital, four factors were found to be significant predictors of increased mortality: these are impaired preoperative ejection fraction, increasing age, impaired preoperative pulmonary function, and abscence of preoperative aspirin medication. These factors should be considered in intensive care planning, long-term follow-up and importantly on clinical decision making in the individual patient.

In order to determine the effect of obesity on the results of coronary artery bypass graft (CABG) surgery, we compared 250 obese patients undergoing CABG procedures between 1984 and 1987 with 250 age- and sex-matched controls of normal body mass index (BMI) undergoing CABG in the same period. The obese group had a greater incidence of diabetes mellitus (p less than 0.02), hypertension (p less than 0.05), hyperlipidaemia (p less than 0.05), and left main stem coronary artery disease (p less than 0.001). No differences were identified in the surgery performed, but obesity was associated with prolonged total bypass time (p less than 0.05). Operative mortality was 0.8% in both groups. Multivariate analysis demonstrated obesity to be an independent risk factor for perioperative morbidity (p less than 0.05). Univariate: respiratory (p less than 0.01); leg wound (p less than 0.001); myocardial infarction (p less than 0.02); arrhythmias (p less than 0.02); sternal dehiscence (p less than 0.02). At a mean follow-up time of 36.9 months obese patients exhibited a greater incidence of significant recurrent angina (p less than 0.01), which was associated with further weight gain (mean 12.2 kg; linear correlation: p less than 0.001, r = 0.891). Although in CABG surgery operative mortality is not increased in obese patients, aggressive pre- and postoperative weight control is indicated to reduce both perioperative morbidity and the incidence of recurrent angina.

A prospective double blind, randomised study was performed in 100 patients undergoing major elective thoracic surgery to assess a new method of prophylaxis of wound infection using one preincisional intraparietal infiltration of cefuroxime sodium along the line of proposed incision as the sole protection against wound infection. A significant (p less than 0.01) reduction in the incidence of wound infection occurred in the antibiotic treated group (2%) compared with the control group (20%), who received by the same route the same volume of saline only. The groups were comparable with respect to age, sex, pathological condition, and operative variables. The use of additional antibiotics was significantly greater in the control group (p less than 0.01), largely owing to a much greater incidence of postoperative pulmonary infection in the control group (60%) than in the antibiotic treated group (40%). No morbidity was associated with this technique. The organisms found in oesophageal and bronchial operative luminal specimens did not correlate with postoperative wound or pulmonary infection or with organisms causing these infections. Reductions in wound and pulmonary infection rates equivalent to those produced by conventional multiple dose parenteral regimens were achieved by this technique.

Strut fracture with disc embolisation from a Bjork-Shiley prosthesis in the aortic position is extremely rare, and almost invariably fatal. We report a case in which the patient survived emergency surgery for this complication. The pathogenesis of strut fracture, its prevention, diagnosis and management are discussed.

The use of a right or left lateral thoracotomy is described as an alternative approach to revisional coronary artery surgery for patients with patent anterior grafts. Five patients underwent successful revisional coronary artery grafting with a total of three internal mammary artery grafts and three saphenous vein grafts. This is a safe technique in patients for whom repeat median sternotomy is potentially hazardous, notably those with patent anterior grafts or close apposition of the heart to the sternal table.

Because little information is available concerning the outcome of surgery for left ventricular aneurysm when multiple concurrent coronary grafts are required, we have reviewed 35 consecutive patients undergoing aneurysm surgery and multiple (greater than or equal to 3) grafts between December 1973 and April 1984. There were 6 operative deaths (17%). All occurred amongst those (16) undergoing LV plication procedures with no deaths amongst those (19) undergoing aneurysm resection (p less than 0.01). Operative mortality was not influenced by preoperative functional status, left ventricular end diastolic pressure, completeness of revascularisation, endarterectomy (13 patients) or whether cold crystalloid cardioplegia or intermittent aortic cross clamp with ventricular fibrillation was used. Overall 5-year actuarial survival was 70% with survival beyond surgery being 84% to 5 years and independent of the type of aneurysm procedure. Of the survivors, 16 were improved by 1-3 functional classes, 3 were unchanged and one was worse. Surgery in this group of patients offers the prospect of good symptomatic improvement and survival figures which at least equal the results of less complex ventricular aneurysm surgery and exceed those reported for medical management.

Small cell carcinoma of the oesophagus is a rare tumour with a poor prognosis. This report presents evidence favouring chemotherapy as the primary treatment.