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This study examined patterns of connectedness among 774 sexually-active gay, bisexual, and other men who have sex with men (GBM), aged ≥ 16 years, recruited using respondent-driven sampling in Metro Vancouver. Latent class analysis examined patterns of connectedness including: attendance at gay venues/events (i.e., bars/clubs, community groups, pride parades), social time spent with GBM, use of online social and sex seeking apps/websites, and consumption of gay media. Multinomial regression identified correlates of class membership. A three-class LCA solution was specified: Class 1 “Socialites” (38.8%) were highly connected across all indicators. Class 2 “Traditionalists” (25.7%) were moderately connected, with little app/website-use. Class 3 “Techies” (35.4%) had high online connectedness and relatively lower in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Socialites also had higher annual incomes than other classes. Techies were more likely than Traditionalists to report recent serodiscordant or unknown condomless anal sex and HIV risk management practices (e.g., ask their partner’s HIV status, get tested for HIV). Traditionalists on the other hand were less likely to practice HIV risk management and had lower HIV/AIDS stigma scores than Socialites. Further, Traditionalists were older, more likely to be partnered, and reported fewer male sex partners than men in other groups. These findings highlight how patterns of connectedness relate to GBM’s risk management. [ABSTRACT FROM AUTHOR]

Background: This study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) hazardous drinking levels would remain high, (2) GBM classified as Hazardous Drinkers will be consistently associated with high risk sex, and (3) GBM classified as Always Hazardous Drinkers differ significantly from Sometimes Hazardous Drinkers. Methods: AUDIT classified participants as Non-Hazardous Drinkers or Hazardous Drinkers, the Cochran-Mantel-Haenszel Test assessed hazardous drinking trends, and Generalized Estimating Equations (GEE) analysis identified Hazardous Drinking covariates. Logistic regression analysis of participants with at least two study visits (575) compared those who were Sometimes Hazardous Drinkers (n = 171) with Always Hazardous Drinkers (n = 129). Results: At baseline 40% of participants were Hazardous Drinkers, but there was a significant decline in hazardous drinking by visit and Hazardous Drinkers were not significantly associated with high risk sex. Always Hazardous Drinkers had significantly more high risk sex and gay bar attendance, but less often sought Internet sex partners compared to Sometimes Hazardous Drinkers. Conclusions: Analyses did not support the first two hypotheses, but distinguishing between Always and Sometimes Hazardous drinkers identified a young GBM subgroup associated with significantly higher levels of high risk sex and social support measures. These results suggest interventions programs based on Social Norms Theory, which predicts peer norms among youth are important factors in regulating drinking patterns, may be effective for these men. [ABSTRACT FROM AUTHOR]

Sexual self-efficacy (SSE) – one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents’ HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14–19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%;p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16–17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted. [ABSTRACT FROM AUTHOR]

Initial research into seroadaptive strategies suggests that, individually, they are potentially effective behavioral methods to reduce risk of HIV transmission. Combining strategies, therefore, has the potential to increase risk reduction. The aim of this study was to determine how gay and bisexual men (GBM) combine strategies. To this end, a total of 774 sexually active GBM, aged ≥16 years, in Metro Vancouver, Canada, were recruited. Grouped by self-reported HIV status, latent class analysis of self-reported condom use, strategic positioning, anal sex avoidance, serosorting, viral-load sorting, and withdrawal were conducted. Multinomial logistical regression identified explanatory variables of class membership (i.e., sensation seeking, treatment optimism, sexual altruism, relationship status, number of partners, anal sex preference). Four latent classes were identified: Condom Users, Multiple Prevention Users, Viral-Load Sorters, and Serosorters. The majority of HIV-negative/unknown men (72 %) and a large proportion of HIV-positive men (42 %) belonged to the Condom Users class. Class membership was associated with age, relationship status, treatment optimism, sexual altruism, sensation seeking, number of recent male anal sex partners, and recent condomless anal sex with a serodiscordant or unknown-status partner. Understanding these distinct patterns allows for tailored interventions addressing GBM's sexual health needs. [ABSTRACT FROM AUTHOR]

Gay and bisexual men's (GBM) group sex parties are considered HIV risk environments due to their association with concurrent sexual partners, condomless anal sex, and polysubstance use. The possibility of group sex party hosts acting as gatekeepers to minimize risks has been suggested, but remains understudied. We analyzed qualitative data from 20 in-depth interviews with North American GBM who recently attended private group sex parties to determine if hosts' actions constitute harm reduction strategies. Results showed hosts acting as gatekeepers before parties by establishing and disseminating themes and rules, screening applicants, and selecting guests. During parties hosts enforced rules and rejected uninvited guests. By their actions, hosts established a more controlled environment compared to public sex-on-premises bathhouses, and facilitated boundary play, the paradoxical behavior of simultaneously desiring risk and safety, previously noted for GBM circuit parties. Results suggest initiating education programs focusing on private group sex party hosts as gatekeepers.

British Columbia's treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers' Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.

Background: We evaluated attitudes toward treatment as prevention (TasP) among gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada., Methods: Sexually active GBM, aged ≥16 years, were recruited between 2012 and 2015 using respondent-driven sampling. At each 6-month follow-up, participants completed a computer-administered questionnaire and nursing visit. Repeated-measures latent class analysis, grouped by self-reported serostatus, identified patterns of TasP endorsement by considering TasP-related awareness, attitudes, and behavior. Binary logistic regression identified covariates of class membership. Bivariate interactions with visit number identified factors associated with longitudinal changes in class membership., Results: A total of 774 men provided 2590 observations. Of these, 698 enrolled in the cohort, 575 had at least 1 follow-up visit. Among these, the median follow-up time was 1.98 years (Q1-Q2: 1.49-2.49 years). Repeated-measures latent class analysis identified 3 classes: "unaware" (64.2% HIV negative/unknown vs. 29.2% of HIV positive), "skeptical" (29.7% vs. 23.1%), and "believing" (6.1% vs. 47.7%). Membership in classes representing higher TasP endorsement was associated with greater odds of condomless anal sex and having more sexual partners. Age, sexual orientation, ethnicity, substance use, and social time spent with other GBM were also associated with class membership. Longitudinally, class membership was stable among HIV-positive men but shifted toward greater TasP endorsement among HIV-negative/unknown men. For HIV-negative/unknown men, increasing endorsement was positively associated with greater education, being employed, being in a relationship, and substance use and inversely associated with recent serodiscordant condomless anal sex or sexually transmitted infection diagnosis., Conclusions: Over time, disparities in TasP diffusion by HIV status have lessened, although continue to persist across other key social strata.

Background: We developed estimates of community viral load (VL) and risk factors for unsuppressed VL from a cross-sectional study of men who have sex with men (MSM) in Vancouver, Canada., Methods: MSM were recruited from February 25, 2012 to February 28, 2014 using respondent-driven sampling (RDS). Participants completed a computer-assisted self-interview questionnaire and a nurse-administered point-of-care HIV test. For HIV-positive participants, we conducted VL and CD4 cell counts. We used RDS-weighted analysis to obtain population estimates of key variables and multivariable logistic regression to examine factors associated with having a VL of ≥200 copies per milliliter among HIV-positive participants., Results: We recruited 719 participants, of whom 119 (16.6%) were seeds. Our estimate of the population prevalence of HIV was 23.4% [95% confidence interval (CI): 15.8% to 31.0%] after RDS adjustments. We estimated that 18.6% (95% CI: 8.8% to 30.4%) of HIV-positive MSM in Vancouver had a VL of ≥200 copies per milliliter. Having an unsuppressed VL was associated with non-white ethnicity [adjusted odds ratio (AOR) = 4.34; 95% CI: 1.67 to 11.1], an annual income of <$15,000 CAD (AOR = 6.43; 95% CI: 2.08 to 19.9), using gamma-hydroxy butyrate in the previous 6 months (AOR = 4.85; 95% CI: 1.79 to 13.2), unprotected anal intercourse with a known HIV-negative or an unknown serostatus partner (AOR = 3.13; 95% CI: 1.10 to 8.90), and disclosing one's HIV serostatus ≥50% of the time (AOR = 7.04; 95% CI: 1.01 to 49.1)., Conclusion: Despite a high prevalence of HIV, we estimated that a small proportion of HIV-positive MSM have undiagnosed HIV and unsuppressed VL. Our results highlight the importance of continued work to address health inequities using a framework based on social determinants of health.