Mancount Sizes Up the Gaps*

1. ManCount Sizes Up the Gaps Dr. Mark Gilbert BC Centre for Disease Control Dr. Terry Trussler Community Based Research Centre Gay Men’s Health Summit - Nov 26, 2010

4. M-Track Surveillance System Montreal Ottawa Toronto Winnipeg Victoria Vancouver

5. New positive HIV tests in MSM, BC

6. Percent of new HIV infections, BC, 2008 Boulos et al. Estimates of HIV Prevalence and Incidence in Canada, 2005. CCDR 2006;32(15):165-174 Chris Archibald, PHAC, personal communication, November 2009.

7. People living with HIV, BC, 2008 Boulos et al. Estimates of HIV Prevalence and Incidence in Canada, 2005. CCDR 2006;32(15):165-174 Chris Archibald, PHAC, personal communication, November 2009.

10. Section 1: Who Participated?

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15. 87% lived in metro Vancouver

16. Section 2: HIV and other infections

17. HIV Prevalence

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21. 13.6% of HIV negative men believed that they were somewhat to very likely to become HIV positive in their lifetime

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25. Section 3: Testing Practices

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30. Section 4: Sexual Health and Behaviour

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39. Implications

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42. Report of findings available at www.mancount.ca Questions? [email_address]

Notas do Editor

ManCount gives us a snapshot of the current state of HIV in the gay and MSM community in Vancouver
ManCount is the Vancouver Site of M-Track, a national second generation HIV surveillance system developed and coordinated by the Public Health Agency of Canada, in partnership with local government, NGO and research organizations
Total, 11, 400 people estimated to be living with HIV in BC in 2008 MSM 42%, MSM-IDU 3%
Gender identity: (more than one option possible) Man – 95.4% Woman – 0.5% Trans man (F to M) - 1.0% Trans woman (M to F) – 0.6% Intersexed - 0.1% Two-spirit – 3.6%
Remainder from nearby cities, elsewhere in BC, Canada, and some from far away
Similar prevalence to what has been measured in similar surveys in Montreal, Toronto, US Prevalence was 21% among residents of metro Vancouver
Differences in the generational experience of HIV Positive in the sense that increased survival, excellence of medical care/HAART Ron Stall & lifetime trajectory Opportunity among younger gay men to halt transmission and to prevent seeing similar prevalences when older
14% of all HIV positive men were unaware Proportion and number of men unaware was greater in younger age groups: 43% were < 30 years old
33% very unlikely 36% unlikely Reflects reality? Reflects fatalism?
Uncertainty – based on laboratory test (not validated as diagnostic test) and questions (as can be treated for these infections, and based on a combination of responses to other questions) Hepatitis C – most had a history of injection drug use; however, some did not suggesting role for sexual transmission of HCV. 62% of HCV +ve on DBS were HIV +ve.
Any STBBI – gonorrhea, chlamydia, genital warts, syphilis, genital herpes Importance as STIs can be affect likelihood of HIV acquisition and transmission
239 specimens tested High but similar to other jurisdictions
68% had tested once for HIV in the past 2 years Young men: 77% had ever tested for HIV Typically as one might expect, ever testing for these infections was lower among < 30 years Testing in the past year had fewer differences by age, often lower at older ages
6.6% tested because of the “system”: being tested for STD, HCW recommended test, saw ad/poster/article about HIV
For many HIV negative men who hadn’t tested due to perceived low risk – answers to other questions suggested this was true About 16% of HIV negative men reported not testing due to “negative consequences”: do not want to know, could not deal, affect relationships/career, discrimination, nothing can be done, reporting, impact on sex life) About 14% not testing because of the system (don’t have a doctor, couldn’t get appointment, don’t know where to go for testing)
For those who had not been tested, reasons for not testing included: concern about their relationships, suspicion that they were already HIV-infected, not wanting to know, being unable to cope with the result
Range of sexual behaviours and profiles; not sexually active, not having anal sex, one to multiple partners 58% reported condom use the last time they had sex Of men who were sexually active More common among HIV positive compared to HIV negative
Pressure greater among HIV unaware men, also among men reporting UAI-US
Likely indicates how became infected, and how may transmit infection One of the inconsistencies that contributes to transmission May be men who are acutely infected with HIV & higher viral loads
Poppers, crystal meth and cocaine were associated with unprotected sex between unknown or different status partners Cocaine is higher and crystal meth lower compared to Sex Now survey data
For men who had disclosed, median of 4 years after first had sex
Multiple strategies – different for different age groups, acting on different drivers, positive and negative men, multiple levels

Mancount Sizes Up the Gaps*

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