ManCount Sizes Up the Gaps Dr. Mark Gilbert BC Centre for Disease Control Dr. Terry Trussler Community Based Research Cent...
A Multi-Agency Collaboration <ul><li>Study Team </li></ul><ul><li>BC Centre for Disease Control:   Dr. Mark Gilbert  (PI),...
What is ManCount? <ul><li>A sexual health survey for gay, bisexual, and other men who have sex with men in Vancouver </li>...
M-Track Surveillance System Montreal Ottawa Toronto Winnipeg Victoria Vancouver
New positive HIV tests in MSM, BC
Percent of new HIV infections, BC, 2008 Boulos et al. Estimates of HIV Prevalence and Incidence in Canada, 2005.  CCDR 200...
People living with HIV, BC, 2008 Boulos et al. Estimates of HIV Prevalence and Incidence in Canada, 2005.  CCDR 2006;32(15...
How ManCount worked <ul><li>Men approached at community venues (bars, events, businesses) in Vancouver </li></ul><ul><ul><...
Interpretation of findings <ul><li>Represents men who go to Vancouver’s gay venues </li></ul><ul><li>Results are estimates...
Section 1:  Who Participated?
 
 
 
 
87%  lived in metro Vancouver
Section 2:  HIV and other  infections
HIV Prevalence
 
HIV treatment <ul><li>In the past 6 months,  71%  of HIV positive men had taken anti-HIV medication </li></ul>
 
13.6%  of HIV negative men believed that they were somewhat to very likely to become HIV positive in their lifetime
Other blood test results <ul><li>Indicate current or past infection </li></ul><ul><li>More uncertainty with these findings...
 
Self-collected rectal swabs <ul><li>HPV infection 62.3% </li></ul><ul><li>Anal dysplasia 42.3% </li></ul><ul><li>Chlamydia...
Section 3:  Testing Practices
 
 
 
Testing among unaware <ul><li>Half had tested for HIV at least once over the previous 2 years  </li></ul><ul><li>(may be b...
Section 4:  Sexual Health and Behaviour
 
<ul><li>Pressure for unprotected sex 29% </li></ul>
 
Risk among unaware <ul><li>More likely to report unprotected sex </li></ul><ul><li>Majority reported using sero-sorting as...
 
 
 
Other health issues <ul><li>Current smoker </li></ul><ul><li>Vaccinated against Hepatitis A, B </li></ul><ul><li>Disclosed...
Implications
Implications: <ul><li>Critical, chronic, and not unique </li></ul><ul><li>Multiple drivers of HIV epidemic </li></ul><ul><...
What next? <ul><li>Need to strengthen our response to HIV prevention in gay men </li></ul><ul><li>Multiple strategies requ...
Report of findings available at  www.mancount.ca Questions? [email_address]
Upcoming SlideShare
Loading in...5
×

Mancount Sizes Up the Gaps*

516

Published on

From Summit 2010: Gay Men's Health

Presented by Mark Gilbert, BC CDC & Terry Trussler, CBRC

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
516
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 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 &amp; 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 &lt; 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 &lt; 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 &amp; 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*

    1. 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
    2. 2. A Multi-Agency Collaboration <ul><li>Study Team </li></ul><ul><li>BC Centre for Disease Control: Dr. Mark Gilbert (PI), Claudia Rank </li></ul><ul><li>BC Centre for Excellence in HIV/AIDS: Dr. Bob Hogg (PI), Eric Druyts, Arn Schilder Dr. David Moore, Steve Kanters, Warren Michelow </li></ul><ul><li>Community-Based Research Centre: Dr. Rick Marchand, Dr. Terry Trussler </li></ul><ul><li>Health Initiative for Men: Wayne Robert, Phillip Banks, Jim Sheasgreen </li></ul><ul><li>Vancouver Coastal Health: Dr. Réka Gustafson (PI), Michael Kwag, Miranda Compton, Meaghan Thumath, Chris Buchner, Stephanie Harvard, Johann Kolstee </li></ul><ul><li>Public Health Agency of Canada: Dana Paquette, Rhonda Kropp, Stephen Cule, Susanna Ogunnaike-Cooke, Maureen Perrin, Marissa Maguire, Liz Venditti, Gayatri Jayaraman, Dr. Chris Archibald, Dr. Tom Wong </li></ul><ul><li>University of British Columbia: Dr. Paul Gustafson </li></ul><ul><li>Survey Interviewers: </li></ul><ul><li>Jody Jollimore, Adam Graham, Dirceu Campos, Lukas Maitland, Olivier Ferlatte, Seamus Sullivan, Ray Sullivan, Blair Petty </li></ul><ul><li>HPV (Self-collection) Component </li></ul><ul><li>Dr. Chen Zhou, Dr. Dirk van Niekerk, Dr. Kathy Seballos, Jane Lo, Dr. Gina Ogilvie, Darlene Taylor, Wendy Mei, Dr. Alberto Severini, Dr. Natasha Press </li></ul><ul><li>Community Advisory Committee </li></ul><ul><li>Robert Hong (VCH), Paul Harris (BCCFE), Shimpei Chihara (ASIA), Elgin Lim (BCPWA), Richard O’Donnell (VCH), Chris Buchner (Qmunity), Robin Parry (Qmunity), Matthew Taylor (PEERS), Hywel Tuscano (YouthCO), Jesse Brown (YouthCO), Devon MacFarlane (VCH), Jody Jollimore (HIM) </li></ul>
    3. 3. What is ManCount? <ul><li>A sexual health survey for gay, bisexual, and other men who have sex with men in Vancouver </li></ul><ul><li>Vision : to collect relevant data to inform collective action to prevent the transmission of HIV and improve sexual health </li></ul><ul><li>Objectives : </li></ul><ul><ul><li>To measure the prevalence of HIV, Hepatitis C, syphilis </li></ul></ul><ul><ul><li>To track trends in testing and sexual behaviours </li></ul></ul>
    4. 4. M-Track Surveillance System Montreal Ottawa Toronto Winnipeg Victoria Vancouver
    5. 5. New positive HIV tests in MSM, BC
    6. 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. 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.
    8. 8. How ManCount worked <ul><li>Men approached at community venues (bars, events, businesses) in Vancouver </li></ul><ul><ul><li>Time-space sampling </li></ul></ul><ul><ul><li>August 2008 to February 2009 </li></ul></ul><ul><ul><li>Eligible if: 19 yrs +, self-identified as man who has ever had sex with a man, English language </li></ul></ul><ul><ul><li>1169 men completed a questionnaire </li></ul></ul><ul><ul><li>1139 men gave a dried blood spot specimen </li></ul></ul><ul><ul><li>Honorarium provided </li></ul></ul><ul><li>Subset of men asked to provide a self-collected rectal swab </li></ul>
    9. 9. Interpretation of findings <ul><li>Represents men who go to Vancouver’s gay venues </li></ul><ul><li>Results are estimates that probably vary from the “true” population results by a few percentage points </li></ul><ul><li>“ To provide reliable – though arguably </li></ul><ul><li>imperfect – indicators on the road </li></ul><ul><li>to a community response” </li></ul>
    10. 10. Section 1: Who Participated?
    11. 15. 87% lived in metro Vancouver
    12. 16. Section 2: HIV and other infections
    13. 17. HIV Prevalence
    14. 19. HIV treatment <ul><li>In the past 6 months, 71% of HIV positive men had taken anti-HIV medication </li></ul>
    15. 21. 13.6% of HIV negative men believed that they were somewhat to very likely to become HIV positive in their lifetime
    16. 22. Other blood test results <ul><li>Indicate current or past infection </li></ul><ul><li>More uncertainty with these findings </li></ul><ul><li>Hepatitis C antibodies </li></ul><ul><ul><li>4.9% positive 23% appear unaware </li></ul></ul><ul><li>Syphilis antibodies </li></ul><ul><ul><li>4.4% positive 31% appear unaware </li></ul></ul>
    17. 24. Self-collected rectal swabs <ul><li>HPV infection 62.3% </li></ul><ul><li>Anal dysplasia 42.3% </li></ul><ul><li>Chlamydia 5.4% </li></ul><ul><li>Gonorrhea 2.1% </li></ul>
    18. 25. Section 3: Testing Practices
    19. 29. Testing among unaware <ul><li>Half had tested for HIV at least once over the previous 2 years </li></ul><ul><li>(may be between screenings) </li></ul>
    20. 30. Section 4: Sexual Health and Behaviour
    21. 32. <ul><li>Pressure for unprotected sex 29% </li></ul>
    22. 34. Risk among unaware <ul><li>More likely to report unprotected sex </li></ul><ul><li>Majority reported using sero-sorting as a strategy </li></ul>
    23. 38. Other health issues <ul><li>Current smoker </li></ul><ul><li>Vaccinated against Hepatitis A, B </li></ul><ul><li>Disclosed had male sex partners to a health care provider </li></ul>38% 64-73% 79%
    24. 39. Implications
    25. 40. Implications: <ul><li>Critical, chronic, and not unique </li></ul><ul><li>Multiple drivers of HIV epidemic </li></ul><ul><li>Prevention is important to gay men, but strategies used may not always be effective </li></ul><ul><li>Testing is high but there are gaps </li></ul><ul><li>Opportunity to reverse trends in young men </li></ul>
    26. 41. What next? <ul><li>Need to strengthen our response to HIV prevention in gay men </li></ul><ul><li>Multiple strategies required </li></ul><ul><li>Beginning to plan collaboratively </li></ul>
    27. 42. Report of findings available at www.mancount.ca Questions? [email_address]
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×