A demographic and health profile of gay and bisexual men in a large Canadian urban setting.

The purpose of this study was to provide both a population estimate and a socio-economic and health profile of gay and bisexual men living with HIV/AIDS in a large Canadian urban centre. A random telephone survey was used to determine the number of men in the study area over the age of 20 identifying as gay or bisexual and to characterize their health and socio-economic status. Out of a total of 1,176 completed interviews, 300 males described themselves as gay or bisexual. Projecting this figure on recent census data we estimated the number of men identifying as gay or bisexual in this region of downtown Vancouver, BC, at 5,100. Among these men we found an HIV prevalence rate of 16%, with those who reported a positive serostatus being less likely to be employed full time and more likely to earn less than $20,000 per year. In terms of clinical characteristics, HIV-positive men had a median CD4 cell count of 397 cells/mm(3) and a median viral load of less than 500 copies/ml. Eighty-three per cent of the HIV-positive respondents were on antiretroviral therapy and the median number of drugs taken by these men was three. In summary, random surveys of populations affected by this epidemic are important for policy makers, clinicians and persons caring for those with HIV/AIDS as they paint a clearer picture of who is being affected and help to identify areas where increased services are needed.

Depressive symptoms decline among persons on HIV protease inhibitors.

OBJECTIVE: To ascertain whether initiation of protease inhibitors was associated with a change in depressive symptoms among persons infected with HIV. METHODS: Study subjects included men and women who were enrolled in the HIV/AIDS Drug Treatment Program and who had completed an annual participant survey before and after initiating triple combination therapy with a protease inhibitor. Depressive symptoms were assessed using the Centre for Epidemiologic Studies-Depression scale (CES-D). Statistical analyses to determine the change in CES-D total and subscale scores before and after protease inhibitor use were conducted using parametric and multivariate methods. RESULTS: Our analysis was restricted to 453 participants. Of these 234 (52%) were depressed at baseline (CES-D score > or = 16). Compared with nondepressed participants, depressed participants were slightly younger (p = .048), less likely to be employed (p < .001) and more likely to have an annual income less than $10,000 per annum (p < .001). After adjusting for CD4 count, employment status, income, age, and CES-D total or subscale score at baseline, we found a significant improvement in total scale score (p = .001) and depressive mood (p = .002), positive affects (p = .005), and somatic symptoms (p = .011) subscale scores at follow-up. There was no significant change in the interpersonal relations score over the study period. CONCLUSION: Our findings indicate that in addition to conferring impressive clinical benefits, protease inhibitor use is associated with a significant improvement in HIV-positive individuals' mental health.

Modern antiretroviral therapy improves life expectancy of gay and bisexual males in Vancouver's West End.

This study was undertaken to evaluate the life expectancy of gay and bisexual men in the West End of Vancouver, British Columbia during two time periods. Mortality data for males were obtained for the periods 1990 to 1992 and 1995 to 1997 and population estimates were obtained from the 1991 and 1996 Census. The proportion of the male population over 20 years of age estimated to be gay and bisexual was derived from a random telephone survey. Mortality patterns were assessed by comparing changes in life expectancy at age 20 years between the periods, and by examining the life expectancy lost attributed to HIV/AIDS. Between the periods there was 3.8 +/- 3.4 years increase in life expectancy among gay and bisexual men. At exact age 20 years, life expectancy increased from 37.0 +/- 3.5 years during the period 1990 to 1992 to 40.8 +/- 2.4 years during the period 1995 to 1997. The loss of life expectancy attributed to HIV/AIDS at this age was 13.8 +/- 3.9 during the first period and 9.8 +/- 3.6 years during the second period. This gain is most likely the result of the improved efficacy of antiretroviral therapies.

Health related quality of life among persons with HIV after the use of protease inhibitors.

OBJECTIVE: This study was conducted to determine the effect of the use of HIV protease inhibitors on the quality of life among persons infected with HIV. METHODS: Subjects were participants in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program who had completed two annual participant surveys, one prior to initiating therapy with a protease inhibitor and one after. Quality of life was measured using the Medical Outcomes Study Short Form Health Survey (MOS-SF). Statistical analyses were conducted using parametric and multivariate methods. RESULTS: Our analysis was based on 179 HIV-positive individuals. Compared to quality of life at baseline, we found no statistically significant changes in the health perception, pain, physical, role and social functioning MOS-SF subscale scores at follow-up. The measure of mental health was the only component to decline significantly over time. Subanalyses found significant increases in the measures of health perception (p = 0.004), physical (p = 0.037), role (p < 0.001) and social functioning (p = 0.053) for individuals with a low baseline quality of life. For those with a higher quality of life before starting a protease inhibitor containing regimen we observed a significant decline in the subscales of mental health (p = 0.001), physical (p = 0.007), role (p = 0.021) and social functioning (p = 0.003) over the study period. CONCLUSIONS: Our findings indicate that despite strict dosage requirements and adverse side effects associated with protease inhibitor use patients are on the whole maintaining their quality of life after starting on a protease inhibitor containing regimen. Continued follow-up of this cohort will be required to determine the long term implications of these observations.