Relationship between disclosure of same-sex sexual activity to providers, HIV diagnosis and sexual health services for men who have sex with men in Vancouver, Canada.

OBJECTIVES: Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care. METHODS: Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test. RESULTS: Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as "gay" or "queer" (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all). CONCLUSIONS: While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.

Impact of statistical adjustment for frequency of venue attendance in a venue-based survey of men who have sex with men.

Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.

Implications for HIV prevention programs from a serobehavioural survey of men who have sex with men in Vancouver, British Columbia: the ManCount study.

BACKGROUND: We examined HIV prevalence, awareness of HIV serostatus and HIV risk behaviour among a sample of men who have sex with men (MSM) in Vancouver. METHODS: MSM > or = 18 years were recruited from August 2008 to February 2009 through community venues. Participants completed a questionnaire and provided a dried blood spot (DBS) for HIV and other STI testing. We performed descriptive statistics and bivariate analyses of key explanatory variables. RESULTS: A total of 1,169 participants completed questionnaires; of these, 1,138 (97.3%) provided DBS specimens suitable for testing. The median age was 33 years (IQR 26-44). A total of 206 (18%) were HIV-positive by DBS, of whom 86% were aware they were positive. HIV seropositivity increased from 7.1% in those < 30 years of age to 19% in those 30-44 years and 34% among those > or = 45 years (p < 0.001 for test of trend). Of the 933 who self-reported as HIV-negative or unknown, 28 (3.0%) tested HIV-positive. Among those not tested for HIV in the previous 2 years, the reasons for not testing differed between participants with undiagnosed HIV infection and those who were HIV-negative. A total of 62% of study participants who self-reported as HIV-negative reported using a condom the last time they had anal sex. The use of risk-reduction measures was reported by 91.1% of all study participants (72% if excluding consistent condom use). CONCLUSION: The majority of MSM in Vancouver have adopted behaviours that reduce their HIV-related risk. However, prevention programs must continue to promote condom use, increase HIV testing, and better inform MSM of the value and limitations of other risk-reduction strategies.

Guidance for considering ethical, legal, and social issues in health technology assessment: application to genetic screening.

OBJECTIVES AND METHODS: Many authors have argued that ethical, legal, and social issues ("ELSIs") should be explicitly integrated into health technology assessment (HTA), yet doing so poses challenges. This discussion may be particularly salient for technologies viewed as ethically complex, such as genetic screening. Here we provide a brief overview of contemporary discussions of the issues from the HTA literature. We then describe key existing policy evaluation frameworks in the fields of disease screening and public health genomics. Finally, we map the insights from the HTA literature to the policy evaluation frameworks, with discussion of the implications for HTA in genetic screening. RESULTS AND CONCLUSIONS: A critical discussion in the HTA literature considers the definition of ELSIs in HTA, highlighting the importance of thinking beyond ELSIs as impacts of technology. Existing HTA guidance on integrating ELSIs relates to three broad approaches: literature synthesis, involvement of experts, and consideration of stakeholder values. The thirteen key policy evaluation frameworks relating to disease screening and public health genomics identified a range of ELSIs relevant to genetic screening. Beyond straightforward impacts of screening, these ELSIs require consideration of factors such as the social and political context surrounding policy decisions. The three broad approaches to addressing ELSIs described above are apparent in the screening/genomics literatures. In integrating these findings we suggest that the method chosen for addressing ELSIs in HTA for genetic screening may determine which ELSIs are prioritized; and that an important challenge is the lack of guidance for evaluating such methods.