Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver, Canada

BackgroundStudies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness.ObjectivesTo determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada.MethodsFrom 2012 to 2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor diagnosed: (1) alcohol/substance use disorder and (2) any other mental health disorder.ResultsOf 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR = 0.52, 95% CI [confidence interval]: 0.27-0.99) and an annual income ≥$30,000 CAD (AOR = 0.38, 95% CI: 0.21-0.67) and positively associated with HIV-positive serostatus (AOR = 2.54, 95% CI: 1.63-3.96), recent crystal methamphetamine use (AOR = 2.73, 95% CI: 1.69-4.40) and recent heroin use (AOR = 5.59, 95% CI: 2.39-13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR = 0.25, 95% CI: 0.08-0.81), being a refugee or visa holder (AOR = 0.18, 95% CI: 0.05-0.65), and living outside Vancouver (AOR = 0.52, 95% CI: 0.33-0.82), and positively associated with abnormal anxiety symptomology scores (AOR = 3.05, 95% CI: 2.06-4.51).ConclusionsMental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring

Résultats canadiens de l’Enquête européenne en ligne sur la sexualité entre hommes (EMIS-2017)

Contexte : En 2017, l’Enquête européenne en ligne sur la sexualité entre hommes (EMIS-2017) a permis de recueillir des données dans 50 pays, y compris le Canada pour la première fois. Objectif : Fournir un aperçu des données canadiennes de l’EMIS-2017, en vue de décrire les besoins associés aux infections transmissibles sexuellement et par le sang (ITSS) des hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec des hommes (gbHARSAH). Méthodes : Le questionnaire de l’EMIS-2017 était une version mise à jour de l’EMIS-2010. Il incluait des données auto-déclarées sociodémographiques ainsi que relatives à toute expérience de discrimination, à la santé mentale et à l’usage de substance, à la connaissance de la prophylaxie préexposition (PrEP) pour le VIH, aux pratiques sexuelles ainsi qu’à l’historique de dépistage et de diagnostic d’ITSS. L’analyse a été principalement descriptive. Résultats : Sur 6 059 répondants au Canada, 5 165 participants ont répondu aux critères d’inclusion à cette analyse. La majorité des participants étaient nés au Canada (79,3 %) et plus de la moitié d’entre eux (56,7 %) étaient âgés de moins de 39 ans. En termes de discrimination associée à leur attirance pour d’autres hommes, les participants ont déclaré un niveau élevé d’intimidation (31,9 %), de la violence verbale (22,1 %) et de la violence physique (1,5 %) au cours de l’année précédente. En matière de santé mentale, 23,9 % enregistraient un résultat modéré à grave de dépression ou d’anxiété. Près des deux tiers (64,1 %) signalaient un usage de substances et un cinquième (21,5 %) déclaraient le recours au chemsex (c.-à-d. l’utilisation de drogues stimulantes pour rendre l’expérience sexuelle plus intense ou la faire durer plus longtemps). Seuls 8,4 % des participants ont signalé l’utilisation de la PrEP pour le VIH; toutefois, 51,7 % ont indiqué être enclins à utiliser la PrEP, si elle était disponible et abordable. Les pratiques sexuelles, comme l’utilisation d’un préservatif, variaient en fonction de la PrEP utilisée; 91,3 % des hommes utilisant la PrEP indiquaient des pénétrations anales sans préservatif (PASP), par rapport à 71,5 % des hommes n’utilisant pas la PrEP. En ce qui concerne le dépistage d’ITSS, 1,5 % a signalé avoir reçu un diagnostic d’hépatite C et 9,0 %, un diagnostic de VIH. Parmi ceux ayant reçu un diagnostic de VIH, la plupart suivaient un traitement (99,1 %) et avaient une charge virale indétectable (96,7 %). Conclusion : Les hommes gbHARSAH au Canada ont fait l’objet d’une stigmatisation, de discrimination et souffrent de troubles mentaux; l’usage de substances était élevé, tout comme les pratiques sexuelles à risque élevé, comme des PASP, parmi certains groupes d’hommes. Un écart existait entre la proportion des hommes intéressés par la PrEP et ceux l’utilisant effectivement; le dépistage complet d’ITSS était faible.Ces résultats peuvent aider les mesures de santé publique et fournir une base d’examen de l’incidence d’interventions actuelles et nouvelles.Dans le cadre du projet ESTICOM (enquêtes et formations européennes visant à améliorer la santé des communautés HARSAH), l’EMIS-2017 a été menée en vertu du contrat de service 2015 71 01 avec la Chafea (organisme de direction en matière de consommation, de santé, d’agriculture et d’alimentation), agissant selon des pouvoirs délégués par la Commission européenne. D’autres contributions financières provenaient de l’Agence de la santé publique du Canada (ASPC) pour le recrutement au Canada. N. J. L. est soutenu par une bourse de recherche de la Michael Smith Foundation for Health Research (#16863). T. A. H. est soutenu par une chaire Endgame Leader de l’Ontario HIV Treatment Network. La promotion de l’enquête et le recrutement des participants canadiens à l’EMIS-2017 ont été financés par l’ASPC

Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017)

Background: In 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time. Objective: To provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM). Methods: The EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive. Results: Of the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%). Conclusion: gbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low. These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.As part of European Surveys and Trainings to Improve MSM Community Health project, EMIS-2017 was carried out under the service contract 2015 71 01 with the Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. Other financial contributions came from the Public Health Agency of Canada (PHAC) for recruitment in Canada. NJL is supported by a Scholar Award from the Michael Smith Foundation for Health Research (#16863). TAH is supported by an Endgame Leader Chair Award from the Ontario HIV Treatment Network. Promotion of the survey and recruitment of Canadian participants in EMIS-2017 was funded by the PHAC

Acceptability of an existing online sexually transmitted and blood-borne infection testing model among gay, bisexual and other men who have sex with men in Ontario, Canada

Objectives Gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBI) due to stigma and other factors such as structural barriers, which delay STBBI testing in this population. Understanding acceptability of online testing is useful in expanding access in this population, thus we examined barriers to clinic-based testing, acceptability of a potential online testing model, and factors associated with acceptability among GBM living in Ontario. Methods Sex Now 2019 was a community-based, online, bilingual survey of GBM aged ≥15. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated using modified Poisson regression with robust variances. Multivariable modelling was conducted using the Hosmer-Lemeshow-Sturdivant approach. Results Among 1369 participants, many delayed STBBI testing due to being too busy (31%) or inconvenient clinic hours (29%). Acceptability for online testing was high (80%), with saving time (67%) as the most common benefit, and privacy concerns the most common drawback (38%). Statistically significant predictors of acceptability for online testing were younger age (PR  =  0.993; 95%CI: 0.991–0.996); a greater number of different sexual behaviours associated with STBBI transmission (PR  =  1.031; 95%CI: 1.018–1.044); identifying as an Indigenous immigrant (PR  =  1.427; 95%CI: 1.276–1.596) or immigrant of colour (PR  = 1.158; 95%CI: 1.086–1.235) compared with white non-immigrants; and currently using HIV pre-exposure prophylaxis (PrEP) compared to not currently using PrEP (PR  =  0.894; 95%CI: 0.828–0.965). Conclusions Acceptability of online testing was high among GBM in Ontario. Implementing online STBBI testing may expand access for certain subpopulations of GBM facing barriers to current in-person testing

Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada’s three largest cities

Background Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. Methods Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. Results Across the cities, 26–40%, 7–14%, 33–39%, and 13–28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06–7.62; Stage 2: aOR = 3.09, 95%CI = 1.19–8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07–2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05–1.48; Stage 2: aOR = 1.24, 95%CI = 1.05–1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13–0.71; Stage 2: aOR = 0.27, 95%CI = 0.12–0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15–0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09–0.30; Stage 2: aOR = 0.18, 95%CI = 0.09–0.35; Stage 3: aOR = 0.38, 95%CI = 0.21–0.61). Discussion Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM