216 research outputs found

    Examining differential success in recruitment using respondent driven sampling (RDS) in a multi-site study of gay, bisexual and other men who have sex with men

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    Background: The Engage Study is a longitudinal biobehavioral cohort study of gay, bisexual and other men who have sex with men (GBM) in Toronto, Montreal, and Vancouver. Baseline data (2,449 participants) were collected from February 2017 - August 2019 using respondent-driven sampling (RDS). Recruitment in Montreal required fewer seeds, had a much shorter recruitment period, and recruited the largest sample. Methods To better understand why RDS recruitment was more successful in Montreal compared to other sites, we conducted an analysis to examine RDS recruitment characteristics for GBM in each of the three study sites, explore demographic characteristics and measures of homophily, that is, the tendency of individuals to recruit other study participants who are like themselves, and compared motivations for study participation. Results Montreal had the greatest proportion of participants over the age of 45 (29.1% in Montreal, 24.6% in Vancouver, and 21.0% in Toronto) and the highest homophily for this age group, but homophily was high across the three cities. Montreal also reported the lowest percentage of participants with an annual income greater or equal to $60,000 (7.9% in Montreal, 13.1% in Vancouver and 10.6% in Toronto), but homophily was similar across all three cities. The majority of participants indicated interest in sexual health and HIV as the main reason for participating (36.1% in Montreal, 34.7% in Vancouver, and 29.8% in Toronto). Financial interest as the main reason for participation was low (12.7% in Montreal, 10.6% in Vancouver, and 5.7% in Toronto). Conclusion Taken together, although we found some differences in study demographic characteristics and homophily scores, we were unable to fully explain the different recruitment success based on the data available. Our study underlines the fact that success of RDS implementation may vary by unknown factors, and that researchers should be proactive and flexible to account for variability.Medicine, Faculty ofNon UBCMedicine, Department ofReviewedFacultyResearcherPostdoctoralUndergraduateOthe

    Unpacking racism during COVID-19: narratives from racialized Canadian gay, bisexual, and queer men

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    Abstract Objective Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined the experiences of gay, bisexual, queer, and other men who have sex with men (GBQM) of colour facing discrimination during COVID-19. Design Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQM living in Vancouver, Toronto, and Montréal, Canada. We conducted two rounds of qualitative interviews (November 2020 to February 2021, and June to October 2021) with 93 GBQM to explore the evolving impact of COVID-19 on their lives. Transcripts were coded using inductive thematic analysis. Data analysis was conducted using Nvivo software. Results Fifty-nine participants identified as Black, Indigenous, and/or a Person of Colour (BIPOC). These GBQM of colour described multiple experiences of discrimination during COVID-19. Although participants did not report experiences of discrimination based on their sexual identity during COVID-19, we found that experiences of racism affected how they were treated within their sexual networks. Experiences of racism were most often reported by East Asian and Black GBQM. These participants faced racism in public and online spaces, primarily in the form of verbal harassment. Several participants were also harassed because they wore face masks. Verbal abuse against GBQM of colour was largely prompted by racist discourses related to COVID-19. Conclusion Racism remains a pernicious threat to the well-being of GBQM of colour. CRT highlights the importance of assessing how sexualized and gendered discourses about race shape the experiences of GBQM of colour navigating multiple epidemics like COVID-19 and HIV. These pervasive discourses unevenly affect racial and sexual minorities across multiple epidemics, and negatively impact health outcomes for these populations

    Examining the secondary impacts of the COVID-19 pandemic on syndemic production and PrEP use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada

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    Background: The secondary impacts of the COVID-19 pandemic may disproportionately affect gay, bisexual, and other men who have sex with men (GBM), particularly related to HIV prevention and treatment outcomes. We applied syndemic theory to examine PrEP disruptions during the during the height of the COVID-19 pandemic in Vancouver, Canada. Methods: Sexually-active GBM, aged 16 + years, were enrolled through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every six months and data were linked to the BC PrEP Program (program responsible for publicly funded PrEP in the province) to directly measure PrEP disruptions. The analysis period for this study was from March 2018-April 2021. We used univariable generalized linear mixed models to examine (1) six-month trends for syndemic conditions: the prevalence of moderate/severe depressive or anxiety symptoms, polysubstance use, harmful alcohol consumption, intimate partner violence, and (2) six-month trends for PrEP interruptions among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine whether syndemic factors were associated with PrEP interruptions. Results: Our study included 766 participants, with 593 participants who had at least one follow-up visit. The proportion of respondents with abnormal depressive symptoms increased over the study period (OR = 1.35; 95%CI = 1.17, 1.56), but we found decreased prevalence for polysubstance use (OR = 0.89; 95%CI = 0.82, 0.97) and binge drinking (OR = 0.74; 95%CI = 0.67, 0.81). We also found an increase in PrEP interruptions (OR = 2.33; 95%CI = 1.85, 2.94). GBM with moderate/severe depressive symptoms had higher odds (aOR = 4.80; 95%CI = 1.43, 16.16) of PrEP interruptions, while GBM with experiences of IPV had lower odds (aOR = 0.38; 95%CI = 0.15, 0.95) of PrEP interruptions. GBM who met clinical eligibility for PrEP had lower odds of experiencing PrEP interruptions (aOR = 0.25; 95%CI = 0.11, 0.60). Conclusion: There were increasing PrEP interruptions since March 2020. However, those most at risk for HIV were less likely to have interruptions. Additional mental health services and targeted follow-up for PrEP continuation may help to mitigate the impacts of the COVID-19 pandemic on GBM.Medicine, Faculty ofNon UBCReviewedFacultyResearche

    Cybersecurity at a Crossroads: Government Perceptions of Sino-Canadian Relations in a Digital Context

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    Over the past decade, cybersecurity has emerged as a key locus of national security policy. The importance of cybersecurity will only increase as states navigate the transition to next-generation internet and telecommunications infrastructure. In the government debates of western democracies, the People’s Republic of China (PRC) and Chinese corporations are frequently cast in the role of challengers to the liberal international order. As a member of the highly integrated Five Eyes intelligence network, Canada has experienced both internal and external pressures to take a firmer stance against foreign direct investment by telecoms giant Huawei and other Chinese corporations on national security grounds. This thesis project uses directed content analysis to examine how government actors construct and present political narratives on cybersecurity concerns related to China during the 42nd Parliament of Canada (December 3, 2015 to September 11, 2019). NVIVO 12 qualitative analysis software was used to categorize and code data from the debates of the House of Commons, the Senate, and the minutes of select parliamentary committees. Deborah Stone’s typology of political narratives is employed to interpret opposing storylines relating to cyberthreats posed to Canada by Chinese state activity. Findings reveal a significant paradigmatic division on Chinese cybersecurity threats separating not only the Justin Trudeau Liberal government and the Conservative Opposition, but also the Canadian Security Intelligence Service (CSIS) and the Communications Security Establishment (CSE), two of Canada’s core intelligence agencies. Whereas both the Liberal government and the CSE broadly promote a narrative of control in relation to cyberthreats, Conservative Party representatives and current and former CSE officials consistently depict of narrative of national security decline and mounting dangers. The existence of these polarized positions within both Parliament and the federal security establishment point to the challenges of crafting coherent, state-facing cybersecurity policy related to the PRC. In addition to revealing this paradigmatic divide, this analysis illustrates the integral role of geopolitical dynamics in Canadian cybersecurity policymaking, particularly the “Five Eyes” security collaboration between Canada, the USA, Australia, New Zealand the United Kingdom. These findings demonstrate the need for inter-agency and international fora to develop enforceable norms of cyber-conduct

    HIV pre-exposure prophylaxis (PrEP) use among Urban Canadian gay, bisexual and other men who have sex with men for whom PrEP is clinically recommended: baseline results from the Engage cohort study

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    Background: in Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Use of HIV pre-exposure prophylaxis (PrEP) by GBM for whom PrEP is clinically recommended, is unknown. We report on PrEP access and factors associated with not using PrEP, among HIV-negative/unknown GBM in Montreal, Toronto and Vancouver. Methods: from 2017 to 2019, the Engage study recruited sexually-active GBM≥16 years in Montréal(M), Toronto(T), and Vancouver(V) via respondent-driven sampling (RDS). Participation included HIV/STI testing and a questionnaire. We examined PrEP access using a health services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those who were PrEP-aware and clinically recommended. Results: a total of 2449 GBM were recruited. 2008 were HIV-negative/unknown with 1159 (n=511(M), n=247(T), n=401(V)) meeting PrEP recommendations. Of these, 1100 were PrEP-aware (RDS-adjusted %: M=85%, T=94%, V=93%), 678 felt the need for PrEP (M=39%, T=56%, V=49%), 406 tried to access it (M=21%, T=33%, V=30%) and 319 used PrEP (M=15%, T=22%, V=22%) in the past 6 months. Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider, and lacking medication insurance. Conclusion: while half of GBM from Canada’s three largest cities met clinical recommendations for PrEP, less than a quarter reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health system barriers is needed to scale-up PrEP access and ultimately end the HIV epidemic among GBM in Canada.<br/

    "You're Gay, It's Just What Happens": Sexual Minority Men Recounting Experiences of Unwanted Sex in the Era of MeToo

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    This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Our grounded theory analysis derives from in-depth interviews conducted with 24 gay, bisexual, queer, and other men who have sex with men (GBM) living in Toronto, Canada, to understand their experiences of sexual coercion. Participants drew on discourse from the #MeToo movement to reconsider the ethics of past sexual experiences. The idea that gay or queer sex is inherently risky and unique from heterosexual relations made negotiating sexual safety challenging. These notions were enforced by homophobic discourses on the one hand, and counter discourses of sexual liberation, resistance to heteronormativity, hegemonic masculinity, and HIV prevention on the other. Biomedical advances in HIV prevention such as pre-exposure prophylaxis (PrEP) and undetectable viral load affected how some participants felt about sexual autonomy and safety. Participants held themselves responsible for needing to be more assertive within sexual encounters to avoid coercion. Many believed that unwanted sex is unavoidable among GBM: if "you're gay, it's just what happens." Targeted education aimed at GBM communities that incorporates insights on GBM sexual subcultures is necessary. This work must be situated within a broader understanding of how gender norms and hegemonic masculinity, racism, HIV status, and other power imbalances affect sexual decision-making, consent, pleasure, and sexual harm.Engage/Momentum II is funded by the Canadian Institutes for Health Research (CIHR, #TE2-138299; #FDN=143342; #PJT-153139), the Canadian Foundation for AIDS Research (CANFAR), the Ontario HIV Treatment Network (OHTN, #1051), the Public Health Agency of Canada (#4500345082), and Ryerson University. Trevor A. Hart is supported by an Ontario HIV Treatment Network Chair in Gay and Bisexual Men’s Health. Daniel Grace is supported by a Canada Research Chair in Sexual and Gender Minority Health

    Patient preferences and quality of life implications of ravulizumab (every 8 weeks) and eculizumab (every 2 weeks) for the treatment of paroxysmal nocturnal hemoglobinuria.

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    BackgroundEculizumab has transformed management of paroxysmal nocturnal hemoglobinuria (PNH) since its approval. However, its biweekly dosing regimen remains a high treatment burden. Ravulizumab administered every 8 weeks demonstrated noninferiority to eculizumab in two phase 3 trials. In regions where two PNH treatment options are available, it is important to consider patient preference.ObjectiveThe aim of this study was to assess patient preference for ravulizumab or eculizumab.MethodsStudy 302s (ALXN1210-PNH-302s) enrolled PNH patients who participated in the extension period of phase 3 study ALXN1210-PNH-302. In the parent study, eculizumab-experienced adult PNH patients received ravulizumab or eculizumab during a 26-week primary evaluation period. All patients in the extension period received ravulizumab. In study 302s, patient treatment preference was evaluated using an 11-item PNH-specific Patient Preference Questionnaire (PNH-PPQ©). Of 98 patients, 95 completed PNH-PPQ© per protocol for analysis.ResultsOverall, 93% of patients preferred ravulizumab whereas 7% of patients either had no preference (6%) or preferred eculizumab (1%) (P ConclusionThis study shows that a substantial proportion of patients preferred ravulizumab over eculizumab and provides an important patient perspective on PNH treatment when there is more than one treatment option