Bisexuality, Poverty & Mental Health: A Mixed Methods Analysis

Highlights

• Poverty is associated with poor mental health among bisexual people.
• Poverty is also associated with experiences of discrimination among bisexuals.
• Multiple pathways may link bisexuality, poverty, and mental health.
• Lack of affordable culturally competent services may sustain the disparities.

Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. 

In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. 

Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. 

Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. 

These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.

Purchase full article at:   http://goo.gl/qFio1c

By:  Ross LE1, O'Gorman L2, MacLeod MA3, Bauer GR3, MacKay J4, Robinson M4.

• 1Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 560, Toronto, Ontario, M5T 3M7, Canada; Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. Electronic address: l.ross@utoronto.ca.
• 2School of Rural and Northern Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, Ontario, P3E 2C6, Canada.
• 3Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, Kresge Building Room K201, London, Ontario, N6A 5C1, Canada.
• 4Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. 
• Soc Sci Med. 2016 Mar 10;156:64-72. doi: 10.1016/j.socscimed.2016.03.009

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Housing Outcomes & Predictors of Success: The Role of Hospitalization in Street Outreach

SUMMARY:

What is known on the subject? 

• Outreach services are often successful in engaging and housing street homeless individuals. People experiencing homelessness have greatly increased rates of mental illness and substance abuse. 

What this paper adds to existing knowledge? 

• Given the relative lack of research involving street homeless individuals, this retrospective chart review examined factors associated with successful housing by a multidisciplinary street outreach team, including the use of hospitalization as an intervention within a housing first framework. The majority of clients were successfully housed by the end of outreach team involvement. An admission to hospital was strongly associated with successful housing for those with a psychotic disorder. 

What are the implications for practice? 

• Multidisciplinary outreach teams, specifically those with psychiatric and nursing support, successfully work with and house people experiencing street homelessness and psychosis. Mental health nurses embedded in the community are an essential link between inpatient and outpatient care for highly vulnerable street homeless individuals.

ABSTRACT:

Introduction 
Housing-first strategies have helped establish housing as a human right. However, endemic homelessness persists. Multidisciplinary outreach teams that include nursing, social and psychiatric services allow for integrative strategies to engage and support clients on their housing trajectory. 

The following retrospective review focused on the identification of demographic, clinical, and service characteristics that predicted the obtainment of housing, and explored the role of psychiatric hospitalization as an intervention, not an outcome measure, in contrast to previous studies. These have rarely focused on street homelessness. 

Method
A retrospective chart review of 85 homeless, primarily rough-sleeping, clients was conducted to determine housing outcomes and the factors associated with obtaining housing through care provided by a psychiatric street outreach team in Toronto, Canada. Demographics, homelessness duration, diagnosis, hospitalization and housing status were tracked during team involvement. 

Results 
Overall, 46% (36/79) were housed during the study term. Securing housing at the end of treatment/data collection was significantly enhanced by hospitalization. It was significantly diminished by psychosis and prior homelessness >36 months . Twenty-three of 31 (74%) hospitalized clients with psychosis were subsequently housed, compared to 4 of 30 (13%) not hospitalized. 

Discussion 
Multidisciplinary street outreach teams successfully house long-standing homeless clients (>12 months without a permanent address) with serious mental illness and/or substance abuse. Hospitalization can be utilized as a complimentary intervention, particularly for those with psychosis, in the continuum of housing first initiatives, and can contribute to securing housing for those with persistent psychotic disorders. 

Implications for nursing practice Community mental health nurses are uniquely positioned to translate care between hospital and community settings, ensuring timely assessment, intervention and treatment of clients who are historically difficult to engage.

Purchase full article at:   http://goo.gl/bXs23W

By:  Lettner BH1, Doan RJ2, Miettinen AW3.

• 1Department of Nursing, University of Toronto, Toronto.
• 2Department of Psychiatry, University of Toronto, Toronto.
• 3Department of Economics, University of Toronto, Toronto. 
• J Psychiatr Ment Health Nurs. 2016 Mar;23(2):98-107. doi: 10.1111/jpm.12287.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Using a Delphi Process to Define Priorities for Prison Health Research in Canada

OBJECTIVES:

A large number of Canadians spend time in correctional facilities each year, and they are likely to have poor health compared to the general population. Relatively little health research has been conducted in Canada with a focus on people who experience detention or incarceration. We aimed to conduct a Delphi process with key stakeholders to define priorities for research in prison health in Canada for the next 10 years.

SETTING:

We conducted a Delphi process using an online survey with two rounds in 2014 and 2015.

PARTICIPANTS:

We invited key stakeholders in prison health research in Canada to participate, which we defined as persons who had published research on prison health in Canada since 1994 and persons in the investigators' professional networks. We invited 143 persons to participate in the first round and 59 participated. We invited 137 persons to participate in the second round and 67 participated.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Participants suggested topics in the first round, and these topics were collated by investigators. We measured the level of agreement among participants that each collated topic was a priority for prison health research in Canada for the next 10 years, and defined priorities based on the level of agreement.

RESULTS:

In the first round, participants suggested 71 topics. In the second round, consensus was achieved that a large number of suggested topics were research priorities. Top priorities were diversion and alternatives to incarceration, social and community re-integration, creating healthy environments in prisons, healthcare in custody, continuity of healthcare, substance use disorders and the health of Aboriginal persons in custody.

CONCLUSIONS:

Generated in an inclusive and systematic process, these findings should inform future research efforts to improve the health and healthcare of people who experience detention and incarceration in Canada.

Below:  Per cent agreement by participants in a Delphi process in 2015 that each topic* is a priority for prison health research in Canada,† N=67 participants. MRSA, methicillin-resistantStaphylococcus aureus. *Abbreviated titles for topics were used in this Figure. Full titles for each topic are provided in table 2; the full titles were used for the second round of the Delphi. †Sorted by the percent of participants who strongly agreed and agreed.

Full article at:   http://goo.gl/IfpdHp

By:  Kouyoumdjian FG1, Schuler A1, McIsaac KE2, Pivnick L3, Matheson FI1, Brown G4, Kiefer L5, Silva D6, Hwang SW1.

• 1Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
• 2Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada Dalla Lana School of Public Health, Toronto, Ontario, Canada.
• 3Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada.
• 4Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
• 5Dalla Lana School of Public Health, Toronto, Ontario, Canada Ontario Ministry of Community Safety and Correctional Services, Toronto, Ontario, Canada.
• 6Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
• BMJ Open. 2016 Jan 14;6(1):e010125. doi: 10.1136/bmjopen-2015-010125. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Online Outreach Services among Men Who Use the Internet to Seek Sex with Other Men (MISM) in Ontario, Canada: An Online Survey

Background

Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to “meet men where they are at,” some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps.

Objective

To investigate MISM's experiences and self-perceived impacts of online outreach.

Methods

From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant).

Results

Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was 

• friendly (130/141, 92.2%), 
• easy to understand (122/140, 87.1%), 
• helpful (115/139, 82.7%), 
• prompt (107/143, 74.8%), and 
• knowledgeable (92/134, 68.7%); 
• half reported they received a useful referral (49/98, 50%). 
• Few MISM felt the interaction was annoying (13/141, 9.2%) 
• or confusing (18/142, 12.7%). 

As a result of their last online outreach encounter, MISM reported the following: 

• better understanding of (88/147, 59.9%) and 
• comfort with (75/147, 51.0%) their level of sexual risk; 
• increased knowledge (71/147, 48.3%); and 
• feeling less anxious (51/147, 34.7%), 
• better connected (46/147, 31.3%), and 
• more empowered (40/147, 27.2%). 

Behaviorally, they reported 

• using condoms more frequently (48/147, 32.7%) 
• and effectively (35/147, 23.8%); 
• getting tested for HIV (43/125, 34.4%) 
• or STIs (42/147, 28.6%); 
• asking for their partners’ HIV statuses (37/147, 25.2%); 
• and serosorting (26/147, 17.7%). 

Few MISM reported 

• no changes (15/147, 10.2%) 
• and most would use these services again (98/117, 83.8%). 

Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%).

Conclusions

This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education.

Full article at:   http://goo.gl/6pYu6G

By:  David J Brennan, MSW, PhD, ¹ Nathan J Lachowsky, PhD,^1,2,3 Georgi Georgievski, HBSc,¹ Brian R Simon Rosser, MPH, PhD,⁴ Duncan MacLachlan,⁵ James Murray, MEd,⁶ and Cruising Counts Research Team¹

¹University of Toronto, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada

²University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada

³British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada

⁴University of Minnesota, School of Public Health, Minneapolis, MN, United States

⁵Ontario HIV Treatment Network, Toronto, ON, Canada

⁶Ontario Ministry of Health and Long Term Care, AIDS Bureau, Toronto, ON, Canada

David J Brennan, University of Toronto, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S1V4, Canada, Phone: 1 416 978 3273, Fax: 1 416 978 7072, Email: ac.otnorotu@nannerb.divad.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Canada's PornHub 2015 Use Review

Via:  http://www.pornhub.com/insights/pornhub-2015-year-in-review  MT https://twitter.com/pornhub

"Why Are You Pregnant? What Were You Thinking?": How Women Navigate Experiences of HIV-Related Stigma in Medical Settings During Pregnancy and Birth

Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. 

This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). 

Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences.

Purchase full article at:   http://goo.gl/a8wEfv

By:   Greene S Msw PhD1, Ion A MSc1, Kwaramba G1, Smith S1, Loutfy MR Md Frcpc Mph2.

• 1 School of Social Work , McMaster University , Hamilton , Ontario , Canada.
• 2 Women's College Research Institute, Women's College Hospital , University of Toronto , Toronto, Ontario, Canada. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Our Harm Reduction Stories: Working Toward Healthier Outcomes

Via:  http://www.regentparkchc.org/

Minding the Gap: Access to Palliative Care and the Homeless

Background

With an ever increasing number of individuals living with chronic and terminal illnesses, palliative care as an emerging field is poised for unprecedented expansion. Today’s rising recognition of its key role in patients’ illnesses has led to increased interest in access to palliative care. It is known that homelessness as a social determinant of health has been associated with decreased access to health resources in spite of poorer health outcomes and some would argue, higher need. This article aims to discuss the current state of affairs with regards to accessing palliative care for the homeless in Canada.

Discussion

Recent review of the literature reveals differential access to palliative care services and outcomes with differing socio-economic status (SES). Notably, individuals of lower SES and in particular, those who are homeless have poorer health outcomes in addition to poor access to quality palliative care. Current palliative care services are ill equipped to care for this vulnerable population and most programs are built upon an infrastructure that is prohibitive for the homeless to access its services. A preliminary review of existing Canadian programs in place to address this gap in access identified a paucity of sporadic palliative care programs across the country with a focus on homeless and vulnerably-housed individuals. It is apparent that there is no unified national strategy to address this gap in access.

Summary

The changing landscape of the Canadian population calls for an expansion of palliative care as a field and as many have put it, as a right. The right to access quality palliative and end of life care should not be confined to particular population groups. This article calls for the development of a unified national strategy to address this glaring gap in our healthcare provision and advocates for attention to and adoption of policy and processes that would support the homeless populations’ right to quality palliative care.

Full article at:   http://goo.gl/G2a2F8

By:   Lise Huynh^12*, Blair Henry²³ and Naheed Dosani⁴⁵⁶⁷

¹Department of Palliative Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

²Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

³Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

⁴Inner City Health Associates, Toronto, ON, Canada

⁵Department of Family & Community Medicine St Michael’s Hospital, Toronto, ON, Canada

⁶Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

⁷Division of Palliative Care, William Osler Health System, Brampton, ON, Canada

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Potential Cost-Effectiveness of Supervised Injection Facilities in Toronto and Ottawa, Canada

BACKGROUND AND AIMS:

Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods.

DESIGN:

Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment.

MEASUREMENTS:

Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios.

FINDINGS:

In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million.

CONCLUSIONS:

Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada.

Purchase full article at:  http://goo.gl/tPClxA

By:  Enns EA1, Zaric GS2, Strike CJ3,4, Jairam JA3, Kolla G3, Bayoumi AM5,6,7,8.

• 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
• 2Ivey Business School, Western University, London, ON, Canada.
• 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
• 4Center for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
• 5Centre for Research on Inner City Health, Li KaShing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
• 6Department of Medicine, University of Toronto, Toronto, ON, Canada.
• 7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
• 8Division of General Internal Medicine, St Michael's Hospital, Toronto, ON, Canada.

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Engagement in HIV Care among Persons Enrolled in a Clinical HIV Cohort in Ontario, Canada, 2001–2011

Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) success. We sought to characterize engagement in HIV care among participants of a large clinical cohort in Ontario, Canada, from 2001 to 2011.

Methods:

The Ontario HIV Treatment Network Cohort Study (OCS) is a multisite HIV clinical cohort, which conducts record linkage with the provincial public health laboratory for viral load tests. We estimated the annual proportion meeting criteria for being in care (≥1 viral load per year), in continuous care (≥2 viral load per year ≥90 days apart), on ART, and with suppressed viral load <200 copies per milliliter. Ratios of proportions according to socio-demographic and clinical characteristics were examined using multivariable generalized estimating equations with a log-link.

Results:

A total of 5380 participants were followed over 44,680 person-years. From 2001 to 2011, we observed high and constant proportions of patients in HIV care (86.3%–88.8%) and in continuous care (76.4%–79.5%). There were statistically significant rises over time in the proportions on ART and with suppressed viral load; by 2011, a majority of patients were on ART (77.3%) and had viral suppression (76.2%). There was minimal variation in HIV engagement indicators by socio-demographic and HIV risk characteristics.

Conclusions:

In a setting with universal health care, we observed high proportions of HIV care engagement over time and an increased proportion of patients attaining successful virologic suppression, likely due to improvements in ART regimens and changing guidelines.

Below:  Proportion meeting HIV care engagement indicators among enrolled participants of the OHTN cohort study, 2001–2011. Proportions shown with 95% CIs. For each year and all indicators shown, the denominator included all participants ever enrolled and who had no record of death as of that year. In care: ≥1 viral load or CD4 cell count per year. In continuous care: ≥2 viral loads per year ≥90 days apart. On ART: initiated antiretroviral treatment in that year or earlier with no record of having stopped. With suppressed viral load: viral load <200 copies per milliliter. Figure ​Figure11 and text provide details.

Full article at:   http://goo.gl/g9vBGh

By:  Ann N. Burchell, PhD,*† Sandra Gardner, PhD,*‡ Lucia Light, MSc,* Brooke M. Ellis, MPHTM,* Tony Antoniou, PhD,§‖Jean Bacon, BA,* Anita Benoit, PhD,¶ Curtis Cooper, MD,# Claire Kendall, MD,**†† Mona Loutfy, MD,‡‡§§‖‖ Frank McGee, BA,¶¶ Janet Raboud, PhD,‡## Anita Rachlis, MD,‖‖*** Wendy Wobeser, MD,†††‡‡‡ and Sean B. Rourke, PhD§*§§§, on behalf of the OHTN Cohort Study Team

^*Ontario HIV Treatment Network, Toronto, Ontario, Canada;

Departments of ^†Epidemiology;

^‡Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;

^§Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada;

^‖Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada;

^¶Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada;

^#Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;

^**Bruyère Research Institute, Ottawa, Ontario, Canada;

^††Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada;

^‡‡Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;

^§§Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada;

^‖‖Department of Medicine, University of Toronto, Toronto, Ontario, Canada;

^¶¶AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada;

^##Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada;

^***Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

^†††Department of Medicine, Queen's University, Kingston, Ontario, Canada;

^‡‡‡Hotel Dieu Hospital, Kingston, Ontario, Canada; and

^§§§Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

Correspondence to: Sean B. Rourke, PhD, Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON M4T 1X3, Canada (e-mail: ac.no.ntho@ekruors).

  

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

HIV Transmission among Men Who Have Sex with Men Due to Condom Failure

Despite preventive efforts, HIV incidence remains high among men who have sex with men (MSM) in industrialized countries. Condoms are an important element in prevention but, given the high frequency of condom use and their imperfect effectiveness, a substantial number and proportion of HIV transmissions may occur despite condoms. We developed a model to examine this hypothesis.

We used estimates of annual prevalent and incident HIV infections for MSM in Ontario. For HIV-negative men, we applied frequencies of sexual episodes and per-contact HIV transmission risks of receptive and insertive anal sex with and without a condom and oral sex without a condom. We factored in the proportion of HIV-infected partners receiving antiretroviral therapy and its impact in reducing transmissibility. We used Monte-Carlo simulation to determine the plausible range for the proportion of HIV transmissions for each sexual practice.

Among Ontario MSM in 2009, an estimated 92,963 HIV-negative men had 1,184,343 episodes of anal sex with a condom and 117,133 anal sex acts without a condom with an HIV-positive partner. Of the 693 new HIV infections, 51% were through anal sex with a condom, 33% anal sex without a condom and 16% oral sex. For anal sex with a condom, the 95% confidence limits were 17% and 77%.

The proportion of HIV infections related to condom failure appears substantial and higher than previously thought. That 51% of transmissions occur despite condom use may be conservative (i.e. low) since we used a relatively high estimate (87.1%) for condom effectiveness. If condom effectiveness were closer to 70%, a value estimated from a recent CDC study, the number and proportion of HIV transmissions occurring despite condom use would be much higher. Therefore, while condom use should continue to be promoted and enhanced, this alone is unlikely to stem the tide of HIV infection among MSM.

Below: Modeled distribution of fraction of new infections due to each sexual practice, with mean and 95 percent confidence intervals

Full article at: http://goo.gl/IUggge

By: Remis RS1, Alary M2, Liu J1, Kaul R3, Palmer RW1.

• 1Ontario HIV Epidemiologic Monitoring Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
• 2Centre de Recherche, CHU de Québec, Québec, Canada; Département de Médecine Sociale et Préventive, Faculté de médecine, Université Laval, Québec, Canada; Institut National de Santé Publique du Québec, Québec, Canada.
• 3Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.  

More at:  https://twitter.com/hiv_insight