The BC-CfE’s Momentum Health Study has been gathering data on the attitudes and behaviours surrounding HIV within Vancouver’s community of gay, bisexual and men who have sex with men (gbMSM). This study is the first to use Respondent Driven Sampling (RDS) to obtain a representative sample of gbMSM reflective of the ethno-cultural diversity of Greater Vancouver and inclusive of subgroups that may have been overlooked in other sampling strategies.
This month, an article using Momentum data was chosen as an editor’s pick by the Journal of Acquired Immune Deficiency Syndromes (JAID). The article looks at rates of viral suppression among Vancouver gbMSM, as well as choices around sex, HIV prevention and drug use. Decades after the launches of countless campaigns around HIV prevention and safer sex, there are important insights on where public health messaging has made a strong impression. It also shows areas that need further recognition and spotlighting.
BC-CfE: The good news about this study is that it shows, despite a relatively high prevalence of HIV among MSM in Vancouver, a small proportion of HIV-positive MSM have undiagnosed HIV (2%) and unsuppressed viral load (18.6%). What factors or public health interventions do you think have lead to these outcomes?
Dr. David Moore: Our study clearly demonstrates the success of the BC approach to actively engaging gay, bisexual and men who have sex with men (gbMSM) in HIV testing and treatment. Very few gbMSM living with HIV are unaware of their infection and nearly all of those who are aware are engaged in care and receiving effective and sustained HIV treatment.
BC-CfE: Men with unsuppressed viral load were more likely to have lower incomes and be from communities of ethnic minority. How does this tie into health inequities?
DM: For many health outcomes-such as diabetes, cancer and cardiovascular disease-individuals from communities of ethnic minority and individuals with lower incomes are often more affected than other groups. HIV is not different in this regard. This suggests, in addition to the HIV-specific interventions we are applying, broader based interventions addressing global health inequities are needed to more effectively combat HIV and other health conditions.
BC-CfE: There were some surprising findings in this study, given the extent of public health awareness campaigns around safer sex and HIV. For instance, only 55% of HIV negative participants and 47% of HIV-positive participants reported asking their partners about their HIV status at least half of the time. How can the public health community use this information to improve their outreach around HIV prevention?
DM: I think this is an important observation and should be discussed openly with the gay and bisexual community, as well as with service providers. Despite the fact that HIV is very common among gbMSM, it is still not as openly discussed as much as it should be. I think the recognition that HIV treatment is a very effective prevention strategy should remove some of the stigma around HIV infection and facilitate more open discussion about HIV serostatus. But we need to do a better job of communicating this to affected communities.
BC-CfE: The study set out, in part, to better understand how drug use and risky sexual behaviour overlapped. What was uncovered?
DM: In this paper, we did find HIV-positive individuals who are potentially able to transmit HIV (meaning those with unsuppressed HIV viral loads) were more likely to report having risky sex and to report the use of specific substances in the previous six months, most notably crystal methamphetamine and/or GHB. This clearly shows the intersection of risky sex and substance use with the lack of engagement in effective HIV care. Individuals who struggle with issues around drug use and risky sex are also more likely to struggle with access to health care.
BC-CfE: What can be done to address issues such as crystal meth use among HIV-positive MSM? Why is this an important issue to tackle at this time?
DM: There is often a perception that nothing can be done to address problematic crystal meth use, especially among gbMSM. However, a number of psychological approaches to reducing use have been shown to be effective. These include cognitive behavioural therapy, motivational interviewing and contingency management (meaning, behaviour therapy techniques that attempt to modify behaviour by controlling consequences). Programs incorporating some or a combination of all these approaches are available in BC; however, they have somewhat limited capacity and geographic availability. Trying to address the upstream drivers of substance use, such as mental health, is an important approach-similar to the importance of addressing upstream factors contributing to health care inequities.
BC-CfE: What other findings from this study do you think will help improve our understanding of how to better reduce HIV transmission among gbMSM?
DM: The study highlights what a great job we have done with Treatment as Prevention¨ to date with gbMSM in BC, and shows exactly where we need to further improve engagement. However, it also highlights the need for adopting other approaches to HIV prevention. If we are going to end the HIV epidemic among gbMSM, we must expand the conversation to include these topics.
Related Link:
Plain Text Summary:Low Prevalence of Unsuppressed Viral Load among Gay and Bisexual Men Living with HIV in Vancouver