Ahead of World AIDS Day on December 1st, we asked several BC-CfE researchers about their work and how it relates to this year’s World AIDS Day theme of ‘End Inequalities. End AIDS. End Pandemics’. Jordan Sang, a BC-CfE Momentum Postdoctoral Research Fellow.
Q.
Tell us about your role and the focus/study of your work?
A.
I am currently a postdoctoral fellow working on the Momentum and Engage studies within the BC Centre for Excellence in HIV/AIDS (BC-CfE). Momentum II/Engage is a longitudinal bio-behavioural cohort of gay, bisexual and other men who have sex with men (GBM) which began in 2017. The study is part of a larger multi-city study conducted in the three largest cities in Canada: Vancouver, Montreal and Toronto. We applied respondent-driven sampling to recruit GBM across the three cities, with recruitment finishing in 2019 and follow-up visits for 4 years. The focus of this work is to follow cohort of GBM to collect detailed findings on sociodemographic, behavioural, attitudinal, and biological information related to sexual health, HIV, hepatitis C, other STIs, substance use, and psychosocial health.
Q.
What role does HIV play in your work and how does it impact your participants?
A.
HIV plays an integral role work in my past and current work. I have over 10 years of HIV-related experiences, beginning my work in community-based organizations to my current position within the BC-CfE focused on addressing critical knowledge gaps in HIV prevention and care among GBM. Results from the recent Engage Technical Report found that GBM in Vancouver are highly engaged in the HIV cascades of care with almost all (99.8%) GBM aware they were living with HIV who were, 88.7% of those who were aware were currently on ART, and among those currently on ART, 98.4% were virologically suppressed. Additionally, among HIV-self-reported negative/unknown participants, 79.4% indicated they had an HIV test in the past year and 15.7% indicated PrEP use in the past six months. (https://momentumstudy.ca/wp-content/uploads/2021/04/Engage-Technical-Report.pdf) These findings highlight how GBM in Vancouver are actively engaged in HIV prevention and care and demonstrate the resilience of GBM. Expanding our work beyond Momentum and Engage, we are now looking to examine data linkages with BC-CfE administrative data to directly assess HIV treatment uptake and PrEP uptake combined with our bio-behavioural data for our participants.
Q.
(If your study involves HIV treatment/care)
What are some concerns you hear from your study participants about accessing HIV care/treatment/testing?
A.
The 2019 novel coronavirus (COVID-19) pandemic has impacted nearly all aspects of everyday life. In addition to physical distancing precautions, the pandemic has a multitude of psychological, social, behavioural and structural effects. One such example is the closure of sexual health clinics in the first wave of the pandemic, a primary site of care and prevention for GBM. Preliminary data collection from GBM in the Momentum Health II study found that one third (32.8%) of participants reported avoiding health services because of concerns about COVID-19 exposure. We also found 21% of GBM reported stopping PrEP completely because of the pandemic and qualitative interviews with participants indicate difficulty getting PrEP appointments and desiring personal connections with healthcare providers rather than the now normal, virtual appointments. The secondary effects of COVID-19 seem to have increased barriers to testing, prevention and care for GBM and I am now leading a new CTN funded project looks to examine these impacts on PrEP and ART continuation among Engage participants.
Q.
The theme of World AIDS Day this year is ‘End Inequalities. End AIDS. End Pandemics’. How do inequalities in HIV care influence your work and are there opportunities to address inequalities to HIV care in your work?
A.
The theme of World AIDS day this year is especially fitting to the work that I am doing and the populations I work with. When the AIDS epidemic first began in North America during the 1980s, it was centered around GBM and today these inequities still remain. In Canada, GBM remain disproportionately burdened by HIV representing only 3% to 4% of the male population, GBM have greater risk of HIV than their heterosexual peers and comprised 49.5% of new HIV infections in 2018. Disparities in HIV are associated with social and structural inequities faced by GBM including discrimination and stigma. In the Engage technical report, two thirds of participants indicated being called a derogatory name in the past year and being treated unfairly by strangers because of their sexual orientation. Thus, reducing barriers to care and social inequities which marginalize GBM is critical in ending HIV/AIDS.
Q.
Can you share any examples of participants overcoming barriers to HIV care thanks to the work you do?
A.
Our work at Momentum and Engage does not directly work with participants and their care. Instead, we collect useful bio-behavioural data among GBM, who are often overlooked in public health research. Knowledge translation and exchange for our study results is critical to our work and we ensure that our study results are appropriately utilized by community members. We work with a Community Engagement Committee, to disseminate results and identify important results they wish to highlight that would benefit community members. Moreover, the BC-CfE is the primary organization responsible for advising the Ministry of Health on HIV-related policies and our results are actively shared with the BC-CfE communications team. Specific research topics are especially relevant, such as PrEP and ART, where study findings are shared with the Committee on Drug Evaluation and Therapeutics, which develops the provincial HIV PrEP and ART guidelines. Lastly, we work closely with collaborators at Vancouver Coastal Health and Fraser Health on various projects and share our study results which may be useful for health promotion and health interventions.