Recent HIV testing behaviour among men having sex with men (MSM) in Montreal, results from the ARGUS 2005 survey

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Recent HIV testing behaviour among men having sex with men (MSM) in Montreal, results from the ARGUS 2005 survey G Lambert 1,2,3, J Cox 1,2,4, F Tremblay, M-A Gadoury, C Tremblay, M Alary, J Otis, R

1 Recent HIV testing behaviour among men having sex with men (MSM) in Montreal, results from the ARGUS 2005 survey G Lambert 1,2,3, J Cox 1,2,4, F Tremblay, M-A Gadoury, C Tremblay, M Alary, J Otis, R Lavoie, R Remis, J Vincelette, C Archibald, P Sandstrom & M-Track Study Researchers 1. Direction de santé publique de Montréal 2. Institut national de santé publique du Québec 3. Univerité de Montréal 4. Mc Gill University Canadian association for HIV research, Quebec, May 2006

2 Context Argus st of biennial surveys of Montreal MSM First site to participate in M-Track Second-generation surveillance system among MSM Monitor HIV, HCV & syphilis & risk behaviours

3 Method Cross-sectional sectional Population Men who have sex with men > 18 years resident of Montreal Recruitment Convenience sample, diversity focus Gay social spaces (bars, saunas, cafés etc Data collection Data collection Anonymous self-administered questionnaire Dried blood spot ; HIV antibodies

4 Results Participation January july 2005

5 Participation by recruitment sites Café 12 Gay strip club 5 Sauna Bar 26 Discothèque 14 Fixed site 18 Association 3 Event 3 Tavern-pub 9 n = 1 957

6 Context HIV Unawareness HIV Testing Prevalence of HIV infection Tested HIV(+) while participating in the study and unaware of their infection. Estimated number of unaware MSM in Montreal (2,8 X ). Never tested for HIV Not tested for HIV in the past 12 months 12,5 95 CI:

7 Objectives To describe caracteristics of MSM unaware of their HIV infection To examine factors associated with recent HIV testing.

8 Characteristics of respondents by HIV and awarenes status Sociodemographic profile Unaware HIV + Aware HIV - n = 54 n = 179 n = 1700 Age 18 to to * 28 * 31 ** 25 ** Ethnocultural group other than french or english canadian * Born outside Canada ** 26 9 ** 13 * Living in the Gay Village * College or University degree 60 Gross annual income < 30K 54 * p < 0.05 ; ** p < 0.001

9 Characteristics of respondents by HIV and awarenes status Socialisation Unaware HIV + Aware HIV - Currently in a common-law relationship Homosexual orientation Spend at least half of free time with gay men Half or more friends are gay Have at least one gay friend who is seropositive Quite or very satisfied with sex life Quite or very satisfied with social life n = n = * 91 * 75 ** n = 1700 * p < 0.05 ; ** p < 0.001

10 Characteristics of respondents by HIV and awarenes status Look for sex Past 6 months, > 1 time Unaware HIV + Aware HIV - n = 54 n = 179 n = 1700 Saunas Bars Internet Public venues (parcs, toilets) Afterhours Raves circuit partys Cafés Gay events Sex parties * p < 0.05 ; ** p < **

11 Characteristics of respondents by HIV and awarenes status Sexual activities Past 6 months At least 1 female partner At least 1 male partner Number of casual partners Anal sex with a man Unprotected anal sex with a casual partner Deliberately had anal sex without using a condom with a casual partner* ( bareback ) Unaware n = HIV + Aware n = 179 HIV - n = ** * p < 0.05 ; ** p < 0.001

12 Characteristics of respondents by HIV and awarenes status Sexual activities Past 6 months, at least once Unaware HIV + Aware HIV - Group sex 1 time Sex with an HIV infected regular partner Sex with a partner from outside Quebec Gave money /drugs/services in exchange for sexual relations Received money /drugs/services in exchange for sexual relations n = n = 179 n = * 8 ** * p < 0.05 ; ** p < 0.001

13 Characteristics of respondents by HIV and awarenes status Drug use during sex Past 6 months, at least once Unaware HIV + Aware HIV - Alcohol Marijuana Poppers Cocaine Speed Ecstasy Special K GHB Crystal * p < 0.05 ; ** p < n = n = 179 n = * 27 ** 19 *

14 Characteristics of respondents by HIV and awarenes status Drug use Unaware HIV + Aware HIV - 5 alcoholic beverages during one sitting > 1 time / week (last 6 months) Sniffed cocaine > 1 time (ever) Sniffed /smoked heroin > 1 time (ever) Injected drugs > 1 time (ever) n = n = 179 n = ** * p < 0.05 ; ** p < 0.001

15 Characteristics of respondents by HIV and awarenes status Attitudes toward HIV Unaware HIV + Aware HIV - I m tired of being told to wear condoms I m tired of always having to be careful when I have sexual relations I m less worried about getting HIV infection / better Rx available I think I m at risk of getting HIV infection (or getting reinfected) HIV/AIDS has become a disease that can be controlled, like diabetes * p < 0.05 ; ** p < n = n = * 45 * 29 * n = 1700

16 Characteristics of respondents by HIV and awarenes status Health issues Unaware HIV + Aware HIV - n = 54 n = 179 n = 1700 History of STI * 38 * Visit with MD past year * Tested for syphilis lifetime * Hepatitis B vaccination 72 * p < 0.05 ; ** p < 0.001

17 Multivariate model of factors associated with being unaware of HIV infection Reference population : HIV infected aware ORadj IC Not having at least one gay friend who is seropositive Born outside Canada Age years

18 Characteristics of respondents by HIV and awarenes status Date of last HIV test Unaware HIV + Aware HIV - 12 months years > 4 years Never n = n = ** 47 ** 0 ** n = 1700 Tested in but month is missing 2 Among tested (45), 7 «didn t receive the result» and 4 «didn t know the result» * p < 0.05 ; ** p < 0.001

19 Justifications for not passing HIV test by age group among those who have never been tested (n = 286) 1. Risk evaluation years (n = 145) years (n = 62) 45 years (n = 79) I am at low risk for HIV infection I always have safer-sex I think I am HIV-negative I have never had sex with an infected person * I don t think I can get HIV * At least 1 reason associated with low risk evaluation * p < 0,05

20 Justifications for not passing HIV test by age group among those who have never been tested (n = 286) 2. Consequences I do not want to know I could not deal with knowing I was infected * I am afraid of having my name reported It could affect my career of insurance It could affect my relationships I am worried about the impact on my sex life I am worried about being discriminated against years (n = 145) years (n = 62) years (n = 79) If I tested (+), nothing can be done At least 1 negative consequence * * p < 0,05

21 Justifications for not passing HIV test by age group among those who have never been tested (n( n = 286) 3. Obstacles years (n = 145) years (n = 62) 45 years (n = 79) I am afraid of needles * I am healthy so I don t need to be tested I do not know where to get the test I don t think the test is always right At least 1 obstacle * * p < 0,05

22 Multivariate model of factors associated with 1) tested > 12 months and 2) never tested Population of reference: Tested 12 m Age 40 Casual partners less than 10 less than 1 to 9 No regular HIV infected partner Common-law relationship Not looking for sex on Internet No use of recreational drugs during sex Bisexual orientation Not looking for sex in bathhouses No sex with partner from outside Quebec No history of STI Less concerned about HIV infection better RX Tested 12 m OR adj 1,6 2,0 1,7 1,8 1,4 1,7 1,6 Never Tested OR adj 1,5 2,2 1,6 2,7 2,2 1,5 1,6 2,6 1,8

23 Limitations Cross sectional design temporal relationship No use of a theoretical model on testing MSM who do not use venues/spaces generalizability Social desirability and recall bias

24 Summary Almost one quarter of MSM with HIV in Montreal are not aware of their infection. HIV (+) unawares are more likely to be aged 18 to 39 and born outside Canada. HIV (+) unawares are sexually active and have unprotected sex. A large proportion of tested HIV (+) unawares did not get their results. Recent HIV screening among MSM in Montreal is lower than recommended. Men aged > 40 years, having lower risk behaviour (number and type of partners, use of recreational drugs), self defined as bisexual and less concerned with HIV appear less likely to have been tested recently (within 12 months). Despite a positive association between risk taking and HIV testing, there is still a gap; at risk individual are not all tested, nor are they all tested at regular short intervals.

25 Acknowledgements Participants ARGUS Associate researchers: Michel Alary René Lavoie Joanne Otis Robert Remis Jean Vincelette Research assistants: Philippe Carrière Marc-André Gadoury François Tremblay Louis Robert Frigault Statistical programmer: Claude Tremblay M-Track Principal researchers: Chris Archibald Tom Wong Associate Researchers Yogesh Choudhri Rhonda Kropp Dana Paquette National HIV & Retrovirology laboratory: Paul Sandstrom John Kim

26 Interviewers Patrick Berthiaume Stéphane Cormier Christian Joubert Ayman Kafal Alexandre Massicotte Alexandre Morin Bernard Ouellet Alexandre Schnubb Study Funding/Support

27 Thank you!

Nikhil Prachand, MPH Britt Skaathun

HIV Prevalence and Unrecognized Infection among Men Who Have Sex With Men in Chicago Chicago HIV Behavioral Surveillance - 2008 Nikhil Prachand, MPH Britt Skaathun HIV/AIDS Surveillance, Epidemiology and