B.C. report recommends inclusive, holistic HIV prevention measures for gay and bisexual men

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As British Columbian gay and bisexual men continue to be overrepresented in the HIV epidemic, a new report from provincial health officer Dr. Perry Kendall recommends a number of strategies that need to be taken, including addressing the underlying factors influencing HIV infection, such as mental health and social context;developing inclusive sex education strategies; and more.  

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Kendall released his annual report on HIV among gay and bisexual men in British Columbia at a news conference hosted by the report's principal author, Dr. Mark Gilbert, at the BC Centre for Disease Control on July 14.

"Gay and bisexual men continue to bear a disproportionate burden of HIV onus," Kendall stated." They make up 54 percent of the incident cases…and about 45 percent of all the cases of people living with HIV in British Columbia."

Dr. Patricia Daly, chief medical officer for Vancouver Coastal Health, noted that while there have been significant decreases among some groups, such as injection drug users (particularly on the Downtown Eastside), Vancouver has had the highest number of new HIV infections among gay and bisexual men in B.C. for the past decade.

"While the rate of HIV infection among gay and bisexual men has come down from the peaks we saw in the early days in the epidemic, we can see in this report that we haven't seen substantial decrease for the last 10 years," she said.

She pointed out, however, that since Vancouver also has the largest population of gay and bisexual men in the province, these numbers don't necessarily mean the risk is higher in Vancouver. Vancouver, she said, represents about three-quarters of all HIV cases in B.C. each year.

Kendall pointed out that research specifically about gay and bisexual men is sorely underfunded.

“Less than 10 per cent of the Canadian Institutes for Health Research's grant budget for HIV prevention is targeting gay and bisexual men,” he said. “So that’s a population where 50 per cent of the current burden is getting less than 10 per cent of the current research, which I think suggests an underinvestment in looking at and understanding prevention in this community.”

He added that anal receptive sex is "about 18 times riskier for transmission" than vaginal insertive sex.

The report revealed some interesting, sometimes surprising, observations from provincial data.

Kendall said that Caucasian men make up the majority of new diagnoses but Asian men (10.6 percent) are rapidly increasing.

The trend of new HIV diagnoses increases with age, with the lowest incidence among young men born 1980 to 1999 (7 percent) but have been steadily increasing. While condom usage for casual sex partners remained high for all gay and bisexual men, the youngest age group reported the highest levels of using condoms.

The highest levels of verbal harassment and suicidality were reported by the youngest age group. This group was most likely to report mental health issues (substance abuse, depression, social isolation), which is related to poor mental health outcomes and sexual risky behaviour.

Both Kendall and Daly recommended a more holistic approach to reduce infection rates effectively, which includes reducing stigma and marginalization.

"The real power of the report is that it reminds us that to improve the health of gay and bisexual men in B.C., we can't focus only on the disease of HIV infection but we need to focus on people and the communities in which they live," Daly said.

Daly also spoke about the report's recommendation to integrate sexual orientation and gender identity into sexual education in schools.

"One of the recommendations that Dr. Kendall made that particularly resonates with me is his call for our comprehensive sexual and reproductive health education strategy for B.C. that is inclusive of all gender and sexual identities and reduces stigma."

She pointed out the example of the recent controversy about the Vancouver School Board's gender policy and how some parents opposed to it due to misunderstanding.

"This demonstrated to me that there's more work to be done on sexual health and reducing stigma in our schools to keep our youth safe and healthy," Daly said.

She also added that Vancouver lacks dedicated shelter beds for homeless LGBT youth, which Toronto recently addressed.

"This may be a small population but they are highly vulnerable, and like women, they may feel uncomfortable accessing shelters populated by older men," she said.

Daly said that one effective measure has been implementing routine HIV testing (of all adults who have been sexually active) at emergency rooms, acute care, walk-in clinics, and more in Vancouver. She said that this routine testing has picked up more new HIV cases than any other testing strategy (rather than just target testing of gay and bisexual men). She said this practise will hopefully be adopted province-wide as 60 percent of B.C. men were out as gay or bisexual to their family doctor while 40 percent were not.

She noted that the number one reason for men not getting tested was a perception of being low-risk.  

Among the report's recommendations are to ensure that prosecutorial guidelines are based on the best evidence on HIV transmission risk and that any criminal charges for possible HIV transmission are based on whether HIV prevention could be achieved in the absence of prosecution.

This point was one of several recommendation that Jesse Brown, executive director for YouthCo, approved of.

"As an organization, we are strongly opposed to the criminalization of HIV non-disclosure as this law discourages HIV testing, further marginalizes groups most at risk, including gay men and youth, and misleads the public through irresponsible and stigmatizing media coverage of criminal proceedings," he stated.

The report was developed with the BC Centre for Disease Control and two advisory groups that included gay and bisexual men and related service providers and organizations.

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