Preexposure Prophylaxis in Latin America and the Caribbean-The Barbados Experience.

This study explored oral pre-exposure prophylaxis (PrEP) awareness, and sexual behavior of gay, bisexual, and other men who have sex with men (gbMSM) in Barbados. Factors associated with PrEP use were examined using Pearson chi-square and logistic regression. Of the 171 male participants who completed the survey, 22% were under 25 years old, 70% identified as gay/homosexual, and 59% were single. PrEP awareness was 77%, and of these 29% were current PrEP users. Users were more likely to have stable living arrangements (p < .05) and to identify as gay/homosexual (p=.03). Uptake by current PrEP users was attributed to non-judgmental and confidential PrEP services. Barriers identified by former PrEP users included cost and risks of STIs. Since the PrEP program is free, as is general health care for STIs, this suggests that there may be a knowledge gap. Further studies are needed to explore perceived barriers to the program.

Experiences of racism, sexual objectification and alcohol use among gay and bisexual men of colour.

Objective: Previous research has shown that experiences of racial discrimination and sexual objectification are associated with health risk behaviours among gay and bisexual men of colour. However, little is known about whether racial discrimination and sexual objectification are associated with alcohol use among this population. This community-based study examined the association between racial discrimination, sexual objectification and alcohol use in a sample of 369 gay and bisexual men of colour (Black/African/Caribbean, Latino/Latin American, South Asian, and East and Southeast Asian) in Toronto.Design: Data were drawn from an online survey designed to examine issues of racism, homophobia, health and well-being among gay and bisexual men of colour in Toronto. Regression analysis assessed the relationship between scores on the Racism and Life Experiences Scale, Sexual Objectification Scale, and the CAGE questionnaire (a screen for alcohol use disorder).Results: Multivariable logistic regression analyses revealed that experiences of racism and sexual objectification are significantly and positively associated with a screening for alcohol use disorder. The interactions between Latino/Latin American race/ethnicity and experience of sexual objectification were also positively associated with a screening for alcohol use disorder.Conclusions: Health professionals should consider the role of racial discrimination and sexual objectification within the context of risk and treatment for alcohol use disorders, harm reduction, and HIV prevention for gay and bisexual men of colour.

Knowledge and awareness of Human Papillomavirus (HPV) and HPV vaccines among Caribbean youth: the case of the Bahamas.

There is a high burden of cervical cancer in the Caribbean region, particularly in the Bahamas, yet there are few studies of Human Papillomavirus (HPV) and HPV vaccine in the region. The objective of this study was to assess the knowledge and awareness of HPV and the HPV vaccine among school-aged youth (15-18 years) living in the Bahamas.Cross-sectional data were obtained from the "Getting to Zero" HIV study in the Bahamas conducted in 2014/2015 (n = 1553). The questionnaire elicited information on knowledge of HPV and HPV vaccines, using previously validated scales. Data analysis included Chi-square tests and Mann Whitney U test.In this sample of school-aged youth, only 10.7% (146/1364) had ever heard of HPV. With respect to those who were sexually active (n = 685), only 10.7% had ever heard of HPV. For those who had heard of HPV, knowledge of HPV and HPV vaccines was assessed on an HPV Knowledge and HPV Vaccine Knowledge scale, respectively. There was no statistically significant difference in mean HPV knowledge score between males and females, or HPV vaccine knowledge scores, between males and females.There was a general lack of awareness of HPV and HPV vaccines among school-aged youth in the Bahamas. This is an important gap in the HPV vaccine strategy and cancer prevention, as this is the age at which most people acquire HPV. It emphasizes the importance of developing a careful implementation plan, with an evaluation of knowledge and attitudes, in order to have an effective HPV vaccine uptake.

"Getting to Zero New HIV Infections in the Caribbean": Knowledge and Attitudes Toward Male Circumcision Among Adolescent Males in The Bahamas.

Male circumcision (MC) plays a significant role in reducing new HIV infections, particularly in high prevalence countries. This cross-sectional study assesses the prevalence of MC and attitudes toward MC among youth aged 15-18 years in The Bahamas, a medium HIV prevalence country. The survey included 797 young men who completed a questionnaire on MC. Data analyses included chi-squared tests. The self-reported prevalence of MC among youth was 16.7% (121/759). Most of the circumcised youth were circumcised as infants, 84% (107/121) were pleased with their circumcision, and 71% would recommend it to others. For uncircumcised youth, 35% (189/533) would consider voluntary male circumcision (VMC) and 26% would recommend MC to others. In all scenarios, circumcised youth were more likely to be positive about MC. Among uncircumcised young men, being older (17-18 years compared to 15-16 years) was the only variable statistically associated with considering MC or recommending MC. After being presented with information on the benefits of MC for HIV prevention, the number of men who were positive about MC increased. Most of the young men in this cohort would consider VMC for reducing HIV incidence. Also, many stated that, if they had a male child, they would have him circumcised. The attitudes of these youth emphasize the need to provide information on HIV in addition to general health benefits of MC if there were to be a sustainable MC program within this population.

Minding the gap: health and social care provider perceptions of parental communication and Black-Canadian youths' sexual health.

Health and social care providers' perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers' perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents' and young people's sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers' perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths' sexual health.

Environmental factors in an Ontario community with disparities in colorectal cancer incidence.

OBJECTIVE: In Ontario, there are significant geographical disparities in colorectal cancer incidence. In particular, the northern region of Timiskaming has the highest incidence of colorectal cancer in Ontario while the southern region of Peel displays the lowest. We aimed to identify non-nutritional modifiable environmental factors in Timiskaming that may be associated with its diverging colorectal cancer incidence rates when compared to Peel. METHODS: We performed a systematic review to identify established and proposed environmental factors associated with colorectal cancer incidence, created an assessment questionnaire tool regarding these environmental exposures, and applied this questionnaire among 114 participants from the communities of Timiskaming and Peel. RESULTS: We found that tobacco smoking, alcohol consumption, residential use of organochlorine pesticides, and potential exposure to toxic metals were dominant factors among Timiskaming respondents. We found significant differences regarding active smoking, chronic alcohol use, reported indoor and outdoor household pesticide use, and gold and silver mining in the Timiskaming region. CONCLUSIONS: This study, the first to assess environmental factors in the Timiskaming community, identified higher reported exposures to tobacco, alcohol, pesticides, and mining in Timiskaming when compared with Peel. These significant findings highlight the need for specific public health assessments and interventions regarding community environmental exposures.

Challenges to the involvement of people living with HIV in community-based HIV/AIDS organizations in Ontario, Canada.

The Greater Involvement of People Living with HIV/AIDS Principle (GIPA) has been a core commitment for many people involved in the community-based HIV/AIDS movement. GIPA refers to the inclusion of people living with HIV/AIDS in service delivery and decision-making processes that affect their lives. Despite its central importance to the movement, it has received little attention in the academic literature. Drawing on focus group discussions among staff members and volunteers of AIDS service organizations, activists, and community members, we explore challenges to the implementation of the GIPA principle in community-based HIV/AIDS organizations in Ontario, Canada. Our findings reveal ways in which implementing GIPA has become more complicated over recent years. Challenges relating to health, stigma and disclosure, evolving HIV/AIDS organizations, and GIPA-related tensions are identified. This paper considers our findings in light of previous research, and suggests some implications for practice.

"Everyone just keeps their eyes closed and their fingers crossed": sexual health communication among black parents and children in Nova Scotia, Canada.

BACKGROUND: Black Canadian youth remain disproportionally affected by an array of social and health issues, including sexually transmitted infections. While research exists in support of the involvement of parents as a key means to prevent or modify harmful behaviours among youth, less is known about how parent-child communication can serve as a prevention intervention strategy within Black families in Canada. This study explores sexual health communication between Black parents and youth in Nova Scotia and identifies facilitators, obstacles and issues that families face in dialoguing about sexual health. METHODS: Focus groups and in-depth interview sessions were held with a diverse sample of parents of Black youth, health and education professionals, and Black youth in Nova Scotia, as part of a larger study aimed at exploring parent-child communication on sexual health and HIV. The research team worked in partnership with and received feedback from key informants and a community advisory committee throughout the various stages of this study. All sessions were audio-taped with permission and thematic analysis was carried out on the verbatim transcripts. RESULTS: Six key themes emerged from the data analysis in relation to parent-child communication within Black families in Nova Scotia: 1. the gendered nature of [sexual] health communication; 2. fear and uncertainty as obstacles; 3. open and honest dialogue from an early age as a facilitator; 4. media as both a catalyst and a barrier; 5. peers as a catalyst; and 6. time constraints as an obstacle. CONCLUSIONS: The findings of this study reveal that parent-child communication regarding sexual health promotion within Black families in Nova Scotia remains varied and is heavily affected by a myriad of intersecting determinants of health faced by Black youth and their parents. Health promotion interventions aimed at fostering and supporting parent-child communication on sexual health must simultaneously target both parents and youth and further, such efforts must engage a high level of cultural competency in order to better meet the needs of this population.

"Never reflected anywhere": body image among ethnoracialized gay and bisexual men.

A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n=61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.

Black gay men as sexual subjects: race, racialisation and the social relations of sex among Black gay men in Toronto.

In this study of Black gay and bisexual men in Toronto, sexually active survey participants reported on their sexual behaviours with male partners of different ethnoracial backgrounds, and interview participants reflected on how their sexual relationships emerged in the context of race and interracial desire. Most survey participants reported sexual relationships with other Black men. Participants were more likely to be insertive with White and other ethnoracial men than with Black men. A significant number of participants who were receptive or versatile with Black partners switched to the insertive role when their sexual partners were not Black. Interview participants ascribed a sense of fulfilment to their sexual relationships with other Black men, but avoided relationships with White men or interpreted such relationships as either purely sexual and/or inflected by their racialised objectification. Others avoided sexual relationships with other Black men or preferred relationships with White men, sometimes in opposition to experiences of oppressive masculinity from some Black partners but mindful of the possibility of racialised encounters with their White partners. Study participants emerge as informed sexual subjects, self-conscious about their sexual relationships and variously inclined to negotiate or resist racialisation and oppression in the private and public spheres.

The MaBwana Black men's study: community and belonging in the lives of African, Caribbean and other Black gay men in Toronto.

In Canada, there is a paucity of research aimed at understanding Black gay men and the antecedents to risk factors for HIV. This study is an attempt to move beyond risk factor analysis and explore the role of sexual and ethnic communities in the lives of these men. The study utilized a community-based research and critical race theory approach. Semi-structured interviews were conducted with eight key informants to augment our understanding of Black gay men and to facilitate recruitment of participants. In-depth interviews were done with 24 Black gay men. Our data showed that the construction of community for Black gay men is challenged by their social and cultural environment. However, these men use their resilience to navigate gay social networks. Black gay men expressed a sense of abjuration from both gay and Black communities because of homophobia and racism. It is essential for health and social programmers to understand how Black gay men interact with Black and gay communities and the complexities of their interactions in creating outreach educational, preventive and support services.

Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in montreal.

OBJECTIVE: To determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with men (MSM) participating in the Omega Cohort Study, 1997 through 2003. METHODS: The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS: Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR = 1.06, 95% confidence interval [CI]: 1.04 to 1.09) and any type of partner (OR = 1.05, 95% CI: 1.03 to 1.07). There was a nonnegligible increase in UAI with casual partners (OR = 1.05, 95% CI: 1.01 to 1.09). For the analysis by calendar time, there were increases in UAI between regular seroconcordant partners (OR = 1.04, 95% CI: 1.02 to 1.05) and any type of partner (OR = 1.03, 95% CI: 1.02 to 1.04). There were nonnegligible increases in UAI with casual partners (OR = 1.03, 95% CI: 1.00 to 1.05) and with any type of partner except a regular seroconcordant partner from 15.7% to 18.8% (OR = 1.02, 95% CI: 1.00 to 1.04). CONCLUSIONS: There was a nonnegligible and consistent increase in UAI among Omega Cohort Study participants between 1997 and 2003. Continuous trend analysis is important because it allows us to follow UAI closely and to implement intervention strategies that may help to stop or reduce the present trend.

Nonnegligible increasing temporal trends in unprotected anal intercourse among men who have sexual relations with other men in Montreal.

OBJECTIVE: The objective of this study is to determine temporal trends in unprotected anal intercourse (UAI) among men who have sex with other men (MSM) participating in the Omega Cohort Study, 1997-2003. METHODS: The Omega Cohort Study was a longitudinal study of HIV-negative MSM aged 16 years or older and living in Montreal. Participants completed self-administered questionnaires and interviews every 6 months. Trend analysis using the generalized estimating equation was done for length of cohort membership (visits) and by calendar time for all visits, per type of sexual partner. Odds ratios (ORs) were calculated to measure the odds of increasing UAI per 6-month period. RESULTS: Among subjects who were followed for at least 4 years, UAI increased with regular seroconcordant partners (OR, 1.06, 95% CI 1.04-1.09), and any type of partner (OR, 1.05, 95% CI 1.03- 1.07). There was a nonnegligible increase in UAI with casual partners (OR, 1.05; 95% CI, 1.01-1.09). For the analysis by calendar time, there were increases in UAI between with regular seroconcordant partners (OR, 1.04; 95% CI, 1.02-1.05) and any type of partner (OR, 1.03; 95% CI, 1.02-1.04). There were nonnegligible increases in UAI with casual partners (OR, 1.03; 95% CI, 1.00-1.05) and with any type of partner except regular seroconcordant partner from 15.7% to 18.8% (OR, 1.02; 95% CI, 1.00-1.04). CONCLUSIONS: There was a nonnegligible and consistent increase in UAI among Omega participants, between 1997 and 2003. Continuous trend analysis is important because it allows us to closely follow UAI and to implement intervention strategies that may help to stop or reduce the present trend.

The six-month incidence of clinically significant low back pain in the Saskatchewan adult population.

STUDY DESIGN: A population-based, longitudinal, mailed survey was conducted. OBJECTIVE: To investigate the 6-month incidence and determinants of clinically significant low back pain in the Saskatchewan adult population. SUMMARY OF BACKGROUND DATA: Few studies have investigated the incidence of significant low back pain in general populations. When available, such studies often differ in the assessment of pain severity. This lack of consensus in measuring pain severity results in large differences in incidence rates. METHODS: A questionnaire requesting information on low back pain and other health conditions was mailed to randomly chosen individuals, ages 20 to 69, residing in the province of Saskatchewan, Canada. Of the 1131 (55%) who responded at baseline, 848 had not experienced clinically significant low back pain during the past 6 months. Clinically significant low back pain was assessed using the Chronic Pain Questionnaire, a 7-item scale that measures the intensity of chronic pain and associated disability. Individuals with no clinically significant low back pain were followed up at 6 months. RESULTS: At the follow-up assessment, 50 individuals reported clinically significant low back pain, representing a cumulative incidence of 8% (95% confidence interval, 6-10.4). In logistic regression models, marital status, rural residency, and history of back and neck pain were associated with the onset of clinically significant low back pain. CONCLUSIONS: The 6-month incidence of clinically significant low back pain is high in Saskatchewan. It is important to prevent this condition because of the high economic and social costs associated with it.

No increase in HIV incidence observed in a cohort of men who have sex with other men in Montreal.

To monitor HIV incidence we tested a cohort of men who have sex with men in Montreal for HIV every 6 months. Between 1996 and 2001, 17 out of 1244 participants seroconverted, for an HIV incidence of 0.56 per 100 person-years (py) (95% CL 0.29, 0.83). The incidence decreased over the study period, from 0.75 to 0.34 per 100 py; which was not statistically significant. An in-depth evaluation of the situation in Montreal could identify useful lessons for prevention efforts elsewhere.