Does Treatment Readiness Shape Service-Design Preferences of Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Crystal Methamphetamine? A Cross Sectional Study.

Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex with men (gbMSM). However, not all gbMSM are interested in changing their substance use. The present study aimed to examine whether participant-preferred service characteristics were associated with their readiness to change. We surveyed gbMSM who used CM in the past six months, aged 18 plus years, on dating platforms. Participants rated service-design characteristics from "very unimportant" to "very important". Multivariable regression tested service preference ratings across levels of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES-8D). Among 291 participants, 38.7% reported their CM use was not problematic, 19.5% were not ready to take any action to reduce or stop using CM, and 41.7% were ready to take action. On average, participants rated inclusive, culturally-appropriate, out-patient counselling-based interventions as most important. Participants with greater readiness-to-change scores rated characteristics higher than gbMSM with lesser readiness. Contingency management and non-abstinence programming were identified as characteristics that might engage those with lesser readiness. Services should account for differences in readiness-to-change. Programs that provide incentives and employ harm reduction principles are needed for individuals who may not be seeking to reduce or change their CM use.

Perceived difficulty of getting help to reduce or abstain from substances among sexual and gender minority men who have sex with men (SGMSM) and use methamphetamine during the early period of the COVID-19 pandemic.

BACKGROUND: This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period. METHODS: SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization). RESULTS: Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60,000 CAD (68.9%). Greater perceived difficulty of getting help was associated with having lower income, sometimes using methamphetamine prior to or during sex, and greater perceived need for help. CONCLUSION: Based on these results, we urge greater investments in one-stop, low-barrier, culturally-appropriate care for SGMSM who use methamphetamine. This is especially important given that participants who perceive themselves as needing help to reduce or abstain from substance use perceive the greatest difficulty of getting such help.

Determining the communicable period of SARS-CoV-2: A rapid review of the literature, March to September 2020.

IntroductionStandard testing for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is based on RT-PCR tests, but detection of viral genetic material alone does not indicate ongoing infectious potential. The ability to isolate whole virus represents a better proxy for infectivity.AimThe objective of this study was to gain an understanding of the current literature and compare the reported periods of positive SARS-CoV-2 detection from studies that conducted RT-PCR testing in addition to experiments isolating whole virus.MethodsUsing a rapid review approach, studies reporting empirical data on the duration of positive RT-PCR results and/or successful viral isolation following SARS-CoV-2 infection in humans were identified through searches of peer-reviewed and pre-print health sciences literature. Articles were screened for relevance, then data were extracted, analysed, and synthesised.ResultsOf the 160 studies included for qualitative analysis, 84% (n = 135) investigated duration of positive RT-PCR tests only, 5% (n = 8) investigated duration of successful viral isolations, while 11% (n = 17) included measurements on both. There was significant heterogeneity in reported data. There was a prolonged time to viral clearance when deduced from RT-PCR tests compared with viral isolations (median: 26 vs 9 days).DiscussionFindings from this review support a minimum 10-day period of isolation but certain cases where virus was isolated after 10 days were identified. Given the extended time to viral clearance from RT-PCR tests, future research should ensure standard reporting of RT-PCR protocols and results to help inform testing policies aimed at clearance from isolation.

Pathways between COVID-19 public health responses and increasing overdose risks: A rapid review and conceptual framework.

BACKGROUND: Emerging evidence indicates that illicit drug overdoses are increasing throughout the COVID-19 pandemic. There is a paucity of evidence on the causative pathways for this trend, but expert opinions, commentaries, and some reviews offer theoretical underpinnings. METHODS: In this rapid review, we collate the available published evidence, expert opinions, commentaries, and reviews on the unintended pathways between COVID-19 public health responses and increasing illicit drug overdoses. Using tenets of thematic analyses and grounded theory, we also offer a visual conceptual framework for these unintended pathways. RESULTS: Our framework focuses on five particular public health responses, namely social isolation/physical distancing/quarantine; staff/resource reallocations and reductions; closures of businesses and other places of employment; border closures and transportation restrictions; and the early release of people from prisons. As argued in the literature reviewed here, these public health responses have unintentionally created increased overdose risks by producing high risk use scenarios; increased risks of relapsing; disrupted addictions services and treatment; an increasingly toxic supply of drugs; and the risk of using with lowered tolerance. CONCLUSIONS: Health care systems should respond to these pathways to mitigate the unintended consequences. Furthermore, the COVID-19 pandemic may represent an opportunity to enact proactive, progressive, and innovative solutions to an overdose crisis that will surely outlast the current pandemic.

Lack of Gender Disparity Among Administrative Leaders of Canadian Health Authorities.

Background: Gender distribution within the managing bodies of the Canadian health authorities has not been studied despite their integral role in the health care system. The purpose of this study is to quantify gender differences and to craft a geographic gender analysis of such distribution. Methods: Retrospective data collection of all Canadian health authorities at the provincial, territorial, regional, and first nations levels was conducted. The dependent variable was gender, and other covariates, where applicable, included province/territory, region, leadership position, education (PhD or Master's), honorary degree, and primary occupation. Any member within the executive managing body or board of directors of a Canadian health authority was included, unless their gender could not be determined, in which case they were excluded. Results: Quantitative analysis of the 67 health authorities revealed 1346 individuals with identifiable gender (710 women; 636 men). Thematic distribution showed no significant difference in the gender distribution by provinces/territories (chi square = 14.248; p = 0.28), by leadership position (chi square = 1.88; p = 0.75), by education (chi square = 1.85; p = 0.17), or by primary occupation (chi square = 1.53; p = 0.46). Conclusion: The overall number of females exceeded that of males and there were no gender disparities. Critical analysis of probable causes was discussed. Further studies should be conducted to examine the policies and programs within the Canadian health authorities that successfully tackle the retention, recruitment, and promotion of females.