Partner notification

Partner notification

Edmonton, Alberta
2016

Intensive HIV partner notification in Edmonton identifies people who don’t know they are living with HIV

New partner notification guidelines were introduced in Edmonton in April 2010. Before 2010, no systematic process for partner notification existed. Since 2010, a dedicated partner notification nurse has provided partner notification services to all people newly diagnosed with HIV. Alberta Health Services evaluated the impact of the new guidelines using data from chart reviews and local databases between April 2010 and December 2013.1

During the study period, a total of 346 people were diagnosed with HIV (index clients). Of the 346 people diagnosed with HIV, 70% (243) provided information on partners who may have been exposed to the virus. A total of 642 partners were reported to public health staff; 77% (495) lived in the Edmonton region. Of the partners that lived in the Edmonton area, 18% (91) were already known to be HIV positive. Of the remaining partners (those that lived in Edmonton and were not known to be HIV positive), 86% (346) were located by a public health nurse and 88% (305) of them were tested.

Seven percent (20) of all located partners were newly diagnosed with HIV. Data suggests that finding new HIV infections was more likely among high prevalence populations such as gay men and other men who have sex with men (MSM) and people who use injection drugs. The number of index clients needed to be interviewed to find one new HIV-positive person was about 10 for MSM and about 12 for people who use drugs, but 144 for heterosexual index clients.

The new partner notification process also found people living with HIV who were not adequately engaged in care. Of the 91 contacts already known to be living with HIV, 45% were not on treatment at all, and more than 40% of those who were on treatment did not have a suppressed viral load. The study did not mention whether efforts were made to help people engage in care.

Although partner notification services are mandated in all provinces and territories, varying models exist across the country to deliver these services. Both the sexual and drug-using partners of people recently diagnosed with HIV are at high risk for HIV infection and should be offered HIV testing and counselling at the earliest opportunity. In Edmonton, a partner notification process using a dedicated partner notification nurse was effective at finding people who didn’t know they were living with HIV, and at identifying people living with HIV in the community who were not adequately engaged in care.

References

Bergman J, Gratrix J, Pillay T, Houston S, Cooper R, Charlton CL, et al. Intensive HIV Partner Notification Is Effective in Identifying New and Previously Diagnosed HIV Infections in Edmonton, Canada. AIDS patient care and STDs [Internet]. 2015 [cited 2015 Jul 13]; Available from: http://online.liebertpub.com/doi/full/10.1089/apc.2015.0033

Ontario online outreach survey

Ontario online outreach survey

Ontario
2016

Ontario study shows online outreach services beneficial for gay, bi, two-spirit and other MSM

Between December 2013 and January 2014, men who use the internet to seek sex with other men were recruited from sexual networking websites, mobile apps and AIDS service organizations in Ontario to complete an anonymous survey online. The survey was developed to assess if gay, bi, two-spirit and other men who have sex with men (MSM) use online outreach services, and their experiences if so. The Ontario-based study1 found that a minority of men have used online outreach (8%), but most of these report a positive change to their HIV and other sexually transmitted infection (STI) prevention and testing behaviour after engaging with online outreach services.

Online outreach services have a positive impact on behaviour change and decision-making

Study respondents reported a number of behaviour changes after their last online outreach encounter:

  • 34% reported getting tested for HIV
  • 29% reported getting tested for STIs
  • 33% reported using condoms more frequently
  • 24% reported using condoms more effectively

Study respondents reported that sexual decision-making was affected by their last online outreach encounter:

  • 25% reported only having sex with partners whose HIV status they knew
  • 18% reported only having sex with sero-concordant partners (partners of the same HIV status as themselves)
  • 5% reported only having sex with HIV-positive partners whose viral load they knew

Online outreach services reach traditionally underserved populations

Critically, the study showed that online outreach was reaching populations of queer men including HIV-positive men, Indigenous and two-spirit men, men from rural areas, and men from disadvantaged socio-economic classes that have often been under-served by health and community services. For example, two-spirit men were three times more likely to have had an online outreach encounter than non-two-spirit men.

Users have positive experience with online outreach services

Study respondents reported positive experiences with online outreach encounters:

  • 87% reported the individual providing the outreach used language they could understand
  • 84% reported they would use the service again
  • 82% reported the individual providing the outreach was helpful
  • 80% reported being comfortable with the interaction
  • 69% reported that the individual providing outreach was knowledgeable
  • 50% reported being provided with a useful referral

What does this mean for Canadian organizations?

We know that gay, bisexual, two-spirit and other MSM are disproportionately affected by HIV in Canada. They are 131 times more likely to get HIV than men who do not have sex with men.2 We also know that MSM are increasingly using modern communication technologies such as cell phones and the Internet to meet other guys, find sex, and seek sexual-health information.3 This transition creates a new way to effectively interact with gay, bisexual, two-spirit and other MSM through outreach services online.

The Ontario-based study found that MSM find online outreach services beneficial, and importantly the data show that online outreach services are connecting with men who may be underserved using other means, including men living with HIV and Indigenous men. However, about one third (32%) reported that they had never used the services because they either did not know about them or know where to find them, suggesting that organizations that provide online outreach may want to consider increasing the promotion of the service.

References

  1. Brennan DJ, Lachowsky NJ, Georgievski G, et al. Online Outreach Services Among Men Who Use the Internet to Seek Sex With Other Men (MISM) in Ontario, Canada: An Online Survey. Journal of Medical Internet Research. 2015;17(12):e277.
  2. Yang Q, Ogunnaike-Cooke S, Halverson J, et al. Estimated national HIV incidence rates among key sub-populations in Canada, 2014. Presented at 25th Annual Canadian Conference on HIV/AIDS Research (CAHR), 12–15 May 2016, Winnipeg, Canada. Abstract EPH3.5.
  3. Community-Based Research Centre for Gay Men’s Health. Pride, Prejudice, & Determinants of Health: What’s trending with young gay men?. Community-Based Research Centre for Gay Men’s Health; 2013. Available from: http://cbrc.net/sites/cbrc.net/files/PPDYouthF%20-AC.pdf [accessed 19 Feb 2016]

Gay Poz Sex

Gay Poz Sex

Toronto, Ontario
2016

Canadian intervention reduces HIV sexual risk behaviours and improves mental health outcomes among HIV-positive gay, bi and other men who have sex with men

Gay Poz Sex (GPS)1,2 is a sexual health counselling program designed for HIV-positive gay, bi and other men who have sex (MSM). This positive prevention intervention was found to significantly reduce sexual HIV risk behaviours and improve mental health outcomes among HIV-positive MSM.

Gay Poz Sex

Gay Poz Sex is a sexual health counselling program aimed at helping men to improve their sex lives according to their own personal values while also reducing participant risks of transmitting HIV or contracting STIs. Condom use is not a focus of the program, as each participant identifies his own sexual health goals according to his own values. A study of the program ran in Toronto from March 2009 to April 2013.

HIV-positive MSM were recruited for GPS through posters and flyers in community spaces and venues, on social media, through the GPS website, and at Toronto Pride. Participants were eligible for the intervention if they:

  • reported having condomless anal sex with another man in the last three months
  • self-reported living with HIV
  • identified as male
  • were over the age of 18
  • could read and write in English

GPS consists of seven weekly two-hour sessions facilitated by two HIV-positive gay men. Groups include between five and eight participants. Sessions 1 and 2 focus on topics related to HIV transmission, sexually transmitted infections (STIs), and challenges related to disclosing an HIV-positive status.

Sessions 3 to 5 focus on helping participants identify their personal sexual health goals and explore any conflict between their sexual health goals and their current behaviour.

Sessions 6 and 7 provide participants with skills such as self-assertion that helps them to have the type of sex they want.

Participants filled out the same survey before the intervention, immediately after the intervention, and three months after the intervention ended. The survey assessed the impact of the intervention on:

  • frequency of condomless anal sex with HIV-negative or unknown status partners
  • frequency of condomless anal sex with HIV-positive partners
  • feelings of depression and loneliness
  • fear of sexual rejection
  • sexual compulsivity and sexual-sensation seeking
  • ability to reduce sexual risk behaviours

Results

In total, 59 HIV-positive MSM completed GPS. The majority of the participants were white, many received social assistance, and about half reported an annual income of less than $20,000.

Overall, GPS significantly reduced condomless anal sex by HIV-positive MSM with all partners (regular and casual) of all HIV statuses (positive, negative and unknown). At baseline, 85% of men reported having condomless anal sex with any partner. This was reduced to 65% immediately after the intervention and to 58% three months after the end of GPS.

The study showed significant reductions in condomless anal sex immediately after the intervention compared to baseline with:

  • casual partners of any status (73% to 58%)
  • casual partners of unknown HIV status (42% to 27%)
  • HIV-positive casual partners (62% to 46%)
  • any HIV-negative or unknown status partners (54% to 37%)
  • any HIV-positive partners (73% to 54%)

The study also showed significant reductions in condomless anal sex three months after the intervention compared to baseline with:

  • casual partners of any status (73% to 50%)
  • casual partners of unknown HIV status (42% to 21%)
  • HIV-positive casual partners (62% to 42%)
  • any HIV-negative or unknown status partners (54% to 29%)
  • any HIV-positive partners (73% to 52%)

Consistent with the values of the program to promote both sexual health and mental health, GPS reduced feelings of loneliness, fear of sexual rejection, and sexual compulsivity.

What does this mean for Canadian organizations?

GPS is an evidence-informed approach to sexual health promotion for HIV-positive MSM. This study has shown that GPS can reduce the sexual risk behaviours among MSM living with HIV and improve mental health outcomes. GPS is currently being delivered in Toronto and in Vancouver, although the Vancouver site was not part of this research study. GPS may be adaptable to other regions across the country because it is delivered by HIV-positive peer facilitators in community-based settings.

References

  1. Hart TA, Stratton N, Coleman TA, et al. A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms. PLOS ONE. 2016 Apr 7;11(4):e0152762.
  2. Hart T.A, Willis AC, Simpson SH, et al. Gay Poz Sex: A Sexual Health Promotion Intervention For HIV-Positive Gay And Bisexual Men. Cognitive and Behavioral Practice. 2016; in press.
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