This proposed study examines the effect of a recently initiated population-level biomedical intervention- expanded universal and free of cost highly active antiretroviral therapy (HAART)-on HIV risk behaviors among a high-risk population, men who have sex with men (MSM), in British Columbia (BC), Canada. Of particular interest is whether the efficacy of expanded HAART access as an HIV prevention measure might be negated by socio-cultural/bio-behavioral factors, including risk compensation or """"""""HAART optimism"""""""" within the MSM communities. The majority of new HIV infections in BC occur among MSM and this has remained largely unchanged since the year 2003 with approximately 200 new infections each year. The preventive value of HAART has been highlighted and the BC Ministry of Health has massively increased funding to expand access to HAART as a strategy to reduce the number of new HIV infections in the province. BC HIV treatment guidelines have also been relaxed so that HAART is available to almost all HIV-infected individuals in the province. Approximately 40% of persons who die from HIV-related causes in BC do not receive ART prior to death and approximately 27% of HIV-infected individuals may be unaware of their HIV status. This major expansion of access to HAART constitutes a population-level biomedical intervention-a rare, natural experiment-thereby creating an opportunity to examine the impact of expanded HAART access on complex determinants of HIV risk behaviors at the individual level. Over the 5-year study period, we propose to use respondent driven sampling (RDS) to recruit a cohort of 270 HIV-positive and 410 HIV-negative MSM (680 in total) aged 16 years and older, and follow them up every 6 months for a median of four years. We propose to use RDS for its strength in recruiting deeply from hidden and diverse populations. Our main aims are to 1) examine trends in sexual risk behavior and attitudes regarding the preventive value of HAART over a 4.5-year period as the numbers of MSM on HAART dramatically increase and the concept of HAART as prevention becomes widely diffused;2) examine how self-reported drug-use before and during sex explains HIV sexual risk behavior;and 3) examine the interactions between soft and hard drug use, HAART optimism and treatment adherence and continuation among HIV-positive MSM receiving HAART. All study participants will be asked to sign a consent form, complete a questionnaire using Computer Assisted Self-Interview technology, and undergo a rapid HIV test, syphilis test, hepatitis C serology, urine and anal swab screens for N. gonnorhea and Chlamydia trachomatis and to provide consent to allow researchers access to health services databases in the province. All HIV-positive individuals not already accessing regular HIV care will be linked to local healthcare providers for regular medical care and for assessment of need for HAART.

Public Health Relevance

The province-wide biomedical intervention of HAART as HIV prevention initiated in British Columbia, Canada is a natural experiment that offers a unique opportunity to observe how a population level HIV intervention would unfold when relatively unaffected by cost barriers or lack of access to health care. It offers a unique natural laboratory for the focused research proposed here to examine how behavioral and socio-cultural factors and drug use interact to contribute to the relative success or shortfall of treatment as prevention, as implemented by the provincial government program. The data we propose to collect will facilitate detecting risk compensatory behavior and changes in attitudes, beliefs and cultural norms to provide insight to policy makers and program planners for responsive prevention initiatives. The data will identify important determinants of success for implementing or evaluating treatment as prevention initiatives in comparable jurisdictions in Canada and the United States. The results of this study will also be of great value for designing better quality, culturally competent sexual and healthy-living services for HIV-positive MSM that support their right to be sexually active and achieve their goals in life.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA031055-02
Application #
8254301
Study Section
Special Emphasis Panel (ZRG1-AARR-F (02))
Program Officer
Lambert, Elizabeth
Project Start
2011-04-15
Project End
2013-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
2
Fiscal Year
2012
Total Cost
$423,107
Indirect Cost
$41,167
Name
Simon Fraser University
Department
Type
DUNS #
208032946
City
Burnaby
State
BC
Country
Canada
Zip Code
V5 1-S6
Card, Kiffer G; Lachowsky, Nathan J; Armstrong, Heather L et al. (2018) The additive effects of depressive symptoms and polysubstance use on HIV risk among gay, bisexual, and other men who have sex with men. Addict Behav 82:158-165
Rich, Ashleigh J; Lachowsky, Nathan J; Sereda, Paul et al. (2018) Estimating the Size of the MSM Population in Metro Vancouver, Canada, Using Multiple Methods and Diverse Data Sources. J Urban Health 95:188-195
Armstrong, Heather L; Roth, Eric Abella; Rich, Ashleigh et al. (2018) Associations between sexual partner number and HIV risk behaviors: implications for HIV prevention efforts in a Treatment as Prevention (TasP) environment. AIDS Care 30:1290-1297
Mosley, Terrance; Khaketla, Moliehi; Armstrong, Heather L et al. (2018) Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012-2016. AIDS Behav 22:3550-3565
Card, Kiffer G; Lachowsky, Nathan J; Cui, Zishan et al. (2018) A Latent Class Analysis of Seroadaptation Among Gay and Bisexual Men. Arch Sex Behav 47:95-106
Roth, Eric Abella; Cui, Zishan; Wang, Lu et al. (2018) Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study. Am J Mens Health 12:1759-1773
Roth, Eric Abella; Cui, Zishan; Rich, Ashleigh et al. (2018) Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment. J Homosex 65:524-539
Card, Kiffer G; Armstrong, Heather L; Lachowsky, Nathan J et al. (2018) Belief in Treatment as Prevention and Its Relationship to HIV Status and Behavioral Risk. J Acquir Immune Defic Syndr 77:8-16
Card, Kiffer G; Armstrong, Heather L; Carter, Allison et al. (2018) A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men. Cult Health Sex 20:1424-1439
Card, Kiffer G; Armstrong, Heather L; Lachowsky, Nathan J et al. (2018) Patterns of Online and Offline Connectedness Among Gay, Bisexual, and Other Men Who Have Sex with Men. AIDS Behav 22:2147-2160

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