Tag Archives: Canada

Delayed linkage to HIV care among asylum seekers

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Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, Canada. BMC Public Health 19, 1683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation

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The Journal of Sex Research, Shayna Skakoon-Sparling & Kenneth M. Cramer (2019) DOI: 10.1080/00224499.2019.1579888

ABSTRACT

Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process.

Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales.

Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies.

The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.

Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

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Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care

CTAC (Canadian Treatment Action Council), 2018

This project explored what issues impact engagement by people living with HIV with healthcare in Ontario. The goal was to identify policy issues that impact treatment access for people living with HIV, and to identify opportunities to make the healthcare system more accessible.

The HIV Cascade of Care is a useful description of the different steps that a person living with HIV will need to take in order to achieve an undetectable viral load and optimal health outcomes, from infection and diagnosis through to Antiretroviral Therapy (ART) initiation and viral suppression.

We know people drop out of the HIV Cascade of Care – e.g. why those starting treatment don’t stay on it. By seeking out policy barriers and developing solutions we can enable people to live long, healthy, and happy lives.

The project has five recommendations around barriers to engagement in the HIV Cascade of Care.

Download report here

 

Grey area: The fragile frontier of dementia, intimacy and sexual consent

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The Globe & Mail (Canada), July 14, 2018

Amid ever-widening cultural conversations about sexual consent, dementia remains uncharted territory. As Canadians live longer, more are moving into long-term care with advancing dementia disorders. It’s a growing population with complex needs, not least of all in their intimate lives.

In the close-quarters environment of nursing homes, these people’s sexuality poses difficult ethical dilemmas for staff and for families

 

Evidence-Informed Public Health: resources and information

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National Collaborating Centre for Methods and Tools (Canada), 2017

Evidence-Informed Public Health is the process of distilling and disseminating the best available evidence from research, context and experience, and using that evidence to inform and improve public health practice and policy.

Put simply, it means finding, using and sharing what works in public health.

Canada’s NCCMT has a range of tools and resources on Evidence-Informed Public Health,  from factsheets to online learning modules.

  • Access EIPH resources here 

What is “successful ageing” for people living with HIV?

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nam/aidsmap,  26 August 2017

When Canadian researchers asked HIV-positive people over the age of 50 how they would define “successful ageing”, six key themes emerged – accepting limitations, staying positive, maintaining social support, taking responsibility, living a healthy lifestyle, and engaging in meaningful activities.

Writing in the International Journal of STD & AIDS, Patricia Solomon and colleagues note the emphasis on individual control. Clinicians and service providers should work with people living with HIV to understand their values and aspirations and help them identify their personal goals, the researchers say.