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HIV diagnosis on first test and infection stage among HIV+ visible minority MSM in British Columbia
Jun 19, 2017 by Teddy Consolacion, Epidemiologist, Clinical Prevention Services, BCCDC
In Canada, it is estimated that one in five people living with HIV are unaware of their status. Although HIV infection rates continue to decline overall in British Columbia, the rates for men who have sex with men (MSM) remain unchanged. Over half of new HIV diagnoses are among MSM, and increasingly among MSM who identify as visible minorities (VM). Little is known about the burden of HIV on VM-MSM in BC.
The provincial Seek and Treat for Optional Prevention of HIV/AIDS program (STOP HIV/AIDS) aims to increase reach and engagement in HIV prevention, testing, linkage to care and treatment. A positive HIV diagnosis on a client’s first test along with an advanced stage of infection at diagnosis can help identify potential gaps in HIV prevention and testing.
To identify these potential gaps, we examined the burden of HIV on VM-MSM. In our study, MSM newly diagnosed with HIV between 2003 and 2015 were linked with their previous HIV testing data from the BC Public Health Laboratory. MSM were categorized based on self-identified ethnicity using Statistics Canada’s definition of VM as “persons, other than aboriginal peoples, who are non-Caucasian in race or non-white in colour”.
Logistic regressions were calculated to examine the odds of having an HIV positive diagnosis on first test, and being diagnosed in acute stage or advanced stage of infection, using VM status as a predictor. Poisson regressions were calculated with VM status to examine trends between last negative and first positive test (inter-test intervals).
The study included 1,963 males (median age = 38 years) who were newly diagnosed, who identified as MSM, and whose VM status was known.
MSM were more likely to be diagnosed on their first test prior to the start of the STOP HIV/AIDS program (see Results table on poster in Additional Resources). The recent expansion of routine testing has encouraged more regular HIV testing than before the STOP program.
Younger MSM were less likely to be diagnosed on their first test (i.e. young MSM were more likely to have a previous negative test on record) and more likely to be diagnosed in an acute stage of infection, partly due to routine testing.
VM-MSM had greater odds of being diagnosed HIV positive on their first test and being diagnosed at an advanced stage of infection.
Median inter-test interval for the sample was 17 months (IQR: 7-47 months). VM status did not significantly predict inter-test intervals, suggesting that once engaged in routine testing, testing patterns are the same between VM and non-VM groups.
These findings suggest that stronger relationships with VM-MSM communities are needed to encourage engagement in testing and to ensure early diagnosis and linkage to care.
This study was presented as a poster at the 2017 Canadian Association for HIV Research conference. You can view / download a PDF of the poster below, under Additional Resources.
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