“While many communities in British Columbia are seeing a dramatic decline in HIV infections thanks to harm reduction and prevention programs, and advancements in diagnosis and treatment, the sub-population of gay and bisexual men is not experiencing this reduction,” said Kendall. “The aim of these recommendations is to renew the focus on prevention and treatment of HIV in this population, better address underlying causes of this epidemic, and work together to create meaningful decreases in HIV incidence and prevalence.”
This provincial health officer’s annual report titled “HIV, Stigma and Society: Tackling a Complex Epidemic and Renewing HIV Prevention for Gay and Bisexual Men in British Columbia” highlights the disproportionate number of new diagnoses among gay and bisexual men in B.C., and the lack of substantial improvements over the last 10 years compared to other exposure groups. In 2011, this group made up 57% of new HIV infections and 45% of all people known to be living with HIV in B.C.
“This report recognizes that HIV is a complex issue, and to prevent infections we need to shift our focus to the underlying drivers of the epidemic in our society, including the continued stigma related to both HIV and sexual orientation,” said Dr. Mark Gilbert, physician epidemiologist at BC Centre for Disease Control and co-author of the report. “This information and the recommendations provide a clear path to reduce HIV infection among gay and bisexual men in B.C.”
The report shows that some sub-populations among gay and bisexual men experience additional vulnerability based on age, ethnicity, and geographic location. For example, over the past ten years, there has been a steady increase among HIV diagnoses among gay and bisexual men born between 1980 and 1999, while the highest number of new diagnoses still occurs among those men born between 1960 and 1979.
“HIV infections have been reduced in some of the worst affected areas within Vancouver Coastal Health,” said Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health. ”The recommendations in this report will improve the overall health of gay and bisexual men, including a reduction in HIV infections.”
To better understand the HIV epidemic among gay and bisexual men, and renew related prevention initiatives, this report examines a series of drivers of the HIV epidemic within this population. Some of these include: awareness of HIV status, access to appropriate health-care, HIV treatment, systemic challenges to HIV prevention, marginalization, stigma, racism, sexual network patterns, sexually transmitted infections, and sexual behaviour.
While many personal variables affect whether HIV transmission ultimately occurs between two people, these drivers can only be fully understood by also considering the impacts of the broader community and societal influences.
“As someone who has devoted much of my professional life to helping raise awareness and reduce stigma surrounding HIV, I welcome a renewed focus on those affected in the gay community,” said Jesse Brown, executive director for YouthCO. “Supporting inclusive sexual health and harm reduction education and services for young gay men will help us achieve our collective goal of an AIDS-free generation in B.C.”
The report includes 15 recommendations from the advisory groups that were involved in the development of this report. The provincial health officer endorses all of these recommendations.
The provincial health officer also offers six priority recommendations for immediate action to reduce the epidemic of HIV among gay and bisexual men in B.C. including:
- The development of a comprehensive provincial health strategy for gay and bisexual men that addresses the drivers of poor health status, including HIV.
- The collaboration of the Ministries of Health and Education, regional health authorities, provincial education partners and other key stakeholders on the development of a comprehensive sexual and reproductive health education strategy for B.C.
- Using the From Hope to Health framework to develop a strategy to improve and expand access to timely HIV and sexually transmitted infection diagnosis, treatment and support for gay and bisexual men.
- As part of the Healthy Minds, Healthy People 10-year plan, develop a strategy to better meet gay and bisexual men’s health care needs related to mental health and problematic substance use.
- Ensure that prosecutorial guidelines incorporate the best available evidence on HIV transmission risk, and that prosecutorial decisions regarding criminal charges for possible transmission of HIV are based on an assessment of whether the desired social outcome (prevention of HIV transmission) could be achieved in the absence of prosecution.
- Support or initiate monitoring and research to identify changes in the population of gay and bisexual men, address gaps in understanding, and evaluate intervention programs, targets and approaches for implementing and expanding promising strategies for HIV prevention.
The report was developed in partnership with the BC Centre for Disease Control with input from two advisory groups that included gay and bisexual men and related service providers and organizations.