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OBJECTIVES:Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care. METHODS:Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test. RESULTS:Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as "gay" or "queer" (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all).CONCLUSIONS: While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.

G ay, bisexual and other men who have sex with men (MSM) remain the population most heavily affected by HIV in Canada and British Columbia (BC). 1,2 MSM are thought to comprise 45% or more of the estimated 9,300-13,500 individuals infected with HIV in BC. 3,4 The number of new diagnoses of HIV among MSM in BC has remained largely unchanged since 2003, with approximately 150-180 new diagnoses each year. 4 We conducted an analysis from an HIV serobehavioural survey of MSM who attend community venues that cater to gay, bisexual and other MSM in Vancouver in order to determine the current state of HIV knowledge and HIV risk and preventive behaviours among this population. METHODS The Public Health Agency of Canada (PHAC) has developed a national enhanced surveillance system for HIV among MSM called M-Track. In Vancouver, M-track was called "The ManCount Survey" and was jointly designed and implemented by PHAC and local partner organizations. The study protocol was approved by the Research Ethics Boards of the University of British Columbia and Health Canada. Participants were recruited from August 1, 2008 to February 28, 2009 through venues that cater to gay, bisexual and other MSM. We used a time-space sampling recruitment methodology based on a two-stage sampling plan. This entailed the construction of a sampling frame of potential recruitment events at participating venues followed by developing a standardized process for sampling these events and venues. Men ≥18 years of age who reported ever having had sex with other men were offered enrolment in the study. Participants were excluded if they had previously completed the survey or were

Literature suggests formative research is vital for those using respondent-driven sampling (RDS) to study hidden populations of interest. However, few authors have described in detail how different qualitative methodologies can address the objectives of formative research for understanding the social network properties of the study population, selecting seeds, and adapting survey logistics to best fit the population. In this paper we describe the use of community mapping exercises as a tool within focus groups to collect data on social and sexual network characteristics of gay and bisexual men in the metropolitan area of Vancouver, Canada. Three key themes emerged from analyzing community maps along with other formative research data: (a) connections between physical spaces and social networks of gay and bisexual men, (b) diversity in communities, and (c) substance use connected with formation of sub-communities. We discuss how these themes informed the planning and operations of a longitudinal epidemiological cohort study recruited by RDS. We argue that using community mapping within formative research is a valuable qualitative tool for characterizing network structures of a diverse and differentiated population of gay and bisexual men in a highly developed urban setting.

We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.