Renewing HIV Prevention for Gay Men in British Columbia

Mark Gilbert, MD, FRCPCClinical Prevention Services

Presentation to BC Gay Men’s Health Summit

November 2013

• Provincial Health Officer will be releasing a report in 2014 entitled “The Current State of the HIV Epidemic among Gay and Bisexual Men in BC: Renewing HIV Prevention”

• Includes and endorses recommendations from Community and Public Health/Clinical Advisory Groups

Background

Number of new HIV diagnoses by exposure group, BC, 2003-2012

Conceptual approach

Key messages

• Is a complex epidemic, no simple solutions• Fundamental differences to other populations, and specific focus on

gay/bi men warranted• Not a uniform population but diverse social/sexual groups• Traditional public health response no longer sufficient: remain

essential strategies, but need more comprehensive, multi-level approaches

• Concerted, focused effort and partnership among government, health agencies, community organizations, researchers

• Gay/bi men first population affected, first to mobilize, with demonstrated resiliency in face of legacy of a devastating epidemic and social marginalization that continues to this day

• Gay/bi men need to be empowered and meaningfully involved in the continued response to the epidemic

Best practices for implementation

• Meaningful involvement & leadership by gay/bi men, which must involve HIV positive men

• Use positive, assets- or strengths-based approaches• Online program/outreach models which are linked to regional on-

the-ground services• Need for services specific to gay/bi men as well as working with

other sectors to improve reach and engagement of existing health services

• Tailored to the epidemiology of the epidemic, reflect regional differences, evolve over time in response

Sub-populations facing additional vulnerability

• HIV positive men• Aboriginal and Two-spirited men• Other ethnocultural minority men• Young gay and bisexual men• Men in suburban, rural and remote regions• Gay and bisexual men in active sexual networks

1. Recommendations at a Policy Level

• Develop, implement and monitor a provincial HIV prevention work-plan for gay and bisexual men in BC, integrated within the provincial STOP HIV/AIDS program

• Develop a long-term provincial health strategy for gay and bisexual men

2. Addressing individual and network level drivers

• Expand HIV testing to increase uptake and frequency of testing among gay and bisexual men, using targeted and routine approaches in a variety of settings

• Continue to support biomedical approaches to HIV prevention

• Promote sexual health by using a sexual health framework that goes beyond HIV, STIs and behaviour to incorporate physical, social and mental aspects of sexual health (e.g., relationships, intimacy, pleasure)

3. Addressing Community & Relationship Drivers

• Support central role of HIV-positive men in HIV prevention

• Implement regular, periodic health promotion and education campaigns for gay/bi men across BC

• Better meet the mental health and substance use needs of gay/bi men in BC

• Engage and support communities of Aboriginal, Two-spirited, and other ethnocultural minority gay and bisexual men to reduce disparities in health and HIV prevention

4. Addressing social and structural Drivers

• Improve the capacity of policies, programs and services within the BC health system to reduce existing health inequities for gay/bi men, in alignment with existing provincial policies for improving health equity and quality

• Support initiatives that aim to reduce stigma and discrimination associated with HIV at a societal level

• Promote positive mental health and wellbeing for gay and bisexual men of all ages by fostering safe and supportive environments

5. Monitoring, evaluation, and research

• Establish ongoing monitoring to identify changes in trends and population dynamics

• Address key gaps in research, both in terms of specific knowledge gaps as well as prioritization of research, related to HIV prevention for gay/bi men in BC

Acknowledgements

• My profound thanks for the support and thoughtful contributions of many people here today

• If you have any SFW images (photos, posters, campaigns) for the report please send them my way

mark.gilbert@bccdc.ca

Tel: 604-707-5615