Effect of HAART expansion on community levels of HIV viral load and HIV risk behaviours among MSM in British Columbia

Chronic and Infectious Diseases

Population and Public Health

Recently the BC Ministry of Health endorsed expanding access to antiretroviral therapy (ART) as a strategy that could reduce the number of new HIV infections by reducing community infectivity levels. Guidelines have also been revised so that many more HIV-infected people may now access ART. The success of ART expansion in reducing new HIV infections might be affected if "ART optimism" causes higher levels of risk behaviour for HIV transmission. Men who have sex with men (MSM) remain the risk group most affected by HIV in Canada and BC. We wish to examine the impact of expansion of access to ART on risk behaviour among the MSM population in Greater Vancouver and on community HIV viral load as a marker of community infectivity. We will conduct two cross-sectional surveys of MSM, spaced over a 5-year period. The surveys will be designed to be representative of the ethnic and sub-cultural diversity of MSM in Greater Vancouver. We will sample 1000 MSM aged 15 years and over at each survey, using members of different sub-populations of MSM (seeds) to recruit a diverse group of MSM. All study participants will be asked to sign a consent form, complete a questionnaire, a rapid HIV blood test, syphilis test, hepatitis C serology, and to provide consent to allow researchers access to health services databases. HIV+ participants in the surveys will be invited to enroll in a longitudinal sub-study with follow-up at 6-month intervals that will examine the effectiveness of a peer-based treatment literacy intervention for increasing ART uptake among HIV+ men currently not on treatment, and on risk behaviour for HIV transmission. The study results will assist service providers and program planners to respond to potential increases in HIV risk behaviours. The results will also directly inform policy makers in Canada and other countries with regards to the added preventive value of ART and influence decisions regarding the further expansion of ART in industrialized countries.