Research

Current and previous research projects undertaken in the HIV Studies Unit explore: prevalence and predictors of HIV and hepatitis C; stigma and discrimination; socio-behavioural dynamics of HIV/AIDS in ethno-racial and immigrant populations; cultural and ethno-cultural aspects of health and sexuality; service providers perspectives on and experiences with HIV; quality of life among people with AIDS; sexuality; drug use.

Prevention, Care, and Support for Vulnerable Populations at Risk of HIV/STI in Shanghai, China:
Principal Investigator: Liviana Calzavara
Teasdale-Cordi, Global Health Research Partnership Program, 2007-2012

Male-Call Canada: An in-depth study of current and emerging issues, and the changing social and behavioural determinants related to HIV transmission among men who have sex with men.
www.malecall.ca

Principal Investigator: Ted Myers
Canadian Institutes of Health Research, 2006-2013

While a significant number of new HIV infections continue to occur among men who have sex with men in Canada, there is a dearth of in-depth and current Canadian data on the social situation, sexual attitudes and knowledge, and the contexts and men’s understanding of risk behaviours related to HIV. This study developed from a national research needs assessment, entitled “The 2005 Sexual Health Promotion Research Needs Assessment for Men Who have Sex with Men in Canada”. The major goal of Male Call Canada is to conduct a cross-sectional nation-wide toll-free telephone survey to gather self-reported information on a broad spectrum of HIV behaviours and related social and behavioural determinants and issues for men who have sex with men in Canada. Through this study, we hope to provide an in-depth understanding of the determinants and current issues related to behaviour and HIV infection for Canadian men who have sex with men; to develop an understanding of variations between provinces (and metropolitan vs. smaller cities) in behaviours, HIV knowledge and factors that contribute to these variations; to develop an understanding of variations among different subgroups of men; to determine trends and changes in patterns of behaviour and HIV related issues affecting men who have sex with men in Canada, through comparison with previously conducted surveys and by examining current attitudes and behavioural responses (to provide, where possible, community-level data to participating communities to help shape future prevention programming and other services).

Sexual Health and Attitudes Research Project (SHARP): Mechanisms of action
Principal Investigator: Trevor Hart
Canadian Institutes of Health Research, 2005-2007

This 4-year study, funded by the Canadian Institutes of Health Research, is the main study in the HIV Prevention Lab. The SHARP study, now in Year 2, examines how developmental events, psychological distress, and health-related attitudes are associated with sexual behaviour among HIV-positive and HIV-negative men who have sex with men (MSM). The goal of the study is to explore mechanisms by which different forms of psychological distress impact upon condom use or lack thereof during sexual intercourse. Data gathered in the study will be relevant to developing programs for preventing HIV transmission to uninfected sexual partners and to protect the health of both HIV-positive and HIV-negative MSM. Data collection is currently underway.

Understanding HIV/AIDS Issues in East African Communities in Toronto: A Survey of Health-related Behaviours, Beliefs, Attitudes and Knowledge
Principal Investigator: Liviana Calzavara
Ontario HIV Treatment Network, Public Health Agency of Canada, 2003-2007

This study was designed to address the lack of information on HIV in African immigrant communities in Ontario. Limited data suggest that rates of HIV infection are higher in these communities than in the general population, and that cultural differences may be a barrier to prevention, HIV testing, and treatment programs. The overall goal of the study is to understand a range of HIV/AIDS issues and concerns in the context of general health problems and attitudes present in these five East African communities in Toronto. Specifically, the objectives are: (1) to describe community beliefs and individual attitudes towards health and HIV/AIDS; (2) to assess knowledge of and sources of information for HIV/AIDS; (3) to describe risk factors and behaviour related to HIV; (4) to measure attitudes towards and use of health care services, health screening, and HIV testing; and (5) to measure the prevalence of HIV infection and other health-related problems. Information gathered through the study will assist in the promotion of long-term public health policy, leading to better programs to reduce HIV transmission and improve care and treatment for those infected with HIV. Information will also be useful for those planning, developing and delivering programs to ensure that programs are suitable, flexible and culturally sensitive. Finally, the study will provide an opportunity for the communities to openly discuss the topic of HIV/AIDS.

Polaris HIV Seroconversion Study: Understanding the Evolution and Impact of HIV Infection
http://www.hivpolaris.org/

Principal Investigator: Liviana Calzavara
Ontario HIV Treatment Network, Canadian Institutes of Health Research, AIDS Bureau, Ontario Ministry of Long-term Care, National Health Research Development Program, 1997-2008

The Polaris HIV Seroconversion Study, initiated in 1998, is a model of integrated research bringing together clinical, basic science, social, epidemiologic, and community researchers, allowing for a more comprehensive understanding of seroconversion from a broad range of perspectives. The research aims to understand factors associated with seroconversion, impact of serostatus, new trends in incident cases and rates of infection, prevalence of viral subtypes and drug resistant strains, the clinical course of early HIV infection, and the effect of early treatment. To accomplish these objectives, an open cohort of documented recent seroconverters (projected n=375) and two matched HIV-negative controls per case (projected n=750) are enrolled and followed over time. Eligible participants are identified at the Public Health Laboratory, Ontario Ministry of Health (PHLS) or secondary sources of recruitment including anonymous test sites, community-based organizations, the Internet, and the media. A quantitative interview is conducted at enrollment and every six months thereafter. Qualitative interviews are conducted with a purposive sample of participants. Blood samples from cases are obtained and medical chart extractions are performed at baseline and every three months thereafter. Samples are assessed to determine viral load, viral subtype, drug resistance mutations, and HIV-specific immunity. Analyses include descriptive, cross-sectional, and longitudinal methods. Secondary analysis of the PHLS HIV testing database are used for population-based analyses. The integration of components encourages satellite and collaborative studies, and minimizes the burden on the study population. Preliminary findings have already made substantial contributions in the areas of rates of new infections, qualitative factors affecting seroconversion, patterns of unsafe sex in bathhouses, factors affecting treatment uptake, characteristics of HIV subtypes and drug resistance patterns, impact of serostatus and the role of HIV testing. Polaris is the only interdisciplinary study of an open cohort of recent seroconverters and controls in Canada or internationally. It creates the opportunity for additional satellite studies and collaboration, and reduces the burden on the study population by reducing the number of studies competing for their participation.

Rehabilitation Services for People Living with HIV/AIDS: Experiences & Responses of People from African and Caribbean Communities Living in Toronto
Principal Investigator: Ted Myers and Cathy Worthington
Canadian Institutes of Health Research, 2003-2007

The course of conditions and diseases associated with HIV infection are continually changing. Since the introduction of highly active antiretroviral therapy (HAART) in 1996, people living with HIV/AIDS (PHAs) are living longer. HIV disease is increasingly perceived as a chronic, long-term condition rather than a terminal illness. This increased chronicity is mirrored by the increasing prevalence of disability among PHAs, and an increased role for rehabilitation. In Canada, rehabilitation in the context of HIV disease is at a formative stage. It is critical that baseline information on the understandings and state of rehabilitation in the context of HIV be collected in order to foster cooperation across health care professional groups, HIV/AIDS organizations, PHAs, sectors of government and private industry, and academe. A pilot study to begin to document the prevalence of impairments, disabilities, and handicaps among PHAs in Canada had been conducted; however, no complementary work had been performed to investigate rehabilitation in the context of HIV from a service provider perspective. The purpose of this descriptive and exploratory study was to investigate the knowledge, attitudes, and, in particular, practices of selected health care provider groups concerning rehabilitation services for PHAs in order to provide baseline data to inform program and policy development.

HIV/AIDS Stigma, Denial, Fear and Discrimination: Experiences & Responses of People from African and Caribbean Communities Living in Toronto
Principal Investigator: Liviana Calzavara
AIDS Bureau, 2004-2007

This study sought to understand the role of stigma, denial, discrimination and fear associated with HIV/AIDS among people who live in Toronto from three sub-Saharan African countries (Ethiopia, Somalia and Kenya) and three Caribbean countries (Jamaica, Trinidad and Guyana). This qualitative study employed in-depth interviews and focus groups with members of these communities who are either infected with HIV, at risk for HIV or of unknown risk. In addition, working groups were held with key stakeholders from the communities (religious, political leaders) and key stakeholders in the areas of health, human rights and immigration. Members of African and Caribbean communities were involved at all levels of research and decision-making with this study. They were included in the research team and in the Advisory Committee that guides and informs the research project. They acted as interviewers/focus group facilitators and as participants in the study. Their experiences, views and observations comprised the research data that will direct the actions and recommendations derived from the study. Study results were presented to members of participating communities through community forums.

A Study of the Prevalence and Determinants of HIV/STI’s and Risk Behaviours in Nigerian Men:
Principal Investigator: Ted Myers
Canadian Institutes of Health Research, 2005-2006

Sub-Saharan Africa remains the region most affected by HIV/AIDS with almost two-thirds of the world’s total number of persons living with the disease. No previous studies in SSA have measured the HIV prevalence, patterns of sexual activity among men who engage in same-sex relationships, and the determinants of risk behaviour and infection. In collaboration with members of the Alliance Rights of Nigeria, an organisation of men who have sex with men, this study will examine the patterns of male same-sex sexual activity and its potential role in HIV and STI acquisition in Nigeria. The specific objectives of this study are to characterize the socio-demographic characteristics, self-reported sexual identity, partner preferences and sexual behaviours among Nigerian men who have sex with men; to determine the prevalence and patterns of high-risk sexual behaviours among Nigerian men who have sex with men and to identify the factors that may be associated; to determine the prevalence and incidence of HIV-1, HIV-2, chlamydia, gonorrhoea, and syphilis and to identify the risk factors that may be associated with HIV, and coinfections among Nigerian men who have sex with men; to explore whether there is an association between stigma (from family, health care providers and community) experienced by Nigerian men who have sex with men and HIV infection.

Prevalence and Predictors of HIV and Hepatitis C in Ontario Jails and Detention Centres:
Principal Investigator: Liviana Calzavara
Priorities Initiative Program, Ontario HIV Treatment Network, Ontario Ministry of Health, 2002-2006

Canadian Harm Reduction Conference Needs Assessment and Evaluation:
Principal Investigator: Dan Allman
Health Canada, 2002-2003

Dual Risk for HIV: Drug Use and Sexual Behaviour among MSM in Toronto
Principal Investigator: Ted Myers
Ontario HIV Treatment Network, 2000-2003

This was a two-phase study. The first consisted of a developmental component and a cross-sectional survey. The second phase consisted of a longitudinal diary study. Methods used in the developmental component included a small number of qualitative interviews to refine the quantitative face-to-face interview schedule for phase I and the event-based diary for phase II. Participants eligible for phase II, were asked to complete, biweekly, five structured diaries for the purpose of collecting event-based data to describe situational and contextual variables that may mediate substance use and sexual risk-taking behaviour. The event-based diary also provided contextual data to examine the meaning surrounding substance use and sexual behaviour of MSM in Toronto. In relevance to the mission and objectives of OHTN, this study addressed emerging issues of HIV infection, though its focus on the dual risk category, MSM/IDU. This risk group continues to constitute an increasing proportion of new HIV infections in Ontario and no study to date in Canada has specifically focused on MSM/IDU’s. Further, this study addressed issues surrounding MSM drug use, sexual behaviour and HIV risk; described the spectrum of MSM drug use, patterns of use and the development of drug use, (drug taking careers); as well as identified the prevalence of different patterns of drug use among a subsample of MSM in Toronto.

HCV Infection and co-infection with HIV in an Ontario-wide sample of gay and bisexual men: Prevalence, geographic patterns and associations with sexual and drug using risk behaviours
Principal Investigator: Ted Myers
Canadian Institutes of Health Research

This study took advantage of a unique opportunity to learn more about the prevalence of Hepatitis C (HCV) infection among gay and bisexual men, to compare known diagnosed cases (those identified in the self-report data) to laboratory test data of the saliva sample, and to examine the extent of co-infection with HIV. The research was conducted on a difficult to identify and research population, namely gay and bisexual men in Ontario will provide the unique opportunity to utilize both behavioural data and biological specimens to further understanding of HCV infection. The purpose of this study was to better understand the extent of HCV infection with a diverse population of gay and bisexual men in Ontario and to explore a variety of predictors of infection. Specifically, the study conducted analyses to determine the prevalence of HCV infection in a diverse sample of gay and bisexual men in Ontario; to determine the extent of undiagnosed infection through a comparison with reported HCV status; to determine the extent of HCV and HIV co-infection in this community sample; to examine the distribution of HCV infection with geographic region of the province, age, sexual and drug injection behaviour, and social groups.