Gay, Lesbian, Bisexual, and Transgender Youth Suicide Problems in Australia and New Zealand?
To Index: Aboriginal / American Indian / First Nations Two-Spirit GLBTQ Information Pages  - A Suicide Focus
Results from more than 30 gay / bisexual male youth suicidality Studies
T-S, T-s: Two Spirit / Two Spirited
GLBTQ: Gay, Lesbian, Bisexual, Transgender, Queer
To Section Index

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Subject Index: GLBT Information in 21 Categories.

Vancouver's MSM Vanguard Cohort, Montreal's MSM Omega Cohort
& Vancouver's VIDUS Cohort (Injection Drug Users):
Aboriginal & Sexual Orientation Related Results...
Suicidality, Sexual Abuse, Sex Trade / Prostitution.



MSM: Men Who Have Sex With Men



Aboriginal Population Estimates: British Columbia
2001 Aboriginal HIV Estimates by Risk Groups

Category
Population
Estimate
Living With HIV
Estimate
All: Males / Females
170,025
Males: 935 (range 822-1,072)
Females: 756 (range 652-887)
Age 15 Years or More: Men / Women
117,317
1,691 (range 1,479-1,955)
1.26% to 1.66%
Injection Drug Users (All)
6,000
1,458 (range 1,202-1,744)
Injection Drugs Users (Vancouver)
3,000
726 ? (= 50% of 1,458)
Injection Drugs Users
(B. C. Minus Vancouver)
3,000
726 ? (= 50% of 1,458)
Gay / Bisexual Males
1,600
186 (range 145, 232)
Low Risk Men: 15-49 Years

16 (range 3-9)
Low Risk Women: 15-49 Years
23 (range 6-41)
Low Risk Men/Women: > 49 Years

6 (range 5-7)
Data Source: Hogg et al. (2005)
Note: North American Indians made-up the largest component of the population at 118,295 (70%), followed by Metis at 44,265 (26%), and Inuit at 800 (0.5%). The rest, 6660 (4%) were Aboriginals of other or multiple origin. The Greater Vancouver population was 36,855 with 10,440 living in the city.
Note: 25% if Injection Drug Users in British Columbia are Aboriginal.

Hogg RS, Strathdee S, Kerr T, Wood E, Remis R (2005). HIV Prevalence among Aboriginal British Columbians. Harm Reduction Journal, 24(2:26). PubMed AbstractFull Text. Full Text.


Vancouver Vanguard Cohort & Montreal Omega Cohort
MSM Males: "Attempted Suicide" Summary
Variable /
Study

All
Males
White
Non-
White
Aboriginal
1Non-
Aboriginal
Vancouver
Vanguard Cohort
Counts, Frequency in Percent (%),
Odd Ratio
(OR): Non-White vs. White
Attempted Suicide
Martindale et al. (1997)
30 / 190
15.8%
?
?
?
?
Attempted Suicide
Martindale et al. (1997)
37 / 203
18.2%
?
?
?
?
Attempted Suicide
Botnick et al. (2002)
67 / 345
19.4%
54 / 290
18.6%
13 / 55
23.6% (1.3)
?
?
Attempted Suicide
Ratner et al. (2003)
64 / 340
18.8%
?
?
?
?


Montreal
Omega Cohort






Attempted Suicide
Otis (2000)

227 / 629
36.1%
Lower2
Higher
Few
Counts3
?
Attempted Suicide
Le Clerc et al. (2002)

217 / 854
25.4%
?
?
Few
Counts3
?






1. Non-Aboriginal. For a Vanguard Project sample of 358 MSMs, Ratner et al (2003) reports: Caucasians = 260 (72.6), Aboriginal = 31 (8.7%), Asians = 33 (9.3%), Others (e.g., Middle East, Blacks, Hispanics) = 34 (9.5%)
2. Lower Includes Lowest for French Canadians and Higher for English Canadians
3. Weber et al (2002) reports that, out of 305 young MSMs in the Omega Cohort (16-30 years old), only one male was Aboriginal


Vancouver Vanguard Cohort & Montreal Omega Cohort
MSM Males: "Attempted Suicide" Summary

Independent Predictors or Likely Predictors for Having Attempted Suicide
All Age Categories for Sexual Abuse, More Sexual Abuse at Younger Ages
 (ORs, Unadjusted = 2.5 - 4.4) - (ORs, Adjusted = 2.6 - 3.7)
Braitstein et al. (2002): Controlling for Demographic Variables
All Age Categories for Sexual Abuse, More Sexual Abuse at Younger Ages
(ORs, Adjusted = 2.6 - 3.8)
Braitstein et al. (2006): Controlling for Demographic Variables
Social Support: Low vs. High (OR, Adjusted: 1.2<2.2<4.1 ) (OR, Unadjusted: Unknown)
Rosenberg Self-Esteem: Low/Moderate vs High (OR, Adjusted: 1.3<2.4<4.3) -
(OR, Unadjusted: 2.3<4.0<7.1)
Popper Use: Past year (OR, Adjusted: 2.0<3.7<6.9) - (OR, Unadjusted:1.3<2.3<4.1)
Botnick et al. (2002); Regression Analysis
Juvenile Prostitution? (OR, Unadjusted: 1.3<2.9<6.4)
Child Sexual Abuse? (OR, Unadjusted: 1.7<3.3<6.4)
Any Sexual Abuse / Assault(s)? (OR, Unadjusted: 1.9<3.4<6.0)
Ratner et al. (2003) No Regression Analysis



Vancouver Vanguard Cohort & Montreal Omega Cohort
MSM Males: Incidences For Sexual Abuse / Assault(s)
Variables /
Study

All
Males
White Non-
White
Aboriginal
(Odds Ratio)
1Non-
Aboriginal
Vancouver
Vanguard Cohort
Counts, Frequency in Percent (%),
Odd Ratio
(OR): Aboriginal vs. Non-Aboriginal
Sexual Abuse, Ever
Martindale et al. (1997)
51 / 203
25.0%
?
? ? ?
Sexual Abuse, < 18 Years
Martindale et al. (1997)
31 / 190
16.3%
? ? ? ?
Sexual Abuse, Ever
Heath et al. (1999)
225 / 658
34.2%
? ? 26 / 55
47.3% (1.8)
199 / 603
33.0%
Perpetrator Was a Relative
Heath et al. (1999)
68 / 659
10.3%
? ? 13 / 56
23.2% (3.0)
55 / 603
9.1%
Sexual Abuse < 12 Years
Heath et al. (1999)
12 /  681
16.4%
? ? 15 / 57
26.3% (1.9)
97 / 624
15.5%
Sexual Abuse < 12 Years
Botnick et al. (2002)
56 / 345
16.2%
? ? ? ?
Sexual Abuse 13-17 Years
Botnick et al. (2002)
37 / 345
10.7%
? ? ? ?
Sexual Abuse < 18 Years
Botnick et al. (2002)
93 / 345
27.0%
? ? ? ?
Sexual Abuse > 17 years
Botnick et al. (2002)
54 / 345
15.6%
? ? ? ?
Sexual Abuse, Lifetime
Botnick et al. (2002)
147 / 345
42.6%
? ? ? ?
Juvenile Prostitution = CSA - Ratner et al. (2003)
30 / 340
8.8%
? ? ? ?
Sexual Abuse < 14 Years
Ratner et al. (2003)
48 / 340
14.1%
? ? ? ?
Sexual Abuse > 13 Years
Ratner et al. (2003)
51 / 342
14.9%
? ? ? ?
Sexual Abuse, Lifetime
Ratner et al. (2003)
119 / 340
35.0%
? ? ? ?
Sexual Abuse, Lifetime
Braitstein et al. (2002)
131 / 482
27.2%
? ? 17 / 38
44.7% (2.3)
114 / 444
25.7%
Montreal
Omega Cohort

Roy et al. (2001a) 512 / 1,489
34.4%


Few
Counts2

Vancouver VIDUS: Injection Drug Users (Non-MSM & MSM) - Craib et al. (2003)
114 / 625
18.2%


23 / 103
22.3% (1.4)
91 / 522
17.4%
1.  Non-Aboriginal. For a Vanguard Project sample of 358 MSMs, Ratner et al (2003) reports: Caucasians = 260 (72.6), Aboriginal = 31 (8.7%), Asians = 33 (9.3%), Others (e.g., Middle East, Blacks, Hispanics) = 34 (9.5%)
2.  Weber et al (2002) reports that, out of 305 young MSMs in the Omega Cohort (16-30 years old), only one male was Aboriginal


Allman D (1999). M is for Mutual. A is for Acts. Male Sex Work and AIDS in Canada. Ottawa: Health Canada. Internet: http://www.walnet.org/members/dan_allman/mutualacts/MUTUALACTS.PDF.
"There is very little documentation or analysis of male sex workers from different ethnic backgrounds in Canada, and almost none on Aboriginal male sex workers, even though Aboriginal men have been found to make up significant proportions of samples of sex workers, street youth and injection drug users (211)."
Report on the Royal Commission on Aboriginal Peoples. Volume 1 to 5. Internet:  Contents. Volume 3 - Gathering Strength, Chapter 2 - The Family. Notes. Internet:  Notes & Contents.
"60. Gilchrist and Winchester quote an estimate by an agency worker in Vancouver that 70 per cent of the male prostitutes in a district known as ‘Boystown’ are Aboriginal. Gay males experience double discrimination: from Aboriginal people because of their homosexuality and from non-Aboriginal people because of their Aboriginal identity."  Gilchrist L, Winchester RA (1995). Kaøptõøtipis, eø-pimohteyahk [Urban Survivors], Aboriginal Street Youth: Vancouver, Winnipeg and Montreal. Research study prepared for RCAP: The Royal Commission on Aboriginal Peoples.
Gilchrist L, Winchester RA (1995). kapitipis e-pimohteyahk [Urban perspectives], Aboriginal Street Youth: Vancouver, Winnipeg and Montreal. Research study prepared for RCAP: The Royal Commission on Aboriginal Peoples. Internet Abstract: http://www.ihpr.ubc.ca/media/Gilchrist1995.pdf N/A. Based on Gilchrist L (1995). kapitipis e-pimohteyahk: Aboriginal street youth in Vancouver, Winnipeg, and Montreal. PhD Dissertation. The University of British Columbia. Full Text.
"The literature on street youth in general is growing, but a paucity of information exists on Aboriginal street youth experience in Canada, even though they are over-represented in the street youth population in most cities... The interviews suggest that Aboriginal street youth run to the streets for many of the same reasons as any other street youth, and once they get there their methods of survival are also somewhat the same as those of many runaways. Their cultural backgrounds, history, and structural conditions at point of origin are, however, different from non-Aboriginal street youth. These conditions make them subject to harsher conditions in state care situations (a common entry-point to street life) and on the street. Many experience overt racism, in addition to the stigmatization that street people encounter, in their everyday lives. The youth interviewed told of identity confusion and self-hatred, dislocation from home and surrogate parent communities, difficulty in reunification, and ignorance about Aboriginal rights, history and culture."


Vancouver Vanguard Cohort & Montreal Omega Cohort
MSM Males: Incidences For Sex Trade Involvement
Variables /
Study

All
Males

White  Non-
White 
Aboriginal
(OR)
1Non-
Aboriginal
Vancouver
Vanguard Cohort
Counts, Frequency in Percent (%),
Odd Ratio (OR): Aboriginal vs. Non-Aboriginal
Sex Trade, Ever
Heath et al. (1999)
165 / 681
24.2%
? ? 37 / 57
64.9% (7.2)
128 / 624
20.5%
Sex Trade, Last Year
Heath et al. (1999)
99 / 681
14.5%
? ? 30 / 57
52.6% (8.8)
69 / 624
11.1%
Sex Trade, Only Before
One Year Ago.

Heath et al. (1999)
66 /  681
9.7%
? ? 7 / 57
12.3% (1.3)
59 / 624
9.5%
Subgroup: Quit the Sex
Trade -
Heath et al. (1999)
66 / 165
40.0%
? ? 7 / 37
18.9% (0.27)
59 / 128
42.8%
Subgroup: In the
Sex Trade > = 1 Year

Heath et al. (1999)

99 / 165
60.0%
? ? 30 / 37
81.0% (3.7)
69 / 128
53.9%
Sex Trade, Ever
Botnick et al. (2002)
61 / 341
17.9%
? ? ? ?
Juvenile Prostitution:
< 18 Years = CSA
Ratner et al. (2003)
30 / 340
8.8%
? ? ? ?
Sex Trade, Ever
Schilder et al. (2001)
144 / 459
31.4%
? ? ? ?
Sex Trade, Last Year
Schilder et al. (2001)
80 / 459
17.4%
? ? ? ?
Sex Trade, Only Before
One Year Ago.

Schilder et al. (2001)
64 / 459
13.9%
? ? ? ?
Sex Trade, Ever
Weber et al. (2002)
139 / 628
22.1%
? ? ? ?
Sex Trade, Ever
Weber et al. (2001)
125 / 761 16.4% 72 / 540 13.3% 53 / 221
24.0%
36 / 72
50% (6.7)
89 / 689
12.9%
Montreal
Omega Cohort





Sex Trade, Ever
Age = 16 - 30 Years
Weber et al. (2002)
31 / 347
8.9%


Few
Counts1

Sex Trade, Ever:
Whole Sample

53.3% are > 30 Years Old -   Roy et al.
(2001a
314 / 1,489
21.1%


Few
Counts1

Vancouver VIDUS:Injection
Drug Users (Non-MSM & MSM) -
Craib et al. (2003)





Sex Trade, Ever
Craib et al. (2003)
53 / 625
8.5%
? ? 6 / 103
5.8% (0.62)
47 / 522
9.0%
1.  Weber et al (2002) reports that, out of 305 young MSMs in the Omega Cohort (16-30 years old), only one male was Aboriginal.



Martindale SL; Strathdee SA, Hogg RS; Cornelisse PGA, MSc; Miller ML,  Devlin B; Montaner JSG, O'Shaughnessy MV, Schechter MF (1997). Evidence of Psychologic Distress in a Cohort of Young Gay/Bisexual Men. Paper presented at the Canadian Association for HIV/AIDS Research, May 23, 1997. Internet: http://cfenet.ubc.ca/vanguard/papers_original/CAHR97Steve.html.

MSM = 203 Males.  Information obtained via questionnaires to 1997.

MSM Males, Elegibility Criteria: 18 to 30 years old at baseline, Living in Greater Vancouver area, Gay, bisexual and/or MSM, No previous positive HIV test result. "Eligible subjects who agree to participate are asked to complete an annual self-administered questionnaire and submit a blood sample for HIV antibody testing, for which they provide informed consent. The questionnaire includes demographics, sexual behaviour with regular and casual partners, sex-trade involvement, recreational drug use and psycho-social issues... This analysis focuses on the first 203 men who have completed follow-up questionnaires... 
As of April 97, follow-up questionnaires and test results had been completed by 203 participants. To date, the return rate for annual follow-up visits is 76%. The median time since the baseline follow-up visit was 13 months. Among the subgroup of 203 men, the median age was 27. Like the overall cohort, most were Caucasian (78%), and most reported not being in a primary relationship since their baseline visit (73%)."

Vanguard Project - Vancouver, B.C. - MSMs
Results at Follow-Up (N = 203 MSM Males)
 Median age of first "coming out":  19 yrs
 Comfortable with sexual orientation:  77%
 Domestic violence:  18%*
  Gay bashing:  11%*
  Sexual abuse
 25%*
  Suicidal ideation:  55%*
Attempted suicide:  18%*
Diagnosed mood disorder/mental disability:  22%*
Drug/alcohol treatment:  7%*
Data Source: Martindale et al. (1997)
* ever in lifetime



Vanguard Project - Vancouver, B.C.
Sexual HIV Risk-Takers (RT) vs. Non-Risk Takers (NRT)
 Variables (%N) n/N
For Variables
RTs
(n=55)
 NRTs (n=135)   P-value
 Non-white 22.1%
42 / 190
 33%
18 / 55
 18%
24 / 135
 0.01
 Sexual abuse < 18 16.3%
31 / 190
 23%
13 / 55
 13%
18 / 135
 0.08
 Domestic violence 17.4%
33 / 190
 30%
17 / 55
 12%
16 / 135
 0.004
 Gay bashing 12.6%
24 / 190
 20%
11 / 55
 10%
13 / 135
 0.04
Mental Health

 Suicide Attempts 15.8%
30 / 190
 25%
14 / 55
 12%
16 / 135
 0.02
 Suicidal ideation 52.6%
100 / 190
 60%
33 / 55
 50%
67 / 135
 0.21
 Mood/mental disorder 23.2%
44 / 190
  25%
14 / 55
 22%
30 / 135
 0.67
 High depression score 25.8%
49 / 190
30%
17 / 55
 24%
32 / 135
 0.37
 Low self esteem 27.4%
52 / 190
 31%
17 / 55
 26%
35 / 135
 0.48
Data Source: Martindale et al. (1997)

*Total: Not given by author. Calculated From RT & NRT Categories.

Relationship Between Being Sexually Abused
before Age 18 Years and Domestic Violence

 -  Sexually abused < 18
 YES  NO

 Domestic  violence

 YES  11 (31.4%)  23 (14%)
 NO  24 (68.6%)  142 (86%)

Chi-square p-value = 0.01
Sexual Abuse experienced before age of 18 years more than
doubles the risk (RR = 2.2) for experiencing domestic violence.
Almost triples the odds: Odds Ratio = 2.8, 95% CI: 1.2, 6.5



Heath KV, Cornelisse PG, Strathdee SA, Palepu A, Miller ML, Schechter MT, O'Shaughnessy MV, Hogg RS (1999). HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men. International Journal of STD and AIDS, 10(9): 582-7. PubMed Abstract. Draft of Paper:  Heath et al. (1999a). HIV-associated risk factors among young Canadian Aboriginal and non-Aboriginal men who have sex with men. Internet: http://cfenet.ubc.ca/vanguard/papers_original/IJSTDAIDSKate.html.

MSM = 681 Males. Information obtained via questionnaires to May, 1998.

Heath-99-aboriginal-non-aboriginal: demographic characteristics


Vanguard Project - Vancouver, B.C. - MSM Males
Aboriginal / Non-Aboriginal: Demographic Associations
Demographic
Attributes
All
n = 681
Aboriginal
n = 57
(8.4%)
Non-Aboriginal
n - 624
(91.6%)
Pearson's p &
Odds Ratios (95%CI)
Unstable Housing
63 / 680
9.3%
19 / 56
33.9%
44 / 624
7.1%
< 0.0000
6.8 (3.6, 12.7)
Income < $10,000

23 / 45
51.1%
159 / 624
25.6%

Income Assistance
132 /
??
102 / 624
16.3%

Unemployed
186 / 666
27.9%
28 / 56
50.0%
158 / 610
25.9%
0.0001
2.9 (1.6, 5.0)
Data Source: Heath et al. (1999), Table 1.



Heath-99-Aborigina-Non-Aboriginal-Risks


Vanguard Project - Vancouver, B.C. - MSM Males
Aboriginal / Non-Aboriginal: Psychosocial Attributes
Variables
n/N For
Variable
(%N)
Aboriginal
n = 57
(8.4%)
Non-Aboriginal
n - 624
(91.6%)
Pearson's p &
Odds Ratios (95%CI)
Forced Sex, Ever
225 / 658
34.2%
26 / 55
47.3%
199 / 603
33.0%
0.03
1.8 (1.0, 3.2)
Perpetrator is
a Relative
68 / 659
10.3%1
13 / 56
23.2%
55 / 603
9.1%
0.0009
3.0 (1.5, 5.9)
Forced Sex
Before Age 12
112 /  681
16.4%
15 / 57
26.3%
97 / 624
15.5%
0.036
1.9 (1.0, 3.6)
Age of First
Consensual Sex

14 Years
17 years
< 0.001


Sold Sex, Ever
165 / 681
24.2%
37 / 57
64.9%
128 / 624
20.5%
< 0.0000
7.2 (4.0, 12.8)
Sold Sex, Past Year
99 / 681
14.5%
30 / 57
52.6%
69 / 624
11.1%
< 0.0000
8.9 (5,0, 15,9)
Sold Sex Only Before
One Year Ago 2
66 /  681
9.7%
7 / 57
12.3%
59 / 624
9.5%
0.490
1.3 (0.58, 3.1)
Subgroup: Quit the
Sex Trade 2
66 / 165
40.0%
7 / 37
18.9%
59 / 128
42.8%
0.0029
0.27 (0.11, 0.66)
 2, 3 Subgroup:
Sex Trade > 1 Year
99 / 165
60.0%
30 / 37
81.0%
69 / 128
53.9%
0.0029
3.7 (1.5, 9.0)


Alcohol
> 20 Drinks/Week

58 / 681
8.5%
12 / 57
21.1%
46 / 624
7.4%
0.0003
3.4 (1.7, 6.8)
Data Source: Heath et al. (1999), Table 2.
1.  For a large random sample of 2,881 MSM males living in the largest American cities, Paul et al. (2001) reports a 35.3% lifetime incidence for sexual victimization, the incidence being 20.6% for sexual victimization having occurred/begun before the age of 18 years (CSA). It is also reported that the incidence for CSA involving a relative was 10.2%.
2. Variables were generated from the counts in the related variables reported on.
3.  This variable means selling sex in the past year and before one year ago.


Paul JP, Catania J, Pollack L, Stall R (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study. Child Abuse and Neglect, 25(4): 557-84.  PubMed Abstract.



Heath-99-Aboriginal-Non-Aboriginal-Sexual-Risks


Botnick MR, Heath KV, Cornelisse PG, Strathdee SA, Martindale SL, Hogg RS (2002). Correlates of suicide attempts in an open cohort of young men who have sex with men. Canadian Journal of Public Health, 93(1): 59-62. PubMed Abstract. Online PDF Draft of Paper.

MSM Sample = 345.
Information obtained via questionnaires to April, 1998.

Vanguard Project - Vancouver, B.C. - MSM Males
Attempted Suicide in Lifetime: Associations
Attempted Suicide = 67 / 345 = 19.4% (Part 1)
Variables
(Suicide Attempters
Missing/Lost)
n/N For
Variable
(%N)
Attempted
Suicide For
Variable
Attempted
Suicide
Others
Pearson's p &
Odds Ratios
(95%CI)
Non-Caucasian
55 / 345
(15.9%)
13 / 55
23.6%
54 / 290
18.6%
0.39
1.3 (0.68, 2.7)
Aboriginal
?
?
?
?
< High School Education 116 / 345
(33.6%)
32 / 116
27.6%
35 / 229
15.3%
0.0063
2.1 (1.2, 3.6)
Income: < $10,000 (3)
73 / 322
(21.2%)
24 / 73
32.9%
40 / 249
16.1%
0.0015
2.6 (1.4, 4.6)





Forced/Coerced Sex: < Age 12
56 / 345
16.2%
18 / 56
32.1%
49 / 289
17.0%
0.0085
2.3 (1.2, 4.4)
Forced/Coerced Sex: Age 12-17
37 / 345
10.7%
16 / 37
43.2%
51 / 308
16.6%
0.0001
3.8 (1.9, 7.9)
Forced/Coerced Sex: < age 18*
93 / 345
27.0%
34 / 93
36.6%
33 / 252
13.1%
< 0.0000
3.8 (2.2, 6.7)
Forced/Coerced Sex: >Age 17
54 / 345
15.6%
14 / 54
25.9%
53 / 291
18.2%
0.1882
1.6 (0.80, 3.1)
Forced/Coerced Sex:: Ever*
147 / 345
42.6%
48 / 147
32.6%
19 / 179
14.5%
< 0.0000
4.6 (2.5, 8.2)
Sex Trade, Ever
61 / 341
17.9%
21 / 61
34.4%
46 / 280
10.6%
0.0013
2.7 (1.4, 4.9)
Data Source: Botnick et al. (2002)
* Generated From Counts Given in Other Sexual Abuse Variables.


Vanguard Project - Vancouver, B.C. - MSM Males
Attempted Suicide in Lifetime: Associations
Attempted Suicide = 67 / 345 = 19.4% (Part 2)
Variables
(Suicide Attempters
Missing/Lost)
n/N For
Attribute
(%N)
Attempted
Suicide
Attribute
Attempted
Suicide
Others
Pearson's p &
Odds Ratios
(95%CI)
Social Support: Low vs. High*
?
?
?
< 0.001
Rosenberg Self-Esteem:
Low/Moderate vs High*
117 / 340
34.4%
41 / 117
35.0%
26 / 223
11.7%
< 0.0000
4.0 (2.3, 7.1)
Popper Use: Past year (1)*
97 / 342
28.4%
29 / 97
29.9%
37 / 244
15.2%
0.0022
2.3 (1.3, 4.1)





CES-D Depression:
Median Score

14
12
< .001
Mood Disorder / Mental Disability Diagnosis
72 / 341
21.1%
24 / 72
33.3%
43 / 269
16.0%
0.0010
2.6 (1.5, 4.7)
Psychiatric Ward, Ever (4)
16 / 322
5.0%
11 / 16
68.8%
52 / 306
17.0%
0.0000
10.7 (3.6, 32.2)
Detox Centre, Ever (6)
7 / 321
6 / 7
85.7%
55 / 314
17.5%
< 0.0000
28.2 (3.3, 239.4)
CAGE: Alcoholic vs. Others
95 / 342
27.8%
31 / 95
32.6%
36 / 247
14.6%
0.0001
2.8 (1.6, 4.9)





Sex Orientation Comfort: Not
Comfortable vs. Somewhat/Totally (3)
7 / 339
2.1%
3 / 7
42.9%
61 / 332
18.4%
0.1014
3.3 (0.73, 3.6)
Data Source: Botnick et al. (2002)
* Independent Predictors in Logistic Regression: Social Support: Low vs. High (OR: 1.2<2.2<4.1) - Rosenberg Self-Esteem: Low/Moderate vs High (OR: 1.3<2.4<4.3) - Popper Use: Past year (OR: 2.0<3.7<6.9)



Ratner PA, Johnson JL, Shoveller JA, Chan K, Martindale SL, Schilder AJ, Botnick MR, Hogg RS (2003). Non-consensual sex experienced by men who have sex with men: prevalence and association with mental health. Patient Education and Counseling, 49(1): 67-74.  PubMed Abstract. Full Text.

Vanguard Cohort Study Sampling Up To January 2000:"The Vanguard Project, started in May 1995, is an ongoing study of HIV rates and risk factors in young men who have sex with men in the Greater Vancouver area of British Columbia, Canada... Men with homosexual and bisexual behavior, aged 19–30 years, recruited through physicians’ offices, walk-in medical clinics, and community outreach, are eligible to participate if they have not previously tested HIV-positive, and if they self-identify as gay or bisexual, or have sex with other men. Participants complete self-administered questionnaires and agree to HIV testing on an annual basis. The analyses reported here are based on all participants who completed the questionnaire between January 1998 and January 2000 to permit a sufficient sample and consistency in data (i.e. same question format)... The study participants (N=358) ranged in age from 19 to 35 years (M=28.6; S.D.=3.6). Most (85.2%) had at least a high school education and most (89.3%) were employed. Their annual income, including funds from salaries, the sex trade, and drug trafficking, ranged from less than CAD$ 5000 to more than CAD$ 50,000 (median earned CAD$ 25,000—29,999). Almost all (96.1%) lived in stable housing (i.e. owned or rented) while the remainder lived in hotels, rooming houses, shelters, hostels, or on the street. The majority of the respondents described themselves as white (72.6%), as single and never married (70.6%), and 87.7% considered themselves gay or homosexual... One-half of the respondents (50%) were currently not involved in an intimate relationship."

MSM = 340 Males. Information obtained via questionnaires from January 1998 to January, 2000.


Vanguard Project - Vancouver, B.C. - MSM Males
Risk Related Odd Ratios: Attempted Suicide, Lifetime
Lifetime Attempted Suicide Incidence For MSM Males: 18.8%

-
N's in Yes / No
Categories
% Incidence
Attempted
Suicide
Odd Ratio For Having
Attempted Suicide
:
Unadjusted OR, 95% CI
Vanguard: suicide-attempt-csa-prostitution
Source: Ratner et al. (2003), Table 3, p. 71.
Lifetime Attempted Suicide Incidence = 18.8% (64 Suicide Attempters)

Juvenile Prostitution (< 18 Years): 30 / 340 = 8.8% (35 / 358 = 9.8%)
Childhood Sexual Abuse (< 14 Years): 48 / 340 = 14.1% (50 / 538 = 14.0%)
Adult Non-Consensual Sex (> 13 years): 51 / 342 = 14.9%  (51 / 358 = 14.2%)
Any Non-Consensual Sex: 119 / 340 = 35% (126 / 358 = 35.2%)
Estimate Differences Exist Because Some Did Not Answer "Attempted Suicide" Question.



O'Connell JM, Lampinen TM, Weber AE, Chan K, Miller ML, Schechter MT, Hogg RS (2004). Sexual risk profile of young men in Vancouver, British Columbia, who have sex with men and inject drugs. AIDS and Behavior, 8(1): 17-23. PubMed Abstract. Full Text.

Vanguard Cohort Study Sampling Up To September 2000: "Between May 1995 and September 2000, HIV seronegative MSM were recruited into an ongoing prospective study of HIV incidence and risk behaviors that has been previously described (Strathdee et al., 1998, 2000). In brief, men were eligible to participate if they were between 15 and 30 years of age at baseline, lived in the Greater Vancouver region, had not previously tested HIV-positive, and self-identified as gay/bisexual or as ever having had sex with other men. Participants were recruited through outreach at gay community events and community health clinics, local physicians, and the gay and mainstream media. Eligible participants were referred to local HIV testing clinics, the study’s research nurse, or their physician’s office, where they completed a confidential self-administered questionnaire and provided a blood sample for HIV antibody testing. Standard survey and testing techniques were used at each location to limit potential biases that might arise from differences between sites. Follow-up visits were conducted annually... Enrolment visit data collected from 910 participants were eligible for this analysis. Of these 910 MSM, 106 (12%) had injected drugs in the previous year and 804 (88%) had not. HIV serologic testing showed 9 of 106 MSM/IDU (8.5%) and 16 of 795 MSM (2.0%) were HIV-positive (p = .001). MSM/IDU were significantly younger, more likely to be Aboriginal, less educated, unemployed, living in unstable housing, and making less than $10,000 per year..."

Vanguard Project - Vancouver, B.C. - MSM Males
Injection Drug Use (IDU) in Past Year
Ethnicity
MSM
N = 910
MSM / IDU
n = 106
MSM, Non-IDU
n = 804
All
891
106 / 910 = 11.6%
804 / 910 =  88.4%
White - 71.2%
643
74 / 643 = 11.5%
569 / 643 = 88.5%
Aboriginal - 10.3%
92
20 / 92 = 21.7% 2
72 / 92 = 78.3%
Other - 17.5%
156
7 / 156 = 4.5%
149 / 156 = 95.5%
Non-Aboriginal - 89.7%
799
81 / 799 = 10.1%
718 / 799 = 89.9%
All 1 - 100%
891
101 / 891 = 11.3%
790 / 891 = 88.7%
Data Source: O'Connell et al. (2004). Calculation Based On Counts Given
1. All who supplied ethnicity information.
2. Walters (2006) reports that, to 2003, American Indian (AI) MSMs account for 73% of AI AIDS cases,  56% Non IDU users, and 17% IDU users. Therefore, 23.4% of AI MSM AIDS in the US are IDU users. Compare to Others, Aboriginal MSM are more at risk for IDU: 21.7% vs. 10.1% - RR = 2.1, 95%CI: 1.4, 3.3 - OR = 2.5, 95%CI: 1.4, 4.2 - p = 0.0008



Walters KL (2006). “My Spirit In My Heart”:  Identity Expressions and Challenges Among American Indian Two-Spirit Women - Mixed Methodology: The Honor Project -: Two-Spirit Health Study: 5-Year Multi-Site National Study 2002-2007. PowerPoint Presentation. Walters K, Evans-Campbell T, Simoni J, Ronquillo T, Bhuyan R ( 2006). “My Spirit in My Heart”: Identity Experiences and Challenges among American Indian Two-Spirit Women. Journal of Lesbian Studies, 10(2/3): 125-149. Abstract. Full Text.

Schilder AJ, Miller ML, Martindale S, Chan K, Weber A, Braitstein P, Spittal PM, Hogg RS (2001). Correlates of childhood sexual abuse in gay and bisexual men in Vancouver. Poster presentation at both the 10th Annual Canadian Conference on HIV/AIDS Research in Toronto in June 2001, and at the AIDS Impact conference in Brighton, England, in July 2001. Internet: http://cfenet.ubc.ca/vanguard/papers_original/CAHR01arn3.html.

MSM = 459 Males. Information obtained via questionnaires from September 1998 to October 2000.


Vanguard Project - Vancouver, B.C. - MSM Males
Child Sexual Abuse (CSA): Demographic Associations
Demographic
Attributes
CSA Incidence for
Demographic Attribute
CSA Incidence
Others
p
Aboriginal
16.5%
Non-Aboriginal
4.9%
< 0.001
Live Unstable Housing
17.9%
Stable Housing
7.6%
 0.001
Less Than High School Education
24.2%
> = High School
9.0%
< 0.001
Unemployed
38.4%
Employed
19.3%
< 0.001
Data Source: Schilder et al. (2001)



Vanguard Project - Vancouver, B.C. - MSM Males
Child Sexual Abuse (CSA) Associations
Variables
n/N For
Variable
(%N)
CSA
n = 166
36.3%
Non-CSA
n = 293
63.7%
Pearson's p &
Odds Ratios (95%CI)

Behaviors

Injecting Drugs (IDU),
Ever
69/ 459
15.0%
43 / 166
25.9%
26 / 293
8.9%
< 0.0000
3.6 (2.1, 6.1)
Injecting Drugs (IDU),
Past Year
52 / 459
11.3%
30 / 166
18.1%
22 / 293
7.5%
0.0006
2.7 (1.5, 4.9)
Injecting Drugs,
Only Before Past Year 1
17 / 459
3.7%
13 / 166
7.8%
4 / 293
1.4%
0.0004
6.1 (2.0, 19.1)
Subgroup
Quit Injecting Drugs
2
17 / 69
24.6%
13 / 43
30.2%
4 / 26
15.4%
0.165
2.4 (0.68, 8.3)
Subgroup: Injected
Drugs > 1 Year 1, 3
52 /  69
75.4%
30 / 43
69.8%
22 / 26
84.6
0.165
0.42 (0.27, 1.4)
Sold Sex, Ever
144 / 459
31.4%
82 / 166
49.4%
62 / 293
21.2%
< 0.0000
3.6 (2.4, 5.5)
Sold Sex, Past Year
80 / 459
17.4%
44 / 166
26.5%
36 / 293
13.3%
0.0001
2.6 (1.6, 4.2)
Sold Sex, Only Before
One Year Ago 1
64 / 459
13.9%
38 / 166
22.9%
26 / 293
8.9%
< 0.0000
3.0 (1.8, 5.2)
Subgroup
Quit Selling Sex 1, 4

64 / 144
44.4%
38 / 82
46.3%
26 / 62
41.9%
0.598
1.2 (0.61, 2.3)
Subgroup: Selling
Sex > 1 Year 1
80 / 144
55.5%
44 / 82
53.6%
36 / 62
58.1%
0.598
0.84 (0.43, 1.6)
Consensual Sex Before
The Age of 18 Years 2,  6
217 / 444
48.9%
113 / 151
74.8%
104 / 293
35.5%
< 0.0000
5.4 (3.5, 8.4)
Casual Sex Partner,
Last Year
2
344 / 436
78.9%
132 /. 153
86.3%
212 / 283
74.9%
0.005
2.1 (1.2, 3.6)
Regular Partner,
Last year
2
340 / 444
76.6%
119 / 157
75.8%
221 / 287
77.0%
0.774
0.94 (0.59, 1.5)
Life Events

Group Home, Ever 5 52 / 432
12.0%
38 / 152
25.0%
14 / 280
5.0%
< 0.0000
6.3 (3.3, 12.1)
Been In Detox Centre,
Ever
5
45 / 435
10.3%
31 / 155
20.0%
14 / 280
5.0%
< 0.0000
4.8 (2.4, 9.2)
Been in Psychiatric Ward,
Ever
5
20 / 425
7.1%
16 / 145
11.0%
14 / 280
5.0%
0.02
2.4 (1.1, 5.0)
Mood Disorder Diagnosis, Ever 5
128 / 447
28.6%
57 / 163
35.0%
71 / 284
25.0%
0.02
1.6 (1.1, 2.4)





Attempted Suicide, Ever  5??
Suicide Ideation??
248 / 458
54.1%
105 / 165
63.6%
143 / 293
48.8%
0.002
1.8 (1.2, 2.7)





Data Source: Schilder et al. (2001)
  1.  Categories Calculated by Author: Subtracting "Past Year" Counts from "Ever" counts.
  2.  MSMs who experienced CSA are not more likely to have quit injecting drugs.
  3.  Means in the past year and before that.
  4.  MSMs who experienced CSA were not more likely to have quit the sex trade.
  5.  Counts Estimated from Percentages Given. Therefore, the counts are close estimates.
  6.  For MSMs, having has consensual sex before the age of 18 would likely be a proxy for "Coming Out".  Seeking male sex partners before age 18, and also being involved in juvenile prostitution positions such adolescents males to more likely experience non-consenting sexual experiences


Multivariate Logistic Regression Model
Independent Predictors of Child Sexual Abuse
Predictors of Child Sexual Abuse
(< 18 Years)
Unadjusted
Odds Ratios
95%
CI
Adjusted
Odds  Ratios
95%
CI
Consensual Sex Before Age 18 Years 5.2
3.4, 8.1
4.6
2.9, 7.4
Been in a Group Home
6.3
3.3, 12.1
4.4
2.2, 8.9
Casual Partner, Past Year
1.9
1.3, 3.1
2.0
1.1, 3.6
Data Source: Regression Model Generated by Schilder et al. (2001), Table 3.



Weber AE, Craib KJ, Chan K, Martindale S, Miller ML, Schechter MT, Hogg RS (2001). Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. International Journal of Epidemiology, 30(6): 1449-54. PubMed Abstract. Discussion 1455-6.  Full Text.

Vanguard Cohort Study Sampling Up To September 2000: "The Vanguard Project is an ongoing prospective study of over 900 gay and bisexual men in the Greater Vancouver region. Men were eligible to participate if they were aged 18–30 years, lived in the Greater Vancouver region, had not previously tested HIV-positive, and self-identified as gay or bisexual or reported having sex with other men. Potential participants were recruited through community outreach at gay community events, community health clinics or local physicians, and through the gay and mainstream media... Of the 761 eligible participants, 126 (16%) reported that they were involved in sex work. Comparison of sex trade workers versus non-sex trade workers revealed significant differences with respect to socio-demographic characteristics... Sex trade workers were younger (median: 23 years versus 26 years, P < 0.001), more likely to be Aboriginal (29% versus 6%, P = 0.001), and to have less than a high school education (40% versus 12%, P < 0.001). Sex trade workers were more likely to report living in unstable housing (45% versus 4%, P < 0.001), to have an annual income of less than $10 000 (58% versus 26%, P < 0.001), and to have ever been in a psychiatric ward (32% versus 6%, P < 0.001). Further, sex trade workers were found to have a high depression score (82% versus 50%, P < 0.001) and to have ever been in jail (54% versus 6%, P < 0.001) compared with non-sex trade workers."

MSM = 761 Males. Information obtained via questionnaires to September 2000.

Vanguard Project - Vancouver, B.C. - MSM Males
Involvement in the Sex Trade
Ethnicity
MSM
N = 761
MSM: Sex Trade
n = 125
MSM, No Sex Trade
n = 636
All
761
125 / 761 = 16.4%
636 / 761 =  83.6%
White - 71.0%
540
72 / 540 = 13.3%
468 / 540 = 86.7%
Aboriginal - 9.5%
72
36 / 72 = 50%
36 / 72 = 50%
Other - 19.5%
149
17 / 149 = 11.4%
132 / 149 = 88.6%
Non-Aboriginal - %
689
89 / 689 = 12.9%
600 / 689 = 87.1%
Data Source: Weber et al. (2001). Calculation Based On Counts Given

Compared to Others, Aboriginal MSM are more like to be involved in sex trade: 50.0% vs. 12.9%
RR = 3.9, 95%CI: 2.9, 5.2 - OR = 6.7, 95%CI: 4.0, 11.3 - p = 0.0000
Aboriginal Males: 36 / 89 = 40.4% of Males Reporting Sex Trade.
McIntyre (2005), from a study of 37 young male prostitutes in Alberta,
reports that
54% of this population are of Aboriginal heritage



Braitstein P, Asselin J, Chan K, Li K, Schilder A, Spittal P, Tyndall M, Schechter MT, RS Hogg1 RS (2002). Differential patterns of sexual violence among men who have sex with men (MSM) versus injection drug using (IDU) men. Poster presentation at the 11th Annual Canadian Conference on HIV/AIDS Research, Winnipeg, Manitoba, April 25-28, 2002. Internet: http://cfenet.ubc.ca/vanguard/posters/PaulaPoster1.pdf..

Data Source:  - Sexual minority data, Vanguard Project, a prospective cohort of young gay and bisexual men in the Greater Vancouver area - 1999 to 2000 self administered survey. - Injection drug user data, Vancouver Injection Drug Users Study (VIDUS), a cohort of injection drug users in the Greater Vancouver area - interviewer-administered baseline questionnaire.

Analysis:  Age-specific analyses based on self-reported age at first incident were constructed as: (1) child sexual abuse (CSA) (aged less than 13 years), (2) adolescence (aged between 13 and 17), and (3) adulthood (aged 18 years or more). -- The data is reported separately for each cohort. -- Multivariate logistic regression was used to determine the magnitude of effect of sexual violence ever and in each age category on each outcome by entering into each model the age category of first sexual violence (and ever experiencing sexual violence) and all fixed sociodemographics (i.e. ethnicity and age and education baseline). The reference category for all regression analyses was never having experienced any sexual violence.

Vanguard Project - Vancouver, B.C. - MSM Males
Lifetime Sexual Abuse/Violence (CSA)
Ethnicity
n/N
(%N)
Sexual Abuse
n = 131
(27.2%)
No Sexual
Abuse - n = 351
(78.8%)
Pearson's p &
Odds Ratios (95%CI)
Aboriginal
38 / 482
(7.9%)
17 / 38
44.7%
21 / 38
55.3%

Non-Aboriginal
444 / 482
(92.1%)
114 / 444
25.7%
330 / 444
74.3%

CSA Risk: Aboriginal  vs. Non-Aboriginal
0.01
2.3 (1.2, 4.6)
Data Source: Braitstein et al. (2002). Data Intake: 1999-2000.



Vancouver Injection Drug Users Study (VIDUS):
Males -
Lifetime Sexual Abuse/Violence (CSA)
Ethnicity
n/N
(%N
)
Sexual Abuse
n = 173
(18.6%)
No Sexual
Abuse - n = 759
(81.4%)
Pearson's p &
Odds Ratios
(95%CI)
Aboriginal
659 / 932
(70.7%)
118 / 659
17.9%
541 / 659
82.1%

Non-Aboriginal
273 / 932
(29.3)
55 / 273
20.1%
218 / 273
79.9%

CSA Risk: Aboriginal  vs. Non-Aboriginal
0.46
  0.86 (0.60, 1.2)
Data Source: Braitstein et al. (2002). Data Intake: 1999-2000.


Vanguard Project & VIDUS: Most Significant Odd Ratios
For Lifetime Sexual Abuse/Violence Effects

Braitstein-02-odd-ratios-results
Data Source: Braitstein et al. (2002). Data Intake: 1999-2000.
   Note: Sexual Abuse Given for Lifetime (Ever), < 13 years, 13-17 Years, and 18+ Years
   Adjusted ORs on the Basis of Demographic Attributes.
   Results for Additional Health Risk Behaviors are Available in the Original Document.


Braitstein P, Asselin JJ, Schilder A, Miller ML, Laliberte N, Schechter MT, Hogg RS (2006). Sexual violence among two populations of men at high risk of HIV infection. AIDS Care.  18(7): 681-9. PubMed Abstract.

The Vanguard (MSM) & VIDUS (IDU) Cohort Studies
Sexual Abuse (SA) Incidences & Associations 1

N's
SA
< 13
SA
13-17
SA
> 17
SA
Age?
SA
> 12
SA
Ever
Non-
SA

Vanguard
All MSM
498
65 / 498
13.0%
23 / 498
4.6%
34 / 498
6.8%
18 / 498
3.6%
75 / 498
15.5%
140 / 498
28.1%
358 / 498
71.9%
Vanguard
Native
38





17 / 38
44.7%
21 / 38
55.3%
Vanguard
Non-Native 2
460





123 / 460
26.7%
337 / 460
73.3%
VIDUS
All
932





173 / 932
18.6%
759 / 932
81.4%
VIDUS: Non-MSM
IDU - All
852
92 / 852
10.8%
21 / 852
2.5%
11 / 852
1.3%
6 / 852
0.70%
38 / 852
4.5%
130 / 852
15.2%
722 / 852
86.8%
VIDUS: Non-MSM
IDU -
Non-Native 2
247





39 / 247
15.8%
208 / 247
84.2%
VIDUS: Non-MSM
IDU - Native
605





91 / 605
15.0%
514 / 605
85.0%
VIDUS: MSM
IDU - All
80
21 / 80
26.2%
11 / 80
13.7%
10 / 80
12.5%
1 / 80
1.25%
22 / 80
27.5%
43 / 80
53.7%
37 / 80
46.3%
VIDUS: MSM
IDU - Non-Native 2
27





16 / 27
59.3%
11 / 27
40.7%
VIDUS: MSM
IDU - Native
53





27 / 53
50.9%
26 / 53
49.1%
Data Source: Braitstein et al. (2006). Data Intake: 1999-2000.
     1. MSM: Men Who Have Sex With Men. - IDU: Injection Drug Users
     2. Generated from data given in other categories.



Vanguard Project & VIDUS: Most Significant Odd Ratios
For Lifetime Sexual Abuse/Violence Effects

Braitstein-06-odd-ratios-results
Data Source: Braitstein et al. (2006). Data Intake: 1999-2000.
   Note: Sexual Abuse Given for < 13 years, 13-17 Years, and 18+ Years
   Adjusted ORs on the Basis of Listed Demographic Attributes.
   Results for Additional Health Risk Behaviors are Available in the Paper.


Kuyper LM, Lampinen TM, Li K, Spittal PM, Hogg RS, Schechter MT, Wood E (2004). Factors associated with sex trade involvement among male participants in a prospective study of injection drug users. Sexually Transmitted Infections, 80(6): 531-5. PubMed Abstract. Full Text. Full Text
"Among the 995 male participants recruited into the VIDUS cohort between 1996 and 2003, the median age was 35 (interquartile range (IQR) 28–41), 191 (19% [119.2%]) were Aboriginal, 623 (63%) reported residing in unstable housing, 184 (19%) were HIV seropositive, and 108 (11%) reported being involved in the sex trade at enrolment." ... Males involved in the sex trade in this setting have higher levels of HIV infection {OR = 1.8} and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded.

"Overall, the 995 participants were seen a total of 8046 times during the follow up period and sex trade involvement was reported at 447 (5.6%) of these visits. The median number of follow up visits among this group was eight. During the follow up period, 102 (10%) individuals initiated sex trade involvement and 70 (7%) became HIV infected. When we examined the gender of sex trade clients, sex with men was reported at 348 (78%) of the visits and with women at 99 (22%) of the visits."

Craib KJP, Spittal PM,K Li K, Heath K, Laliberte N, Tyndall M, O’Shaughnessy MV, Schechter1 MT (2002). Comparison of HIV Incidence Rates Among Aboriginal and Non-Aboriginal Participants in a Cohort of Injection Drug Users in Vancouver. Internet Conference Abstract: http://www.pulsus.com/cahr2002/abs/abs315.htm.
"To compare cumulative HIV incidence rates among aboriginal and non-aboriginal participants in a cohort of injection drug users (IDUs).
Methods: The Vancouver Injection Drug User Study (VIDUS) is a prospective study of IDUs. This analysis was based on 941 participants (230 aboriginals and 711 non-aboriginals) who were recruited between 05/96 and 12/00.."  Aboriginal: 230 / 941 = 24.4%
"Aboriginal participants were significantly younger (33 vs. 35 years; p=0.017). The mean duration of self-reported injection drug use was similar in both groups (11.8 vs. 13.2 years; p=0.215). As of 12/01, 44 of 230 [19.1%] aboriginal participants had seroconverted compared to 68 of 711 [9.6%] non-aboriginals. After 44 months of follow-up, the cumulative incidence of HIV infection was significantly higher among aboriginal participants (19.9% vs. 10.2%; p<0.001). Cumulative incidence was significantly higher among male aboriginals compared to male non-aboriginals (19.4% vs. 9.2%; p=0.007). Cumulative incidence was significantly higher among female aboriginal participants compared to female non-aboriginals (20.2% vs. 9.4%; p=0.007)."
Craib KJ, Spittal PM, Wood E, Laliberte N, Hogg RS, Li K, Heath K, Tyndall MW, O'Shaughnessy MV, Schechter MT (2003). Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver. CMAJ: Canadian Medical Association Journal, 168(1): 19-24. PubMed Abstract. Full Text. Full Text.
"A total of 1437 participants were recruited and completed the enrolment questionnaire between May 1996 and December 2000. Of these, 941 were found to be HIV negative at enrolment and completed at least one follow-up visit during the observation period. Of the 941 participants, 230 (24.4%) were Aboriginal and 711 (75.6%) non-Aboriginal. Among the Aboriginal participants 101 (43.9%) reported being Aboriginal, 97 (42.2%) First Nations and 32 (13.9%) Métis. The proportion of participants who enrolled in 1996/97 was similar in the Aboriginal and non-Aboriginal groups (80% and 82% respectively; p = 0.87)."

"In summary, our findings show that the incidence of HIV infection among both male and female Aboriginal IDUs is twice that among non-Aboriginal IDUs and that risk factors among Aboriginal IDUs may vary by sex. Currently, British Columbia is developing a new AIDS strategy encompassing recommendations made by the BC Aboriginal AIDS Task Force.11 Our study highlights the urgent need for the rapid implementation of evidence-based prevention interventions that are planned and delivered in partnership with Aboriginal AIDS service organizations and the Aboriginal community."

Vancouver Injection Drug Users Study: VIDUS
Aboriginal/Non-Aboriginal Males
HIV-Negative At Study Enrolment
Variables
n/N
(%N) For
Variables
Aboriginal
n = 103
(16.8%)
Non-Aboriginal
n = 522
(85.2%)
Pearson's p &
Odds Ratios (95%CI)
Aboriginal vs. Others
Nonconsensual
Sex, Ever
114 / 625
18.2%
23 / 103
22.3%
91 / 522
17.4%
0.24
1.4 (0.81, 2.3)
Sex Trade
53 / 625
8.5%
6 / 103
5.8%
47 / 522
9.0%
0.29
0.62 (0.26, 1.5)
Data Source: Craib et al. (2003)

Note: For Aboriginal Males, OR for HIV seroconversion as related to Sex Trade = 2.7 (0.6–12.5)

Miller CL, Strathdee SA, Spittal PM, Kerr T, Li K, Schechter MT, Wood E (2006). Elevated rates of HIV infection among young Aboriginal injection drug users in a Canadian setting. Harm Reduction Journal, 3:9. PubMed Abstract. Full Text. Full Text.
Note: Males and Females Combined For Analysis. "Between May 1996 and May 2003, 1548 participants were recruited into the VIDUS study among whom there were 291 (19%) participants aged ≤24 years. Overall, 80 (27%) of the youth were Aboriginal and 211 (73%) were non-Aboriginal... there was no statistical difference between Aboriginal and non-Aboriginal youth with respect to age [median 16 (IQR: 14–18) vs. 17 (IQR: 15–19) respectively (p = 0.114)]; however, Aboriginal youth had, on average, been injecting longer [median number of years since first injection was 5 (IQR: 2–8) vs. 3 (IQR: 1–5)] than non-Aboriginal youth (p =< 0.001). Aboriginal youth were more likely to be female (OR: 2.22 [CI: 1.31–3.79]), report a history of sexual abuse (OR: 1.78 [CI: 1.06–2.99]), work in the sex trade (OR: 2.90 [CI: 1.70–4.94]), report a recent STI (OR: 1.73 [CI: 1.03–2.93]) and inject cocaine (OR: 2.00 [CI: 1.17–3.42]) and speedballs (OR: 2.07 [CI: 1.06–4.02]) on a frequent basis... In the multi-variable analysis that adjusted for all variables significant in the univariate analysis, independent associations with Aboriginal ethnicity were HIV positivity (OR: 2.54 [CI: 1.25–5.16]), HCV positivity (OR: 1.91 [CI: 1.00–3.65]), and sex trade involvement (OR: 2.08 [CI: 1.15–3.77])."

Weber AE, Chan K, George C, Hogg RS, Remis RS, Martindale S, Otis J, Miller ML, Vincelette J, Craib KJ, Masse B, Schechter MT, LeClerc R, Lavoie R, Turmel B, Parent R, Alary M (2001a). Risk factors associated with HIV infection among young gay and bisexual men in Canada. Journal of Acquired Immune Deficiency Syndromes, 28(1):1-8. PubMed AbstractFull Text.
"The Vanguard Project and the Omega Cohort are prospective cohort studies of gay and bisexual men ongoing in Vancouver and Montreal, respectively.... Men who were HIV-seropositive at baseline (n = 48) were more likely to report living in unstable housing, to have had less than a high school education, and to have been unemployed than those who were HIV-negative (n = 1325). HIV-positive men were also more likely to report having engaged in sexual risk behavior, including having had consensual sex at a younger age, having had at least 6 partners during the previous year, ever having been involved in the sex trade, and having engaged in unprotected receptive anal intercourse... Compared with HIV-negative men, men who seroconverted were more likely to report ever having been involved in the sex trade and engaging in unprotected receptive anal intercourse...."

The Vancouver Vanguard Project Cohort &
Montreal Omega Cohort Studies - MSM Males

Involvement in the Sex Trade / Baseline HIV Status
Variables
n/N
(%N) For
Variable
HIV -
n = 1,325
(97.3%)
HIV +
n = 48
(2.7%)
Pearson's p &
Odds Ratios (95%CI)
For Sex Trade Involvement
&
Becoming HIV +
Sex Trade
Involvement
344 / 1,350
25.5%
320 / 1,303
24.6%
24 / 47
51.1%
< .0000
3.2 (1.8, 5.8)*
Data Source: Weber et al. (2001a)
* "Multivariate logistic regression analysis was used to assess risk factors associated with HIV-positive serostatus (Table 4). For all men, having less than a high school education [OR = 2.2], history of cocaine use [OR = 2,2], and having ever been involved in the sex trade were independently associated with HIV-positive serostatus." OR For Sex Trade & Seroconversion = 2.08, 95% CI: 1.05, 4.00.


The Vancouver Vanguard Project Cohort &
Montreal Omega Cohort Studies - MSM Males

Involvement in the Sex Trade / HIV Seroconversion
Variables
n/N
(%N) For
Variable
HIV -
n = 1,325
(97.3%)
HIV +
n = 26
(2.7%)
Pearson's p &
Odds Ratios (95%CI)
For Sex Trade Involvement &
Becoming HIV +
Sex Trade
Involvement
333 / 1,329
25.1%
320 / 1,303
24.6%
13 / 26
50.0%
0.003
3.1 (1.4, 6.7) *
Data Source: Weber et al. (2001a)
" "After adjusting for cohort, analysis of baseline predictors of seroconversion revealed that for all men, having ever been involved in the sex trade was associated with a threefold increase in the odds of seroconversion (odds ratio [OR]  3.08, 95% confidence interval [CI]: 1.41–6.73)."


Weber AE, Otis J, Chan K, Lavoie R, Martindale S, Leclerc R, Miller ML, Turmel B, Craib KJP, Alary M, Schechter MT, Hogg RS (2002). Comparison of Sexual Risk Behavior Among Gay and Bisexual Men - A Two-City Comparison. Internet: http://cfenet.ubc.ca/vanguard/posters/AmyPoster3.pdf.

The Vancouver Vanguard Project Cohort &
Montreal Omega Cohort Studies
Young MSM Males - Age = 16-30 Years
Aboriginal,
Sex Trade & Bisexual Incidences
Variable
Vanguard Cohort
Omega Cohort
Aboriginal
67 / 618 =  10.8%
1 / 305 = 0.33%
Sex Trade
Involvement
139 / 628 = 22.1%
31 / 347 = 8.9%
Sex With Males & Females
In Previous Year
161 / 633 = 25.4%
54 / 359 = 15.0%
Data Source: Weber et al. (2002)


Remis RS, Alary M, Otis J, Mâsse B, Demers E, George C, Vincelette J, Turmel B, Lavoie R, LeClerc R, Parent R, Omega Study Group (2002). Trends in HIV incidence in the Omega cohort of men who have sex with men (MSM) in Montreal: October 1996 - February 2002. Presented at the Canadian Association of HIV/AIDS Research 11th Annual Scientific Conference, Winnipeg, Manitoba, April 25-28, 2002. Internet: http://www.phs.utoronto.ca/ohemu/doc/Pres023_HIVincOmega2002.ppt.
The OMEGA Study is a cohort of 2,000 seronegative gay men whom are following to better understand HIV transmission in Montreal. First participant was recruited in October 1996.
French Canadian = 1,332 (76.1%)
English Canadian = 138 (7.9%)
Others = 279 (16.0%)
Total = 1,749

Otis J (2000). Événements suicidaires chez les hommes gais.  Vis-à-vie, 10(2). Full Text.

Study Subsample of Omega Cohort (N = 1,749) = 629 MSM Males.

Montreal MSM Omega Cohort
Suicidality Results - N = 629 Males
Variable
Variable
Frequency
Incidence
Suicide
Ideation

Never
28.7%
Once
23.5%
2 to 5 Times
23.0%
6 to 50 Times
13.2%
More than 50 Times
11.6%
Any
71.3%



Attempted
Suicide?

No 63.9%
Once
21.4%
2 to 5 Times
11.0%
More Than 5 Times
3.7%
Yes
227 / 629
36.1%
More Than Once
14.7%
Data Source: Otis (2000)


Noted Characteristics For MSM Male Who Attempted Suicide
Mean Age of First Suicide Attempt = 20 Years Old
Mean Age of Last Suicide Attempt by Multiple Suicide Attempters = 27 Years Old.
Attempted Suicide Incidences are Higher For:
English Canadians or Others, compared to French Canadians. Incidences are not given.
Unemployed MSMs.
MSMs who inject drugs on a recurring basis.
MSMs who had engaged in prostitution in the past two years.
MSMs reporting sexual abuse/assault(s) in lifetime: 2-times more at risk for having attempted suicide.
Some Characteristics of MSMs Who Attempted Suicide:
More likely to feel isolated and alone in past 6 months.
Have felt distant from their families.
Have had difficulties having relationship with others.
Have more difficulties accepting their homosexual orientation.
Have more difficulties being "out" with others.
Multiple Suicide Attempters:
Are More likely to be less educated.
Have greater fears that others will discover their homosexual orientation.
Were more often victims of discrimination because of their sexual orientation.

Le Clerc R, Otis J, Lavoie R, Alary M, Turmel B, Vincelette J, Gaudreault M, Engler K, Remis R, Parent R, Mâsse B, Omega Study Group (2002). Sexual abuse, suicide attempts and psychological difficulties among men who have affective and sexual relations with men (MASM): A risky combination. Presentation at the Canadian Association of HIV/AIDS Research 11th Annual Scientific Conference, Winnipeg, Manitoba, April 25-28, 2002. Internet: http://cahr-acrv.ca/english/resources/abstracts_2002/abs/abs410.htm.
Analysis of 854 participants who had,  by August 31 2001, completed their fifth visit(T4) at Omega, a longitudinal study conducted in Montreal since 1996.
25.4% of MSMs reported having attempted suicide:  217 / 854
32.9% of MSMs reported past sexual abuse/assault(s).
11.9% of MSMs reported both past sexual abuse/assault(s) and having attempted suicide.
Logistic Regression Independent Predictors of MSMs reporting both past sexual abuse/assault(s) and having attempted suicide. They seemed to have suffered recurrently from:
Physical/emotional distance from loved ones (Odds Ratio: 2.65, 95%CI: 1.42-4.95)
Socio-economic insecurity/uncertainty about the future (Odds Ratio: 95%CI: 1.20-3.36)
Difficulties satisfying sexual/emotional needs on an interpersonal level (Odds Ratio: 2.12, 95%CI: 1.15-3.91)
Difficulties associated with their sexual orientation (Odds Ratio: 6.19, 95%CI: 2.03-18.16)
Emotional instability (Odds Ratio: 3.80, 95%CI: 2.39-6.01).
Predictors of Risky Anal Sex:
Having experienced both sexual abuse/assault(s) and attempting suicide (Odds Ratio: 1.98, 95%CI:  1.26-3.10)
Independent Predictors of Injecting Drugs:
Having Attempted Suicide (Odds Ratio: 2.64, 95%CI: 1.08-6.47)
Having experienced both sexual abuse/assault(s) and attempting suicide (Odds Ratio: 2.61, 95%CI: 1.02-6.64)
Independent Predictors of  Prostitution:
Having Attempted Suicide  (Odds Ratio: 2.58, 95%CI: 1.30-5.13)
Having experienced sexual abuse/assault(s) (Odds Ratio: 2.74, 95%CI: 1.51-4.95)
Having experienced both sexual abuse/assault(s) and attempting suicide (OR: 2.02, 95%CI: 0.94-4.35)

Roy JL, Zunzunegui MV, Vincelette J, Otis J, Alary M, Remis R, Lavoie R, LeClerc R, Masse B, Parent R, Turmel B, Gaudreault M, the Omega Study group (2001). Differences Between Omega Study Participants Who Have Received Drugs in Exchange for Sex and Those Who Have Only Received Money and/or Other Goods In Exchange For Sex: Characteristics and HIV Risk Behaviours
Presented at the Canadian Association for HIV Research Conference in 2001. AbstractPowerPoint Presentation.
Study based on 1,489 MSMs (as of September 30, 2000): 314 (21.1%) reporting having exchanged sex for money, goods, or drugs (PROS). Comparing those who exchanged sex for drugs (PROS-D = 97: 6.5%), to those who only exchanged sex for money or goods (PROS-ND = 217: 14.6%).

Result: "Among the prostitutes, the PROS-D are in a more difficult socio-economic situation.  For them, selling sex may be the only way to get the drugs they need.  The physical and psychological addiction to drugs can force these men to do some sexual behaviours that they would not normally do.  This could explain the broader range of sexual behaviours with clients and the higher proportion of non-gays in this group.  PROS-D have more HIV risk behaviours than the other PROS. "

Roy JL, Zunzunegui1 MV, Vincelette J, Otis J, Alary M, Remis R, Lavoie R, LeClerc R, Masse B, Parent R, Turmel B, Gaudreault M, the Omega Study group (2001a). Characteristics Associated With HIV Risk Behaviours and HIV Infection Among Omega Study Participants Having Received Money, Drugs, and/or Other Goods in Exchange For Sex. Presented at the Canadian Association for HIV Research Conference in 2001.  Internet: PowerPoint Presentation.

Study based on 1,489 MSMs (as of September 30, 2000):

The Montreal MSM Omega Cohort
Demographic & Risk Attributes
Variable
*All
N = 1,489
100%
Sex Trade
n - 314
21.1%
No Sex Trade
n = 1,175
78.9%
Pearson's p &
Odds Ratios
(95%CI)
> 30 Years Old
53.3%
51.3%
53.8%
0.91 (0.71, 1.2)
High School Education
 or Less
29.9%
46.2%
25.5%
2.4 (1.9, 3.2)
< $10,000 Income
28.5%
40.1%
25.4%
2.0 (1.5, 2.6)
Not Gay/Homosexual
Identified
18.7%
27.8%
16.3%
2.0 (1.5, 2.7)





Sexual Abuse/Assault(s),
Ever
512/1,489
34.4%
44.1%
31.8%
1.7 (1.2, 2.1)
Paying For Sex
21.7%
36.5%
17.7%
2.7 (2.0, 3.5)
With Male Prostitute
Perform Anal Sex
6.7%
15.4%
4.4%

With Male Prostitute
Perform Anal Sex
5.9%
11.3%
4.4%

With Female Prostitute
Perform Vaginal Sex
3.2%
7.7%
2.0%

With Female Prostitute
Perform Vaginal Sex
1.0%
3.7%
0.27%

Lifetime
> 5 female Sex Partners
9.4%
17.7%
7.2%
2.8 (1.9, 4.0)
Life, With Female
Performed Anal Sex
16.0%
27.3%
13.0%
2.5 (1.7, 3.7)
Last 6 Months
Female Sex Partner
12.2%
21.4%
9.8%
2.5 (1.6, 3.9)
Lifetime
Injection Drug Use

8.6%
22.3%
5.0%
5.5 (3.7, 7.9)
Hepatitis B
33.1%
53.4% 27.7% 3.0 (2.1, 4.4)
HIV-Positive
1.60%
4.6%
0.80
5.8 (2.5, 13.5)
Data Source: Roy et al. (2001a)
* Calculated from Two Other Percentages Given.



Vancouver's HIV/AIDS Related Projects, Prevention Efforts, and Studies


The Vanguard Project  - Website: http://cfenet.ubc.ca/vanguard/
"The Vanguard project is one of the largest and longest running behavioural and HIV seroincident studies of young gay and bisexual men in North America. The purpose of this study is to identify determinants of high-risk sexual behaviour and substance abuse and continue studies of HIV incidence among this cohort. Recruitment began in May 1995, and closed in 2002. Follow-up will continue until the first quarter of 2004. Nationally, the Centre has developed links with researchers in B.C. and in Montreal. Internationally, the Centre has collaborated with sites in Europe and Australia, as well as the first Phase III efficacy trial of a candidate HIV vaccine (AIDSVAX). The Centre currently has CIHR funding to conduct a sub-study on the prevalence, incidence and determinants of human papillomaviruses infection and anal canal cell dysplasia in men who have sex with men." Citation from http://cfenet.ubc.ca/content.php?id=20.

Vancouver Injection Drug User Study (VIDUS)
"VIDUS is an ongoing investigation of over 1,300 injection drug users in Vancouver that began 1996. VIDUS provides a means of tracking HIV incidence and prevalence among injection drug users over time. The study has also provided the information necessary to evaluate and recommend outbreak interventions for this high risk and traditionally under-serviced group." Citation from http://cfenet.ubc.ca/content.php?id=20.

CEDAR – Understanding HIV vulnerability in young Aboriginal drug users (A multi-disciplinary northern-southern collaboration)
The Centre recently determined the incidence of HIV infection among Aboriginal participants in VIDUS was twice that of non-Aboriginal counterparts. The Centre is currently undertaking studies focusing on young Aboriginal drug users to determine why these people are at particularly high risk of HIV infection and to develop strategies that reduce this risk." Citation from http://cfenet.ubc.ca/content.php?id=20.

Community Health and Safety Evaluation Project (CHASE) - Website: http://chase.hivnet.ubc.ca/project/database.htm

"The Vancouver Coastal Health Authority and its community partners have recognized the importance of an integrated health approach for marginalized persons located in Vancouver’s Downtown Eastside. VCHA has opened four new facilities designed to enhance health services for this community. These include:

  • Downtown Community Health Centre
  • Pender Community Health Clinic
  • The Contact Centre
  • The Life Skills Centre

Rigorous evaluation is imperative to establish which programs and strategies are truly achieving their goals of improving health and reducing drug-related harms. The overall purpose of the CHASE project is to determine the health impact of these new initiatives on the residents of the DTES. To date, the CHASE Project has enrolled over 2000 individuals residing in the DTES and will prospectively follow the uptake of community health and social services among these participants." Citation from http://cfenet.ubc.ca/content.php?id=20.


eSIS: Evaluation of Supervised Injecting Study
"The Centre has been enlisted to evaluate North America’s first medically supervised injection facility, located in Vancouver’s Downtown Eastside. The Evaluation of Supervised Injecting Study (eSIS) will review the impact of the facility over a three-year period. The Centre study will evaluate changes in HIV risk behaviour, overdose rates, addiction treatment and public injecting since the site opened in September 2003." Citation from http://cfenet.ubc.ca/content.php?id=20.
http://cfenet.ubc.ca/vanguard/publications.htm#Papers%20in%20Press%20(accepted%20for%20publication)
search cohort MSM HIV "attempted suicide"
http://www.vancouver.ca/fourpillars/pdf/report_vancouver_2005.pdf


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Subject Index: GLBT Information in 21 Categories.




More Information at: The Original Site on GB Male Suicide Problems