Background and ObjectivesOver the past few years in Qu & eacute;bec, Canada, exclusion criteria for blood donation and plasma donation for fractionation have been modified. H & eacute;ma-Qu & eacute;bec, the institution responsible for blood products, has made changes to allow more inclusive access to blood and plasma donation, in accordance with evolving scientific data concerning donation safety. The study, conducted before those changes were implemented, aimed to assess acceptability of recipients and parents of recipients of plasma-derived products for men who have sex with men (MSM) to become eligible to donate plasma for fractionation.Materials and MethodsEight qualitative interviews (4 focus groups, 4 individual) were conducted with a total of 17 plasma product recipients and parents of children needing plasma-derived products. Data were analysed using thematic analysis.ResultsParticipants were rather favourable regarding acceptability of MSM as potential donors. Participants viewed this change as necessary and beneficial. They also felt they must rely on trust in H & eacute;ma-Qu & eacute;bec, conferred automatically or by default. However, some participants raised concerns about donation safety and reported feeling helpless regarding inclusion of MSM. The importance of being informed and that recipients' safety be prioritized first and foremost were also mentioned.ConclusionDespite their nuanced attitudes, recipients showed high levels of acceptability of including MSM in plasma donation for fractionation. Actions can be taken to reduce concerns regarding the safety of products received.

In Canada, the highest increases in rates of sexually transmitted infections (STIs) and substance use disorders occur among emerging adults aged 18 to 29 years old. Most research on risk-taking behaviors have focused on adolescents or males only—especially gay and bisexual men. This study aimed to assess patterns of sexual and substance use risk-taking behavior (i.e., early sexual onset, number of sexual partners, inconsistent condom use, unconventional sexual behaviors, binge-drinking, and polysubstance use); investigate whether sociodemographic and individual characteristics predict risk-taking profiles; and examine whether risk-taking profiles are associated with differential health outcomes (i.e., STI testing and diagnosis, substance use problems). Latent class analyses were conducted on a sample of 602 heterosexual French-Canadian emerging adults (84% female; M age = 22.3) who completed an online questionnaire. Four profiles were identified: inactive low-risk (13.5%), active low-risk (34.7%), mid-risk (42.3%), and high-risk (9.5%). The two higher risk-taking profiles were overrepresented by older participants, females, and impulsive sensation seekers. Participants in the mid- and high-risk profiles had higher odds of having been screened for and been diagnosed with STIs, and of reporting more substance use problems.

BACKGROUND:In 2021, Canada implemented a pilot plasma program allowing some sexually active men who have sex with men (including but not limited to gay and bisexual men; gbMSM) to donate plasma. Changes to plasma donation policy could help address inequities in access to plasma donation and increase Canada's domestically collected plasma supply if more gbMSM donate as a result. We aimed to (1) examine views regarding plasma donation and the pilot program prior to implementation and (2) identify modifiable theory-informed predictors of gbMSM's intention to donate plasma.METHODS:We developed, piloted, and disseminated a questionnaire informed by the Theoretical Domains Framework (TDF). We recruited gbMSM in London (ON) and Calgary (AB) to an anonymous, online cross-sectional survey.RESULTS:A total of 246 gbMSM completed the survey. On scales from 1 (strongly disagree) to 5 (strongly agree), general intention to donate was high (mean = 4.24; SD = 0.94). The pilot program itself was mostly acceptable (mean = 3.71, SD = 1.16), but the intention to donate under the unique requirements of the pilot program was lower than general intention (mean = 3.58; SD = 1.26). Two domains from the theoretical domains framework (TDF) (beliefs about consequences of donating plasma and social influences) were independently associated with general intention to donate.DISCUSSION:The pilot plasma program as an incremental step toward more inclusive policies was mostly viewed as acceptable by the impacted communities. Historical and ongoing exclusions create unique barriers to donation. There are clear opportunities for developing theory-informed interventions to support gbMSM to donate plasma as policies continue to become more inclusive and more become eligible to donate.

Abstract Introduction HIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021. Methods We used an agent‐based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID‐19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual‐level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post‐exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free‐of‐charge), and improving retention. Results Over 2013–2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3–0.6) to 0.2 (90% CrI: 0.1–0.2) per 100 person‐years. PrEP coverage among HIV‐negative MSM remained low until 2015 (<1%). Afterwards, coverage increased to a maximum of 10% of all HIV‐negative MSM, or about 16% of the 62% PrEP‐eligible HIV‐negative MSM in 2020. Over 2015–2021, PrEP averted an estimated 20% (90% CrI: 11%–30%) of cumulative HIV acquisitions. The hypothetical scenarios modelled showed that, at the same coverage level, prioritizing PrEP to high sexual activity MSM could have averted 30% (90% CrI: 19%–42%) of HIV acquisitions from 2015‐2021. Even larger impacts could have resulted from higher coverage. Under the provincial eligibility criteria, reaching 10% coverage among HIV‐negative MSM in 2015 and 30% in 2019, like attained in Vancouver, could have averted up to 63% (90% CrI: 54%–70%) of HIV acquisitions from 2015 to 2021. Conclusions PrEP reduced population‐level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition.

BackgroundCanada has incrementally reduced restrictions to blood and plasma donation that impact men who have sex with men, gay, bisexual, and queer men, and some Two Spirit, transgender and non-binary individuals (MSM/2SGBTQ+). Prior to the launch of a pilot program in 2021 enabling some MSM/2SGBTQ + to donate source plasma, we explored the acceptability of the program among individuals who could become eligible to donate in the program.MethodsWe invited men identifying as MSM/2SGBTQ + to participate in two consecutive semi-structured interviews to explore their views on blood and plasma donation policy, plasma donation, and the proposed Canadian plasma donation program. Interview transcripts were analyzed thematically and acceptability-related themes were mapped onto the Theoretical Framework of Acceptability.ResultsTwenty-seven men identifying as having sex with men participated in 53 interviews. Eighteen themes were mapped onto the seven construct domains of the Theoretical Framework of Acceptability. Underlying all aspects of acceptability was a tension between four primary values influencing participants' views: altruism, equity, supply sufficiency, and evidence-based policy. The program was viewed as welcome progress on a discriminatory policy, with many excited to participate, yet tension with inequitable aspects of the program undermined support for the program and interest to contribute to it. The high demands of the program are unique for MSM/2SGBTQ + and are only tolerable as part of a program that is an incremental and instrumental step to more equitable donation policies.ConclusionFindings highlight past experiences of exclusion in Canada as a unique and critical part of the context of the donation experience among MSM/2SGBTQ+. Despite the program's goals of greater inclusivity of MSM/2SGBTQ + individuals, the anticipated experience of the program included continued stigmatization and inequities. Future research should seek to understand the experienced views of MSM/2SGBTQ + donors to ensure that as policies change, policies are implemented equitably.

4 Abstract 74 Background: HIV pre-exposure prophylaxis (PrEP) has been recommended and partly 75 subsidized in Québec since 2013. We aimed to evaluate the population-level impact of PrEP on 76 HIV transmission among men who have sex with men (MSM) in Montréal over 2013-2021. 77 Methods: We used an agent-based mathematical model of sexual HIV transmission to estimate 78 the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without 79 PrEP. The model was calibrated to local MSM survey and cohort data and accounted for 80 COVID-19 pandemic impacts on sexual activity, prevention, and care. To assess potential 81 optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high 82 sexual activity or aged (cid:0) 45 years, increasing coverage to levels achieved in Vancouver (where 83 PrEP is free-of-charge), and improving retention. 84 Results : Over 2013-2021, the estimated annual HIV incidence decreased from 0.4 (90% credible 85 interval [CrI]: 0.3-0.6) to 0.2 (90%CrI: 0.1-0.2) per 100 person-years. PrEP coverage in HIV-86 negative MSM remained low until 2015 (<1%). Afterward, coverage increased to a maximum of 87 10% (15% of those eligible for PrEP) and the cumulative fraction of HIV acquisitions averted 88 over 2015-2021 was 20% (90%CrI: 11%-30%). The hypothetical scenarios modelled showed 89 that PrEP could have averted up to 63% (90%CrI: 54%-70%) of acquisitions if coverage reached 90 10% in 2015 and 30% in 2019, like in Vancouver. 91 Interpretation : PrEP reduced population-level HIV transmission among Montréal MSM. 92 However, our study suggests missed prevention opportunities and provides support for public 93 policies that provide PrEP free-of-cost to MSM at high risk of HIV acquisition.

Background and Objectives Blood operator must establish selection criteria according to the populations at risk of blood-related infections and complications. Therefore, this study aimed to assess the risks of transfusion-related acute lung injury (TRALI) and human immunodeficiency virus (HIV) associated with donations from trans persons. Materials and Methods Donor screening data from Hema-Quebec were used. The risks of TRALI and HIV were estimated based on internal data and assumptions derived from the literature. The risk was assessed under four scenarios: a most likely scenario, an optimistic scenario and two pessimistic scenarios. All scenarios assumed no prior screening for trans donors. Results The trans population comprised 134 donors, including 94 (70.1%) trans men. Of the 134 donors, 58 (43.3%) were deferred from donating a blood-derived product because of an ongoing gender-affirming genital surgery, and the remaining 76 (56.7%) were eligible donors. The risk of having a TRALI-causing donation, given that it comes from a trans man, was estimated at one every 115-999 years for all scenarios. The risk of having an HIV-contaminated donation, given that it comes from a trans woman, was estimated at one every 1881-37,600 years for all scenarios. Conclusion This study suggests that donations from trans persons are associated with a negligible risk of TRALI and HIV.

Canadian Blood Services introduced new eligibility criteria that allows some sexually active gay, bisexual, and other men who have sex with men (gbMSM) to donate source plasma, marking a significant change from time-based deferral criteria. We aimed to identify potential barriers and enablers to implementing the new criteria from the perspective of donor center staff. We conducted Theoretical Domains Framework-informed interviews with staff from two source plasma donation centers in Canada. We completed 28 interviews between June 2020 and April 2021. Three themes representing eight domains captured key tensions. Valuing inclusive eligibility criteria : staff support inclusive criteria; many were concerned the new criteria remained discriminatory. Investing in positive donor experiences : staff wished to foster positive donor experiences; however, they worried gbMSM donors would express anger and disappointment regarding the new criteria, staff would experience unease over using stigmatizing criteria and convey nonverbal cues of discomfort, and recurring plasma donors may behave inappropriately. Supporting education , training , and transparency of eligibility criteria : participants believed providing in-person training (i.e., to explain criteria rationale, address discomfort, practice responding to donor questions) and ensuring donors and the public were well-informed of the upcoming changes would improve implementation. Participant views emphasize the importance of supporting staff through training and transparent communication to optimize the delivery of world-class equitable care for a new cohort of donors who have previously been excluded from plasma donation. Findings inform which staff supports to consider to improve implementation as policies continue to shift internationally.

BACKGROUND AND OBJECTIVES:Several blood services might eventually interview donors with gender-neutral questions on sexual behaviors to improve the inclusivity of blood donation. We tested two ways (i.e., "scenarios") of asking donors about their recent sexual behaviors.MATERIALS AND METHODS:The study comprised 126 regular source plasma donors and 102 gay, bisexual, and other men who have sex with men (gbMSM), including 73 cis-gbMSM (i.e., the "cis-gbMSM subgroup," which excluded nonbinary, genderqueer, and trans individuals). In Scenario 1, participants were asked if, in the last 3 months, they "have […] had a new sexual partner or more than one sexual partner." In Scenario 2, they were asked "Have you had a new sexual partner?" and "have you had more than one sexual partner?". Validation questions included more specific questions on the type of partners and sexual activity.RESULTS:Among plasma donors, sensitivity was 100.0% for both scenarios; specificity was 100.0% and 99.1% for Scenarios 1 and 2, respectively. Among gbMSM, sensitivity was 74.5% and 82.9% for Scenarios 1 and 2, respectively; specificity was 100.0% for both scenarios. Among cis-gbMSM, sensitivity was 88.6% and 100.0% for Scenarios 1 and 2, respectively; specificity was 100.0% for both scenarios. The area under the receiver operating characteristic curve of Scenario 2 was significantly higher than that of Scenario 1 among gbMSM and in the cis-gbMSM subgroup (all p < .05).CONCLUSION:Scenario 2 questions performed well among plasma donors and cis-gbMSM, but less so in the broader gbMSM population.

Background Schools need to collaborate with health network to actualize their important role in promoting sexual health among students. Studies focus on determinants of teacher’s intention to deliver sexuality education (SE), but do not take into consideration the specificity of the action and the context, i.e., the multiple teaching strategies they could choose. Teachers can deliver SE by (a) teaching students alone, (b) co-teaching, (c) inviting a sexual health educator in their classroom. The purpose of this study is to investigate the psychosocial determinants of teachers' intention to deliver SE in any of those roles, using a theory-based approach. Methods Godin's (2012) health behavior change theoretical framework - an integrated version of Ajzen's planned behavior theoretical framework, Triandis's interpersonal behaviors, and Banduras's social cognitive theory - was used to measure teachers' intentions and determinants to do SE. A 66-minute online questionnaire was sent to teachers at a school service center in Quebec. Hierarchical logistic regression analyses were conducted to assess the relationship between the independent variables (determinants of intention) and the intention to teach alone SE, co-teach, or invite a sexual health educator. Results A total of 295 teachers from 51 elementary and 12 secondary schools were selected for analyses. Nearly 40% (39.9%) of the study participants had a favorable intention to teach SE alone to their students, 36.2% by co-teaching and 76.5% by inviting a sexual health educator. The main predictors of intention were respectively: a) for the teaching SE alone model ( R 2 =58%): self-efficacy in sexual health education (OR = 6.07; p < .001), followed by moral norm (OR = 5.35; p < .001), descriptive norm (OR = 3.37; p < .01), comfort teaching the SE curriculum (OR = 3.09; p < .01), and past experience (OR = 2.89; p < .01). Age was also negatively associated with the outcome variable (OR = 0.92; p < .001). b) For the co-teaching model ( R 2 =46%): moral norm (OR = 7.97; p < .001), followed by educational attainment (OR = 3.40; p < .05), teaching multi-age or multi-grade groups (OR = 2.36; p < .05), and self-efficacy with working in partnership (OR = 1.27; p < .05). Further, age (OR = .93; p < .001) and gender (OR = .44; p < .05) were negatively associated with the outcome variable. c) For the inviting sexual health educator model ( R 2 =55%): moral norm (OR = 3.81; p < .001), followed by anticipated regret (OR = 2.45; p < .05), and descriptive norm (OR = 2.38; p < .05). Teachers who reported feeling comfortable teaching the SE curriculum (OR = .45; p < .05) were less likely to intend inviting a sexual health educator. Conclusions Results indicate that determinants of teacher intention are relatively distinct depending on whether teachers make the decision to teach SE to their students alone, co-teach, or invite a sexual health educator in their classroom. The study further suggests complementary strategies being adopted by schools to optimize implementation of SE program.

Background and objectives Several approaches are currently under study to contribute to efforts to allow men who have sex with men (MSM) to donate blood. One of these approaches involves implementing a programme of plasma donation for fractionation, with a quarantine period. The goal of this article is to identify the determinants of intention to participate in the plasma donation programme among MSM in Montreal, Canada. Materials and methods Based on the theory of planned behaviour, a questionnaire was developed to measure MSM's intention to donate plasma and identify influencing factors. A multiple linear regression analysis was conducted to identify the determinants of intention to donate plasma. Results Respondents' (N = 933) intention to donate plasma in the next six months was moderate. The multiple linear regression model explained 55% (P < 0 center dot 001) of the variation of intention. Intention was predicted by attitudes (beta = 0 center dot 34, P < 0 center dot 001), perceived behavioural control (beta = 0 center dot 28, P < 0 center dot 001), aged under 35 years (beta = 0 center dot 26, P < 0 center dot 001), history of blood donation (beta = 0 center dot 24, P < 0 center dot 001), subjective norm (beta = 0 center dot 21, P < 0 center dot 001), income above $40,000 (beta = 0 center dot 20, P < 0 center dot 001), moral norm (beta = 0 center dot 18, P < 0 center dot 001) and higher level of involvement in various issues LGBTQ+ communities are fighting for (beta = 0 center dot 09, P < 0 center dot 001). Conclusion Our analyses show that intention to donate plasma within the proposed programme is associated with personal, social and structural factors, but more strongly predicted by factors related to the theory of planned behaviour. Our results also highlight the importance of involving MSM; community acceptability of the plasma donation programme would probably be higher if MSM felt respected and party to the decisions.

Background Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies. Methods This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research. Discussion Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.

Les traitements médicaux pour lutter contre le VIH/sida ont été limités pendant la plus grande partie de l’histoire de l’épidémie marquée par de nombreux décès. Depuis les années 1990, la mise au point de nouveaux médicaments antirétroviraux, sans constituer une cure, ont contribué chez plusieurs à l’amélioration de l’état de santé. Pour d’autres personnes vivant avec le VIH/sida, les effets indésirables des médicaments ont remis en question l’intérêt de ce traitement. Cet article explore, à partir de témoignages de personnes, hommes et femmes, vivant avec le VIH/sida à Montréal, les représentations contradictoires, oscillant entre scepticisme et espoir, entourant l’usage de ces médicaments.

The current study aimed to document intervention practices, challenges, and training needs concerning the intersections between HIV and intimate partner violence (IPV) among community service providers ( n = 12). A direct content analysis using the Trauma-Informed Approach was performed. Results revealed that community service providers need to create a safe, trusting, and mutually collaborative environment in which the intersections between HIV and IPV trauma are recognized, screened, and discussed with women. These results also highlight the need to consolidate partnerships between HIV and IPV organizations to provide relevant services that consider traumatic experiences. Overall, these findings support the urgent need to develop, implement, and evaluate targeted community interventions that jointly address HIV and IPV.

Pre-exposure prophylaxis (PrEP) became publicly available in Quebec for gay, bisexual and other men who have sex with men (GBM) in 2013. We used baseline data from Engage, a cohort of GBM recruited by respondent-driven sampling, to examine patterns of combination HIV prevention use among Montreal GBM since PrEP became available. Latent class analysis, stratified by HIV status, was used to categorize GBM by self-reported use of biomedical and behavioural prevention strategies. Correlates of resulting classes were identified using multinomial logistic regression. Among HIV-negative/unknown GBM (n = 968), we identified four classes: low use of prevention (32%), condoms (40%), seroadaptive behaviour (21%), and biomedical (including PrEP; 7%). Those using prevention ( condoms , seroadaptive behaviour , and biomedical ) had a higher number of anal sex partners and were more likely to report a recent sexually transmitted infection diagnosis . GBM using biomedical prevention also had a higher level of formal education. Among GBM living with HIV (n = 200), we identified three classes: mainly antiretroviral treatment (ART) with viral suppression (53%), ART with viral suppression and condoms (19%), and ART with viral suppression and seroadaptive behaviour (18%). Again, the number of anal sex partners was higher among those using condoms and seroadaptive behaviours. Our findings show antiretroviral-based prevention, either alone or in combination with other strategies, is clearly a component of the HIV prevention landscape for GBM in Montreal. Nevertheless, PrEP uptake remains low, and there is a need to promote its availability more widely.

Le « chemsex » est un phénomène préoccupant relativement à la santé sexuelle des hommes qui ont des relations sexuelles avec d’autres hommes (HRSH). Cet article décrit le profil des consommateurs de substances habituellement liées au « chemsex » dans un échantillon formé des 11 841 répondants de la 4e édition du Net Gay Baromètre français (2013) ayant consommé au moins une substance au cours des 12 derniers mois. Trois groupes de répondants ont été constitués : groupe 1, ceux qui ont consommé au moins une substance dans les douze derniers mois, excluant les substances liées au « chemsex » (81,3 %) ; groupe 2, les consommateurs occasionnels (1 à 9 fois) de ces substances (14,2 %) ; groupe 3, les consommateurs réguliers (10 fois ou plus) (4,5 %). Les groupes 2 et 3 ont été contrastés au groupe 1 par l’analyse de régression logistique polynomiale. Les répondants des groupes 2 et 3 se distinguent de ceux du groupe 1 par une prise de risques sexuels plus grande avec les partenaires occasionnels et par des indices de santé plus problématiques. Le groupe 3 affiche, sur toutes ces caractéristiques, un profil de vulnérabilité plus alarmant. Les résultats soulignent l’hétérogénéité des patrons de consommation et des risques pour la santé parmi les consommateurs de substances psychoactives habituellement associées au « chemsex » et l’importance de déployer des interventions qui tiennent compte de ces besoins et vulnérabilités distinctes.

Previous maternity experiences may influence subsequent reproductive intentions and motherhood experiences. We used latent class analysis to identify patterns of early motherhood experience reported for the most recent live birth of 905 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Four indicators were used: difficulties getting pregnant, feelings when finding out pregnancy, feelings during pregnancy, and feelings during the first year postpartum. Most (70.8%) pregnancies analyzed occurred before HIV diagnosis. A four-class maternity experience model was selected: "overall positive experience" (40%); "positive experience with postpartum challenges" (23%); "overall mixed experience" (14%); and "overall negative experience" (23%). Women represented in the "overall negative experience" class were more likely to be younger at delivery, to not know the HIV status of their pregnancy partner, and to report previous pregnancy termination. Women represented in the "positive experience with postpartum challenges" class were more likely to report previous miscarriage, stillbirth or ectopic pregnancy. We found no associations between timing of HIV diagnosis (before, during or after pregnancy) and experience patterns. Recognition of the different patterns of experiences can help providers offer a more adapted approach to reproductive counseling of women with HIV.