OBJECTIVES:Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care. METHODS:Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test. RESULTS:Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as "gay" or "queer" (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all).CONCLUSIONS: While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.

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Background Expedited partner therapy (EPT) can prevent transmission of sexually transmitted infections (STIs) and reinfection of the index patient. We surveyed family physicians (FPs) in British Columbia to understand their perceptions of barriers and facilitators to EPT use and explored how perceptions varied by demographic and practice characteristics. Methods Survey participants were recruited through the Divisions of Family Practice, which include greater than 90% of FPs in British Columbia. Common barriers and facilitators for EPT were identified using descriptive statistics. The association between each EPT barrier and facilitator and demographic and practice characteristics were tested using χ2 test. Results One hundred eighty-one FPs started the survey, of which 146 (80.7%) answered 10 questions or more and were analyzed. Overall, inaccurate information about sex partners (88 [60.3%] of 146) and medicolegal concerns (87 [59.6%] of 146) were the most common barriers reported. Family physicians in nonurban settings were more likely to identify insufficient time as a barrier compared with FPs in urban settings (P < 0.01). The most common facilitators were having a health care professional for follow-up after prescribing EPT (110 [75.3%] of 146), improved remuneration (93 [63.7%] of 146), clear clinical guidelines around EPT (87/146, 59.6%), and having a legal framework (92 [63.0%] of 146). Family physicians practicing for less than 9 years (the median) were more likely to identify the latter as facilitating EPT compared with FPs practicing for 9 years or longer (P < 0.05). Conclusions Ensuring patients have access to a health care professional for follow-up, improved remuneration, and development of clinical guidelines and a legal framework can support the implementation of EPT. Tools catered to different practice types and contexts may help increase EPT use.

Increased rates of screening, advances in molecular diagnostics, the opportunity for patients to give non-invasive urine specimens, and higher numbers of re-infection may account for some of these increases. Improved detection may not account for all of the increase, however, as the 2009 Canadian Chlamydia rate and the 2010 rate continued to rise (259 per 100,000 and 277.6 per 100,000 in 2009 and 2010, respectively). 2 In women, Chlamydia infection can cause a spectrum of disease, ranging from asymptomatic infection to pelvic inflammatory disease. 3 In particular, infertility may result from untreated infection. Because Chlamydia infections can cause significant morbidity and are largely preventable, this is an infection of public health concern. Case finding has two immediate goals: 1) to prevent complications in the case and 2) by treating the case and sexual partners, to prevent further spread of the disease. Not much is known about Chlamydia infection rates among people of Chinese ethnicity in Canada. Vancouver and Richmond, British Columbia, are adjacent municipalities with a high proportion of visible minorities. The 2006 Canadian Census found that approximately 50.5% and 65% of Vancouver and Richmond residents, respectively, self-identified as belonging to a visible minority; people of Chinese ethnicity predominated. 4 In the United States, Chlamydia rates vary significantly by race, from a high of 2,056.9 per 100,000 population in African Americans to a low of 225.9 per 100,000 among Asians/Pacific Islanders in 2008. 5 Thus it is conceivable that Chlamydia infections may also vary significantly among different ethnic groups in Canada. While US data suggest that Chlamydia incidence may be comparatively low among ethnic Chinese in Vancouver and Richmond, local ethnicity-specific data on Chlamydia rates are lacking. Understanding the local epidemiology of Chlamydia will allow public health practitioners to tailor STI prevention programs in Vancouver and Richmond to the local disease burden and cultural context. Current Canadian guidelines suggest screening for STIs in women with known risk factors. 6 These guidelines do not recommend screening for women over the age of 25 in stable, monogamous relationships. For immigrants and refugees, the guidelines suggest a "non-judgmental and culturally sensitive STI risk assessment." There are no separate recommendations about

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Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced education in the Family Medicine residency. We aimed to test whether alerts to encourage spaced education can improve clinical knowledge as measured by scores on the Canadian Family Medicine certification examination. Method: We conducted a cluster randomized controlled trial to empirically and pragmatically test spaced education using two versions of the Family Medicine Study Guide mobile app. 12 residency training programs in Canada agreed to participate. At six intervention sites, we consented 335 of the 654 (51%) eligible residents. Residents in the intervention group were sent alerts through the app to encourage the answering of questions linked to clinical cases. At six control sites, 299 of 586 (51%) residents consented. Residents in the control group received the same app but with no alerts. Incidence rates of case completion between trial arms were compared using repeated measures analysis. We linked residents in both trial arms to their knowledge scores on the certification examination of the College of Family Physicians of Canada. Results: Over 67 weeks, there was no statistically significant difference in the completion of clinical cases by participants. The difference in mean exam scores and the associated confidence interval did not exceed the pre-defined limit of 4 percentage points. Conclusion: Further research is recommended before deploying spaced educational interventions in the Family Medicine residency to improve knowledge.

Objective To explore Canadian FPs' experiences with, perceived barriers to, and perceived facilitators of FP-initiated partner notification (PN) for HIV and other sexually transmitted infections (STIs), as well as to inform the development of tools that might enhance this work. Design Online survey. Setting British Columbia.Participants A total of 146 FPs recruited through the Divisions of Family Practice community-based networks of FPs throughout the province. Main outcome measuresFamily physicians' current STI and PN practices, opinions regarding FP-initiated PN, perceived barriers to and facilitators of FPinitiated PN, and preferred PN resources. This article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.