BackgroundThe emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men.MethodsWe undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies.ResultsContributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk.ConclusionsThese findings indicate that notions of “safety” and “risk” based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men’s current prevention needs. Interventions should advance gay men’s communication and self-advocacy skills in order to optimize these strategies.Electronic supplementary materialThe online version of this article (10.1186/s12889-019-6452-7) contains supplementary material, which is available to authorized users.

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Extensive research has been conducted on the contraceptive decision-making that patients engage in during their appointment with healthcare providers and the approaches used by providers during this process, but less information is available on what happens prior to the appointment that may contribute to patients’ decisions. Here, we use data from semi-structured interviews with 17 patients at a sexual health clinic about their experience obtaining contraception to explore the process of choosing a method. Participants were recruited through posters in the clinic waiting room and via information posted on the clinic’s social media feeds. Interviews were thematically analyzed, and two main themes identified. The first theme was the importance of seeking out information online and from social networks prior to seeing a provider, to the extent that most participants had settled on a method prior to their discussion with a physician. The second theme was the priorities identified by participants in their decision-making, primarily side effects. The findings suggest that key moments of decision-making may not take place during a contraceptive counselling appointment, but rather beforehand through independent research, discussions with others, and previous experiences with contraception. The experiences of participants in this study indicate that contraceptive counselling should include discussion of the information patients have gleaned from other sources and acknowledge the importance of experiential information as well as factual.

Introduction: COVID-19 has had a profound effect on every aspect of contemporary life, including sexuality. Physical distancing measures and limitations on large gatherings explicitly restrict in-person group sex events. We sought to understand how the pandemic and associated public health control measures have affected group sex practitioners and activities. Methods: We used a community-based participatory research approach. In fall 2019, we recruited a Community Advisory Board (CAB) of group sex key informants via community agencies, social media, and relevant websites (e.g., FetLife, Squirt). To be eligible, participants had to be at least 18 years old and have recently participated in a local group sex event (i.e. sex, broadly defined, with more than 3 people). Ethics approval was secured for the CAB as a longitudinal focus group study. Focus group meetings were audio recorded, transcribed, and thematically analyzed. In December 2019, participants were asked about definitions of group sex. In May 2020, participants were asked about COVID-19 impacts. Results: Key informants shared that due to COVID-19 restrictions, group sex events were cancelled and participants only had sex with others they were isolating with. Participants emphasized the challenges of isolation, the need to be patient, but also the opportunities associated with isolation. Participants reported attending online group sex events (e.g. Zoom orgies) as well as skill-building classes (e.g. rope bondage). Participants anticipated in-person events in the future, but felt that moving online opened up new opportunities for community-building. Conclusions: Participants adhered to physical distancing protocols and quickly adapted to social isolation through innovative use of technology.

Background This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period. Methods SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization). Results Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60,000 CAD (68.9%). Greater perceived difficulty of getting help was associated with having lower income, sometimes using methamphetamine prior to or during sex, and greater perceived need for help. Conclusion Based on these results, we urge greater investments in one-stop, low-barrier, culturally-appropriate care for SGMSM who use methamphetamine. This is especially important given that participants who perceive themselves as needing help to reduce or abstain from substance use perceive the greatest difficulty of getting such help.