title: HIV Community Viral Load and Factors Associated With Elevated Viremia Among a Community-Based Sample of Men Who Have Sex With Men in Vancouver, Canada.
abstract: BACKGROUND
  We developed estimates of community viral load (VL) and risk factors for unsuppressed VL from a cross-sectional study of men who have sex with men (MSM) in Vancouver, Canada.
  
  
  METHODS
  MSM were recruited from February 25, 2012 to February 28, 2014 using respondent-driven sampling (RDS). Participants completed a computer-assisted self-interview questionnaire and a nurse-administered point-of-care HIV test. For HIV-positive participants, we conducted VL and CD4 cell counts. We used RDS-weighted analysis to obtain population estimates of key variables and multivariable logistic regression to examine factors associated with having a VL of ≥200 copies per milliliter among HIV-positive participants.
  
  
  RESULTS
  We recruited 719 participants, of whom 119 (16.6%) were seeds. Our estimate of the population prevalence of HIV was 23.4% [95% confidence interval (CI): 15.8% to 31.0%] after RDS adjustments. We estimated that 18.6% (95% CI: 8.8% to 30.4%) of HIV-positive MSM in Vancouver had a VL of ≥200 copies per milliliter. Having an unsuppressed VL was associated with non-white ethnicity [adjusted odds ratio (AOR) = 4.34; 95% CI: 1.67 to 11.1], an annual income of <$15,000 CAD (AOR = 6.43; 95% CI: 2.08 to 19.9), using gamma-hydroxy butyrate in the previous 6 months (AOR = 4.85; 95% CI: 1.79 to 13.2), unprotected anal intercourse with a known HIV-negative or an unknown serostatus partner (AOR = 3.13; 95% CI: 1.10 to 8.90), and disclosing one's HIV serostatus ≥50% of the time (AOR = 7.04; 95% CI: 1.01 to 49.1).
  
  
  CONCLUSIONS
  Despite a high prevalence of HIV, we estimated that a small proportion of HIV-positive MSM have undiagnosed HIV and unsuppressed VL. Our results highlight the importance of continued work to address health inequities using a framework based on social determinants of health.
authors.affiliation: *Department of Medicine, University of British Columbia, Vancouver, Canada; †BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; ‡University of California San Francisco, San Francisco, CA; §University of Victoria, Victoria, Canada; ‖Positive Living Society of BC, Vancouver, Canada; ¶Interior Health, Kelowna, Canada; and #Simon Fraser University, Burnaby, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Moore
authors.forename: Zishan
authors.initials: Z
authors.lastname: Cui
authors.forename: Nathan
authors.initials: N
authors.lastname: Lachowsky
authors.forename: Henry F
authors.initials: HF
authors.lastname: Raymond
authors.forename: Eric
authors.initials: E
authors.lastname: Roth
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Rich
authors.forename: Paul
authors.initials: P
authors.lastname: Sereda
authors.forename: Terry
authors.initials: T
authors.lastname: Howard
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.forename: Allan
authors.initials: A
authors.lastname: Lal
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Trevor
authors.initials: T
authors.lastname: Corneil
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D015497:HIV-1; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000706:statistics & numerical data; D019562:Viral Load; D014766:Viremia / Q000097:blood*
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