Rob Wolvin: The Vanguard Project is a Health Canada funded program seeking to find out how and why young men who have sex with men are becoming infected with HIV. Joining us in the studio is Steve Martindale, the project's coordinator
Robb Atkinson: Steve, welcome to The Coming Out Show again.
Steve: Thank you.
Robb: So, I thought we already knew how people could acquire HIV.
Steve: Well, we certainly have a good understanding of how people are acquiring it, but what we want to look at is what infection rates are like among young gay and bisexual men. Most of the research that has been done to date is looking at an older population. A lot of the men who are enroled in the current study that has been running since 1982 are now in their 30s and 40s, and not that much is known in Canada about infection rates in the under-25 set. There's been a fair bit of research in the States done, particularly in San Francisco and New York, in this age range, but very little done in Canada. So we'd like to get an accurate assessment of what infection rates are like in younger gay and bisexual men, and look at what other factors - I mean we understand transmission routes, but things like ethnicity, education, language barriers, what else plays into what's likely to put people at risk for HIV?
Robb: Obviously you must have some suspicions along this line. Are you using the American model, what's happening down there, and extrapolating infection rates that are occurring in the States up into Canada?
Steve: Well we hope to be able to compare our data to other studies that are happening in other centres, particularly across Canada, and certainly we'll be comparing our results with research that's being done in the States. I'm not sure if we're taking exactly the same approach or making the same assumptions. We want to see what the situation is locally and how it compares internationally.
Robb: It was my understanding, that the rate of incidence of HIV and AIDS in the gay male population was actually decreasing?
Steve: Well it can be really confusing with the statistics, because it depends how things are worded. People can say things like, "The rate of increase is decreasing," but it still means that more people are getting infected. And with the bulk of the infection still being in the gay community, even if the rate of increase is not rising as it once was, given that the majority of people with HIV and AIDS are still gay men, even a slight increase in terms of percentage can represent a lot of people in sheer numbers. So you can really play around with the statistics and you have to be really careful with it, because depending on what you're looking at, you know, if you've got five people in a certain group with HIV this month and the next month you have ten, then that's 100% increase; but if you have 1000 and the next month you have another 100, that's only a 10% increase, but you're talking in sheer numbers substantially more individuals. And that's what we're seeing in the gay community: infection rates may be plateauing or may even be dropping, but it just represents so many people, and there's still, particularly with young gay men
Robb: But there is this sort of generational difference that we're not aware of.
Steve: Sure. There just isn't the data. I mean we just don't know, really. We have an anecdotal sense that people are protecting themselves, and we have an anecdotal sense that an alarming number of young gay men are still getting infected, but we don't really know what that looks like in terms of percentages or how it compares to other centres, or how it compares to other populations.
Robb: Are you aware of any sort of resistance towards safer sex practice by young men? In previous studies any anecdotal information on that?
Steve: I'm not sure about resistance, but I think that young gay men are just like young straight men, and young people in general, that they tend to suffer from an acute sense of immortality, and I think that's true for gay or straight. The other thing is that for young men, risk is really associated with masculinity, that young men are supposed to take risks; they're supposed to be athletic and adventurous, and in sports and in business you're supposed to take risks, but when it comes to sex the message has been, "Don't take risks," and yet risk is really tied up with young men's sense of who they are, whether they're gay or straight. So I think that presents a real range of problems for people. Education is always a real challenge, because how do you reach young gay men who aren't out yet, who aren't self-identified as gay or bisexual? Their first sexual experiences may well take place before they self-identify as gay or bisexual, so how do you reach them? You can't go into a high school and say, "We just want to talk to the gay kids," because nobody will come forward. So the challenge I think is to make education that's aimed at everyone to make that comprehensive. The entire school curriculum needs to include gay-specific information so that all the kids get it, and of course there's great resistance to that.
Robb: Is there much health education on AIDS in high schools these days?
Steve: There's quite a lot, and the work that I've done in high schools, I've been impressed with the knowledge level of young people. Young people who are within the school system tend to be very knowledgeable. Now if they're outside of the school system if they're street-involved or street-entrenched, or drop-outs then we can't be sure what sort of information they're getting. But within the school system the knowledge level tends to be really high, but that doesn't necessarily translate into action. And we find that both among young straight kids and young gay men: the fact that they have the facts and the information at their disposal doesn't mean they're necessarily incorporating behaviour change or risk reduction into their lifestyles. And knowledge without the accompanying action isn't a whole lot of use. So it can be difficult to tell what people are actually doing just based on what they know.
Robb: OK, let's move on to the Vanguard Project study itself. Now, what is it entailing? I know you're asking for about 1000 young men?
Steve: We're looking for 1000 young men, and they don't have to be gay; they can self-identify as straight or bisexual. The criteria is that they need to be having sex with other men, and they have to be between the ages of 18 and 30, and living in the Lower Mainland.
Robb: So does this mean if they've had sex one experience with another man, they'd be eligible?
Steve: Sure, they'd even be eligible if they've never had sex. If they're thinking about having sex with other men, or if they have had a single sexual experience. As I say, it doesn't matter how they self-identify, whether gay, straight or bisexual, but they have to be within the Lower Mainland and under 30. We're particularly interested in the 18 to 25 year olds. We're accepting people into the study up to age 30, but the study will carry on for at least three years, and hopefully longer, and so if we can enrol people in the study at a young age then we'll be able to follow them for a number of years.
Robb: This is quite a long-term project, then?
Steve: Certainly. And this is the sequel to a study that is ongoing at the moment and has been running since 1982, and that study is called the Vancouver Lymphadenopathy-AIDS Study, it's quite a lengthy name, but it's run by the BC Centre for Excellence, and this is the same organization that is bringing the Vanguard Project. Now this study's been running since 1982, which pre-dates AIDS. I mean, in 1982 people didn't know what AIDS was, HIV hadn't been identified, there wasn't an antibody test available, but gay men were getting sick, and blood was being drawn and held onto, and we have that data and those blood samples dating back to 1982. So the VLAS has been running for 13 years now, and as I say the majority of the men in that study are in their 30s and 40s, or are now deceased, so we can't tell a lot from that cohort about the situation with young gay men, and that's what we'd like to look at with this project.
Robb: And if someone joins, what's their obligation? They have to give blood, obviously, and how frequently?
Steve: It's just a once-a-year commitment. All we require from participants is that they have an HIV test, which a lot of young people are doing anyway on an annual basis, a lot of people get tested every six months, routinely. So if you're being tested annually anyway, it doesn't require very much more effort, you just have to enrol in the study and then we'll need access to the results, and it also requires that you complete a questionnaire once a year. We have a detailed questionnaire which looks at things like sexual behaviours, substance use, demographic information like education levels and ethnicity, and so you need to complete the questionnaire once a year, and have your blood tested. And we're really open to a real range of participants, and of different levels of confidentiality. People can remain anonymous in this study if they want to, they can be completely open with us, they can provide their full names or not, they don't even need to get their own blood results. If people have a resistance to finding out what their own antibody status is, it is possible to participate in this project without finding out your own results.
Robb: But if people do want to have the results, they would be made available to them?
Steve: Absolutely. Not only their results but also we're trying to assist young men in accessing better health care, so we're available to do referral if people want to be referred to testing sites anywhere in the Lower Mainland, we can do that. We can hook people up with gay doctors or gay-friendly doctors. If people aren't satisfied with the type of health care they're now receiving, we can assist them in improving that. I really believe people should approach the health care system as a consumer, and if you're not satisfied with your doctor, find another one. And if your doctor is homophobic, then change doctors. If you've had a bad experience at a clinic, go to a different clinic. And we can assist people in navigating their way through the health care system, and getting better health care, and finding health care providers who are familiar with their issues and familiar with their sexual activities, because it's no good going to a clinic or a doctor who hasn't got a clue about what you're doing sexually or what risks you may be at, or how specific diseases may manifest themselves. You need to have people who are familiar with these things, and we can assist people in accessing better health care.
Robb: And you are guaranteeing anonymity, for those who don't want to be identified?
Steve: Yes, the results are strictly confidential. We will be compiling the data obviously, but we're not attaching names to any of the results that we get, and if people want to participate, it's easier for us if people provide us with a phone number where we can reach them because we need to follow up from year to year. We need to get ahold of people and say, "It's time for your test again and to fill out the questionnaire." But people have a range of options: they can provide us with a phone number or a fax number; or they can reach us through the internet, through e-mail; somebody could give me a postal box, and as long as I could reach them at that postal box from year to year
Robb: I suppose the difficulty is that once they have started, keeping track of them.
Steve: That's been one of the challenges in the existing research is that people move around so much, especially with younger people. I think it's a challenge we're going to face in this study is that I know myself I've moved around a lot, and a lot of people my age and younger are quite transient, particularly if they're just leaving home, if they're no longer with their parents, or if they're students, people tend to move a lot. So that's going to be one of our challenges, is how to reach people from year to year. But that's not really for the participants to worry about, I mean we're going to
Robb: That's for the bureaucrats.
Steve: Yes, we're going to do our best to try to track people, but we certainly won't be if people have concerns about confidentiality, if you participate in the study you won't be getting something in the mail with "AIDS" on the envelope, we won't be calling you up and leaving explicit messages on your answering machine. If we can't track you down we won't call your mother and ask her where you are. We're going to assure people's confidentiality.
Robb: And where can people gather more information and/or begin to participate?
Steve: Well people can do one of two things: they can either call us, or they can drop by we now have an outreach office at the Gay and Lesbian Centre, at 1170 Bute Street, and they can drop by and visit us there at the outreach office and sign up for the study that way.
Robb: And is there a start date?
Steve: We're starting now to recruit. We will be launching an actual recruitment campaign in the near future, so people can watch for that. And we're accepting names at this point, and we will be making a real push for enrolment over the next six months until we get our full cohort.
Robb: It will be very interesting to see what the results are, given that invincibility that young people tend to carry with them.
Steve: And it's something we can contribute to the international
research as well, we've got the International
AIDS Conference happening here in Vancouver in the summer of '96.
It seems like a long way off now, but it's just a year and a half
away. And that will be a huge event, it will be comparable to
the Gay Games. They're expecting 20,000 people to descend on Vancouver
for that conference, and we'll be presenting results from this
research at that conference, so people who participate now can
be a part of that whole process, and we can contribute on the
international stage in terms of research for what's happening
locally in Vancouver.
Robb: Well it sounds like a very important piece of research, and I hope you get a lot of people out who respond to it.
Steve: I hope so too, and I would encourage people, particularly if they live outside of the West End, if they live anywhere else in the Lower Mainland, I would encourage people who are bisexual or closeted, people who aren't certain about their sexuality, people who aren't certain about their HIV status, we're looking for a real range of people, people of different ethnicities, different socio-economic levels, I would encourage anyone listening to give us a call and sign up for the study or find out more.
Robb: Steve Martindale, thank you very much for joining us tonight.
Steve: Thank you.
Robb: Good luck!
For more information, contact:
Bonnie Devlin
Vanguard Project Coordinator
608 - 1081 Burrard Street
Vancouver, BC, Canada, V6Z 1Y6
Tel: (604)806-8306
Fax: (604)806-9044