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Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey

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Background

Few assessments of associations between structural-level factors and HIV among gay
men and other men who have sex with men (MSM) have been conducted, especially in sub-Saharan
Africa. Our objective was to examine HIV testing history, HIV status, and stigmas
among MSM living in ten countries with heterogeneous legal environments.

Methods

This study used pooled data from ten country-specific, cross-sectional studies done
in 25 sites in Burkina Faso, Cameroon, Côte d’Ivoire, The Gambia, Guinea-Bissau, Nigeria,
Senegal, Eswatini, Rwanda, and Togo. MSM were recruited by respondent-driven sampling
and were eligible if they met country-specific requirements for age, area of residence,
and self reported being assigned male sex at birth and having anal sex with a man
in the past 12 months. Policy related to same-sex sexual behaviour for each country
was categorised as not criminalised or criminalised. Countries were also categorised
on the basis of recent reports of prosecutions related to same-sex sexual acts. Legal
barriers were defined as those that legally prevented registration or operation of
sexual orientation related civil society organisations (CSOs). Individual data on
HIV testing history, HIV status, and stigma were collected via interviewer-administered
sociobehavioural questionnaires and HIV testing. Multilevel logistic regression with
random intercepts was used to assess the association between policies, recent prosecutions,
legal barriers to CSOs, and HIV-related factors with adjusted odds ratios (aORs) and
95% CIs.

Findings

Between Aug 3, 2011, and May 27, 2020, we recruited 8047 MSM with a median age of
23 years (IQR 21–27). 4886 (60·7%) lived in countries that criminalise same-sex sexual
acts. HIV prevalence among MSM was higher in criminalised settings than non-criminalised
settings (aOR 5·15, 95% CI 1·12–23·57); higher in settings with recent prosecutions
than in settings without prosecutions (12·06, 7·19–20·25); and higher in settings
with barriers to CSOs than without barriers to CSOs (9·83, 2·00–48·30). HIV testing
or status awareness was not associated with punitive policies or practices. Stigma
was associated with HIV status but did not consistently vary across legal environments.
Disparities in HIV prevalence between MSM and other adult men were highest in punitive
settings.

Interpretation

Structural risks including discriminatory country-level policies, prosecutions, and
legal barriers might contribute to higher HIV prevalence among MSM. Taken together,
these data highlight the importance of decriminalisation and decreasing enforcement,
alongside stigma reduction, as central to effective control for HIV.

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Funding

National Institutes of Health.

Translation

For the French translation of the abstract see Supplementary Materials section.

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RCMP warn about benzodiazepine-laced fentanyl tied to overdose in Alberta – Edmonton Journal

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Grande Prairie RCMP issued a warning Friday after it was revealed fentanyl linked to a deadly overdose was mixed with a chemical that doesn’t respond to naloxone treatment.

The drugs were initially seized on Feb. 28 after a fatal overdose, and this week, Health Canada reported back to Mounties that the fentanyl had been mixed with Bromazolam, which is a benzodiazepine.

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Mounties say this is the first recorded instance of Bromazolam in Alberta. The drug has previously been linked to nine fatal overdoses in New Brunswick in 2022.

The pills seized in Alberta were oval-shaped and stamped with “20” and “SS,” though Mounties say it can come in other forms.

Naloxone treatment, given in many cases of opioid toxicity, is not effective in reversing the effects of Bromazalam, Mounties said, and therefore, any fentanyl mixed with the benzodiazepine “would see a reduced effectiveness of naloxone, requiring the use of additional doses and may still result in a fatality.”

Photo of benzodiazepine-laced fentanyl seized earlier this year by Grande Prairie RCMP after a fatal overdose. edm

From January to November of last year, there were 1,706 opioid-related deaths in Alberta, and 57 linked to benzodiazepine, up from 1,375 and 43, respectively, in 2022.

Mounties say officers responded to about 1,100 opioid-related calls for service, last year with a third of those proving fatal. RCMP officers also used naloxone 67 times while in the field, a jump of nearly a third over the previous year.

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CFIA continues surveillance for HPAI in cattle, while sticking with original name for disease – RealAgriculture

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The Canada Food Inspection Agency will continue to refer to highly pathogenic avian influenza in cattle as HPAI in cattle, and not refer to it as bovine influenza A virus (BIAV), as suggested by the American Association of Bovine Practitioners earlier this month.

Dr. Martin Appelt, senior director for the Canadian Food Inspection Agency, in the interview below, says at this time Canada will stick with “HPAI in cattle” when referencing the disease that’s been confirmed in dairy cattle in multiple states in the U.S.

The CFIA’s naming policy is consistent with the agency’s U.S. counterparts’, as the U.S. Animal and Plant Health Inspection Service has also said it will continue referring to it as HPAI or H5N1.

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Appelt explains how the CFIA is learning from the U.S. experience to-date, and how it is working with veterinarians across Canada to stay vigilant for signs of the disease in dairy and beef cattle.

As of April 19, there has not been a confirmed case of HPAI in cattle in Canada. Appelt says it’s too soon to say if an eventual positive case will significantly restrict animal movement, as is the case with positive poultry cases.

This is a major concern for the cattle industry, as beef cattle especially move north and south across the U.S. border by the thousands. Appelt says that CFIA will address an infection in each species differently in conjunction with how the disease is spread and the threat to neighbouring farms or livestock.

Currently, provincial dairy organizations have advised producers to postpone any non-essential tours of dairy barns, as a precaution, in addition to other biosecurity measures to reduce the risk of cattle contracting HPAI.

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Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star

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Canada has seen a concerning rise in measles cases in the first months of 2024.

By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.

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