As you said, I can't amend the motion, but they have the vote, so nothing's getting passed unless they support it. Beyond that, whether they support it or don't support it, I would appreciate their input. I love bipartisanship. I love collaboration. I would like to know, with this further information now being on the record, whether they would like to retract or backtrack on that amendment.
Do you know what? I think I'll go further. I don't think it might be; I think it is stigmatizing to the 2SLGBTQQIA+ community to have adopted that and to declare in the motion that there are disproportionate impacts on the present epidemic in Manitoba to that community, when quite the contrary seems to be true.
That's not just in the study I was reading. I saw a news bulletin from the public health service in Manitoba underscoring this point, and I think it is an important point. I think that if that misapprehension is further promulgated, it could expose members of the 2SLGBTQQIA+ community to further stigmatization.
I'm just putting that on the floor because I want to make as much space as possible for them to provide their input on that consideration. I will continue talking until such time as they want to provide their input.
Resuming our discussion of the study, I think we mentioned that it's a retrospective cohort study of individuals who are referred to the centralized program in Manitoba. By the way, kudos to Manitoba. I practised medicine in Ontario for a long time, and we do not have such a centralized service. Things are quite ad hoc. It's surprising that, even with the centralized service, unfortunately the epidemic seems to be centred there presently.
Whom did they study? The study says:
Adults 18 years or older who received a new HIV diagnosis in Manitoba during the study period and whose previous HIV test result was unknown or negative for HIV were included.
Those are the individuals who were included. The study continues:
People previously diagnosed with HIV who were transferred to care in Manitoba from out-of-province or another country were excluded....
Data were collected from medical records. The variables gathered at the time of HIV diagnosis included age in years, sex assigned at birth (female and male, no intersex was reported)—
That makes me wonder if.... We left out the “A” in the motion, but we included the “I”. If there were no “I”s in this paper, I wonder why one was included and the other was not.
—self-reported gender, sexual orientation, race/ethnicity...substance use and route, and living in a rural or urban area. Houselessness (yes or no) was defined by self-reported houselessness or if the treatment team documented houselessness or unstable housing.
That's unfortunate to me—a bit of editorializing here—because I think that in the introduction, they talked about how the severity of houselessness was associated independently with HIV infection in Manitoba during the study period. It's kind of unfortunate—just reading in the study design—that they decided to treat it as a binary variable when the authors know very well that houselessness is indeed a spectrum.
The outcomes were all diagnoses of STBBIs that a participant had documented from the start of their medical record (earliest result in 2010) until the time of data collection and were recorded. The final date of data inclusion was December 31, 2022—
Oh my. Wow. All of this they found out....
What we're about to find out from the study is from data collected before December 31, 2022, so this has been going on for quite some time. It is now years later that our present study is taking this up—our putative, hypothetical, perhaps-going-to-start HIV study, as soon as some agreement is reached about also studying PrescribeIT.
The paper continues:
STBBIs detected more than 15 days before HIV diagnosis were classified as “before HIV diagnosis”. STBBIs within the time frame of 15 days before to 15 days after HIV diagnosis date were classified as “STBBIs at time of HIV diagnosis”. STBBIs diagnosed more than 15 days after HIV diagnosis were classified as “STBBIs after HIV diagnosis”.
That's pretty simple and logical, but I'm glad they spelled it out. In addition:
STBBIs were defined as the following diagnoses and associated tests: gonorrhea and chlamydia (urine nucleic acid amplification test or swabs of the cervix and/or anus), syphilis (rapid plasma reagin, venereal disease reference laboratory test, and treponemal antibody serologic tests), hepatitis B (serologic tests for hepatitis B surface antigen and hepatitis B core antibody), and HCV (HCV antibody serology and HCV RNA).
Syphilis rapid plasma reagin and venereal disease reference laboratory test titers were used to determine the number of distinct syphilis diagnoses. Titers that remained stable or changed in one direction (i.e. decreased or increased four-fold over time) were recorded as single diagnoses. Titers that increased four-fold after a decrease were considered a syphilis reinfection and recorded as two separate diagnoses. Additional syphilis diagnoses were only recorded if there were decreasing titers, followed by increasing titers, suggestive of treatment between separate infections. Only the first positive treponemal antibody test was recorded because this test remains positive after syphilis infection.
For gonorrhea and chlamydia diagnoses, if a positive test was followed by a negative test and subsequent positive test, the participant was recorded as having two distinct diagnoses. Each additional gonorrhea and chlamydia diagnosis recorded had to be separated from the next recorded case by a negative test result. If the participant had repeated positive gonorrhea and chlamydia tests without an interim negative test, it was assumed that the person had one untreated infection. The [dates] of hepatitis B and C results were recorded as the first positive results only, unless a person had evidence of HCV sustained virologic response, followed by repeat positive testing.
Biases
To avoid measurement bias, several records were reviewed by two reviewers to ensure consistency in data collection between reviewers. All people newly diagnosed with HIV in Manitoba during the study period were included, which minimized selection bias.
That's really impressive. They included all people newly diagnosed with HIV in Manitoba during the study period. I don't think many jurisdictions can say they have such excellent health records. It's probably a function of having this centralized HIV service that they can confidently put in black and white, in their paper, that they caught every single one of the positive HIV tests in this present research. Wow.
It continues:
Statistical methods
The rates of individual STBBIs before, at, and after HIV diagnosis were analyzed by sex at birth, injection drug use status, use of methamphetamines, and housing status. We also calculated the proportion of concomitant STBBIs (none, one, two, three, four or more new STBBIs diagnoses) before, at, and after HIV diagnosis by sex at birth, injection drug use status, use of methamphetamines, and housing status. Finally, we calculated the number of new STBBIs diagnoses in females and males before, at, and after HIV diagnosis.
A Fisher's exact test was used when a chi-square could not be appropriately applied for qualitative variables and the Mann-Whitney U test for quantitative variables. The crude and adjusted relative risks (RRs) were calculated to identify the factors—