Abstract
Pre-exposure prophylaxis (PrEP) became publicly available in Quebec for gay, bisexual and other men who have sex with men (GBM) in 2013. We used baseline data from Engage, a cohort of GBM recruited by respondent-driven sampling, to examine patterns of combination HIV prevention use among Montreal GBM since PrEP became available. Latent class analysis, stratified by HIV status, was used to categorize GBM by self-reported use of biomedical and behavioural prevention strategies. Correlates of resulting classes were identified using multinomial logistic regression. Among HIV-negative/unknown GBM (n = 968), we identified four classes: low use of prevention (32%), condoms (40%), seroadaptive behaviour (21%), and biomedical (including PrEP; 7%). Those using prevention (condoms, seroadaptive behaviour, and biomedical) had a higher number of anal sex partners and were more likely to report a recent sexually transmitted infection diagnosis. GBM using biomedical prevention also had a higher level of formal education. Among GBM living with HIV (n = 200), we identified three classes: mainly antiretroviral treatment (ART) with viral suppression (53%), ART with viral suppression and condoms (19%), and ART with viral suppression and seroadaptive behaviour (18%). Again, the number of anal sex partners was higher among those using condoms and seroadaptive behaviours. Our findings show antiretroviral-based prevention, either alone or in combination with other strategies, is clearly a component of the HIV prevention landscape for GBM in Montreal. Nevertheless, PrEP uptake remains low, and there is a need to promote its availability more widely.
Highlights
Gay, bisexual, queer, and other men who have sex with men (GBM), including transmen, bear a disproportionate burden of HIV in Canada [1]
Measures concerning prevention of HIV transmission by GBM living with HIV included: consistent condom use; antiretroviral treatment (ART) with viral suppression; any strategic positioning; any serosorting; any Pre-exposure prophylaxis (PrEP)-use sorting
Sexual health and related factors included: unknown HIV status (HIV-negative models), STBBI diagnosis in the past 12 months (P12M), number of anal sex partners (P6M), HIV status of main partner (HIV-negative models; we used having a main partner in HIV-positive models due to small cell counts), perceived risk of acquiring/transmitting HIV, and HIV treatment optimism
Summary
Bisexual, queer, and other men who have sex with men (GBM), including transmen, bear a disproportionate burden of HIV in Canada [1]. Extended author information available on the last page of the article suggests GBM accounted for 41% of diagnosed HIV infections in 2018 [1]. In 2017, Montreal announced it would become the first UNAIDS Fast-Track city in Canada [3] and committed to ending the HIV/AIDS epidemic by 2030 [4]. With this renewed drive towards HIV elimination, it is necessary to assess current strategies used for HIV prevention by GBM in Montreal and to understand the factors associated with prevention use to devise appropriate prevention policy and programming
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