Prevalence of HIV and sexually transmitted and blood-borne infections, and related preventive and risk behaviours, among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver: results from the Engage Study

Trevor A Hart,Darrell H S Tan,Nathan Lachowsky,David M Moore,Shayna Skakoon-Sparling,Joseph Cox,Abbie Parlette,Daniel Grace,Allan Lal,Jody Jollimore,Herak Apelian,Gilles Lambert,Syed W Noor,Jordan M Sang

doi:10.17269/s41997-021-00546-z

Abstract

ObjectivesThe last Canadian biobehavioural surveillance study of HIV and other sexually transmitted and blood-borne infections (STBBI) among gay, bisexual and other men who have sex with men (GBM) was conducted in 2010. We designed a study to measure STBBI prevalence among GBM in metropolitan Montreal, Toronto and Vancouver and to document related preventive and risk behaviours.MethodsThe Engage Cohort Study used respondent-driven sampling (RDS) to recruit GBM who reported sex with another man in the past 6 months. At baseline, we examined recruitment characteristics of the samples, and the RDS-II-adjusted distributions of socio-demographics, laboratory-confirmed HIV and other STBBI prevalence, and related behaviours, with a focus on univariate differences among cities.ResultsA total of 2449 GBM were recruited from February 2017 to August 2019. HIV prevalence was lower in Montreal (14.2%) than in Toronto (22.2%) or Vancouver (20.4%). History of syphilis infection was similar across cities (14–16%). Vancouver had more HIV-negative/unknown participants who reported never being HIV tested (18.6%) than Toronto (12.9%) or Montreal (11.5%). Both Montreal (74.9%) and Vancouver (78.8%) had higher proportions of men who tested for another STBBI in the past 6 months than Toronto (67.4%). Vancouver had a higher proportion of men who used pre-exposure prophylaxis (PrEP) in the past 6 months (18.9%) than Toronto (11.1%) or Montreal (9.6%).ConclusionThe three largest cities of Canada differed in HIV prevalence, STBBI testing and PrEP use among GBM. Our findings also suggest the need for scale-up of both PrEP and STI testing among GBM in Canada.

Highlights

The last national Canadian biobehavioural sexually transmitted and blood-borne infections (STBBI) surveillance study of gay, bisexual and other men who have sex with men (GBM), M-Track, was in 2010 (Public Health Agency of Canada [PHAC], 2011)
Engage is the first study in approximately a decade to present HIV and other STBBI prevalence using biological data in a representative sample of urban GBM in Canada
We identified some similarities in sexual health outcomes among GBM in the largest cities in Canada such as history of syphilis infection, and notable differences, such as in HIV prevalence and pre-exposure prophylaxis (PrEP) uptake

Summary

Introduction

The last national Canadian biobehavioural STBBI surveillance study of gay, bisexual and other men who have sex with men (GBM), M-Track, was in 2010 (Public Health Agency of Canada [PHAC], 2011). Since that multi-city surveillance study, most biobehavioural Canadian studies focused on GBM have not incorporated cross-city comparisons. Half of reported HIV diagnoses continue to be among GBM in Canada (Bourgeois et al, 2017). GBM are 131 times more likely to contract HIV than other Canadian men (Yang et al, 2016). HIV prevalence among GBM tends to be highest in the largest cities (e.g., BC Centre for Disease Control, 2019; Blouin et al, 2019; Ontario HIV Epidemiology and Surveillance Initiative, 2018). Diagnoses of other STBBIs, such as syphilis, chlamydia, gonorrhea, and hepatitis C virus (HCV), remain common among GBM, with GBM comprising the majority of syphilis cases (PHAC, 2019)

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