Background Lymphogranuloma venereum (LGV), caused by invasive subtypes of Chlamydia trachomatis, is a sexually transmitted infection (STI) that has been increasing in Canada. Initially, most cases were among symptomatic men who have sex with men (MSM) living with HIV. More recently, a trend towards an increasing proportion of asymptomatic LGV cases has been seen, potentially due to routine STI screening for people using HIV pre-exposure prophylaxis (PrEP) programs. Using data from 2019 – specifically, the year following the introduction of publicly-funded PrEP in BC - this study describes the epidemiology of LGV in the context of widespread PrEP availability in BC.

Methods A retrospective chart review of all LGV cases diagnosed in BC from 01/2019-12/2019 was performed. We collected sociodemographic information, clinical LGV information and previous STI diagnosis history. Binomial logistic regression was completed to compare the clinical presentation of PrEP users and non-users.

Results Among the 119 cases, 115 were among MSM (96.6%, 115/119) and 2 were among transgender women (1.7%, 2/119), with a mean age of 38.0 years. Eighty cases occurred in HIV-negative individuals (67.2%, 80/119) and the majority were using PrEP (66.3%, 53/80). Among PrEP users, most were asymptomatic (52.8% 28/53) with a mean HIRI-MSM score of 25.4 at the time of PrEP initiation. HIV-negative individuals on PrEP were more likely to present with asymptomatic LGV compared to HIV-negative individuals not on PrEP (OR 3.56; 95% CI 1.26 - 10.9). Nearly half of individuals had previously or concurrently tested positive for syphilis (48.7%, 58/119).

Conclusion BC has seen shifts in the epidemiology of LGV, with a majority of cases being seen in asymptomatic HIV-negative men on PrEP. Our findings support the importance of routine testing combined with reflex LGV testing for chlamydia-positive rectal specimens to ensure the appropriate treatment and prevention of onward transmission.

Background: Approximately 8-20% of Canadian GBM report past year methamphetamine use; most occurs in a sexual context. Methamphetamine use can be associated with adverse sexual health outcomes, including increased risk of HIV transmission. Psychosocial factors associated with methamphetamine use remain understudied. Using structural equation modeling, we tested factors associated with methamphetamine use among GBM living with HIV and HIV-negative GBM.
Methods: We examined baseline data from 2,449 GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver (Engage Cohort Study). Structural equation models were fit using weighted least squares estimation and adjusted for sampling bias (RDS-II weights) and demographic covariates, including race/ethnicity. We examined measures of heterosexist discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape (i.e., using drugs to avoid thinking about sexual risks) as factors associated with recent methamphetamine use.
Results: 28% of GBM living with HIV (n=423) and 4% of HIV-negative (n=1800) participants reported methamphetamine use in the past six months, respectively. The hypothesized models (see Figure 1) fit the data well (CFIs≥.95, RMSEAs≤.03). Among both subsamples, discrimination was positively associated with psychological distress and psychological distress was indirectly associated with recent methamphetamine use through sexual compulsivity and cognitive escape.
Conclusion: Methamphetamine use is more common among GBM living with HIV than HIV-negative GBM. GBM’s methamphetamine use may be related to coping with discrimination-based psychological distress. Sexual compulsivity and cognitive escape are two coping behaviours that mediated this relationship. Interventions to reduce potential methamphetamine-related harms need to consider the motivations for sexualized methamphetamine use.

Background: We sought to evaluate the population-level trends of the “Undetectable equals Untransmittible” (U=U) campaign among gay, bisexual, trans, Two-Spirit, and queer men and non-binary people (GBT2Q) across Canada, especially the impacts among GBT2Q living with HIV.

Methods: Data are from community-based repeated cross-sectional bilingual (English/French) surveys: 2015 (online), 2018 (pride festivals), 2019 (online), 2020 (online), and 2021 (online). Online recruitment used paid sociosexual websites/apps advertisements and community-based organizations’ social media and email lists. Eligible participants were at least 15 years old, lived in Canada, and either identified as non-heterosexual or reported sex with a man in the past 5 years. Women were ineligible. Temporal trends were evaluated using multivariate logistic regressions, with survey year (continuous) as the primary explanatory variable, controlling for age, education, ethnoracial identity, geography, gender identity, transgender status, and HIV status. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are shown.

Results: The pooled sample included 23,460 responses. Knowledge that HIV medications effectively suppress one’s viral load increased from 69.6% in 2015 to 87.8% in 2021 (AOR=1.31, 95%CI: 1.12-1.54). Knowledge of the U=U scientific consensus increased from 71.7% in 2018 to 82.4% in 2021 (AOR=1.28, 95%CI:1.11-1.48). However, the practice of viral load sorting (condomless sex only with an undetectable partner) did not change over time: 3.7% in 2015 to 7.6% in 2021 (AOR=1.18, 95%CI: 0.86-1.63). When participants living with HIV were asked about U=U impacts, a third reported decreased shame (39.8%), stigma (37.9%), and rejection by sexual partners (28.5%); one in five reported increased pressure to take medications (17.1%); and a third reported increased mental well-being (32.9%), quality of sex life (30.8%), and social well-being (28.1%).

Conclusions: While U=U knowledge has increased over time among GBT2Q, behavioural uptake and self-reported impacts remain incommensurate. Future research and interventions should interrogate and address this gap.

Background: HIV-related anxiety is experienced by many gay, bisexual, and other men who have sex with men (GBM). Pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition and may help to reduce HIV-related anxiety. While research has examined the mental health impacts of PrEP use among GBM there is a lack of research that explores how PrEP use impacts HIV-negative GBM’s feelings of HIV-related anxiety and having sex with GBM who are living with HIV.

Methods: As part of a mixed-methods study on Scaling up PrEP Implementation (PRIMP), we conducted semi-structured interviews with 20 HIV-negative GBM, all of whom were current or former PrEP users living in British Columbia. Interviews focused on their experiences getting access to and taking PrEP. Participants were asked about PrEP’s impact on their sexual health, mental health, and their perspectives on having sex with people living with HIV. The data was analyzed and coded using thematic analysis.

Results: Prior to being prescribed PrEP, several participants described experiencing high levels of HIV-related anxiety that negatively impacted their romantic and sexual lives. Nearly all participants identified feeling less anxious and having a “peace of mind” about contracting HIV as a result of being prescribed PrEP. While some participants described being comfortable having sex with someone who is living with HIV, many still felt reticent, or outright rejected this possibility. This is despite the fact that these participants had knowledge of PrEP’s efficacy and campaigns like Undetectable=Untransmissible.

Discussion and Implications: Our findings support the broader impact of PrEP to support the mental health and HIV-related anxiety reduction of HIV-negative GBM. However, the decline of HIV-related anxiety did not fully eliminate stigmatizing attitudes about people living with HIV.

Background: Epidemics impact individuals unevenly across race, gender, and sexuality. Recent scholarship on COVID-19 & HIV– as well as COVID-19 and racism–have utilized the construct of a 'double pandemic' to describe ongoing crises in public health. We examined how racism framed experiences of COVID-19 public health measures for gay, bisexual, and queer men (GBM) of colour in Canada.

Methods: Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBM living in Vancouver, Toronto, and Montreal. We conducted two rounds of qualitative interviews (11/2020-01/2021 and 06/2021-10/2021) with GBM of colour (n=59) where they shared their experiences of the COVID-19 pandemic, including experiences with discrimination. Interviews were coded in NVivo software using critical race theory as an analytical framework.

Results: Participants’ age ranged from 24 to 64 yrs/old. The majority of participants identified as Mixed Race (n=22), East Asian (n=14) and Black (n=8). Nineteen percent were living with HIV (n=11). Several GBM described their experiences of discrimination during COVID-19 in relation to other epidemics their communities have faced, including HIV. Some GBM also underlined how COVID-19 strengthened these dynamics, resulting in racialized communities being more vulnerable to contracting COVID-19. Some GBM also felt more exposed to racism during the COVID-19 pandemic, including xenophobic harassment. Some participants expressed concern about accessing health services during the pandemic for fear of discrimination and others described how COVID has increased their experiences with sexual racism.

Conclusion: How GBM of colour experience epidemics like HIV and COVID-19 is often tied to racism, which continues to negatively impact the health of GBM of colour. For these participants, racism affects their relationships with healthcare providers and potential partners. Public health interventions that position racism as one among several epidemics risk ignoring the specific ways racism exceeds the lifetimes of viral epidemics like HIV and COVID-19.

Background
The secondary impacts of the COVID-19 pandemic may disproportionately affect the health and wellbeing of gay, bisexual and other men who have sex with men (GBM), particularly related to HIV. We assessed trends of syndemic production and trends and correlates of pre-exposure prophylaxis (PrEP) interruptions among HIV-negative/unknown GBM in Vancouver.

Methods
Sexually-active GBM, aged ≥16 years, were recruited through respondent-driven sampling (RDS) from February 2017-August 2019. Participants completed a Computer-Assisted Self-Interview every 6 months and data were linked to BC HIV Drug Treatment Program to assess PrEP uptake and continuation. We used univariable generalized-linear mixed models to examine 1) trends in syndemic conditions (i.e. anxiety, depression, interpersonal violence, polysubstance use, alcohol use) and 2) trends in PrEP interruptions (6-month periods) among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine the individual additive and interaction effects of syndemics on PrEP use among GBM reporting PrEP use before study visit. Follow-up analyses includes data from before and during the COVID-19 pandemic (March 2018-April 2021).

Results
Our study included 760 participants/data on 2339 visits, from March 2018-April 2021. Depressive symptoms increased over the study period (OR=1.33, 95%CI=1.14-1.54) with an increase after the onset of COVID-19 in Canada. We also found a trend of increased PrEP interruptions over time (aOR=2.59, 95%CI=1.96, 3.42). The time-period after the onset of COVID-19 (Sept 2020-April 2021) had greater odds of PrEP interruptions (aOR=16.33, 95%CI=4.73, 56.44) compared to the March 2018-March 2020 time-period. The only associated syndemic condition was depression (aOR=7.22, 95%CI=1.12,46.47). We did not find interactions with other syndemic conditions.

Conclusions
We found increased depressive scores and PrEP interruptions among HIV-negative/unknown GBM since the onset of COVID-19. Additional mental health services and targeted follow-up for assessment for PrEP continuation may be needed to mitigate the impacts of the pandemic on GBM.