Background: British Columbia (BC) has dedicated $48 million in additional annual funding to support expanded HIV testing and improved engagement/retention in HIV care since 2010. We compared HIV care cascade metrics for GBM in Vancouver, across two time-periods 2012-2014 and 2017-2019.
Methods: Participants were sexually-active GBM aged ≥16 years, who gender identified as men and were recruited through respondent driven sampling (RDS) in two independent cross-sectional studies: Momentum I (M1, February 2012-February 2014) and Momentum II (M2, February 2017-July 2019). Participants completed a computer-based survey and tests for HIV and other sexually transmitted infections. For GBM living with HIV, we measured HIV viral load (VL). We calculated RDS-II adjusted proportions and 95% confidence intervals for all variables for each time-period.
Results: We recruited 719 participants (119 seeds) in M1 and 753 participants (117 seeds) in M2. Among those who reported HIV negative/unknown serostatus, 66.1% (95% CI 60.0-72.2), reported testing for HIV in the previous year in M1 and 65.3% (95% CI 57.6-72.9) in M2. HIV prevalence was 25.8% (95% CI 21.1-30.6) in M1 and 20.4% (95% CI 14.5-26.3) in M2, with 0.4% (95% CI 0.0-0.9) previously undiagnosed in M1 and 0.1% (95% CI 0.0-0.2) in M2. Among GBM living with HIV, 83.9% (95% CI 76.3-91.5) were receiving ART and 82.3% were virologically suppressed (VL≤200 copies/mL) (95% CI 73.6-91.1) in M1 and 84.8% were receiving ART (95% CI 72.8-96.8) and 97.4% (94.6-100.0) were virologically suppressed in M2. Twelve participants in M1 and 11 in M2 reported not receiving ART but had VL <200 copies/mL.
Conclusion: Additional investments in the HIV response appear to have improved care cascade parameters for GBM in Vancouver, namely very low undiagnosed fraction and very high proportion of VL suppression. BC appears to have achieved 95-95-95 targets for this key population in Metro Vancouver.

Background: Phylogenetic analyses of the interrelationships of viral sequences from the provincial genotyping program has provided a molecular epidemiological framework to reconstruct HIV transmission networks in Quebec. We applied these methods to gain insights on HIV transmission patterns among Men having Sex with Men (MSM) and Heterosexual groups.

Methods: Phylogenetic analyses on HIV-1 polymerase sequences was performed using Maximum Likelihood methods and HIV-TRACE (Transmission Cluster Engine) platforms. Time trends in patterns of viral spread was assessed in three populations, including i) MSM (n=4800); ii) Heterosexuals with subtype B infections, including People who Inject Drugs (PWID) and recent migrants from the Americas (n=1836); and iii) Heterosexuals harboring non-B viral subtypes (n=1578). Epidemiological features implicated in clustering included region, sex, age, viral load, disease stage, recency of infection (based on % mixed base calls) and treatment status.

Results: Three patterns of viral spread occurred among MSM, including singleton transmissions (n=1404), small clusters (2-5 members) and large cluster networks (8-150 members). There has been a progressive decline in singleton transmissions and small cluster networks occurred over the 2007 to 2019 period. Large cluster outbreaks sustained the epidemic, rising from 18% to 65% of infections in MSM from 2002 to 2019. Overall, cluster size was inversely correlated with the recency of infection and age of subjects (p<0.001). The epidemic among PWID was largely historic (pre-2011). Large cluster outbreaks in Montreal and Quebec City was associated with the spread of transmitted resistance and non-B subtypes. Phylogenetics inferences revealed the introduction and crossover of subtype B and non-B subtype sub-epidemics related to recent migration and globalization.

Discussion: Phylogenetic inferences showed a decline in the epidemic among MSM. There remains a need to improve testing and prevention paradigms for younger individuals and recent migrants to avert large cluster transmission cascades and better control the HIV epidemic.

Gay, bisexual and queer men (GBQM) are at high risk of HIV and other sexually transmitted and blood-born infections (STBBIs). A growing body of research links HIV/STBBIs risk behaviours within this population to sexualized substance use, a practice colloquially referred to as "chemsex" and “PNP”. While research in this area has predominantly focused on establishing the connections between substance use and sexual health-related outcomes, the literature focused on the perspectives of GBQM, including subjective rationales for chemsex, the meaning given to chemsex experiences, and GBQM’s thoughts about the best strategies to minimize the harm associated with chemsex, is limited. To address these knowledge gaps, we launched a community-based research initiative called Chemstory. Drawing on the principles of art-based research methods, Chemstory is a project centered around the production of podcasts by GBQM with a history of chemsex to share their perspectives and experiences. In collaboration with knowledge users, researchers, and an expert in podcasting, we designed a workshop series on podcasting that will be implemented in the winter of 2021 with a diverse group of 20 GBQM in Montreal (In French and English). The training includes three sessions covering the ethics of podcasting, storytelling, podcast production and podcast dissemination. The workshop series will prepare each participant to produce a 15-minutes podcast focusing on aspects of their experience they wish to share. The podcasts will then be analysed to build new knowledge about chemsex and HIV/STBBIs prevention grounded in the lived experience of GBQM with a history of chemsex. Finally, with the participants’ consent, we will disseminate the podcasts broadly to encourage and facilitate nuanced and compassionate conversations about chemsex and HIV/STBBIs prevention within the GBQM community as well as among health care professionals and policy makers.

Introduction
Human papillomavirus (HPV) prevention via vaccination is a priority for gay, bisexual and other men who have sex with men (GBM). Monitoring HPV prevalence can measure vaccine impact; however, estimates may vary depending on how specimen validity is defined. We estimated HPV prevalence among self-identified GBM and compared findings using different definitions of specimen validity.

Methods
Participants in the Engage Cohort Study aged 16 to 30 years self-collected anal specimens for HPV testing. We defined specimen validity as testing positive for (1) either HPV DNA using the Roche Linear Array or a human β-globin DNA cellular control, as is typical in HPV studies; or (2) human β-globin DNA regardless of HPV DNA positivity. We calculated prevalence for any HPV type, any vaccine-preventable types (HPV-6/11/16/18/31/33/45/52/58), and HPV-16. Estimates are pooled by city and weighted to account for respondent-driven sampling.

Results
Amongst 847 GBM (median age = 26 years, 5.9% HIV-positive), anal specimens from 645 (76.2%) were judged valid using definition 1 whereas 402 (47.5%) using definition 2. As expected, HPV prevalence was consistently lower when definition 2 was used. The magnitude of the absolute difference was greater when more HPV types were combined in an HPV outcome definition (Table 1).

Conclusions
Regardless of the validity definition used, anal HPV prevalence was high. In our study, due to the non-trivial proportion of β-globin-negative specimens, point prevalence estimates were markedly higher for definition 1 compared to definition 2. Thus, our estimates from definition 2 are likely closer to underlying population prevalence.