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Event-level studies measure substance use and sexual behaviors happening during a specific sexual encounter, ensuring that both variables are temporally paired. This study explored the event-level associations between a range of sexual behaviors (masturbation, anal sex, oral sex, rimming, fisting, sex toys, and group sex) and five sexualized substances (poppers, methamphetamine, GHB, ecstasy/MDMA, and ketamine) used during 11,582 sexual events reported by 762 gay, bisexual, and other men who have sex with men (GBMSM) in Vancouver, Canada. Data were obtained from a prospective cohort of GBMSM who self-reported their behaviors via computer-based questionnaires on their last sexual encounter with up to five of their most recent partners in the past six months. These clustered data were analyzed with multivariable generalized linear mixed models. Participants reported popper use in 16.1% of sexual encounters, methamphetamine in 8.6%, gamma-hydroxybutyrate (GHB) in 4.1%, ecstasy/3,4-methylenedioxymethamphetamine (MDMA) in 3.3%, and ketamine in 1.5%. Condomless receptive anal sex (25.0% of events) was associated with increased odds of using poppers, methamphetamine, GHB, and ecstasy/MDMA. Group sex (13.1% of events) and sharing sex toys (2.0% of events) were more likely with the use of all five substances. Receiving money/drugs/goods in exchange for sex (2.5% of events) was associated with increased odds of poppers, methamphetamine, GHB, and ecstasy/MDMA use. GBMSM living with HIV (29.9% of participants) had higher odds of using poppers, methamphetamine, and GHB, but lower odds of using ecstasy/MDMA. In conclusion, these event-level results suggest public health strategies are needed to address the possible negative impacts of sexualized substance use among GBMSM.

Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use.Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM.Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all plt;0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (plt;0.001), Toronto 21.4-31.4% (plt;0.001) and Vancouver 21.7-59.5% (plt;0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18).Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.

Bear identity exists as an understudied subgroup among gay, bisexual and other men who have sex with men (gbMSM). Given associations between Body Mass Index (BMI) and Bear identity, we examined prevalence estimates and effect modification between Bear identity, BMI, and cardiovascular health. Data is from February 2012–February 2018 and comes from a longitudinal-cohort of gbMSM in Metro Vancouver, recruited using respondent-driven sampling (RDS). We conducted univariable and multivariable logistic regression using RDS weighting. A total of 161 (21.3%) gbMSM self-identified as a Bear/Cub/Otter (BCO) and 48 (7.2%) gbMSM who identified as a BCO had a measured BMI ≥ 30. Multivariable results found non-BCO identity and a BMI ≥ 30 (aOR = 11.27; 95% CI = 2.88, 44.07) was associated with greater odds of history of cardiovascular health condition and/or associated risk factors compared to gbMSM who did not identify as a BCO and had a BMI < 30. The majority of gbMSM with BMI ≥ 30 identified as a BCO. However, BCO identity was not the most significant effect modifier for BMI on a history of a cardiovascular health condition and/or associated risk factors. Interventions should target all gbMSM with increased risk for cardiovascular disease and clinicians should be mindful of culturally sensitive prevention and care for gbMSM who identify as a BCO.

BackgroundDue to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression.MethodsParticipants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012–February 2015) with follow-up visits occurring every 6 months until February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale.ResultsOf the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship.ConclusionThere may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.

Background Availability and public funding of pre-exposure prophylaxis (PrEP) varies by jurisdiction in Canada. We conducted a multi-site prospective-longitudinal study to assess trends and correlates of PrEP awareness and use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Toronto and Montreal. Methods Sexually-active GBM, aged ≥16 years, were recruited through respondent-driven sampling (RDS) from February 2017 with follow-up data collected to March 2020. Participants completed a Computer-Assisted Self-Interview to assess PrEP awareness and use. Analyses were limited to HIV-negative GBM. We used generalized estimating equations accounting for two levels of clustering (RDS recruitment chain; participant) to evaluate temporal trends (monthly prevalence) of awareness and past six-month usage of PrEP. Multivariable models were built using backward selection to minimize QIC to identify correlates for two outcomes 1) PrEP awareness, and 2) PrEP use. Results We recruited 2008 HIV-negative GBM (N=622 from Vancouver, N=418 from Toronto, and N=968 from Montreal). Awareness of PrEP increased significantly in all three sites: Montreal, 81.2% during the first 6-month period to 91.4% during the last 6-month period (p Conclusions PrEP awareness was very high among GBM in all three cities. Uptake was highest in Vancouver where full public funding and active health promotion began in 2018 for those clinically eligible. Health policy and public health intervention can remove key barriers to PrEP implementation.

Introduction Treatment as prevention strategies have been variously applied across provinces in Canada. We estimated HIV care cascade indicators and correlates of unsuppressed viral load (VL) among gay, bisexual and other men who have sex with men (GBM) recruited in Vancouver, Toronto and Montreal. Methods Sexually active GBM, aged ≥16 years, were recruited through respondent‐driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer‐Assisted Self‐Interview and tests for HIV and other sexually transmitted infections (STIs). We conducted bivariate analyses comparing RDS‐adjusted proportions across cities. We used multivariable logistic regression to examine factors associated with having a measured VL ≥ 200 copies/mL with data pooled from all three cities. Results We recruited 1179 participants in Montreal, 517 in Toronto and 753 in Vancouver. The RDS‐adjusted HIV prevalence was 14.2% (95% CI 11.1 to 17.2) in Montreal, 22.1% (95% CI 12.4 to 31.8) in Toronto and 20.4% (95% CI 14.5 to 26.3) in Vancouver (p

Event-level studies measure substance use and sexual behaviors happening during a specific sexual encounter, ensuring that both variables are temporally paired. This study explored the event-level associations between a range of sexual behaviors (masturbation, anal sex, oral sex, rimming, fisting, sex toys, and group sex) and five sexualized substances (poppers, methamphetamine, GHB, ecstasy/MDMA, and ketamine) used during 11,582 sexual events reported by 762 gay, bisexual, and other men who have sex with men (GBMSM) in Vancouver, Canada. Data were obtained from a prospective cohort of GBMSM who self-reported their behaviors via computer-based questionnaires on their last sexual encounter with up to five of their most recent partners in the past six months. These clustered data were analyzed with multivariable generalized linear mixed models. Participants reported popper use in 16.1% of sexual encounters, methamphetamine in 8.6%, gamma-hydroxybutyrate (GHB) in 4.1%, ecstasy/3,4-methylenedioxymethamphetamine (MDMA) in 3.3%, and ketamine in 1.5%. Condomless receptive anal sex (25.0% of events) was associated with increased odds of using poppers, methamphetamine, GHB, and ecstasy/MDMA. Group sex (13.1% of events) and sharing sex toys (2.0% of events) were more likely with the use of all five substances. Receiving money/drugs/goods in exchange for sex (2.5% of events) was associated with increased odds of poppers, methamphetamine, GHB, and ecstasy/MDMA use. GBMSM living with HIV (29.9% of participants) had higher odds of using poppers, methamphetamine, and GHB, but lower odds of using ecstasy/MDMA. In conclusion, these event-level results suggest public health strategies are needed to address the possible negative impacts of sexualized substance use among GBMSM.

Background Awareness, availability, and public funding of pre-exposure prophylaxis (PrEP) has increased substantially since it was approved by Health Canada in 2016 but policies and guidelines vary by province. Given the dynamic nature of PrEP policy and promotion, we sought to determine awareness and use of PrEP among gay, bisexual, and other men who have sex with men (gbMSM) in Vancouver, Toronto, and Montreal. Methods Beginning in 02/2017, sexually-active gbMSM ≥16 years and living in Vancouver, Toronto, or Montreal were recruited into a cohort study using respondent-driven sampling (RDS). Data are included up to 08/2018. At study visits every 6 months (Vancouver) or 12 months (Toronto, Montreal), participants completed a computer-assisted self-interview which included questions on PrEP awareness and use in the past 6 months (P6M). We used RDS-adjusted, general estimating equations accounting for two levels of clustering (RDS recruitment chain; participant) to evaluate temporal trends (monthly prevalence) of awareness and P6M usage of PrEP among HIV-negative participants. Results 1619 HIV-negative gbMSM completed 2074 study visits (1205 Montreal, 285 Toronto, 584 Vancouver). Over the course of the study, PrEP awareness significantly increased among gbMSM in Montreal from 62.6% during the first 6-month period to 84.8% during the last 6-month period (OR:1.07, 95%CI:1.02–1.12, per month); awareness remained consistent in Toronto (89.8%–96.0%, ns) and Vancouver (84.5%–95.0%, ns). Use of PrEP increased significantly in all three sites: Montreal, 10.5% during the first 6-month period to 30.9% during the last 6-month period (OR:1.06, 95%CI:1.02–1.11); Toronto, 12.5% to 23.3% (OR:1.15, 95%CI:1.02–1.30); Vancouver, 11.4% to 35.2% (OR:1.16, 95%CI:1.06–1.27). Conclusion Awareness of PrEP appears to be ≥85% among HIV-negative gbMSM across all three cities. Even though provincial policy and programs differ greatly in availability and cost of PrEP, use of PrEP increased in all sites during the course of the study. Disclosure No significant relationships.