Travelling for sex, attending gay-specific venues, and HIV-related sexual risk among men who have sex with men in Ontario, Canada

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) remain the group most affected by HIV in Canada. Travelling for sex and attendance at specific venues for sex have been linked to elevated HIV risk among GBMSM, but most research on these mobilities and sexual health has focused on GBMSM living in large cities. The purpose of this study was to explore HIV-related sexual risk among GBMSM from mid-sized cities and rural regions who attend gay-specific venues and/or travel for sex. A cross-sectional online survey was completed by a convenience sample of individuals (n = 526) self-identifying as LGBTQ who lived, worked, or studied in Waterloo Region, a mixed urban-rural region in the southwestern part of Ontario, Canada. Analyses for the current study were restricted to those identifying as GBMSM (n = 269). Multinomial logistic regression models were created to explore travelling outside of the Region for sex, as well as recent attendance at gay-specific venues, and their associations with a contextual measure of HIV-related sexual transmission risk. Individuals reporting high HIV risk were significantly more likely to travel outside of Waterloo Region for sex than individuals reporting no HIV risk (OR = 3.08; 95% CI: 1.20, 7.93). The association between travel and risk was strengthened after controlling for education, marital status, sexual orientation, gender modality, and social support (OR = 5.07; 95% CI: 1.73, 14.87). GBMSM who reside outside of large cities may travel farther, enter unfamiliar scenes, or be less privy to information disseminated through current health promotion initiatives for GBMSM in large cities. Due to the dynamic geographic status of GBMSM travelling for sex and attendance at venues, HIV prevention initiatives that target these individuals may benefit from additional conceptualization of health promotion delivery in terms of social and sexual networks, rather than simply by place of residence.

Maximizing the impact of limited vaccine supply under different epidemic conditions: a two-city monkeypox modelling analysis

“…Although our study, for simplicity, focused on two weakly-connected networks, it highlights the importance of measuring outcomes for a population overall, by considering that geographies are comprised of interconnected networks. That is, while cities across Canada, and globally, feature important within- and between-city differences in size and configuration of transmission networks [21,22], and in access to interventions/services [20,23,24], ultimately these cities remain connected with respect to transmission, and cannot be considered in isolation over longer time horizons [7,22,25].…”

“…Figure 1a illustrates the modelled city/risk strata, Figure 1b illustrates the sveir health states, and Table 1 summarizes the default model parameters. To parameterize the model, we drew on prior analyses of gbmsm sexual networks in Canada [6,7], and emerging mpvx epidemiological data in the context of the current epidemic [8–12]. Appendix A provides additional details about the model implementation and parameterization.…”

“…As one specific example setting, we chose parameters representative of Toronto (city A) and another medium-sized Ontario city (city B), with gbmsm population sizes of 80,000 and 20,000, respectively, and 10% sexual/social network connectivity ( ϵ c = 0.9) [7]. We also modelled R 0 = 2.0 in Toronto versus 1.5 in city B, reflecting differences in sexual network density as suggested by differential prevalence of bacterial sexually transmitted infections across Ontario cities [19,20].…”

Exploring Experiences with Social Inclusion, Food Security and Housing Among People Living with HIV: A Qualitative Analysis

“…In comparison to a city with a larger health promotion infrastructure, individuals from the Waterloo Region may have less knowledge about the sexual transmission of HIV. 16 Moreover, as ACCKWA services three cities and their accompanying townships, users may have to travel longer distances to access care. 17 Thus, an important caveat of our research is that our participants, who are residents within this region, may experience less access to care, as well as higher levels of marginalization or stigma, compared to those living in more urban settings.…”

Queer expectations: An empirical critique of rural LGBT+ narratives

“…Alongside, the abundant literature that exists on gay urban areas is an equally mature area of research on rural gay life. The narratives put forward by these studies suggest that rural LGBT+ persons face structural constraints that impact individuals differently, but ultimately cause most to migrate to urban areas where their identities are more tolerated (Armstrong et al, 2020; Giano et al, 2020; Hubach et al, 2019; Weston, 1995). Other studies of rural cultures note that a heteronormative culture exists which calls upon LGBT+ persons to downplay their identities, ultimately causing an erasure and marginalization of LGBT+ persons (Bell, 2000; Boulden, 2001).…”