Grant: CIHR Fellowship

Syphilis is recognised by the Canadian Government as a national public health threat. Syphilis notifications increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020. While rates of infection have increased among both males and females, and are highest among males, the largest increase has been among females at 773% compared to males at 73%. A result of syphilis among females has been increases in congenital syphilis, i.e., infection of a baby during pregnancy, which can lead to long-term disability and still-birth. Evidence within Canada and abroad has linked syphilis among females and heterosexual males to substance use, including injection drug use. Structural determinants of health such as unstable housing and incarceration have also been linked to increases in syphilis. Despite this, there remains a poor understanding of syphilis epidemiology among people who inject drugs. Likewise, there is a complete lack of formative research to inform the design and implementation of syphilis testing for this key population group. Drawing on the Hepatitis Cohort Study (HEPCO), the longest running cohort study of people who inject drugs in Canada, my research program will provide contemporary data on the prevalence and incidence of syphilis among people who inject drugs in Montreal. As people who inject drugs are not a homogenous population group, this work will give attention to the intersection of gender, sexuality, and structural factors in determining who is at increased risk for syphilis. I will also lead research on understanding ways to improve syphilis testing among people who inject drugs using both quantitative and qualitative methods. Findings from my research will play a critical role in informing provincial and national guidelines and the development and implementation of syphilis testing among people who inject drugs before it becomes endemic among this key population group.