Grant: Catalyst Grant: STBBI Research in Canada: Beyond HIV/AIDS/Hepatitis C - General

An estimated 85% of syphilis cases occur among gay, bisexual, and other men who have sex with men (including trans, queer, non-binary, and Two-Spirit peoples; 2SGBTQ). Within this population, only a small proportion have ever acquired syphilis. Further analyses suggest that syphilis risk is driven by individuals with larger sexual networks. Consequently, syphilis infections among 2SGBTQ people are clustered in large urban centres across Canada, within so-called geographic "hotspots." It is apparent that the education and uptake of syphilis prevention strategies have not been sufficient to eradicate syphilis. The aim of this catalyst grant proposal is to leverage community-based surveillance data to explore the development of tailored and evidence-based syphilis prevention strategies within hotspot neighbourhoods across Canada. To accomplish this aim, we will (1) Identify syphilis hotspots by calculating syphilis infection rates using community-based survey data and validating the identified hotspots using public health surveillance data, (2) Identify and compare the prevalence of the risk management practices associated with the greatest reduction in syphilis risk for 2SGBTQ people within hotspot and non-hotspot regions; and (3) Assess the acceptability, feasibility, and appropriateness of under-utilized community and public health risk management strategies that could reduce syphilis risk within hotspot and non-hotspot regions. To accomplish these aims, we will use serial cross-sectional data from the 2018, 2019, 2020, 2021, and 2022 Sex Now Survey, Canada's largest and longest running enhanced surveillance study of 2SGBTQ. Sex Now employs a community-based design, recruits large samples of 2SGBTQ in each cycle, and collects survey data and biological specimens (e.g., dried blood spots). Survey data includes a wide variety of behavioural, social, and structural variables that play an important role in syphilis transmission.