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Epidemiology & Monitoring

Category: Men who have sex with men

(P236) Sex toy sharing and post-exposure prophylaxis (PEP) among gay, bisexual and other men having sex with men (GBM); results from the Engage Cohort Study

Tuesday, July 25, 2023
16:00 – 18:00 CST

    Primary Presenter(s)

  • Joseph Cox, MD MSc (he/him/his)

    Associate Professor
    McGill University
    Montreal, Quebec, Canada

    • Co-Author(s)

  • GL

    Gilles Lambert

    • Co-author(s)

  • AF

    Alain Fourmigue

    Research Associate
    Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Quebec, Canada

  • MD

    Milada Dvorakova

    Research Project Manager
    Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre
    Montreal, Quebec, Canada

  • DG

    Daniel Grace

    University of Toronto
    Toronto, Ontario, Canada

  • DM

    David Moore

    BC Centre for Excellence in HIV/AIDS, British Columbia, Canada

  • TH

    Trevor Hart

    Toronto Metropolitan University (formerly Ryerson), Quebec, Canada

  • NL

    Nathan J. Lachowsky

    Associate Professor
    Public Health and Social Policy, University of Victoria
    Victoria, British Columbia, Canada

  • JJ

    Jody Jollimore

    Canadian AIDS Treatment Information Exchange (CATIE), British Columbia, Canada

Background
PEP recommendations related to sharing of sex toys are mainly based on expert opinion. The objective of the present analysis is to inform on the risk of acquiring HIV and syphilis associated with sex toy sharing using data from the Engage Cohort Study.

Methods
The Engage Study is a cohort of sexually active GBM recruited between Feb-2017 and Aug-2019 using respondent-driven-sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. At each visit, participants underwent screening for sexually transmitted and blood-borne infections (STBBIs) and completed a questionnaire concerning their last sexual encounter(s) with their last five sexual partners in the past six months. We calculated three-city pooled incidence rates of HIV and syphilis along with rate ratios and predictive values of sex toy sharing for HIV and syphilis infection. Results were adjusted for RDS recruitment and loss-to-follow-up (LTFU) using a combination of RDS-II weights and inverse-probability-of-censoring weights. 95% CIs were calculated using robust variance estimation.

Results
Participants included in the analysis were those determined to be HIV-negative at baseline visit (n=1995). Between Feb-2017 and Aug-2022, a total of 20 prospective HIV and 104 prospective syphilis infections were observed for a time contribution of 5723 person-years (PY). Adjusted incidence rates of HIV and syphilis were 0.3 [95% CI 0.2;0.6] and 1.3 [95% CI 1.0;1.8] per 100 PY, respectively. Among 27554 sexual encounters, 1.3% (n=369) involved sex toy sharing (Table 1); 0.3% (n=79) involved sex toy sharing in a higher risk context, i.e. while not on PrEP with a partner (other than the main partner) of unknown HIV status or of HIV positive status with an unknown or detectable viral load, and 0.1% (n=42) involved sex toy sharing in a higher risk context but without penile-anal intercourse. Due to small counts, no inference was made for these last two cases.

Conclusion
Incidence rates of HIV and syphilis among (HIV-negative) urban Canadian GBM were low and sharing of sex toys was infrequent, causing uncertainty in RR estimation. Nonetheless, low sensitivity and low positive predictive values suggest that sex toy sharing may not be an indication for PEP after potential exposure to HIV or syphilis.