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Examining Associations Between Resilience and PrEP Use Among HIV-negative GBM in Toronto, Montreal and Vancouver

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Abstract

This study evaluated the association between resilience and PrEP use among a population-based sample of Canadian gay, bisexual, and other men who have sex with men (GBM). Sexually active GBM aged ≥ 16 years old were recruited via respondent-driven sampling (RDS) in Toronto, Montreal, and Vancouver from 02/2017 to 07/2019. We conducted a pooled cross-sectional analysis of HIV-negative/unknown GBM who met clinical eligibility for PrEP. We performed multivariable RDS-II-weighted logistic regression to assess the association between scores on the Connor-Davidson Resilience-2 Scale and PrEP. Mediation analyses with weighted logistic and linear regression were used to assess whether the relationship between minority stressors and PrEP use was mediated by resilience. Of 1167 PrEP-eligible GBM, 317 (27%) indicated they took PrEP in the past six months. Our multivariable model found higher resilience scores were associated with greater odds of PrEP use in the past six months (aOR = 1.13, 95%CI = 1.00, 1.28). We found that resilience reduced the effect of the association between heterosexist discrimination and PrEP use. Resilience also mediated the relationship between internalized homonegativity and PrEP use and mediated the effect of the association between LGBI acceptance concern and PrEP use. Overall, PrEP-eligible GBM with higher resilience scores had a greater odds of PrEP use in the past six months. We also found mixed results for the mediating role of resilience between minority stress and PrEP use. These findings underline the continued importance of strength-based factors in HIV prevention.

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Data Availability

Data is available from the corresponding author upon reasonable request.

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Funding

The authors would like to thank the Engage/Momentum II study participants, office staff, and community engagement committee members, as well as our community partner agencies. Engage is led by Principal Investigators in Montreal: Joseph Cox and Gilles Lambert; Trevor Hart and Daniel Grace in Toronto; David Moore, Nathan Lachowsky and Jody Jollimore in Vancouver. Engage/Momentum II is funded by the Canadian Institutes for Health Research (CIHR, #TE2-138299; #FDN = 143342; #PJT-153139), the Canadian Foundation for AIDS Research (CANFAR), the Ontario HIV Treatment Network (OHTN, #1051), the Public Health Agency of Canada (#4500345082), and Ryerson University. TAH is supported by an Endgame Leader Chair Award in Gay and Bisexual Men’s Health from the Ontario HIV Treatment Network. DMM and NJL are supported by Scholar Awards from the Michael Smith Foundation for Health Research (#5209, #16863). SSS is supported by CTN and CIHR postdoctoral fellowship awards. DG is supported by a Canada Research Chair in Sexual and Gender Minority Health. JMS is supported by a CTN postdoctoral fellowship award and a Michael Smith Foundation for Health Research trainee award.

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Authors and Affiliations

  1. British Columbia Centre on Substance Use, Vancouver, BC, Canada

    Jordan M. Sang

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

    Lu Wang, David M. Moore, Justin Barath, Allan Lal & Nathan J. Lachowsky

  3. University of British Columbia, Vancouver, BC, Canada

    David M. Moore

  4. Toronto Metropolitan University, Toronto, ON, Canada

    Trevor A. Hart, Shayna Skakoon-Sparling & Abbie Parlette

  5. University of Toronto, Toronto, ON, Canada

    Trevor A. Hart & Daniel Grace

  6. School of Human Sciences, Louisiana State University Shreveport, Shreveport, LA, USA

    Syed W. Noor

  7. Engage Community-Advisory Committee, Vancouver, BC, Canada

    Sarah Chown

  8. Direction régionale de santé publique -Montréal, CIUSSS Centre-Sud-de-l’Ile-de- Montréal, Montréal, QC, Canada

    Gilles Lambert & Joseph Cox

  9. Institut national de santé publique du Québec, Montréal, QC, Canada

    Gilles Lambert

  10. McGill University, Montréal, QC, Canada

    Joseph Cox & Herak Apelian

  11. Community-Based Research Centre, Vancouver, BC, Canada

    Jody Jollimore & Nathan J. Lachowsky

  12. University of Victoria, Victoria, BC, Canada

    Nathan J. Lachowsky

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  1. Jordan M. Sang
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Contributions

DMM, NJL, JC, GL, JJ, RSH and TAH designed the study. HA, AP and AL supervised data collection and study implementation. JB was responsible for managing the study database and developed the analytic dataset. SWN and SSS provided consultation on the analysis plan. LW conducted the analyses. JMS developed the first draft of the manuscript and all authors provided input on updated versions. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Jordan M. Sang.

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The study was approved by research ethics boards at Ryerson University, University of Toronto, St. Michael’s Hospital, University of Windsor, University of British Columbia, Providence Health Care, University of Victoria, Simon Fraser University, and the Research Institute of the McGill University Health Centre.

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Sang, J.M., Wang, L., Moore, D.M. et al. Examining Associations Between Resilience and PrEP Use Among HIV-negative GBM in Toronto, Montreal and Vancouver. AIDS Behav 27, 3109–3121 (2023). https://doi.org/10.1007/s10461-023-04031-1

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