Abstract
Objectives
Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC.
Methods
We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing.
Results
Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p < 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p = 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93).
Conclusion
gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.
Résumé
Objectifs
Les taux de syphilis ont augmenté en Colombie-Britannique et affectent de manière disproportionnée les hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec des hommes (gbHARSAH). Une campagne de marketing social (Syphistory) a été mené de janvier à septembre 2017 avec pour objectif principal d’informer sur la syphilis et pour objectif secondaire d’augmenter le dépistage de la syphilis chez les gbHARSAH en Colombie-Britannique.
Méthodes
Nous avons réalisé deux sondages, l’un avant et l’autre après la campagne, sur un échantillon de convenance constitué de patients fréquentant des cliniques ITS, pour évaluer les changements dans les connaissances sur la syphilis à l’aide de tests t unilatéraux. Nous avons utilisé les mesures Piwik en ligne pour examiner la portée de la campagne et les données provinciales sur les tests pour examiner les tendances quant au dépistage de la syphilis. Nous avons utilisé les données de l’étude Engage à Vancouver, pour identifier les facteurs associés à la sensibilisation lors de la campagne et les associations avec le dépistage de la syphilis.
Résultats
Sur les 2 155 visiteurs du site Web Syphistory dont la position géographique était connue, 79,4 % provenaient de la Colombie-Britannique. De plus, les participants aux cliniques ITS ayant vu la campagne ont démontré une meilleure connaissance de la syphilis (9,7/12, 80,8 %) par rapport à ceux n’ayant pas vu la campagne (moyenne 8,9/12, 74 %) (p<0,001). Les taux provinciaux de dépistage de la syphilis étaient de 8 764 et 9 749 au cours des 12 mois précédant et suivant la campagne; cependant, nous n’avons pas trouvé de tendance globale à la hausse des dépistages suite à la campagne (p=0,147). Parmi les participants Engage, 12,7 % ont déclaré avoir vu la campagne en ligne et nous avons trouvé une association entre l’exposition à la campagne et le dépistage récent de la syphilis (RCa=2,73; IC à 95 %=1,51, 4,93).
Conclusion
Les gbHARSAH qui ont vu la campagne étaient plus susceptibles de déclarer avoir été testés pour la syphilis au cours des six derniers mois. Les participants aux cliniques ITS qui ont déclaré avoir vu la campagne avaient également une meilleure connaissance de la syphilis que ceux qui ne l’ont pas vue.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Deidentified participant data used in this analysis are stored at the BC CDC and the BC CfE.
Code availability
Access to the data and code are available on request.
References
Abramovitz, D., Volz, E. M., Strathdee, S. A., Patterson, T. L., Vera, A., Frost, S. D. W., & Proyecto, E. (2009). Using respondent-driven sampling in a hidden population at risk of HIV infection: Who do HIV-positive recruiters recruit? Sexually Transmitted Diseases, 36(12), 750–756. https://doi.org/10.1097/OLQ.0b013e3181b0f311
Adam, P. C. G., de Wit, J. B. F., Bourne, C. P., Knox, D., & Purchas, J. (2014). Promoting regular testing: An examination of HIV and STI testing routines and associated socio-demographic, behavioral and social-cognitive factors among men who have sex with men in New South Wales, Australia. AIDS and Behavior, 18(5), 921–932. https://doi.org/10.1007/s10461-014-0733-z
BC Centre for Disease Control. (2016). BC Syphilis Action Plan. Retrieved from http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/Syphilis%20Action%20Plan.pdf. Accessed May-June 2021.
BC Centre for Disease Control. (2018). STI: Annual Report 2016. Retrieved from Vancouver, BC. http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/STI/STI_Annual_Report_2016.pdf. Accessed May-June 2021.
BC Centre for Disease Control. (2020). Reportable Diseases Data Dashboard. Retrieved from http://www.bccdc.ca/health-professionals/data-reports/reportable-diseases-data-dashboard. Accessed May-June 2021.
BC Centre for Disease Control. (2021). Reportable Diseases Data Dashboard. Retrieved from http://www.bccdc.ca/health-professionals/data-reports/reportable-diseases-data-dashboard. Accessed May-June 2021.
Cox, J., Apelian, H., Moodie, E. E. M., Messier-Peet, M., Hart, T. A., Grace, D., et al. (2021). Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: A cross-sectional analysis of the Engage cohort study. CMAJ Open, 9(2), E529–E538. https://doi.org/10.9778/cmajo.20200198
Darrow, W. W., & Biersteker, S. (2008). Short-term impact evaluation of a social marketing campaign to prevent syphilis among men who have sex with men. American Journal of Public Health, 98(2), 337–343. https://doi.org/10.2105/AJPH.2006.109413
Gile, K. J., & Handcock, M. S. (2010). Respondent-driven sampling: An assessment of current methodology. Sociological Methodology, 40(1), 285–327. https://doi.org/10.1111/j.1467-9531.2010.01223.x
Gray, R. T., Hoare, A., Prestage, G. P., Donovan, B., Kaldor, J. M., & Wilson, D. P. (2010). Frequent testing of highly sexually active gay men is required to control syphilis. Sexually Transmitted Diseases, 37(5), 298. https://doi.org/10.1097/OLQ.0b013e3181ca3c0a
Grier, S., & Bryant, C. A. (2005). Social marketing in public health. Annual Review of Public Health, 26(1), 319–339. https://doi.org/10.1146/annurev.publhealth.26.021304.144610
Hart, T. A., Moore, D. M., Noor, S. W., Lachowsky, N., Grace, D., Cox, J., Skakoon-Sparling, S., Jollimore, J., Parlette, A., Lal, A., Apelian, H., Sang, J. M., Tan, D. H. S., Lambert, G., & the Engage Study Team. (2021). Prevalence of HIV and sexually transmitted and bloodborne infections, and related preventive and risk behaviours, among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver: Results from the Engage Study. Canadian Journal of Public Health, 112(6), 1020–1029.
Kumar, N., Forastiere, L., Zhang, T., Yang, F., Li, K. T., Tang, W., . . . Alexander, M. (2020). Lack of sexual behavior disclosure may distort STI testing outcomes. BMC Public Health, 20(1), 616-616. https://doi.org/10.1186/s12889-020-08768-5
Miller, S. (2012). Piwik web analytics essentials (New ed.). Packt Publishing, Limited.
Moore, D. M., Cui, Z., Skakoon-Sparling, S., Sang, J., Barath, J., Wang, L., et al. (2021). Characteristics of the HIV cascade of care and unsuppressed viral load among gay, bisexual and other men who have sex with men living with HIV across Canada’s three largest cities. Journal of the International AIDS Society, 24(4), e25699-n/a. https://doi.org/10.1002/jia2.25699
Pedrana, A., Hellard, M., Guy, R., El-Hayek, C., Gouillou, M., Asselin, J., et al. (2012). Stop the drama Downunder: A social marketing campaign increases HIV/sexually transmitted infection knowledge and testing in Australian gay men. Sexually Transmitted Diseases, 39(8), 651–658. https://doi.org/10.1097/OLQ.0b013e318255df06
Plant, A., Javanbakht, M., Montoya, J. A., Rotblatt, H., O’Leary, C., & Kerndt, P. R. (2014). Check yourself: A social marketing campaign to increase syphilis screening in Los Angeles County. Sexually Transmitted Diseases, 41(1), 50–57. https://doi.org/10.1097/OLQ.0000000000000069
Plant, A., Montoya, J. A., Rotblatt, H., Kerndt, P. R., Mall, K. L., Pappas, L. G., et al. (2010). Stop the sores: The making and evaluation of a successful social marketing campaign. Health Promotion Practice, 11(1), 23–33. https://doi.org/10.1177/1524839907309376
Public Health Agency of Canada. (2015). Syphilis among gay, bisexual, two-spirit and other men who have sex with men: A resource for population-specific prevention. Retrieved from Ottawa, Ontario: http://publications.gc.ca/collections/collection_2015/aspc-phac/HP40-134-2015-eng.pdf. Accessed May-June 2021.
Ross, C., Shaw, S., Marshall, S., Stephen, S., Bailey, K., Cole, R., et al. (2016). Impact of a social media campaign targeting men who have sex with men during an outbreak of syphilis in Winnipeg, Canada. Canada Communicable Disease Report, 42(4), 45–49. https://doi.org/10.14745/ccdr.v42i02a04
Stahlman, S., Plant, A., Javanbakht, M., Cross, J., Montoya, J. A., Bolan, R., & Kerndt, P. R. (2015). Acceptable interventions to reduce syphilis transmission among high-risk men who have sex with men in Los Angeles. American Journal of Public Health (1971), 105(3), e88–e94. https://doi.org/10.2105/AJPH.2014.302412
Stephens, S. C., Bernstein, K. T., McCright, J. E., & Klausner, J. D. (2010). Dogs are talking: San Francisco’s social marketing campaign to increase syphilis screening. Sexually Transmitted Diseases, 37(3), 173–176. https://doi.org/10.1097/OLQ.0b013e3181bf5a80
Thurnheer, M. C., Weber, R., Toutous-Trellu, L., Cavassini, M., Elzi, L., Schmid, P., et al. (2010). Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study. AIDS (London, England), 24(12), 1907–1916. https://doi.org/10.1097/QAD.0b013e32833bfe21
Vega, M. Y., & Roland, E. L. (2005). Social marketing techniques for public health communication: A review of syphilis awareness campaigns in 8 US cities. Sexually Transmitted Diseases, 32(10 Suppl), S30–S36. https://doi.org/10.1097/01.olq.0000180461.30725.f4
Wong, W., Chaw, J. K., Kent, C. K., & Klausner, J. D. (2005). Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002-2003. Sexually Transmitted Diseases, 32(7), 458–463. https://doi.org/10.1097/01.olq.0000168280.34424.58
Acknowledgements
We would like to thank the BCCDC Public Health Laboratory, BCCDC STI clinic, and Health Initiative for Men for distributing the Syphistory survey, and most importantly, the Syphistory survey participants. We would also like to thank the Engage Study participants, office staff, and community advisory board as well as our community partners: Health Initiative for Men, YouthCO HIV & Hep C Society, and Positive Living Society of BC.
Funding
This work was supported by the Canadian Institutes of Health Research (TE2-138299, FDN-143342, PJT-153139), the Canadian Association for HIV/AIDS Research (CANFAR, #Engage), the Ontario HIV Treatment Network (OHTN, #1051), and the Public Health Agency of Canada (#4500345082). JMS is supported by a CTN Postdoctoral Fellowship Award and Michael Smith Foundation for Health Research Trainee award. NJL was supported by a CANFAR/CTN Postdoctoral Fellowship Award. DMM and NJL are supported by Michael Smith Foundation for Health Research Scholar Awards (#5209, #16863). DG is supported by a Canada Research Chair in Sexual and Gender Minority Health.
Author information
Authors and Affiliations
Contributions
Jordan Sang led manuscript writing, analysis consultation, and manuscript preparation. Jason Wong conceived the research idea, led the campaign, led the preliminary analyses, provided consultation, and provided feedback for the manuscript. Venessa Ryan conducted analyses and provided feedback for the manuscript. Emma Cumming assisted with analyses. Lu Wang and Zishan Cui assisted with analyses and provided feedback for the manuscript. Nicanor Bacani assisted in data cleaning for the data. Devon Haag supported the campaign and assisted with analyses. Nathan Lachowsky, Joseph Cox, and Daniel Grace are principal investigators for Engage and provided feedback for the manuscript. Michael Otterstatter provided consultation for the analyses. Muhammad Moshed provided expertise for syphilis testing. Joshua Edward led the survey evaluation with community organizations. Troy Grennan led the campaign and provided consultation for the manuscript. Jillian Arkles and Bobbi Brownrigg supported the campaign. Robert S. Hogg is a principal investigator for the Momentum Study. David Moore is a principal investigator for Engage, oversaw analyses, and provided feedback for the manuscript.
Corresponding author
Ethics declarations
Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committees (McGill University Health Centre REB# 15-623-MUHC; Ryerson University REB# 2016-113; University of Toronto REB# 00033527; St. Michael’s Hospital REB# 17-043; University of Windsor REB# 16-180; University of British Columbia REB# H16-01226) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent for publication
Not applicable.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sang, J.M., Wong, J., Ryan, V. et al. Examining the impacts of a syphilis awareness campaign among gay, bisexual, and other men who have sex with men (gbMSM) in British Columbia, Canada. Can J Public Health 114, 295–307 (2023). https://doi.org/10.17269/s41997-022-00690-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-022-00690-0