Introduction A complex, persistent syphilis epidemic has affected gay, bisexual and other men who have sex with men (gbMSM) in major urban centres in North America for over a decade. Our objective was to explore the sexual travels, networks, and knowledge of gbMSM in Toronto.
Methods We conducted in-depth interviews between June and July 2016 with 31 gbMSM who were ≥18 years, actively seeking sexual partners, and living, working or socialising in downtown Toronto. We asked participants to map their egocentric sexual network, share their sexual partner-seeking strategies and knowledge of STIs. We analysed travel patterns between participants and their sexual partners, including in relation to the core area of elevated syphilis rates, and used interview transcripts to interpret and explore the context from which observed patterns emerged.
Results Four geosexual archetypes dominated the egocentric sexual network maps, namely, hosters, two types of travellers: house-callers and rovers, and geoflexibles. These archetypes were observed in both core and noncore areas. Hosters usually or always hosted sex at their residence, creating a centralised sex phenomenon. Travellers rarely or never had sex at their residence. House-callers usually or always had sex at the residence of their sex partners; rovers also had sex at venues and other public spaces. Travellers created a dispersed sex phenomenon and bridging core, peripheral, and distant areas. Geoflexibles had sex anywhere (i.e.,home, venues, partner residences, public spaces). Participants practiced 1–2 online or in-person partner seeking strategies with little regard for syphilis because of overwhelming concern for HIV, lack of awareness of the syphilis epidemic, and treatability of the syphilis.
Conclusion Geo-sexual patterns and travel between sexual partners suggest specific archetypes exist comprising the larger gbMSM sociocentric sexual network. Future research should better define and characterise these archetypes and explore how each may impact STI transmission and intervention.