09 boodram

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09 boodram

  1. 1. Preliminary Findings of the Population-Specific HIV/AIDS Status Report: Gay, Bisexual, Two-Spirit and other Men who have Sex with Men Chris Boodram, MSW Centre for Communicable Diseases and Infection Control Determinants of Health and HIV Vulnerability and Resilience among Gay, Bisexual, Two-Spirit & other MSM in Canada
  2. 2. Outline <ul><li>Report Purpose </li></ul><ul><li>Approach </li></ul><ul><li>Findings </li></ul><ul><li>Next Steps </li></ul>
  3. 3. Report Purpose <ul><li>Population-Specific Status Reports are part of efforts under Federal Initiative to Address HIV/AIDS in Canada to develop discrete approaches to address HIV/AIDS for key populations: </li></ul><ul><ul><li>People from countries where HIV is endemic </li></ul></ul><ul><ul><li>Aboriginal Peoples </li></ul></ul><ul><ul><li>People living with HIV/AIDS </li></ul></ul><ul><ul><li>Women </li></ul></ul><ul><ul><li>Youth </li></ul></ul><ul><ul><li>Gay, two spirit, bisexual, and other men who have sex with men </li></ul></ul><ul><ul><li>People who use drugs </li></ul></ul><ul><ul><li>People in prison </li></ul></ul><ul><li>Status reports are an important step in knowledge translation and exchange to get research evidence into the hands of those who need it </li></ul><ul><li>Population terminology – identity vs. epidemiology </li></ul>
  4. 4. Approach <ul><li>Summarize current evidence on the impact of HIV/AIDS among gay and other MSM in Canada, with a special focus on vulnerability/resiliency to HIV/AIDS from a determinants of health perspective </li></ul><ul><li>Defined methodology: </li></ul><ul><ul><li>Review of academic and grey literature </li></ul></ul><ul><ul><li>Standard inclusion/exclusion criteria </li></ul></ul><ul><ul><li>Collaboration with other departments and governments </li></ul></ul><ul><li>Guidance from a National Expert Working Group </li></ul>
  5. 5. Overview of Findings
  6. 6. Demographic Profile <ul><li>Comprehensive demographic data on gay men and other MSM in Canada is not available. </li></ul><ul><ul><li>Majority of demographic data in report comes from the 2007 and 2008 Canadian Community Health Surveys (CCHS). </li></ul></ul><ul><ul><li>All data based on individual self-report by “out” gay and bisexual men (a subset of these populations). Accuracy further limited by small sample sizes. </li></ul></ul><ul><li>One estimate based on CCHS data: about 195,000 gay and bisexual men in Canada – just over 1% of Canadian men </li></ul><ul><ul><li>Measurement issues inherent in asking about sexual orientation (attraction, behaviour, identity) </li></ul></ul><ul><ul><li>Accuracy of response (stigma) </li></ul></ul><ul><ul><li>Variation in estimates from other sources </li></ul></ul><ul><ul><li>Strong likelihood this estimate reflects underreporting </li></ul></ul><ul><li>Majority of self-identified gay/bisexual men reside in Quebec (31.8%), Ontario (33.1%) and British Columbia (14.3%), are Canadian-born (82%), identify as white (87%), and have higher education levels that, but similar income levels to, heterosexual men </li></ul><ul><li>Gay men report same overall health status as heterosexuals but also more chronic health conditions and mood and anxiety disorders (2003 & 2005 CCHS) </li></ul>
  7. 7. Status of HIV/AIDS among Gay and other MSM <ul><li>1979-2009, 55.4% (n=19,287) of reported positive HIV tests and 68% (n=13, 476) of all AIDS diagnoses reported to PHAC with known exposure category were attributed to the MSM exposure category </li></ul><ul><li>MSM exposure category accounted for 41.8% (n=545) of new HIV infections in Canada in 2009, down from 45.1% (n=557) in 2008, still the largest category of HIV exposure in Canada </li></ul><ul><ul><li>Represents an increase by 31.3% over 1999-2009 </li></ul></ul><ul><li>From 1998-2009, White men accounted for the majority (79.7%) of positive HIV test reports attributed to MSM, followed by Asian men (6%), Aboriginal men (5%), Latin American men (5%), South Asian men (2%), Black men (2%) and Other (less than 1%) </li></ul>
  8. 8. Number of positive HIV test reports among men, by exposure category
  9. 9. Vulnerability and Resilience to HIV/AIDS
  10. 10. Homophobia, Heterosexism, Coming Out and Related Stigma <ul><li>Homophobia (external and internalized) and heterosexism are overarching factors contributing to HIV vulnerability. </li></ul><ul><li>Ability to “come out” – i.e. be open about one’s sexual orientation – in a safe, supportive environment has a significant impact on vulnerability/resilience </li></ul>
  11. 11. Healthy Childhood Development <ul><li>Ability of gay/bi youth to “come out” in a safe and supportive environment has a significant effect on vulnerability/resilience over the life course. </li></ul><ul><li>Experiences of homophobia (e.g. bullying) in childhood linked to increased HIV vulnerability over the life course. </li></ul><ul><li>Childhood sexual assault linked to HIV risk behaviours in adulthood. </li></ul>
  12. 12. Culture <ul><li>Ethno-cultural minority gay and other MSM tend to be burdened by stereotyping, discrimination and can also be overlooked in research on gay men </li></ul><ul><li>Two-Spirit, gay and bisexual Aboriginal men multiply burdened by homophobia, transphobia, racism and the legacy of colonization. </li></ul>
  13. 13. Social Support Networks <ul><li>Strong, supportive networks are a key source of resiliency </li></ul><ul><li>Gay and bisexual men have consistently less social support than heterosexual men </li></ul><ul><li>More research is needed on social support networks among gay and other MSM, and how they contribute to resiliency </li></ul>
  14. 14. Social and Physical Environments <ul><li>High levels of community engagement among gay and other MSM </li></ul><ul><li>Bars, and especially bathhouses, well-studied as locations of risk, but also beginning to be understood as sources of resilience </li></ul><ul><li>More research needed on gay neighbourhoods, community spaces, rural/remote areas, and internet as a source of social support needed. </li></ul>
  15. 15. Health Services <ul><li>Internalized homophobia, fear of stigma can make gay and other MSM reluctant to communicate health needs, access health services </li></ul><ul><li>Homophobia in the health sector, lack of knowledge of specific health needs, are barriers to access. </li></ul><ul><li>Barriers also exacerbated by rural location, ethnocultural minority status. </li></ul>
  16. 16. Personal Health Practices and Coping Skills <ul><li>While many gay and other MSM use condoms consistently, a significant subset of the population engages in unprotected anal intercourse. </li></ul><ul><ul><li>Unprotected sex is influenced by various interconnected environmental, psychosocial and personal factors </li></ul></ul><ul><ul><li>Small ‘clusters’ of men consistently engage in one or more risk behaviours, e.g. recreational drug use, ‘barebacking’ </li></ul></ul><ul><li>In addition to condom use, gay men and other MSM use a number of strategies to reduce their risk of HIV transmission, including sero-sorting, strategic positioning, and antiretroviral-based prevention </li></ul><ul><li>HIV testing uptake is quite high among gay men and other MSM in Canada. The majority of men (86%) who took part in Phase 1 of M-Track reported having been tested for HIV. </li></ul>
  17. 17. Currently-Funded Research <ul><li>Comparatively little current research on HIV among gay and other MSM identified (39 current projects in 2006-11) </li></ul><ul><li>Three-quarters of the projects examined HIV among gay men and other MSM in Quebec, Ontario and British Columbia </li></ul><ul><li>General areas of research included prevention, access to care and treatment strategies, mental health, determinants of health, and community research capacity building, research dissemination and knowledge transfer </li></ul><ul><li>Many projects focused on specific groups of gay men and other MSM: </li></ul><ul><ul><li>Youth </li></ul></ul><ul><ul><li>People who use drugs </li></ul></ul><ul><ul><li>Two-spirit, gay, bisexual and other Aboriginal MSM </li></ul></ul><ul><ul><li>People from countries where HIV is endemic, specifically Black men of African and Caribbean descent living in Canada </li></ul></ul><ul><ul><li>Gay men and other MSM living with HIV/AIDS </li></ul></ul><ul><ul><li>Gay men and other MSM in prisons </li></ul></ul><ul><ul><li>Trans men who have sex with men </li></ul></ul>
  18. 18. Areas for Further Research <ul><li>The following areas have been identified as areas needing additional research: </li></ul><ul><li>Resilience against HIV/AIDS among gay and other MSM </li></ul><ul><li>Impact of homophobia/heterosexism and related stigma </li></ul><ul><ul><li>Ability to ‘come out’ in a safe and supportive environment </li></ul></ul><ul><ul><li>Homophobic bullying of children and adolescents </li></ul></ul><ul><li>Impact of physical and social environments (e.g. rural areas, schools and gay neighbourhoods) </li></ul><ul><li>Impact of social support networks, such as family (biological and chosen), friends, lovers, casual sexual relationships, and broader communities </li></ul>
  19. 19. Areas for Further Research (2) <ul><li>Knowledge and cultural competency among health service providers </li></ul><ul><li>Demographics, epidemiology and factors affecting HIV vulnerability/resilience among: </li></ul><ul><ul><li>Ethnocultural minority gay and other MSM </li></ul></ul><ul><ul><li>Two-Spirit, gay and bisexual Aboriginal men </li></ul></ul><ul><ul><li>Older gay and other MSM </li></ul></ul><ul><ul><li>Trans men who have sex with men </li></ul></ul><ul><ul><li>MSM who do not identify as gay, bisexual or two-spirit </li></ul></ul>
  20. 20. Responses to HIV/AIDS <ul><li>The Federal Initiative to Address HIV and AIDS in Canada identifies gay and other MSM as a key at-risk population. </li></ul><ul><li>Two provinces (Ontario and Quebec) have strategies specific to gay men and other MSM </li></ul><ul><li>In provinces with a general HIV/AIDS strategy, most identify gay men and other MSM as a population that is particularly affected by HIV/AIDS (Nova Scotia, Manitoba, Saskatchewan, Alberta, BC) </li></ul><ul><li>74 organizations were identified that offer HIV/AIDS related projects targeting gay men and other MSM; these were mainly ASOs and community health/service organizations. Very few projects were offered by organizations exclusively or primarily serving gay and other MSM </li></ul><ul><li>About half of the projects targeted specific subpopulations of gay men and other MSM, such as Aboriginal people, other ethnic minority men including those from countries where HIV is endemic, GBTQ youth, and trans men </li></ul>
  21. 21. Report Next Steps <ul><li>Finalize report </li></ul><ul><li>Dissemination </li></ul><ul><li>Findings will inform research, policy and programming with respect to HIV/AIDS among gay, bisexual, two-spirit and other men who have sex with men. </li></ul>
  22. 22. Acknowledgements <ul><li>Sincere appreciation to current and former members of the National Expert Working Group for their contributions: </li></ul><ul><ul><li>Suhail Abualsameed </li></ul></ul><ul><ul><li>Stephen Alexander </li></ul></ul><ul><ul><li>Jacqueline Arthur </li></ul></ul><ul><ul><li>Philip Banks </li></ul></ul><ul><ul><li>Chris Boodram </li></ul></ul><ul><ul><li>Moffatt Clarke </li></ul></ul><ul><ul><li>Jeff Dodds </li></ul></ul><ul><ul><li>Brooke Ellis </li></ul></ul><ul><ul><li>Brian Gottheil </li></ul></ul><ul><ul><li>Maham Hai-Tadesse </li></ul></ul><ul><ul><li>Gens Hellquist </li></ul></ul><ul><ul><li>Clare Jackson </li></ul></ul><ul><ul><li>Ed Jackson </li></ul></ul><ul><ul><li>Jay Koornstra </li></ul></ul><ul><ul><li>Kristina Lalonde Tomas </li></ul></ul><ul><ul><li>Maria MacIntosh </li></ul></ul><ul><ul><li>Duncan MacLachlan </li></ul></ul><ul><ul><li>Marissa McGuire </li></ul></ul><ul><ul><li>Bill Ryan </li></ul></ul><ul><ul><li>Wayne Roberts </li></ul></ul><ul><ul><li>Carlos Rivas </li></ul></ul><ul><ul><li>Farzana Saadat </li></ul></ul><ul><ul><li>Michael Smith </li></ul></ul><ul><ul><li>Geneviève Tremblay </li></ul></ul><ul><ul><li>Russell Westhaver </li></ul></ul><ul><ul><li>Art Zoccole </li></ul></ul>
  23. 23. Contact information <ul><li>Chris Boodram </li></ul><ul><li>Senior Policy Analyst </li></ul><ul><li>Programs and Partnerships Division, </li></ul><ul><li>Centre for Communicable Diseases and Infection Control, PHAC </li></ul><ul><li>[email_address] </li></ul><ul><li>Brian Gottheil </li></ul><ul><li>Manager, Populations and Health Determinants Section </li></ul><ul><li>Programs and Partnerships Division, Centre for Communicable Diseases and Infection Control, PHAC </li></ul><ul><li>[email_address] </li></ul>

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