Unmasking the Gender Factor in Gay Men's Health: Sex Now Survey 2010

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Terry Trussler, CBRC. Gay Men's Health Summit, 2010

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  • Summit 2009 was a significant point of departure for the Sex Now Survey, involving a major shift of thinking.
  • Shifting the survey to examine determinants of health was one step. Looking for mental health indicators of gay men’s marginalization was another. How to include gender was unclear. Summit 2009 suggested we would need census- like population scale data to observe social inequities i.e., by comparing gay and straight men.
  • At the time Sex Now 2010 was launched we only had a promotional budget in place. The momentum was strong to proceed with the survey, so we thought of it as a “pilot year” in which we would launch into new kinds of questions based on determinants. And since it was a pilot year we thought we would try to engage gay men nation wide instead of just British Columbia. In Internet terms a national survey would be little more promotional effort than a regional one. We had Olivier’s help with translating the survey and promotion into French. We just had to make all of our usual connections work nation-wide.
  • The response was slow to start until we got our promotional strategy into place. Once launched the response was like winning the lottery. We counted hundreds of responses every few minutes and several thousand over the first weekend.
  • We felt that the audience enthusiasm was a strong endorsement of the questionnaire and the direction we were going. But more than that, such widespread participation across the country seemed to be telling us that gay men had something to say and they were using the survey to do that.
  • The sample age was older than other Sex Now surveys. We might have expected that about 1/3 of the sample would be under thirty… it was only 20%.
  • The questionnaire was set up to look at the relationship between mental wellness and sexuality. We looked for indicators of marginalization by proportions affected.
  • Looking across age groups suggested that the indicators lose impact with age. “It get’s better?” Or, is the data telling us that gay marginalization has heated up and the gay youth of today are more affected than ever? Whatever, the effects of marginalization appear to be highest among gay youth.
  • Except for these indicators. Does the recognition of how gay marginalization affects one’s career increase with age or is there simply more time to be affected?
  • HIV positive men also appear to be more affected than others. However, it is unclear whether these effects are indicating additional marginalization with being positive or whether being positive is an “outcome” of increased exposure that some men might have had.
  • We thought of counseling as a potential “outcome” of exposure to marginalization and the stress it creates. The data seem to suggest that many who accessed counseling services tried more than one practitioner.
  • As predicted by “minority stress” theory “depression” was the most common reason to have sought mental health services.Counseling services appear to get a “C” rating insofar as the proportion of client’s satisfied.
  • The odds of being treated for depression associated with indicators of marginalization was very strong. On the other hand the association between treatment for depression and risky sex did not appear to be strong at all – interesting because conventional wisdom suggests there is a link between depression and HIV infection.
  • These findings are interesting to see in a large sample. We get a sense of proportion and relationship between variables. However, we still lack the critical comparisons that population level data could provide to show the disparities in these values between gay and non gay men. Nonetheless, new ideas were developing with new directions taken from Summit 2009. Starting with Foucault. Foucault interrogated classical texts from Greek times to explore sex before sexuality – when there were no laws, no sins, no judgments about sex. Obviously civilization got on without. But appearances affected social standing and social standing affected what one was at liberty to do.
  • Even in Greek times it was recognized that some men, philosophers among them, might never be married. In our times being unmarried is a sign of non-conformity with masculine gender expectations.
  • Gender nonconformity is interesting because it accounts for pre-sexual marginalization that many gay men recognize in their own histories.
  • The overall effect of marginalization appears to affect us “environmentally“ as minority stress.
  • Intersectionality came to our attention through Olivier’s doctoral studies at SFU and his interest in studying institutional marginalization.
  • The link between Foucault’s ideas about sexuality as the apparatus of power and Intersectionality’s interest in the uneven distribution of power seemed compelling and a potential way to inform a new analysis of Sex Now…
  • If social status is rewarded by gender conformity then it appears there are varying levels of conformity within our data – especially, the 19% of men married or partnered with women.
  • We did not ask about gender identity. It was never very useful in behavioural analysis of HIV risk. Instead we divided the sample into conforming and non-conforming using married or partnered with a woman as the defining symbol of conformist masculinity. In HIV prevention a distinction is often made between “identifying gay men” and “other men” known as MSM. But due to low attachment to gay culture MSM have been difficult to research. The Internet appears to have changed the situation.
  • According to OlenaHankivinskyIntersectionality might suggest an in-gender comparison of conforming and non-conforming men. Keep in mind that we are looking at “men having sex with men”. So the sexuality is the same but gender conformity is what makes the difference between groups. Notice an enormous difference in sero-prevalence between the 2 groups – already a very large health disparity becomes apparent.
  • We asked all respondents about their most recent sex. The data showed very little difference in sexuality between groups.
  • On the other hand, strong differences defined by higher intensity of attraction and intimacy with men appear to be more commonly experienced by gay men – desire for emotional involvement and a relationship with another man. Could these features be considered a cultural factor defining gay men’s difference with MSM?
  • Could gay men’s intimacy desires ultimately define gender nonconformity? In general there was a significant gap between gay men and MSM in those who had accessed counseling particularly for depression. Remember that treatment for depression already appears to be a sentinel for marginalization.
  • Gay men were twice as likely to have accessed any counseling and to have been treated for depression than MSM.
  • Gender non conformists appear to elicit enormously more marginalization than conformists by our indicators.
  • Non conforming men were more than 8 times more likely to be bullied than conformists and 4 times more likely to have had their career affected.
  • It’s difficult to account for all the mechanisms- some may be cultural - but circumstances translate to greater sexual risk in gender nonconformists which may be the result of acting out attachment and intimacy desires that define the essential difference between gay and other men.
  • The disparities in terms of STI outcomes between gay men and MSM were striking.
  • Note that gay men are 8 times more likely to have an HIV infection than MSM.
  • The consequences of gender non-conformity appear to be social inequities. Gender conformity appears to assign privilege and higher status even given stigmatized sexuality – which may be masked by gender conformity.
  • Intersectionality reminds us that there maybe many hidden dimensions within categories such as marriages of economic convenience between gay men and lesbians. In the aggregate, however, MSM appear to be privileged by conforming to mainstream expressions of masculinity.
  • On the whole, Sex Now 2010 has shown us far more than we were expecting to see.
  • When we can identify and understand how people create and sustain an oppressive social world, we have gained important tools we can useto change it. For example, HIM recently encountered a policy negotiation in which counting the “absence of mention” of gay men in strategic documents played the defining role. Are we ready for a new form of gay health activism?
  • We are launching into a prototype with a new joint initiative at HIM-CBRC. By Summit 2011 we should have some new data and experiences to talk about.
  • Unmasking the Gender Factor in Gay Men's Health: Sex Now Survey 2010

    1. 1. Unmasking the gender factorSEX NOW Survey 2010<br />
    2. 2. Sexual orientation alone may be inadequate <br />to explain gay health disparities…<br /> Investigate Gender Determinants<br />
    3. 3. Retooling Sex Now Survey<br />From behaviouralrisk factors to <br />determinantsof health indicators...<br />How are marginalization, social stress & mental wellness related? … to gay health outcomes? <br /> i.e. suicide, depression, HIV, STI…<br />What social inequities elicit gay health disparities? <br />
    4. 4. National Promotion<br />
    5. 5. Recruitment<br />
    6. 6. Recruitment<br />
    7. 7. Sample age<br />
    8. 8. Marginalization Indicators<br />
    9. 9. Marginalization X Age<br />
    10. 10. Marginalization X Age<br />
    11. 11. Marginalization Indicators<br />
    12. 12. Counseling<br />51% accessed counseling services <br />
    13. 13. Counseling Topics<br />64% were satisfied with services <br />
    14. 14. Care for Depression<br />
    15. 15. Linking ideas<br />“Sexuality is the apparatus of power”<br /> Michel Foucault<br /> How did that come to be?<br /> The History of Sexuality v 1-3<br /> Heterosexuality doesn’t exist without <br /> homosexuality to explain it.<br />
    16. 16. Linking ideas<br />Archives of Sexual Behavior, Vol. 33, No. 2, April 2004, pp. 117–128 ( C ° 2004)<br />Gender Nonconformity, Childhood Rejection, and Adult Attachment: <br />A Study of Gay Men<br />Monica A. Landolt, Ph.D.,1 Kim Bartholomew, Ph.D.,2;4 Colleen Saffrey, B.A. (Hons),2 Doug Oram, M.A.,2 and Daniel Perlman, Ph.D.3<br />
    17. 17. Linking ideas<br />Public Health and Human Rights<br />APHA 134th Annual Meeting and Exposition<br />November 4-8, 2006<br />Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals<br />Allegra Raboff Gordon, MPH and Ilan H. Meyer, PhD. Mailman School of Public Health, Columbia University,<br />
    18. 18. Linking ideas<br />Psychological Bulletin <br />American Psychological Association, Inc.<br />2003, Vol. 129, No. 5, 674–697<br />Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual<br />Populations: Conceptual Issues and Research Evidence<br />Ilan H. Meyer<br />Columbia University<br />“Minority Stress”<br />
    19. 19. Linking ideas<br />Critical Public Health<br />Vol. 18, No. 3, September 2008, 271–283<br />Intersectionality and the determinants of health: a Canadian perspective<br />OlenaHankivskya* and Ashlee Christoffersenb<br />“policy decisions create relational inequities in which some groups <br />benefit and others experience more marginalization and oppression.”<br />
    20. 20. Intersectionality & Gay Health Determinants<br />Focus on social inequities<br />Intersecting systems of oppression/privilege <br />i.e. Gender andSexuality (+ age, income, race, social location…)<br />Interrogate the relationship between social categories… embrace complexity…<br />
    21. 21. Social Status<br />
    22. 22. Masculinities<br />
    23. 23. In-gender comparison<br />HIV+ Gay 9.2% MSM 1.1%<br />
    24. 24. Common Practices<br />
    25. 25. Varied Masculinities<br />
    26. 26. Varied Outcomes<br />
    27. 27. Minority Stress Indicators<br />
    28. 28. Marginalization Indicators<br />
    29. 29. Odds of Marginalization <br />
    30. 30. Transmission Risk<br />
    31. 31. Outcomes<br />
    32. 32. Disparities<br />
    33. 33. Varied Masculinities<br />
    34. 34. Summarizing Disparities<br />
    35. 35. Summarizing Ideas<br />Marginalization strongly associated with treatment for depression<br />Youth and HIV+ men experienced highest rates of marginalization<br />Gay men experienced higher rates of marginalization, depression, HIV and STI than MSM<br />Gender non-conformity helps explain gay health disparities<br />
    36. 36. Practice Implications<br />Critical Public Health<br />Vol. 18, No. 1, March 2008, 87–96<br />The social construction of gay oppression as a determinant<br />of gay men’s health: ‘homophobia is killing us’<br />Jeffrey P. Aguinaldo<br />Department of Sociology, Wilfrid Laurier University, Waterloo, Canada<br />“The problem is not the oppressed it is the oppressor.”<br />Observe and count all the subtle and<br />obvious ways heterosexism occurs and goes unchallenged and uncontested…<br />
    37. 37. Next Steps<br />Determinants Survey 2011<br />Young Gay Investigator Team - YGIT<br />Measuring Marginalization and Resilience<br />How is “gay oppression” being done?<br />Distribute the evidence gathering…<br />
    38. 38. Acknowledgements<br />Questionnaire Development: Carl Bognar, Bill Coleman, Olivier Ferlatte, Jody Jollimore, Mike Kwag, Rick Marchand<br />Survey Promotion: Justin Go, Glenn Doupe & CDC Internet Team<br />Technical Assistance: Sean Lytle, Rachel Thompson<br />Knowledge Transfer & Translation: Public Health Agency of Canada<br />Dissemination: Province of British Columbia<br />

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