Going beyond behaviours in gay men’s health is a venture beyond field boundaries, along trails less traveled, without many affirming signposts…
The survey’s recruitment achieved widespread coverage of Canada, including all provinces and territories and a diverse mix of urban, suburban and rural men.
Within group analysis looks at the whole population and divisions in experience…
The largest group were keeping their sexuality a secret but another large group seemed to be out to everyone in their environment.
The idea of between group analysis is to uncover inequities that remain concealed by the within group analysis.
Here again we see the gradient show up as a disparity among men who feel their career was damaged by discrimination in the workplace.
We don’t see the same gradient pattern with education, but as shown in SN 2010, on average, gay men were more highly educated than bisexual men or MSM.And, on average, they also earned substantially less annual income with their education than bisexual or married MSM.
So… what happens to men who suffer discrimination at work due to their sexuality? Is there a health impact that can be measured? That’s what we want to know in Outcome Analysis. We will use Logistic Regression to model the multiple factors that may be involved in answering this question.
115 2 the gradient copy Terry Trussler
Pride, Prejudice & Determinants of HealthTerry TrusslerEdDCommunity Based Research CentreFor Gay Men’s Health
Health & Social Theory• Social Determinants (SDOH) Marmot et al.• Minority Stress Meyer et al.• IntersectionalityHankivsky et al.• Syndemic Production Stall et al.See: US Institute of Medicine Report on LGBT Health (2011)
Minority StressMeyer et al. (2010)MentalDisordersContextualStressorsStructuralDisadvantage
Gay Health @ Work• Workplace prejudice lore• Social context of “gender order”• Origins of Canada’s Health Policy• Whitehall Studygradientsocial status health statusWhat do disparities reveal?
Whitehall StudyMarmot et al. 200400.511.522.53Distress & DiseaseHigh ControlIntermediateLow Control
Sex Now 2011• September 2011- February 2012• Men seeking men online• n=8,607 participants• All provinces/territories• Average age 43, Range 13-84• Gay 65% Bisexual 32% Straight 2%• Married MSM 21%
Health Effects of PrejudiceOutcomes COR (95%CI) AOR (95%CI)Career damage - status loss 8.272 (6.982-9.801) 7.382 (6.014-9.061)Suicidality 2.460 (2.177-2.781) 1.672 (1.405-1.885)Depression .934 ( .831-1.049) .913 ( .797-1.046)Emotional care seeking 2.753 (2.420-3.132) 1.667 (1.431-1.943)HIV sexual risk (UAIU) 1.535 (1.359-1.733) 1.249 (1.084-1.439)STI (gonorrhea) 1.998 (1.517-2.633) 1.595 (1.158-2.197)Age adjusted logistic regression: employment discrimination vs. no discrimination
Health Effects of PrejudiceIntersections: “axes of(dis)advantage”• Age (<30: depression)• Class ($100K+: UAIU)• Race/Ethnicity (min: UAIU)• HIV status (HIV+: suicidality)• Orientation (bisexual: suicidality, UAIU)
Global FundAdam, B. (2011)05101520253035US $ MillionsGaySex WorkersIDU
AcknowledgementsVancouver FoundationPublic Health Agency of CanadaProvince of British Columbia
acknowledgementsCBRCOlivier Ferlatte, Travis SalwayHottes, Rick Marchand,Craig Phillips, David Ham & the CBRC BoardInvestigaytorsAlex Chen, JoshunDulai, Daren Ho, Trevor Hodges, David Le,Daniel McGraw, Keith Reynolds, Jordan Sang, Jaedyn StarrDialogueMoffat Clarke, Jeff Dodds, Mark Gilbert, OlenaHankivsky,Ilan Meyer, aaronpoirier… and many more