Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights

Transcription

1 Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights Overview In 2010, the AIDS Committee of Cambridge, Kitchener, Waterloo & Area (ACCKWA) received funding from the Public Health Agency of Canada for their Gay Men s HIV Prevention Project. The Gay Men s HIV Prevention Project is about promoting health (e.g., HIV education, testing, communication, and condom use), building community partnerships and addressing the factors that impact sexual health. To support this project, Region of Waterloo Public Health gathered sexual health related information about gay, bisexual and other men who have sex with men (MSM) in Waterloo Region so it can be used to develop and improve programs and services. Individual online surveys and interviews with gay, bisexual and other MSM were used to gather sexual health related information. Research papers related to the topic were also read to provide background information and to support the findings.

2 Who we asked OVERVIEW Two hundred and one (201) gay, bisexual, and other MSM took the survey. Sixteen men were also interviewed. To learn more about the men in our study we asked them their age, residence, education level, income, and sexual identity. Age The men who completed the survey varied in age; 50 per cent were over 30 years of age and 50 per cent were under 30 years of age. The age group with the highest number of respondents was 20 to 24 (29%) followed by 40 to 59 (26%). Residence The men lived throughout Waterloo Region including Waterloo, Kitchener, Cambridge and the townships. Education We asked the men who took the survey to tell us how much education they had. Thirty-eight per cent of the men were enrolled in college/university and two per cent were enrolled in high school at the time of the survey. The other men had differing levels of education: One per cent completed elementary/primary school 40 per cent completed secondary/high school 42 per cent completed college/university 16 per cent completed a graduate degree Income The income of the men who participated in out study ranged from under $20,000 a year to over $80,000 a year. Sexual identity Most of the men in our study identified as gay. Survey participants (201) Gay 80% Bisexual 15% Queer 8% Unsure or questioning 4% Heterosexual 3% Two spirited 3% Other 3% No response 3% Interviewees (16) Gay 88% Bisexual 13% Queer 6% Other 6% No response 3% Gender Eight of the men surveyed, and one of the men interviewed, indicated they were transgender, transitioning or had a history of transitioning. The other men in the study identified their gender as male. Survey participants (201) Male 96% Transgender/Transitioning 4% Interviewees (16) Male 94% Transgender/Transitioning 6% 1 Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights

3 Programs and Services Survey participants were asked specific questions about programs and services in Waterloo Region. We asked the men who participated in our study questions about programs and services for gay, bisexual and other MSM in our community. We were looking for answers to the following three questions: What are the barriers to accessing sexual health programs and services? We learned that fifty-one per cent of men in our study had sought sexual health information, programs and services in Waterloo Region. When asked if there are adequate sexual health services in Waterloo Region, slightly over half (53%) of the men surveyed said there were, 23 per cent said there were not adequate services and 13 per cent said somewhat. Forty-three per cent of men who completed the survey said they did not experience any barriers accessing sexual health programs and services in Waterloo Region. We asked the participants who said they experienced barriers what the barriers were. They said: Not knowing where to look for the services Being embarrassed Concern about privacy/confidentiality Not having transportation Several men in the study indicated that the current clinic hours, specifically the fact that services are not available on weekends, is a barrier. The men we interviewed also said they were concerned about privacy and confidentiality. These men were worried about being seen attending programs and services that might appear to be specifically for gay men especially if they have not disclosed their sexual orientation to everyone. Health care providers making assumptions about gay, bisexual and other men who have sex with men was identified as a barrier to accessing primary care services. A percentage of the survey participants reported their primary health care provider: Made negative comments or gestures about lesbian, gay, bisexual, or trans people Refused to discuss or address health concerns related to being gay, bisexual, or a man who has sex with a man Made assumptions about him or his health based on his sexual orientation 9% 6% 13% Assumed he was straight/heterosexual 46% Assumed he had a lot of sex partners based on his sexual orientation 14% Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights 2

4 Programs and Services What are their sexual health needs? When asked what their prevention/sexual health needs are, the men in the study strongly identified the need for more clinical services, specifically STI and HIV testing, anonymous HIV testing and increased access to condoms. When we asked what topics they want to know more about, the men said they wanted more information on: Transmission of HIV HIV testing (e.g., home test and rapid test for HIV) Health effects and treatment of HIV Risks associated with various sexual activities (e.g., intercourse without condoms, giving/receiving oral sex) Anal sex Oral sex Dangers associated with the use of various substances/drugs Health information for trans people Local data on HIV and other STIs Men also said there should more public education on: HIV Sexual health Available local sexual health services Men who were interviewed also suggested that more groups and support networks, increased availability of gay positive health care providers, and more community outreach would be beneficial for addressing their needs. Improved sexual health education that includes both lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) and heterosexual information was also recommended by study participants. What are the characteristics of a supportive environment for sexual health programs and services? One of the things we learned was that, where programs and services are offered and who provides them matters to gay, bisexual and other men who have sex with men. The men in the study were clear that they wanted programs and services to occur in a friendly, gay positive location that is identified as such (by rainbow flags, stickers, posters, etc.) with a strong emphasis on confidentiality and anonymity. Some men who were interviewed said that testing could be done in social venues such as gay events; whereas, others said they preferred a health care setting. It was also suggested that services for gay, bisexual and other MSM should be offered in places that offer multiple services as a way of reducing the stigma associated with testing. The men in the study said that programs and services should be provided by health care providers who (are): Non-judgmental Understand and know how to interact with individuals from the LGBTQ/MSM community Knowledgeable about sexual health (including for trans people) Recognize that some clients may engage in higher risk sexual practices (e.g., sex without condoms) Willing to discuss harm reduction strategies not just abstinence 3 Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights

5 Accessing Sexual Health Information In addition to asking the men about programs and services, we also asked them about sexual health information. We wanted answers to the following questions: How do gay, bisexual and other MSM access sexual health information? According to the literature and study participants, the internet is a primary source of sexual health information. The men identified the search engine Google and the websites for the AIDS Committee of Cambridge, Kitchener, Waterloo & Area and Region of Waterloo Public Health as sites they use to get sexual health information. Internet discussion forums which offered more personalized information and were interactive were also noted as popular sources for accessing sexual health information. We asked survey participants, How do you access sexual health information? I use the internet 88% I talk to my friends 44% I speak with an outreach worker 13% I attend community events 12% I attend discussion groups 10% Learning in a group setting, such as through a workshop, was also considered to be a useful method of receiving sexual health information. Presentations, information postings in gay venues, and community-based campaigns were also identified as potential sources of information. What are the barriers to accessing sexual health information for gay, bisexual and other MSM? Both the literature and study participants indicated that LGBTQ sexual health information is not being provided to youth in schools. The potential stigma associated with asking questions in school about same-sex sexuality was also a barrier. In addition, HIV prevention strategies were rarely discussed, were abstinence focused, and were targeted at heterosexuals. Study participants also shared that they did not receive adequate sexual health education from their parents or their primary care provider when they were young. Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights 4

6 Sexual Behaviours, Attitudes and Knowledge We also asked the men in our study about sexual behaviours, attitude and knowledge. We wanted answers to the following questions: What are the current characteristics and sexual behaviours of gay, bisexual and other MSM in Waterloo Region? Gay, bisexual and other MSM reported being interested in a variety of relationships that include both long-term monogamous and short-term relationships (e.g., dating, friends with benefits) although the majority of the survey and interview participants were single. The majority of men in our study reported having sex with more than two partners in the past 12 months and 60 per cent reported engaging in anal sex. Gay, bisexual and other MSM in our study also reported using the internet, including mobile applications and chat rooms, and both gay and straight bars as venues to look for sexual partners. Alcohol was frequently used both during and prior to sexual activity by the men in our study. Less frequently used, but still reported, was use of marijuana, erectile dysfunction treatment medication and poppers. The use of condoms is an effective way of stopping the spread of sexually transmitted infections and HIV. The men in our study used condoms inconsistently when engaging in anal sex and some men reported they never use a condom: Every time 39% Most of the time 30% Sometimes 9% Rarely 12% Never 11% Some men reported engaging in unprotected anal intercourse with men who they knew to be HIV positive and with men whose HIV status was unknown to them. In addition to inconsistent condom use, the men in our study were also inconsistent in asking their partners about their STI status with some men never asking their partners for this information: Always 41% Most of the time 13% Sometimes 13% Rarely 11% Never 22% Sixty-six per cent of the men in our study have been tested for sexually transmitted infections; this is similar to the number of men who have been tested for HIV. We followed up with the men who indicated they had not been tested for asked them to identify their reasons for not being tested. Men could choose all reasons why they hadn t got tested. The top five reasons chosen by the men in the study were: I am at low risk for HIV infection 51% I have not had anal sex 33% I think I am HIV-negative 29% I did not have sex with an infected person 29% I always have safer sex 22% We also asked the men (158) how confident they were that their potential sex partner would disclose his HIV status. Sixty-six per cent of survey respondents stated they were not or only somewhat confident a potential partner would disclose their HIV status. Very confident 15% Confident 20% Somewhat confident 39% Not confident 27% 5 Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights

7 Sexual Behaviours, Attitudes and Knowledge What is the current sexual health knowledge base of gay, bisexual and other MSM in Waterloo Region? To assess knowledge of HIV and STIs we asked the men to indicate whether they agreed or disagreed with statements regarding sexual health, risk reduction practices, and transmission of HIV and STIs. Overall, the men in our study have a high level of accurate knowledge. The chart below shows the percentage of men who gave an incorrect response. In addition, all of the HIV-positive men in our survey sample indicated they understood the components of the Canadian HIV disclosure law. Statement People can protect themselves from HIV by using a condom every time they have anal sex. Having sex with only one faithful uninfected partner can reduce the risk of HIV transmission. I would always have symptoms if I contracted an STI. Syphilis can be transmitted through unprotected oral sex. Incorrect responses 14% 13% 13% 5% A healthy person can have HIV. 1% What is/are the most effective way(s) to influence gay, bisexual and other MSM to adopt healthy sexual behaviours and attitudes? Use of the internet in various ways, such as video tutorials, anonymous discussion forums, and videos in an edutainment format has been identified in the literature as an effective way to influence gay, bisexual and other MSM to adopt healthy sexual behaviours and attitudes. The men in our study agreed that using the internet was a good way to reach gay, bisexual and other men who have sex with men and suggested that service providers and educators place links to health-related sites on commonly-used social media applications such as dating websites and mobile applications. Outreach that provides sexual health information is also an effective way for reaching MSM. The men in our study suggested the distribution of local pink pages as a way to increase access to sexual health information. Changes to the education system were also recommended. Interview participants suggested that schools adopt a more comprehensive approach to sexual health education (i.e., integrating HIV and other aspects of sexual health and behaviours with decision-making and life choices). Participants also said that education needs to address stigma and promote self-acceptance and normalization of LGBTQ identities. In addition rapid testing offered in community settings has been identified in the research as a way to increase the uptake of HIV testing as can opt-out testing (HIV testing done routinely unless the client specifically refuses the test) in sexual health clinics. Mentorship programs and other peer-delivered programs have also been identified as effective strategies. Study participants proposed that mentorship programs could be implemented through community members and organizations. Group intervention activities that taught skills, used role plays and live demonstrations, had multiple sessions and that were delivered by other MSM were shown to be effective. Gay, Bisexual and Other Men Who Have Sex with Men in Waterloo Region: Report Highlights 6

8 Conclusion This study provided valuable insight into the behaviours, knowledge, attitudes and sexual health needs of gay, bisexual and other MSM in Waterloo Region. It also reports on the existing sexual health programs and services in Waterloo Region for gay, bisexual and other MSM, and the barriers to accessing sexual health programs, services, and health information in the community. The findings will be used by Public Health and other community organizations to develop and/or improve programs and services in our community. For a copy of the full report please visit For more information about the survey please contact: Information and Planning Program Infectious Diseases, Dental and Sexual Health Division Region of Waterloo Public Health 99 Regina Street South, 2 nd floor, Waterloo, Ontario N2J 4V3 Phone: ext TTY: charold@regionofwaterloo.ca For more information about the Gay Men s HIV Prevention Project please contact: AIDS Committee of Cambridge, Kitchener, Waterloo and Area King Street West Kitchener, Ontario N2G 1C7 Phone: m2m@acckwa.com gmsh@acckwa.com Partial funding for this project was provided by the Public Health Agency of Canada. The views expressed herein do not neccessarily represent the views of the Public Health Agency of Canada. This document is available in accessible formats upon request. Created October 2013.