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A survey study to determine health disparities among men who have sex with men in Eastern Ontario: looking beyond sexual risk and the gay, urban core

  • Maxime Charest1
  • Sahar Razmjou2
  • Patrick O’Byrne3
  • Paul MacPherson1,2,4,5,*,

1School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada

2Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada

3School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1H 8M5, Canada

4Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada

5Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada

DOI: 10.22514/jomh.2023.024 Vol.19,Issue 4,April 2023 pp.58-69

Submitted: 06 October 2022 Accepted: 17 February 2023

Published: 30 April 2023

*Corresponding Author(s): Paul MacPherson E-mail: pmacpherson@toh.ca

Abstract

To create health promotion programs and clinical guidelines inclusive of gay, bisexual and other men who have sex with men (gbMSM), a better understanding of the health and social determinants that influence health outcomes for these men is required. Health research on gbMSM, however, has focused primarily on sexual health and HIV (human immunodeficiency virus) with most information coming from men living in large urban centers. To address this limitation and better characterize the overall health of this population, we conducted a survey of gbMSM living in Eastern Ontario, Canada. The survey, completed anonymously, was available from June to October 2015. A total of 674 gbMSM completed the survey; 61% were urban, 23% suburban and 16% lived in small towns or rural settings. The average age was 44.2 years, ranging from 18 to 83 years. Healthcare engagement was high for all groups of gbMSM, though disclosure of sexual orientation to healthcare providers varied based on the gender of sexual partners. Urban men tended to be younger, sexually active only with men, open about their sexual orientation, and more likely to use recreational drugs while men living in small towns and rural settings tended to be older, bisexual and more likely to conceal their sexual orientation. While the physical health of respondents was on par with national averages for men, we found younger men were more likely to suffer from anxiety and use recreational drugs while older men were more likely to develop problem alcohol use. Depressive symptoms were high across all demographic groups. Our data demonstrate that while gbMSM in Eastern Ontario have a high degree of contact with the healthcare system, considerable health inequities remain unaddressed. We also find significant health differences among gbMSM depending on age, area of residence, and degree of disclosure of sexual orientation.


Keywords

Health; Eastern Ontario; Men who have sex with men; Sexual orientation; Urban; Suburban; Rural


Cite and Share

Maxime Charest,Sahar Razmjou,Patrick O’Byrne,Paul MacPherson. A survey study to determine health disparities among men who have sex with men in Eastern Ontario: looking beyond sexual risk and the gay, urban core. Journal of Men's Health. 2023. 19(4);58-69.

References

[1] Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association Journal. 2016; 188: E474–E483.

[2] Kitts RL. Barriers to optimal care between physicians and lesbian, gay, bisexual, transgender, and questioning adolescent patients. Journal of Homosexuality. 2010; 57: 730–747.

[3] Knight RE, Shoveller JA, Carson AM, Contreras-Whitney JG. Examining clinicians’ experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. Health Education Research. 2014; 29: 662–670.

[4] Stott DB. The training needs of general practitioners in the exploration of sexual health matters and providing sexual healthcare to lesbian, gay and bisexual patients. Medical Teacher. 2013; 35: 752–759.

[5] Statistics Canada. Same-sex couples and sexual orientation... by the numbers. 2015. Available at: https://www.statcan.gc.ca/eng/dai/smr08/2015/smr08_203_2015 (Accessed: 31 August 2022).

[6] Dean L, Meyer IH, Robinson K, Sell RL, Sember R, Silenzio VMB, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. Journal of the Gay and Lesbian Medical Association. 2000; 4: 102–151.

[7] Goins ES, Pye D. Check the box that best describes you: reflexively managing theory and praxis in LGBTQ health communication research. Health Communication. 2013; 28: 397–407.

[8] Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. The Lancet. 2012; 380: 367–377.

[9] Christopoulos KA, Das M, Colfax GN. Linkage and retention in HIV care among men who have sex with men in the United States. Clinical Infectious Diseases. 2011; 52: S214–S222.

[10] Cowan SA, Gerstoft J, Haff J, Christiansen AH, Nielsen J, Obel N. Stable incidence of HIV diagnoses among Danish MSM despite increased engagement in unsafe sex. Journal of Acquired Immune Deficiency Syndromes. 2012; 61: 106–111.

[11] de Vries HJ. Sexually transmitted infections in men who have sex with men. Clinics in Dermatology. 2014; 32: 181–188.

[12] Mimiaga MJ, O’Cleirigh C, Biello KB, Robertson AM, Safren SA, Coates TJ, et al. The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. Journal of Acquired Immune Deficiency Syndromes. 2015; 68: 329–336.

[13] O’Byrne P, MacPherson P, Ember A, Grayson M, Bourgault A. Overview of a gay men’s STI/HIV testing clinic in Ottawa: clinical operations and outcomes. Canadian Journal of Public Health. 2014; 105: e389–e394.

[14] Purcell DW, Johnson CH, Lansky A, Prejean J, Stein R, Denning P, et al. Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. The Open AIDS Journal. 2012; 6: 98–107.

[15] Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall RD. Mental health and HIV risk in men who have sex with men. Journal of Acquired Immune Deficiency Syndromes. 2010; 55: S74–S77.

[16] Velter A, Barin F, Bouyssou A, Guinard J, Léon L, Le Vu S, et al. HIV prevalence and sexual risk behaviors associated with awareness of HIV status among men who have sex with men in Paris, France. AIDS and Behavior. 2013; 17: 1266–1278.

[17] Boehmer U. Twenty years of public health research: inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health. 2002; 92: 1125–1130.

[18] Mercer CH, Prah P, Field N, Tanton C, Macdowall W, Clifton S, et al. The health and well-being of men who have sex with men (MSM) in Britain: evidence from the third national survey of sexual attitudes and lifestyles (Natsal-3). BMC Public Health. 2016; 16: 525.

[19] Cochran SD, Mays VM. Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III. American Journal of Public Health. 2000; 90: 573–578.

[20] Hirshfield S, Wolitski RJ, Chiasson MA, Remien RH, Humberstone M, Wong T. Screening for depressive symptoms in an online sample of men who have sex with men. AIDS Care. 2008; 20: 904–910.

[21] Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009; 50: 613–621.

[22] Statistics Canada. Health fact sheets primary health care providers, 2019. 2019. Available at: https://www150.statcan.gc.ca/n1/pub/82-625- x/2020001/article/00004-eng.htm (Accessed: 31 August 2022).

[23] Statista. Percentage of Canadians that visited their primary care physician a select number of times per year as of 2018. 2018. Available at: https://www.statista.com/statistics/891832/doctors-visits-among-canadians/ (Accessed: 31 August 2022).

[24] Statistics Canada. Health fact sheets: dental care, 2018. 2018. Available at: https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00010-eng.htm (Accessed: 31 August 2022).

[25] Public Health Agency of Canada. Addressing stigma: towards a more inclusive health system. 2019. Available at: www.canada. ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-toward-more-inclusive-health-system.html?utm_medium=email&utm_source= stakeholder&utm_campaign=cpho-19 (Accessed: 31 August 2022)

[26] Leung AA, Bushnik T, Hennessy D, McAlister FA, Manuel DG. Risk factors for hypertension in Canada. Health Reports. 2019; 30: 3–13.

[27] Statistics Canada. Cholesterol levels of adults, 2012 to 2013. 2013. Available at: https://www150.statcan.gc.ca/n1/pub/82-625-x/2014001/article/14122-eng.htm (Accessed: 31 August 2022).

[28] Statistics Canada. Health fact sheets diabetes, 2017. 2017. Available at: https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm (Accessed: 31 August 2022).

[29] Public Health Agency of Canada. Report from the Canadian chronic disease surveillance system: heart disease in Canada, 2018. 2018. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-heart-disease-Canada-2018.html (Accessed: 31 August 2022).

[30] Statistics Canada. Mental and substance use disorders in Canada 2012. 2015. Available at: https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11855-eng.htm (Accessed: 31 August 2022).

[31] Health Canada. Canadian alcohol and drug use monitoring survey. 2011. Available at: https://www.canada.ca/en/health-canada/services/health-concerns/drug-prevention-treatment/drug-alcohol-use-statistics/canadian-alcohol-drug-use-monitoring-survey-summary-results-2011.html#a4 (Accessed: 31 August 2022).

[32] Health Canada. Canadian alcohol and drug use monitoring survey. 2012. Available at: https://www.canada.ca/en/health-canada/services/health-concerns/drug-prevention-treatment/drug-alcohol-use-statistics/canadian-alcohol-drug-use-monitoring-survey-summary-results-tables-2012.html#t1 (Accessed: 31 August 2022).

[33] Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M. The multinational men’s attitudes to life events and sexuality (MALES) study: I. prevalence of erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion. 2004; 20: 607–617.

[34] Adams J, McCreanor T, Braun V. Gay men’s explanations of health and how to improve it. Qualitative Health Research. 2013; 23: 887–899.

[35] Koester KA, Collins SP, Fuller SM, Galindo GR, Gibson S, Steward WT. Sexual healthcare preferences among gay and bisexual men: a qualitative study in San Francisco, California. PLOS ONE. 2013; 8: e71546.

[36] Meckler GD, Elliott MN, Kanouse DE, Beals KP, Schuster MA. Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Archives of Pediatrics and Adolescent Medicine. 2006; 160: 1248–1254.

[37] Neville S, Henrickson M. Perceptions of lesbian, gay and bisexual people of primary healthcare services. Journal of Advanced Nursing. 2006; 55: 407–415.

[38] Haines M, O’Byrne P, MacPherson P. Gay, bisexual, and other men who have sex with men: barriers and facilitators to healthcare access in Ottawa. The Canadian Journal of Human Sexuality. 2021; 30: 339–348.

[39] Brennan DJ, Ross LE, Dobinson C, Veldhuizen S, Steele LS. Men’s sexual orientation and health in Canada. Canadian Journal of Public Health. 2010; 101: 255–258.

[40] Cochran SD, Ackerman D, Mays VM, Ross MW. Prevalence of non-medical drug use and dependence among homosexually active men and women in the us population. Addiction. 2004; 99: 989–998.

[41] Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry. 1999; 56: 876–880.

[42] King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008; 8: 70.

[43] Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin Journal. 2003; 129:674–697.

[44] Mills TC, Paul J, Stall R, Pollack L, Canchola J, Chang YJ, et al. Distress and depression in men who have sex with men: the urban men’s health study. American Journal of Psychiatry. 2004; 161: 278–285.

[45] Pakula B, Shoveller JA. Sexual orientation and self-reported mood disorder diagnosis among Canadian adults. BMC Public Health. 2013; 13: 209.

[46] Paul JP, Catania J, Pollack L, Moskowitz J, Canchola J, Mills T, et al. Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. American Journal of Public Health. 2002; 92: 1338–1345.

[47] Plöderl M, Tremblay P. Mental health of sexual minorities. A systematic review. International Review of Psychiatry. 2015; 27: 367–385.

[48] Safren SA, Blashill AJ, O’Cleirigh CM. Promoting the sexual health of MSM in the context of comorbid mental health problems. AIDS and Behavior. 2011; 15: S30–S34.

[49] Sandfort TGM, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: findings from a Dutch population survey. American Journal of Public Health. 2006; 96: 1119–1125.

[50] Skegg K, Nada-Raja S, Dickson N, Paul C, Williams S. Sexual orientation and self-harm in men and women. American Journal of Psychiatry. 2003; 160: 541–546.

[51] Boyd CJ, McCabe SE, d’Arcy H. Ecstasy use among college under-graduates: gender, race and sexual identity. Journal of Substance Abuse Treatment. 2003; 24: 209–215.

[52] Lachowsky NJ, Dulai JJS, Cui Z, Sereda P, Rich A, Patterson TL, et al. Lifetime doctor-diagnosed mental health conditions and current substance use among gay and bisexual men living in Vancouver, Canada. Substance Use & Misuse. 2017; 52: 785–797.

[53] Stall R, Paul JP, Greenwood G, Pollack LM, Bein E, Crosby GM, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the urban men’s health study. Addiction. 2001; 96: 1589–1601.

[54] Bostwick WB, Meyer I, Aranda F, Russell S, Hughes T, Birkett M, et al. Mental health and suicidality among racially/ethnically diverse sexual minority youths. American Journal of Public Health. 2014; 104: 1129–1136.

[55] Storholm ED, Siconolfi DE, Halkitis PN, Moeller RW, Eddy JA, Bare MG. Sociodemographic factors contribute to mental health disparities and access to services among young men who have sex with men in New York city. Journal of Gay & Lesbian Mental Health. 2013; 17: 10.



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