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This study piloted the GPS (Gay-Positive Sex) Latino program for men who have sex with men (MSM) who immigrated to Canada. GPS Latino is an individual counseling intervention program that involves the provision of information, motivational interviewing, and behavioral skills building to reduce risk behaviors associated with HIV and STI transmission. We designed a pre-post study without control to assess the effects of GPS Latino on depression, loneliness, the self-efficacy of condom use negotiation, and condomless anal sex (CAS). During the study, one HIV-positive peer counselor administered six 2-hour counseling sessions to 11 participants living with HIV and 10 HIV-negative MSM Latinos living in Toronto, Canada. A paired t-test and a McNemar test were employed to assess the effects of GPS Latino twelve months after the start of the intervention. Our study shows a reduction in CAS (any partner) from 90% at the baseline to 62% at the 12-month follow-up ( p = 0.06). The findings also indicate an increase from 19.2 to 21.5 ( p = 0.01) in self-efficacy of negotiating condom use in HIV-negative participants. As a peer-led counseling intervention, GPS Latino may offer an efficient way of concurrently reducing CAS and increasing condom use negotiation in immigrant Latino men who have sex with men.

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Introduction Despite strong evidence from low- and middle-income countries supporting the use of task shifting to provide quality, cost-effective HIV-related health services, this strategy has been adopted less widely in high-income countries such as Canada. Methods In 2020, we conducted semi-structured interviews with 19 clinicians (e.g., psychologists, nurses, physicians) and 14 community health workers (CHWs) in Ontario to examine their perspectives on the prospect of shifting HIV/STBBI testing services and PrEP in Ontario, Canada. Interviews were transcribed and then analyzed using content analysis. A community consultation with key stakeholders was also performed to assess the validity of the findings. Results There was substantial agreement between clinicians and CHWs with respect to shifting specific tasks related to HIV/STBBI testing and PrEP. In particular, most participants felt that rapid HIV testing could and should be provided by CHWs and that ASOs could be ideal sites for clients to obtain and use self-testing kits for STBBIs. Most respondents agreed that CHWs have the skills and expertise required to perform most non-clinical services related to PrEP (e.g., pre-counselling, follow-up, case management). The co-location of clinicians and CHWs could help support the development of task shifting initiatives. Conclusion Findings indicate that there is enthusiasm among both clinicians and CHWs with respect to shifting HIV prevention services. Creative solutions are required to have a meaningful impact on HIV incidence in this population. Policy Implications With adequate training and supervision, non-regulated CHWs should be allowed to provide certain HIV prevention services such as rapid HIV testing. A provincial, publicly funded program for PrEP is recommended.

Blood donation policies governing men who have sex with men have shifted significantly over time in Canada—from an initial lifetime ban in the wake of the AIDS crisis to successive phases of time-based deferment requiring periods of sexual abstinence (5 years to 1 year to 3 months). We interviewed 39 HIV-negative gay, bisexual, queer, and other sexual minority men (GBM) in Vancouver, Toronto, and Montreal to understand their willingness to donate blood if eligible. Transcripts were coded following inductive thematic analysis. We found interrelated and competing expressions of biological and sexual citizenship. Most participants said they were “safe”/“low risk” and “willing” donors and would gain satisfaction and civic pride from donation. Conversely, a smaller group neither prioritized the collectivizing biological citizenship goals associated with expanding blood donation access nor saw this as part of sexual citizenship priorities. Considerable repair work is required by Canada’s blood operators to build trust with diverse GBM communities.

Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation. However, they also report more unmet mental health needs. To better understand this phenomenon, we conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada. Interviews were analysed using grounded theory. Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers. The first were general barriers, hurdles to mental healthcare not exclusive to sexual minorities. These included financial and logistical obstacles, the prominence of psychiatry and the biomedical model, and unsatisfactory provider encounters. The second were sexual minority barriers, obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included experiencing discrimination and distrust, and limited sexual minority affirming options. Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma. Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men. Research must consider the upstream policy changes necessary to counteract these harms.

Background As of 2019, men who have sex with men (MSM) in Canada are ineligible to donate blood if they have had oral or anal sex with another man in the last 3 months. Deferral policies targeting MSM are largely interpreted as unjust by gay, bisexual, and other men who have sex with men (GBMSM) – shaping their desire to donate blood and engage with blood operators. This mixed methods study explores interest in blood donation among GBMSM as well as willingness (and eligibility) to donate under four different deferral policies. Methods We surveyed 447 GBMSM who were recruited from the Ontario-wide #iCruise study. Participants were asked whether they were interested in blood donation and if they were willing to donate under each of our four deferral policies. We also completed interviews with 31 of these GBMSM. Participants were asked to describe their feelings about blood donation, their views on our different deferral policies, the impact of a policy change, as well as other means of redress. Results Most participants (69%) indicated that they were interested in donating blood. Despite this, an interpretation of the MSM deferral policy as discriminatory was common among all participants. Our mixed methods findings indicate that, among those who were interested in blood donation, the adoption of one of the alternative policies presented in this study (specifically Policy 2 or Policy 3) would significantly increase the number of participants willing to donate and be viewed as “a step in the right direction.” However, many participants who were not interested in blood donation argued that a gender-neutral deferral policy would need to be implemented for them to donate. Participants recommended that blood operators consider efforts to repair relations with GBMSM beyond policy change, including pop-up clinics in predominantly queer areas and diversity sensitivity training for staff. Conclusion We argue that the most impactful policy shift would be the implementation of an individual risk-based deferral policy that is applied to all donors regardless of sexual orientation or gender identity. However, given MSM’s historical exclusion from blood donations, blood operators should pair this policy shift with community relationship-building efforts.

Our grounded theory analysis derives from in-depth interviews conducted with 24 gay, bisexual, queer, and other men who have sex with men (GBM) living in Toronto, Canada, to understand their experiences of sexual coercion. Participants drew on discourse from the #MeToo movement to reconsider the ethics of past sexual experiences. The idea that gay or queer sex is inherently risky and unique from heterosexual relations made negotiating sexual safety challenging. These notions were enforced by homophobic discourses on the one hand, and counter discourses of sexual liberation, resistance to heteronormativity, hegemonic masculinity, and HIV prevention on the other. Biomedical advances in HIV prevention such as pre-exposure prophylaxis (PrEP) and undetectable viral load affected how some participants felt about sexual autonomy and safety. Participants held themselves responsible for needing to be more assertive within sexual encounters to avoid coercion. Many believed that unwanted sex is unavoidable among GBM: if "you're gay, it's just what happens." Targeted education aimed at GBM communities that incorporates insights on GBM sexual subcultures is necessary. This work must be situated within a broader understanding of how gender norms and hegemonic masculinity, racism, HIV status, and other power imbalances affect sexual decision-making, consent, pleasure, and sexual harm.

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30-49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Objectives: HIV pre-exposure prophylaxis (PrEP) may change serosorting patterns. We examined the influence of serosorting on the population-level HIV transmission impact of PrEP, and how impact could change if PrEP users stopped serosorting. Design: We developed a compartmental HIV transmission model parameterized with bio-behavioural and HIV surveillance data among men who have sex with men in Canada.Methods: We separately fit the model with serosorting and without serosorting (counterfactual; sero-proportionate mixing (random partner-selection proportional to availability by HIV-status)), and reproduced stable HIV epidemics with HIV-prevalence 10.3%-24.8%, undiagnosed fraction 4.9%-15.8%, and treatment coverage 82.5%-88.4%. We simulated PrEP-intervention reaching stable pre-specified coverage by year-1 and compared absolute difference in relative HIV-incidence reduction ten-years post-intervention (PrEP-impact) between: models with serosorting vs. sero-proportionate mixing; and counterfactual scenarios when PrEP users immediately stopped vs. continued serosorting. We examined sensitivity of results to PrEP-effectiveness (44%-99%; reflecting varying dosing or adherence levels) and coverage (10%-50%).Results: Models with serosorting predicted a larger PrEP-impact than models with sero-proportionate mixing under all PrEP-effectiveness and coverage assumptions (median (inter-quartile-range): 8.1%(5.5%-11.6%)). PrEP users’ stopping serosorting reduced PrEP-impact compared with when PrEP users continued serosorting: reductions in PrEP-impact were minimal (2.1%(1.4%-3.4%)) under high PrEP-effectiveness (86%-99%); however, could be considerable (10.9%(8.2%-14.1%)) under low PrEP effectiveness (44%) and high coverage (30%-50%). Conclusions: Models assuming sero-proportionate mixing may underestimate population-level HIV-incidence reductions due to PrEP. PrEP-mediated changes in serosorting could lead to programmatically-important reductions in PrEP-impact under low PrEP-effectiveness. Our findings suggest the need to monitor sexual mixing patterns to inform PrEP implementation and evaluation.

There is mounting urgency regarding the mental health of gay, bisexual and other men who have sex with men (GBM). We examined how GBM are understanding the relationship between HIV and their mental health given the increasing biomedicalisation of HIV prevention and care. Our Grounded Theory analysis derived from qualitative interviews with 24 GBM living in Toronto, Canada, including both HIV-negative and HIV-positive men. Participants understood biomedical advances, such as undetectable viral load and pre-exposure prophylaxis (PrEP), as providing some relief from HIV-related distress. However, they offered ambivalent perspectives on the biomedicalisation of HIV. Some considered non-HIV-specific stressors (e.g. unemployment, racial discrimination) more significant than HIV-related concerns. These men expressed HIV-related distress as being under control due to biomedical advances or as always negligible when compared to non-HIV-specific stressors. Others emphasised the ongoing mental health implications of HIV (e.g. enduring risk and stigma). We describe a tension between optimistic responses to biomedicine's ability to ease the psychosocial burdens associated with HIV and the inability for biomedicine to address the social and economic determinants driving the dual epidemics of HIV and mental distress amongst GBM. We argue for more socio-material analysis over further sexual behavioural analysis of GBM mental health disparities.

Background Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. Method HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. Results There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. Conclusions The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. Trial Registration ClinicalTrials.gov NCT02546271

Background Men who have sex with men (MSM) are not eligible to donate blood or plasma in Canada if they have had sex with another man in the last 3 months. This time-based deferment has reduced since 2013; from an initial lifetime ban, to five-years, one-year, and now three-months. Our previous research revealed that gay, bisexual, queer, and other MSM (GBM) supported making blood donation policies gender-neutral and behaviour-based. In this analysis, we explored the willingness of Canadian GBM to donate plasma, even if they were not eligible to donate blood. Methods We conducted in-depth interviews with 39 HIV-negative GBM in Vancouver (n = 15), Toronto (n = 13), and Montreal (n = 11), recruited from a large respondent-driven sampling study called Engage. Men received some basic information on plasma donation prior to answering questions. Transcripts were coded in NVivo following inductive thematic analysis. Results Many GBM expressed a general willingness to donate plasma if they became eligible; like with whole blood donation, GBM conveyed a strong desire to help others in need. However, this willingness was complicated by the fact that most participants had limited knowledge of plasma donation and were unsure of its medical importance. Participants’ perspectives on a policy that enabled MSM to donate plasma varied, with some viewing this change as a “stepping stone” to a reformed blood donation policy and others regarding it as insufficient and constructing GBM as “second-class” donors. When discussing plasma, many men reflected on the legacy of blood donor policy-related discrimination. Our data reveal a significant plasma policy disjuncture—a gulf between the critical importance of plasma donation from the perspective of Canada’s blood operators and patients and the feelings of many GBM who understood this form of donation as less important. Conclusions Plasma donor policies must be considered in relation to MSM blood donation policies to understand how donor eligibility practices are made meaningful by GBM in the context of historical disenfranchisement. Successful establishment of a MSM plasma donor policy will require extensive education, explicit communication of how this new policy contributes to continued/stepwise reform of blood donor policies, and considerable reconciliation with diverse GBM communities.

Drawing on 24 interviews conducted with gay, bisexual, queer and other men who have sex with men (GBM) living in Toronto, Canada, we examined how they are making sense of the relationship between their mental health and substance use. We draw from the literature on the biopolitics of substance use to document how GBM self-regulate and use alcohol and other drugs (AODC) as technologies of the self. Despite cultural understandings of substance use as integral to GBM communities and subjectivity, GBM can be ambivalent about their AODC. Participants discussed taking substances positively as a therapeutic mental health aid and negatively as being corrosive to their mental wellbeing. A fine line was communicated between substance use being self-productive or self-destructive. Some discussed having made ‘problematic’ or ‘unhealthy’ drug-taking decisions, while others presented themselves as self-controlled, responsible neoliberal actors doing ‘what a normal gay man would do’. This ambivalence is related to the polarizing binary community and scientific discourses on substances (i.e. addiction/healthy use, irrational/rational, uncontrolled/controlled). Our findings add to the critical drug literature by demonstrating how reifying and/or dismantling the coherency of such substance use binaries can serve as a biopolitical site for some GBM to construct their identities and demonstrate healthy, ‘responsible’ subjectivity.

BackgroundHIV pre-exposure prophylaxis (PrEP) may change serosorting patterns. We examined the influence of serosorting on the population-level HIV transmission impact of PrEP, and how impact could change if PrEP users stopped serosorting.MethodsWe developed a compartmental HIV transmission model parameterized with bio-behavioural and HIV surveillance data among men who have sex with men in Canada. We separately fit the model with serosorting and without serosorting (random partner-selection proportional to availability by HIV-status (sero-proportionate)), and reproduced stable HIV epidemics (2013-2018) with HIV-prevalence 10.3%-24.8%, undiagnosed fraction 4.9%-15.8%, and treatment coverage 82.5%-88.4%. We simulated PrEP-intervention reaching stable coverage by year-1 and compared absolute difference in relative HIV-incidence reduction 10-year post-intervention (PrEP-impact) between: models with serosorting vs. sero-proportionate mixing; and scenarios in which PrEP users stopped vs. continued serosorting. We examined sensitivity of results to PrEP-effectiveness (44%-99%) and coverage (10%-50%).FindingsModels with serosorting predicted a larger PrEP-impact compared with models with sero-proportionate mixing under all PrEP-effectiveness and coverage assumptions (median (inter-quartile-range): 8.1%(5.5%-11.6%)). PrEP users” stopping serosorting reduced PrEP-impact compared with when PrEP users continued serosorting: reductions in PrEP-impact were minimal (2.1%(1.4%-3.4%)) under high PrEP-effectiveness (86%-99%); however, could be considerable (10.9%(8.2%-14.1%)) under low PrEP effectiveness (44%) and high coverage (30%-50%).InterpretationModels assuming sero-proportionate mixing may underestimate population-level HIV-incidence reductions due to PrEP. PrEP-mediated changes in serosorting could lead to programmatically-important reductions in PrEP-impact under low PrEP-effectiveness (e.g. poor adherence/retention). Our findings suggest the need to monitor sexual mixing patterns to inform PrEP implementation and evaluation.FundingCanadian Institutes of Health ResearchRESEARCH IN CONTEXTEvidence before this studyWe searched PubMed for full-text journal articles published between Jan 1, 2010, and Dec 31, 2017, using the MeSH terms “pre-exposure prophylaxis (PrEP)” and “homosexuality, male” and using key words (“pre-exposure prophylaxis” or “preexposure prophylaxis” or “PrEP”) and (“men who have sex with men” or “MSM”) in titles and abstracts. Search results (520 records) were reviewed to identify publications which examined the population-level HIV transmission impact or population-level cost-effectiveness of PrEP in high-income settings. We identified a total of 18 modelling studies of PrEP impact among men who have sex with men (MSM) and four studies were based on the same model with minor variations (thus only the most recent one was included). Among the 15 unique models of PrEP impact, three included serosorting. A total of nine models have assessed the individual-level behaviour change among those on PrEP and its influence on the transmission impact of PrEP. Specifically, the models examined increases in number of partners and reductions in condom use. Most models predicted that realistic increases in partner number or decreases in condom use would not fully offset, but could weaken, PrEP”s impact on reducing HIV transmission. We did not identify any study that examined the influence of serosorting patterns on the estimated transmission impact of PrEP at the population-level, or what could happen to HIV incidence if the use of PrEP changes serosorting patterns.Added value of this studyWe used a mathematical model of HIV transmission to estimate the influence of serosorting and PrEP-mediated changes in serosorting on the transmission impact of PrEP at the population-level among MSM. We found the impact of PrEP was higher under epidemics with serosorting, compared with comparable epidemics simulated assuming sero-proportionate mixing. Under epidemics with serosorting, when PrEP users stopped serosorting (while other men continue to serosort among themselves) we found a reduced PrEP impact compared with scenarios when PrEP users continued to serosort. The magnitude of reduction in PrEP impact was minimal if PrEP-effectiveness was high; however, could be programmatically-meaningful in the context of low PrEP-effectiveness (e.g., poor adherence or retention) and high PrEP coverage. To our knowledge, our study is the first to directly examine the influence of serosorting and PrEP-mediated changes in serosorting on the transmission impact of PrEP and its underlying mechanism.Implications of all the available evidenceOur findings suggest that models which do not consider baseline patterns of serosorting among MSM could potentially underestimate PrEP impact. In addition to monitoring individual-level behavioural change such as condom use, our findings highlight the need to monitor population-level sexual mixing patterns and their changes over time among MSM in the design and evaluation of PrEP implementation.

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing–based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.

This paper enquires into the nexus of migration with sexual health among gay Latino migrants in Canada. Interviews with 25 Spanish-speaking interviewees are examined in light of models developed from studies of Latinos in the United States. Canadian immigration policy appears to result in a somewhat different selection of immigrants compared to the United States. Migrants come from a wide range of national and regional backgrounds intersected by race, generation, and social class that influence their perceptions of and adjustment to Canadian society. Pre-migration HIV knowledge varied strongly by generation with older men recalling public panic concerning HIV and younger men receiving formal education about it. Migration enters into the mix of conditions as kin ties can be less confidently relied on among gay men compared to their heterosexual counterparts and by exacerbating vulnerability among those seeking to develop new social and sexual networks.

Drawing on interviews with 40 gay, bisexual, and queer trans men in Ontario, Canada, we describe understandings of, and strategies for affective and behavioral negotiation within virtual and physical sexual fields in which they might find male sexual partners. Participants drew sharp distinctions between gay and queer sexual fields. Specific websites for seeking sex also emerged as important fields with their own internal logics. Sexual field choice was heavily impacted by social and medical gender affirmation. Participant narratives highlighted the interplay of personal and socio-historical transitions—including accessing medical transition technologies, the rise of virtual sexual fields, and increasing trans male visibility—in producing rapidly changing sexual opportunity structures. Comfort and success navigating extant sexual fields varied, with many reporting some degree of satisficing to balance the potentials for pleasure and risk.

Project PRIDE (Promoting Resilience In Discriminatory Environments) is an 8-session small group intervention aimed at reducing negative mental and behavioral health outcomes resulting from minority stress. This study reports the results of a one-armed pilot test of Project PRIDE, which aimed to examine the feasibility and potential for efficacy of the intervention in a sample of 33 gay and bisexual men aged 18 to 25. The intervention appeared feasible to administer in two different sites and all participants who completed posttreatment (n = 22) or follow-up (n = 19) assessments reported high satisfaction with the intervention. Small to large effect sizes were observed for increases in self-esteem; small effect sizes were found for decreases in loneliness and decreases in minority stress variables; and small and medium effect sizes were found for reductions in alcohol use and number of sex partners, respectively. Overall, Project PRIDE appears to be a feasible intervention with promise of efficacy.

Using latent class analysis (LCA), we examined patterns of participation in multiple scenes, how sexual risk practices vary by scene, and psychosocial factors associated with these patterns among 470 gay, bisexual, and other men who have sex with men (GBM) recruited from Toronto. We calculated posterior probability of being in a class from participation in nine separate scenes. We used Entropy, the Bayesian information criterion and the Lo-Mendel-Rubin likelihood ratio test to identify the best fit model. Fit indices suggested a four-class solution. Half (50%) of the GBM reported no or minimal participation in any scene, 28% reported participating in the dance club scene, 16% reported participating in the BDSM, bear, and leather scenes, and 6% reported participating in circuit, party and play, and sex party scenes. Compared to GBM who did not participate in scenes, GBM participating in the BDSM-Bear-Leather scene were more likely to be older, white, to report higher sexual self-esteem, and to engage in condomless anal sex; Party and Play scene members were more likely to be of Asian origin, and to use drugs before and during sex, whereas Dance Club scene members were more likely to be younger and to report lower self-esteem but higher hope. LCA allowed us to identify distinct social niches or micro-cultures and factors characterizing these micro-cultures. GBM differ in their risk for HIV and STIs according to characteristics associated with participation in distinct micro-cultures associated with scenes. Tailored interventions may be needed that focus on reducing HIV risk and promoting sexual health in specific contexts such as the BDSM-Bear-Leather and Party and Play.

Syndemics research shows the additive effect of psychosocial problems on high-risk sexual behavior among gay and bisexual men (GBM). Psychosocial strengths may predict less engagement in high-risk sexual behavior. In a study of 470 ethnically diverse HIV-negative GBM, regression models were computed using number of syndemic psychosocial problems, number of psychosocial strengths, and serodiscordant condomless anal sex (CAS). The number of syndemic psychosocial problems correlated with serodiscordant CAS (RR = 1.51, 95% CI 1.18-1.92; p = 0.001). When adding the number of psychosocial strengths to the model, the effect of syndemic psychosocial problems became non-significant, but the number of strengths-based factors remained significant (RR = 0.67, 95% CI 0.53-0.86; p = 0.002). Psychosocial strengths may operate additively in the same way as syndemic psychosocial problems, but in the opposite direction. Consistent with theories of resilience, psychosocial strengths may be an important set of variables predicting sexual risk behavior that is largely missing from the current HIV behavioral literature.

Background In 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time. Objective To provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM). Methods The EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive. Results Of the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%). Conclusion gbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low.These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.

Investigation of the social and psychological antecedents of the HIV epidemic has identified a syndemic of conditions associated with risk behavior and seroconversion. This study inquires into the resilient practices and developmental processes of gay and bisexual men at the nexus of syndemic conditions to understand the pathways that lead to health problems or well-being. Interviews with 40 men identified branching pathways from home environments into schools that either offer refuge or a regime of gender discipline and bullying. Some found escape routes from hostile environments in worlds of books, pop culture, or internet chat. In adolescence, one set of men identified the development of sexual relationships with older men as a lifeline that brought a measure of emotional growth. This study points to resilience pathways and social resources that could make a difference in the lives of those deemed to be “high risk.”

Background Internationally, Canada was one of the first countries to offer free HPV vaccination to young gbMSM. The provinces of British Columbia (BC), Ontario (ON) and Quebec (QC) implemented HPV vaccination programs in 2015–2016 for gbMSM aged 9–26. We explored HPV vaccine initiation and among unvaccinated men, potential barriers to uptake. Methods Engage is a sexual health study among gbMSM aged 16+ in Vancouver BC, Toronto ON, and Montreal QC, the largest urban centres in each province. Men are recruited via respondent driven sampling (RDS). We estimated the proportion that had initiated HPV vaccination and among unvaccinated men, compared proportions to responses on HPV vaccine knowledge and willingness, healthcare access and sexual orientation disclosure by age (eligible for free vaccination: ≤26 and ineligible for free vaccination: ≥26 years old). Proportions were RDS unadjusted. Results From 01/2017 to 31/12/2018, 2099 men enrolled (542 Vancouver, 378 Toronto, 1179 Montreal). Their median age was 33 years (IQR 27–46). In Vancouver, Toronto, and Montreal, 48.6%, 44.1% and 44.2% of men aged ≤26 and 24.9%, 30.3% and 7.1% of men aged ≥26 had 1+ dose of the HPV vaccine, respectively. Among unvaccinated men, more men aged ≥26 versus ≤26 accessed healthcare (family doctor/sexual health/HIV care) (87.2% vs 78.9%, p=0.0008) and disclosed their sexual orientation to their family doctor (86.2% vs 64.4%, p Conclusion Preliminary analyses indicate that HPV vaccine initiation in this population remains suboptimal. Among unvaccinated gbMSM ≤26, accessing healthcare, not disclosing sexual orientation and willingness to get vaccinated may be barriers to vaccine uptake. Disclosure No significant relationships.

Background Canada was one of the first countries to offer publicly funded programs providing HPV vaccine free of charge to gbMSM. In 2015–2016, the provinces of British Columbia (BC), Ontario (ON), and Quebec (QC) implemented programs for gbMSM aged 9–26 years. We sought to explore where men received the HPV vaccine and the influence of healthcare engagement on vaccination. Methods Engage is a sexual health study among gbMSM aged 16+ in the largest urban centres in each province: Vancouver, BC; Toronto, ON; and Montreal, QC. Men are recruited via respondent driven sampling (RDS). We compared proportions (non-RDS adjusted) to questionnaire responses on healthcare engagement among vaccinated (1+ doses) versus unvaccinated in the subset of men aged ≤26 years old at enrolment. Results From 01/2017 to 31/12/2018, 477 men aged ≤26 enrolled (144 Vancouver, 84 Toronto, 249 Montreal). Their median age was 24 years (IQR 22–25). In Vancouver, Toronto and Montreal, respectively, 48.6%, 44.1%, 44.2% had initiated HPV vaccination with 58.6%, 56.8% and 48.2% of vaccinated men having received all 3 doses. Popular venues for vaccination included a: sexual health clinic (50.7%), medical clinic not specializing in sexual health (14.8%), community health centre (10.6%), and doctor’s office (7.4%). Compared to unvaccinated men, more vaccinated men had a family doctor (65.9% vs 52.3%, p=0.0047), had a different provider/clinic for sexual health care or had a HIV care provider (66.8% vs 51.8%, p=0.0022), had a STI/HIV test in the past year (90.8% vs 68.6%, p Conclusion Compared to unvaccinated men, vaccinated men were more engaged in healthcare. It is unknown whether men requested the vaccine or providers offered it. Nevertheless, our findings suggest opportunistic HPV vaccination when men receive other services, particularly those related to sexual health. Disclosure No significant relationships.

Anti-LGBT politics around the world have undergone a major transformation over the last half century. While European powers once held themselves up as defenders of Christian morality and patriarchy, characterizing Asia, Africa, and the Americas as locations of sexual disorder, in the 21st century many of the countries of the Global South construct LGBT sexualities as pathological, threatening, or criminal, while many countries of the Global North incorporate sexual orientation in a discourse of human rights, democracy, and individual freedom. Many of the social forces of nationalism and populism of the early 21st century place the well-being of LGBT citizens in jeopardy, and conflicts between these divergent visions of the good society continue to have grave consequences for LGBT people around the world.

This chapter explores how political economy shapes the social organization of sexuality and intimacy, in particular, modern formations of LGBT people. Political economy affects sexuality at three broad levels: (1) through the articulation of kinship and gender with the division of labor, it creates both openings and limits to same-sex relationships; (2) through demands imposed on contemporary workers, citizens, and consumers by neoliberalism, markets influence norms of conduct and success strategies even in personal relationships; (3) political economy generates hierarchies of entitlement and exclusion which impact LGBT peoples and the social constituencies around them who construct them as symbols of progress or decline. Reviewing both historical and anthropological evidence and the growing international divide between LGBT-affirming and repressing countries, the chapter contextualizes current contentions about the rise of homonationalism in a larger geopolitics of north and south.

Despite the widespread use of cognitive-behavioral therapy and motivational interviewing techniques among behavioral clinicians, most mental health clinicians do not know how to use these techniques for HIV prevention and sexual health promotion. Even less information is available to clinicians on how to work with HIV-positive gay and bisexual men who are at risk for transmitting HIV due to condomless anal sex. The purpose of the present paper is to assist behavioral therapists who are treating HIV-positive gay and bisexual men who engage in sexual behavior that may place them at risk for transmitting HIV or for other sexually transmitted infections. Gay Poz Sex is a form of small group counseling that uses the Information-Motivation-Behavioral Skills model (e.g., Fisher & Fisher, 2000) as the theoretical basis, and a combination of psychoeducation, motivational interviewing, and cognitive-behavioral skills such as stimulus control and role-play exercises. The treatment has the goal of promoting a positive sense of sexual well-being and reducing sexual behavior associated with the transmission of HIV, such as condomless anal sex. This paper illustrates, using three case examples, the application of empirically supported therapy techniques to reduce condomless anal sex for HIV-positive gay and bisexual men.

While past studies have measured several indicators of relationship quality in relation to types of relationship agreement, most have not included polyamorous relationships, and have almost exclusively included samples of gay men. The purpose of this study was to address this gap by examining five dimensions of relationship quality and eight dimensions of relationship equity in a sexually diverse Canadian sample (N = 3463) across three types of relationship agreements (monogamous, open, and polyamorous). The data were collected online as part of a larger study. In order to compare relationship types on relationship dimensions, MANCOVAs were computed using age, relationship duration, cohabitation status, sex, sexual orientation, and an interaction term of sex and sexual orientation as control variables. High scores of relationship quality and equity were reported by the overall sample, and scores on all scales did not significantly differ by types of relationship agreements. Overall, these results strongly suggest that these types of relationship agreements are equally healthy viable options.

Young gay and bisexual men are at increased risk for human immunodeficiency virus (HIV) infection. Research suggests that the stress associated with being a stigmatized minority is related to negative mental health outcomes, substance use, and condomless sex. However, interventions aimed at reducing HIV risk behaviors in young gay and bisexual men have failed to address these important variables. The purpose of the present paper is to assist cognitive and behavioral therapists who work with young gay and bisexual men to conduct therapy for stress management and HIV prevention. This paper provides an overview of the research on stress and coping among gay and bisexual men and its relation with condomless sex among young gay and bisexual men. The treatment described here integrates minority stress theory (e.g., Meyer, 2003) and stress and coping theory (e.g., Lazarus, 2000) in a small group counseling framework that uses psychoeducation, cognitive reframing, and role plays to help young gay and bisexual men to manage stress, reduce substance use, and reduce condomless sex. The application of empirically supported theory and a combination of cognitive and behavioral techniques to reduce both psychological distress and HIV risk behavior for young gay and bisexual men is illustrated using three case examples. The present treatment may help therapists working with young HIV-negative gay and bisexual men who engage in condomless sex and who wish to remain HIV-negative by decreasing their HIV risk behavior.

In contemporary Western society, changing norms around marital monogamy represent one possible element of a broader transformation in the institution of marriage. To capture these transformations, many scholars over the past three decades have drawn upon a detraditionalization thesis that details a marked shift in the way marriage is constructed in Western societies following World War II. This body of research suggests a growing focus on individual satisfaction and mutually fulfilling partnerships as the foundation of contemporary marital forms (Cherlin, 2004; Giddens, 1992; Gross, 2005). Such shifts in the construction of marriage have been attributed to a range of factors, including advances in reproductive technologies (Giddens, 1992), the late modern process of individualization (Beck & Beck-Gernsheim, 1995, 2002), and as an outcome of social movements (Castells, 1997). Further, historical shifts in political economy, perhaps most importantly women's mass entry into the labor market, are believed to have brought about fundamental challenges to the traditional nuclear family, including the distribution of domestic labor and bifurcated gender roles associated with male breadwinning and female domesticity (Gerson, 1993, 2011; Giddens, 1992; Hochschild, 1989; Laslett & Brenner, 1989; Luxton, 1980).While some respond to detraditionalization with nostalgia for (an apparently) lost world of moral order, other theorists celebrate the emergence of norms and practices that challenge traditional social arrangements long held together by patriarchal power, such as nonmarital childbearing and cohabitation, as well as same-sex, interracial, and interreligious relationships (Casper & Bianchi, 2002; Rosenfield, 2007; Thornton & Young-DeMarco, 2001). To be sure, while marriage is still conceived as an important milestone in adult life for many individuals (Cherlin, 2004), others are opting for alternative intimate relationships that "queer" traditional institutions (Weeks, 2007). One critical question arising in the face of these broad social changes is how gender and sexual orientation may bear on the construction and practice of monogamy in the context of state-sanctioned marriage.In this article, we draw on an original qualitative study of 90, largely White, urban, middle-class, Canadian heterosexual and same-sex marriages to explore the detraditionalization thesis with respect to how contemporary couples conceive of and structure sexual relations within their marriage. The race and class characteristics of this self-selected sample make it especially useful for a consideration of the detraditionalization thesis which, if valid, should be reflected most strongly among men and women of this demographic (i.e., the socially enfranchised citizens of Western society). Furthermore, comparison of heterosexual and homosexual marriages is particularly timely because same-sex civil marriage has rapidly become a legal reality throughout parts of the Western world, thus raising the empirical question of the applicability of the detraditionalization thesis to these new, state-sanctioned marital forms. Same-sex marriages also offer a unique window into how gender may matter in shaping diverse marital forms in light of the detraditionalization thesis.Toward this end, we first turn to existing research on the strength of traditional social norms surrounding marriage and an attendant literature on relationship practices among heterosexual and same-sex couples. Next, we outline the methodological procedures upon which this study is based. In the following section we draw from our in-depth interviews with heterosexual and same-sex married participants to address how couples conceive of and negotiate the normative emphasis on sexual fidelity in marriage. These data suggest patterned variation along three dimensions of detraditionalization, including (1) general attitudes toward marital monogamy, (2) beliefs about the place of monogamy within the respondent's own marriage, and (3) the actual behaviors that characterize the intimate life of the respondents' marriage. …

Research on casual sexual relationships and experiences (CSREs) has increased in the last decade; however, there is no consensus about the scope and definition of CSREs. To describe the main forms of CSREs, a latent profile analysis was performed on single and sexually active men and women aged from 18 to 30 years old who described their last casual sexual experience. Five profiles were identified: 1) the one-time sexual encounter; 2) the ex-romantic partnership, in which one still has sexual contact after ending their romantic relationship; 3) the mostly about sex partnership, in which contacts are primarily sexual, whether or not a friendship exists; 4) the intimate and sexual partnership, a hybrid of friend and romantic partner with whom one has frequent sexual and social interactions without commitment or intent to form a couple; 5) the friendship first partnership, a friendship to which sex is added, where social activities and friendly interactions dominate. Participants across profiles differed according to the number of sexual partners in the past year, their intention of having other sexual contacts with the partner, being under the influence of alcohol or drugs during the most recent sexual encounter with their partner and their type of sexual exclusivity agreement. This research contributes to a better description and understanding of CSREs among young adults and to further specifying its area of investigation.

International audience; The advancements of "treatment as prevention" (TasP), "undetectable viral load" (UVL) and "pre-exposure prophylaxis" (PrEP) are redefining HIV prevention standards. Relying on the concept of biosociality, this article explores how gay men rally around, debate, and sometimes disagree about these emerging HIV prevention technologies. This article is based on data from the Resonance Project, a Canadian community-based research project. Twelve focus groups (totalling 86 gay and bisexual men) were held in three Canadian cities (Montreal, Toronto, Vancouver) in 2013-2014. Respondents view UVL and PrEP through the prism of their generational experience of HIV prevention. In this respect, biosocialities highlight an experiential dimension that is tied to the context of the HIV epidemic. The biosocialities of HIV prevention are also built around serological identities. However, our study shows the diversity of these positions. Analysis grounded in biosocialities is useful for better understanding how scientific information circulates, is made sense of, and generates debate among gay men.

Adverse childhood experiences (ACEs; e.g., neglect, sexual abuse) among gay, bisexual, and other men who have sex with men (GBM) may not occur in isolation, but may be connected and occur in clusters. Most studies have measured ACEs individually, hierarchically, additively, or in a binary fashion (presence or absence of ACEs), rather than treating them as connected and clustered. This study examined these competing approaches of scoring ACEs and their relative power at predicting health outcomes. We examined abuse (sexual, physical, and emotional) and neglect (physical and emotional) experiences among a non-random sample of 470 Toronto GBM using the Childhood Trauma Questionnaire Short Form subscales. We compared five scoring schemas: (1) five individual scores for each form of maltreatment; (2) a composite score summing all of the maltreatment scores; (3) a hierarchical regression model with sexual abuse entered first then followed by physical abuse, emotional abuse, physical neglect, and emotional neglect; (4) a severity-based categorization; and (5) a latent profile-based categorization. Experiences of abuse and neglect were not uncommon (22-33%) and some participants experienced multiple forms of abuse and neglect (r = .33-.65, df = 464-467; p .001; shared variance, r

This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48–69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70–48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23–0.93) and social support (AOR = 0.08, 95% CI 0.01–0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.

Research on casual sexual relationships (CSRs) among emerging adults is prevalent, yet our empirical and theoretical knowledge of relationship processes involved in these relationships is limited. The present study's objective was to compare four CSR partner types (acquaintance, friend, non-dating partner, ex-romantic partner) on passion, intimacy, and commitment, the components of Sternberg's triangular theory of love. A total of 441 Canadians aged 18-25 years who were not in a romantic relationship, and who reported having had more than one sexual contact with their last CSR partner, completed an online survey. Across all partner types, passion was highest, followed by intimacy and commitment. Levels of passion, intimacy, and commitment generally increased with partner familiarity. However, CSR partner type differences on the three components were partially explained by CSR components (i.e., frequency of sexual activity, frequency of social activity, whether partners saw each other with the main goal of having sex, sexual exclusivity agreement, and hopes about the relationship). Results are consistent with CSRs' emphasis on sexuality, and, to a lesser extent, emotions. However, they challenge the mainstream and scientific conflation of CSRs with an absence of emotional bond, commitment, or love.

Life history interviews were conducted with 40 gay and bisexual men to identify modes of syndemic experience and risk practice. Out of the interview narratives emerged one major and two minor modes of developmental pathways whereby syndemic conditions are navigated and expressed: (1) a combination of adverse childhood events with later episodes of depression and/or substantial substance use, (2) personal disruption that led to periods of depression and anxiety associated with the stresses of migration, and (3) a disorientation and an unravelling of life trajectory in the transition from family of origin to college or work. Risk practices fell into three high-risk modes: active and frequent engagement in condomless sex; unassertive deferment to a partner’s initiation of condomless sex; and episodic risk combined with a risk reduction strategy. Three low risk modes were also identified: no recent condomlessness but multiple risk history in interview; a trajectory over time from high to low risk; and consistent low risk practice. These different modes of syndemic experience and risk management may have implications for identification of the effective HIV prevention tools that work best for different sets of men.

Purpose – The purpose of this paper is to develop a profile of the sexual behavioural characteristics of black men who have sex with men (MSM) in the Greater Toronto Area (GTA), Canada who constitute a unique mixture in terms of background, race, ethnicity, and culture. Having a profile of the sexual health and risk taking behaviours of these men is important since it provides information on these black Canadian men in comparison other black MSM. Design/methodology/approach – Data were collected as part of a cross-sectional study of black MSM in GTA. Survey participants completed a questionnaire requesting information on socio-demographic characteristics, sexual behaviour, general and mental health, and awareness of social marketing strategies for gay men. The study was conducted in 2007-2008, through convenience sampling. Based on the data collected, the authors characterized the profile of black MSM with respect to sexual risk behaviours. Findings – The authors collected data on 168 black MSM. These men perceived their general health to be good. However, a large proportion of them practiced inconsistent condom use but this varied according to the ethnicity of the partner. Inconsistent condom use also varied by place of birth with Canadian-born men and Caribbean-born men less likely to consistently use condoms than African-born men. In multiple regression analysis, being born in Africa favoured condom use. Men were also more likely to practice inconsistent condoms use when the sexual partner was non-black. Further, when sex with other black men was examined, those who were older (30 years) and had not disclosed their sexuality were more likely to stop using condoms. Other variables which were expected to have associations with inconsistent condom use, based on studies in other jurisdictions – such as previous sexually transmitted infections, sex with women, sex while travelling, and drug use were not related to inconsistent condom use. Research limitations/implications – While the survey data were based on a relatively small sample size and may not be representative of the entire black MSM population in the GTA, it provides a basis for ongoing and targeted support for black MSM particularly those born in Canada. Older men who are not open with their sexuality may be at a risk of acquiring or transmitting HIV. Future research should focus on these men. Originality/value – This report provides a perspective on the sexual health and risk taking behaviours of black MSM in Canada. This is particularly important since their social history and health determinants are different from those of US African Americans. The results will stimulate further research targeting this group, and support HIV programmes and services for these men.

Over the last decade, there have been a rising number of prosecutions for nondisclosure of HIV status along with heightened media attention to the issue in Canada. One hundred twenty-two people living with HIV were interviewed concerning the effects of criminalization on their sense of personal security and their romantic and sexual relationships. The largest number of respondents believe that criminalization has unfairly shifted the burden of proof so that they: are held to be guilty until proven innocent; are now caught in a difficult he-said/(s)he-said situation of having to justify their actions, disgruntled partners now have a legal weapon to wield against them regardless of the facts and the onus now falls on women whose male partners could ignore their wishes regarding safer sex. In terms of general impact, many respondents report: a heightened sense of uncertainty, fear or vulnerability, but others feel that the climate of acceptance is still better than in the early days of the epidemic or that the prosecution of the high profile cases is justified. The increasing focus of the court system on penalizing non-disclosure is having counter-productive or unanticipated consequences that can run contrary to the ostensible objective of discouraging behaviour likely to transmit HIV.