Chapter 6: Population-specific HIV/AIDS status report: Gay, bisexual, two-spirit and other men who have sex with men - Current response

Chapter 6 – Current Response to HIV/AIDS among Gay, Bisexual, Two-Spirit, and Other Men who have Sex with Men

This chapter provides an overview of the strategies, coalitions, networks, organizations and programmatic responses to the issue of HIV/AIDS among gay, bisexual, two-spirit and other men who have sex with men (MSM) in Canada. It focuses exclusively on those strategies, coalitions, networks, organizations and projects that specifically addressed HIV/AIDS among gay men and other MSM. An examination of the response to the various determinants of health and how they impact gay men and other MSM was beyond the scope of this report. Nonetheless, Chapter 4 provides an in-depth examination of the determinants of health as they impact the vulnerability and resilience of gay and other MSM to HIV/AIDS.

6.1 Methodology

To obtain information on HIV-specific projects, coalitions, committees, plans and policy initiatives that existed from 2006 to 2010, information-gathering templates were circulated to federal, provincial and territorial officials through the Federal/Provincial/Territorial Advisory Committee on AIDS (F/P/T AIDS), and the Public Health Agency of Canada's (PHAC) national and regional HIV/AIDS program consultants. As discussed in Chapter 2, Toronto, Vancouver, and Montréal have greater populations of gay and other MSM when compared with other Canadian cities. As a result, projects funded by the Toronto Public Health's AIDS Prevention Community Investment Program, the Regional Health Authorities in Vancouver, and l'Agence de la santé et des services sociaux de Montréal, were also included in the analysis. Private sector organizations were not included in the information-gathering process. Although efforts were made to identify as many projects as possible, it is acknowledged that this chapter has likely not identified all projects addressing HIV among gay men and other MSM in Canada.

Projects, coalitions, committees, plans and policy initiatives were selected for inclusion in this chapter, if they fit the following criteria:

• HIV/AIDS specific;
• In existence as of 2006; and
• Specifically targeted toward gay and other MSM.

Responses lacking a description or a specified target population specified in the information-gathering template required further exploration to be included in the analysis. Where possible, the website of the organization behind each project was reviewed to determine and analyze the type of services being offered and which sub-population it addressed (if any) within the gay men and other MSM community (e.g., two-spirit, gay men and other MSM living with HIV/AIDS, GBTQ youth, gay men and other MSM from countries where HIV is endemic, and transmen).

For the sake of brevity, these projects, coalitions, committees, plans and policy initiatives will be referred to as responses throughout the chapter.

6.1.1 Gay Men and Other MSM as Part of the General Response

Gay and other MSM are included in a number of wide-ranging general responses to HIV/AIDS across Canada. However, these responses were not analyzed for this chapter because they are not specific to gay and other MSM.

There is also a movement in Canada toward a holistic approach to the health of gay and bisexual men, which goes beyond an exclusive focus on HIV/AIDS. (1) This shift acknowledges the broader health issues that gay and bisexual men, as well as lesbian, gay, bisexual, two-spirit and queer (LGBTQ) populations face beyond HIV/AIDS. It reflects an approach to HIV prevention that situates vulnerability to, and resilience against, HIV within the broader context of men's lives. (2) Although a thorough overview of this holistic approach is outside the scope of this report, it is important to acknowledge that it is part of the Canadian landscape of research, policy and practice for gay and bisexual men's health.

6.1.2 Gay Men and Other MSM as Part of a Community or Group

Some organizations have projects that address gay men and other MSM as part of a target group within certain community or culturally-based organizations. Some of these responses focus on the whole community or a sub-group of it, while also supporting gay men and other MSM-specific activities; accordingly, these responses were included in the analysis.

6.1.3 Gay Men and Other MSM as Stand-alone Categories

Organizations across Canada addressing HIV/AIDS have responded to the needs of gay men and other MSM by developing population-specific responses. These responses were included in the analysis as responses targeting only gay men and other MSM, which were categorized as stand-alone organizations/projects.

6.1.4 Limitations

It is important to note certain limitations of the methodology for this chapter. First, some projects, programs or initiatives, such as projects focused on health care and social services delivered by provinces and territories, may not have been captured through the information-gathering methodology used in this report. In addition, data were unavailable from some of Quebec's regional health authorities, which manage local community programs.

Second, as discussed in Sections 6.1.1 to 6.1.3, this study only includes those projects, coalitions, networks, committees, plans and policy initiatives specifically designed for gay men and other MSM, either exclusively or as part of a broader group. Responses that focus on the general population or any other specific population were excluded from the analysis. Accordingly, the projects analyzed do not represent the full list of projects that may address HIV/AIDS among gay men and other MSM as part of a broader geographic or population focus.

Third, using websites as a source for information has some limitations due to inconsistencies in updates, which may have resulted in the inclusion of services that are no longer active and the exclusion of those that are active.

6.2 Population-specific Strategies

This section provides an overview of existing strategies targeting gay men and other MSM to address HIV/AIDS at national and provincial/territorial levels. As discussed in Chapter 3, the MSM exposure category in 2009 continued to account for the highest proportion of positive-HIV test reports in Canada. As a result, responses targeting gay men and other MSM are a priority for many national and provincial/territorial governments and organizations across Canada.

6.2.1 National Population-specific Strategies

The Federal Initiative to Address HIV/AIDS in Canada identifies gay men and other MSM as one of eight key populations at risk of, or disproportionately affected by, HIV/AIDS. (3) The Federal Initiative was developed as the Government of Canada’s response to Leading Together, Canada Takes Action on HIV/AIDS. (4) Leading Together is a stakeholder-led document that outlines a coordinated nationwide approach to HIV/AIDS in Canada. It highlights the importance of community involvement in the response, as well as the need for culture, gender and age appropriate programs and services.

The Canadian Aboriginal AIDS Network’s Aboriginal Strategy on HIV/AIDS in Canada II for First Nations, Inuit and Métis Peoples from 2009 to 2014 identifies two-spirit people, including gay, lesbian, bisexual and inter-sex individuals, as part of the diverse Aboriginal population affected by HIV/AIDS. (5)

6.2.2 Provincial Population-specific Strategies

Currently, Quebec is the only province where an HIV/AIDS strategy specific to gay men and other MSM was identified. Quebec’s Cadre de référence pour la prévention de la transmission de l’infection au VIH et des autres infections transmissibles sexuellement et par le sang (ITSS) touchant les HARSAH was developed in 1999 and is presently under revision.

In addition, the following provinces have HIV/AIDS strategies that identify gay men and/or MSM as a population particularly affected by HIV/AIDS: Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia (see Appendix B). Some of these strategies outline specific activities directed toward gay men and other MSM as populations particularly affected by HIV/AIDS.

6.3 Population-specific Networks, Coalitions and Advisory Bodies

This section provides an overview of existing HIV/AIDS-related provincial networks, coalitions and advisory bodies specific to gay men and other MSM. No national or territorial organizations of this type were identified. These networks, coalitions and advisory bodies undertake a variety of activities, such as providing advice, advocacy and research.

In Quebec, the organization COCQ-sida has several committees, including one focused on gay and other MSM. These committees identify training and knowledge-transfer projects and intervention and communication tools. COCQ-sida is the Quebec network of AIDS service organizations.

In Ontario, the Gay Men's Sexual Health Alliance (GMSH) is a coalition of gay men and their allies, including representatives from community-based AIDS service organizations, public health units, HIV researchers, policy makers, people living with HIV, and other interested individuals. The GMSH aims to foster a systematic, evidence-informed, skilled, consistent and effective response to the sexual health needs of Ontario's diverse communities of gay, bisexual, two-spirit and other MSM. It aims to reduce the transmission of HIV and other STIs, and to improve the overall health and well-being of gay, bisexual, two-spirit and other MSM. The GMSH is housed at the Ontario AIDS Network and includes a central staff and other human resource supports as needed. The GMSH produces a strategic plan to assist in the ongoing planning of sexual health services for gay/MSM. Other ongoing activities include an annual provincial sexual health summit, province-wide campaigns, the production and dissemination of tools, resources and best practices guides for use by front-line workers serving gay and other MSM. GMSH also produces and participates in community-based research. The GMSH has a Provincial Advisory Body that meets quarterly, and also has several working groups:

• The Gay/Bi/Queer Trans Men’s Working Group is made up of transmen and non-transmen (both community members and service providers), who live and work in Ontario. The group aims to raise awareness and share knowledge about the sexual health of transmen.
• The Poz Prevention Working Group undertakes work on an as-needed basis, and provides feedback on events, publications, campaigns and other projects undertaken by the GMSH.
• Working groups for specific time-limited tasks, including a Campaign Working Group and GMSH Summit Planning Committee.

In addition, the AIDS Bureau of the Ontario Ministry of Health and Long-Term Care coordinates a series of policy processes to address HIV and other sexual health issues in gay men's lives, including a gay men's testing campaign, work to advance screening for anal dysplasia and anal cancer, and work to address syphilis in gay men in the province.

Manitoba has a Gay, Lesbian, Bisexual, Transgender, Two-spirited Coalition consisting of a number of community organizations with extensive experience connecting and working with gay, bisexual, two-spirit and other MSM. The Coalition has recently received funding to develop educational resources designed to promote a broader message regarding overall STI/HIV prevention and awareness.

In British Columbia, an annual Gay Men's Health Summit is hosted by the Community-Based Research Centre that brings together community members, researchers and all levels of government from the province and across the country to improve the health and wellness of gay men.

6.4 Program Analysis

This section provides an overview of current projects that address HIV/AIDS among gay men and other MSM. The main objective of the data-gathering process was to identify time-limited projects addressing HIV/AIDS among gay men and other MSM in Canada. Projects identified in this section include those that were active between 2006 and 2010. Projects and their respective organizations are listed in Appendix B. It is important to note that this analysis does not include HIV/AIDS programs that have been integrated into regular provincial or territorial health care and social service delivery activities. It should also be noted that due to the time-limited nature of the projects and the time lapse between the writing and the publication of this report, some projects may no longer be active.

Projects identified in this section are analyzed according to type of organizations addressing gay men and other MSM, geographic distribution, and subpopulations of gay men and other MSM.

6.4.1 Distribution of Organizations with Programs/Services Targeting Gay and Other MSM

A total of 67 organizations engaged in HIV/AIDS-related projects targeting gay men and other MSM. Figure 23 illustrates the distribution of these organizations by type of organization (i.e., AIDS service organizations, AIDS service organizations serving specific populations, such as ethnocultural groups, service organizations specifically for gay and other MSM, organizations serving LGBTQ populations, and community health, social service, or governmental organizations). Of the identified organizations that target gay men and other MSM, the majority (59%) were AIDS service organizations (ASOs). Twelve percent represented AIDS service organizations that offer services to specific populations, such as particular ethnocultural groups. Fifteen percent of the organizations represented community health, social services, and governmental organizations, such as public health. Nine percent of organizations identified targeted gay men and other MSM exclusively, with an additional 4% of organizations serving the LGBTQ population more generally.

Figure 23: Distribution of organizations involved in the response to HIV/AIDS among gay and other MSM, by type of organization (n=67)

6.4.2 Geographic Distribution of Projects Addressing Gay and Other MSM

A total of 135 projects were identified that offered HIV/AIDS-related programs and services in Canada. Figure 24 illustrates the distribution of projects addressing gay and other MSM by province. Ontario, Quebec, and British Columbia had the greatest number of identified HIV/AIDS projects targeting gay and other MSM when compared with other provinces, comprising about 86% of all identified projects. In addition, 8% served gay and other MSM living in the Atlantic provinces, specifically Newfoundland and Labrador, Nova Scotia and New Brunswick. No projects were identified that were specific to gay and other MSM living in Manitoba or Northern Canada (i.e., Yukon, Northwest Territories, Nunavut).

Figure 24: Distribution of Projects Addressing Gay Men and Other MSM, by Province (n=135)

Note. No projects were identified in Manitoba or Northern Canada (i.e., Yukon, Northwest Territories, Nunavut).

6.4.3 Projects Addressing Gay and Other MSM

A total of 135 projects were identified through the information-gathering process described in Section 6.1 (Appendix B). It is important to note that projects that recognized gay and other MSM as part of a general response to HIV/AIDS along with other vulnerable populations (i.e., people who use injection drugs, Aboriginal Peoples, people from countries where HIV is endemic, women, youth at-risk and people in prison) were not included in this analysis because these projects were not specific to gay and other MSM.

Figure 25: Projects addressing gay and other MSM, by topic

Source: (24). Data for Canada, Quebec, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia excludes census data for one or more incompletely enumerated Indian reserves or Indian settlements.

Of the projects identified, 53 (39%) involved the provision of information through workshops or educational sessions. Topics included HIV prevention, gay men's health, sexual orientation and homophobia. An additional 17 projects (13%) provided print resources, including information brochures and pamphlets, as well as resources to prevent HIV infection, such as condoms. Six projects involved knowledge development or exchange pertaining to gay and other MSM and HIV, such as conferences, creating networks or undertaking research. An additional four projects were focused on the creation of resources or guides for gay and other MSM or for service providers. The guides covered topics such as legal issues for gay and other MSM living with HIV/AIDS, sexual health services for gay and other MSM, and information on coming out for Black lesbian, gay, bisexual and trans youth and their families.

A substantial proportion of the identified projects (44 projects or 33%) were support services, which included support groups, peer support, individual counselling, drop-in sessions and social activities. Outreach in physical environments such as bars, clubs, bathhouses and public spaces comprised 19% of the projects (or 26 projects). Nine projects (7%) included training for service providers or peers to provide prevention, care and support for gay and other MSM living with or at risk for HIV infection. Clinical services and referrals for HIV testing, treatment, counselling and other services or support made up 16% of the projects (22 projects).

6.4.4 Response to HIV/AIDS Among Specific Populations Within Gay Men and Other MSM Communities

This section provides an overview of projects addressing gay and other MSM who are also members of other vulnerable populations or groups. While the majority of projects (61%) were addressed to the overall gay and other MSM population, over one-third (39%) focused on specific subpopulations of gay and other MSM. These include Aboriginal men (Section a), men from ethnocultural groups, including those from countries were HIV is endemic (Section b), sexually diverse youth (Section c), gay men and other MSM living with HIV/AIDS (Section d), and transmen (Section e). Other subpopulations of gay and other MSM identified include those with disabilities (Section f), male sex workers (Section g) and those with substance use issues (Section h).

a) Two-Spirit, Gay, Bisexual and Other Aboriginal MSM

Of the projects identified, two target two-spirit, gay, bisexual or other Aboriginal MSM. Both were projects of 2-Spirited People of the 1st Nations, an organization based in Toronto. The projects provided HIV prevention services, including education and counselling on pre- and post-testing for HIV [G43, G44].

b) Ethnic Minority Gay and Other MSM

A total of 13 projects were identified addressing ethnic minority gay and other MSM, all of which took place in Ontario. Of these projects, more than half addressed Black, African and Caribbean gay and other MSM [G47, G48, G77-G82], while the others addressed South Asian [G73, G74], Asian [G75, G76], and Spanish-speaking [G83] gay men and other MSM. Most of the projects involved education and information provision (7 projects) and support services (6 projects).

c) Sexually Diverse Youth

Nineteen projects were identified addressing sexually diverse youth. The majority served youth through education and awareness activities, such as workshops and awareness sessions [G4, G12, G17, G28, G32, G46, G95, G96, G129, G135] and support groups [G17, G50, G56, G76, G80, G100, G129, G135]. Other responses targeting youth included outreach activities [G129], providing training to young gay men to become community leaders in sexual health [G66], and the development of a publication for sexually diverse Black youth and their parents with information on coming out [G79]. One project had a more specific goal of developing an online forum for gay youth [G1].

d) Gay Men and Other MSM Living With HIV/AIDS

Twelve projects were identified that addressed gay and other MSM living with HIV/AIDS. The majority (9 projects) involved providing social support through activities such as support groups, peer support, individual counselling, drop-in sessions and social activities [G25, G61, G68, G69, G70, G71, G103, G115, G130]. One project targeted Portuguese-speaking gay and other MSM living with HIV/AIDS through community development initiatives [G61]. Two projects involved the creation of documents on legal issues for gay men, such as HIV disclosure [G84, G94]. One project was a program on positive prevention, including information on HIV transmission and risk reduction strategies, and accessing services and support [G71].

e) Transgender Communities

Although none of the projects identified targeted transmen specifically, eight were identified that addressed the needs of transgender communities in general. Most of the projects provided support and outreach services for trans people, including the AIDS Coalition of Cape Breton's Sydney Transgender Access, Resource and Support (S.T.A.R.S.) program [G5], C.A.C.T.U.S Montréal [G20], AIDS Network Outreach and Support Society (or ANKORS) [G113], AIDS Vancouver's BOYS R Us program [G114] and PEERS Vancouver's Hustle: Men on the Move program [G129]. In addition, the 519 Church Street Community Centre in Toronto has developed a sexual health resource booklet for transmen and their partners, called "Getting Primed" [G45].

f) Gay and Other MSM with Disabilities

Two projects were identified addressing gay and other MSM with disabilities. One project offers HIV and STI information to gay, bisexual, and trans youth with developmental disabilities [G95]. Another project provides information on prevention and sexual health for gay and other MSM with hearing impairments [G22].

g) Gay and Other MSM as Sex Workers

Four projects were identified that addressed gay and other MSM who work or previously worked in the sex trade. All four projects provide services such as outreach, prevention and education, support, and referrals to male and trans sex workers and former sex workers in Montréal [G19, G34] and Vancouver [G114, G129].

h) Gay and Other MSM With Substance Use Issues

Two of the projects identified addressed gay and other MSM with substance use issues. The project SPUNK! [G67] in Toronto uses motivational interviewing and group interventions to support substance-using gay men to make changes in use patterns and promote increased adoption of safer sex practices. The project VAMP (Vancouver Addictions Matrix Program) [G133] in Vancouver is a support program for gay men recovering from addiction to methamphetamine.

6.5 References

[1] Mule NJ, Ryan B, Jackson E. Challenges and opportunities: bridging HIV/AIDS with broader LGBTQ health and wellbeing. Unpublished 2011.

[2] Tooley L. Re-centering our approach to gay and bisexual men's health and HIV prevention. Prevention in Focus: Spotlight on Programming and Research [Internet]. 2011. Available from: http://www2.catie.ca/en/pif/fall-2011/re-centering-our-approach-gay-and-bisexual-men-s-health-and-hiv-prevention

[3] Public Health Agency of Canada. The Federal Initiative to Address HIV/AIDS in Canada: Strengthening Federal Action in the Canadian Response to HIV/AIDS [Internet]. Ottawa: Public Health Agency of Canada. 2004 [cited 2009 January]. Available from: http://www.phac-aspc.gc.ca/aids-sida/fi-if/fa-if/pdf/fed_init_e.pdf

[4] Canadian Public Health Association. Leading Together: Canada Takes Action on HIV/AIDS (2005-2010) [Internet]. Ottawa: Canadian Public Health Association. 2005 Oct [cited 2008 May]. Available from: http://www.leadingtogether.ca/pdf/Leading_Together.pdf

[5] Canadian Aboriginal AIDS Network. Aboriginal strategy on HIV/AIDS in Canada II for First Nations, Inuit and Métis peoples from 2009 to 2014 [Internet]. Ottawa: Canadian Aboriginal AIDS Network. 2009 Mar. Available from: http://www.2spirits.com/ASHAC%202009.pdf