Chapter 7: Population-specific HIV/AIDS status report: Gay, bisexual, two-spirit and other men who have sex with men - Conclusion

Chapter 7 – Conclusion

Gay, bisexual, two-spirit and other men who have sex with men (MSM) comprise a unique segment of the HIV/AIDS epidemic in Canada. This is the first time the Public Health Agency of Canada (PHAC) has attempted to present evidence from a variety of sources in one document to better understand the impact of HIV and AIDS on gay and other MSM. This status report does not include an exhaustive list of program, policy and research gaps, nor does it prescribe solutions to address existing gaps. However, it is hoped that the evidence provided in the report will be useful to governments, non-governmental organizations, public health officials, researchers, communities and others in informing the development of programs and policies addressing HIV/AIDS and issues related to the determinants of health in these populations.

Surveillance data indicate that gay and other MSM continue to be the population most affected by HIV/AIDS in Canada. An understanding of the true impact of HIV on this population and on specific sub-populations such as ethnocultural minority, two-spirit and other Aboriginal MSM, relative to other at-risk populations, remains a challenge because of the lack of authoritative demographic information on gay and other MSM, which would be necessary to calculate population prevalence. This report confirms that HIV/AIDS among gay, bisexual, two-spirit and other MSM is closely linked to a variety of factors and determinants of health, which influence the population’s vulnerability to HIV/AIDS. Research described in this report indicates that homophobia, heterosexism and related stigma and discrimination are key overarching factors influencing all other determinants of health for gay and other MSM, and ultimately their vulnerability to HIV infection. Homophobia, in particular, is linked to poorer mental health outcomes among gay and other MSM, which in turn are associated with higher rates of risky sexual behaviour, such as unprotected anal intercourse.

Other important determinants of vulnerability include the ability—particularly for youth—to safely “come out” and be open about their sexuality without jeopardizing their safety and social support networks; the multiple sources of marginalization faced by gay and other MSM who are also members of ethnoracial minorities; reduced access to social support networks; and reduced access to safe and affirming health services, due to both a lack of awareness of the unique health concerns of gay and other MSM, as well as perceived and actual homophobia within health systems.

In terms of personal health practices and coping skills, gay and other MSM have some of the highest rates of HIV testing, and the majority of gay and other MSM take steps to protect themselves from HIV infection, including using condoms consistently and correctly. Drug use, AIDS optimism, and the influence of social and physical environments on decision making during sexual encounters may contribute to HIV risk for this population. A small number of men involved in specific sexual networks regularly engage in multiple high-risk behaviours such as barebacking and drug use.

Sources of resiliency against HIV among gay and other MSM include the ability to “come out” in a safe and supportive social context; access to social support networks, including friends, sexual and romantic partners, relational and “chosen” families, and broader gay communities; and the community resiliency demonstrated by gay activism, including the gay community’s early and effective response to HIV/AIDS.

While HIV vulnerability related to sexual practices among this population is well understood, vulnerability related to other socioeconomic factors is much less well researched. More Canadian research is needed to more fully understand factors such as social support networks; healthy childhood development (including the impact of homophobic bullying); and physical and social environments other than bathhouses. Specific sub-populations whose HIV vulnerability and resilience is not well understood include ethnocultural minority MSM; trans men who have sex with men; older gay and other MSM; gay and other MSM in rural and remote areas; and gay and other MSM involved in sex work. As with other key populations, resilience against HIV among gay and other MSM is also not well understood. More research is needed to better understand and harness sources of resiliency within these populations.

The response to HIV/AIDS among gay, bisexual, two-spirit and other MSM involves a wide array of organizations, communities and governments, which have built networks across the country and encouraged knowledge exchange and culturally relevant approaches to HIV/AIDS. The sharing of best practices across sectors and jurisdictions should be fostered and encouraged, along with increasing partnerships among a wider range of stakeholders, and better use of evidence in the development of strategies and interventions.

Since the beginning of HIV/AIDS in Canada, stakeholders involved in addressing HIV/AIDS among gay, bisexual, two-spirit and other MSM have demonstrated a strong collective will and leadership. Their unwavering dedication to increasing HIV/AIDS awareness and to reducing homophobia, heterosexism and related stigma and discrimination has contributed to better prevention, care, treatment and support for gay and other MSM at risk of, and living with, HIV. This report acknowledges the key role stakeholders have played, celebrates their successes, and highlights the ongoing commitment of governments, stakeholders and communities to addressing HIV/AIDS among gay, bisexual, two-spirit and other MSM.

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