Conformity to Masculinity Norms and Mental Health Outcomes Among Gay, Bisexual, Trans, Two-Spirit, and Queer Men and Non-Binary Individuals.

Homophobia and biphobia negatively impact the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary individuals (GBT2Q) and sexual and gender minority men, but little is known about the impact of gender-related oppression. The current study examines the impact of pressure to conform to masculine norms in Canada-based GBT2Q individuals. Specifically, the associations between (a) gender expression and pressure to be masculine and (b) pressure to be masculine and depression, anxiety, and self-rated mental health were investigated. Drawing from an online national cross-sectional survey of 8,977 GBT2Q individuals and sexual and gender minority men living in Canada aged 15 years or older, 56.4% (n = 5,067) of respondents reported experiencing pressure to conform to masculine norms. Respondents were more likely to report masculine pressure if they were younger than 30 years, described their gender expression as fluid, identified their sexuality as queer, were an ethnoracial minority, and were trans. Pressure to be masculine was associated with increased odds of depression, anxiety, and reporting poor or fair mental health. The current study provides evidence of the detrimental impact of pressure to conform to masculine norms on the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary peoples.

Prevalence and Correlates of Incarceration Among Trans Men, Nonbinary People, and Two-Spirit People in Canada.

In the United States, sexual and gender minority populations are known to experience both higher rates of incarceration and more harmful experiences while incarcerated. However, little is known about incarceration rates or experiences among these populations in Canada or among trans men, nonbinary people, and Indigenous Two-Spirit people. This community-based research study analyzed anonymous self-completed survey data from gay, bisexual, trans, and queer men, and nonbinary and Two-Spirit people to determine the prevalence and correlates of lifetime incarceration among trans men, nonbinary, and Two-Spirit participants. Overall, 5.7% of trans participants, 10.6% of nonbinary participants, and 19.7% of Two-Spirit participants reported being incarcerated in their lifetime, all higher than the prevalence among cisgender non-Two-Spirit participants (3.7%). Multivariable logistic regression models revealed both similar and different correlates of incarceration for trans, nonbinary, and Two-Spirit participants, including older age, less education, experiences of forced sex as a minor, hepatitis C virus (HCV) and HIV diagnoses, substance use, and being less out about one's sexuality. Our findings highlight the disproportionate and inequitable incarceration of trans men, nonbinary, and Two-Spirit people and underscore the need for access to gender diverse, culturally competent HCV and HIV screening, prevention, treatment, and harm reduction in correctional facilities.

Implementing community-based Dried Blood Spot (DBS) testing for HIV and hepatitis C: a qualitative analysis of key facilitators and ongoing challenges.

BACKGROUND: In 2018, the Community-Based Research Centre (CBRC) invited gay, bisexual, trans, queer men and Two-Spirit and non-binary people (GBT2Q) at Pride Festivals across Canada to complete in-person Sex Now surveys and provide optional dried blood spot (DBS) samples screening for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). As there is a lack of research evaluating the implementation of DBS sampling for GBT2Q in community settings, we aimed to evaluate this intervention, identifying key facilitators and ongoing challenges to implementing community-based DBS screening for HIV/HCV among GBT2Q. METHODS: We conducted sixteen one-on-one interviews with individuals involved with the community-based DBS collection protocol, including research staff, site coordinators, and volunteer DBS collectors. Most individuals involved with DBS collection were "peers" (GBT2Q-identified). The Consolidated Framework for Implementation Research (CFIR) guided our data collection and analysis. RESULTS: Interviewees felt that DBS collection was a low-barrier, cost-effective, and simple way for peers to quickly screen a large number of Sex Now respondents. Interviewees also noted that the community and peer-based aspects of the research helped drive recruitment of Sex Now respondents. Most interviewees felt that the provision of results took too long, and that some Sex Now respondents would have preferred to receive their test results immediately (e.g., rapid or point-of-care testing). CONCLUSION: Peer-based DBS sampling can be an effective and relatively simple way to screen GBT2Q at Pride Festivals for more than one sexually transmitted and blood borne infection.

Who knows about U = U? Social positionality and knowledge about the (un)transmissibility of HIV from people with undetectable viral loads.

"U = U" is the principle that HIV is untransmittable from people living with an undetectable HIV viral-load. Wide-spread knowledge about U = U is believed to produce public health benefit by reducing HIV-related stigma - promoting wellbeing for people living with HIV. Therefore, we examined the diffusion of U = U with respect to the social position of sexual and gender minority men (SGMM). Participants were SGMM recruited from 16 LGBTQ2S+ pride festivals across Canada. Social position was measured using an index assessing whether participants were (a) trans, (b) a person of colour, (c) Indigenous, (d) born abroad, (e) bisexual or straight, (f) not out, (g) struggling with money, (h) not college educated, (i) and not participating in LGBTQ2S+ Organizations, Queer Pop-ups, or HIV advocacy organizations. Multivariable logistic regression tested whether Index Scores were associated with knowledge about U = U. Among 2681 participants, 72.6% knew about U = U. For HIV-negative/unknown status SGMM, each 1-point increase in Social Positionality Index Scores was associated with a 21% reduction in the odds that they knew about U = U (aOR: 0.79 [0.73, 0.85], per 1-point increase). Results indicate that social marginalization harms the diffusion of HIV-related biomedical knowledge, independent of risk-taking behaviour and other factors.

Stepping Stones or Second Class Donors?: a qualitative analysis of gay, bisexual, and queer men's perspectives on plasma donation policy in Canada.

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.

Health and well-being of trans and non-binary participants in a community-based survey of gay, bisexual, and queer men, and non-binary and Two-Spirit people across Canada.

There is a paucity of population health data on the experiences of transgender, non-binary, and other gender minority gay, bisexual, and queer men, and Two-Spirit people in Canada. To address this gap, this article presents a socio-demographic and health profile of trans and non-binary participants from the community-based bilingual 2018 Sex Now Survey. Participants were recruited in-person from Pride festivals in 15 communities to self-complete an anonymous paper-and-pen questionnaire. To be eligible, participants needed to be at least 15 years old, live in Canada, either report a non-heterosexual sexual identity or report sex with a man in the past 5 years, and not report gender identity as a woman. Through community consultations the survey was inclusive of trans men, non-binary people, and Two-Spirit people. Three gender groups (cisgender, transgender, and non-binary) were created, and trans and non-binary participants were compared with their cisgender peers across a variety of demographic, mental health, sexual health, and general health indicators. Odds ratios were calculated to determine initial significance for categorical variables, and adjusted odds ratios were calculated to control for five possible confounders (age, ethnoracial identity, country of birth, sexual identity, and financial strain). Significant differences emerged across all sets of indicators, with many of these findings remaining significant after adjusting for confounding variables, including significantly higher reported rates of mental health challenges and sexual health service barriers for trans and non-binary participants compared to the cisgender group. Trans and non-binary participants were also more likely to be in polyamorous relationships. Collectively, our findings demonstrate that trans and non-binary people experience significant disadvantages compared with cisgender sexual minority men. Improved educational supports and employment protections, access to queer and gender affirming healthcare, and trauma-informed mental health services are needed to improve the health wellbeing of trans and non-binary people in Canada.

It's in Me to Give: Canadian Gay, Bisexual, and Queer Men's Willingness to Donate Blood If Eligible Despite Feelings of Policy Discrimination.

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.

Gay and bisexual men's views on reforming blood donation policy in Canada: a qualitative study.

BACKGROUND: Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months. METHODS: To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada's three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men's preferred policy directions and their opinions about a policy change proposed by Canada's blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada. RESULTS: Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the "same for everyone" and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple "gender blind" and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement. CONCLUSION: A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.

"Condoms are like public transit. It's something you want everyone else to take": Perceptions and use of condoms among HIV negative gay men in Vancouver, Canada in the era of biomedical and seroadaptive prevention.

BACKGROUND: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. METHODS: We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. RESULTS: Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. CONCLUSIONS: These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.

Gay Men's Understanding and Education of New HIV Prevention Technologies in Vancouver, Canada.

Effective rollout of HIV treatment-based prevention such as pre-exposure prophylaxis and treatment as prevention has been hampered by poor education, limited acceptability, and stigma among gay men. We undertook a thematic analysis regarding the education sources and acceptability of these New Prevention Technologies (NPTs) using 15 semistructured interviews with gay men in Vancouver, Canada, who were early adopters of NPTs. NPT education was derived from a variety of sources, including the Internet, health care providers, community organizations, sexual partners, and peers; participants also emphasized their own capacities as learners and educators. Acceptable forms of NPT education featured high-quality factual information, personal testimony, and easy access. Stigma was highlighted as a major barrier. For public health, policy makers, and gay communities to optimize the personal and population benefits of NPTs, there is a need for increased community support and dialogue, antistigma efforts, early NPT adopter testimony, and personalized implementation strategies.