The Facts

This page is your guide to understanding:

  • The intersections between sexuality, ethnicity, gender, and healthcare.

  • How this study seeks to understand barriers to STBBI prevention services.

  • The significance of this study in regard to improving access to services.

Background

Gay, bisexual, and other queer men (GBQM) report poorer health outcomes compared to heterosexual men due to homophobia and heterosexism [1-3]. Because of marginalization, GBQM are more likely to experience sexually transmitted and blood-borne infections (STBBI), such as HIV [4]. South Asians in Canada also experience poorer health outcomes due to racism, with differences existing between South Asians born in Canada and South Asians who were not [5]. For South Asian GBQM living in Canada, some studies have found that experiences of discrimination impacts their mental and sexual well-being [6-8]. There is also evidence that prevention strategies such as regular HIV/STI testing, use of pre- and post-exposure prophylaxis for HIV (PrEP and PEP), and being treated for HIV and other STBBI reduces transmission [9-12]. However, there is little data on whether South Asian GBQM have tried to access or use these services within Canada.

  • 1. Meyer IH. Minority Stress and Mental Health in Gay Men. J Health Soc Behav. 1995;36(1):38-56. doi:10.2307/2137286

    2. House of Commons. The Health of LGBTQIA2 Communities in Canada. House of Commons of Canada; 2019:42-1. Accessed May 14, 2021. https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/report-28/

    3. DiPlacido J. Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In: Stigma and Sexual Orientation:  Understanding Prejudice against Lesbians, Gay Men, and Bisexuals. Psychological perspectives on lesbian and gay issues, Vol. 4. Sage Publications, Inc; 1998:138-159. doi:10.4135/9781452243818.n7

    4. Hatzenbuehler ML, Nolen-Hoeksema S, Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychol. 2008;27:455-462. doi:10.1037/0278-6133.27.4.455

    5. Veenstra G. Racialized identity and health in Canada: Results from a nationally representative survey. Soc Sci Med. 2009;69(4):538-542. doi:10.1016/j.socscimed.2009.06.009

    6. Durrani S, Sinacore AL. South Asian-Canadian Gay Men and HIV: Social, Cultural, and Psychological Factors That Promote Health. Can J Couns Psychother. 2016;50(2). Accessed March 31, 2022. https://cjc-rcc.ucalgary.ca/article/view/61099

    7. Hart TA, Sharvendiran R, Chikermane V, Kidwai A, Grace D. At the intersection of homophobia and racism: Sociocultural context and the sexual health of South Asian Canadian gay and bisexual men. Stigma Health. Published online March 4, 2021. doi:http://dx.doi.org/10.1037/sah0000295

    8. Ratti R, Bakeman R, Peterson JL. Correlates of high-risk sexual behaviour among Canadian men of South Asian and European origin who have sex with men. AIDS Care. 2000;12(2):193-202. doi:10.1080/09540120050001878

    9. Public Health Agency of Canada. Sexually Transmitted and Blood Borne Infections (STBBI) prevention guide. Published December 9, 2021. Accessed April 14, 2022. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/stbbi-prevention-guide.html

    10. Riddell J, Amico KR, Mayer KH. HIV Preexposure Prophylaxis: A Review. JAMA. 2018;319(12):1261-1268. doi:10.1001/jama.2018.1917

    11. Sultan B, Benn P, Waters L. Current perspectives in HIV post-exposure prophylaxis. HIVAIDS Auckl NZ. 2014;6:147-158. doi:10.2147/HIV.S46585

    12. Cohen J. HIV Treatment as Prevention. Science. 2011;334(6063):1628-1628. doi:10.1126/science.334.6063.1628t goes here

Study Aims

We are conducting a study to examine how intersecting forms of discrimination affects access to sexually transmitted and blood-borne infection (STBBI) prevention services for South Asian gay, bi, and other queer (GBQM) men living in Canada. Examples of STBBI include HIV, Hepatitis-C, gonorrhea, chlamydia, syphilis, and HPV. Using survey data we will first examine if there is a relationship between experiencing at least racist or heterosexist discrimination and accessing one of the aforementioned prevention services among South Asian GBQM in Canada. We will then interview South Asian GBQM living in the Greater Toronto Area about experiences of discrimination when trying to access STBBI prevention services. Lastly, using both survey and interview data, we will determine how STBBI prevention access could be improved for South Asian GBQM in Canada.

Significance

The findings from this study will illuminate the barriers that South Asian GBQM living in Canada experience in accessing sexual health services, providing opportunities to improve access through tailored interventions in the form of culturally competent and anti-oppressive sexual health services, programming, and policies, thereby improving the sexual health and well-being of this population over time.

Additional Information

South Asian GBQM living in Canada experience intersecting forms of discrimination such as racism, xenophobia, and homophobia which affects their mental and sexual health. Please see below some facts from Canadian studies or reports about South Asian GBQM:

  • In 2019, South Asian, West Asian, and Arab individuals comprised 5% of HIV cases in Canada, with 90% of the cases occurring in men. [1]

  • Men who have sex with men represented the highest proportion of all HIV cases (42%) among South Asian, West Asian, and Arab men. [2]

  • South Asian GBQM living in Canada have reported psychological distress due to experiences of HIV stigma and homophobia from within the South Asian community. [3]

  • South Asian GBQM in Canada have reported that social support and access to HIV testing, education, and services would make them less likely to participate in behaviours that would increase their changes of acquiring HIV (e.g., condomless anal sex). [3]

  • Some South Asian GBQM living in the Greater Toronto Area report exclusion from white dominated gay spaces and social harm from family members due to their sexual orientation, which has led to distress, social isolation, and loneliness. [4]

  • South Asian GBQM living in the Greater Toronto Area have suggested that HIV prevention promotion strategies should address social isolation and loneliness as well. [4]

  • 1. Haddad N, Weeks A, Robert A, Todden S. HIV in Canada—surveillance report, 2019. Can Commun Rep. 2021;47(1):77-86.

    2. Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2014. Published November 27, 2015. Accessed June 19, 2022. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hiv-aids-canada-surveillance-report-december-31-2014.html

    3. Durrani S, Sinacore AL. South Asian-Canadian Gay Men and HIV: Social, Cultural, and Psychological Factors That Promote Health. Can J Couns Psychother. 2016;50(2). Accessed March 31, 2022. https://cjc-rcc.ucalgary.ca/article/view/61099

    4. Hart TA, Sharvendiran R, Chikermane V, Kidwai A, Grace D. At the intersection of homophobia and racism: Sociocultural context and the sexual health of South Asian Canadian gay and bisexual men. Stigma Health. Published online March 4, 2021. doi:http://dx.doi.org/10.1037/sah0000295