Building Better Health for Gay Men: Challenges and Opportunities

in British Columbia

Presentation to the Gay Men’s Health Summit

October 31, 2008

Dr. Perry Kendall

Provincial Health Officer

Part 1 – The Current Health Status of Gay Men

Part 2 – Social Factors that Influence the Health of Gay Men

Part 3 – Where does Gay Men’s Health need to go?

Part 4 – Opportunities to Consider

Part 1 – The Current Health Status of Gay Men

• Gay men have a distinct health status, which suggests a population-specific approach

• What health issues drive the gay men’s health agenda?– Infections: HIV, STI, HCV– Mental health challenges: problematic substance use,

depression, sexual and physical abuse, suicide– Chronic disease: anal cancer

Self-reported Health Status

STI/HIV Prevention and Control, BCCDC, 2008

0

100

200

300

400

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Number of Infectious

Syphilis Cases

HIV Positive MSM MSM Heterosexual Males, Females

Documentation of HIV Status

STI/HIV Prevention and Control, BCCDC, 2008

STI/HIV Prevention and Control, BCCDC, 2008

Hall et al, JAMA 2008; 300(5):520-529

Year of identification of co-infection with HIV and HCV, MSM, BC, 1995-2007

0

2

4

6

8

10

12

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er o

f ca

ses

MSM/IDU ( MSM)non-IDUSTI/HIV Prevention and Control, BCCDC, 2008

Mental Health• Urban Men’s Health Study (US):

Adapted from: Stall et al, AJPH, 2003; 93(6):939-944.

Mental Health & HIV

Adapted from: Stall et al, AJPH, 2003; 93(6):939-944.

Substance Use•Discussion has been focused on link to risk behaviours

•BCCfE observed in a Vancouver cohort of gay men increases in substance use and UAI from 1997 to 2002

•ACT Literature review examined drug use among gay men who frequent clubs or parties

•Themes:

•Poly-drug use prevalent but rarely excessive

•Relationship between substance use and sexual risk behaviour is not completely clear

•Social networks are primary source of information about poly-drug use

Substance Use – Crystal Meth

0

2

4

6

8

10

12

2002 2004 2006 2007

Community Based Research Centre, Sex Now Surveys: 2002-2007

Self-reported Crystal Meth Use – Gay men in BC

Anal Cancer

In the US: • Overall incidence of anal cancer in males is low

(0.8 cases per 100,000)

• However, the incidence among MSM is high, particularly in the presence of HIV (estimated at 35 and 70 cases per 100,000 in HIV-negative and HIV-positive MSM, respectively).

M-Track Survey - HPV Component, Study Protocol, Vancouver Site. 2008.

Part 2 – Social Factors that Influence the Health of Gay Men

• Stigma, marginalization and homophobia• Shifts in how gay men define community and

connect with each other• Unintended consequences of broader

presence/visibility of social issues related to gay men

• Influence of political environments

Heterosexism

Stigma

Homophobia

Prejudice events

Discrimination

Violence

Adapted from: Dodds et al. It makes me sick. Sigma Research, 2005.

Health Impacts• Reported experiences of stigma and

homophobia associated with poor mental health outcomes including:– Low self-esteem– Eating disorders– Problematic alcohol & substance use– Depression– Heightened levels of anxiety– Suicide and self-harm

Scott et al. UK Gay Men’s Health Network, 2004.

Findings of the BC Adolescent Health Survey

LGB youth more likely to report:• Running away from home• Early intercourse, increased

number sex partners• Current smoking, alcohol, other

drug use• Emotional stress • Suicidal ideation and attempts• Sexual and physical abuse• Victimization experiences at

school• Discrimination based on sexual

orientation

LGB youth less likely to report:• Sports and physical activity

• Feeling cared about by parents and connected to families

• Health as “good” or “excellent”

Saewyc et al. Not yet Equal: The Health of Lesbian, Gay & Bisexual Youth in BC. McCreary Centre Society, 2007.

Internet Partners

0

10

20

30

40

50

60

2002 2004 2006 2007

Self-reported use of Internet to find partners – Gay men in BC

Community Based Research Centre, Sex Now Surveys: 2002-2007

Internet Partners - Opportunities

Victoria Times Colonist, 2008

Community Attachment

0

10

20

30

40

50

60

70

2002 2004 2006 2007

Self-reported affiliation with the gay community – Gay men in BC

Community Based Research Centre, Sex Now Surveys: 2002-2007

Unintended Consequences of Greater Visibility

Gay Male Development and Violence/Victimization

Gay-related development

Parental physical abuse (2+ times, < 17 yo) %

Harassed for being gay (2+ times, < 17 yo) *

 %

Forced sex (1+ time, < 18 yo)

%

Early (n=603)

26.2 76.8 21.6

Middle (n=1462)

19.2 67.1 14.4

Late (n=308)

17.6 46.4 14.6

Friedman et al. AIDS and Behaviour 2008; 12:891-902.

Developmental Profiles and Health of Gay Men

05

1015202530354045

PartnerAbuse

GayVictimization

Depression UnprotectedAnal Int.

HIV+ 3+ Drugs

Early GRD Middle GRD Late GRD

Friedman et al. AIDS and Behaviour 2008; 12:891-902.

Political Environments

• Social issues can be used as a ‘wedge’ to leverage political support

• Can result in further stigmatization

• Can also serve to distract from other issues or specifics of political platforms

Part 3 – Where does gay men’s health need to go?

• Defining the vision for gay men’s health

• Communicating this vision to decision makers

Ryan et al. Valuing gay men’s lives. Gay & Lesbian Health Services Saskatoon, 2001.

New Era of the HIV Epidemic

• Re-position HIV within broader gay men’s health context

• Shift prevention efforts beyond individual behaviour change to interaction with social context

Part 4 – Opportunities to consider

• Expansion of HAART - HIV is on the health agenda, and rising rates among gay men are of significant concern

• Mental Health and Substance Use framework• Emphasis on upstream prevention and expanded

primary care to address rising health care costs• Allies: how does gay men’s health link with the broader

men’s health movement?• Partnerships, collaborative initiatives, working together:

– Community members, community groups and public health

There is no magic bullet