Since the beginning of the epidemic, HIV has disproportionately affected gay men and other men who have sex with men (MSM) in Canada. Of the estimated 71,300 people living with HIV in Canada in 2011 (prevalence), 50% were in MSM. Furthermore, an estimated 50% of all new HIV infections in 2011 (incidence) were among MSM, a rate that has remained generally steady across time. Owing to the continuing high rates of HIV prevalence and incidence among MSM, there is a pressing need to understand the attitudes, opinions and behaviours of MSM -- and their HIV prevention needs -- in order to inform and improve education, policies and programs.
Recently, two important research projects have sought to meet these needs by conducting 1) a national toll-free telephone survey among MSM across Canada and 2) a survey of Canadian AIDS Service Organizations (ASOs) working in MSM health.
Male Call Canada
The national telephone survey -- "Male Call Canada" -- was a bilingual, university-community collaboration undertaken by academic and community investigators from across Canada. This study aimed to better understand the social contexts of MSM, their attitudes and knowledge towards sex, sexuality, health and well-being, and their understanding of risk behaviours related to HIV and STIs. MSM were recruited through a variety of different mechanisms (including traditional classified advertisements and social media campaigns) and encouraged to volunteer to be interviewed by calling an anonymous toll-free telephone line.
Between October 2011 and February 2012, over 1,200 interviews were conducted over the phone. Calls were received from all of Canada's provinces and territories. The average age of respondents was 45 years (range 16-89), and the majority (68%) lived in an urban setting. Most respondents (55%) self-identified as gay, with the remainder identifying as straight, bisexual, queer, two-spirit or other. Nationally, 6.6% reported that they were living with HIV.
Some examples of key findings are:
- Condom use: Approximately 50% reported always using condoms. However, half felt that condoms make sex less pleasurable and a significant proportion (30%) suggested that they would be willing to have sex with a person who is HIV-positive without a condom.
- HIV testing: The majority (75%) had tested for HIV in the past and 35% had done so in the previous 6 months. For those who had never tested for HIV, the main reasons for not testing were the belief they were HIV-negative (84%) or that they were at low risk of HIV infection (74%).
- HIV transmission: Overall knowledge of how HIV could be transmitted was high. Half of men (50%) agreed that a man is at an increased risk for HIV if he is a bottom
This is only a snapshot of the information available. A full technical report and 20 graphic novel-like fact sheets are available, which provide a more complete picture of the findings.
National Survey of Canadian ASOs
A related project surveyed Canadian ASOs to gain insight into research needs for sexual health promotion among MSM. In total, 34 staff persons from the Atlantic (13%), Ontario (33%), Pacific (10%), Prairies (13%) and Quebec (30%) regions completed the on-line survey.
Based on the survey results, the investigators made a series of research, programming and policy recommendations, such as the need for:
- More research studies, both quantitative and qualitative, exploring the lives of rural MSM, youth MSM and the complex issues that have arisen as a result of the criminalization of HIV.
- Identification and utilization of revenue streams for MSM-related HIV prevention research. Only a minority (27%) of respondents ever had received funding to do their own HIV prevention research for MSM.
- An increase in the development of research capacity at ASOs to foster more community-based research for MSM, through the increased availability of research tools, access to conferences and the ability to conduct independent research.
- Development of programs for "hidden" groups of MSM, religious MSM, trans MSM and MSM who don't identify as gay. These groups were identified by participants as being missed by existing programs or having unmet sexual health promotion needs.
- Ongoing advocacy efforts to fund HIV prevention programs and staff for MSM. Overall, 33% of respondents reported that their organization did not have a dedicated programming position to work with MSM and 13% said they had not received funding for MSM-specific HIV prevention.
- Continued HIV prevention programs that target the internet and capitalize on this medium.
- Reinforcement of existing MSM-related mental health services and expansion to the majority of ASOs.
The final report includes additional recommendations and identifies the ongoing and evolving needs of MSM based on a comparison with previous surveys/assessments.
What Do the Surveys Tell Us?
The "Male Call Canada" survey has added to our understanding of the behaviours, knowledge, attitudes and opinions of MSM living in Canada. The findings can be used by those working in HIV to help inform community-level discussions and shape programming and research for this population. The related survey of Canadian ASOs can help organizations, funders and policy makers gain a better understanding of research, programming and policy needs and help to better develop programming and policies for MSM in Canada.
Sexually transmitted infections and HIV transmission -- CATIE Fact sheet