Health-policy makers often make decisions that drastically impact people all across the country, but before they can do that, they need to understand what the population truly needs. That can be difficult, though, when policies affect specific groups with even more specific health needs — such as men who have sex with men.
Gay, bisexual, and other men who have sex with men (gbMSM) can be uniquely affected by sexual health-related policies, but it’s historically been very difficult to get information that truly represents their needs as a diverse population.
A survey to bridge the gap
A major initiative to gather information has been the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS), which asks questions about the mental and sexual health practices of gbMSM all over Europe — and, in the 2017 version, also those of men in Canada. “This is really meant to be kind of a public health report,” said Dr. David Brennan, a professor and assistant dean, research at U of T’s Faculty of Social Work, who was instrumental in implementing the survey in Canada.
This was the first study in a long time to gather health information about the sexual health of gbMSM on a national scale. It contains results from both transgender and cisgender respondents from a variety of backgrounds all across the country. The survey’s questions were informed by health experts from across Canada, and cover topics like safe sex practices, drug use, depression, anxiety, and homophobia.
Some of these trends have been investigated by more specific studies in the past, and the new study is consistent with past results. For example, rates of anxiety and depression in gbMSM were higher than rates in the general population, according to Brennan. There’s still, however, a wealth of new information to be found from the study, as it measured some things that have, frankly, not been measured before.
Reducing the risks associated with sex between men
Today, gbMSM in Canada can find plenty of information online about safe sexual practices. In fact, Brennan recounted that his research lab, CRUISElab, discovered that most gbMSM turn to Google for sexual education.
However, over the last few years, there have been a few very important developments for HIV-related sexual health, and it’s unclear how far this information has travelled. One of the goals of this survey was to measure the prevalence of knowledge and usage of pre-exposure prophylaxis (PrEP), a drug that can be used to prevent infection in HIV-negative people who are at risk of contracting HIV.
PrEP’s a fairly recent development that has only become widespread since the last EMIS in 2010, and it is not covered by provincial health insurance in most parts of Canada, including Ontario.
This may pose a significant barrier to men interested in using the drug, as evidenced by the numbers in the study — while only about 8.4 per cent of Canadian respondents had ever used PrEP, over 50 per cent said they’d be likely to use it if it were both available and affordable. More respondents had used PrEP in Québec and in British Columbia — where the drug is covered by the province — than in Ontario.
Another important area the study illuminated is ‘party-and-play’ sex, or ‘chemsex,’ in which participants use drugs to enhance their sexual experience. When injectable drugs are introduced in sexual situations, there can be a much higher risk of participants contracting certain sexually transmitted infections.
Conclusions do not indicate a lack of concern with safe practices
That being said, Brennan recommended that readers be wary about assuming chemsex participants are automatically less concerned with sexual safety. Some researchers have found that in gatherings where participation incurs a greater risk of sexually-transmitted infections, participants build up a community of sorts to take care of each other’s sexual health.
Not only should the general public avoid leaping to conclusions, but researchers should as well. It’s easy to draw conclusions that might be unconsciously influenced by our prior biases, especially when reading research on gbMSM. In Canada, the survey reached out to a lot of participants through dating apps, which could affect the study’s results, as these participants may be more likely to have more or more frequent sexual partners.
This doesn’t, however, mean that they’re necessarily being less safe than the general population.
“I’ve had many calls from reporters wanting me to tell them that people using these apps are actually having more unsafe sex. And, no, there’s really not much evidence to show that,” said Brennan. “It’s less about the venue or the location and more about… preferred behaviour.”
The survey is, of course, limited in its sampling methods — it can only collect data from participants who were willing to reach out in response to ads on dating apps, or at sexual health centres that the study has paired with across the country.
But that doesn’t mean the data is any less useful. This data could be instrumental in drafting a health policy that accounts for the realities of being a Canadian man in the LGBTQ+ community.