A survey study to determine health disparities among men who have sex with men in Eastern Ontario: looking beyond sexual risk and the gay, urban core

Abstract

To create health promotion programs and clinical guidelines inclusive of gay, bisexual and other men who have sex with men (gbMSM), a better understanding of the health and social determinants that influence health outcomes for these men is required. Health research on gbMSM, however, has focused primarily on sexual health and HIV (human immunodeficiency virus) with most information coming from men living in large urban centers. To address this limitation and better characterize the overall health of this population, we conducted a survey of gbMSM living in Eastern Ontario, Canada. The survey, completed anonymously, was available from June to October 2015. A total of 674 gbMSM completed the survey; 61% were urban, 23% suburban and 16% lived in small towns or rural settings. The average age was 44.2 years, ranging from 18 to 83 years. Healthcare engagement was high for all groups of gbMSM, though disclosure of sexual orientation to healthcare providers varied based on the gender of sexual partners. Urban men tended to be younger, sexually active only with men, open about their sexual orientation, and more likely to use recreational drugs while men living in small towns and rural settings tended to be older, bisexual and more likely to conceal their sexual orientation. While the physical health of respondents was on par with national averages for men, we found younger men were more likely to suffer from anxiety and use recreational drugs while older men were more likely to develop problem alcohol use. Depressive symptoms were high across all demographic groups. Our data demonstrate that while gbMSM in Eastern Ontario have a high degree of contact with the healthcare system, considerable health inequities remain unaddressed. We also find significant health differences among gbMSM depending on age, area of residence, and degree of disclosure of sexual orientation.