Unmasking the gender factor

SEX NOW Survey 2010

Sexual orientation alone may be inadequate to explain gay health disparities…

Investigate Gender Determinants

Retooling Sex Now Survey

From behavioural risk factors to

determinants of health indicators...

How are marginalization, social stress & mental wellness related? … to gay health outcomes?

i.e. suicide, depression, HIV, STI…

What social inequities elicit gay health disparities?

National Promotion

Recruitment

n=7982

Contact siteBanner adEmail blastWOMOther

RecruitmentBritish Columbia 1413 20.1%

Alberta 1019 14.5%

Saskatchewan 213 3.0%

Manitoba 291 4.1%

Ontario 3060 43.6%

Quebec 580 8.3%

New Brunswick 137 2.0%

Nova Scotia 72 2.4%

PEI 31 0.4%

Newfoundland 77 1.1%

Yukon 5 0.1%

NWT 9 0.1%

Nunavut 15 0.2%

Sample age

Mean = 43

<25 9.6%25-29 10.1%30-39 18.8%40-59 50.6%60+ 10.9%

Marginalization Indicators

Suicidal Bullied Forced Career Isolated Low mood

05

101520253035404550

Marginalization X Age

<25 25-29 30-39 40-59 60+0

10

20

30

40

50

60

SuicidalBulliedIsolatedLow mood

Marginalization X Age

<25 25-29 30-39 40-59 60+0

5

10

15

20

25

30

Forced sexCareer affected

Marginalization Indicators

Suicid

al

Bullied

Forc

ed

Caree

r

Isol

atio

n

Low m

ood

0

10

20

30

40

50

60

70

HIV+HIV-

Counseling

Psyc

holo

gist

Ther

apist

Psyc

hiat

rist

Peer

sup

port

Other

0

10

20

30

40

50

60

51% accessed counseling services

Counseling Topics

Depre

ssio

n

Fam

ily

Relat

ions

hip

Sex

Comin

g ou

t

Subs

tanc

es0

10

20

30

40

50

60

64% were satisfied with services

Care for Depression

Suicidal

Low Mood

Career

Bullied

Isolation

Forced sex

Risky sex

0 1 2 3 4 5 6

odds of being treated

Linking ideas

“Sexuality is the apparatus of power” Michel Foucault

How did that come to be?

The History of Sexuality v 1-3

Heterosexuality doesn’t exist without homosexuality to explain it.

Linking ideas

Archives of Sexual Behavior, Vol. 33, No. 2, April 2004, pp. 117–128 ( C ° 2004)

Gender Nonconformity, Childhood Rejection, and Adult Attachment: A Study of Gay Men

Monica A. Landolt, Ph.D.,1 Kim Bartholomew, Ph.D.,2;4 Colleen Saffrey, B.A. (Hons),2 Doug Oram, M.A.,2 and Daniel Perlman, Ph.D.3

Linking ideas

Public Health and Human RightsAPHA 134th Annual Meeting and ExpositionNovember 4-8, 2006

Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals

Allegra Raboff Gordon, MPH and Ilan H. Meyer, PhD. Mailman School of Public Health, Columbia University,

Linking ideas

Psychological Bulletin American Psychological Association, Inc.2003, Vol. 129, No. 5, 674–697

Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and BisexualPopulations: Conceptual Issues and Research Evidence

Ilan H. MeyerColumbia University

“Minority Stress”

Linking ideas

Critical Public HealthVol. 18, No. 3, September 2008, 271–283

Intersectionality and the determinants of health: a Canadian perspective

Olena Hankivskya* and Ashlee Christoffersenb

“policy decisions create relational inequities in which some groups benefit and others experience more marginalization and oppression.”

Intersectionality & Gay Health Determinants

Focus on social inequities

Intersecting systems of oppression/privilege

i.e. Gender and Sexuality (+ age, income, race, social location…)

Interrogate the relationship between social categories… embrace complexity…

Social Status

Masculinities

49.7% Single 4.8% Married/man23.7% Partnered/man14.2% Married/woman 4.9% Partnered/woman 2.7% Other

Masculinities

Conforming Non-conforming

Married to woman Single

Partnered with woman Married to man

Partnered with man

Other

“MSM” “Gay”

In-gender comparison

Gay 6303 81%MSM 1490 19%

HIV+ Gay 9.2% MSM 1.1%

Common Practices

Mas-turbate

Oral Anal Leather Rough0

5

10

15

20

25

30

35

GayMSM

Varied Masculinities

Relationship

Dating

Involvement

Intensity

Intimate style

0 1 2 3 4 5 6 7 8 9

MSMGay

Varied Outcomes

Couns

elin

g

Depre

ssio

n

Fam

ily

Partn

er Sex

C' Out

Subs

tanc

e0

10

20

30

40

50

60

Gay MSM

Minority Stress Indicators

Counseling

Depression

Family

Relationship

0 0.5 1 1.5 2 2.5

MSMGay

Marginalization Indicators

Bullied Suicidal Forced sex

Career Isolated Low Mood

0

10

20

30

40

50

Gay MSM

Odds of Marginalization

Low mood

Isolated

Suicidal

Career affected

Bullied

0 1 2 3 4 5 6 7 8 9

MSM Gay

Transmission Risk

Top Bottom Any0

5

10

15

20

25

30

35

GayMSM

Outcomes

Chlam

ydia

HPV

Gonor

rhea

Syph

ilis

Herpe

s

Hep C

0

0.5

1

1.5

2

2.5

3

3.5

GayMSM

Disparities

HIV

Syphilis

Gonorrhea

Herpes

Chlamydia

HPV

Hep C

0 1 2 3 4 5 6 7 8 9

MSMGay

Varied Masculinities

Low attachment

Web Contact

High Income

Preoccupation/sex

Adventurous style

0 1 2 3 4 5 6 7 8 9 10

MSMGay

Summarizing Disparities

Conforming Non-conforming

Income Marginalization

Marginalization Mental distress

Mental distress Sexual risk

Sexual risk HIV

HIV STI

STI

“MSM” “Gay”

Summarizing Ideas

Marginalization strongly associated with treatment for depression

Youth and HIV+ men experienced highest rates of marginalization

Gay men experienced higher rates of marginalization, depression, HIV and STI than MSM

Gender non-conformity helps explain gay health disparities

Practice ImplicationsCritical Public HealthVol. 18, No. 1, March 2008, 87–96

The social construction of gay oppression as a determinantof gay men’s health: ‘homophobia is killing us’

Jeffrey P. AguinaldoDepartment of Sociology, Wilfrid Laurier University, Waterloo, Canada

“The problem is not the oppressed it is the oppressor.”

Observe and count all the subtle andobvious ways heterosexism occurs and goes unchallenged and uncontested…

Next Steps

Determinants Survey 2011

Young Gay Investigator Team - YGIT

Measuring Marginalization and Resilience

How is “gay oppression” being done?

Distribute the evidence gathering…

Acknowledgements

Questionnaire Development: Carl Bognar, Bill Coleman, Olivier Ferlatte, Jody Jollimore, Mike Kwag, Rick Marchand

Survey Promotion: Justin Go, Glenn Doupe & CDC Internet Team

Technical Assistance: Sean Lytle, Rachel Thompson

Knowledge Transfer & Translation: Public Health Agency of Canada

Dissemination: Province of British Columbia