Improving Men’s Health in the Interior of BC :

1. Improving Men’s Healthin the Interior of BC: A focus on MSM Funding Provided By: Irving K Barber School of Arts and Sciences Institute of Health Living and Chronic Disease Prevention UBC Okanagan Principal Investigator: Susan Holtzman, PhD Undergraduate Researcher: Karly Drabot

2. Before we get started… “men who have sex with men” • Not all men who have sex with men (MSM) consider themselves gay • The term “MSM” was created to include men who have sex with men who may or may notidentify as gay or bisexual What do we mean by “MSM”?

3. Previous Research on the Healthof MSM • DID YOU KNOW? • BUT... • MSM, compared to heterosexual men, are approximately TWICE as likely to have unmet health care needs (Statistics Canada, 2005) • MSM represent about 50% of all new cases of HIV and 70% ofall new cases of infectious syphilis(BC Centre for Disease and Control, 2009) • MSM are 17 times more likely than heterosexualmen to develop anal cancer (Centre for Disease and Control, 2008) • MSM are nearly 3 times more likely to seek treatment from a psychologist and 2 to 14 times more likely to commit suicide, compared with heterosexual men(Statistics Canada, 2005; Lewi, 2009)

4. Looking Closer to Home The vast majority of research on MSM has been conductedin major urban centres, such as Vancouver and Toronto. Research on MSM living outside these major urban centres is severely lacking,and these men may be at even greaterrisk of poor health (Preston et. al, 2004). The goal of the following presentation is to: (1) Increase your awareness of the key issues and concerns facing MSM using recent and local data from the Interior of BC (2) Provide concrete suggestions and guiding principles for how to best address the needs of MSM in your practice

5. The UBCO MSM Health Survey In the Fall of 2010, Dr. Holtzman’s HealthPsychology laboratory at UBC Okanaganconducted the first health survey of MSMliving in the Interior Health Region of BC Our collaborators included: • The Living Positive Resource Centre, Kelowna • Dr. Zachary Walsh, Assistant Professor of Psychology,UBC Okanagan • Dr. Eli Puterman, Research Scientist,University of California – San Francisco Participants completed an anonymous online survey containingwell-established, well-validated measures of health and well-being

6. A diverse sample of 160 MSM participated • 81% were Caucasian11% were Aboriginal • 40% considered themselves to be a spiritual person • The average age was 39, ranging from 18 to 72 • 35% of participants were from smaller communities (e.g., Nelson or Summerland) and 65% were from larger communities (e.g., Kelowna or Kamloops) • 58% were single and 42% were either married or in a committed relationships

7. KEY FINDINGS Please pay close attention, there will be a brief quiz at the end!

8. Key Findings Communication • “Most of the time you get the feeling that you are making the health care provider uncomfortable” Study Participant • Over ONE THIRD (37%) had not told their health care provider that they have sex with men

9. Key Findings Comfort with Health Care Provider “I feel my family doctor looks at me differently ordown to me for the fact I am [gay].” Study Participant • About ONE QUARTER (24%) reported feeling “uncomfortable” or “very uncomfortable” talking to their health care provider about their sexual health

10. Key Findings Discrimination “I cannot find a doctor to take me as a patient. They always tell me to go to Vancouver, which is a 4+ hour drive from here.” Study Participant (HIV+) • 11% reported feeling discriminated against by their health care provider inthe past 12 months

11. Key FindingsHIV Testing • ONE QUARTER (25%) reportedthat they had NEVER been tested for HIV • 10% reported they have not been HIV tested because they fear others will find out their test result or that people will assume they are gay

12. Key FindingsSexual Behaviour * Defined as having unprotected anal intercourse with either one partner with unknown or different HIV status or with at least one partner out of multiple sexual partners. • 43% of MSM reported engaging in risky sexual behaviour* with a male in the past three months

13. Key Findings Mental Health Sexual health isn’t the only issue… • 45% reported clinically significant levels of depressive symptoms • Rates of depression are significantly higher among MSM in the BC Interior, particularly compared to the general Canadian population (approximately 16% of all Canadians will experience depression in their lifetime;Health Canada, 2009)

14. 5LITTLE things you can do to make a BIG difference

15. Create a welcoming office Tip #1 Post a rainbow sticker on your office wall or window* to communicate that you provide an open office. *Many MSM report that this small gesture would make a big difference. Educate your MOAs and staff concerning the need for increased awareness on MSM issues and institutional anti-discrimination policies.

16. Tip #2 Use gender-neutral languageand adopt an inclusive attitude Ask about sexual health in an open-ended way, free of judgments and assumptions. Use language mirroring the patient’s language. Eg., “Do you have a partner or spouse?”vs. “Are you married?”Eg., “Do you have sex with men, women, or both?”vs. “Are you gay?”

17. Tip #3 Take a frequent sexual health history Do not assume sexual behaviour and identity are static and unchanging. Ask if patient is sexually active: “Have you been sexually involved with anyone during the past year, including oral, vaginal, or anal sex, or other kinds of sexual practices?” • If so, ask about past and current sexual partners: • “Have you been (or are you currently) sexually involved with men, women, or both?” • Ask about risky sexual behaviours: • “Do you ever have sex without a condom?” • Assess patient’s comfort with sexual identity and desire: • “Do you have any sexual concerns or questions you’d like to discuss?”“Do you have any concerns or questions about your sexuality? Sexual identity? Or sexual desires?” Emphasize that it is routine and confidential: • Eg., “Now I am going to ask you some questions about your sexual health. These questions are very personal but important for me to know to help keep you healthy. I ask these questions of all my patients, and, like the rest of this visit, this information is strictly confidential.”

18. Tip #4 Encourage regular HIV/STI • testing “I have not gotten tested for STI/STDs yet because I have only been sexually active with other men for a short period of time.”StudyParticipant • Regardless of symptoms or condom use, sexually active MSM should be tested at least annually for: • HIV (if HIV negative or not tested within the previous year) • Syphilis • Hepatitis B Do not assume MSM have HIV, but encourage appropriate testing, especially if your patients report that they do not use condoms or use condoms only part of the time.

19. Tip #5 Screen for common mental health concerns • To obtain mental health screening tools and resources, go to the Practice Support Mental Health Module at: • http://www.practicesupport.bc.ca/psp-learning/mental-health/tools-resources • Or contact Reed Scott, the Coordinator of the Practice Support Program: • Reed.Scott@interiorhealth.ca • 250 980 5029 The Practice Support Program(created by Interior Health, BC Ministry of Health, and the BC Medical Association) offers learning modules and training for family physicians to help them screen patients for mental health conditions.