Pathways for Sexual Health Promotion Among Indigenous Boys and Men: A Community Report

Citation

Gaspar, C. M., Rand, J., Biderman, M., Boussard, A., Bogner, E., Lekas, S., Miller, D., McMillian, J., & Numer, M. (2021). Pathways for Sexual Health Promotion Among Indigenous Boys and Men: A Community Report. Halifax, NS.

Executive Summary

The Pathways for Sexual Health Promotion among Indigenous Boys and Men was a research project designed to specifically understand Indigenous boys’ and men’s holistic sexual health in Canada, and more specifically in Atlantic Canada. It was co-developed by Dalhousie University, Healing Our Nation and Mi’kmaw Native Friendship Centre. The project was supported by the Canadian Institutes of Health

Research (CIHR) through a Catalyst Grant and aimed to meet the following objectives:

• Review the academic and grey literature on the current state of holistic sexual health among Indigenous boys and men provincially and nationally

• Organize community consultations in partnership with community organizations to explore the topic of Indigenous boys’ and men’s holistic sexual health

• Gain insight into the perspectives, experiences and contributions of key informants and stakeholders

• Investigate the role of post-colonial masculinities in the production of Indigenous boys’ and men’s holistic sexual health

  A key message driving the project was the need to provide Indigenous boys

  and men spaces of healing and mentorship to inform sexual health programing. The

  specific findings from this project include:

• The review of the literature emphasized that there is a scarcity of research exploring the sexual health of Indigenous boys and men in Canada, particularly in the Atlantic Canada region.

• Community consultation demonstrated the need for safer spaces for Indigenous boys and men to be able to talk about sexual health to promote healthy relationships and positive sexual health practices through role modeling.

• The findings from the stakeholder interviews revealed three pathways for sexual health promotion: 1) developing healthy relationships and highlighting role models, 2) providing access to comprehensive sexual health information, and 3) fostering open communication among Indigenous boys and men.

• Emerging from the 10 interviews with Indigenous men were two key themes: 1) the systems of oppression that effected their journeys; and 2) the systems of support that have and will enable them to recover.

  The findings from this project informed the proposal for a larger CIHR Operating grant project, Indigenous Masculinities and Sexual Health: Exploring community- driven interventions among boys and men through land-based methodologies, in collaboration with Dalhousie University, Healing Our Nation and the Mi’kmaw Native Friendship Centre. This Indigenous Masculinities and Sexual Health Project is now exploring holistic sexual health of Indigenous boys and men through Major Gatherings and Learning Lodges. These gatherings and lodges are being developed by Healing Our Nation and the Mi’kmaw Friendship Centre based on the findings from this catalyst project and the community-based sexual health findings are being explored by the Sexual Health and Gender Research Lab at Dalhousie University.

To read the full report, click the button below:

Wired Sex Assemblages among Men who have Sex with Men: Sexualized Drug Use, Hook-Up Apps, and HIV Service Provision

Citation

Holmes, D., Numer, M., Hammond, C., Joy, P., Sinno, J., Patten, S., & LeBlanc, M. (2021) Wired Sex Assemblages among Men who have Sex with Men: Sexualized Drug Use, Hook-Up Apps, and HIV Service Provision. Journal of Homosexuality. 

Abstract

Sexualized drug use is a form of sexual practice that resists risk-based discourses (otherwise referred to as “radical sex practices”) and is reportedly common among gay, bisexual and other men who have sex with men (GBMSM). With the growth of online technologies, the use of hookup apps has also increased. We refer to men’s use of drugs, apps, and sex form as “wired sex” that forms what post-structuralist theorists Deleuze and Guattari described as an assemblage. Perspectives of the health and social service providers who work directly with GBMSM has not been explored. This research project involved a critical discourse analysis of 13 semi-structured interviews with service providers in Canada to understand their perspectives and interactions with wired sex assemblages. We identified several themes reflecting the social and political effects of wired sex assemblages and discuss the implications of these effects on services provision with GBMSM.

Attitudes and Practices of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis.

Citation

Sinno, J., Cochkanoff, N., Doria, N., Numer, M., Neyeldi, H., & Tan, D. (2021). Attitudes and Practices of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis. HIV/AIDS - Research and Palliative Care.13(1). DOI: 10.2147/HIV.S287201

Abstract

Introduction: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that requires the ongoing support of physicians to be accessible. Recently, Nova Scotia experienced a 100% increase in HIV diagnoses. The purpose of this study is to explore the relationship between physicians’ support of PrEP, knowledge of PrEP, and PrEP prescribing history using the information-motivation-behavioral (IMB) skills model.

Methods: An online survey was distributed to physicians in Nova Scotia, Canada, and eighty physicians participated. Two exploratory factor analyses were conducted with items from the Support of PrEP scale and Knowledge of PrEP scale. A mediation analysis was conducted to assess if knowledge of PrEP mediated the relationship between support of PrEP and whether physicians have prescribed PrEP in the past.

Results: On average, physicians reported strong support for PrEP, and as support for PrEP increased so did knowledge of PrEP. Further, physicians who had prescribed PrEP demonstrated strong knowledge of PrEP and physicians who had not prescribed PrEP reported feeling neutral. The 95% bootstrap confidence interval indirect effect of Support for PrEP on prescription history did not include zero (B = 1.59, 95% BsCI [0.83, 3.57]) demonstrating that the effect of support for PrEP is mediated by knowledge of PrEP. The most commonly identified barrier to prescribing PrEP was the lack of drug coverage among patients.

Conclusion: The results of the mediation analysis support the IMB skills model regarding support for PrEP, Knowledge of PrEP, and having prescribed PrEP in the past. Our findings suggest that to improve PrEP uptake in Nova Scotia, educational interventions for physicians and universal coverage of the drug would be necessary.

Keywords: HIV pre-exposure prophylaxis, health care providers, attitudes, knowledge, barriers, accessibility, health care access, information-motivation-behavior skills model

This paper is open access. Read it here.

Grinding Against HIV Discourse: A Critical Exploration of Social Sexual Practices in Gay Cruising Apps.

Citation

Numer, M., Holmes, D., Joy, P., Thompson, R., & Doria, N. (2019). Grinding Against HIV Discourse: A Critical Exploration of Social Sexual Practices in Gay Cruising Apps. Gender, Technology and Development. DOI: 10.1080/09718524.2019.1684022

Abstract

Social networking applications (SNAs), such as Grindr, are shaping the identities and sexual practices of gay, bisexual and other men who have sex with men (GBM). This qualitative study aimed to gain a deeper understanding of the role of such technologies in social sexual practices, particularly in relation to risk management and prevention of HIV and other sexually transmitted blood-borne infections (STBBIs). Poststructuralism and queer theory were used to critically examine the relationship between GBM and SNAs in a sample of people who use Grindr. Sixteen people, identifying as men who used Grindr, were interviewed. Discourse analysis was employed to critically examine the relationship between GBM and SNAs, and three threads of discourse emerged: Language and images, Filtering, and Trust. These threads of discourse provide insight into how the sexual beliefs, values, and practices of GBM are shaped on SNAs.

https://doi.org/10.1080/09718524.2019.1684022

Graphic facilitation as a tool to guide community-based research on Indigenous boys’ and men’s sexual health.

Citation

Doria, N., Biderman, M., Miller, D., Prosper, A., & Numer, M. (2019). Graphic facilitation as a tool to guide community-based research on Indigenous boys’ and men’s sexual health. Journal of Indigenous HIV Research, 10, 20-27. Retrieved from https://www.ahacentre.ca/uploads/9/6/4/2/96422574/
graphic_facilitation.pdf (Open Access)

Abstract

The sexual health of Indigenous1 boys and men is becoming increasingly recognized as an important area of research (Bingham et al., 2014; Grace 2003; Healey & Meadows, 2007). To date, however, much of the research exploring the sexual health of Indigenous Peoples has focused on women and girls. While further research is needed to explore the sexual health of Indigenous boys and men, future research must consider how interacting and dimensional factors such as colonization, racism, discrimination and prejudice contribute to poor sexual health outcomes (Bird et al., 2016; George et al., 2016; Hallett et al., 2017; Negin, Aspin, Gadsden, & Reading, 2015; Reading, Wien, & National Collaborating Centre for Aboriginal Health, 2009; Reading, Loppie, & O’Neil, 2016). It is important to recognize that generations of trauma and abuse have produced the poor social conditions in which Indigenous Peoples experience worse sexual health compared to the national average, such as higher rates of HIV and other STBBIs (Haddad et al., 2018). This paper describes our experience of conducting a community consultation to explore the current state of Indigenous boys and men’s sexual health and wellness. We also discuss our experience of using graphic facilitation as a culturally responsive tool to collect qualitative data on this subject matter. The community consultation is an outcome of a larger program of research that ultimately aims to decrease HIV rates within the Indigenous community across Atlantic Canada and beyond. Ethical approval for this project was obtained from both the Dalhousie Research Ethics Board and Mi’kmaw Ethics Watch

This paper is open source. Read it here.

Gay men’s sexual health promotion in virtual space: Exploring stakeholders’ attitudes and approaches to outreach on mobile apps in Nova Scotia.

Citation

Thompson, R., Joy, P., Numer, M., & Holmes, D. (2018). Gay men’s sexual health promotion in virtual space: Exploring stakeholders’ attitudes and approaches to outreach on mobile apps in Nova Scotia. The International Journal of Community Diversity, 18(3-4), 17-29.

Abstract

HIV infections are still are a concern for many gay men in Canada despite prevention efforts. Social networking applications (SNAs) have predominantly been where gay men meet for sexual encounters. Grindr is the most common app used, which is a GPS-enabled SNA that was released in 2009. In Nova Scotia, there is a culture of silence in the gay community surrounding HIV/AIDS discourses. It is suggested that the perspective of professional stakeholders in sexually transmitted and blood borne infections (STBBI) prevention is needed to enhance prevention efforts. The purpose of this qualitative study is to explore the perspectives of service providers regarding STBBI risk on one SNA for gay men. Key stakeholders in this current study were sexual health service providers working in Nova Scotia. Four stakeholders were interviewed as part of a larger study. Secondary thematic analysis was employed to examine this data for this research project. The interviewed stakeholders experienced outreach challenges because of the “changed landscape” of online partner finding. Stakeholders have an interest in accessing these spaces for prevention and suggest that online forums such as Grindr can be used for sexual health prevention aimed at gay men. Further, leaders in the gay men’s community may be able to help service providers understand the implications and potential contributions of sexual health promotion efforts.

http://hdl.handle.net/10222/75936

HIV/AIDS and the public health paradox: A poststructural discourse analysis of the impact of HIV Messaging on gay men in Nova Scotia.

Citation

Numer, M., Gahagan, J., Brown, M., & Atkinson, S. (2017). HIV/AIDS and the public health paradox: A poststructural discourse analysis of the impact of HIV Messaging on gay men in Nova Scotia. The International Journal of Health, Wellness and Society, 7(3), 91-104. DOI: 10.18848/2156-8960.

Abstract

Three decades of public health and health promotion policies and programs, in Nova Scotia, have aimed to reduce the rate of new HIV infections. Yet, gay men in this province continue to experience the highest rates of HIV transmission and have the highest proportion of people living with this disease in Canada. In this paper, the authors employ a Foucauldian conceptual framework and a qualitative post-structural discourse analysis to examine the role of public health in HIV messaging and how this has shaped our knowledge and understanding of gay men in the modern age of HIV/AIDS. Seventeen HIV activists in Nova Scotia were interviewed, and the transcripts are the textual source of the discourse analysis. An investigation of local public health efforts can illustrate the impact of the often-unseen dimensions of power and also the unintended consequences of health messaging on target populations. The findings suggest that public health efforts aimed at HIV prevention and stigma reduction are neither apolitical nor neutral. Rather, while these public policy efforts are aimed at HIV prevention, by attempting to regulate sexual subjectivities, they have become a form of discourse that has entered into the subject experience of gay men. This paper explores some of the ways in which public health HIV discourse impacts the subject experience by examining the effects of mainstreaming HIV messaging, sanitizing messaging for public consumption, and avoiding candid discussions about gay men’s sexual practices in the context of public health.

https://doi.org/10.18848/2156-8960/CGP/v07i03/91-104

The sexual health of gay men in the post-AIDS era: Feminist, post-structuralist and queer theory perspectives.

Citation

Numer, M., & Gahagan, J. (2009). The sexual health of gay men in the post-AIDS era: Feminist, post-structuralist and queer theory perspectives. International Journal of Men’s Health, 8(2), 155-168. DOI: 10.3149/jmh.0802.155

Abstract

This article discusses feminist, post-structuralist and queer theories as a framework for masculinities research on sexual health promotion efforts targeting gay men, particularly in relation to HIV prevention. The theories discussed have the potential to challenge the social categories associated with gender, sex, sexual identity and sexual orientation which often determine identities and subjectivities. Recognizing masculinity as a gender "performance" rather than a fixed identity enables health researchers to more fully investigate gendered sexual behaviors which are imbued with social, political and economic meaning. A combined feminist, post-structuralist and queer theoretical framework provides a way to understand how concepts of masculinity organize social interactions and how these in turn shape and inform the sexual health behaviors of men. The purpose of this article is to offer an approach for use by gay men's health researchers working on health promotion.

http://dx.doi.org/10.3149/jmh.0802.155

The sexual health of gay men: Exploring the intersections of identity, masculinities and sexual health promotion.

Citation

Numer, M. (2008). The sexual health of gay men: Exploring the intersections of identity, masculinities and sexual health promotion. The International Journal of Diversity in Organisations, Communities and Nations Annual Review, 8(3), 249-254. DOI 10.18848/1447-9532/CGP/v08i03/39611

Abstract

This paper will explore the implications of traditional masculinity in relation to public health discourse aimed at the sexual health of gay men. The examination of gay men as gendered subjects who perform gender acts in relation to sexual health practices is critical to addressing issues of diversity in this sector of health care, particularly in relation to HIV/AIDS. Despite the growing attention given to the theory and practice associated with gay men’s sexual health behaviors, there remains a gap in the literature and a lack of understanding of dominant or hegemonic masculinity as it influences the sexual health practices of gay men. Traditionally, there is a paradoxical relationship between gay men and the notions of masculinity. While gay men theoretically hold a subordinate position in the hierarchy of heterosexual hegemonic masculinity, there exists a similar masculine hierarchy within the gay male community which in turn has an erotic association. That is, gay men are often ranked according to their ability to “measure up”, both in relation to other men and as sexual objects, to the standard of hegemonic masculinity which entail power, dominance, invulnerability and more. This situation, along with the recent theorizing of men’s practices of masculinity being associated with their poorer health, leads to the logical conclusion that gay men’s sexual health practices can be linked to a systemic hegemonic masculinity. If the full breadth and depth of sexual health among young gay men are to be considered in the development of health policy and health promotion, the intersections of gender, sex and sexuality must be explored. The aim of this argument is to present issues of diversity within the category “men”, and to illustrate the multiplicities and intersections of identity within the category “gay men”.

https://doi.org/10.18848/1447-9532/CGP/v08i03/39611