1. 1 1 Gay, Two Spirit, Bisexual and Other Men who have Sex with Men And HIV/AIDS Jacqueline Arthur HIV/AIDS Policy, Coordination and Programs Division CATIE Pacific Educational Conference Richmond, BC - October 29, 2009

2. 2 Expert Working Group Bill Ryan, Action Sero-Zéro, (McGill University) Gens Hellquist, Canadian Rainbow Health Coalition Phillip Banks, Health Initiative for Men Society Stephen Alexander, Canadian AIDS Society Jay Koornstra, Bruce House Carlos Rivas, AIDS Committee of Toronto Art Zoccole Two-Spirit People of the First Nations Maria MacIntosh, AIDS Coalition of Nova Scotia Suhail AbualSameed, Sherbourne Health Centre Russell Westhaver, St. Mary’s University Ed Jackson, CATIE Stephen Smith, FPT Advisory Committee on HIV/AIDS Rhonda Kropp / Robert Lerch, Public Health Agency of Canada Moffatt Clarke, Public Health Agency of Canada Susannah Ogunnaike-Cooke, Public Health Agency of Canada Michael R Smith, Public Health Agency of Canada Geneviève Tremblay / Jacqueline Arthur, Public Health Agency of Canada

3. 3 Gay, Two Spirit, Bisexual, and Other Men who have Sex with Men What is the status of HIV/AIDS in this population? 1985 – 2007: 56.6% of positive HIV test reports among all adults with reported exposure category 67.0% of all positive HIV test reports among men Up to 2006: ON (40.8%), QC (28.6%) and BC (19.4%) represent the highest distribution of total AIDS cases attributed to MSM

4. 4 Gay, Two Spirit, Bisexual and other Men who have Sex with Men as a "Population" Demographic picture difficult to construct: –traditional data sources tend not to gather data on sexual orientation –more recently, data on marital status is emerging, but this pertains to segments of this group –much of the "population description" comes from extrapolations on smaller studies within the gay population in specific sites –we cannot generalize this to the larger "community"

5. 5 This is the best picture we could get… Demographic Profile Status of the Epidemic VulnerabilityResponse Research Lack of data Collection and presentation of data Methodology and scope

6. 6 Factors Affecting Vulnerability to HIV Homophobia Determinants of health –Social Support Networks; –Culture; –Social & Physical Environments; –Personal Health Practices and Coping Skills; –Healthy Child Development; and, –Access to Appropriate Health Services.

7. 7 Issues Affecting Vulnerability for Racial & Ethno-cultural Groups Minority stress - a term coined by the US researcher Raphael Díaz to describe the increased vulnerability to HIV facing minority gay men that may point to: –broad social homophobia or discrimination against their group; –homophobia or anti-HIV sentiments within their group; –discrimination within the gay male community as well. "When you're on a reserve, you're native, but when you're off the reserve you're just like everybody else, and...after a while that kind of wears on you. It's just like you lose that specialness of being in your community. And that's very strong"

8. 8 Populations within Populations Several studies support the conclusion that the best results are to be gained by interventions that focus on sub- populations: –Clemon George: On the importance of community in HIV risk-taking behaviour –Lee, Nambiar, Poon, Bereket, Hart & Murray: Social Vulnerabilities Contributing to Sexual Risk Behaviors amongst Ethno-racial MSM - preliminary findings from a community- based research study –George, Husbands, Makoroka, Adam, Remis, Rourke, Beyene: MaBwana, Reaching Black Men who have Sex with Men in Toronto - the importance of community –Mark Gilbert: The Health of Lesbian, Gay, Bisexual, Transgendered, Two-spirited and Questioning Youth in British Columbia and the Influence of the School Environment

9. 9 HIV Vulnerability and Resilience Tracing the move toward gay men's health: A paradigm shift –From HIV prevention organizations that use gay men's health as a means of prevention - to gay men's health organizations that deal with the health issues gay men face, and integrate HIV prevention as a central priority. 1980's - 1995 HIV as an overwhelming crisis in the gay men's community 2000 - Health Canada sponsors the National Reference Group for Gay Men Early 2000s - USA gay men's wellness movement gains momentum 2004 - Leading Together centralized focus on gay community (and others) 2005 Gay Net/Réseau Gai emerges from CAS Skills Building Symposium in Montréal 2005/06 Gay Zone, a program area of AIDS Vancouver, shifts to a private group called HIM - Health Initiative for Men 2008 Montréal's Séro Zéro rebrands from a focus on HIV prevention to Rézo, with a broad focus on gay men's health

10. 10 For Information… HIV/AIDS Policy, Coordination and Programs Division, Populations Section Jacqueline Arthur, A/Manager jacqueline_arthur@phac-aspc.gc.ca (613) 957-7477 Thank You