HIV Prevention, Risk Perceptions, Behaviours, and Health Care Access Among Gay, Bisexual, Two-Spirit, and Other Men Who Have Sex with Men in the Context of Changing Social-Historical, Messaging, and Socio-Sexual Environments

First diagnosed in gay men, the human immunodeficiency virus (HIV) continues to have a disproportionate impact on gay, bisexual and other men who have sex with men (hereafter, referred to as MSM). Over half the people in Canada living with HIV are MSM, and they account for about 70% of all new diagnoses among males in BC and about 75% of new diagnoses among men in Ontario. The HIV prevalence of MSM who participated in Canadian national M-Track surveillance was 15.1% (11.1%-23.1%). Senior, junior and community-based researchers in BC, Alberta, Ontario and Nova Scotia have come together to articulate a focused research agenda designed to reinvigorate HIV prevention for MSM. We hypothesize that MSM's sexual, physical and mental health experiences, their risk perceptions and behaviours as well as their access to and use of health services are influenced by social, legal, media, and sexual environments, which have all changed dramatically over the past three decades. Our objectives are to: (1) examine how the four environmental domains (sociocultural and legal landscape, media, perceptions of risk in changing virtual and real-world communities, access to appropriate health care and social services) impact the experiences of sexual, physical and mental health and health care access for a diverse sample of MSM across Canada and influence their risk and resiliency for HIV and other STIs; (2) identify policy and program changes that would reinvigorate HIV prevention for MSM; and (3) enhance capacity to conduct research on the changing social environments and determinants of health for MSM and to develop appropriate programs and services. To achieve these objectives, we will use a two-phase mixed method design to collect information. Phase 1 will involve an online, cross-sectional questionnaire (n=1000) recruiting MSM from four provinces. In Phase 2, we include 400 in-depth interviews recruited from the online survey to explore research questions qualitatively.