"Placing" HIV Risk and Prevention among Men in Nova Scotia: An Intersectional Determinants of Health Approach

This project integrates health geography and health promotion approaches to examine the ways in which local context in Nova Scotia informs the ways in which men (including men who have sex with men) encounter HIV risk and respond to prevention strategies. The study hypothesizes that place-mediated determinants of health such as social support networks, social environments, gender, and sexuality influence: (1) constructions of maleness and masculinity, (2) related risk factors for HIV, (3) non-normative health-seeking behaviors such as HIV counseling and testing and (4) the effectiveness of HIV prevention strategies traditionally geared toward men in metropolitan areas. Nova Scotia, with a varied social and political landscape that differs from more commonly studied provinces, is an ideal location to explore how place factors (e.g., urban/rural cultural differences and access issues, variations in support for non-mainstream sexualities and uptake of health services) influence HIV risk and prevention among men. This project employs an exploratory, qualitative methodology consisting of in-depth interviews with individual men (HIV-positive and -negative) and sexual health/mental health workers in the nine Nova Scotia district health authorities tasked with meeting the complex sexual, mental, and physical health needs of the diverse populations of men across the province. This study will also examine how the ways in which gender is constructed across places and sexual contexts (e.g., having unprotected sex or opting out of testing as "masculine" behaviors) contribute to HIV risk and, conversely, inform the uptake of prevention messaging. This research will provide a more sophisticated understanding of how key determinants of health, including place, gender, and sexuality, shape HIV risk. It will also inform recommendations for how to integrate these factors into the provincial HIV strategy, resulting in a more nuanced approach to HIV prevention among men in Nova Scotia.