1,721,103 research outputs found
Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men
Full text linkMcKirnan’s Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan’s Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/ acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV- related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escap
A syndemic in nonurban gay and bisexual men in British Columbia and within Island Health
Full text linkInequitable HIV acquisition persists among gay and bisexual men (GBM). In 2017, GBM represented 69.8% of new HIV diagnoses in British Columbia (BC) and 80.5% of new HIV diagnoses within Island Health (BCCDC, 2019). I used syndemic theory to examine the relationship between nonurban living environment, syndemic factors, and health outcomes among GBM within Island Health and in BC. I conducted a secondary analysis of the Community Based Research Centre’s Sex Now 2015, a national cross-sectional survey of approximately 8000 Canadian GBM. I conducted chi-square tests to compare levels of stigma stratified by urban or nonurban, Cramer’s V to examine the association between syndemic factors, and Poisson regression to determine which demographics and health outcomes were associated with more syndemic outcomes. I found prevalent stigma that negatively impacts urban and nonurban GBM. Urban GBM experience more stigma (e.g., called names or slurs) and worse outcomes (e.g., considered suicide) than nonurban GBM in Island Health and BC. Among nonurban GBM within Island Health, Cramer’s V may demonstrate a syndemic (e.g., strong associations between several measures of stigma such as verbal violence and discrimination at work and health outcomes such as depression, suicide, partner violence, and alcohol use). Among nonurban GBM within Island Health, Poisson regression revealed that more syndemic factors were associated with negative health outcomes and risk factors, such as attempting suicide, condomless sex, having sexual partners of unknown HIV status, and living with HIV. These findings suggest that a syndemic can occur among nonurban GBM without migration to a large urban centre. Key implications include a need for structural change to destigmatize sexual diversity. Results illustrate a need to normalize conversations about mental health among GBM who would benefit from co-located services that address stigma, mental health, substance use, and sexual health.Graduat
BLOOD DONATION IN THE ERA OF BIOMEDICAL HIV PREVENTION AND GENDER-NEUTRAL DONOR SCREENING
Full text linkObjective.
Canada’s implementation of gender-neutral sexual behaviour screening allows sexually active men who have sex with men to donate blood for the first time. Public health campaigns promoting effectiveness of pre-exposure prophylaxis (PrEP) and undetectable = untransmittable (U=U) for HIV prevention heavily target sexual and gender minorities. Donor deferral policies remain in place for both methods. This thesis explores the tension between the effectiveness of these HIV prevention methods and donor policies considering them indicators of HIV risk.
Methods.
I wrote an algorithm approximating donor eligibility producing two analytic samples; one including PrEP use, one including HIV-negative men using U=U. I then estimate the proportion of donors who would be deferred for each prevention method. Chapter Two uses logistic regression to investigate PrEP use as a motivator for blood donation. Chapter Three describes HIV risk and protective factors for HIV and compares these observations to population health estimates of HIV incidence risk.
Results.
The algorithm identified n = 2,301 potential donors when PrEP users were included. Of these n = 85 (3.7%) would have been deferred for PrEP use. When repeated with HIV-negative donors using U=U, n= 2,354 donors were identified and n = 53 (2.3%) would have been deferred. PrEP use was not associated with willingness to donate. Estimates of HIV acquisition risk observed in the U=U analytic sample showed high risk of HIV acquisition. Contradictorily, a high number of combination HIV prevention strategies were also observed in the sample.
Conclusion.
It is likely donors are deferred solely for their choice of HIV prevention method. Having made a past donation was the best predictor of willingness to donate blood. Observed combination HIV prevention strategies employed by the U=U analytic sample did not support high public health estimates of HIV acquisition risk. Future research should explore PrEP adherence in samples of donors deferred for PrEP use and adjusting estimates of HIV acquisition risk to consider PrEP and U=U in risk estimates.Graduat
The Medicine Bundle Pilot: An Indigenous Two-Spirit Approach to HIV and STBBI Health in British Columbia
Full text linkThe social determinants of health and the determinants of Indigenous health, including the historical and ongoing effects of settler-colonialism across Turtle Island, contribute to increased rates of HIV and sexually transmitted and blood-borne infections (STBBI) facing Indigenous people in Canada. Two-Spirit and queer Indigenous folks face further systemic barriers to accessing sexual health resources. The Medicine Bundle Pilot project takes a strengths-based approach to addressing health inequities in HIV and STBBI awareness and prevention. The Medicine Bundle Pilot was developed by the Community-Based Research Centre’s Two-Spirit Program to address barriers and increase culturally safe access to sexual health resources for Indigenous people in British Columbia. The Medicine Bundle is an Indigenous-developed approach to the HIV self-test kit and dried-blood spot test, combining traditional Indigenous medicines with Western sexual health resources. Medicine Bundles were distributed to Indigenous communities and community members across British Columbia, fostering safer pathways to care. My thesis aimed to (1) understand participants’ experience with the Medicine Bundle Pilot, and (2) determine barriers and access limitations to sexual health resources for Indigenous people in British Columbia. Existing barriers include limited access to sexual health resources within communities and being wrongfully denied access to services. Results demonstrate that the Medicine Bundle is a very effective sexual health resource for Indigenous people, and participants reported improved experiences with testing through the Medicine Bundle.Graduate2025-01-1
Medical assistance in dying and mental illness: Perspectives from 2S/LGBTQ+ individuals in Atlantic Canada
Full text linkIn March 2027, medical assistance in dying (MAID, also referred to as physician-assisted suicide) in Canada will be available to those with mental illness (MI) as the sole underlying condition (MAID-MI). The literature surrounding MAID-MI rarely consults individuals with MI; consequently, there is urgent need to understand this population’s perspectives. A key intersecting/sub-population is 2S/LGBTQ+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer) Atlantic Canadians with MI, who will be disproportionately affected by the change in MAID eligibility for several reasons. These include: 1) intersections of sexual/gender minority status with homelessness and poverty, and the impact of rising costs of living in Atlantic Canada; 2) associations between sexual/gender minority status and MI/suicidality, and the impact of barriers to accessing timely and competent healthcare in Atlantic Canada, specifically gender-affirming and mental health care; and 3) associations between homelessness, suicidality, and likelihood of seeking MAID. This study used an interpretive description methodology, informed by a feminist-of-colour disability framework, and community collaboration, and engaged 2S/LGBTQ+ Atlantic Canadians with mood disorders through qualitative one-on-one interviews to understand their perspectives on MAID-MI and how their experiences and identities impacted these perspectives. Of the 38 participants, 63% were white and the remaining 37% represented diverse races/ethnicities: Indigenous, First Nations, Métis, or Inuit; Black, East or Southeast Asian; Latino/Latina/Latine/Latinx; and South Asian. A minority (21%) identified as cisgender. A reflexive thematic analysis of the verbatim interview transcripts focused on the topic of autonomy in the context of MAID-MI within the Atlantic Canadian healthcare system. These results identify possible complications for MAID-MI implementation and highlight areas where additional safeguards could be enacted to ensure equity for and prevent abuse of power against 2S/LGBTQ+ or other marginalized communities.Graduat
The lived experience of North Park neighbourhood residents as it relates to community planning, social inclusion, and well-being
No full textThis research aims to gather input into the health, wellness, social inclusion and dynamics within Victoria’s North Park, a mixed-used mixed income neighbourhood. Employing a community-based participatory approach in collaboration with the North Park Neighbourhood Association, 19 participants were interviewed. Analysis revealed diverse perceptions of the neighbourhood emphasising the community in a period of transition, competing interpersonal relationships and the impact of policy and bylaws on daily life. Residents expressed frustration with political decision-making processes and tensions between housed and unhoused neighbours and territorial stigma was pervasive. Despite advocacy for inclusivity, exclusionary attitudes persisted. Placemaking was identified as both a barrier and facilitator to community connection and well-being, alongside concerns about ongoing development and gentrification. This research underscores the importance of accessible public spaces and community programming as vital resources for fostering well-being and inclusion through centering community voices in neighbourhood planning. While territorial stigma persists, opportunities for meaningful community engagement offer hope for resilience and connection. Achieving this outcome requires buy-in from both community and local government, and equitable decision-making processes to promote community well-being in dynamic urban environments.Graduat
Psychedelic revival: a mixed-methods analysis of recreational magic mushroom (psilocybin) use for transformational, micro-dosing and leisure purposes
Full text linkBackground: Following years of inactivity, psychedelic research has rapidly expanded within clinical and therapeutic fields. In particular, magic mushrooms (psilocybin), a plant-based psychedelic, have been researched for the treatment of complex mental health and substance dependence conditions, and yielded promising results. Largely due to the historical baggage of the psychedelic movement in the 1950s-1970s, and the stigma of recreational substance use, recreational magic mushroom users have been ignored within the current psychedelic revival. This thesis addressed this gap, examining the magic mushroom recreational substance use patterns of emerging adults in Victoria, British Columbia. Theory and Methods: Using the normalization thesis as the guiding theoretical framework, this thesis used a sequential-exploratory mixed methods design. Statistical analysis of quantitative cross-sectional interviews (n=558) conducted between 2008 -2016 generated rates of use, availability, and self-rated knowledge rates of magic mushrooms users. Qualitative cross-sectional semi-structured interviews (n=20) analyzed through thematic analysis determined substance use behaviors with reference to the current social and cultural context. Participants were recreational magic mushroom users, aged 19- 24.
Results: Quantitative results indicated high overall rates of lifetime and past year magic mushroom use, with the lowest reported prevalence rate of lifetime use occurring in 2014 (86%), suggesting high rates of use within the recreational substance using population. There were no statistically significant relationships between year and lifetime or past year rates magic mushroom use. Gender was statistically significantly associated with magic mushroom use, with males being more likely to use magic mushrooms. Qualitative results indicated dynamic and strategically planned magic mushroom experiences. Themes developed include: shifting understandings, optimizing experience, purpose driven use; and post-trip impact. Participants reported using for transformational, micro-dosing, and leisure purposes. Discussion: Results suggested that magic mushroom use is in the process of differentiated normalization and assimilative normalization, influenced by developmental, social and cultural forces. Recreational users report substance use practices that have not been widely reported with the substance use literature, including using small doses of magic mushrooms (i.e. micro-dosing) for self-enhancement and therapeutic purposes. Results can be applied to the current psychedelic revival in three ways: (1) directing future clinical research directions and; (2) provide lived and experience and relevancy to clinical research, which will improve applicability and; (3) re-conceptualizing the identity of a recreational substance user, which has important implications regarding stigmatization.Graduat
Exploring the Social Determinants of Health Associated with Sexually Transmitted Infections in Older Women
Full text linkSexually Transmitted Infections (STIs) are on the rise among older women in British Columbia (BC); yet, sexual health research has paid little attention to this population. Similarly, STI prevention, testing, and treatment strategies often concentrate on youth or young adults. This community-based participatory research study examined how and to what extent social determinants influence STI prevention, testing, and treatment among older women (60+) in BC. This includes stigma around older adult sexuality, which is more prevalent in older women and creates barriers to safer sex practices and access to appropriate sexual health services. A mixed- method design, using cross-sectional surveys and interviews with older women across BC, contributed to understanding the sexual health needs of this population. The key themes that influence older women’s STI prevention, testing, and treatment experiences include: 1) knowledge and beliefs, 2) stigma and shame, 3) social determinants of health such as education, access to care without discrimination, and relationships with trust. This research not only contributes to the knowledge base around older women’s social determinants of health in relation to STI-related behaviours, but also provides data to inform recommendations regarding the development of equitable policies, programs, and services that promote the sexual health of older women in BC.Graduat
An Intersectionality-Informed Analysis of Loneliness and Discrimination Experienced by 2S/GBTQ+ People Living With Disabilities Before and During the COVID-19 Pandemic
Full text linkIntroduction: Social inequities such as loneliness and discrimination due to sexual orientation (herein, discrimination) are prevalent across disabled people and Two-Spirit, Gay, Bisexual and Trans men, Queer and Non-Binary (2S/GBTQ+) communities. However, little is known about how loneliness and discrimination were experienced in Canada at the intersection of disability and 2S/GBTQ+ communities, especially before and during the COVID-19 pandemic. Method: To address this knowledge gap, four cycles (2019, 2020, 2021, 2022) of cross-sectional, bilingual, community-based Sex Now survey data were used, which included 2S/GBTQ+ people aged 15 years or older and living in Canada. A total of 12,355 2S/GBTQ+ participants responded to loneliness outcomes, and 11,575 to discrimination outcomes. A multi-stage data analysis was conducted. First, crosstabulations and chi-square tests were used to describe and test for differences across outcomes across the four survey cycles. Second, pooled data were analyzed to describe and test for differences in outcomes based on social determinants of health. Third, stratified analyses were repeated for participants living with and without a disability. Finally, only among 2S/GBTQ+ participants living with disabilities, multivariable logistic regression models of each outcome identified 1) temporal trends by survey year, and 2) social determinants of health correlates. Results: There were statistically significant differences in outcomes across survey cycles, which were greater among 2S/GBTQ+ participants living with a disability. Compared with 2019 (before COVID-19), the odds of reporting loneliness were greater for 2S/GBTQ+ participants living with disabilities in 2020 and 2021 (but not 2022). 2S/GBTQ+ participants living with a disability who reported a racialized identity, financial strain, or a gender-expansive identity had greater odds of reporting loneliness. Compared with 2019 (before COVID-19), decreased odds of reporting discrimination were found in 2021 and 2022 (but not 2020). Generally, older 2S/GBTQ+ participants living with a disability were less likely to experience discrimination. 2S/GBTQ+ participants living with disabilities who were racialized, queer versus bisexual identified, and gender-expansive reported greater odds of discrimination. Conclusions: These findings suggest that 2S/GBTQ+ people living with disabilities were impacted by greater loneliness and lesser discrimination during COVID-19. However, social inequities were also present among 2S/GBTQ+ people living with disabilities. Equitable policy planning is needed to ensure that underserved yet deserving communities are not disproportionally affected by future pandemics and associated public health responses.Graduat
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