Trevor J. Smith (2021)
Research Report: Trevor J. Smith (2021)
Who are you?
My name is Trevor J. Smith (he/him), and I am proud to have been part of the first cohort of Investigaytors in 2020. I acknowledge my privilege as a white, gay and cisgender male, and a settler on Treaty 1 territory. I am graduating June 2021 from the University of Manitoba with a Bachelor of Arts (Hons.) degree, majoring in psychology. I have served as the 2SLGBTQ+ Representative for the University of Manitoba Students’ Union since May 2019 and I will continue in the position until April 2021. I also served as President of the Rainbow Pride Mosaic, which is the U of M’s 2SLGBTQ+ student club. I have always been involved in giving back to the community, and I volunteered for several years with the Pride Winnipeg Coffee House event, including giving a speech about building bridges between the 2SLGBTQ+ community and allies. I have also given speeches about the 2SLGBTQ+ community and the importance of diversity at elementary and middle schools, and I am passionate about education. I grew up in rural Manitoba, and my love of flamboyantly debating Queer issues with rural Manitobans has been described as “a unique form of activism” – I proudly marched in the first Steinbach Pride, and I love being a social butterfly at country music festivals. I try to use my privilege to expand the Queer community’s collective safe space in Manitoba where I can. My dream and goal is to bring my passion and advocacy for the community to my future career as a clinician.
What is your research question?
I wanted to have a look at the possible implications of disclosing one’s sexual orientation with one’s health care provider in the context of sexual health. More precisely, I wanted to see if men openly discussing their sexual orientation with their health care provider was related to: (a) whether or not they had ever been tested for HIV and other STIs, and (b) the frequency with which they were tested for HIV and other STIs. Using the data from the Manitoba 2SGBQ+ Men’s Health Study, I analyzed bivariate crosstabs which compared whether or not men openly discussed their sexual orientation with their health care provider across four questions from the survey pertaining to whether men had ever been tested for HIV/STIs and how frequently.
Why did you pick this research question?
As someone who knows many men who do not feel comfortable or safe openly disclosing that they have sex with other men, this question hits close to home for me. While many Queer folks can relate to having at least one negative interaction with health care providers on the basis of our sexual orientation and/or gender, we ultimately may not be receiving the care we need if we cannot freely discuss our sexual orientation with our providers. My personal experience is with the stigma and shame that might be prevalent in some rural Manitoban communities, but I also have friends whose families come from various other backgrounds that are also less than accepting of diverse sexual orientations, which could result in men not discussing their sexual orientations with their health care providers. My prediction was that openly discussing one’s sexual orientation with one’s health care provider would be related with an increased likelihood of having ever been tested for HIV/STIs, as well as an increased frequency of those tests.
What do the results say?
Again, I looked at whether openly discussing one’s sexual orientation with one’s health care provider was related with ever being tested for HIV/STIs, as well as with the frequency of HIV/STI testing.
When asked, “Do you talk openly about your sexual orientation with your health care provider?” on the survey, 74.5% of respondents said yes, and 25.5% said no (n=368). I used this as my independent variable, and compared four questions pertaining to ever having been tested for HIV/STIs, as well as with the frequency of HIV/STI testing, to see if there was any relation.
HIV testing practices
Responding to the survey question, “Have you ever been tested for HIV? (HIV tests involve either a blood draw, a point of care test [rapid testing – finger prick], or both),” most respondents (78.5%) indicated that they had been tested for HIV before, while 21.5% of respondents indicated that they had not ever been tested for HIV (n=382). When comparing the responses of men who did or did not openly discuss their sexual orientation with their health care provider, there were differences in their responses about whether they had ever been tested for HIV (i.e, there were statistically significant differences based on a Chi-square test with a p<0.05 significance threshold; in this case, p<0.001). Of respondents who had been tested for HIV, most (83.6%) spoke openly to their health care provider, while 16.4% did not; of respondents who had never been tested for HIV, more than half (57.9%) did not discuss their sexual orientation with their health care provider, while 42.1% talked openly about it.
In response to, “Typically, how often are you tested for HIV?” approximately one third (32%) of respondents were tested once per year, followed in response frequency by every 6 months (24.5%), every 3 months (19.4%), less frequently than once every two years (17%), and once every two years (7.1%; n=294). Again, there was a significant difference (p<0.001) between respondents who spoke openly about their sexual orientation and those who did not. The analysis revealed the trend that men who spoke openly about their sexual orientation with their health care providers had a higher likelihood of pursuing more frequent HIV testing: for instance, of men who were tested for HIV once every 6 months, 91.5% openly disclosed their sexual orientation to their health care provider, while 8.5% did not. Conversely, of men who were tested less frequently than once every two years, a much lower 59.1% openly disclosed their sexual orientation to their health care provider, while 40.9% did not.
STI testing practices
When asked, “Have you ever been tested for a sexually transmitted infection (STI, also known as sexually transmitted disease/STD) other than HIV? (STI tests include a combination of blood draw, throat and rectal swabs and urinalysis),” around three quarters (72.7%) of respondents had undergone testing for an STI before, while 27.3% had not ever received an STI test (27.3%; n=385). There was again a significant difference (p<0.001) between respondents who spoke openly about their sexual orientation with their health care provider and those who did not. The STI testing practice results closely mirrored the results for HIV testing practices: of the respondents who had been tested for STIs besides HIV, 82.6% were open about their sexual orientation with their health care provider, while 17.4% were not. Of the respondents who had never been tested for STIs besides HIV, only 53.7% openly discussed their sexual orientation with their health care provider, while 46.3% did not.
In terms of frequency, when asked, “Typically, how often are you tested for STIs?” around half (52.3%) of the respondents were typically tested every three to six months as recommended for MSM (20.5% every 3 months; 31.8% every 6 months), while 26.4% of respondents were typically tested once per year, 8.9% once every two years, and 12.4% less frequently than once every two years (n=258). There was yet another significant difference (p<0.002) between those who discussed their sexual orientation with their health care providers and those who did not. For comparison’s sake, of respondents who were tested every 3 months, 82.4% openly discussed their sexual orientation with their health care provider, while 17.6% did not. In contrast, of participants who were tested less frequently than once every two years, only 64.5% discussed their sexual orientation with their health care provider, while 35.5% did not.
What are your reflections on the results?
The data suggest that men who have sex with men who do not openly talk about their sexual orientation with their health care providers may be less likely to have ever been tested for HIV and other STIs at all, and if they had been tested, a high proportion of these men indicated being tested less frequently than once every two years, which may not be frequently enough to curb the spread of STIs or ensure proper treatment in the event of infection. Future research should further examine this population and develop strategies to increase the rate of testing. Perhaps health care facilities could do more to advertise that their staff are welcoming of diverse sexual and gender identities, which might make patients feel more comfortable disclosing their sexual practices by reducing the perception of stigma. As well, it may behoove health care providers to recommend occasional HIV and other STI testing to all their patients, or at the very least, discuss the importance of testing, recognizing that not every patient will feel comfortable disclosing the types of sexual activities they engage in, if they even volunteer being sexually active at all. This practice might logically reduce the number of people who have never had an HIV or other STI test, regardless of whether or not they disclose their sexual orientation.
Even among men who discussed their sexual orientation with their health care providers, many were getting tested less frequently than every 3-6 months. There are several explanations for this finding. One is that this could reflect barriers to access for certain Manitobans, such as living in a more remote location without convenient access to testing. Another is that they may not have up-to-date knowledge regarding recommendations for frequency of testing. A third possibility could be that the respondents reporting less frequent testing were choosing to abstain from sex or were in a monogamous relationship. It may be worthwhile to further examine men who have disclosed their sexual orientation to their health care providers but who may be getting tested less frequently than is recommended, to determine if this group might possibly benefit from a higher frequency of HIV/STI testing.
Lastly, it will be interesting to compare these findings to those of future survey iterations. As diverse sexual orientations become less taboo with time, I would be curious to see if, in the future, more men feel comfortable openly disclosing their sexual orientation to their health care provider, and if that might be associated with an increase in the overall frequency of testing.
