Chris Campbell (2021)
Research Report: Chris Campbell (2021)
Who are you?
My name is Chris, and I helped to plan and coordinate the first cohort of the Investigaytors program with Jared Star in 2020. I am a white, gay and queer, cisgender man and I’m a settler in Winnipeg on Treaty 1 land, which brings certain privileges and responsibilities with it. I have made my career in research, working for a variety of academic studies involving 2SLGBTQ+ education and equity (primarily with Dr. Catherine Taylor at The University of Winnipeg on the RISE Research Program, www.uwinnipeg.ca/rise), and I am currently working on my PhD in Education at the University of Manitoba. In 2019, I began working on the Manitoba 2SGBQ+ Men’s Health Study with Dr. Rusty Souleymanov—which collected data on the experiences of 2SGBQ+ cis and trans men in Manitoba’s health-care system.
I see research as a vital part of working toward greater social equity and addressing various forms of oppression in social relations, including systemic and institutional structures like education and health care. Research is often seen as something that is highly specialized and reserved for those in formal positions, but I’ve increasingly seen how we all engage in research to live our lives and make decisions. It’s something that is available to all of us and, I hope, can help us understand our social and cultural relationships better—even helping us to advocate for social change to redress inequities perpetuated by heteronormativity, cisnormativity, racism, colonialism, and ableism. This is why I get excited about research and working with people and on topics related to 2SLGBTQ+ communities.
What is your research question?
In thinking about how to frame a question using data from the Manitoba 2SGBQ+ Men’s Health Study, I decided to take up a question that engaged with two of the major themes of the study, looking at participants’ perceptions of discrimination and how this may affect access to health care for 2SGBQ+ cis and trans men. Specifically: How do perceptions of discrimination in health-care settings affect 2SGBQ+ men’s ability to access health care that is responsive to their needs as 2SGBQ+ men?
To answer this question, I looked at bivariate crosstabs comparing recent experiences of discrimination across six questions from the survey related to respondents’ openness about their sexual orientation with health providers, their rating of the importance of having a 2SGBQ+ doctor, and their practices regarding HIV/STI testing (whether they had ever had HIV/STI tests and with what frequency).
Why I picked this research question?
I wanted to look at experiences of discrimination (as my independent variable) to see how respondents’ experiences of discrimination may have affected their ability to access health care and the frequency with which they access it. My initial thinking was that experiences of discrimination among 2SGBQ+ men will have a negative impact on their inclination to access health care. This would not necessarily mean that they are not accessing health care, but they may be doing it less frequently and have greater apprehension when doing so. I suspect that those with experiences of discrimination in health-care settings would access health care less frequently and report that it is more important for them to have a health-care provider that they can be open with about their sexual orientation.
What do the results say?
As I mentioned above, I chose to look at how recent experiences of discrimination in health-care settings affected how 2SGBQ+ men’s accessed health care.
When asked “Over the past two years, how often have you experienced discrimination (i.e., treated badly or unfairly, denied equal treatment or services, verbally harassed or disrespected, physically assaulted or attacked) in health care settings?” the majority (65.3%) of respondents reported they had experienced some form of discrimination in the past two years (34.7% had not; n=343). Specifically, 2.3% reported that they had “Always” experienced discrimination in the past two years, 13.4% selected “Usually,” 31.5% “Sometimes,” and 18.1% “Rarely,” with 34.7% of respondents saying they had “Never” experienced discrimination in the past two years.
Using this as my independent variable, I compared six questions that focused on health-care access to see whether experiences of discrimination affected respondents’ ability to be open about their sexual orientation with their health providers, respondents’ ratings on the importance of having a 2SGBQ+ doctor, and whether this variable affected respondents’ HIV/STI testing practices.
Talking openly about sexual orientation with health-care provider
In response to the question “Do you talk openly about your sexual orientation with your health care provider?” three-quarters of respondents (74.5%) reported that they could, while 25.5% said they could not (n=368).
When we compared the responses of those that had experienced discrimination in health-care settings, we found there were no differences in their responses about whether they were open with their health-care provider about their sexual orientation (i.e., there were no statistically significant differences based on a Chi-square/X2 test with a p<0.05 significance threshold).
Importance of having a doctor or health-care provider who identified as a 2SGBQ+ man
When asked “How important is it to you that your doctor or health care provider is also a Two-Spirit gay, bisexual, or queer identified man?”, respondents were relatively evenly distributed (n=362), with 12.7% reporting “It’s necessary for me,” 20.4% “It’s extremely important, but not necessary,” 18.8% “It’s very important, but not necessary,” 20.4% “I’d prefer it, but am fine either way,” and 27.6% saying “It doesn’t matter to me” (n=362).
When we compared the results of those who reported having experienced discrimination with respondents’ ratings of how important it was to have a 2SGBQ+man, we found that there were statistically significant differences (p<0.05). While I won’t report the entire crosstab results, I would generally summarize the difference by noting that higher numbers of those who reported having experienced discrimination in health-care settings said that it was necessary or very important to them to have a 2SGBQ+ doctor or health-care provider.
We can see this more clearly represented in the data if we look at those who reported having “Never” experienced discrimination in healthcare settings in the past two years (34.9% of sample). Respondents who reported not having been discriminated in the past two years were less adamant about having a 2SGBQ+ doctor or health-care provider, with 60.7% of those who said “It doesn’t matter to me” having reported never having experienced discrimination and 53.5% of those saying “I’d prefer it, but am fine either way,” and lower numbers reported among those who said it was necessary (18.2%), extremely important (15.5%), or very important (12.1%) to them.
HIV and STI testing practices
We asked about HIV and STI testing in separate questions in the survey, finding slight variations in responses. When we asked “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)?”, the majority of respondents (78.5%) reported having been tested at some point (21.5% had not been tested for HIV; n=382). 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),” almost three-quarters (72.7%) reported having received an STI test at some point (27.3% had not received an STI test; n=385). However, when we used participants’ responses about their experiences of discrimination in health-care settings to compare whether this impacted whether they had ever received an HIV or STI test, we found there were no significant differences for either question.
There were, however, significant differences (p<.005) when it came to frequency of testing. Overall, when asked “Typically, how often are you tested for HIV?” respondents reported the following: 19.4% reported they were tested for HIV every 3 months, 24.5% said they were tested every 6 months, 32.0% said they were tested once per year, 7.1% said they were tested once every two years, and 17.0% said they were tested less frequently than once every two years (n=294). When we compared the results of those who reported having experienced discrimination with how frequently they reported being tested for HIV, we found that those who had never experienced discrimination reported being tested less frequently than those who had—contrary to what I expected to see. For instance, there were higher numbers of those who reported never having experienced discrimination in the less frequent testing range (50.0% in the category of less than every two years, 42.1% once every two years, and 44.9% once per year) than in the more frequent and recommended 3 and 6 month testing schedule (27.8% and 27.5% respectively). However, among those who reported “sometimes” experiencing discrimination, the main differences seemed to located in higher representation for those who were tested every 6 months (42.0%) and once every two years (42.1%), and in lower representation for those tested less frequently than once every two years (17.5%).
Again, there was a significant difference between respondents who had experienced discrimination in health-care settings and those who had not when it came to frequency of STI testing. When asked “Typically, how often are you tested for STIs?” respondents reported the following: 20.5% said they were tested for STIs every 3 months, 31.8% said they were tested every 6 months, 26.4% said they were tested once per year, 8.9% said they were tested once every two years, and 12.4% reported they were tested for STIs less frequently than once every two years (n=258). When we compared the results of those who reported having experienced discrimination with how frequently they reported being tested for STIs, we found that those who had never experienced discrimination were less frequently tested, with 61.3% being tested once every two years and 40.3% once per year; there were fewer respondents who said they had never experienced discrimination among those tested once every 6 months (22.4%). Again, I found that there were notable differences among those who reported “sometimes” experiencing discrimination, with higher numbers among those tested every 6 months (47.4%) and lower numbers for those tested every 3 months (24.0%) and less frequently than once every two years (16.1%).
What are your reflections on the results?
Overall, I think there is more research needed on how experiences of discrimination impact 2SGBQ+ men’s access to health care. This is especially important when thinking about respondents’ frequency of testing for HIV and for STIs, where results seem to indicate that those who had experienced discrimination in health-care settings were tested more frequently than those who had not—or that more frequent experiences of discrimination did not deter respondents from frequent testing. (Note: It’s also possible that other confounding variables are at play in this relationship.)
Respondents’ preference for a 2SGBQ+ doctor or health-care provider is a clear indicator that 2SGBQ+ men would like a health practitioner who understands their needs, especially among those who have experienced discrimination at some point. For those who have experienced discrimination in health-care settings, particularly if they had experienced discrimination based on their sexual orientation (as 23.3% of those who reported having experienced discrimination indicated) or gender identity (as 24.5% of those who had experienced discrimination indicated), it makes sense that they would be more inclined to want a health practitioner who identified as 2SGBQ+.
I am not entirely sure how to make sense of the significant differences in the findings on frequency of testing for HIV and STIs. There are not clear trends between the two crosstab analyses, nor is it clear why those who had experienced discrimination seem to be represented among those tested more frequently. These are not necessarily definitive trends, but they are, I think, suggested by the data. I can think of two possible explanations here:
(1) Those who are tested more frequently are those who recognize the importance of frequent testing for their own health and may have more frequent exposure to a variety of health settings, increasing their likelihood of encountering discriminatory behaviours. For example, we might consider participant responses to questions about other health conditions, results of previous HIV or STI testing, or their sexual practices to see if they may have reason to more regularly frequent health-care settings.
(2) Recruitment for the survey was conducted among marginalized populations (for instance, among clientele of Nine Circles clinic), who may have had experiences of discrimination elsewhere and who, as a result, have sought out “alternative” health services and ended up being connected with a health provider who provides regular testing services as part of their mandate.
Finally, it is encouraging that there are no significant differences among those who had experienced discrimination and their ability to discuss their sexual orientation with their health provider. This suggests that those who do disclose their sexual orientation are no more likely to experience discrimination as a result—although again this may be the result of participants seeking out health-care providers who respondents knew to be affirming. However, it is also worth noting here that only three-quarters of the sample did feel they could be open with their health provider, suggesting that one-quarter has misgivings about disclosing or feels unable to do so for some reason, leaving 2SGBQ+ specific health needs unaddressed.
