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Exploring Health Care Access for Gay, Bisexual, and Other Men Who Have Sex with Men Living in Middlesex County, Ontario

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Exploring Health Care Access for Gay, Bisexual, and Other Men Who Have Sex with Men Living in Middlesex County, Ontario Western University Scholarship@Western Electronic Thesis and Dissertation Repository 9-26-2014 12:00 AM Exploring Health Care Access for Gay, Bisexual, and Other Men Who Have Sex with Men Living in Middlesex County, Ontario Todd A. Coleman The University of Western Ontario Supervisor Dr. Greta Bauer The University of Western Ontario Graduate Program in Epidemiology and Biostatistics A thesis submitted in partial fulfillment of the equirr ements for the degree in Doctor of Philosophy © Todd A. Coleman 2014 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Health Services Research Commons Recommended Citation Coleman, Todd A., "Exploring Health Care Access for Gay, Bisexual, and Other Men Who Have Sex with Men Living in Middlesex County, Ontario" (2014). Electronic Thesis and Dissertation Repository. 2469. https://ir.lib.uwo.ca/etd/2469 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. EXPLORING HEALTH CARE ACCESS FOR GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN LIVING IN MIDDLESEX COUNTY, ONTARIO (Dissertation format: Integrated Article) by Todd Anthony Coleman Graduate Program In Epidemiology & Biostatistics A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Todd Anthony Coleman 2014 iii Abstract Published research suggests gay, bisexual, and other men who have sex with men (GB-MSM) present in health care with additional, distinct psychosocial and sexual health concerns compared to heterosexual men, emphasizing the importance of access to health care for these groups. This exploratory thesis used data from the online survey (n=202) of the Health in Middlesex Men Matters (HiMMM) Project – a community-based study examining health care access for GB-MSM living in Middlesex County, Ontario. For each manuscript, blockwise modified Poisson regression models were fit sequentially with predisposing, enabling, and need variables, as theorized by the Behavioral Model of Health Services Use. The first manuscript identified factors associated with access to a primary care provider (PCP), identifying subgroups with which to direct health care promotion efforts centred upon access. Older age, student status, marital and relationship status, social support (from a significant other and from GLBT - gay, lesbian, bisexual and transgender - communities), and self-perceived general health were crudely associated with having a PCP and were variably significantly associated with the outcome during the modelling process with additional variables. The second examined factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues. Marital/relationship status, experiences of homophobia, and assessment of provider’s communication were associated with having a PCP know respondents’ sexual orientation, crudely and in the modelling process with other variables. Internalized homonegativity, experiences of homophobia, provider communication, and prior negative experiences with a PCP were associated with talking to a PCP about GB-MSM health issues. The third examined demographic, socio-behavioural, and community-relevant factors associated with mental health service utilization in the past 12 months for local GB-MSM. Access to a PCP, childhood versus current religiosity or spirituality, self-perceived mental health, and internalized homonegativity were associated with the outcome, crudely, and in the blockwise modelling process with other variables. The fourth manuscript investigated demographic and socio-behavioural factors associated with not accessing HIV testing services, and explored descriptive reasons for this, iv discussing implications for HIV testing promotion. Factors significantly associated with being untested included social connection to GLBT communities, current versus childhood religiosity/spirituality levels, education, and employment. Keywords: Health care access; HIV testing; gay, bisexual, and other men who have sex with men; mental health service utilization; primary care v Co-Authorship Statement All chapters, including the four manuscripts that present results, of this thesis were written by Todd Coleman and are intended to fulfill the requirements of his doctoral degree in the Department of Epidemiology & Biostatistics. These manuscripts were all written based on data collected from the Health in Middlesex Men Matters (HiMMM) Project. The HiMMM Project is a community-based research project initiated by Mr. Coleman, based on his attendance at a community health forum for the local “lesbian, gay, bisexual, two-spirit, questioning,” or “LGBT2SQ” communities in London, Ontario in 2006. Mr. Coleman conceived the original idea for the project, built the research team, and designed all elements of the project in collaboration with the research team. Mr. Coleman participated in all project activities, including writing two funding proposals; writing two research ethics board submissions; designing a capacity-building phase; managing the project’s qualitative recruitment; conducting qualitative interviews; managing quantitative survey recruitment; cleaning and creating new variables for the quantitative data set; completed most data analysis (all data analysis related to this thesis); participated in knowledge translation activities; and was primarily responsible for general project management activities. The manuscripts in this dissertation represent work completed by Mr. Coleman. He conceived of the research questions, designed the analyses, conducted all analyses, and wrote all components of the manuscripts. Research questions were formed based on findings from the LGBT2SQ health forum, and informational needs from the Regional HIV/AIDS Connection, St. Joseph’s Infectious Diseases Care Program, the Options Anonymous HIV Testing Clinic at the London InterCommunity Health Centre, and the Middlesex London Health Unit. Analyses were designed by Mr. Coleman with assistance from his Thesis Supervisory Committee – Drs. Greta Bauer, Barry Adam, Kathy Nixon Speechley. Drs. Greta Bauer and Kathy Nixon Speechley were consulted and provided guidance in matters related to survey design and data analysis, as needed. All manuscripts were drafted by Mr. Coleman. The Thesis Supervisory Committee and HiMMM research team provided feedback on each of the four manuscripts. Team members who assisted in conceptualization, who worked on commenting and editing of the manuscripts were listed as authors. vi Dedication To all those who have inspired me over this incredible mind-expanding journey, I appreciate and cherish you all. vii Acknowledgements There are many people that need to be thanked for their direct or indirect contributions to this thesis: Firstly, I would like to thank my supervisor, Dr. Greta Bauer, for her tremendous direction throughout the past seven years. It has been a long, long journey and I could not imagine having anyone else guiding me through it. The HiMMM Project research team (Daniel Pugh, Gloria Aykroyd, Meredith Fraser, Kevin Murphy, Rob Newman, Lyn Pierre Pitman, Leanne Powell, and former members Edwin Scherer, Rick Mulvaney, and Mark Defend), for their enthusiasm, support, insights, and feedback. The organizations affiliated with the HiMMM Project (Regional HIV/AIDS Connection, St. Joseph’s Infectious Diseases Care Program, Options Anonymous HIV Testing Clinic, Middlesex-London Health Unit) for their in-kind support of resources and meeting space throughout the years. Dr. Barry Adam for providing important and valued knowledge regarding historical and evolution of sexual minority communities in Canada, and his insightful and crucial feedback on the HiMMM Project and this thesis. Dr. Kathy Nixon Speechley, for her expertise in survey design and research methods, her meticulous feedback, and her ongoing support throughout the writing process. The Infection & Immunity Group (Jennifer Jairam, Jessica Armstrong, Nooshin Khobzi, Karin Hohenadel, Shamara Baidoobonso, Xuchen Zong, Ayden Scheim, Kaitlin Bradley, Roxanne Longman, Andrew Warner, Soraya Blot, Melissa MacLeod, Christopher Dharma, Rachel Giblon) whose members have helped me so much over the course of the years in many aspects of this project. The Canadian Institutes of Health Research and the Ontario HIV Treatment Network for their generous financial support of my thesis research. To Michael, for his love, understanding, and support throughout this entire process. To my parents, Ronald and Lise, for their love and support and everything else they have done throughout the years to help me on this academic journey. Finally, to all participants of any phase of the HiMMM Project for sharing their personal stories and information. viii Table of Contents Certificate of Examination ………………………………………………………. ii Abstract ………………………………………………………….………………. iii Co-Authorship Statement ………………………………………………………... v Dedication ……………………………………………………………………….. vi Acknowledgments ……………………………………………………………….. vii Table of Contents ………………………………………………………………... viii List of Tables ……………………………………………………………………. xii List of Figures …………………………………………………………………… xiv List of Appendices ………………………………………………………………. xv List of Abbreviations and
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