Research

  • Experience and unmet needs of transgender middle-aged and older adults in oncology care: A qualitative study

    Transgender older adults are at higher risk of poor health outcomes when compared to other non-transgender sexual minority older adults. One-third (33%) of transgender persons reporting at least one negative healthcare experience by healthcare providers due to being transgender (e.g. verbal harassment, refusal of treatment due to their gender identity. Additionally, nearly one-quarter (23%) of transgender persons avoid seeking health care due to fear of discrimination and mistreatment. Cancer is a disease of aging, with individuals >65 years accounting for 60% of all newly diagnosed cancer and 70% of all cancer deaths. Therefore, it stands to reason that a significant but underrepresented number of middle-aged and older transgender people may already have cancer, or are at increased risk of developing it. We can anticipate a continued increase of older cancer patients who are transgender and who will require quality health care and services in the foreseeable future. This is particularly important as cancer is a strong driver for functional decline and a heightened risk of depression in older adults. For persons who are lesbian, gay, bisexual, or transgender (LGBT), a cancer diagnosis may confer higher risk of adverse physical and psychological outcomes compared to those who are heterosexual and/or cisgender. Understanding the cancer care experiences and unmet needs of this marginalized, vulnerable population is a vital first step in the effort to improve care, promote positive care experiences, and decrease the risk of psychosocial distress related to cancer and cancer care. The purpose of this study is to explore the cancer care experiences and potential unmet needs of transgender middle-aged and older adults with cancer.

  • The Ontario PrEP Cohort Study

    PrEP use is becoming more common, but there are still questions about how PrEP will be used by communities most impacted by the HIV epidemic and what potential benefits and challenges will arise as PrEP use grows. The Ontario PrEP Cohort study seeks to answer these questions by enrolling 1250 participants who are using PrEP across the province and collecting data on their health and behaviour while using PrEP, how they think and feel about using PrEP, and their experiences accessing healthcare. We to use this data to inform policies and decision – making regarding PrEP access across Ontario.

  • Supporting Trans and Gender Diverse Youth: Policy and Practice

    Transphobia, and addressing gender justice in the school system have been identified as significant human rights issues. The primary objective of this proposed research is to investigate trans specific education policy contexts and practices with the view to generating knowledge about how the experiences of transgender youth, gender non-conformity and gender creative expression are being addressed in the school system and pedagogically in classrooms (Ehrensaft, 2014;Meyer & Pullen-Sansfacon, 2014; Martino & Cumming-Potvin, 2016; 2018; Ryan et al., 2013; DePalma, 2013). How can the accounts of trans, non-binary and gender diverse youth be employed to better inform current practice in schools with respect to supporting gender expansive education? While there is evidence of trans specific school board policies in jurisdictions such as Ontario and California where we are conducting research, there is no detailed analysis of such polices, no school-based research that has investigated the effects of these policies, and scant research that has been generated about trans-affirmative pedagogical practices in the classroom and which centre the accounts of trans and gender diverse youth as a vital and necessary source of knowledge. The aim of this research, therefore, is to generate knowledge about trans-affirmative policies and practices in school boards/districts and to centre the accounts of trans and non-binary youth both inside and outside of school. Research is needed that seeks to include the interpretive insights of transgender, gender diverse and non-binary students and educators, as well as those from the broader trans community, with the expressed purpose of learning about policy and pedagogical effects of trans-affirmative interventions in schools from their standpoints. Central to this study, therefore, is a commitment to interpretive collaborative research that is grounded in a recognition of the need to learn from transgender, non-binary and gender diverse youth, trans educators, community members and to involve them in an examination of current trans policies and resources that are being employed in schools (Dodson et al., 2007). Moreover, in order to ensure “the spectrum of identities found within the community” (Green, 2010, p. 3), a diverse representation of subgroups from within the trans community will be included in the sample (Namaste, 2000). Interpretive input from and collaboration with trans, non-binary and gender diverse students, educators and community members will lead to building more informed and grounded knowledge and understanding of current policies and pedagogical practices in the education system that are committed to ensuring transformative gender justice (Travers, 2014; Stryker, 2006; Noble, 2004).

  • The Queer Feels Study

    Sexual and gender minority (SGM) individuals are at increased vulnerability to mental health difficulties compared to their heterosexual and cisgender counterparts. Minority stress theory has spawned a large body of research indicating that experiences of stigma and discrimination can account for such mental health discrepancies. Recent research suggests that emotion regulation may be a mechanism through which stigma compromises well-being, however research has yet to examine individual factors related to emotion regulation that may increase vulnerability or bolster resilience to negative well-being following stigma-related events. The proposed study applies the psychological mediation framework (Hatzenbuehler, 2009) to examine pathways from stigma-related events to negative affect and psychological distress. The mediating roles of emotion regulation, resilient coping, self-compassion, social support and internalized stigma will be examined. Moreover, general developmental moderators of the stigma- distress relationship including childhood violence history, and attachment style, will be examined, as well as LGBT-specific moderators of the stigma- distress relationship including discrimination history and LGBT connectedness. LGBTQ2S individuals over the age of 18 (n=125) will be recruited for an online, cross-sectional baseline survey of demographics, emotion regulation ability, childhood violence history, attachment style, social support, self-compassion, resilient coping, LGBT connectedness and experiences of minority stress. Participants will then report on their daily experiences of stressful events, stigma-related events, affect, emotion regulation and emotion-focused coping for 10 days via using a smartphone app. Hierarchical linear modeling will be used to determine the relationship between stigma and affect within participants (Level 1) and across participants (Level 2), and the role of hypothesized mediators will be examined in Level 2 of the model. The proposed study aims to inform LGBTQ2S-specific psychotherapy interventions that focus on emotion regulation, self-compassion and enhancing resilience aimed at alleviating minority stress in LGBTQ2S individuals.

  • An Examination of Resilience Against HIV/AIDS Among Middle-aged and Older Men Who Have Sex With Men: Resources, Strengths, and Protective Factors

    Background and Rationale: There is considerable resilience among middle-aged and older, cis and trans, gay, bisexual, and other men who have sex with men (MSM) against HIV/AIDS. Despite being part of a population at increased risk for acquiring HIV, many MSM aged 40 years and older (40+) have remained HIV-negative (HIV-) since the start of the epidemic. Among HIV-positive (HIV+) MSM aged 40 years and older, many have exhibited resilience against HIV/AIDS not only by surviving its adverse impacts, but also by living active and full lives; fiercely advocating for their rights, and health care and service needs; and staunchly supporting and promoting prevention and intervention programs dedicated to ending HIV/AIDS. Since the beginning of the HIV/AIDS epidemic in the early 1980s, MSM have remained the population most affected by HIV/AIDS in Canada. Although the proportion of HIV cases among MSM 30 to 39 years old has been decreasing since 1994, the proportion of new HIV infections among 40+ MSM has been increasing since the beginning of the epidemic. The Public Health Agency of Canada reports that most research available on HIV/AIDS among MSM focuses on their vulnerability and that research on resilience of MSM against HIV/AIDS is wanting. It also reports that although there are studies on young MSM and resilience, there is a lack of research undertaken with older MSM. This suggests that resilience of older MSM against HIV/AIDS represents a serious research gap. Scientific literature and historical accounts provide evidence of resilience among MSM, and some research shows the challenges and coping strategies of HIV+ older MSM. However, to date, there has been no research conducted to examine the resilience of both HIV+ and HIV- 40+ cis and trans MSM against HIV/AIDS. Aim: The aim of our project is to examine the resources, strengths, and protective factors HIV+/- 40+ MSM possess that prevent HIV acquisition and transmission in the community and allow them to thrive in a society that may not be ready to meet the growing needs of a burgeoning number of older MSM and HIV long-term survivors in the decades to come. Project Design: Staying true to the tenets of Community-Based Research (CBR), we plan to recruit and include in our project several HIV+ and HIV- 40+ MSM as members of our Community Advisory Board and as peer researchers (PRs) so that they can provide input and feedback on all aspects and during all stages of the research process as full partners. We will provide training for our PRs so that they can interview thirty HIV+ and thirty HIV- 40+ cis/trans MSM from across Ontario to explore their resilience against HIV/AIDS. Our PRs will use an interview guide – informed, developed, and created with the input of our relevant stakeholders – to conduct confidential, semi-structured, digitally audio-recorded interviews with study participants. We will be employing a constructivist grounded theory approach to our research project, including multiple perspectives and interpretations into the iterative process of generating information and theory from the critical thematic analysis of interview data at different phases of the project.

  • Toward a Practice Framework for Sexual and Gender Minority Forced Migrants Acculturating into Canadian Society

    Through individual interviews, this study aims to achieve two objectives. The first objective of this study is to illuminate how LGBTQ-affirmative mental health care providers and refugee mental health providers describe their readiness to support LGBTQ forced migrants in Canada. The second objective is to learn what therapeutic approaches best support LGBTQ forced migrants’ mental health and wellbeing. The specific aims of the study are to a) identify gaps in knowledge, attitudes, and skills in serving LGBTQ refugees/forced migrants; b) uncover emerging best practices for serving LGBTQ refugees/forced migrants that can be shared with a diverse array of mental health practitioners; and c) understand from LGBTQ refugees/forced migrants who have received treatment from mental health providers what factors facilitated and/or hindered their mental health and wellbeing. These objectives and aims will be achieved through triangulating the insights, expertise, and experiences with four subsample groups: 1) LGBTQ-affirmative mental health providers with no experience serving refugees; 2) refugee mental health providers with no experience serving LGBTQ individuals; 3) mental health providers who have experience serving LGBTQ refugees/forced migrants; and 4) LGBTQ forced migrants themselves who have received treatment from mental health providers. Samples will be recruited across Canada.

  • Development and Validation of Sexual Quality of Life Questionnaire for Men-Who-Have-Sex-with-Men with Prostate Cancer

    The purpose of this study is to develop a sexual function survey specific for men who have sex with men (MSM) and others with prostates, and who have also been diagnosed with prostate cancer. This survey will be used to further research on MSM and other people with prostates who have prostate cancer, and help such men make treatment decisions. Our goal is to reach 200 participants for this phase before we analyze results for producing a more refined assessment tool for the final phase of our study.

  • Engage: Advancing Gay and Bisexual Men’s Sexual Health

    Engage is a 5-year Canadian collaboration between researchers and community-based organizations on HIV and sexual health among gay, bisexual, and queer men, including trans men and other men who have sex with men (gbMSM) in Canada. Its three primary aims are to provide research evidence to inform HIV and STBBI prevention initiatives for Canadian gbMSM, build capacity for a pan-Canadian network on HIV and sexual health research for gbMSM, and integrate community engagement into all stages of the project to enhance community-researcher collaboration and bidirectional knowledge exchange.