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Still, We Thrive: Exploring Structural Barriers: Facilitators to Wellness Among Gay, Bi, Trans, and Other Men Who Have Sex with Men (GBTMSM)

still-we-thrive-exploring-structural-barriers-facilitators-to-wellness-among-gay-bi-trans-and-other-men-who-have-sex-with-men-gbtmsm

Researcher bios and how their research backgrounds relate to this study

Todd Coleman is an Assistant Professor and researcher at Wilfrid Laurier University. He co-directs the Social Inclusion & Health Equity Research Group, a dynamic hub for community partners, undergraduate and graduate students, and research partners to collaborate on high quality, rigorous research that results in program and policy change. Todd's research primary focuses on the broad areas of population health, HIV/AIDS, healthcare access, sexual health, and human sexuality, and focuses specifically on the impacts of various forms of social exclusion on health, mental health, and wellbeing.
Lucas Gergyek is a Community Psychology graduate student and researcher at Wilfrid Laurier University. He first began working in the GBTMSM sexual health and broader health sector in fall 2019, when he began volunteering at the AIDS Committee of Ottawa (ACO) as an outreach and community engagement assistant. In this role, Lucas worked predominantly with the men who have sex with men (MSM) priority area, assisting in facilitating a weekly HIV and STBI testing clinic where he provided sexual health, substance use and mental health education and harm reduction resources and supplies. In the spring of 2020, Lucas joined the Social Inclusion and Health Equity Research Group, and more recently, joined the team at the Gay Men's Sexual Health Alliance as a practicum student turned project contractor. In these roles, Lucas seeks to foster community-based collaboratives between community members, service providers, other researchers, and policy makers to produce high-quality research that characterizes how structural- and community-level factors influence the wellbeing of GBTMSM across a number of measures, including in regard to service access, community navigation, sexual health, mental health, substance use.

Purpose of this research project

Historically and concurrently, structural violence has been a significant force influencing the sexual health and broader health of gay, bisexual, transgender and other men who have sex with men (GBTMSM). Yet to date, the majority of projects exploring the health inequities facing GBTMSM have focused on intrapsychic and behavioural factors as most related to poor health outcomes. As well, these studies are sometimes deficits focused, and fail to evaluate how GBTMSM continue to thrive, and maintain positive health. As a result, the ways in which systems and policies underlie and perpetuate health inequities facing GBTMSM have been somewhat obscured. Connectedly, little is known about the relevance of 2SLGBTQ+ affirming systems and policies for the wellbeing of GBTMSM. As well, the majority of studies characterizing the sexual health and broader health of GBTMSM are quantitative in nature, and come from large metropolitan centres, such as Toronto. As a result, in-depth, region-specific data is lacking, and local 2SLGBTQ+ organizations are compelled to rely on data that may not be generalizable to the GBTMSM in their regions. To best inform GBTMSM service provision across the SW Ontario region, it is pertinent that qualitative data recognizing how relevant factors (e.g., rurality) may be associated with unique health outcomes especially for those with overlapping marginalized identities is gathered. Accordingly, this study seeks to expand on the scarce qualitative literature exploring how systems and policies may act as structural barriers and facilitators to wellness for GBTMSM. 30 GBTMSM with diverse ethnoracial identities, gender identities, HIV statuses and ages from across Southwestern Ontario (approximately five per region) will be purposively sampled through local AIDS service organizations (ASOs), other agencies working with GBTMSM and through outreach through social media platforms, such as Instagram, and dating/hook-up apps, such as Grindr, Scruff and Squirt. Semi-structured/narrative blended interviews will seek to characterize how systems and policies serve as barriers and facilitators to wellness. Particular questions will tend to favour a structural level analysis, asking participants to reflect on their experiences with heteronormativity and/or cisnormativity, racism, healthcare access, sexual health education, and community cohesion. An inductive latent thematic approach following Braun & Clark’s Six Phases will be employed to develop a coding grid, where a final set of themes will be identified. Knowledge produced through this project will be used to identify tangible points for systems change, where greater 2LGBTQ+ affirming policies can be introduced. As well, to facilitate in member checking and knowledge mobilization, an optional virtual retreat will be held, where participants will have the opportunity to review emerging themes and represent their narrative accounts through arts-based mediums to be displayed on a research project website.

How this research will help LGBT2SQ people and communities

This project seeks to support LGBT2SQ people and communities in a number of ways. Firstly, the knowledge garnered from this project will contribute to the prospective development and adaptation of services provided to GBTMSM in the SW Ontario region, and prospectively, beyond. As well, the findings from this study will be used to identify tangible points for systems change, where greater 2SLGBTQ+ affirming policies, systems and services can be introduced. Connectedly, the project will assist in the development of new knowledge regarding the barriers and facilitators to wellbeing that GBTMSM face in the community. As well, the study will offer participants the space to reflect on how factors such as social support networks and self-care techniques contribute to their positive wellbeing, encouraging space for positive self-reflection. Finally, the knowledge garnered from this project will seek to supplement knowledge gaps, better positioning agencies and services in the Southwestern Ontario region to best meet the needs of GBTMSM they may interact with and/or serve.

Participants

Any individual who identifies as gay, bisexual, trans, or a man who has sex with men (GBTMSM) over the age of 18 who currently lives in the Southwestern Ontario region (inclusive of Hamilton, Kitchener-Waterloo, London, Guelph, Windsor, and Niagara) can participate in this research project.

Compensation

Participants will be compensated $40 CAD for their time and expertise.

Mitigation measures

This project seeks to garner insight into the lived experiences of GBTMSM, a diverse subpopulation who continue to face a great deal of community- and societal-level stigmatization and alienation. Accordingly, the research team intends to carry out this proposed project with sensitivity and inclusion as top priorities. Regardless, there are some important ethical considerations that must be addressed. Perhaps most significantly, there is a heightened risk for emotional discomfort due to self-disclosure and the nature of the interview questions. As part of the interview process, the interviewee will be asked to share detailed information regarding their experiences of heteronormativity, cisnormativity and/or racism; these discussions may be triggering for some. However, participants will be provided with a resource list in their consent package, outlining relevant counselling/support options in the case that a participant experiences distress during or after their interview. In addition, the secondary investigator (Lucas) has over two years of counselling experience, and both the primary and secondary investigators (Todd & Lucas) have extensive experience working in the GBTMSM sexual health sector. Ultimately, if significant emotional discomfort occurs during the interview, the researchers will not hesitate to end the session if the interviewee wishes to do so. In this case, the interviewee will be ensured that they will still receive compensation for their time and will be directed to the appropriate follow-up resource.
In addition, moral ambiguity and risk are of especial relevance to the proposed research project. As mentioned, participants will be asked to share detailed information about the ways in which systems and policies perpetuate heteronormativity, cisnormativity and/or racism, perhaps leading participants to reflect on experiences of discrimination, victimization and violence. The secondary investigator (Lucas) feels confident that his extensive experience working as a counsellor will provide him with the relevant foundation to support participants during triggering disclosures. As well, during these interviews, participants may potentially disclose highly sensitive information, such as childhood emotional, physical or sexual abuse, or abuse and/or mistreatment by a healthcare or social service provider. If the participant still lives with an emotionally, physically, or sexually abusing guardian or partner, the participant and researchers will co-construct a safety plan. Rather than alerting social service or policing bodies and putting the participant in danger, the interviewer will provide the participant with a referral to a relevant support service (e.g., SPECTRUM Waterloo). Moreover, to protect the well-being of the interviewers, the SIHER Group will create space for those conducting these interviews to debrief, and process emotional impact.
In addition, coercion is an ethical threat inherent to this project, as two of the researchers hold a significant amount of privilege as white, cisgender male researchers working with a diverse sample of GBTMSM. In this context, power asymmetry is inevitable, as the research process is oppressive, and social differences may be emphasized in this context (DiCicco-Bloom & Crabtree, 2006). In an attempt to attenuate the impacts of these asymmetries, the research team has hired Fabian Fletcher (ACCKWA), a BIPOC GBTMSM-identified community worker and research assistant to conduct the interviews and data analysis alongside. The researcher hopes that including the perspectives of Fabian will broaden the scope and inclusion of this project. As well, for BIPOC participants, the researcher hopes that the presence of Fabian will serve to increase comfortability and build rapport, curating a more meaningful space for discussion. Moreover, to minimize the influence of coercion, the researcher will engage in reflexivity before and throughout the research process, recording questions and concerns in their research journal. As well, a well-documented method for minimizing the implications of such power differentials involves integrating reciprocity into the creation of knowledge by offering some personal information (DiCicco-Bloom & Crabtree, 2006). Accordingly, the researcher has included a prompt in the interview guide which allows them to share some sensitive details of their own, seeking to build rapport and minimize power asymmetries.
Finally, protecting the confidentiality and privacy of participants is of the utmost importance to the research team. Only de-identified and anonymized quotations will be presented in the final paper and any resulting future publications or knowledge mobilization projects. As well, as mentioned previously, to provide adequate context for knowledge uptake, demographic identifiers will be associated with each quotation presented. However, specific cities and counties within each ASO’s catchment area will not be linked to these quotations. Rather, only the general catchment area will be reflected, seeking to minimize the recognizability of certain quotations. Regardless, the research team intends to outline the limits of confidentiality prior to recruitment, and throughout the research process, in that there is the potential for de-identified and anonymized quotations to be recognized by those close to the participant

Promoting the Study

This study is being promoted through the social media platforms of AIDS service organizations (ASOs) and other agencies and services that work with GBTMSM in the Southwestern Ontario region (e.g., SPECTRUM Waterloo). As well, the study will be promoted on Instagram through a research project account (@stillwethrive), where the research team will connect with ASOs and other agencies working with GBTMSM to inquire about sharing our posts containing study information and eligibility details. Finally, the study will be promoted on GBTMSM dating/hook-up apps (Grindr, Scruff, Squirt) by use of a study profile. Through these means, prospective participants will have access to study information, eligibility criteria, and compensation details. As well, these profiles will represent an opportunity for prospective participants to connect and ask any questions or garner further clarification on the project.

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