A syndemic in nonurban gay and bisexual men in British Columbia and within Island Health

Abstract

Inequitable HIV acquisition persists among gay and bisexual men (GBM). In 2017, GBM represented 69.8% of new HIV diagnoses in British Columbia (BC) and 80.5% of new HIV diagnoses within Island Health (BCCDC, 2019). I used syndemic theory to examine the relationship between nonurban living environment, syndemic factors, and health outcomes among GBM within Island Health and in BC. I conducted a secondary analysis of the Community Based Research Centre’s Sex Now 2015, a national cross-sectional survey of approximately 8000 Canadian GBM. I conducted chi-square tests to compare levels of stigma stratified by urban or nonurban, Cramer’s V to examine the association between syndemic factors, and Poisson regression to determine which demographics and health outcomes were associated with more syndemic outcomes. I found prevalent stigma that negatively impacts urban and nonurban GBM. Urban GBM experience more stigma (e.g., called names or slurs) and worse outcomes (e.g., considered suicide) than nonurban GBM in Island Health and BC. Among nonurban GBM within Island Health, Cramer’s V may demonstrate a syndemic (e.g., strong associations between several measures of stigma such as verbal violence and discrimination at work and health outcomes such as depression, suicide, partner violence, and alcohol use). Among nonurban GBM within Island Health, Poisson regression revealed that more syndemic factors were associated with negative health outcomes and risk factors, such as attempting suicide, condomless sex, having sexual partners of unknown HIV status, and living with HIV. These findings suggest that a syndemic can occur among nonurban GBM without migration to a large urban centre. Key implications include a need for structural change to destigmatize sexual diversity. Results illustrate a need to normalize conversations about mental health among GBM who would benefit from co-located services that address stigma, mental health, substance use, and sexual health.