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Unemployment is more common among people living with HIV (PLWH) compared to the general population. PLWH who are employed have better physical and mental health outcomes compared to unemployed PLWH. The main objective of this mixed-methods study was to conduct a program evaluation of Employment Action (EACT), a community-based program that assists PLWH in Toronto, Ontario, Canada to maintain meaningful employment. We extracted quantitative data from two HIV services databases used by EACT, and collected qualitative data from 12 individuals who had been placed into paid employment through EACT. From 131 clients included in the analysis, 38.1% (n = 50) maintained their job for at least 6 weeks within the first year of enrollment in the EACT program. Gender, ethnicity, age, and first language did not predict employment maintenance. Our interviews highlighted the barriers and facilitators to effective service delivery. Key recommendations include implementing skills training, embedding PLWH as EACT staff, and following up with clients once they gain employment. Investment in social programs such as EACT are essential for strengthening their data collection capacity, active outreach to service users, and sufficient planning for the evaluation phase prior to program implementation. [ABSTRACT FROM AUTHOR]

Critical scholarship has illustrated how COVID-19 public health policies can enact racism, classism, and cis-heteronormativity, perpetuating harms among vulnerable communities. We sought to examine the accounts of gay, bisexual, and queer men (GBQM) in Canada on how normative ideologies played out in COVID-19 directives and what impacts these orders had on their lives. Two rounds of semi-structured interviews with GBQM in Montreal (n = 30), Toronto (n = 33), and Vancouver (n = 30) were conducted between November 2020-February 2021 and June-October 2021 (N = 93). Our reflexive thematic analysis drew on the frameworks of cis-heteronormativity and intersectionality to examine how normative assumptions about kinship, sociality, and privilege in COVID-19 public health directives were understood and experienced by GBQM. Our participants explicated how cis-heteronormativity was pervasive in COVID-19 public health messaging, noting that stay-at-home orders and limits on social gatherings reinforced heterosexual forms of kinship. The privileging of cis-heteronormative sociality had detrimental effects on the sense of belonging and identity formation of many participants due to restricted access to queer spaces during the pandemic. Others indicated that stay-at-home orders failed to account for the heterogeneity of queer people's experiences of homelessness and structural racism. These findings provide valuable insights into how public health efforts to control COVID-19 infections have overlooked the complex forms of kinship among GBQM, the importance of queer spaces and community organizations, and the varying vulnerabilities of diverse lesbian, gay, bisexual, trans, and queer (LGBTQ+) groups. [ABSTRACT FROM AUTHOR]

In efforts to prevent the spread of COVID-19, jurisdictions across the globe, including Canada, enacted containment measures that affected intimacy and sexual relations. This article examines how public health measures during COVID-19 impacted the sexual practices of sexual minority men— gay, bisexual, queer and other men who have sex with men—and how they adopted and modified guidelines to prevent the transmission of COVID-19, HIV and other sexually transmitted infections (STIs). We conducted 93 semi-structured interviews with men (n = 93) in Montreal, Toronto and Vancouver, Canada, between November 2020 to February 2021 (n = 42) and June to October 2021 (n = 51). Across jurisdictions, participants reported changes to sexual practices in response to public health measures and shifting pandemic contexts. Many men indicated that they applied their HIV/STI risk mitigation experiences and adapted COVID-19 prevention strategies to continue engaging in casual sexual behaviours and ensure sexual safety. 'Social bubbles' were changed to 'sex bubbles'. Masks were turned into 'safer' sex tools. 'Outdoor gathering' and 'physical distancing' were transformed into 'outdoor sex' and 'voyeuristic masturbation'. These strategies are examined in connection to the notion of 'reflexive mediation' to illustrate how sexual minority men are simultaneously self-responsibilising and resistant, self-monitoring and creative. [ABSTRACT FROM AUTHOR]

Experts have warned that COVID-19 control measures may amplify health inequities among gay, bisexual, queer, and other men who have sex with men (GBM). For HIV-negative GBM, concerns have been raised as to how COVID-19 will disrupt access to HIV pre-exposure prophylaxis (PrEP). Our study offers empirical findings on these issues, drawing on in-depth interviews conducted with 25 HIV-negative GBM living in Ontario, Canada during the first wave of the COVID-19 pandemic. Our thematic analysis draws from the sociology of risk to elucidate how a public health morality – a contested ethical framework determining how to be a 'responsible' sexual citizen during the COVID-19 pandemic – informs GBM's sexual and PrEP decision-making. This public health morality was shaped by several factors, including: self-concern versus risks posed to others; anxiety, economic precarity, and becoming COVID-19 weary; shaming public health non-compliance; and comparisons with HIV and shaming (queer) sex. The participants significantly altered their sexual practices, with some stopping, restarting, and others stockpiling their PrEP. While some men's sexual practices ran counter to public health messaging to avoid 'non-essential' contact with those outside of their households, their risk reduction strategies, including avoiding new sexual partnerships and evaluating people's 'common-sense', mirrored the negotiated safety strategies earlier developed to mitigate HIV risk. Public health advice must account for the nuanced ways in which GBM are mitigating COVID-19 risks and are responding to a complex public health morality, in order to avoid stigmatization and potentially increasing COVID-19 transmission by neglecting practical risk reduction measures. [ABSTRACT FROM AUTHOR]

Our grounded theory analysis derives from in-depth interviews conducted with 24 gay, bisexual, queer, and other men who have sex with men (GBM) living in Toronto, Canada, to understand their experiences of sexual coercion. Participants drew on discourse from the #MeToo movement to reconsider the ethics of past sexual experiences. The idea that gay or queer sex is inherently risky and unique from heterosexual relations made negotiating sexual safety challenging. These notions were enforced by homophobic discourses on the one hand, and counter discourses of sexual liberation, resistance to heteronormativity, hegemonic masculinity, and HIV prevention on the other. Biomedical advances in HIV prevention such as pre-exposure prophylaxis (PrEP) and undetectable viral load affected how some participants felt about sexual autonomy and safety. Participants held themselves responsible for needing to be more assertive within sexual encounters to avoid coercion. Many believed that unwanted sex is unavoidable among GBM: if "you're gay, it's just what happens." Targeted education aimed at GBM communities that incorporates insights on GBM sexual subcultures is necessary. This work must be situated within a broader understanding of how gender norms and hegemonic masculinity, racism, HIV status, and other power imbalances affect sexual decision-making, consent, pleasure, and sexual harm. [ABSTRACT FROM AUTHOR]

Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation. However, they also report more unmet mental health needs. To better understand this phenomenon, we conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada. Interviews were analysed using grounded theory. Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers. The first were general barriers, hurdles to mental healthcare not exclusive to sexual minorities. These included financial and logistical obstacles, the prominence of psychiatry and the biomedical model, and unsatisfactory provider encounters. The second were sexual minority barriers, obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included experiencing discrimination and distrust, and limited sexual minority affirming options. Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma. Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men. Research must consider the upstream policy changes necessary to counteract these harms. [ABSTRACT FROM AUTHOR]

HPV-associated anal cancer is one of the most prevalent non-AIDS defining cancers affecting gay men living with HIV. Drawing on interviews with 25 HIV-positive gay men living in Toronto in 2017, we explored their responses to anal cancer as a comorbidity risk and the necessity of preventative screening. These participants had previously been screened for anal cancer through a clinical trial. The majority of our sample did not initially consider anal cancer a health priority. They relied on narratives of living with HIV - that is, on their HIV biographies - to make sense of anal cancer’s significance given their self-described lack of knowledge. This included references to personal-level narratives of the biographical disruption and revision associated with a HIV diagnosis, as well as reflections on community-level and socio-historical trends in the HIV epidemic. Drawing on these narratives, some started to accept anal cancer as a significant comorbidity risk, while others remained ambivalent. Those who began to accept anal cancer as significant integrated it into their HIV biographies to present anal cancer as a threat to the ontological security they have gained managing HIV in an era of effective treatment and to position themselves as pragmatic, responsible health-seekers. Others drew on their HIV biographies to vocalise resistance to chronic risk and medicalisation. Our analysis points to the fundamental role narratives play on everyday risk perception practices, health decision-making and, for those managing a chronic illness, on securing ontological security and presenting a coherent self-identity under conditions of expanding risks and prevention possibilities. [ABSTRACT FROM AUTHOR]