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Coulaud PJ, Parent N, Stehr R, Salway T, Knight R. Acceptability of integrating mental health and substance use care within sexual health services among young sexual and gender minority men in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104459. [PMID: 38788388 DOI: 10.1016/j.drugpo.2024.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Despite well-established evidence showing that young sexual and gender minority (SGM) men experience disproportionate mental health and substance use inequities, few sexual health services provide mental health and substance use care. This qualitative study examined the experiences and perspectives about integrated care models within sexual health services among young SGM men experiencing mental health and substance use challenges. METHODS Semi-structured interviews were conducted with 50 SGM men aged 18-30 years who reported using substances with sex in Vancouver, Canada. Interviews were analyzed using thematic analysis. RESULTS Three themes were identified: 1) participants asserted that their sexual health, mental health and substance use-related health needs were interrelated and that not addressing all three concurrently could result in even more negative health outcomes. These concurrent health needs were described as stemming from the oppressive social conditions in which SGM men live. 2) Although sexual health clinics were considered a safe place to discuss sexual health needs, participants reported not being invited by health providers to engage in discussions about their mental health and substance use health-related needs. Participants also perceived how stigmas associated with mental health and substance use limited their ability to express and receive support. 3) Participants identified key characteristics they preferred and wanted within integrated care, including training for health providers on mental health and SGM men's health and connections (e.g., referral processes) between services. Participants also recommended integrating social support programs to help them address SGM-related social challenges. CONCLUSION Our findings highlight that SGM men's sexual health, mental health and substance use-related health needs and preferences are interrelated and should be addressed together. Tailored training and resources as well as structural adaptations to improve communication channels and collaborative connections between health providers are required to facilitate the development of integrated care for young SGM men.
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Affiliation(s)
- Pierre-Julien Coulaud
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
| | - Natasha Parent
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rodney Stehr
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Rod Knight
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada; École de Santé Publique de l'Université de Montréal, Montréal, Québec, Canada; Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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Salway T, Black S, Kennedy A, Watt S, Ferlatte O, Gaspar M, Knight R, Gilbert M. "Syndemic moral distress": sexual health provider practices in the context of co-occurring, socially produced sexual and mental health epidemics. BMC Health Serv Res 2022; 22:750. [PMID: 35668408 PMCID: PMC9169335 DOI: 10.1186/s12913-022-08149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Syndemic' refers to socially produced, intertwined, and co-occurring epidemics. Syndemic theory is increasingly used to understand the population-level relationships between sexual health (including HIV) and mental health (including problematic substance use) epidemics. Syndemic-informed clinical interventions are rare. METHODS We therefore asked 22 sexual health practitioners from six sexual health clinics in British Columbia, Canada to define the word 'syndemic' and then asked how the theory related to their clinical practice. RESULTS Responses to syndemic theory ranged widely, with some practitioners providing nuanced and clinically informed definitions, others expressing a vague familiarity with the term, and others still having no prior knowledge of it. Where practitioners acknowledged the relevance of syndemic theory to their practice, they articulated specific ways in which syndemics create moral distress, that is, feeling that the most ethical course of action is different from what they are mandated to do. While some practitioners routinely used open-ended questions to understand the social and economic contexts of patients' sexual health needs, they described an uneasiness at potentially having surfaced concerns that could not be addressed in the sexual health clinic. Many observed persistent social, mental health, and substance use-related needs among their patients, but were unable to find feasible solutions to these issues. CONCLUSIONS We therefore propose that interventions are needed to support sexual health practitioners in addressing psychosocial health needs that extend beyond their scope of practice, thereby reducing 'syndemic moral distress'.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada.
| | - Stéphanie Black
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada
| | - Angel Kennedy
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada
| | - Olivier Ferlatte
- École de Santé Publique de L'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N1X9, Canada.,Centre de Recherche en Santé Publique, 7101 Avenue du Parc, Montréal, Québec, H3N1X9, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T3M7, Canada
| | - Rod Knight
- BC Centre On Substance Use, 1045 Howe Street, Suite 400, Vancouver, BC, V6Z2A9, Canada.,Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, BC, V6T1Z3, Vancouver, Canada
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The Relationship Between Sexual and Gender Stigma and Difficulty Accessing Primary and Mental Healthcare Services Among LGBTQI + Populations in Thailand: Findings from a National Survey. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00740-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Sexual and gender stigma is a known contributor to population health inequities; however, its impact on healthcare access among sexual and gender minorities (SGM) in Thailand is understudied. Therefore, we sought to examine the level of SGM stigma and its impact on self-reported difficulty accessing primary and mental healthcare services among a nationally recruited sample of lesbian, gay, bisexual, transgender, queer, intersex, and other gender and sexually diverse (LGBTQI +) people in Thailand. A previously validated sexual stigma scale was adapted to ascertain perceived and enacted SGM stigma. Between January and March 2018, 1,350 LGBTQI + participants completed the online survey, and the median age was 27 (quartiles 1, 3: 23, 33) years. In total, 169 (12.5%) and 269 (19.9%) reported difficulty accessing primary and mental healthcare and 365 (27.0%) reported actively concealing their gender expression to access care. In multivariable logistic regression analyses, experiences of enacted stigma were independently associated with difficulty accessing primary (adjusted odds ratio [AOR] = 1.35; 95% confidence interval [CI]: 1.11–1.63) and mental healthcare (AOR = 1.26; 95% CI: 1.07–1.48), while experiences of perceived stigma were independently associated with difficulty accessing mental healthcare only (AOR = 1.20; 95% CI: 1.07–1.34). Our findings call for multi-level interventions to decrease SGM stigma and improve healthcare access among SGM in Thailand.
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Watt S, Salway T, Gómez-Ramírez O, Ablona A, Barton L, Chang HJ, Pedersen H, Haag D, LeMoult J, Gilbert M. Rumination, risk, and response: a qualitative analysis of sexual health anxiety among online sexual health chat service users. Sex Health 2022; 19:182-191. [DOI: 10.1071/sh21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
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Salway T, Ablona A, Chang HJ, Watt S, Worthington C, Grace D, Wong J, Ogilvie G, Grennan T, Gilbert M. Self-rated mental health among sexual health service clients during the first months of the COVID-19 pandemic, British Columbia, Canada. Prev Med 2021; 153:106789. [PMID: 34506815 PMCID: PMC8431968 DOI: 10.1016/j.ypmed.2021.106789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/03/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March-May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.
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Affiliation(s)
- Travis Salway
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada; Centre for Gender and Sexual Health Equity, Canada.
| | | | | | - Sarah Watt
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada
| | | | | | - Jason Wong
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Canada; University of British Columbia, Canada.
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McCann E, Brown MJ, Taylor J. The views and experiences of bisexual people regarding their psychosocial support needs: a qualitative evidence synthesis. J Psychiatr Ment Health Nurs 2021; 28:430-443. [PMID: 32780489 DOI: 10.1111/jpm.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Bisexual people experience significantly poorer mental health and higher rates of self-harm and suicidality than their gay, lesbian or heterosexual counterparts. Although little is understood about why these disparities exist, bisexual people have been found to have unique life experiences that separate them from other sexual minority groups. Despite these health disparities and unique experiences, in research and in clinical settings, bisexual people are often incorporated under the LGBTQI+ umbrella and their needs are not seen as being different to those of other sub-groups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper brings together the findings of the small but growing body of literature reporting on the psychosocial support needs of bisexual people. The findings reported on herein provide novel insights, collated and synthesized that will prove valuable to policy makers, service providers and researchers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper clearly illustrates that bisexual people experience significant barriers to accessing the support services they need and that current competent service provision for this population is severely limited. The findings presented in this paper shed light on the unique psychosocial needs of bisexual people and highlight the need for practice change to reduce barriers to service access and ensure inclusive and culturally competent care for this community. ABSTRACT: Introduction Despite consistent evidence of poor mental health among what is a relatively large population group, research examining bisexual mental health remains sparse. Aim To identify the psychosocial needs of people who are bisexual and establish factors that may support or inhibit access to appropriate psychosocial interventions and supports. Method A qualitative evidence syntheses of the empirical evidence. Results A total of 15 papers were included in the review. The PRISMA process was used. Following data analysis, four main themes emerged that were (a) experiences of being bisexual, (b) mental health experiences and concerns, (c) service access and responses and (iv) communities and supports. Discussion Bisexual people have unique and specific psychosocial support needs that relate to, but are also different from, the needs of the broader LGBTIQ+ community. This study provides valuable insights into how future policy, practice, education and training and research can better address the needs of this highly vulnerable group. Implications for Practice This study highlights the psychosocial complexities associated with bisexuality and provides evidence for the need for improvement in current support services to ensure inclusivity and culturally competent care.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College, University of Dublin, Dublin, Ireland
| | - Michael J Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Julia Taylor
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
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Ambivalence and the biopolitics of HIV pre-exposure prophylaxis (PrEP) implementation. SOCIAL THEORY & HEALTH 2021; 20:171-187. [PMID: 33462539 PMCID: PMC7807412 DOI: 10.1057/s41285-020-00154-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/21/2022]
Abstract
Ambivalence, the vacillation between conflicting feelings and thoughts, is a key characteristic of scientific knowledge production and emergent biomedical technology. Drawing from sociological theory on ambivalence, we have examined three areas of debate surrounding the early implementation of HIV pre-exposure prophylaxis, or PrEP, for gay, bisexual, queer, and other men who have sex with men in Canada, including epistemology and praxis, clinical and epidemiological implications, and sexual politics. These debates are not focused on the science or efficacy of PrEP to prevent HIV, but rather represent contradictory feelings and opinions about the biopolitics of PrEP and health inequities. Emphasizing how scientists and health practitioners may feel conflicted about the biopolitics of novel biomedical technologies opens up opportunities to consider how a scientific field is or is not adequately advancing issues of equity. Scientists ignoring their ambivalence over the state of their research field may be deemed necessary to achieve a specific implementation goal, but this emotion management work can lead to alienation. We argue that recognizing the emotional dimensions of doing HIV research is not a distraction from "real" science, but can instead be a reflexive site to develop pertinent lines of inquiry better suited at addressing health inequities.
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