1. IMAGINE MEN’S HEALTH STUDY Brennan, D.J.*, Souleymanov, R., George, C., Hart, T.A., Newman, P. *Associate Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto; Ontario HIV Treatment Network Applied HIV Research Chair

2. An Examination of the Level of Masculinity Ascribed to One’s Sexual Role and Its Relation to HIV Sexual Risk Behaviours among Gay and Bisexual Men of Colour in Toronto, Ontario

3. ABOUT IMAGINE MEN’S HEALTH STUDY This community-based research study was designed to examine body image, health and well-being among gay and bisexual men (GBM) of colour. Rationale/motivation to conduct this research Ideas leading towards the development of the IMH study

4. PI: Dr. David J. Brennan There is no conflict of interest to declare in the current study The current study is funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) Dr. David J. Brennan’s research is supported by an OHTN Applied HIV Research Chair DECLARATION OF CONFLICT OF INTEREST & FUNDING

5. Principal Investigator David J. Brennan, Ph.D., Associate Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto and the Ontario HIV Treatment Network Applied HIV Research Chair Co-investigators Clemon George, Ph.D., Assistant Professor, University of Ontario Institute of Technology Trevor A. Hart, Ph.D., Associate Professor of Psychology, Ryerson University Peter A. Newman, Ph.D., Professor at the Factor- Inwentash Faculty of Social Work, University of Toronto, and Canada Research Chair in Health and Social Justice Ishwar Persad, Centre for Addiction & Mental Health Andre L. Ceranto, AIDS Committee of Toronto Riz Quiaoit, Community Member RESEARCH TEAM

6. Shazad Hai, MSM Outreach Coordinator, Alliance for South Asian AIDS Prevention Daniel Le, Gay Men’s Health Promoter, Asian Community AIDS Services David Lewis-Peart, MSM Outreach Coordinator, Black CAP Marco Posadas, Bathhouse Counselor Initiative Coordinator, AIDS Committee of Toronto Tavinder Channa, Community Member Dexter Roberts, Community Member Siva Gunarathnam, Gay Men’s Outreach Coordinator, AIDS Committee of Toronto Anthony Chen, Community Member Gerardo Betancourt, HIV Prevention Program Coordinator, Centre for Spanish Speaking Peoples Marco Gomez, Policy consultant COMMUNITY ADVISORY COMMITTEE

8. STUDY BACKGROUND Multi-phase, mixed-methods study Phase 1: Focus groups & interviews (n=61) Phase 2: Survey (n=369) Community collaboration Roles of Community Advisory Committee (CAC) 4 Ethnoracial communities East/Southeast Asian Black/Caribbean/African Hispanic/Latino/Brazilian South Asian

9. METHODS Eligibility 18 years old+ male Identify as gay or bisexual or report having had sex with another man in the past 12 months Identify with at least one of the four ethnoracial communities English speaking

10. METHODS Data Collection Online survey Completers (n=410) Non-completers (n=510) Completion rate: 44%

11. RECRUITMENT Research Team and Community Advisory Committee ASOs: BlackCAP, ACAS, ASAAP, CSSP, ACT Online listserves: RHO, OHTN, RHN, Senior Pride Network, & CATIE listservs Community agencies/groups: 519, SOY, SALAAM. CAMH, Hassle Free, Maple Leaf Clinic Bath houses, bars & clubs, dance venues Online postings on Craigslist, Facebook, Twitter Word of Mouth Church Street postings Xtra! Magazine Proud FM

12. STUDY BACKGROUND Previous research has shown that sexual risk has been associated with measures of masculinity (Halkitis & Parsons, 2003) Based on predominantly white samples (Hamilton & Mahalik, 2009) Little is known about how the level of masculinity ascribed to one’s sexual role is associated with sexual risk behaviors among GBM of color. Purpose To examine the relationship between the level of masculinity ascribed to one’s sexual role, demographics, and HIV sexual risk among a community-based sample of GBM of colour in Toronto

13. METHODS Measures Demographics Questionnaire Perceived Masculinity Subjective Gender Identity Subscale (Cheseboro & Fuse, 2001) Sexual Risk Behaviours Questionnaire (SDCAI; serodiscordant condomless anal intercourse)

14. METHODS Data Analysis Used SPSS-21 Pearson Correlations, Analysis of Variance, Logistic Regression Analysis

15. PERCEIVED MASCULINITY SUBJECTIVE GENDER IDENTITY SUBSCALE (Cheseboro & Fuse, 2001), Modified Version When you think of or imagine the sexual role that you generally have of yourself, you think of yourself as: When you think of or imagine the sexual role that your friends have of you, your friends treat you as When you think of or imagine the sexual role that strangers have of you, strangers treat you as: When you think of or imagine the sexual role that intimate (i.e., sexual) partners have of you, intimate partners treat you as: Never masculine 1 2 3 4 5 6 7 Highly masculine

16. The number of times IN THE PAST 6 MONTHS you did each of these activities with: 1.HIV-positive male sexual partners, 2.HIV-negative sexual partners and 3.Sexual partners of unknown HIV status, Sexual Risk was defined as serodiscordant condomless anal sex with primary partners or any condomless anal sex with secondary partners SEXUAL RISK BEHAVIOURS QUESTIONNAIRE Being a “bottom” (getting fucked) without a condom. Being a “bottom” (getting fucked) using a condom. Being a “top” (fucking a guy) without a condom. Being a “top” (fucking a guy) using a condom.

17. SEXUAL RISK BEAHVIOURS QUESTIONNAIRE Being a “bottom” (getting fucked) without a condom. Being a “bottom” (getting fucked) using a condom. Being a “top” (fucking a guy) without a condom. Being a “top” (fucking a guy) using a condom. SDCAI – R (Receptive) SDCAI – I (Insertive) overall SDCAI (both receptive and insertive)

18. Sample CharacteristicsFrequency (n) Percentage (%) or Mean (S.D.) Race (N=389) Black, African, Caribbean East/South East Asian Latino, Hispanic, Brazilian South Asian Mixed 84 105 94 82 24 21.6 27 24.2 21.1 6.2 Sexual Orientation (N=382) Homosexual/Gay Bisexual Heterosexual 317 60 5 83 15.7 1.3 Age (mean, SD) (N=389) 18-24 25-29 30-39 40-49 50+ 63 97 128 86 15 33.1 (8.6) 16.2 24.9 32.9 22.1 3.9 FINDINGS

19. CharacteristicFrequency (n) Percentage (%) or Mean (S.D.) Household Income ($) (N=389) 0-9,999 10,000-29,999 30,000-59,999 60,000+ 73 111 107 98 18.8 28.5 27.5 25.2 Nation of Birth (N=389) Canadian-Born Foreign-Born 124 265 31.9 68.1 Highest Education Level Completed (N=385) High School or Less Some Post-Secondary/College Bachelor Degree or Greater 90 102 193 23.4 26.5 50.1 HIV Status (N=378) Positive Negative Not Sure 64 284 30 16.9 75.1 7.9

20. FINDINGS Bivariate Analyses Serodiscordant condomless anal intercourse (F= 2.8, df=4, p<.05): Black participants (M=11.2, SD=25.7) report more sexual risk behaviours compared to East/ South East Asian participants (M=2.0, SD=7.7) (p<.05)

21. FINDINGS Logistic Regression Modeling Sig. Final Model (p<.001) for SDCAI-I Final model accounts for 19% of the variance in SDCAI-I (outcome variable): R 2 =19.3 Not significant: overall SDCAI (p=.209) or SDCAI-R (p=.10) Variables entered in the model: age, household income, sexual orientation, HIV status, perceived masculinity

22. FINDINGS: SDCAI-I Logistic RegressionBS.E.pAOR 95%CI Household Income 0-9,999 (ref = 60,000+)1.05.368.0042.49 [1.18-5.26] HIV Status HIV-positive (ref =HIV-neg.) 2.423.40<.0013.40 [1.76-1.65] HIV-unknown (ref =HIV-neg.) 1.124.86<.0014.86 [1.92-12.35] Perceived Masculinity (Sexual Role/Masculinity).50.024.003 1.06 [1.01-1.11] * Significant Final Model (p<.001)

23. FINDINGS: SDCAI-R Logistic RegressionBS.E.pAOR 95%CI HIV Status HIV-positive (ref =HIV-neg.) 2.040.36<.0017.70 [3.81-15.6] HIV-unknown (ref =HIV-neg.) 1.120.49<.0017.26 [2.77-19.01] *Final model for SDCAI-R not significant: p=.10

24. FINDINGS: overall SDCAI Logistic RegressionBS.E.PAOR 95%CI Household Income 0-9,999 (ref = 60,000+)0.91 0.46.052.47 [1.01-6.09] HIV Status HIV-positive (ref =HIV-neg.) 1.890.34<.0016.61 [3.39-12.93] HIV-unknown (ref =HIV-neg.) 2.210.52<.0019.15 [3.24-25.77] *Final model for the overall SDCAI not significant: p=.209

25. IMPLICATIONS Insertive SDCAI was significantly associated with the participants’ level of masculinity ascribed to their sexual roles, HIV status, and income among GBM of colour Heteronormative measurements of masculinity Further research is needed to better understand the link between the level of masculinity ascribed to one’s sexual role and sexual risk-taking within the context of HIV/STI prevention among GBM of color

26. IMPLICATIONS These findings add another dimension to HIV prevention work by suggesting that addressing the beliefs and behaviours regarding masculine gender roles has the potential to promote sexual health among GBM of colour

27. COMMENTS? QUESTIONS?

28. THANK YOU! The participants Members of Community Advisory Committee Members of Research Team Staff Team: Rusty Souleymanov Kenta Asakura Georgi Georgievski

29. David J. Brennan, MSW, Ph.D. Associate Professor Ontario HIV Treatment Network Applied HIV Research Chair Factor-Inwentash Faculty of Social Work, University of Toronto david.brennan@utoronto.ca CONTACT