Sex out of the City (Out of the bushes and into the bedrooms)

1. Sex out of the City(Out of the bushes and into the bedrooms) The Mating and Dating Habits of the Rural Male in BC

2. Definition • Men having Sex with Men (MSM) is defined as any male who has a consensual sexual encounter with another male, but who may not necessarily identify as gay or bisexual, either publicly or privately.

3. A Women’s Issue • This makes MSM not only a risk-laden activity for the men involved who do not use condoms, but also more importantly it is an issue for the women in their lives who are the unwitting and unsuspecting victims of the risk behaviours being undertaken by the men in their lives.

4. Our Research • Much research has been completed with respect to the mating and dating habits of the human male, but for a variety of reasons the majority of this research has been conducted in the urban centers. Those of us outside of the mega-population bases are left out of so much research; we decided to do our own.

5. In the beginning… • It all started in March 2002 when we conducted a capacity building project on Community Based Research. The results were the design for a Community Based Research project on MSM in the Okanagan. This became know as: “Out of the Bushes and into the Bedrooms”

6. “Until lions have their own historians, tales of the hunt will always glorify the hunter.”~ African proverb “We are the experts in our own lives. However,… other experts come in and research us, tell our stories and make a living and a reputation off our lives.” ~ Theresa Healy, PhD “No research is worth the sacrifice of one’s person’s human dignity.” “The MSM community is so hidden because many of the men risk losing a lot if they are found out. We, as researchers, can not be harassing them or driving them from the safe places they have found.” Interesting Observations/Quotes

7. Questions RaisedWho and Where Who do we need to reach? • MSM & their partners & Families • Subgroups – Gay, Bi, Transgendered, Sex Trade workers, Hobbyists, one timers • Corrections facilities, Churches Where do we reach them? • Anywhere men go • Parks, restaurants, washrooms, and cyber chats. • Beaches, bushes, internet, bars, gyms, male escorts, sex trade, gospel mission, YMCA, word of mouth

8. What do we need to know? Numbers (Does the number of MSM justify the effort?) What is happening? (Preferences and practices) Demographics Attitudes (Social, individual) What risks are they taking? (do they know/care?) How are they accessing men? How do they identify – privately/publicly?

9. More Research • Once we established that we knew less than we thought we did, the next step we to apply for research grants to explore this issue and to provide real solutions to reaching MSM with positive health information.

10. FUNDING • Representatives from AIDS Service Organizations (ASOs) in rural communities received two research grants to delve into the murky waters of men who have sex with men, regardless of their sexual orientation, and choose to live far away from Vancouver or Victoria.

11. Rural Communities • Considering the MSM population is a difficult one to identify, it is also a difficult group to reach and educate with respect to safer sex practices and reducing the probability contracting HIV and/or HCV. As they were difficult to reach and teach in the urban centers, the problems were magnified in rural settings. • The ad hoc group of ASOs including Living Positive Resource Centre (LPRC), Okanagan Aboriginal AIDS Society (OAAS), AIDS Services of Kamloops (ASK), ANKORS and C-SHARP. Together with the BCPWA Community Based Research Capacity Building Program, we put together a research proposal to design a research tool to attract the attention of MSM who resided in rural areas.

12. Concept • The concept was to discover the habits of rural MSM, so a campaign could be developed and directed to reach and educate them with respect to safer sex practices and reducing the probability contracting HIV and/or HCV.

13. Logistics • Due to the logistical challenge of reaching people in small communities and overcoming the question of confidentiality, the vehicle we chose was the Internet. BC Centre for Disease Control; STD Control, and Chee Mamuk accepted the partner-proposal, with each department providing separate funding.

14. Web Survey • Two websites were developed, one to attract the attention of the Native MSM population (http://nativeman2man.com) and one to attract the attention of the non-Native MSM population (http://man2man.ca); both acting as portals to the independent survey which was hosted on Survey Monkey.

15. Time Frame • The Internet pages were constructed without the survey in March 2005 with links contrived to attract the attention of our target audience (MSM) for a two-month period of time. This gave us time to develop a database of regular visitors to the site who were in effect a captive audience as we built in the capacity for mass mailing to all who registered.

16. Spreading the Word • The survey was advertised in community newspapers that would accept our ad (not all did), by placement in search engines, direct email to health related agencies and word of mouth.

17. Going LIVE! • The survey went live in May 2005 with an expected two-month active collection period with the objective to gain data from 75 participants, with a stretch objective to have 100 completed surveys. When the survey closed July 23 after an open and active data collection period of 58 days, we had information on 102 participants.

18. West Kootenays (Rural) Vancouver Island (Rural) East Kootenays (Rural) Columbia Valley (Rural) Okanagan Valley (Rural) Cariboo (Rural) Cranbrook Fort St. John Castlegar Trail Kelowna Penticton Kamloops Quesnel Prince George Salmon Arm Merritt Chilliwack Lake Country Terrace Campbell River Nanaimo Kitimat Prince Rupert Port Alberni Vancouver and Victoria Who Answered The Call?

19. Meeting Criteria • The ages of the respondents ranged from 18 to 81 with the average age being 48 years 21 days, with 21.2% of the respondents being 60 + • Of the respondents, 10.2% were from Victoria and 19.38% were from Vancouver, so 70%+ of our respondents met our mandated criteria.

20. Majority Rules Ø64.3% of the respondents have graduated College Technical School or University Ø50.5% said they were European, while 10.1% claimed Aboriginal ancestry. Ø39.6% have an annual income between $30K and $50K, with an additional 28.1% of the respondents earn over $50K Ø54.7% of the men hook up when they are out of town, and 43% prefer the great outdoors Ø51.6% of the respondents only have sex with other men, while 26.3% also have sex with women

21. Sexuality Stats ØPublicly, 62.5% present themselves as heterosexual, while privately only 16.7% consider themselves heterosexual ØThe top four reasons they keep their private self different from their true selves are; - fear of being harassed in public or private, - being rejected by friends, family or co-workers, - being harassed sexually and - being denied job opportunities.

22. Condom Use • 76.3% pay retail for their condoms, with a distant second at 21.5% getting their condoms from AIDS service organizations. • 54% use a condom with their male partners, while 45% of the time when they have sex with a woman, they either “don’t pay attention” or don’t use a condom

23. MSM Poster Child • Educated, middle-aged, middle-class, publicly heterosexual male who is looking for anonymous sex while he is out of town, and hooks up with his temporary male partner via the Internet. He is most likely to have sex out doors where he may or may not use purchased condoms with his date. When he goes home to his female partner, it is equally unlikely that he will wear a condom.

24. Getting Educated Ø48.8% ask for HIV information when they go for a regular check-up with their physician Ø55.7% would prefer to receive information on health issues such as HIV through the Internet.

25. One Problem • In that almost half of the MSM do not use a condom during their anonymous sexual encounters is reason enough to have some concerns about the transmission of HIV.

26. A Bigger Problem • In that over one quarter of the MSM also have unprotected sex with their female partners, begs the question as to how many women are being infected with HIV, unaware of their partner’s clandestine activities, therefore seeing no need to get tested.

27. Women and HIV • The proportion of HIV tests in females attributed to heterosexual contact increased from 46% in 1999 to 64.8% in 2003. • Heterosexual contact still remains the main risk factor for HIV infection in women. • The HIV/AIDS epidemic among women is of particular concern because of the potential for transmission to their infants. 

28. The potential MSM population is not a population that is easy to identify beyond being a male who enjoys very short-term relationships. The potential female target population is any who have a close enough relationship with a male to either share injection drug paraphernalia or to have unprotected sex. Resolving Problems

29. Educating The Masses • Education being the key but which is the target audience and how are they reached? • Targeting the male population may be easier as this is the key to slowing the spread of HIV.

30. Brainstorm: Social Marketing Ideas • How do we reach the rural MSM? Keep in mind the target audience is publicly heterosexual and will not respond to messages aimed at the gay community (i.e.: the Assumptions Campaign). They purchase condoms and enjoy anonymous sex while out of town.

31. Postcard size education pieces at the condom rack in pharmacies (e.g.: “Don’t get it on until you put it on”)? Condom machines in the truck stops, nailed to trees in parks, and in every public washroom? Internet advertising on mainstream websites, airline/travel-oriented magazine awareness (e.g.: “Out of town? Feeling lonely? – It takes less time to use protection than to explain the disease to your wife.”) Ideas?

32. Brainstorm:Further Research What additional community based research can be conducted in a variety of rural communities by collaborating with your corporate and community peers?

33. THANKS! • Sincere thanks to: • Lucy Barney (Chee Mamuk) • BC Centre for Disease Control: STD Division • All 102 participants