Gay and Bisexual Men’s Health Matters

Gay and bisexual men have health concerns much like all men do. However, gay and bisexual men’s health matters present a particular challenge because many gay and bi men encounter barriers in accessing health care and health information. Much of what we know about men’s health is based on heterosexual men. In this section, you will find many resources and links to information that specifically relates to gay and bisexual men’s health.

Pour une série de matériaux en français, le contrôle dehors SeroZero et leur page de ressource.

Topics included in this section:

Going to your healthcare provider?

STIs and Sexual Health

Parenting and Fertility Options

Going to your healthcare provider

It is very important for you to be able to have an open and honest relationship with your healthcare providers. Sometimes we are embarrassed to ask questions, or to fully explain the reasons for our visits --- and this affects our health. Some gay men are not out to their healthcare providers and this can affect their health, too.

It isn’t always easy to find a doctor who will respect you as a gay or bisexual man. You may run into some doctors who are homophobic or aren’t sensitive to gay or bisexual patients’ needs. If your doctor makes homophobic comments, disrespects you, or ignores your requests for a check-up, you should look for another doctor who is more sensitive to gay patients’ needs. Call around to various LGBTIQ organizations and find out if there are any LGBTIQ friendly physicians in your area accepting patients.

What gay and bi men should look for in a doctor/patient relationship? A video interview with a physician discussing the issue.

Top 10 things gay and bi men should discuss with their physicians (pdf)

For healthcare providers:

Fenway Health has online learning modules on LGBT healthcare provision

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STIs and Sexual Health : Important Info for Gay and Bi Men

Since the early 1980s, HIV and AIDS have been the primary focus of sexual health education and information for gay and bisexual men, with good reason. Until the mid-1990s, few effective treatments for HIV were available and many people who were infected died. Today, new drugs are helping people live longer, but HIV infection remains incurable and potentially deadly.

This focus on HIV might make it seem that other sexually transmitted infections (STIs) are less serious, or perhaps even a thing of the past. However, today, rates of some STIs like syphilis, gonorrhea, and human papilloma virus are increasing in our community.

And while it’s true that these and other STIs are easier to treat than HIV and may not cause any future serious problems if caught in time, they are serious infections that can have real consequences for your health. Further still, some STIs like hepatitis A and B, can lead to months of acute and debilitating sickness and lasting liver disease. Although most STIs are not as dangerous as HIV, it is important to know the risk factors for each and how to prevent, recognize and treat them.

For more STI information specific to gay and bi men:

LGV
Chlamydia
Genital Herpes
Syphilis
Gut infections (amoebiasis, Shigellosis, giardiasis and salmonellosis)
Thrush
Scabies
Pubic lice
Molluscum
Hepatitis A
Hepatitis B
Hepatitis C
Gonorrhoea
Genital Warts
HIV

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Smoking and gay and bisexual men

Gay men are more likely to smoke, start smoking earlier, and continue smoking for longer than straight men. HIV positive gay men are more likely to smoke than HIV negative gay men, and are more likely to suffer from smoking related illnesses, such as lung cancer and emphysema, than HIV negative smokers.

Why is this? Well, there a variety of factors, but one of the overarching root factors is homophobia. LGBTIQ people’s lives have added stress and societal factors that lead to us making some poor choices about our health. This is not an excuse, necessarily, but an explanation and another reason we need to work toward putting an end to homophobia.

For a document discussing the issue of smoking among LGBT youth (pdf).

The Toronto Rainbow Tobacco Survey found that:

36% of LGBTTQ participants reported current smoking, compared to 17% of Toronto adults (18+) as reported by Toronto Public Health. Smoking prevalence rates are reported for nine different sexual orientation and gender identity groups, including the first known data reporting on gender queer people.

Interested in quitting?

One place to start is the Smoker’s Helpline (1 877 513-5333) or www.smokershelpline.ca.

Toronto Public Health has some information about quitting smoking for the LGBTQ community.

Other Quitting Resources:

Canadian Cancer Society: www.cancer.ca

Gay American Smoke Out: www.gaysmokeout.net

Health Canada: www.gosmokefree.ca

Heart and Stroke Foundation: www.heartandstroke.ca

Proud to Quit: www.proudtoquit.ca

Sherbourne Health Centre: www.sherbourne.on.ca

Smokers' Helpline: 1-877-513-5333 or www.smokershelpline.ca/

Toronto Health Connection: 416-338-7600 or www.toronto.ca/health/quit_smoking.htm

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Alcohol, Drugs, and Gay and Bisexual Men

The following is an excerpt from a pamphlet (pdf) produced by the Centre for Addiction and Mental Health (CAMH) in Toronto:

There are many reasons why people drink or use other drugs. However, there are issues specific to lesbian, gay, bisexual, transgendered, transsexual, two-spirit, intersex and queer people’s lives that can further affect our substance use. Facing isolation, alienation and discrimination from a homophobic society is stressful; escaping from this is one of the main reasons why people in our communities use alcohol or other drugs. Until recently, there were few social alternatives to the bar, rave or circuit party scenes that allowed us to go out, relax and feel part of a community. Until recently, there were few counselling resources specifically for our communities. However, you don’t need to face substance use alone. Specialized programs are available to help you.

It is natural to have some concerns about what may happen if you ask for help.

You may worry that service providers and counsellors will not respect or understand your circumstances, or will be ignorant about sexual orientation or gender identity issues.

People of colour and other oppressed groups often face extra barriers in getting access to services. Counsellors may make stereotypical assumptions about the relationship between your sexual orientation and your substance use. It may be hard to be “out” or totally open about your life when you are in counselling. You may be concerned about your privacy and whether others could “out” you.

For information on services for our community and where they are:

Rainbow Services at CAMH offers confidential, free counselling and additction treatment services to the lesbian, gay, bisexual, transgendered, transsexual, two-spirit, intersex, and queer communities in Ontario. For more info, call: 1-800-463-6273 or visit their website at www.camh.net

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Cancer and Gay and Bisexual Men

Gay men may be at increased risk for certain forms of cancer, and illnesses linked to cigarette smoking.

Some cancers are more commonly seen in persons with HIV infection. For example, Kaposi's sarcoma and certain types of lymphomas are more common in people with HIV. Since HIV is found in higher rates among gay men in Western nations, cancers associated with HIV infection are more common among gay men in these parts of the world.

Some strains of HPV -- the virus that causes genital and anal warts are linked to certain forms of cancer. When this virus causes cancer in men, it most often causes anal cancer. Anal HPV infection primarily occurs through unprotected anal intercourse, and direct penis-to-rectum contact during sex (skin rubbing). Anal cancer occurs more frequently in men with damaged immune systems (including those with HIV). Smoking may increase the risk of cancer as well. HPV on the penis can also cause penile cancers, but this is quite rare.

Gay men may also be at increased risk for liver cancer. As stated above, gay men are considered at increased risk for hepatitis B infection, which has been linked to liver cancer and other forms of liver disease (including cirrhosis of the liver).Vaccinations for Hep B (and Hep A) are available and free of charge to gay and bisexual men in our area. Contact Public Health in your area to find out how to get protected

In addition to anal and liver cancers, gay men may also be at increased risk for lung cancer and other cancers linked to cigarette smoking. It has been suggested that smoking rates among gay men may be higher than the general population. Of course, smoking also has many other health risks, including an increased risk for emphysema and heart disease.

For resources on how to quit smoking

For more information on gay and bisexual men and the increased risk of anal cancer as a result of anal HPV infections.

For an essay/article by Sky Gilbert on Gardasil vaccine and HPV among queer men

For information about Hepatitis B and how to get vaccinated or find out if you are

For information about cancer support groups specifically for LGBTQ people

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Gay, Bisexual Men and Ageing

For an interesting paper on Ageing in a non-heterosexual context

For a truly comprehensive links page for LGBTQ issues related to ageing, check out the University of Calgary’s internet resource page.

Coming Out Later in Life

‘Coming out’, or being open to friends and family about an individual’s gay or bisexual sexual orientation, can be a challenging and difficult experience for many men. In particular, men who have sex with men (MSM) who also identify as being heterosexual during periods in their adult life can find the coming out process particularly challenging. This experience of coming to terms with a homosexual or bisexual orientation is unique and different to each individual.

Out Late: A Guide for Older Men Coming Out aims to provide men who are coming out later in life with basic information about gay community dynamics, sexuality identity, HIV transmission, and safe sex as well as broader health promotion messages about STIs and drug use. It is from an Australian health promotion organization, ACON

Topics covered include:

Coming out – what’s involved?
What it’s like to be gay in our society
Sex and gay men
Health risks and sex – looking after yourself

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Gay and bisexual men and Mental Health

Mental-health issues cannot be ignored. We tend to suffer from depression and low self-esteem more than heterosexual men. We live in a world where we are often told we are "bad." Some of us are abandoned by our biological families. Discrimination against us is still too common. The way that society often treats us can lower our self-esteem and lead to depression. For example, suicide rates among gay and bisexual youth are higher than heterosexual youth. When we have low self-esteem, we tend to value our life (and our health!) less seriously. We are therefore less likely to protect ourselves against HIV and other STIs, and other health problems.

What can be done about this? This is another difficult problem to solve. A strong effort needs to be made to increase self-esteem in the LGBTIQ community, especially in young gay and bisexual men. Perhaps programs using gay and bisexual male role models can be developed to teach young gay and bisexual men that their futures can be successful. In men who are suffering from depression, low self-esteem and similar issues, an effort must be made to get them into mental-health counselling, with counsellors who are comfortable in dealing with gay and bisexual issues.

Gay and bisexual men are also a part of the 1 in 5 Ontarians who have experienced mental health issues. These issues range from difficulty coping with life’s stress, to the effects of a significant mental health issue such as schizophrenia. Mental health issues are common amongst all people, but it seems that the effects of homophobia only add to the common burden.

If you are in crisis right now, there is someone you can call

Resources in our community (pdf)

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Parenting and Fertility Options for Gay and Bisexual Men

The information provided below is from the pamphlet, Parenting Options for Gay Men, one of a series of pamphlets on Queer parenting. These pamphlets can be found and downloaded on the Family Services of Toronto website.

In the past, heterosexual families were viewed as the only acceptable place within which to raise children. Many gay and bisexual men had children within heterosexual relationships but were forced to remain closeted for fear of losing their children. More recently, due to human rights struggles waged over many years by lesbian, gay, bisexual and trans communities, it has become more possible for cisgender* and transgender gay and bisexual men to become parents while being open about their identities. [*cisgender=non-trans]

GBQ men considering parenthood reflect the reality that many men are actively interested in raising children. It is very important to some men to experience fatherhood and to have loving relationships in a family that includes children. Some choose single parenthood, some parent in same-sex couples and some arrange joint parenting with others with whom they, or a partner, can biologically create children.

GBQ men who parent face many commonly-held, but inaccurate, stereotypes. These include the assumption that women are essential to the nurturing of children, that "gay men" are likely to sexually abuse children, and that "gay men" are too busy thinking about or having sex to properly care for children. Many leading child welfare, psychological and children's health organizations have issued policy statements refuting these ideas and declaring that a parent's sexual orientation is irrelevant to his or her ability to raise a child.

In 2003 the Canadian Psychological Association (CPA) issued a statement that reads, in part: "According to the CPA, the psychosocial research into lesbian and gay parenting indicates that there are essentially no differences in the psychosocial development, genderidentity or sexual orientation between the children of gay or lesbian parents and the children of heterosexual parents."

Recent research also points to some interesting and positive possibilities for children who grow up in lesbian/gay/bisexual-led families (see, for example, Stacey & Biblarz [2002] Does the Sexual Orientation of Parents Matter? American Sociological Review 66.)

Lesbian, gay, bisexual and transgender (LGBTQ) people are creating families in diverse and creative ways. The options for GBQ men who are considering parenthood include:

Adoption

(public, private, or international)

Adoption refers to the process of becoming a legal parent or guardian of a child to whom one is not biologically related. It is now legal in Ontario for two people in a same-sex relationship to jointly adopt. There is currently a lot of educational work being donewithin Children's Aid Societies, and within private adoption agencies, to increase awareness and support for adoption by LGBT people. However, there is still much work to be done, and LGBT people attempting adoption continue to report that they face barriers.

Public Adoption through the Children's Aid Society

In Ontario, GBQ men, as individuals or as couples, are able to adopt children who are in the custody of the Children's Aid Society (CAS) and who no longer haveaccess to their biological parents. There are no costs involved with a public adoption. The CAS requires that you attend the "Adoption Decision Program" and a social worker must do a home study as part of the process. While all individuals or couples who are eligible to adopt through the CAS are in theory equal, the needs of the child are determined by social workers representing the child, with input from others involved with the child, including the foster family.

Private Adoption

Private adoption usually takes place through doctors, adoption agencies or individual licencees within Canada, without the involvement of the Children's Aid Society. There is usually a fee involved and it can be expensive. A child's birth parents can influence decisions about where a child is placed and these decisions can be affected by values and beliefs concerning LGBT people as parents.

International Adoption

Most same-sex international adoptions are done by people who, for the purposes of adoption, are single and not open about their sexual orientation. The regulations that guide international adoptions are unique to each country. Some countries will no longer allow single people to adopt as they assume that some of these individuals are "gay or lesbian". In order to qualify to adopt internationally, you have to have a home study done by a social worker who assesses your suitability to adopt.

If you are planning on being open about your sexual orientation and/or gender identity, a great deal depends on the individual social worker's knowledge levels and professionalism. As you have to pay for this assessment, you can choose a social worker with whom you are comfortable and who is familiar with LGBT-led families. In Ontario, you must work with an agency licensed to facilitate international adoptions. International adoption is also an expensive process. Check online with the Ontario government or with the Adoption Council of Ontario to find out which agencies focus on adoption from particular countries.

JOINT PARENTING WITH OTHERS

Many GBQ men create families with others with whom they, or a partner, can biologically create children or take on parenting roles with other parents and their children. Many queer women and men have chosen to have and raise children together, outside of an intimate partnership, creating new and innovative kinds of families. These families can include many configurations, such as: multiple caregivers, two single individuals who parent together, two couples or a couple and an individual. If you are considering a joint parenting arrangement, it is helpful to spend a lot of time getting to know the people you intend to parent with, exploring your (and their) parenting values, discussing important issues and drawing up a joint parenting contract. While coparentingcontracts are not legally binding, drawing up. Co-parenting, like all parenting, requires flexibility, communication, trust and a willingness to deal with the unexpected. (See brochure on Co-Parenting.)

SURROGACY

Some GBQ men have become parents through the use of a surrogate, a person who carries a child they do not intend to parent. There are two main types of surrogates. Traditional surrogates are people who have their own egg fertilized and carry the pregnancy. Gestational surrogates carry a pregnancy created through a fertilized egg from another person, an egg donor, and thus are not biologically related to the child they are carrying. There is usually a financial arrangement to compensate for the expenses of thesurrogate during the pregnancy. Surrogates can be contacted individually or through agencies.*

*The Assisted Human Reproduction Act (2004) may have serious implications for surrogacy arrangements in Canada. The Act prohibits commercial surrogacy by making it an offence to pay, offer to pay or advertise to pay "consideration" to a person to be a surrogate.

Resources and Support

Daddies & Papas 2B/TransFathers 2B

The LGBT Parenting Network (Sherbourne Health Centre) and Queer Parenting Programmes at The 519 Church St. Community Centre sponsor two bi-annual 11-week courses for men considering parenthood. DP2B has been designed for GBQ men. TF2B has been designed recognizing the unique challenges for trans men of all sexual orientations. These courses provide detailed information about the options available to GBQT men considering parenthood, as well as an opportunity to connect with others who are deciding if and how to bring children into their lives.

Daddy, Papa & Me

Queer Parenting Programmes at The 519 Church St. Community Centre runs a monthly queer-positive family resource program for fathers and their children (birth to age 6). Come meet other families in this kids' play space, which has toys, activities, music, snacks, children's and parenting books and other resources. We also keep in touch through an e-mail list. Second Saturday of every month from 10:00 a.m. to 1:00 p.m.