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Improving the Health of Men
  Who Have Sex with Men:
    Engaging Local Physicians

                   Funding Provided By:
        Irving K Barber School of Arts and Sciences
Institute of Health Living and Chronic Disease Prevention
                       UBC Okanagan

          Principal Investigator: Susan Holtzman, PhD
          Undergraduate Researcher: Karly Drabot
                                                            S
                           Page 1 of 20
Project Goals
(1) Increase physician awareness of the key
   issues and concerns facing men who have sex
   with men (MSM) in the Interior of BC

(1) Provide concrete suggestions and guiding
   principles for how to best address the needs
   of MSM

(1) Evaluate the effectiveness of
   the method of dissemination
Previous Research on the Health
               of MSM
• TWICE as likely to have unmet health care needs


    • 50% of all new cases of HIV
    • 70% of all new cases of infectious syphilis




• 17 times more likely to develop anal cancer


    • 3 times more likely to seek treatment from a
      psychologist
    • 2 to 14 times more likely to commit suicide
BUT…
• Majority of research has been
  conducted in major urban cities




• Research on MSM living outside these
  major urban centres is severely lacking
The UBCO MSM Health Survey

In 2010, Dr. Holtzman‟s Health Psychology
laboratory conducted one of the first health
surveys of MSM living in the Interior of BC

                   • 160 MSM living in the BC
                     Interior
                   • Well-established, well-validated
                     measures of health and well-
                     being
                   • Questions regarding satisfaction
                     with health care providers and
                     treatment
Key Findings
1. ONE QUARTER (25%) reported
   that they had NEVER been tested
   for HIV


2. Over ONE THIRD (37%) had not
   told their health care provider that
   they have sex with men


3. 45% reported clinically significant
   levels of depressive symptoms
          6
Key Findings
4. 43% reported engaging in risky
   sexual behaviour* with a male in
   the past three months

5. ONE QUARTER (24%) reported
   feeling “uncomfortable” or “very
   uncomfortable” talking to their
   health care provider about their
   sexual health

6. 11% reported feeling
   discriminated against by their
   health care provider in the past 12
         7
S
Design

                 1. Address six key
                   findings from the
   Online          UBCO MSM Health
                   Survey
PowerPoint
                 1. Provide suggestions
Presentation       for improving practice
                   and communication
                   with MSM patients
Before we continue…




• Not all men who have sex with men (MSM)
 consider themselves gay
• The term “MSM” includes men who may
  or may not identify as gay or bisexual
Key Findings
                           Key Findings
         “I cannot find a doctor to take me as a patient. They always tell me
HIV + Study to go to Vancouver, which is a 4+ hour drive from here.”
             “I cannot find a doctor to take me as a patient. They always tell
             “I cannot find a doctor to take me as a patient. They always tell
                                                                    Study Participant

Participant
Participant                              (HIV+)


Quote
  Quote      me toto go to Vancouver, whicha 4+4+ hour drive from here.”!
               me go to Vancouver, which is is a hour drive from here.”
   • 11% reported feeling discriminated
  11% reported feeling discriminatedprovider
     against by their health care against by
 their health care12 monthsthe past 12 months
     in the past provider in

                                • Perceived discrimination can
         Why is this
          W hy is this           • lead to a range of negative
                                    Perceived discrimination can
        important to
         important to               lead to a range of negative
                                   physical and emotional
            you?                   health consequences health
                                    physical and emotional
             you?                   consequences for M SM .
                                   for MSM.
5 Guiding Suggestions

1. Create a welcoming office

2. Use gender-neutral language and adopt
   an inclusive attitude

3. Take a frequent sexual health history

4. Encourage regular HIV and STI testing

5. Screen for common mental health
   concerns           12
Tip # 1



          Post a rainbow sticker on
           Post a rainbow wall or on
              your office sticker
          your office wall or window
           window to communicate
           that you provide thatopen
            to communicate an you
             provide an open office.
                     office.
          *Many MSM report that this small gesture would
                      make a big difference.
           *M any M SM report that this small gesture would
                       make a big difference.


 Educate your MOAs and staff concerning the
  Educate your M OA s and staff concerning the
need for increased awareness on MSM issues
need for increased awareness on M SM policies.
  and institutional anti-discrimination issues and
    institutional anti-discrimination policies.
Evaluate Effectiveness
       of the Online Presentation

Multiple Choice Quiz
Assess if participants were paying
attention




Questionnaire
Assess content and impact of
presentation
Development of PowerPoint Presentation


Kevin Saya-Moore
  Project Coordinator,
  Engaging Physicians Project
  Living Positive Resource Centre



Dr. Toye Oleyese
   Champion Physician,
   Engaging Physicians Project
Reaching the Physicians

               Website




            Study Invitation
Reed Scott
  Coordinator,
  Practice Support Program
Results
27 opened the study link  11 completed the
                  study
                       • 6 male & 5 female
                          GPs
                       • Age: 34 to 57
                       • Practicing: 7 to 34
                          years
                       • Heterosexual
In the future, how would you prefer to receive this type of
              information? Please select all that apply.

12

10

8

6

4

2

0
Results


• 10 (of the 11) physicians agreed
  that this new information provided
  would have an effect on their
  practice
Implications & Suggestions
MSM Health Survey
  • Great need to increase physician awareness of
    MSM and ease stigma against MSM living
    outside of major urban cities in Canada

Online PowerPoint Presentation
  • Need to recognize MSM within the health care
     system
  • Need for funding and resources to address and
     reduce MSM stigma
  • Need for further research on effective
     dissemination methods within the medical
     community
Dr. Irving K. Barber Endowment Fund

                   AIDS Community Action Program

Acknowledgement     Public Health Agency of Canada

                          Dr. Susan Holtzman
       s
                           Dr. Toye Oleyese

                            Mr. Saya-Moore

                            Mr. Reed Scott
Questions?
Quiz Questions
                                                       Correct
                                                    Responses
1. Why is the information in this presentation
   important for you and your practice?                 11/1
                                                           1
1. How many MSM in the BC Interior have not told
   their physicians that they have sex with men?
                                                        10/1
2. What percentage of MSM reported clinically              1
   significant levels of depressive symptoms at the
   time of completing the survey?
                                                        8/11
3. Approximately ____ of MSM in the BC Interior
   have not been tested for HIV.
                                                        7/11
4. What are some simple, yet significant, ways to
   better serve MSM in the BC Interior?
Quiz Answers
1. a. MSM living in the BC Interior, and around the
world, often do not receive adequate care for their physical
and mental health
   b. By providing adequate care for MSM, you are indirectly
extending your care to women and other men who are not
MSM
   c. Substandard care of MSM is a primary factor in the
surge of HIV among MSM as well as lower health outcomes
overall.
   d. All of the above
2. 37%
3. 45%
4. 1/4
5. a. Create a welcoming office
                               24
   b. Use gender-neutral language and adopt an inclusive
Questionnaire Results

1. 11/11 agreed that the information in the
   presentation was clear and concise

2. 8/11 disagreed that the presentation took up
   too much of their time (3/11 reported „neutral‟)

3. 4/11 agreed that the information provided was
   new to them (4/11 indicated „neutral‟ and 3/11
   „disagreed‟)

4. 10/11 agreed that this new info provided
   would have an effect on their practice

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Karly Drabot & Kevin Saya-Moore, "Improving the Health of Men Who Have Sex with Men: Engaging Local Physicians"

  • 1. Improving the Health of Men Who Have Sex with Men: Engaging Local Physicians Funding Provided By: Irving K Barber School of Arts and Sciences Institute of Health Living and Chronic Disease Prevention UBC Okanagan Principal Investigator: Susan Holtzman, PhD Undergraduate Researcher: Karly Drabot S Page 1 of 20
  • 2. Project Goals (1) Increase physician awareness of the key issues and concerns facing men who have sex with men (MSM) in the Interior of BC (1) Provide concrete suggestions and guiding principles for how to best address the needs of MSM (1) Evaluate the effectiveness of the method of dissemination
  • 3. Previous Research on the Health of MSM • TWICE as likely to have unmet health care needs • 50% of all new cases of HIV • 70% of all new cases of infectious syphilis • 17 times more likely to develop anal cancer • 3 times more likely to seek treatment from a psychologist • 2 to 14 times more likely to commit suicide
  • 4. BUT… • Majority of research has been conducted in major urban cities • Research on MSM living outside these major urban centres is severely lacking
  • 5. The UBCO MSM Health Survey In 2010, Dr. Holtzman‟s Health Psychology laboratory conducted one of the first health surveys of MSM living in the Interior of BC • 160 MSM living in the BC Interior • Well-established, well-validated measures of health and well- being • Questions regarding satisfaction with health care providers and treatment
  • 6. Key Findings 1. ONE QUARTER (25%) reported that they had NEVER been tested for HIV 2. Over ONE THIRD (37%) had not told their health care provider that they have sex with men 3. 45% reported clinically significant levels of depressive symptoms 6
  • 7. Key Findings 4. 43% reported engaging in risky sexual behaviour* with a male in the past three months 5. ONE QUARTER (24%) reported feeling “uncomfortable” or “very uncomfortable” talking to their health care provider about their sexual health 6. 11% reported feeling discriminated against by their health care provider in the past 12 7
  • 8. S
  • 9. Design 1. Address six key findings from the Online UBCO MSM Health Survey PowerPoint 1. Provide suggestions Presentation for improving practice and communication with MSM patients
  • 10. Before we continue… • Not all men who have sex with men (MSM) consider themselves gay • The term “MSM” includes men who may or may not identify as gay or bisexual
  • 11. Key Findings Key Findings “I cannot find a doctor to take me as a patient. They always tell me HIV + Study to go to Vancouver, which is a 4+ hour drive from here.” “I cannot find a doctor to take me as a patient. They always tell “I cannot find a doctor to take me as a patient. They always tell Study Participant Participant Participant (HIV+) Quote Quote me toto go to Vancouver, whicha 4+4+ hour drive from here.”! me go to Vancouver, which is is a hour drive from here.” • 11% reported feeling discriminated 11% reported feeling discriminatedprovider against by their health care against by their health care12 monthsthe past 12 months in the past provider in • Perceived discrimination can Why is this W hy is this • lead to a range of negative Perceived discrimination can important to important to lead to a range of negative physical and emotional you? health consequences health physical and emotional you? consequences for M SM . for MSM.
  • 12. 5 Guiding Suggestions 1. Create a welcoming office 2. Use gender-neutral language and adopt an inclusive attitude 3. Take a frequent sexual health history 4. Encourage regular HIV and STI testing 5. Screen for common mental health concerns 12
  • 13. Tip # 1 Post a rainbow sticker on Post a rainbow wall or on your office sticker your office wall or window window to communicate that you provide thatopen to communicate an you provide an open office. office. *Many MSM report that this small gesture would make a big difference. *M any M SM report that this small gesture would make a big difference. Educate your MOAs and staff concerning the Educate your M OA s and staff concerning the need for increased awareness on MSM issues need for increased awareness on M SM policies. and institutional anti-discrimination issues and institutional anti-discrimination policies.
  • 14. Evaluate Effectiveness of the Online Presentation Multiple Choice Quiz Assess if participants were paying attention Questionnaire Assess content and impact of presentation
  • 15. Development of PowerPoint Presentation Kevin Saya-Moore Project Coordinator, Engaging Physicians Project Living Positive Resource Centre Dr. Toye Oleyese Champion Physician, Engaging Physicians Project
  • 16. Reaching the Physicians Website Study Invitation Reed Scott Coordinator, Practice Support Program
  • 17. Results 27 opened the study link  11 completed the study • 6 male & 5 female GPs • Age: 34 to 57 • Practicing: 7 to 34 years • Heterosexual
  • 18. In the future, how would you prefer to receive this type of information? Please select all that apply. 12 10 8 6 4 2 0
  • 19. Results • 10 (of the 11) physicians agreed that this new information provided would have an effect on their practice
  • 20. Implications & Suggestions MSM Health Survey • Great need to increase physician awareness of MSM and ease stigma against MSM living outside of major urban cities in Canada Online PowerPoint Presentation • Need to recognize MSM within the health care system • Need for funding and resources to address and reduce MSM stigma • Need for further research on effective dissemination methods within the medical community
  • 21. Dr. Irving K. Barber Endowment Fund AIDS Community Action Program Acknowledgement Public Health Agency of Canada Dr. Susan Holtzman s Dr. Toye Oleyese Mr. Saya-Moore Mr. Reed Scott
  • 23. Quiz Questions Correct Responses 1. Why is the information in this presentation important for you and your practice? 11/1 1 1. How many MSM in the BC Interior have not told their physicians that they have sex with men? 10/1 2. What percentage of MSM reported clinically 1 significant levels of depressive symptoms at the time of completing the survey? 8/11 3. Approximately ____ of MSM in the BC Interior have not been tested for HIV. 7/11 4. What are some simple, yet significant, ways to better serve MSM in the BC Interior?
  • 24. Quiz Answers 1. a. MSM living in the BC Interior, and around the world, often do not receive adequate care for their physical and mental health b. By providing adequate care for MSM, you are indirectly extending your care to women and other men who are not MSM c. Substandard care of MSM is a primary factor in the surge of HIV among MSM as well as lower health outcomes overall. d. All of the above 2. 37% 3. 45% 4. 1/4 5. a. Create a welcoming office 24 b. Use gender-neutral language and adopt an inclusive
  • 25. Questionnaire Results 1. 11/11 agreed that the information in the presentation was clear and concise 2. 8/11 disagreed that the presentation took up too much of their time (3/11 reported „neutral‟) 3. 4/11 agreed that the information provided was new to them (4/11 indicated „neutral‟ and 3/11 „disagreed‟) 4. 10/11 agreed that this new info provided would have an effect on their practice

Editor's Notes

  1. The goals of my project were…So why were these goals and this topic important to me? Well *switch slide*
  2. A vast literature suggests that MSM do not receive adequate health care, however *switch slide*
  3. Research indicates that MSM living in rural communities may be at even greater risk of poor health.In response to this, the UBCO MSM Health Survey was conducted *switch slide*
  4. Some alarming key findings came from the results of this survey. For example…It was clear from these results that the MSM population in the Interior of BC was not receiving adequate health care.
  5. Therefore, there was a need to engage and educate the local physicians about the health issues facing MSM in their community. *chat about different dissemination options* After some brainstorming with Dr. Holtzman, we decided to create an online presentation to communicate the key findings to local physicians.
  6. Started the presentation with a definition and explanation of the term MSMThe 6 key findings from the UBCO MSM health survey followed this slide.
  7. This is an example of one of the 6 key findings I presented to the physicians.For the key finding about discrimination, I provided a participant’s quote. He said….
  8. So these were simple, yet effective means of improving practice.For each suggestion I provided an example and explanation for how to appropriately do so.
  9. This was the slide for the first suggestion.*go through it*It was important to disseminate the survey results to the physicians, but it was equally important for me to collect information from the physicians.
  10. Although it was extremely important to disseminate the results and suggestions to physicians, it was equally important to collect information from the physicians.I created 5 very basic quiz questions which directly addressed the key findings provided in the presentation. This allowed me to assess if the physicians were paying attention and if their awareness of the Lastly, I created a brief questionnaire to assess the content and impact of the presentation. For example, *list some example questionnaire items*
  11. In developing the powerpoint presentation, I connected with Kevin Saya-Moore, Project Coordinator for the Engaging Physicians Project, and Dr. O, the Champion Physician of the Engaging Physicians Project. It was great to receive feedback and advice from Kevin, a member of the BC Interior MSM population, to ensure I was using correct terminology and offering impactful suggestions.And i really appreciated Dr. Toye’s recommendations and edits as he was a part of the population I was targeting - physicians practicing in the BC Interior
  12. Explain the process of uploading the presentation and contacting the physicians with the study invitation and presentation link
  13. To date, we have had 27 physicians start the study and 11 physicians complete the study. We don’t know why the physicians chose not to complete the study…topic? Time? Other? *demographics*Although we do not have enough participants to scientifically examine the data at this point, I will share some of my preliminary results with you
  14. As well, *chat about the graph*However, we do understand that this may not represent the preferences of all physicians practicing in the BC Interior as these 11 physicians are the 11 who chose to participate and complete the study.
  15. It’s not about the docs personal opinions about MSM, it is about docs meeting the needs of their patients and offering appropriate health care.
  16. Add 6 key findings & 5 suggestions
  17. 1. a. MSM living in the BC Interior, and around the world, often do not receive adequate care for their physical and mental healthb. By providing adequate care for MSM, you are indirectly extending your care to women and other men who are not MSMc. Substandard care of MSM is a primary factor in the surge of HIV among MSM as well as lower health outcomes overall. d. All of the above