Tailoring tobacco smoking reduction and cessation interventions with gay men living with HIV

Kevan (name changed) participated in one of two participatory focus groups held in Victoria and Vancouver in the spring of 2013 to provide advice on helping create services for men living with HIV who smoke tobacco products. During the focus group he learned that smoking rates among gay men and persons living with HIV (PLWH) are 2 – 4 times higher than the general population. Smoking is a major modifiable determinant of health associated with significant comorbidities (e.g., cardiovascular, neuropsychiatric, pulmonary, renal diseases) and HIV disease progression. Among gay and bisexual men, heavier tobacco use is associated with more severe illness symptoms and higher smoking rates are associated with comorbid illness. Previous smoking reduction and cessation (SRC) interventions used generalized (one-size-fits-all) approaches that have limited success with gay men. Tailoring SRC interventions to the unique needs of gay PLWH may improve the success of SRC with these men. Working with gay men living with HIV who smoke, the BC Lung Association’s QuitNow Program, and researchers from the Schools of Nursing at the University of British Columbia and the University of Ottawa are exploring the use of personas and empathy mapping to develop a tailored SRC web-assisted tobacco intervention (WATI).

Kevan and his peers were invited to become researcher-participants in the development of personas representing the typical gay man living with HIV who smokes. Personas are used in marketing to develop “detailed descriptions of imaginary people constructed out of well-understood, highly specified data about real people.” Personas help people who do not belong to a target market understand the needs of people like Kevan and how their culture influences health promotion and smoking behaviors. During participatory design sessions, Kevan and his peers generated a name and demographic information for their ‘persona’ and ascribed unique thoughts, feelings, and behaviors to each persona.  Four personas emerged from the design sessions, Joe Average, Biff Barista, Riley Homo, and Joe Schmo.

Joe Average, for example, is an HIV positive gay man living with his partner in a mid-sized city. He works full time He is a pack-a-day smoker who often smokes with his partner, co-workers, or friends. He is strongly goal oriented and he strives to manage his HIV. He makes sure that he eats right and gets plenty of exercise. Often under deadlines for his job, he finds himself smoking to relieve stress. He smokes as part of his many routines, including taking medications and vitamins, activities of daily living (e.g., showering), socializing with co-workers, smoking marijuana with his partner, and he sometimes smokes cigarettes after getting high on marijuana. Although concerned with his health, he hasn’t been able to quit smoking.

The four personas created by Kevan and his peers were analyzed using ethnographic and thematic analysis techniques to understand the collective needs of HIV positive gay men who smoke and how culture influences their SRC efforts. The first theme that emerged was navigating life and HIV, followed by triple stigma (i.e. gay-related stigma, HIV-related stigma, smoking-related stigma), immunity to public health messages, complexity of managing HIV, complexity of managing identity, benefits of smoking, anxiety about life, and apathy about life. Our goals with Kevan and his peers are to engage with gay men living with HIV who smoke as researcher-participants. This approach affords gay men living with HIV who smoke the opportunity to collaborate with each other, policy makers, researchers, and clinicians in the development of a WATI that includes input and collaboration from all stakeholders.



J. Craig Phillips, PhD, LLM, RN, ARNP, PMHCNS-BC, ACRN, Associate Professor, School of Nursing, University of Ottawa

Jack Boomer

Jack Boomer, MPA, B.Ed., Director, QuitNow, BC Lung Association, Principal, Context Research

Leanne M. Currie, PhD, RN, Associate Professor, School of Nursing, University of British Columbia

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Sex & Substance Use Among Transgender Gay, Bisexual & Other Men Who Have Sex with Men

Gay, bisexual and other men who have sex with men (GBMSM) make up over 50% of new HIV infections in British Columbia, as well as almost half of those living with HIV in the province. Despite up to two-thirds of transgender men identifying as gay, bisexual or queer, the presence of transgender GBMSM within the largely cisgender (people whose gender identity is consistent with their sex assigned at birth) gay men’s communities is often invisible. While the link between substance use and HIV sexual risk is well-documented among gay men, little is known about trans GBMSM’s relationship to this culture of substance use with sex.

Trans people are generally left out of epidemiological surveillance and the collection of other public health data, sometimes explicitly excluded from research studies. What we do know about the size of the population and their health profile is largely based on small convenience samples, with the recent exception of theTransPULSEstudy conducted in Ontario which used respondent driven sampling (RDS) to recruit 433 trans people across the province. Further to the lack of data, research with transgender people has generally focused on gender identity, leaving the experiences of trans GBMSM not well documented.

The Momentum Health Study is a new opportunity to learn more about the health of GBMSM. A five-year bio-behavioural longitudinal study, Momentum is open to HIV-positive and HIV-negative cisgender and transgender men who are sexually active with other men in the Greater Vancouver Region. Following participants in the cohort over the study period Momentum will produce quantitative clinical, behavioural and psychometric data and provide a deeper understanding of some of the complexities around sexual health, gender identity and sexual orientation, sexual risk and decision making through qualitative interviewing.

In preliminary quantitative analysis, almost half the trans GBMSM in Momentum used at least one substance (primarily alcohol and cannabis) as did their partners, during one of their most recent sexual encounters while one-quarter did not know the HIV status of their sexual partner prior to sex. Overall, transgender GBMSM in the study appear to be engaging in lower HIV sexual risk behaviours than their cisgender peers as well as employing more HIV risk reduction strategies, despite not testing for HIV as frequently.

As a longitudinal bio-behavioural study, Momentum will provide an opportunity to gain a picture of the clinical and behavioural sexual health of trans GBMSM over time, adding to the limited knowledge on these men’s health. The initial take away is that public health prevention and harm reduction interventions targeting gay, bisexual and other men who have sex with men need to acknowledge the inclusion of trans men within these communities and ensure they are inclusive of trans gay men.


Author: Ashleigh Rich, Research Coordinator, Momentum Health Study, BC Centre for Excellence in HIV/AIDS in Vancouver

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC