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BackgroundDrug user networks and community-based organizations advocate for greater, meaningful involvement of people with lived experience of drug use in research, programs and services, and policy initiatives. Community-based approaches to research provide an opportunity to engage people who use drugs in all stages of the research process. Conducting community-based participatory research (CBPR) with people who use drugs has its own ethical challenges that are not necessarily acknowledged or supported by institutional ethics review boards. We conducted a scoping review to identify ethical issues in CBPR with people who use drugs that were documented in peer-reviewed and grey literature.MethodsThe search strategy focused on three areas; community-based research, ethical issues, and drug use. Searches of five academic databases were conducted in addition to a grey literature search, hand-searching, and consultation with organizational partners and key stakeholders. Peer reviewed literature and community reports published in English between 1985 and 2013 were included, with initial screening conducted by two reviewers.ResultsThe search strategy produced a total of 874 references. Twenty-five references met the inclusion criteria and were included in our thematic analysis. Five areas were identified as important to the ethics of CBPR with people who use drugs: 1) participant compensation, 2) drug user perspectives on CBPR, 3) peer recruitment and representation in CBPR, 4) capacity building, and 5) participation and inclusion in CBPR.ConclusionsWe critically discuss implications of the emerging research in this field and provide suggestions for future research and practice.

In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.

Health professionals should consider the role of racial discrimination and sexual objectification within the context of risk and treatment for alcohol use disorders, harm reduction, and HIV prevention for gay and bisexual men of colour.

Previous research has highlighted the association between HIV sexual risk behaviors, muscularity concerns, and masculinity among gay and bisexual men (GBM). A few studies that explored these issues, however, have used relatively small sample sizes and predominantly White GBM samples. In addition, little is known about whether a drive for muscularity and perceptions of masculinity are associated with HIV sexual risk behaviors among GBM of color. This community-based study examined the association between drive for muscularity, masculinity, and HIV sexual risk among a sample of 389 GBM of color in Toronto. In multivariable analyses, drive for muscularity and masculinity were significantly associated with HIV sexual risk, after controlling for sociodemographic variables and internalized homophobia. Findings suggest that a desire to be more muscular or a disappointment with one’s musculature, as well as an endorsement of body image and penis size as indicators of masculinity may play a role in HIV sexual risk behaviors. This study is among the first to examine the role of drive for muscularity and notions of masculinity in relation to HIV sexual risk exclusively among an ethnoracially diverse sample of GBM. Further research is needed to better understand the link between body image and masculinity to reduce HIV risk among GBM of color.

Background As of 2019, men who have sex with men (MSM) in Canada are ineligible to donate blood if they have had oral or anal sex with another man in the last 3 months. Deferral policies targeting MSM are largely interpreted as unjust by gay, bisexual, and other men who have sex with men (GBMSM) – shaping their desire to donate blood and engage with blood operators. This mixed methods study explores interest in blood donation among GBMSM as well as willingness (and eligibility) to donate under four different deferral policies. Methods We surveyed 447 GBMSM who were recruited from the Ontario-wide #iCruise study. Participants were asked whether they were interested in blood donation and if they were willing to donate under each of our four deferral policies. We also completed interviews with 31 of these GBMSM. Participants were asked to describe their feelings about blood donation, their views on our different deferral policies, the impact of a policy change, as well as other means of redress. Results Most participants (69%) indicated that they were interested in donating blood. Despite this, an interpretation of the MSM deferral policy as discriminatory was common among all participants. Our mixed methods findings indicate that, among those who were interested in blood donation, the adoption of one of the alternative policies presented in this study (specifically Policy 2 or Policy 3) would significantly increase the number of participants willing to donate and be viewed as “a step in the right direction.” However, many participants who were not interested in blood donation argued that a gender-neutral deferral policy would need to be implemented for them to donate. Participants recommended that blood operators consider efforts to repair relations with GBMSM beyond policy change, including pop-up clinics in predominantly queer areas and diversity sensitivity training for staff. Conclusion We argue that the most impactful policy shift would be the implementation of an individual risk-based deferral policy that is applied to all donors regardless of sexual orientation or gender identity. However, given MSM’s historical exclusion from blood donations, blood operators should pair this policy shift with community relationship-building efforts.

Gay and bisexual men (GBM) are an underexamined population in body image research, given the relatively high levels of body dissatisfaction reported among GBM compared with that of heterosexual men. However, distress related to appearance among GBM may not be exclusive to anxiety about having a perfect physique. The present study used the 16-item Social Appearance Anxiety Scale (SAAS; Hart, Flora, et al., 2008) in a racially diverse sample of 389 GBM of color to examine the psychometric properties of a measure of anxiety about being evaluated for one’s overall appearance. Similar to other studies of undergraduate students (e.g., Levinson & Rodebaugh, 2011; Levinson et al., 2013), the SAAS had a unifactorial structure and was highly internally consistent. Social appearance anxiety was highly correlated with anxiety and body image dissatisfaction. Social appearance anxiety had moderate to large correlations with other established measures of body image dissatisfaction and psychological distress. Racist experiences were associated with social appearance anxiety above and beyond correlations of social appearance anxiety with anxiety and body image dissatisfaction. The present study also extends beyond previous research on body image and anxiety among GBM by demonstrating the importance of minority stress-related variables that go beyond sexual orientation, such as racism experiences.

The Internet is a common tool for gay, bisexual, and other men who have sex with men (MSM) to find sexual partners and sexual health information. Given persistently high human immunodeficiency virus (HIV) infection rates among MSM, it is important to examine the role of online outreach for MSM as part of HIV prevention and care. We provide an overview of the unique perspectives of online sexual health outreach, delivered through AIDS Service Organizations (ASOs) through sociosexual Internet sites and mobile applications. Data were drawn from the qualitative arm of the community-based Cruising Counts study conducted across Ontario from December 2013 to January 2014. ASO online outreach providers and managers (n = 22) were recruited to complete a 1-h in-person/telephone interview to explore in-depth their experiences with, and perspectives on, delivering online outreach services for MSM in Ontario. Thematic analyses were conducted inductively using NVivo 10. Service providers suggested a high demand for online outreach services for MSM. Strengths and advantages of online outreach over face-to-face outreach included anonymity, instant access to services, peer model, and accessing hard-to-reach populations of MSM. Barriers included consistent quality of service, collaborations between companies that own online technologies and outreach service agencies, budgetary and staff capacity issues, and uncertainty of best practices and evaluation parameters for online outreach. Findings from these interviews can inform service providers, policy makers, and researchers on how online sexual health outreach can play a greater role in HIV prevention by better acknowledging and addressing the opportunities and barriers experienced by service providers working with MSM communities online.