Disparities in Healthcare, STI Testing, and PrEP Access Among Newcomer Sexual Minority Men in Canada

Abstract

Gay, bisexual, and other men who have sex with men (GBM) are more likely to be diagnosed with HIV and other sexually transmitted infections (STIs) compared to the general population. Although newcomers (i.e., those who arrived ≤ 5 years prior to study participation) generally experience a health advantage compared to non-immigrants and more established immigrants (i.e., healthy immigrant effect), they also experience disparities in access to primary healthcare providers, which may lead to unique vulnerabilities for the sexual health of GBM immigrants. We examined disparities in healthcare access, STI testing, and HIV pre-exposure prophylaxis (PrEP) use among immigrant and non-immigrant GBM. Using baseline data from the Engage Cohort Study (n=2449), we found that newcomer GBM (vs. non-immigrant GBM) were less likely to have a primary healthcare provider, which mediated disparities in both access to STI testing and use of preventative interventions (e.g., PrEP). These disparities dissipated after controlling for precarious migration status (e.g., refugees and refugee applicants, temporary foreign workers, international students and undocumented immigrants), suggesting that disparities in newcomer GBM healthcare access may, in part, be carried by the large number of newcomers with precarious migration statuses, a particularly vulnerable sub-group in this population.