Placing HIV beyond the metropolis: Risks, mobilities, and health promotion among gay men in the Halifax, Nova Scotia region

Abstract

Research on HIV/AIDS among gay men in North America has departed from pure disease diffusion models to consider the social and environmental contexts where transmission may take place. Most of this work, however, focuses on large metropolitan areas and operationalizes the concept of place with only some degree of nuance. Large cities-and the bars, bathhouses, and gay villages within them-are often treated as containers of attributes that contribute to and concretize HIV risk. This article therefore seeks to apply a critical, ecological conception of place to understanding HIV risk, education, and prevention among gay men in the small city-region of Halifax, Nova Scotia. Using in-depth interviews with HIV/AIDS-related service providers and self-identified gay men, the study highlights four dynamics of HIV risk potentially affecting gay men in smaller cities and rural areas: (1) institutional ambivalence toward HIV education and messaging, (2) narrow conceptions of risk, (3) migrations into unfamiliar social and sexual environments, and (4) social and structural barriers to health service utilization. Keywords: HIV/AIDS, gay men, Nova Scotia, sexual health, health promotionSituer le VIH au-del a de la m etropole : les risques, les mobilit es, et la promotion de la sant e chez les hommes gais dans la r egion d'Halifax, NouvelleEcosseLes travaux de recherche men es sur le VIH/sida chez les hommes gais en Am erique du Nord ont rompu avec les mod eles limit es a la diffusion de la maladie afin de tenir compte davantage des contextes sociaux et environnementaux de transmissions possibles. Cependant, ce corpus scientifique est consacr e aux grandes r egions m etropolitaines et applique la notion de lieu de faS con peu nuanc ee. Les grandes villes, les bars, les saunas, et les villages gais qu'on y retrouve sont souvent d esign es comme des milieux caract eris es par les attributs qui favorisent et concr etisent le risque de transmission du VIH. S'appuyant sur une conception ecologique critique du lieu, cet article a pour objet de mettre en lumi ere le risque, les programmes d' education et la pr evention en mati ere de VIH chez les hommes gais a Halifax, NouvelleEcosse, une viller egion de petite taille. Au moyen d'entrevues r ealis ees aupr es de fournisseurs de services sp ecialis es dans le VIH/sida et aupr es d'hommes s' etant d eclar es gais, l' etude montre combien les dynamiques sociales et institutionnelles particuli eres ont une influence sur la faS con dont les gais de la r egion conS coivent et se pr eoccupent du risque de transmission du VIH. Leurs r ecits mettent en evidence l'ambivalence institutionnelle envers les programmes d' education et la communication de messages portant sur le VIH, les n egociations individuelles complexes entourant l'identit e sexuelle et l'acte sexuel proprement dit, et les obstacles a l'acc es aux services de sant e sexuelle. Il en ressort un agencement particulier de discours sur le VIH et des risques potentiels que courent les hommes gais dans les petites villes et les autres ...

Sexuality, space, gender, and health: Renewing geographical approaches to well‐being in lesbian, gay, bisexual, transgender, and queer populations

“…Recent work has outlined the different “socio‐geographies” of health education and health services for LGBTQ populations, noting both measurable and perceived differences in access to care across large cities, smaller towns, and rural areas (Baker & Beagan, ). There is increasing evidence to suggest that less inclusive health education in socially conservative environments can create a sexual health disadvantage for those who identify as LGBTQ (Lewis, ).…”

Linked life courses in fieldwork: researcher, participant and field

“…), could migration, life course disruption and social isolation also be ‘syndemic’ with HIV? Taking cues from the other researchers, I learned to frame the broader life trajectories of individual gay men in these epidemiologic terms (Lewis ).…”

“…Many service providers had also experienced the years of in‐fighting among Halifax's AIDS service organisations (ASOs) competing for limited HIV prevention funding (see Lewis ) and often seemed wary of sharing knowledge outside of their own organisations. One participant described an institutional culture of silence around HIV in Nova Scotia.

The Atlantic region in and of itself, our HIV, our prevalence is quite low, we're not part of the big three [Montreal, Vancouver and Toronto], in any way, shape or form … there's often a perception that there's no HIV here ergo there's no risk … [in other cities] there's posters for testing all over the place.

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Urban encounters and sexual health among gay and bisexual immigrant men: perspectives from the settlement and aids service sectors

“…In terms of health, a number of diffusionist studies have examined return migration of HIV‐positive gay men to rural locations and its implications for local the health care systems (Cohn and others ; Ellis and Muschkin ) while ignoring the particularities of how or why they left or became infected. A few recent studies, however, explain more clearly how past trauma, loss of social supports, precarious employment, and a lack of familiarity with new social and sexual environments can all foreground post‐migration risk behaviors such as substance abuse and unprotected sex (Bruce and Harper ; Egan and others ; Lewis , ).…”

“…Previous studies of local and regional migration among gay men in the United States and Canada suggest that post‐migration struggles, which can include coming out, the loss of social and financial supports, the search for new social circles, and encounters with new sexual environments, all have significant implications for mental and sexual health (Bruce and Harper ; Egan and others ; Frye and others 2014; Lewis , ). A limited body of work suggests that international immigrants face the same issues upon arrival in a new country, but that they are made even more complicated by racism, nativism, and a lack of familiarity with North American conceptions of gay identity and community (Carillo 2004; Bianchi and others ; Munro and others ; Carillo and Fontdevila ).…”