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Imagine Men’s Health Study – Health and Well-being among Gay and Bisexual Men of Colour in Toronto: Intersections of Body Image, Racism, Homophobia, and Gender Roles

Contents

I Introduction
II Study objectives
III Study context
IV Phase 1: Qualitative interviews
V Phase 2: Online survey
VI Study implications
VII Notes and resources

--Submitted by David J. Brennan and Rusty Souleymanov

I Introduction

Gay and bisexual men (GBM), particularly men who identify with ethnoracial communities, are at a disproportionately high risk for negative health outcomes (Keogh, Henderson, & Dodds, 2004; Remis, Swantee, Schiedel, Fikre, & Liu, 2007; Wolitski, Stall, & Valdiserri, 2008). For instance, in the area of sexual health, GBM of colour represent a growing proportion of new HIV diagnoses in Ontario. A report published in 2005 indicates that GBM of colour (in particular, Black, Southeast/East Asian, and Latino GBM) account for an increasing proportion (from 4% – 8% increase) of new HIV diagnoses in Ontario, while the proportion among White GBM had declined (Remis, Swantee, Schiedel, Fikre, &  Liu, 2007).

Research (including meta-analyses) consistently reports greater body dissatisfaction among GBM compared to heterosexual men (Beren, Hayden, Wilfley, Grilo, 1996; Chaney, 2008; Morrison, Morrison, & Sager, 2004; Tiggemann, Martins, & Kirkbride, 2007). Body image dissatisfaction among GBM has been associated with sexual risk behaviours (Wilton, 2009; De Santis et al., 2012) symptoms of depression (Blashill, 2010; Olivardia, Pope, Borowiecki, & Cohane, 2004), appearance-related anxiety (Blashill, 2010), and disordered eating symptomology (Blashill, 2010).

However, since the majority of body image-related studies conducted among GBM have employed predominantly White samples this has resulted in significant limits in the current state of knowledge about body image concerns for GBM of color. The Imagine Men’s Health (IMH) study sought to address this research gap.

II Study objectives

The IMH study launched in 2010 and was designed to shed light on the issues related to body image, race, racism, homophobia, as well as health and well-being among gay and bisexual men (GBM) of colour from the four largest ethnoracial communities in the Greater Toronto Area (Black/African/Caribbean, East and Southeast Asian, South Asian, and Latino/Hispanic/Brazilian communities). We wanted to understand how these issues were experienced and dealt with by GBM of colour. We also wanted to examine if there were any associations between body image concerns, experiences of racism and the mental, physical and sexual health, in particular risk for HIV and other sexually transmitted infections, of GBM of colour.

III Study context

This community-based research study was funded by the Social Sciences and Humanities Research Council of Canada. It consisted of two phases: For Phase 1, we conducted focus groups and interviews with 61 participants between April and May of 2010. [1] These focus groups informed the development of Phase 2, for which a comprehensive online survey [2] was administered to 410 GBM of colour between March and June of 2012.  

Ideas leading towards the development of the IMH study were based on previous research (see Brennan, Crath, Hart, Gadalla, Gillis, 2011) focused on issues of body image among GBM in Toronto. That study indicated that GBM of colour experience body image issues differently from their White counterparts. As a result, Professor Brennan’s research team worked collaboratively with various Toronto-based social service agencies (BlackCAP, Asian Community AIDS Services, AIDS Committee of Toronto, Alliance for South Asian AIDS Prevention, Centre for Spanish Speaking People) to discuss the development of a research project specifically designed to elucidate issues related to body image among GBM of colour.

This collaboration [3] included the formation of a Community Advisory Committee (CAC) comprised of more than 17 GBM of colour representing various ethnoracial communities and agencies who generously offered their personal and professional experiences to help the research team develop and design the study within an anti-oppressive and anti-racist framework. The CAC helped the research team with the development of the interview questions and the survey, recruitment and data analysis. The CAC also modified existing survey instruments in order to better account for the experiences of racism and homophobia prevalent among this population.

IV Phase 1: Qualitative interviews

We recruited men (total sample = 61) who were at least 18 years of age; spoke English proficiently;  identified as gay or bisexual or reported having sex with another man in the last 12 months, and  identified as being at least one of the following four ethnoracial groups: South Asian, Black/African/Caribbean, Southeast/East Asian, and Latino/Hispanic/ Brazilian. We conducted focus groups separately with men over the age of 30 and men under the age of 30. Participants were asked to share how they experience their own bodies, including both positive views and struggles. They were also asked how they think Toronto’s gay male community generally perceives the bodies of other GBM of colour.

Findings

Three major themes [2] came up across the focus groups and individual interviews:

1. GBM of colour face immense cultural pressure to meet body image ideals within the predominantly White gay community in Toronto.

Participants in this study suggested that the media play a significant role in influencing the ways they perceive and feel about their own bodies. Participants reported how certain images (White, fit, masculine and muscular body ideals) dominate magazine covers, and how their race or body types are not represented in them. For example, a Black GBM (age > 30) suggested how such images in the media impact how he feels about himself:

“Look at the cover of the publication. Like…fab ( a Toronto based gay magazine that is no longer published) …who usually gets profiled on the cover is … a Caucasian male, lots of muscles…spread eagle [legs and arms spread apart]…. And I understand…you’re selling magazines, but for the rest of us, who don’t fit that profile, and don’t have a good strong sense of self, I can see how damaging that could be. How you don’t think when you look in the mirror that ‘I’m hot’, because …you never see yourself reflected anywhere.”

2. Racism and other types of social oppression have a negative impact on GBM of colour and their well-being.

Due to the ideal body images prevalent in Toronto’s gay community, a South Asian GBM (age < 30) spoke about his feelings of being ignored and invisible because he is not White:

“I’m fairly decent looking. Many times I walk into a social situation and I’d be like ‘why do I feel as if I’m being ignored?’ Why is it that people look at you, turn away the moment you look at them? And I really do think that it’s a race factor.”

On the other hand, others reported feeling too visible because their non-White bodies are fetishized and sought after because of certain racial stereotypes. These stereotypes comprise certain body parts (e.g., penis size), and a racialized expectation of sexual prowess. According to a Black GBM (age > 30):

“Being African, everybody thinks you have a 13 or 14-inch penis...[and] you can shag for six hours, non-stop flight...They don’t think you are a human being, you can have a normal size (penis)… You get affected because...as you take it out, they say, “You are black, you should have something bigger than that.” So, it’s the disappointment...Of course, it affects you. It affects your self-esteem.”

3. GBM of colour show resistance against culturally dominant body image ideals.

Some of our participants talked how body image ideals prevailing in Toronto’s gay community have deleteriously impacted their health and well-being. In an attempt to meet these ideals, some men from the Latino/Brazilian group (age > 30) and East/Southeast Asian group (age >30), respectively, talked about how they have resorted to steroid use, disordered eating, and unsafe sexual practices:

“I’d skip meals. I’ve made myself vomit... so that I could look good for the evening... When I used to drink, I would not eat meals, because I was going to go out and party, because I wanted to look good. So to the detriment of my health, I will do that.”

“When I get picked up, I feel accepted....I say, ‘wait a minute, maybe I ain’t that bad looking.’ So, my insecurities about my body have led me to have promiscuous sex; it’s as simple as that, just because I want to be accepted by somebody, and if you go and you get picked up you feel that much better about yourself. ”

Many participants also actively resisted the cultural pressures to conform to body image ideals, and gave examples of strategies employed by gay men of colour to cope with these challenges. Here is an example of what a participant from a Black GBM group (age > 30) said:

“I got invited to…Pride beach party...and I said no... I can...imagine the expectation of body, you know, what it’s going to be like to be in this space.  And at this point...in my life, I don’t need to be in those spaces to be validated... I’ve…cocooned myself with a set of friends, community people, that don’t have those issues around body... I surround myself with my own that validates me, that I feel that I can...express myself in whatever way I feel and not be judged.”

V Phase 2: Online survey

Based on the results from Phase 1, a comprehensive online survey (using fluidsurveys.com) was developed to help understand the health and well-being of a larger sample of GBM of colour. We collected data from 410 men between March and June, 2012. The following analyses utilized a sample of 389 GBM of colour who answered all the survey questions.

Figure 1. Percent of Participants by Race/Ethnicity (N=389) 
Figure 1. Percent of Participants by Race/Ethnicity (N=389)

Survey results

  • The mean age was 33 years.
  • Among respondents, 64 (16.9%) were HIV-positive, 284 (75.1%) were HIV-negative, and 30 (7.9%) were unsure of their HIV serostatus.
  • East/Southeast Asian men reported lower rates of HIV risk behaviours compared to men of other race/ethnicity. Those with unsure HIV status reported higher rates of HIV risk than HIV-positive or negative men.

Among GBM of colour, pressures to conform to muscular body image ideals and masculine gender roles in the gay community may be influencing sexual risk.

We examined the relationship between the drive for muscularity, perceived beliefs about masculinity, and HIV risk among GBM of colour in Toronto.

Instruments

Body image was measured using the Drive for Muscularity scale. Sociocultural beliefs about masculinity were measured by the Perceived Masculinity Scale which assessed beliefs regarding physical appearance and penis size as indicators of masculinity. HIV risk was assessed as unprotected anal intercourse in the last six months with a partner whose status was serodiscordant or unknown. Relationships between Drive for Muscularity, Perceived Masculinity, demographics (age, income, sexual orientation) and HIV risk were examined using bivariate tests and logistic regression modeling.

Statistical results

Logistic regression analysis indicated Drive for Muscularity (OR=1.31, 95%CI=1.02-1.70), and Perceived Masculinity (OR=1.05, 95%CI=1.01-1.10) were significantly associated with HIV risk, after controlling for age, education and sexual orientation.

These results advance our knowledge of the role that drive for muscularity and perceived masculinity has in the health and wellbeing of GBM of color.

VI Study implications

The results of the qualitative phase of the study highlighted how multiple forms of oppression (e.g., racism, colonialism, sexism, homophobia) intersected with one another to impact the body image and overall well-being of GBM of colour. Survey analyses indicated that among GBM of colour, pressures to conform to muscular body image ideals and masculine gender roles in the gay community may be influencing sexual risk, potentially contributing to new HIV infections. Taken together, the findings from this project are relevant to those who provide a broad range of services to GBM of colour. Health professionals, service providers, and policy makers who work with GBM of colour should consider the role body dissatisfaction, racial discrimination, homophobia, gender roles, and sexual objectification play in the development of potential negative health outcomes for this population.

Recommendations for individual interventions

Using the findings from this study, service providers can develop strategies to:

  • Mitigate the negative emotional impact on GBM of colour when they encounter rejection and discrimination because of their race, sexual orientation, or gender expression.
  • Help GBM’s identify coping strategies and resources to deal with these deleterious health outcomes.
  • Resist stereotypes in the mainstream society, gay community, and media.
  • Promote positive body images.

Recommendations for structural interventions

  • Community interventions geared towards media representations of GBM of colour are essential, as these representations have serious repercussions for the health and well-being of the GBM of colour.
  • Policy makers should work towards continuing funding support for organizations that seek to dismantle racism, homophobia and other social oppressions that impact the well-being of these men.


VII Notes and resources

1. A full description of the qualitative phase of the IMH study has been published in: Brennan, D.J., Asakura, K., George, C., Newman, P.A., Giwa, S., Hart, T.A., Souleymanov, R., Betancourt, G. (2013). “Never reflected anywhere": body image among ethnoracialized gay and bisexual men. Body Image, 10(3), 389-98.

2. A full report of the quantitative phase of the IMH project has been published in: Brennan, D.J., Souleymanov, R., Asakura, K. (2013). Colour Matters: Body Image, Racism, and Well-being among Gay and Bisexual Men of Colour in Toronto A Report of the Imagine Men’s Health Study. CATIE: Canadian AIDS Treatment Information Exchange. http://www.catie.ca/sites/default/files/Colour%20Matters_IMH%20REPORT%20...

3. The authors would also like to thank all the individuals who worked diligently with us to develop and implement this research project.

Further references

Blashill, A. J. (2010). Elements of male body image: Prediction of depression, eating pathology and social sensitivity among gay men. Body Image, 7, 310-316.

Brennan, D. J., Crath, R., Hart, T. A., Gadalla, T., & Gillis, L. (2011).Body satisfaction and disordered eating among men who have sex with men in Canada. International Journal of Men’s Health, 10(3), 253-268.

Brennan, D. J., Asakura, K., George, C., Newman, P. A., Giwa, S., Hart, T. A., Souleymanov, R., Betancourt, G. (2013). “Never reflected anywhere”: Body image among ethnoracialized gay and bisexual men. Body Image: An International Journal of Research, 10(3), 389-398. doi: 10.1016/j.bodyim.2013.03.006

Brennan, D. J., Craig, S. L., & Thompson, D. E. A. (2012). Factors associated with a drive for muscularity among gay and bisexual men. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 14(1), 1-15. doi: 10.1080/13691058.2011.619578

Brennan, D.J., Souleymanov, R., Asakura, K. (2013). Colour Matters: Body Image, Racism, and Well-being among Gay and Bisexual Men of Colour in Toronto A Report of the Imagine Men’s Health Study. Canadian AIDS Treatment Information Exchange (CATIE).http://www.catie.ca/sites/default/files/Colour%20Matters_IMH%20REPORT%20...

Cheseboro, J. W., & Fuse, K. (2001). The development of a perceived masculinity scale.   Communication Quarterly, 49(3), 203-278.

Keogh, P., Henderson, L., Dodds, C. (2004). Ethnic minority gay men: Redefining community, restoring identity. London: Sigma Research.

McCreary, D. R., &Sasse, D. K. (2000). An exploration of the drive for muscularity in adolescent boy and girls. Journal of American College Health, 48(6), 297-304.

Remis, R.  S., Swantee, C., Schiedel, L., Fikre, M., & Liu, J. (2007). Report on HIV/AIDS in Ontario 2005. Available: http://www.phs.utoronto.ca/ohemu/tech%20reports.html.

Wolitski, R. J., Stall, R. & Valdiserri R. O. (2008), Unequal opportunity: Health disparities affecting gay and bisexual men in the united states. New York: Oxford University Press.