Academic journal article The Geographical Review

Urban Encounters and Sexual Health among Gay and Bisexual Immigrant Men: Perspectives from the Settlement and AIDS Service Sectors

Academic journal article The Geographical Review

Urban Encounters and Sexual Health among Gay and Bisexual Immigrant Men: Perspectives from the Settlement and AIDS Service Sectors

Article excerpt

In the United States and Canada, gay men's health researchers have devoted increasing attention to the risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among Latinos, Asians, and other ethnic minority men who are also gay, bisexual, or MSM--men who have sex with men (Ratti and others 2000; Yoshikawa and others 2004; Fernandez and others 2005, 2009; Akin and others 2008; Choi and others 2013). Although the men included in this research are often foreign-born, few studies examine specifically how the immigration and resettlement processes they undertake mediate their sexual health behaviors or outcomes (although see Carillo 2004; Bianchi and others 2007; Carillo and Fontedevila 2014). Instead, most studies use quantitative hypothesis testing to link risk behaviors such as unprotected sex with individual-level characteristics such as drug use (Fernandez and others 2005, 2009), social network size (Yoshikawa and others 2004; Choi and others 2013), and online network use (Chiu and Young 2015). Although the more contextual economic, legal, and social transitions affecting gay immigrants are well documented (LaViolette 2003; Ramirez 2005; Romero 2005; Simmons and others 2008; Lewis and Naples 2014), they are rarely considered in epidemiological studies. Consequently, the relationships between migration, resettlement, and sexual health--and the reasons why certain risk factors and risk behaviors emerge in the first place--are poorly understood.

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 2011; Egan and others 2011; Frye and others 2014; Lewis 2014, 2015). 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 2007; Munro and others 2013; Carillo and Fontdevila 2014). These studies suggest that sexual health behaviors are shaped not only by values or knowledge, but also by the dynamics of specific, interactive encounters in bars, clubs, hookup sites, and health-promotion outlets. Focusing on three cities in Ontario, Canada--Greater Toronto, Ottawa, and London--this article employs an urban ecological approach to demonstrate that gay and bisexual men's interactions with various urban environments (for example, the settlement agency, the clinic, and the gay bar) in the postmigration period have significant implications for their sexual health behaviors and outcomes.

APPROACHES TO UNDERSTANDING SEXUAL HEALTH TRANSITIONS IN GAY AND BISEXUAL IMMIGRANT MEN

Research on immigrant health in North America has typically focused on post-migration changes in diet, living conditions, employment, and subsequently the development of chronic disease differentials over the life course (see Asanin and Wilson 2008). Less work has focused on the sexual health of immigrants, and even less on that of sexual-minority individuals within immigrant populations. The majority of the work in this specific subfield has been taken on by psychologists and epidemiologists, is typically framed by ethnicity (not migration) and operationalized through predictive, hypothetic-deductive frameworks. The current focus on measurable variables rather than theoretical development means that much of the research revisits well-worn theories of immigrant health rather than creating new ideas or models more relevant to sexual health or sexual-minority individuals.

Many of the studies of HIV risk among gay and bisexual "ethnic minority" men employ measures or scales of acculturation as predictors of risk behaviors such as unprotected sex, or sex with a known serodiscordant partner (that is, one with a differing HIV status), or sex with a high number of partners (Ratti and others 2000; Poppen and others 2004; Jarama and others 2005; Akin and others 2008; Nakamura and Zea 2010). …

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