Figure 7: Preferred Methods of Acquiring Information on HIV and Safer Sex

(ix) Healthcare access: While most of our ISgbMSM participants (70.7%, n=65) were on insurance with their school, some (13.0%, n=12) received insurance through their work and others who were permanent residents (11.9%, n=10) were on the Ontario Health Insurance Plan (OHIP). There was also a small number of respondents (5.4%, n=5) that did not have any healthcare insurance coverage at all.

Amongst survey participants, over half (53.3%, n=49) of respondents reported that they had a primary healthcare provider. Of those that reported having a healthcare provider, most of whom (46.8%) indicated that they preferred to a doctor through a walk-in clinic as opposed to having a regular family doctor (30.7%).

Despite half of the respondents reported being comfortable discussing their sexuality and sexual health with their healthcare providers (50%, n=46), when asked where they would get their information on HIV and safer sex practices, less than expected (19.6%, n=18) of respondents indicated that they would get this information from their healthcare providers. The internet is still the most preferred method of accessing information on HIV and safer sex practices (92.4%, n=85).

92.4% Internet

Figure 7: Preferred Methods of Acquiring Information on HIV and Safer Sex.

Amongst our participants, almost half (44.6%, n=41) reported having experienced language barriers while accessing healthcare or other social services since moving to Canada. However, even though a language barrier only impacted half of the group, an overwhelming proportion of respondents (80.4%, n=74) stated that it was important to them to receive programs and services that were culturally sensitive to their needs and experiences as East and Southeast Asian gbMSM men.

Discussion:

The results of this explorative needs assessment highlighted some of the unique experiences, challenges, and barriers faced by ISgbMSM upon arrival to Canada, all of which are directly implicated in their health and wellbeing, as well as their needs concerning HIV prevention. More specifically, we noted various recurring themes associated with their migration and settlement experiences, limitations in knowledge of safer sex upon arrival in Canada and substance use, as well as barriers faced when trying to access healthcare and social services in Toronto.

As predicted, the most commonly discussed challenge faced by ISgbMSM was the issue of social isolation upon arrival in Canada. Despite all participants reporting that their overall first impressions of Canada were that people were kind and welcoming across various networks in their lives (e.g. campus, classes, social groups in the community), more than one-third of survey respondents still reported that they do not feel like they belonged, with specific di culties fitting in with the 2SLGBTQ+ community in Toronto. Along with the stresses associated with their loss of support networks from home, the impacts of isolation on ISgbMSM may have been exacerbated by experiences of racial microaggressions (e.g. stereotyped), mocked for their accents or other language barriers faced, and exclusions from social gatherings(11,12). At the intersections of challenges faced, Asian ISgbMSM are faced with compounding issues when attempting to connect with the mainstream gay community in Toronto, where whiteness is upheld as the standard and racialized men are often harassed, fetishized, or excluded(13–17). One interview participant highlighted:

“Like I found it like the queer community here is kind of white […] Like the example of Ru Paul and stuff - like I watch Ru Paul now just because - not because I like it - just because I can have like some topics that I can catch on the trends. So my friends whenever they have a conversation, so I would be like 'Oh I know what you're talking about' […] So like I feel like I'm getting used to it, like blending into another culture but like, in general, I'm just like yeah, like I'm like an outsider. Like if we talk about LGBTQ like - I'm LGBTQ, but I'm not your LGBTQ” -ISgbMSM from Hong Kong, age 22

The priority of rebuilding one’s support network in a new environment while simultaneously needing to compromise their views of themselves, interests, or comfort in order to fit in may also be a common stressor faced by Asian ISgbMSM(18). Further mental health distress may arise due to the conflicting experience and the overall impression that “it’s more diverse and inclusive in Western culture” (ISgbMSM from China, 24 years old). As reported by almost half of our participants, racism also negatively impacts the development of sexual networks in the form of sexual racism, where Asian men are purposefully rejected on the basis of their race(13,19). These culminating experiences may contribute to feelings of loneliness, powerlessness, and a loss of control, poor mental health, poor self-esteem while simultaneously increasing HIV risk amongst Asian ISgbMSM(7,13,18–21). However, participants discussed how they managed their feelings of isolation, including joining extracurricular groups at school, volunteering with ethno-racial community agencies, and building networks of other Asian community members, which aligns with a common coping strategy among Asian newcomers to rea rm their ethnic and cultural heritage, while simultaneously resisting social and environmental forces of racism(11,22). One recurring trend shared among some of the ISgbMSM participants is the value of establishing online friendships on social media pages and dating apps.

“But I think in most cases I don't like - it's not like I am not able to [make friends], it's more like I'm not willing to. Like sometimes I want to kind of take care of any kind of adversities just myself before I necessarily need help. And anyways, I don't know if it's weird, but just for me, sometimes I make online friends that are like I would never meet them or like we would we have never met. But I share some of the emotions of life with them just because I do not, you know - When you're sharing with somebody that you know that you will not have any kind of involvement in each other's life, so then you kind of like speak freely. That's also how I dealt with my emotions and stuff. Yeah, but not necessarily the friends that I'm close with.”

- ISgbMSM from China, age 24

This phenomenon of seeking refuge in online spaces and confiding in digital friendships is not surprising, nor is it a novel phenomenon, especially amongst the 2SLGBTQ+ community. The preference for utilizing online platforms among Asian ISgbMSM may be associated with the anonymity and discretion associated with these tools, which o ers them opportunities and safety to undergo self-exploration without fear of social repercussions among peers and family(23–25) .