Abstract
There is a paucity of population health data on the experiences of transgender, non-binary, and other gender minority gay, bisexual, and queer men, and Two-Spirit people in Canada. To address this gap, this article presents a socio-demographic and health profile of trans and non-binary participants from the community-based bilingual 2018 Sex Now Survey. Participants were recruited in-person from Pride festivals in 15 communities to self-complete an anonymous paper-and-pen questionnaire. To be eligible, participants needed to be at least 15 years old, live in Canada, either report a non-heterosexual sexual identity or report sex with a man in the past 5 years, and not report gender identity as a woman. Through community consultations the survey was inclusive of trans men, non-binary people, and Two-Spirit people. Three gender groups (cisgender, transgender, and non-binary) were created, and trans and non-binary participants were compared with their cisgender peers across a variety of demographic, mental health, sexual health, and general health indicators. Odds ratios were calculated to determine initial significance for categorical variables, and adjusted odds ratios were calculated to control for five possible confounders (age, ethnoracial identity, country of birth, sexual identity, and financial strain). Significant differences emerged across all sets of indicators, with many of these findings remaining significant after adjusting for confounding variables, including significantly higher reported rates of mental health challenges and sexual health service barriers for trans and non-binary participants compared to the cisgender group. Trans and non-binary participants were also more likely to be in polyamorous relationships. Collectively, our findings demonstrate that trans and non-binary people experience significant disadvantages compared with cisgender sexual minority men. Improved educational supports and employment protections, access to queer and gender affirming healthcare, and trauma-informed mental health services are needed to improve the health wellbeing of trans and non-binary people in Canada.
Highlights
A robust body of evidence demonstrates that gay, bisexual, queer and other sexual minority men in Canada face a greater burden of health inequities–for example, in relation to mental health and HIV transmission–when compared with their heterosexual peers
Community partners promoted the survey in advance of these events through their social media and listservs; additional online promotion was done by Community-Based Research Centre (CBRC)
A higher percentage of trans respondents participated in the smaller cities of Halifax, London, and the interior of British Columbia (Kelowna and Kamloops) compared with cisgender participants, while Ottawa had a smaller percentage of trans respondents participate
Summary
A robust body of evidence demonstrates that gay, bisexual, queer and other sexual minority men in Canada face a greater burden of health inequities–for example, in relation to mental health and HIV transmission–when compared with their heterosexual peers. Findings from Sex 2015, a national health and wellbeing survey of gay, bisexual, and queer men and non-binary and Two-Spirit people (GBT2Q) in Canada, indicate that trans GBT2Q participants were significantly more likely to report experiencing healthcare discrimination in their lifetime and in the past 12 months when compared with cisgender GBT2Q participants [6]. Bauer et al estimate that 38% of trans people in Ontario had prior trans-specific negative experiences with family physicians, and approximately half were uncomfortable discussing trans issues with their doctor [2]. These statistics highlight that barriers to acceptable healthcare persist for many trans and non-binary people
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