Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Epidemiology and Biostatistics


Dr. Greta Bauer


Published research suggests gay, bisexual, and other men who have sex with men (GB-MSM) present in health care with additional, distinct psychosocial and sexual health concerns compared to heterosexual men, emphasizing the importance of access to health care for these groups.

This exploratory thesis used data from the online survey (n=202) of the Health in Middlesex Men Matters (HiMMM) Project – a community-based study examining health care access for GB-MSM living in Middlesex County, Ontario. For each manuscript, blockwise modified Poisson regression models were fit sequentially with predisposing, enabling, and need variables, as theorized by the Behavioral Model of Health Services Use.

The first manuscript identified factors associated with access to a primary care provider (PCP), identifying subgroups with which to direct health care promotion efforts centred upon access. Older age, student status, marital and relationship status, social support (from a significant other and from GLBT - gay, lesbian, bisexual and transgender - communities), and self-perceived general health were crudely associated with having a PCP and were variably significantly associated with the outcome during the modelling process with additional variables.

The second examined factors associated with sexual orientation disclosure and communication with providers about GB-MSM health issues. Marital/relationship status, experiences of homophobia, and assessment of provider’s communication were associated with having a PCP know respondents’ sexual orientation, crudely and in the modelling process with other variables. Internalized homonegativity, experiences of homophobia, provider communication, and prior negative experiences with a PCP were associated with talking to a PCP about GB-MSM health issues.

The third examined demographic, socio-behavioural, and community-relevant factors associated with mental health service utilization in the past 12 months for local GB-MSM. Access to a PCP, childhood versus current religiosity or spirituality, self-perceived mental health, and internalized homonegativity were associated with the outcome, crudely, and in the blockwise modelling process with other variables.

The fourth manuscript investigated demographic and socio-behavioural factors associated with not accessing HIV testing services, and explored descriptive reasons for this, discussing implications for HIV testing promotion. Factors significantly associated with being untested included social connection to GLBT communities, current versus childhood religiosity/spirituality levels, education, and employment.