Disparities in healthcare, STI testing, and PrEP access among newcomer sexual minority men in Canada's three largest urban centers

Abstract

Gay, bisexual, and other men who have sex with men (GBM) are more likely to be diagnosed with HIV and other sexually transmitted infections (STIs) compared with the general population. Although newcomers generally experience a health advantage in Canada compared with non-immigrants and more established immigrants (i.e., healthy immigrant effect), they also experience disparities in access to healthcare services. These disparities, in turn, may lead to unique vulnerabilities for the sexual health of GBM immigrants. We examined disparities in healthcare access, STI testing, and HIV pre-exposure prophylaxis (PrEP) use among immigrant and non-immigrant GBM. Using baseline data (collected between February 2017 and August 2019) from a multisite cohort study of GBM in Toronto, Vancouver, and Montreal (n = 2449), we found that newcomer GBM (migrated ≤ 5 years prior) were less likely to report having a primary healthcare provider than non-immigrants. This had a weak indirect effect in mediating both access to STI testing and the use of HIV PrEP. These disparities dissipated after controlling for migration precarity (e.g., refugees and those without permanent residency), suggesting that disparities in newcomer GBM healthcare access may, in part, be driven by the large number of newcomers with precarious migration statuses. Public Significance Statement: New immigrants tend to be less likely to have a primary healthcare provider or use other sexual health clinics, which can have adverse consequences for sexual health. This disparity appears to be largely concentrated among temporary foreign workers, international students, and refugees. Interventions should target policies that increase the number of primary healthcare providers, and address immigration policies that lead to fear of deportation due to one's health.