Sex Now survey examines generational differences of Canadian queer men

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      As LGBT people continue to break new ground with rights gains and mainstream acceptance, a new frontier is developing not just in the present but also when it comes to historical perspectives.

      While there may have always been significant queer figures in history, there haven't been large generations of out LGBT people as queer history has been riddled with secrecy, suppression, erasure, omission, concealment, obscurity, and more.

      With LGBT rights movements have grown to be a few decades old, studies can now be conducted to examine several generations of out queer people in ways that couldn't be done before.

      Such was the impetus of the latest queer men sex survey conducted by the Vancouver-based Community Based Research Centre.

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      In an interview with the Georgia Straight, CBRC research director Terry Trussler explained by phone that at the Gay Men's Health Summit in 2013, they featured University of California Santa Cruz associate professor Phillip Hammack to present a keynote speech on life-course theory. The approach involves examining how people are influenced by social, cultural, and economic factors of the time period they grew up in, and Hammack examined five generations of out U.S. gay men.

      "His presentation really swept through the audience," Trussler said, noting that at a social event afterward, everyone afterwards was talking about which generation they were a part of.

      Hammack's theoretical approach, Trussler went on to say, explained some things they were observing such as marked generational differences in attitudes towards pre-exposure prophylaxis (PrEP, or medication that prevents HIV infection). For instance, they had noticed that younger generations were open to using it whereas, he said, "older gay men were resistant to the idea that you really needed medicine to control this".

      Noticing what a chord Hammack's presentation struck, Trussler and his colleagues made gay generations the theme for their 2014-15 Sex Now survey, a national survey they conduct every few years about men who are have sex with men (MSM).

      The survey (which was the eighth one since 2002) was conducted online from October 2014 to May 2015, gathering 8,000 completed surveys from across Canada. 

      The researchers then organized the data into five age groups: 15 to 24, 25 to 34, 35 to 44, 45 to 59, and over 60.

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      Generational Gay Legal, born from 1944 to 1955, consists of those over 60, or the baby boomers, who came of age in the late 1960s and 1970s. As the Stonewall riot occurred in the U.S. in 1969, Prime Minister Pierre Trudeau decriminalized homosexuality in Canada with the Criminal Law Amendment Act of 1968-69. This generation experienced much of the devastation that the HIV/AIDS epidemic wrought upon individuals, families, social networks, communities, and more.

      Generation Gay Pride encompasses men aged 45 to 59. These men, born from 1956 to 1970, range from late boomers to Generation X and came of age from the mid-1970s to the late 1980s. This generation witnessed the Toronto bathhouse raids in 1981, which sparked mass gay political mobilization and the formation of Toronto Pride. Large numbers of this generation were infected before the HIV/AIDS crisis was recognized and identified.

      Generation Safe Sex consists of men aged 35 to 44, who were born from 1971 to 1980 and spanning Generations X and Y. The HIV/AIDS crisis unfolded as this generation was coming out. Being gay was often associated with HIV, AIDS, and death but the safe sex revolution also arose in response during this time.

      Generation ART, comprised of men aged 25 to 34 who were born from 1981 to 1990, range from Generation Y to millennials. As they were coming out, they witnessed the first successful HIV treatments, known as antiretroviral therapy (ART) which was first announced at the International Conference on AIDS in Vancouver in 1996. Infections began to decline and HIV–positive men were able to have casual sex. However, a nascent wave of increased HIV infections arose by 2001.

      The youngest group, Generation Gay Marriage, is made up of millennials aged 15 to 24 who were born from 1991 to 2000. This generation grew up as same-sex marriage was legalized in Canada in 2005. As LGBT people were becoming more accepted in the mainstream, queer millennials faced heightened violence in high schools due to their greater visibility. Meanwhile, rapid social technological developments, including smart phones, apps, the internet, and social media, has been a dominant influence upon LGBT culture, such as permitting greater access to LGBT content despite geographic location, online hookup culture, and more. This group also expressed the most gender and sexual identity diversity out of all the groups, and the majority of this group were still living at home and in school.

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      The survey report, entitled Gay Generations: Life Course and Gay Men's Health, notes that the two eldest groups "are missing great numbers of gay men who died in the pandemic". It also points out that the HIV/AIDS epidemic in Canada occurred several years after events in the U.S. (not to mention same-sex marriage was legalized in Canada years before the U.S.) and therefore the Canadian experience differs from results obtained from Hammack's study of American men.

      Here are some highlights of the survey results.

      Coming out

      Generation ART (ages 25 to 34) reported the highest levels of being out to friends and family, and in schools, workplaces, and communities. The least out were members of the eldest generation. The study notes that the increase in being out with younger generations "seems indicative of the effect of liberalizing social values since the 1960s". It also states that "some young men under 25 appear to be in the process of emerging" as within the youngest group, 64 percent were out to friends (the second highest percentage of all age groups) while only 40 percent were out to family (the lowest number of all age groups).

      Older generations had larger numbers of respondents who never came out (the eldest group had 40 percent whereas the youngest group had 21 percent) or came out later in life, and also tended to have their first sexual experience with another man later in life (often during more liberal time periods). The study notes that "the greater presence of bisexual men in the older cohorts may be affecting proportions due to a strong pattern of concealing their sexuality".

      One-third of Generation ART (25 to 34) and Generation Gay Pride (35 to 44) had moved from rural locations or suburbs to a city centre to develop their sexual orientation identity. While many older age groups did the same, a higher number moved between urban locations.

      The study notes that Vancouver, Toronto, and Montreal had the highest proportions of out men while suburbs and smaller cities had significantly smaller percentages.

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      Discrimination

      Curiously enough, increasingly liberal attitudes towards LGBT people are not reflected in decreased experiences of discrimination. Quite the opposite, surprisingly enough.  

      The youngest generation reported the highest levels of being called homophobic names (63 percent), rumours about sexuality (62 percent), attention to appearance (40 percent), being socially excluded (29 percent), and cyberbullying (25 percent). They also reported the highest levels of verbal violence and hate talk before age 18 (45 percent). Levels of physical violence were similar across all age groups (from 12 to 14 percent) except for the eldest group which reported the lowest level (six percent).

      Trussler explained that one factor that might be at play is that queer men are coming out at much younger ages than older generations, at a time when peers have less socialization than if coming out as an adult.

      "One interpretation of this is that because gay life was pretty much underground and not talked about [in the past], people could also hide behind a veneer of masculinity or whatever and get by without there being violence, and now that there is so much talk about it and people can be identified…that in younger people who have less emotional control and haven't been socialized to not be violent, there's been a lot more going on in high school."

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      Anxiety about discrimination does significantly decrease with age.

      The areas of greatest concern for all age groups were other country customs (from 64 percent amongst the youngest respondents to 49 percent of the oldest respondents) and the justice system (54 percent from the youngest males to 36 percent of the oldest). About one-third of all age groups were concerned about Canada Customs border entry.

      When using online dating sites or mobile apps, two-thirds of all respondents reported experiencing discrimination. While the older generations experienced the most ageism (36 percent of the youngest compared to 57 and 60 percent for the eldest two groups), Generation ART and Generation Safe Sex reported the most discrimination based on body shape, size, or look (58 and 53 percent respectively). Racism was significantly higher among the two youngest groups (18 and 19 percent compared to three percent for the oldest group). Discrimination based on gender presentation and sexual orientation was highest for the youngest group (21 and 14 percent respectively, compared to four percent for both for the oldest group).

      Trussler said that these results raise questions about what the longterm health consequences are of being treated violently as a youth.

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      Sexual activity

      Differences in sexual attitudes were the most pronounced between the youngest and oldest groups.

      While casual sex was the primary sex-seeking activity for all groups, larger numbers of younger men dated with the intention to find a boyfriend.

      High-risk sexual activity appeared to produce the most consistent results across all age groups. The majority of all age groups reported using a condom with sexual partners whose HIV status was unknown, ranging from 73 to 78 percent. The study notes that "there has been little substantial change in this pattern over the last decade".

      Condom usage for casual sex or hookups, or with anonymous partners, was strongest among the youngest group (43 percent responded with "always") and decreased with age (30 percent of the eldest group responded with "always").

      For condom usage with partners who had the same HIV status as the respondent, the most marked differences were between the youngest and oldest group, with 39 percent of the youngest respondents never having sex without a condom with such a partner compared to 50 percent of the oldest group.

      While the eldest generation relied heavily upon the internet for hookups (56 percent compared to 25 percent for the youngest group), younger men tended to use mobile apps (40 percent for Generation Gay Marriage) significantly more than older men (only 4 percent for Generation Gay Legal).

      Older men also reported more bathhouse or outdoor cruising (10 and 7 percent respectively for the eldest group) compared to the youngest group (one percent for both).

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      When asked about the ages of partners, the most equally divided results for partners of varying ages came from Generation Safe Sex (aged 35 to 44). The youngest group reported 57 percent having sex with partners the same age and 39 percent having sex with a guy over five years older. Meanwhile, 67 percent of the oldest group had sex with men more than five years younger and 28 percent around the same age.

      Oral sex was almost uniform across all ages (varying very little between 80 and 82 percent) whereas anal sex and masturbation decreased with age.

      For sexual positions, bottoming was highest among the youngest group (54 percent), which also reported the least topping (25 percent). Topping was highest amongst Generation Safe Sex (35 to 44; 38 percent). This age group and Generation Gay Pride (45 to 59) also reported the least bottoming (44 percent).

      When it comes to sex combined with substance use, the report states that substance use is "one of the mutually reinforcing epidemics influencing HIV infection rates in gay men".

      The vast majority of respondents in all age groups did not combine sex with substance use, ranging from 74 percent among the youngest group to 62 percent of the eldest group. However, the category also included Viagra or Cialis use, which was highest among the eldest group (22 percent). Alcohol use decreased with age, from 14 percent of the youngest group to only six percent of the oldest group.

      In contrast, however, alcohol increased with age for recreational use, from 26 percent for the youngest men up to 42 percent for the eldest. Binge drinking decreased with age, with the two youngest groups reporting 49 and 48 percent binge drinking once a month or less in the past year, while 60 percent of the eldest group reporting never binge drinking in the same time period.

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      Health

      Generation ART reported the highest levels of STI and HIV testing (65 and 64 percent respectively), with the lowest testing levels reported from the youngest and eldest generations. However, the researchers point out that "the data may be affected by age related sexuality (youngest and oldest cohorts) such as a lack of recent partners or only low-risk encounters".

      Nonetheless, with overall testing in all age groups hovering between 50 and 65 percent, the report also states "there is work to do in every age cohort".

      While the youngest group had the largest number who had never had an HIV test (37 percent), all other groups had few who reported the same (ranging from 11 to 19 percent). HIV–positive result increased with age, from two percent amongst the youngest group to 12 percent among the second oldest group.

      Trussler pointed out that recommended routine HIV–testing should be at least once a year (and could be more, depending on the number of partners).

      While the middle-aged groups were the most out to their healthcare providers (from 63 to 67 percent), the youngest and oldest groups were the least (50 and 59 percent respectively).

      "Guys who come out to their physician are three times more likely to be testing at least annually for HIV," Trussler said, in comparison to guys who aren't out to their healthcare provider. He also said that doctors can provide more health recommendations and options to men who are out.

      The study notes that "bisexual men are disproportionately less inclined to come out to their doctor who also may be treating their wife and kids".

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      Overall, Trussler says the results of the survey suggest that healthcare providers should consider different ways to talk to men about PreP and be aware of how different generations have varying allegiances to safe-sex measures such as condoms.

      In the conclusion, the researchers point out that "millennials have never known a time when the internet, websites, and emails did not exist". With major shifts in how technological developments are influecing society, the study notes that such factors are affecting gay millennials not only in mainstream society but also in gay culture.

      While the future may appear to be promising, the survey results reveal some seemingly counterintuitive developments, such as increased experiences of homophobia among younger generations. Nonetheless, the study also points to issues that health organizations and professionals can take into consideration when addressing LGBT individuals or communities.

      The full survey report can be found at the CBRC website.

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