Journal Articles


Brennan, D.J., Lachowsky, N.J., Georgievski, G., Rosser, B.R.S., MacLachlan, D., Murray, J., & Cruising Counts Team. (2015). Experience and impact of online outreach services among men who use the Internet to seek sex with other men (MISM) in Ontario, Canada. Journal of Medical Internet Research, 17(12), e277. doi:10.2196/jmir.4503


Background: Men who use the Internet to seek sex with other men (MISM) are increasingly using the Internet to find sexual health information and to seek sexual partners, with some research suggesting HIV transmission is associated with sexual partnering online. Aiming to “meet men where they are at,” some AIDS service organizations (ASOs) deliver online outreach services via sociosexual Internet sites and mobile apps.

Objective: To investigate MISM’s experiences and self-perceived impacts of online outreach.

Methods: From December 2013 to January 2014, MISM aged 16 years or older were recruited from Internet sites, mobile apps, and ASOs across Ontario to complete a 15-minute anonymous online questionnaire regarding their experience of online outreach. Demographic factors associated with encountering online outreach were assessed using backward-stepwise multivariable logistic regression (P<.05 was considered significant).

Results: Of 1830 MISM who completed the survey, 8.25% (151/1830) reported direct experience with online outreach services. Encountering online outreach was more likely for Aboriginal versus white MISM, MISM from Toronto compared with MISM from either Eastern or Southwestern Ontario, and MISM receiving any social assistance. MISM who experienced online outreach felt the service provider was friendly (130/141, 92.2%), easy to understand (122/140, 87.1%), helpful (115/139, 82.7%), prompt (107/143, 74.8%), and knowledgeable (92/134, 68.7%); half reported they received a useful referral (49/98, 50%). Few MISM felt the interaction was annoying (13/141, 9.2%) or confusing (18/142, 12.7%). As a result of their last online outreach encounter, MISM reported the following: better understanding of (88/147, 59.9%) and comfort with (75/147, 51.0%) their level of sexual risk; increased knowledge (71/147, 48.3%); and feeling less anxious (51/147, 34.7%), better connected (46/147, 31.3%), and more empowered (40/147, 27.2%). Behaviorally, they reported using condoms more frequently (48/147, 32.7%) and effectively (35/147, 23.8%); getting tested for HIV (43/125, 34.4%) or STIs (42/147, 28.6%); asking for their partners’ HIV statuses (37/147, 25.2%); and serosorting (26/147, 17.7%). Few MISM reported no changes (15/147, 10.2%) and most would use these services again (98/117, 83.8%). Most MISM who did not use online outreach said they did not need these services (1074/1559, 68.89%) or were unaware of them (496/1559, 31.82%).

Conclusions: This is the first online outreach evaluation study of MISM in Canada. Online outreach services are a relatively new and underdeveloped area of intervention, but are a promising health promotion strategy to provide service referrals and engage diverse groups of MISM in sexual health education

Citation: Peterson, J.L., Miner, M.H, Brennan D.J., & Simon Rosser, B.R. (2012). HIV treatment optimism and sexual risk behaviors among HIV positive African American men who have sex with men. AIDS Education and Prevention, 24:2, 91-101. doi: 10.1521/aeap.2012.24.2.91

The association between HIV treatment optimism—beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV—and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIVpositive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.

Citation: Brennan, D.J., Crath, R., Hart, T.A., Gadalla, T., & Gillis, L. (2011). Body Dissatisfaction and Disordered Eating Among Men Who Have Sex with Men in Canada. International Journal of Men’s Health, 10:3, 253-268. doi:  10.3149/jmh.1003.253


Abstract: Evidence suggests that gay, bisexual and other men who have sex with men (MSM) score higher than heterosexual-identifying men on disordered eating symptomology (DES). This exploratory study examined if the following psychosocial factors were associated with DES among a diverse sample of MSM: race, age, sexual identity, sexual risk, substance use, depression, history of childhood sexual abuse (CSA) and internalized homophobia. Using cross sectional data collected at “Pride Toronto 2008” (N = 383), multivariate analysis revealed the following factors to be associated with DES: CSA, depression, being White (vs. Black or Asian), being younger, and engaging in behaviours to increase muscle mass. These results may inform the development of useful and efficacious interventions to reduce the risks associated with body dissatisfaction and DES among MSM.

Citation: Brennan, D.J., Ross, L.E, Dobinson, C., Veldhuizen, S., & Steele, L.S. (2010). Men’s Sexual Orientation and Health in Canada, Canadian Journal of Public Health, 101:3, 255-258.


Objectives: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity.

Methods: Utilizing the Canadian Community Health Survey data (Cycle 2.1, 2003; n=49,901), we conducted multivariable logistic regression to assess the independent effects of sexual orientation on health status and health risk behaviours. For all multivariate models, we calculated odds ratios, p-values, standard errors, and 95% confidence intervals (CIs) using the bootstrap re-sampling procedure recommended by Statistics Canada.

Results: When compared to heterosexual men, gay and bisexual men did not report more respiratory conditions; had lower rates of obesity and overweight BMI; and reported more mood/anxiety disorders, and a history of lifetime suicidality. Gay and bisexual men did not report higher rates of daily smoking or risky drinking, however, gay men reported an almost six-fold increase in STD diagnoses when compared to heterosexual men.

Conclusion: This study represents the largest-known population-based data analysis on health risks and behaviours among men of varying sexual orientations. These findings raise important concerns regarding the impact of sexual orientation on mental and sexual health. Limitations of this data set, including those associated with measurement of sexual orientation, are discussed. Further research is required to understand the mechanisms that influence these health resiliencies and disparities.

Key words: Health disparities; homosexuality; gay men; bisexual men; health behaviors; general population sample; sexual identity.

Citation: Brennan, D.J., Welles, S.L., Miner, M.H., Ross, M.W., Rosser, B.R., & Positive Connections Team. (2010). HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: findings from the positive connections study, AIDS Education & Prevention, 22:2, 126-137.
Abstract:  This study was designed to examine the impact of HIV treatment optimism on sexual risk among a racially diverse sample of HIV-positive MSM. Survey data were collected from 346 racially diverse HIV-positive MSM.

Citation: Brennan, D.J., Welles, S.L., Miner, M.H., Ross, M.W., Mayer, K.H., Rosser, B.R., & Positive Connections Team. (2009). Development of a treatment optimism scale for HIV-positive gay and bisexual men, AIDS Care, 21:9, 1090-1097. doi: 10.1080/09540120802705859.
Abstract: Potential items to be included in an HIV Treatment Optimism scale were reviewed by 17 HIV-positive gay and bisexual men (GBM), resulting in a 21-item test instrument. After pilot testing, data were collected from a multi-city sample of high-risk HIV-positive GBM (n = 346), who were currently on treatment and were recruited to attend a two-day sexual health seminar. The scale items were analyzed utilizing Principal Components Analysis and reliability testing. The factor analysis resulted in the development of three separate scales. The Susceptibility scale contained 10 items associated with a belief that HIV is less transmissible while on HIV treatment. The Condom Motivation scale contained five items addressing a decreased motivation to use condoms while on treatment and the Severity scale contained four items associated with a decreased sense of the severity of an HIV diagnosis. Reliability coefficients (α ) and mean inter-item correlations (M) for the three scales were acceptable (Susceptibility, α = 0.86, M = 0.39; Condom Motivation, α = 0.84, M = 0.50; Severity, α = 0.71, M = 0.37). Combined as one scale, the reliability coefficient was respectable (α = 0.76), but the mean inter-item correlation was 0.14. Based on this analysis, use of a single measure was not supported and three separate scales were developed. The scales were equivalent across racial groups except White men were more like to report a decreased motivation to use condoms compared to Black or Latino men. Three separate scales addressing beliefs about the transmissibility of HIV while on treatment (Susceptibility), the quality of life while on HIV treatment (Severity) and the motivation to use condoms consistently while on treatment (Condom Motivation) may be better markers for assessing optimistic beliefs about HIV treatment among HIV-positive GBM.

Keywords: HIV optimism, gay men, HIV, scale development

Citation: Welles, S.L., Baker, A.C., Miner, M.H., Brennan, D.J., Jacoby, S., Rosser, B.R. (2009). History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men, American Journal of Public Health, 99:6, 1079-1086. doi: 10.2105/AJPH.2007.133280.


Objectives: We assessed rates of childhood sexual abuse and its demographic and mental health correlates among HIV-positive men who reported unsafe anal intercourse with other men in the past year.

Methods: We conducted a cross-sectional analysis of baseline data from 593 HIV-positive men who have sex with men enrolled in the Positive Connections intervention.

Results: Childhood sexual abuse was reported by 47% of participants; 32% reported frequency as often or sometimes. Men reporting abuse were more likely to be Latino (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.6, 4.2; P < .001) or African American (OR = 1.8; 95% CI = 1.2, 2.7; P = .005) than White. Among those who were abused, more frequent abuse was associated with more sexual contacts (for each, rate ratio [RR] = 1.3; P < .001) and unsafe anal intercourse (often, RR = 1.5; sometimes, RR = 2.0; P < .001) compared with men who were not abused.

Conclusions: History of childhood sexual abuse is highly prevalent among HIV-positive men who engage in risky sexual behavior with other men and appears to be more common among men of color. Our findings suggest that abuse is associated with a significantly increased risk of sexually transmitted infections.

Citation: Brennan, D.J., Hellerstedt, W.L., Ross, M.W., & Welles, S.L. (2007). History of Childhood Sexual Abuse and HIV Risk Behaviors in Homosexual and Bisexual Men, American Journal of Public Health, 97:6, 1107-1112. doi: 10.2105/AJPH.2005.071423.


Objectives: We examined the prevalence and frequency of childhood sexual abuse and their association with sexual risk among a sample of gay and bisexual men.

Methods: Cross-sectional data were collected by survey from randomly selected gay and bisexual men who attended the 1997 and 1998 Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals. Data included demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs (such as crack, cocaine, Ecstasy, amyl nitrate, crystal methamphetamine, and Special K), and history of exchanging sex for payment.

Results: Childhood sexual abuse was reported by 15.5% of the survey respondents (n = 134). Those who reported experiencing abuse regularly were more likely to (1) be HIV positive, (2) have exchanged sex for payment, and (3) be a current user of sex-related drugs. Neither unsafe sex nor sexually transmitted infections were associated with childhood sexual abuse.

Conclusions: These findings show that more than 1 in 7 gay and bisexual men in a non-clinical, festival-based setting were victims of childhood sexual abuse and that childhood sexual abuse was associated with alarmingly high rates of men who were HIV infected and antecedent risk behaviors.