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Understanding the drivers of the HIV epidemic among gay and bisexual men in BC


This week, the Office of the Provincial Health Officer in collaboration with the BC Centre for Disease Control released a report titled “HIV, Stigma and Society”. The report examines the underlying drivers of the current HIV epidemic among gay and bisexual men* in BC, in order to understand why new HIV diagnoses in this population have not declined as they have in other groups affected by HIV in the province. 

This report reviews current trends and examines the influence of factors at multiple-levels on HIV trends among gay and bisexual men* in BC, including:

  • behavioural and biological (such as condom use, viral load),
  • community and relationships (such as mental health, intimacy, sexual networks), and
  • societal and structural levels (such as stigma, marginalization, access to appropriate health care).

The report also uses a population health approach which focuses on the “upstream” factors that influence the health of gay and bisexual men* in BC.


The report includes a series of 15 recommendations for HIV prevention that target drivers at each level. These recommendations were contributed by two advisory groups made up of gay men’s health and HIV prevention leaders from community organizations, public health agencies, clinical services, and research.

In addition, the advisory groups identified groups of gay and bisexual men* where additional efforts would be needed, including:

  • HIV-positive men,
  • Aboriginal and Two-spirited men,
  • other ethnocultural minority men,
  • young gay and bisexual men,
  • men in active sexual networks, and
  • men in suburban, rural and remote regions of the province.

The PHO identified six priority recommendations for immediate attention in order to renew HIV prevention among gay and bisexual men* in BC:

  • Development of a comprehensive provincial health strategy for gay and bisexual men, which addresses the drivers of poor health status, including HIV.
  • Collaboration of the Ministries of Health and Education and key stakeholders on the development of a comprehensive sexual and reproductive health education strategy for BC.
  • Using the From Hope to Health Framework, develop a strategy to improve and expand access to timely HIV and STI diagnosis, treatment and support for gay and bisexual men.
  • As part of the Healthy Minds, Health People 10-year plan, develop a strategy to better meet gay and bisexual men’s health care needs related to mental health and problematic substance use.
  • Ensure that prosecutorial guidelines incorporate the best available evidence on HIV transmission risk, and that prosecutorial decisions regarding criminal charges for possible transmission of HIV are based on an assessment of whether prevention of HIV transmission could be achieved in other ways (e.g., through public health legislation).
  • Support or initiate monitoring and research to identify changes in the population of gay and bisexual men, address gaps in understanding, and evaluate intervention programs, targets and approaches for implementing and expanding promising strategies for HIV prevention.


Currently, gay and bisexual men* make up over half of all new diagnoses each year and represent the largest group of people living with HIV in BC. To further reduce HIV incidence in BC requires a meaningful reduction in incidence in this population. This report provides guidance for renewing HIV prevention for gay and bisexual men* such that this goal can be achieved.

* The report uses the term “gay and bisexual men” which is defined as men who have romantic or sexual relationships with other men, regardless of their own sexual or gender identity. This is used instead of the term “men who have sex with men” or MSM.

For more information

Provincial Health Officer’s Annual Report. HIV, Stigma and Society: Tackling a Complex Epidemic and Renewing HIV Prevention for Gay and Bisexual Men in British Columbia. July 2014.