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ONTARIO MEN'S SURVEY

The 2002 Ontario Men's Survey questioned gay and bisexual men about social issues, sexuality and HIV. Anonymity was guaranteed. The two-part study was an important follow-up to the 1991 National Men's Survey. Researchers approached men in bars, bathhouses and at local community groups.

WHY ONTARIO?
Ontario has the largest and most diverse population of gay and bisexual men in Canada; its communities are diverse, as are the gay bars, bathhouses, and social groups. Researchers were able to talk to men of different age and ethnic groups and men with different relationship experiences.

THE RESEARCH TEAM
The survey was conducted by a team of researchers working at the University of Toronto in consultation with a provincial community advisory committee. The fifteen educators on the advisory committee represented organizations from different regions across the province. To reflect some of the diversity in Ontario, the questionnaire was translated into six languages: Chinese, French, Spanish, Portuguese, Tamil and Vietnamese.

THE INVESTIGATORS

PROJECT DIRECTOR

UNANSWERED QUESTIONS
The survey was designed to help in the creation of educational campaigns directed to specific groups, such as younger men and men in relationships. It provided information for educators and caregivers who design programmes and strategies, and allowed researchers to evaluate the effectiveness of education and support programmes. Survey results could be used to strengthen arguments to government officials and others who control the resources needed to fight AIDS; it also revealed how much gay and bisexual men have learned about AIDS. And it provided a guide for future surveys of gay and bisexual men in Ontario and in other communities across Canada.

PART I: THE QUESTIONNAIRE
The survey questionnaire was developed by the investigators, the provincial community advisory committee and other researchers in Canada and elsewhere.

THE QUESTIONS
Previous surveys were a primary source for the direction and scope of the questionnaire. Some questions allowed comparisons with other studies of gay and bisexual men in Canada. Twenty gay and bisexual men pre-tested the questions; their comments helped shape the final questionnaire. The questionnaire consisted of 88 questions; it could be completed in 15 minutes. The survey included questions designed to give AIDS educators, counsellors, researchers and programme planners more detailed information on issues related to:

• community involvement and socialization;

• mobility in the gay community;

• experiences of racism within gay and bisexual communities;
  sexual activities with different types of men in different types of relationships;

• challenges of using condoms;

• HIV antibody testing (including testing outside the community);

• AIDS education and prevention for gay and bisexual men.

PART II: A SALIVA SAMPLE
After they completed the questionnaire, men were asked to provide an optional saliva sample, which was sent to a lab and tested for HIV (AIDS) antibodies. The saliva sample was voluntary. The study used saliva because it is easy to collect: participants put a plastic stick with a cotton pad on the end under the tongue until the indicator turned blue, about two minutes. (The colour change means the cotton pad has absorbed enough saliva.) Samples were sealed in unmarked tubes, sent to the lab and tested for HIV antibodies. (The saliva can also be tested for hepatitis viruses. Some of these hepatitis viruses are sexually transmitted and some could affect the progression of HIV disease.)

ANTIBODIES AND VIRUSES
Antibodies are proteins the body produces in response to toxins or viral infections. They are part of the body's attempt to fight off the infection. Antibodies for HIV, the Human Immunodeficiency Virus, are signs or markers that the virus is present. Testing a person for HIV antibodies is one way to see whether that person may have been infected with HIV.

SALIVA AND HIV ANTIBODIES
The presence of antibodies in saliva does not mean the virus can be transmitted through saliva. Saliva contains many fewer antibodies than blood or semen, but the test is sensitive enough to correctly identify a person's exposure to the AIDS virus more than 98% of the time. Saliva has been used for research purposes in most Canadian provinces where people have been recruited in public settings. Some Canadian insurance companies use the test to screen their applicants, and the technology is being used in the U.S. in home testing kits. In the Ontario Men's Survey, the testing procedure was used for research purposes only.

WHY A SALIVA SAMPLE?
The AIDS epidemic in Canada has hit gay and bisexual men the hardest. No studies were done on the extent of HIV infection in the community. Many people thought the official numbers of cases of AIDS and HIV were misleading, and that more accurate information was needed. The survey tested men who may not have been tested before or who may have been tested some time ago to try to ascertain how quickly men were becoming infected. The anonymous HIV test allowed researchers to estimate numbers of known and hidden HIV infections among gay and bisexual men. Individuals were asked to state their HIV status; the saliva test was used to check that status.

ANONYMITY AND CONFIDENTIALITY
The survey was designed to be completely anonymous. In accordance with the ethical requirements agreed upon by community groups, the university and the funding agency, participants did not give names or other identifying information. Researchers sought 5,000 men through community groups, gay-identified bars and bathhouses. The number of respondents provided a large enough sample to make it impossible to identify any one person.

The Ontario Men's Survey also protected the confidentiality of responses. Completed questionnaires and saliva samples were placed in an unmarked envelope, which was sealed and deposited in a collection box by the respondent. Envelopes were opened in the research office, and questionnaires and HIV tests were assigned corresponding numbers so they were anonymously linked. Respondents were instructed not to put any identifying marks on the questionnaire or the saliva collector.

SAMPLE RESULTS
Results of saliva tests were anonymous to both investigators and respondents, so investigators could not provide respondents with results.

INFORMATION ON HIV TESTING AND COUNSELLING IN ONTARIO
Respondents with questions about HIV testing and counseling services were directed to a doctor, a local AIDS service organization or the AIDS hotline.

OMS VOLUNTEERS
Teams of screened and trained volunteers spent three months collecting questionnaires and saliva samples. All signed an oath of confidentiality. Volunteers explained the survey to men and asked them to participate, then ensured that anonymity and confidentiality were maintained throughout the process. Anyone with questions about the Ontario Men's Survey was directed to the survey information line or web site.

PAYMENT
Men who participated received a coupon for $5.00, which could be redeemed for cash or donated to one of several local community groups or AIDS organizations.

COMMUNITY FEEDBACK
After the data were collected and analyzed a brief community report was published in the Pride Week issues of XTRA!, and CAPITAL XTRA! A full report has been published. Further, community forums will be held across the province to discuss the findings of the study.

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Last Update: June 24, 2004