The Social Geography of Partner Selection in Toronto, Canada: A Qualitative Description of “Convection Mixing”

Abstract

The geographic distribution of sexually transmitted infections reflects the underlying social process of sexual partner selection. This qualitative study explored the social geography of partner selection among sexual minority men and used the results to develop a mid-range theory of STI transmission. In-depth interviews with 31 sexual minority men who lived, worked, or socialized in Toronto, Canada, occurred in June and July 2016. Participants were asked how they found sexual partners and reconstructed their egocentric sexual networks for the previous 3 months. Participants described an iterative process of partner selection involving intention (sex versus dating), connecting with community, and selecting a partner based on intersecting partner characteristics (external, internal, and emergent feelings when interacting with potential partners) and personal preferences. Geography influenced partner selection three ways: (1) participant search patterns maximized the number of potential partners in the shortest distance possible; (2) the density of sexual minority men in a participant’s community directly impacted participant’s social and sexual isolations; and (3) geosexual isolation influenced sexual mixing patterns. Participants described “convection mixing,” where assortative urban mixing nested within disassortative suburban mixing resulted in movement from the suburbs to downtown and back to the suburbs. We theorize that convection mixing may be contributing to the persistence of STI epidemics in core and outbreak areas by creating STI reservoirs outside of, and connected to, core and outbreak areas.

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References

  1. Adam, B. D., Gardner, S., Major, C., Campbell, D., Light, L., & Globerman, J. (2016). Promoting HIV testing for gay and bisexual men. Health Promotion Practice,17(1), 40–47. https://doi.org/10.1177/1524839915605060.

    Article  PubMed  Google Scholar 

  2. Algarin, A. B., Ward, P. J., Christian, W. J., Rudolph, A. E., Holloway, I. W., & Young, A. M. (2018). Spatial distribution of partner-seeking men who have sex with men using geosocial networking apps: Epidemiologic study. Journal of Medical Internet Research,20(5), e173. https://doi.org/10.2196/jmir.9919.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Alirol, E., Wi, T. E., Bala, M., Bazzo, M. L., Chen, X. S., Deal, C., … Hook, E. W. (2017). Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines. PLoS Med,14(7), e1002366. https://doi.org/10.1371/journal.pmed.1002366.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Apostolopoulos, Y., Sönmez, S., Shattell, M., Kronenfeld, J., Smith, D., & Stanton, S. (2011). Cruising for truckers on highways and the internet: Sexual networks and infection risk. AIDS Education and Prevention,23(3), 249–266. https://doi.org/10.1521/aeap.2011.23.3.249.

    Article  PubMed  Google Scholar 

  5. Beymer, M. R., Weiss, R. E., Bolan, R. K., Rudy, E. T., Bourque, L. B., Rodriguez, J. P., & Morisky, D. E. (2014). Sex on demand: Geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County. Sexually Transmitted Infections,90(7), 567–572. https://doi.org/10.1136/sextrans-2013-051494.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boutin, C. A., Venne, S., Fiset, M., Fortin, C., Murphy, D., Severini, A., … Labbé, A. C. (2018). Lymphogranuloma venereum in Quebec: Re-emergence among men who have sex with men. Canada Communicable Disease Report,44(2), 55–61.

    Article  Google Scholar 

  7. Charmaz, K. (2008). Constructionism and the grounded theory. In J. A. Holstein & J. F. Gubrium (Eds.), Handbook of constructionist research (pp. 397–412). New York: The Guilford Press.

    Google Scholar 

  8. Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications Inc.

    Google Scholar 

  9. Creswell, J. S. (2014). Research design: Qualitative, quantitative and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage Publication.

    Google Scholar 

  10. Desai, M., Field, N., Grant, R., & McCormack, S. (2017). Recent advances in pre-exposure prophylaxis for HIV. British Medical Journal (Clinical Research Ed.),359, j5011. https://doi.org/10.1136/bmj.j5011.

    Article  Google Scholar 

  11. Doherty, I. A. I. A., Serre, M. L. M. L., Gesink, D., Adimora, A. A., Muth, S. Q. S. Q., Leone, P. A. P. A., & Miller, W. C. W. C. (2012). Sexual networks, surveillance, and geographical space during Syphilis Outbreaks in Rural North Carolina. Epidemiology,23(6), 845–851. https://doi.org/10.1097/EDE.0b013e31826c2b7e.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Elwood, S., Lawson, V., & Sheppard, E. (2017). Geographical relational poverty studies. Progess in Human Geography,41(6), 745–765. https://doi.org/10.1177/0309132516659706.

    Article  Google Scholar 

  13. Gesink, D., Racey, C. S., Seah, C., Zittermann, S., Mitterni, L., Juzkiw, J., … Allen, V. (2016). Mycoplasma genitalium in Toronto, Ont: Estimates of prevalence and macrolide resistance. Canadian Family Physician,62(2), e96–e101.

    PubMed  PubMed Central  Google Scholar 

  14. Gesink, D. C., Sullivan, A. B., Norwood, T. A., Serre, M. L., & Miller, W. C. (2013). Does core area theory apply to sexually transmitted diseases in rural environments? Sexually Transmitted Diseases,40(1), 32–40. https://doi.org/10.1097/OLQ.0b013e3182762524.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gesink, D., Wang, S., Guimond, T., Kimura, L., Connell, J., Salway, T., … Brennan, D. J. (2018). Conceptualizing geosexual archetypes: Mapping the sexual travels and egocentric sexual networks of gay and bisexual men in Toronto, Canada. Sexually Transmitted Diseases,45(6), 368–373. https://doi.org/10.1097/OLQ.0000000000000752.

    Article  PubMed  Google Scholar 

  16. Gesink, D., Wang, S., Norwood, T., Sullivan, A., Al-Bargash, D., & Shahin, R. (2014). Spatial epidemiology of the syphilis epidemic in Toronto, Canada. Sexually Transmitted Diseases,41(11), 637–648. https://doi.org/10.1097/OLQ.0000000000000196.

    Article  PubMed  Google Scholar 

  17. Ghaziani, A. (2010). There goes the gayborhood? Culture Reviews,9(4), 64–66.

    Google Scholar 

  18. Ghaziani, A. (2015). Gay enclaves face prospect of being PassÉ’’: How assimilation affects the spatial expressions of sexuality in the United States. International Journal of Urban and Regional Research,39(4), 756–771. https://doi.org/10.1111/1468-2427.12209.

    Article  Google Scholar 

  19. Gindi, R. M., Sifakis, F., Sherman, S. G., Towe, V. L., Flynn, C., & Zenilman, J. M. (2011). The geography of heterosexual partnerships in Baltimore city adults. Sexually Transmitted Diseases,38(4), 260–266. https://doi.org/10.1097/OLQ.0b013e3181f7d7f4.

    Article  PubMed  Google Scholar 

  20. Gorbach, P. M., Murphy, R., Weiss, R. E., Hucks-Ortiz, C., & Shoptaw, S. (2009). Bridging sexual boundaries: Men who have sex with men and women in a street-based sample in Los Angeles. Journal of Urban Health,86(S1), 63–76. https://doi.org/10.1007/s11524-009-9370-7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Grbich, C. (2007). Qualitative data analysis: An introduction. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  22. Grosskopf, N. A., LeVasseur, M. T., & Glaser, D. B. (2014). Use of the Internet and mobile-based “apps” for sex-seeking among men who have sex with men in New York City. American Journal of Men’s Health,8(6), 510–520. https://doi.org/10.1177/1557988314527311.

    Article  PubMed  Google Scholar 

  23. Grov, C., Breslow, A. S., Newcomb, M. E., Rosenberger, J. G., & Bauermeister, J. A. (2014). Gay and bisexual men’s use of the Internet: Research from the 1990s through 2013. Journal of Sex Research,51(4), 390–409. https://doi.org/10.1080/00224499.2013.871626.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jensen, J. S., Cusini, M., Gomberg, M., & Moi, H. (2016a). 2016 European guideline on Mycoplasma genitalium infections. Journal of the European Academy of Dermatology and Venereology,30(10), 1650–1656. https://doi.org/10.1111/jdv.13849.

    Article  PubMed  Google Scholar 

  25. Jensen, J. S., Cusini, M., Gomberg, M., & Moi, H. (2016b). Background review for the 2016 European guideline on Mycoplasma genitalium infections. Journal of the European Academy of Dermatology and Venereology,30(10), 1686–1693. https://doi.org/10.1111/jdv.13850.

    Article  PubMed  Google Scholar 

  26. Klausner, J. D., Kent, C. K., Wong, W., McCright, J., & Katz, M. H. (2005). The public health response to epidemic syphilis, San Francisco, 1999–2004. Sexually Transmitted Diseases,32(10 Suppl.), S11–S18.

    Article  Google Scholar 

  27. Klein, H. (2011). Using a syndemics theory approach to study HIV risk taking in a population of men who use the internet to find partners for unprotected sex. American Journal of Men’s Health,5(6), 466–476. https://doi.org/10.1177/1557988311398472.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kovach, M. (2009). Indigenous methodologies: Characteristics, conversations and contexts. Toronto: University of Toronto Press.

    Google Scholar 

  29. Lewis, N. M., Bauer, G. R., Coleman, T. A., Blot, S., Pugh, D., Fraser, M., & Powell, L. (2015). Community cleavages: Gay and bisexual men’s perceptions of gay and mainstream community acceptance in the post-AIDS, post-rights era. Journal of Homosexuality,62(9), 1201–1227. https://doi.org/10.1080/00918369.2015.1037120.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Linton, S. L., Cooper, H. L. F., Luo, R., Karnes, C., Renneker, K., Haley, D. F., … Rothenberg, R. (2017). Changing places and partners: Associations of neighborhood conditions with sexual network turnover among african american adults relocated from public housing. Archives of Sexual Behavior, 46(4), 925–936. https://doi.org/10.1007/s10508-015-0687-x.

  31. Logan, J. J., Jolly, A. M., & Blanford, J. I. (2016). The sociospatial network: Risk and the role of place in the transmission of infectious diseases. PLoS ONE,11(2), e0146915. https://doi.org/10.1371/journal.pone.0146915.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lorimer, K., Flowers, P., Davis, M., & Frankis, J. (2016). Young men who have sex with men’s use of social and sexual media and sex-risk associations: Cross-sectional, online survey across four countries. Sexually Transmitted Infections,92, 371–376. https://doi.org/10.1136/sextrans-2015-052209.

    Article  PubMed  Google Scholar 

  33. Mathur, P., Zurlo, J., Albright, P., Crook, T., Whitener, C., & Du, P. (2014). Rising syphilis infection among rural HIV-infected men who routinely received risk-reduction counseling: New challenges to HIV prevention in clinical care. Journal of AIDS Clinical Research. https://doi.org/10.4172/2155-6113.1000333.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Merton, R. K. (1957). Social theory and social structure. New York, NY: Free Press.

    Google Scholar 

  35. Michaud, J. M., Ellen, J., Johnson, S. M., & Rompalo, A. (2003). Responding to a community outbreak of syphilis by targeting sex partner meeting location: An example of a risk-space intervention. Sexually Transmitted Diseases,30(7), 533–538. https://doi.org/10.1097/00007435-200307000-00001.

    Article  PubMed  Google Scholar 

  36. Nash, C. (2013a). Queering neighbourhoods: Politics and practice in Toronto. ACME: An International E-Journal for Critical Geographies,12(2), 193–219.

    Google Scholar 

  37. Nash, C. J. (2013b). The age of the “post-mo”? Toronto’s gay village and a new generation. Geoforum,49, 243–252. https://doi.org/10.1016/J.GEOFORUM.2012.11.023.

    Article  Google Scholar 

  38. Neaigus, A., Jenness, S. M., Reilly, K. H., Youm, Y., Hagan, H., Wendel, T., & Gelpi-Acosta, C. (2016). Community sexual bridging among heterosexuals at high-risk of HIV in New York City. AIDS and Behavior,20(4), 722–736. https://doi.org/10.1007/s10461-015-1244-2.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nguyen, T. Q., Kohn, R. P., Ng, R. C., Philip, S. S., & Cohen, S. E. (2018). Historical and current trends in the epidemiology of early syphilis in San Francisco, 1955 to 2016. Sexually Transmitted Diseases,45, S55–S62. https://doi.org/10.1097/OLQ.0000000000000870.

    Article  PubMed  PubMed Central  Google Scholar 

  40. O’Byrne, P., & MacPherson, P. (2016). HIV treatment as prevention in men who have sex with men: Examining the evidence. Canadian Medical Association Journal,188(3), 198–203. https://doi.org/10.1503/cmaj.150605.

    Article  PubMed  Google Scholar 

  41. O’Byrne, P., MacPherson, P., Roy, M., & Orser, L. (2017). Community-based, nurse-led post-exposure prophylaxis: Results and implications. International Journal of STD and AIDS,28(5), 505–511. https://doi.org/10.1177/0956462416658412.

    Article  PubMed  Google Scholar 

  42. Philen, R. C. (2006). A social geography of sex: Men who have sex with men (MSMs) and gay bars on the. Journal of Homosexuality,50(4), 31–48. https://doi.org/10.1300/J082v50n04_02.

    Article  PubMed  Google Scholar 

  43. Phillips, G., II, Birkett, M., Hammond, S., & Mustanski, B. (2016). Partner preference among men who have sex with men: Potential contribution to spread of HIV within minority populations. LGBT Health,3(3), 225–232. https://doi.org/10.1089/lgbt.2015.0122.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Rosser, B. R. S., West, W., & Weinmeyer, R. (2008). Are gay communities dying or just in transition? Results from an international consultation examining possible structural change in gay communities. AIDS Care,20(5), 588–595. https://doi.org/10.1080/09540120701867156.

    Article  Google Scholar 

  45. Solomon, M. M., & Mayer, K. H. (2015). Evolution of the syphilis epidemic among men who have sex with men. Sexual Health,12(2), 96–102. https://doi.org/10.1071/SH14173.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Statistics Canada. (2017). Census in Brief: Same-sex couples in Canada in 2016. https://www12.statcan.gc.ca/census-recensement/2016/as-sa/98-200-x/2016007/98-200-x2016007-eng.cfm.

  47. Stenger, M. R., Pathela, P., Anschuetz, G., Bauer, H., Simon, J., Kohn, R., … Torrone, E. (2017). Increases in the rate of neisseria gonorrhoeae among gay, bisexual and other men who have sex with men findings from the sexually transmitted disease surveillance network 2010–2015. Sexually Transmitted Diseases,44(7), 393–397.

    Article  Google Scholar 

  48. Sullivan, P. S., Carballo-Diéguez, A., Geff, D., & Coates, T. (2012). Successes and challenges of HIV prevention in men who have sex with men. The Lancet,380, 388–399. https://doi.org/10.1016/S0140-6736(12)60955-6.

    Article  Google Scholar 

  49. Toronto Public Health. (2016). Sexually transmitted bloodborne infections: Communicable diseases in Toronto, 2015. http://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Communicable%20Disease%20Control/Communicable%20Disease%20Surveillance/Annual%20Reports/Files/pdf/2/STIwHeps_AnnualReport_eng_2015_v2.pdf.

  50. Toronto Public Health. (2018). Communicable diseases in Toronto—2017. Retrieved December 7, 2018 from https://www.toronto.ca/community-people/health-wellness-care/health-inspections-monitoring/communicable-diseases-toronto-2016/.

  51. Tsai, A. C., & Burns, B. F. (2015). Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept. Social Science and Medicine,139, 26–35. https://doi.org/10.1016/j.socscimed.2015.06.024.

    Article  PubMed  Google Scholar 

  52. Unemo, M. (2015). Current and future antimicrobial treatment of gonorrhoea—the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infectious Diseases,15, 364. https://doi.org/10.1186/s12879-015-1029-2.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Unemo, M., & Jensen, J. S. (2017). Antimicrobial-resistant sexually transmitted infections: Gonorrhoea and Mycoplasma genitalium. Nature Reviews Urology,14(3), 139–152. https://doi.org/10.1038/nrurol.2016.268.

    Article  PubMed  Google Scholar 

  54. Vaughan, A. S., Kramer, M. R., Cooper, H. L., Rosenberg, E. S., & Sullivan, P. S. (2017). Activity spaces of men who have sex with men: An initial exploration of geographic variation in locations of routine, potential sexual risk, and prevention behaviors. Social Science and Medicine,175, 1–10. https://doi.org/10.1016/j.socscimed.2016.12.034.

    Article  PubMed  Google Scholar 

  55. Wasserheit, J. N., & Aral, S. O. (1996). The dynamic topology of sexually transmitted disease epidemics: Implications for prevention strategies. Journal of Infectious Diseases,174(Suppl. 2), S201–S213.

    Article  Google Scholar 

  56. Wertheim, J. O., Leigh Brown, A. J., Hepler, N. L., Mehta, S. R., Richman, D. D., Smith, D. M., & Kosakovsky Pond, S. L. (2014). The global transmission network of HIV-1. Journal of Infectious Diseases,209(2), 304–313. https://doi.org/10.1093/infdis/jit524.

    Article  PubMed  Google Scholar 

  57. White Hughto, J. M., Pachankis, J. E., Eldahan, A. I., & Keene, D. E. (2017). “You Can’t Just Walk Down the Street and Meet Someone”: The intersection of social-sexual networking technology, stigma, and health among gay and bisexual men in the small city. American Journal of Men’s Health,11(3), 726–736. https://doi.org/10.1177/1557988316679563.

    Article  PubMed  Google Scholar 

  58. Williams, M. L., Atkinson, J., Klovdahl, A., Ross, M. W., & Timpson, S. (2005). Spatial bridging in a network of drug-using male sex workers. Journal of Urban Health: Bulletin of the New York Academy of Medicine,82(1 Suppl. ), i35–i42. https://doi.org/10.1093/jurban/jti022.

    Article  Google Scholar 

  59. Wilson, S. (2008). Research is ceremony: Indigenous research methods. Winnipeg: Fernwood Publishing.

    Google Scholar 

  60. Wilson, P. A., Nanin, J., Amesty, S., Wallace, S., Cherenack, E. M., & Fullilove, R. (2014). Using syndemic theory to understand vulnerability to HIV infection among Black and Latino men in New York City. Journal of Urban Health,91(5), 983–998. https://doi.org/10.1007/s11524-014-9895-2.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Wood, E., Chan, K., Montaner, J. S., Schechter, M. T., Tyndall, M., O’Shaughnessy, M. V., & Hogg, R. S. (2000). The end of the line: Has rapid transit contributed to the spatial diffusion of HIV in one of Canada’s largest metropolitan areas? Social Science and Medicine,51(5), 741–748. https://doi.org/10.1016/S0277-9536(99)00479-7.

    Article  PubMed  Google Scholar 

  62. Youm, Y., Mackesy-Amiti, M. E., Williams, C. T., & Ouellet, L. J. (2009). Identifying hidden sexual bridging communities in Chicago. Journal of Urban Health,86(S1), 107–120. https://doi.org/10.1007/s11524-009-9371-6.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Zenilman, J. M., Ellish, N., Fresia, A., & Glass, G. (1999). The geography of sexual partnerships in Baltimore: Applications of core theory dynamics using a geographic information system. Sexually Transmitted Diseases,26(2), 75–81.

    Article  Google Scholar 

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Acknowledgements

We thank the participants for sharing their knowledge, stories and experiences.

Funding

This project was funded in part by the Canadian Institutes of Health Research funding reference number 492948.

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Correspondence to Dionne Gesink.

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Gesink, D., Salway, T., Kimura, L. et al. The Social Geography of Partner Selection in Toronto, Canada: A Qualitative Description of “Convection Mixing”. Arch Sex Behav 49, 1839–1851 (2020). https://doi.org/10.1007/s10508-019-01484-1

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Keywords

  • Geosexual isolation
  • Partner selection
  • Sexual minority men
  • Sexual mixing patterns
  • Social geography
  • Sexual orientation