Gay men in small cities are more likely to remain closeted, and therefore less likely to be tested for HIV, according to a study from UBC Okanagan.
The study's author, psychology professor Susan Holtzman, spoke to men at pride events and online dating sites throughout the B.C. interior.
She found many of them keep their sex lives secret — even from their doctors — which means they are less likely to be tested for HIV.
'Internalized homophobia' to blame
Holtzman says some of the reluctance comes from a relative lack of openness in communities outside of Canada's major cities.
She says many of the men she spoke with were reluctant to acknowledge their sexuality, even to themselves.
"It is sad because I think we'd like to think that our society has made gains in terms of acceptance and openness. But clearly, at least in our sample, these types of views are still present and they're also influencing health."
These findings come as little surprise to Ciro Panessa, director of chronic diseases for Northern Health.
He has identified a number of challenges for people living with HIV in rural and northern communities, including fear.
"There's certainly still discrimination and stigma around HIV, for people living with HIV. And so one of the impetuses is to… normalize HIV testing."
Northern Health now offers routine HIV screenings to all adult patients.
Since the program began in 2009, HIV testing and treatment has steadily increased, while deaths from the virus are on the decline.
Education and openness needed
Holtzman says normalizing testing is important, but so is normalizing conversations about sexuality.
"A lot of it comes down to education," she says. "The attention that sexual minority health gets at medical school is miniscule, currently."
She also wants people to be more comfortable talking about sex with their healthcare providers.
"It doesn't even necessarily have to be about same-sex practices, it's just 'are you sexually active? Are you at risk? Let's get you tested."