HIV now fects more heterosexual people than gay or bisexual men – we need a new strategy | Ian Green | The Guardian

Contents:

• HIV AND GAY AND BISEXUAL MEN
• DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN
• HIV NOW FECTS MORE HETEROSEXUAL PEOPLE THAN GAY OR BISEXUAL MEN – WE NEED A NEW STRATEGY
• CDC: GAY MEN OVER 44 TIM MORE LIKELY HIV+ THAN HETERO MEN
• SEXUAL RISK FOR HIV AMONG GAY MALE COUPL: A LONGUDAL STUDY OF THE IMPACT OF RELATNSHIP DYNAMICS

HIV AND GAY AND BISEXUAL MEN

CDC is fundg a monstratn project 4 jurisdictns to intify active HIV transmissn works and implement HIV terventns for Hispanic/Lato gay, bisexual, and other men who have sex wh men.

In 2017, CDC award nearly $11 ln per year for five years to 30 CBOs to provi HIV ttg to young gay and bisexual men of lor and transgenr youth of lor, wh the goal of intifyg undiagnosed HIV fectns and lkg those who have HIV to re and preventn servic. Over the last 30 years, efforts to prevent new HIV fectns among gay and bisexual men have been guid by paradigms that hold dividuals rponsible for their health behavrs.

More recently, wh the game-changg breakthroughs the bmedil arena, attentn has shifted to the bmedil preventn strategi, which clu preexposure prophylaxis (PrEP) for gay, bisexual, and other MSM (Grant et al., 2010) and vagal microbicis for women (Abdool et al., 2010). In rponse to the alarmg health dispari among gay and bisexual men, there has been a ll to broan the preventn lens to exame the fluence of multiple social and ntextual factors fluencg health behavrs (Halkis & Cahill, 2011).

DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN

Dpe clear evince for the social termants of HIV transmissn and the beneficial effects of stctural terventns (Adimora & Auerbach, 2010), there have been limed efforts targetg the social equali, which place gay and bisexual men at greater risk for the acquisn of HIV disease. Of particular relevance to HIV preventn among gay and bisexual men are the social ndns that place at heightened risk for acquirg HIV as pared to our heterosexual unterparts. In this article, nsiratn is given to the manner through which discrimatn and homophobia, which may have been heightened bee of the AIDS epimic (Halkis, 1999), perpetuate HIV vulnerabili for gay and bisexual men.

HIV NOW FECTS MORE HETEROSEXUAL PEOPLE THAN GAY OR BISEXUAL MEN – WE NEED A NEW STRATEGY

Such health vulnerabili driven by homophobia are often exacerbated for gay and bisexual men of lor, who are often further burned by the social circumstanc of racism and poverty. Sce discrimatn based on sexual inty is cril to the ias beg put forth, and sce the HIV preventn needs of gay and bisexual men differ wily om those of non-gay or bisexual MSM (Halkis, 2010b), the foc of this issue of the newsletter is on gay and bisexual men, and not MSM general. In the now historic document, which recently reached s 30th anniversary, the CDC (1981) reported five s of Pnmocystis rii pnmonia young gay men who otherwise should have been healthy.

Wh bewilrment and fear, I read Robert Altman’s (1981) acunt of “doctors New York and California [who] have diagnosed among homosexual men 41 s of a rare and often rapidly fatal form of ncer. ” In the followg years, I wnsed the eptn of the disease, which s early years was given the name GRID (gayrelated immunoficiency disease) bee of s omniprence the gay populatn (Shilts, 2007; Weeks & Almo, 2010). However, spe the fact that the disease no longer remas nfed solely to gay and bisexual men, the realy is that this segment of the populatn is the one most affected by this epimic.

CDC: GAY MEN OVER 44 TIM MORE LIKELY HIV+ THAN HETERO MEN

Male populatn 18–44 years of age (Chandra, Mosher, Copen, & Snean, 2011), MSM, primarily gay and bisexual men, acunt for more than 50 percent of all AIDS s and all HIV fectns and 57 percent all new HIV fectns (CDC, 2011b). Dpe creased visibily, acceptance and recent socpolil advanc, gay and bisexual men ntue to live a society that privileg heterosexualy while nigratg nonheterosexual relatnships, behavrs and inti (Herek, Gillis, & Cogan, 2009).

Opprsive social stctur and equali affectg gay and bisexual men have been implited perpetuatg not only the HIV epimic but also rat of anal ncer, Hepatis B, human papillomavis (HPV) and lymphogranuloma vernrm (LGV) fectns, syphilis, gonorrhea and Hepatis C (Wolski & Fenton, 2011). The stctural ndns, which take the form of discrimatn and homophobia (Wolistki & Fenton, 2011; Wolski, Stall, & Validiserri, 2008), are further pound by racism and enomic dispari for gay and bisexual men of lor.

SEXUAL RISK FOR HIV AMONG GAY MALE COUPL: A LONGUDAL STUDY OF THE IMPACT OF RELATNSHIP DYNAMICS

Exposure to and experienc of homophobia have been implited substance abe, risky sexual behavrs, negative body image, suici attempts, creased strs and limed social support among gay and bisexual men (Halkis, Fischgnd, & Parsons, 2005; Mayer, Bradford, Makadon, Stall, & Goldhammer, 2008; Wolski, Stall, Valdiserri, 2008). Moreover, experienc wh homophobia have been shown to terfere wh the abily of gay and bisexual men to tablish and mata longterm same-sex relatnships, which protect agast HIV acquisn (Diaz, Ayala, Be, Henne, & Mar, 2001).

The experienc of homophobia may exert their effects on sexual risk takg directly by exacerbatg mental health burn (Halkis, 2010b; Johnson, Carri, Chney, & Mor, 2008). Experienc wh opprsn and homophobia, which tend to perva fay, school and muny settgs, are pecially relevant for gay and bisexual young men, who are the procs of tablishg their personal inti.

G., immigrants) who grow up wh people like themselv and who receive the support of their fai, gay and bisexual youth equently have more plited and often abive fay dynamics (D’Augelli, Hershberger, & Pilkgton, 1998; Pilkgton & D’Augelli, 1995). (2009) monstrated that gay and bisexual men wh histori of childhood sexual abe were more likely to report both unprotected anal terurse, to rive fewer benefs om participatn preventn programs, and to be at an overall greater risk for HIV fectn. Recently our rearch team at the Center for Health Inty, Behavr and Preventn Studi (CHIBPS) at New York Universy documented the risks and rilienci of young gay and bisexual men ag 13–29 a study named Project Dire.