HIV and Gay and Bisexual Men | NIH

Contents:

• HIV AMONG GAY AND BISEXUAL MEN THE U.S.
• HIV AND ALL GAY AND BISEXUAL MEN
• DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN
• NST T="UNFED"!=TYPEOF HTMLIMAGEELEMENT&&"LOADG" HTMLIMAGEELEMENT.PROTOTYPE;IF(T){NST T=DOCUMENT.QUERYSELECTORALL("IMG[DATA-MA-IMAGE]");FOR(LET E OF T){(E.SETATTRIBUTE("SRC",),E.REMOVEATTRIBUTE("DATA-SRC")),(E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET"));NST T=E.PARENTNO.QUERYSELECTORALL("SOURCE[DATA-SRCSET]");FOR(LET E OF T)E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET");PLETE&&(,E.PARENTNO.PARENTNO.QUERYSELECTOR("[DATA-PLACEHOLR-IMAGE]"))}}HIV BASICSOVERVIEWABOUT HIV & AIDSWHAT ARE HIV AND AIDS?HOW IS HIV TRANSMTED?WHO IS AT RISK FOR HIV?SYMPTOMS OF HIVDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSHISTORYHIV AND AIDS TIMELEMAKG A DIFFERENCESUPPORTG SOMEONE LIVG WH HIVSTANDG UP TO STIGMAGETTG INVOLVEDHIV PREVENTNUSG HIV MEDITN TO RCE RISKHIV TREATMENT AS PREVENTNPRE-EXPOSURE PROPHYLAXIS (PREP)POST-EXPOSURE PROPHYLAXIS (PEP)RCG SEXUAL RISKPREVENTG SEXUAL TRANSMISSN OF HIVRCG RISK OM ALHOL & DG USEALHOL AND HIV RISKSUBSTANCE USE AND HIV RISKRCG RISK OF PERATAL TRANSMISSNPREVENTG PERATAL TRANSMISSN OF HIVPOTENTIAL FUTURE OPTNSHIV VACCLONG-ACTG HIV PREVENTN TOOLSMICROBICISHIV TTGLEARN ABOUT HIV TTGWHO SHOULD GET TTED?HIV TTG LOTNSHIV TTG OVERVIEWUNRSTANDG HIV TT RULTSJT DIAGNOSED: WHAT'S NEXT?LIVG WH HIVTALKG ABOUT YOUR HIV STATSTARTG HIV CAREFD A PROVIRLOTE AN HIV CARE PROVIRTYP OF PROVIRSTAKE CHARGE OF YOUR CAREGETTG READY FOR YOUR FIRST VISWHAT TO EXPECT AT YOUR FIRST HIV CARE VISSTAYG HIV CAREPROVIR VISS AND LAB TTSMAKG CARE WORK FOR YOUSEEG YOUR HEALTH CARE PROVIRHIV LAB TTS AND RULTSRETURNG TO CAREHIV TREATMENTHIV TREATMENT OVERVIEWVIRAL SUPPRSN AND UNTECTABLE VIRAL LOAD TAKG YOUR HIV MEDICE AS PRCRIBEDTIPS ON TAKG YOUR HIV MEDITN EVERY DAYPAYG FOR HIV CARE AND TREATMENTOTHER RELATED HEALTH ISSUOTHER HEALTH ISSU OF SPECIAL CONCERN FOR PEOPLE LIVG WH HIVALHOL AND DG USECORONAVIS (COVID-19) AND PEOPLE WH HIVHEPATIS B & CIMMUNIZATNS AND PEOPLE WH HIVFLU AND PEOPLE WH HIVMENTAL HEALTHMPOX AND PEOPLE WH HIVOPPORTUNISTIC INFECTNSSEXUALLY TRANSMTED INFECTNSSMOKGHIV AND WOMEN'S HEALTH ISSULIVG WELL WH HIVTAKG CARE OF YOURSELFAGG WH HIVEMERGENCI AND DISASTERS AND HIVEMPLOYMENT AND HEALTHEXERCISE AND PHYSIL ACTIVYFOOD SAFETY AND NUTRNHOG AND HEALTHTRAVELG OUTSI THE U.S.YOUR LEGAL RIGHTSCIVIL RIGHTSWORKPLACE RIGHTSLIMS ON CONFINTIALYFERAL RPONSENATNAL HIV/AIDS STRATEGYNATNAL HIV/AIDS STRATEGY (2022-2025)PRR NATNAL HIV/AIDS STRATEGI (2010-2021)ENDG THE HIV EPIMICABOUT ENDG THE HIV EPIMIC THE U.S.OVERVIEWKEY STRATEGIPRRY JURISDICTNSHHS AGENCI INVOLVEDFUNDGTIMELELEARN MORE ABOUT EHEREADY, SET, PREPREADY, SET, PREPREADY, SET, PREP PHARMACIREADY, SET, PREP ROURCAHEADAHEAD: AMERI’S HIV EPIMIC ANALYSIS DASHBOARDFERAL ACTIVI & AGENCIHIV PREVENTN ACTIVIHIV TTG ACTIVIHIV CARE AND TREATMENT ACTIVIHIV REARCH ACTIVIACTIVI COMBATG HIV STIGMA AND DISCRIMATNPOLICI & ISSUTHE AFFORDABLE CARE ACT AND HIV/AIDSHIV CARE CONTUUMSYRGE SERVIC PROGRAMSFUNDGBUDGETFERAL FUNDG FOR HIV/AIDSMORY HIV/AIDS FUNDOVERVIEWBACKGROUNDFUND ACTIVITHE FUND ACTNPACHAABOUT PACHACHARTERMEMBERS & STAFFSUBMTEPRR PACHA MEETGS AND REMENDATNSCAMPAIGNSI AM A WORK OF ART CAMPAIGNAWARENS CAMPAIGNSPEPFAR & GLOBAL AIDSGLOBAL HIV/AIDS OVERVIEWPEPFARU.S. GOVERNMENT GLOBAL HIV/AIDS ACTIVIGLOBAL HIV/AIDS ORGANIZATNSEVENTSAWARENS DAYSNATNAL BLACK HIV/AIDS AWARENS DAY FEBARY 7HIV IS NOT A CRIME AWARENS DAY FEBARY 28NATNAL WOMEN AND GIRLS HIV/AIDS AWARENS DAY MARCH 10NATNAL NATIVE HIV/AIDS AWARENS DAY MARCH 20NATNAL YOUTH HIV & AIDS AWARENS DAY APRIL 10HIV VACCE AWARENS DAY MAY 18NATNAL ASIAN & PACIFIC ISLANR HIV/AIDS AWARENS DAY MAY 19HIV LONG-TERM SURVIVORS AWARENS DAY JUNE 5NATNAL HIV TTG DAY JUNE 27ZERO HIV STIGMA JULY 21SOUTHERN HIV/AIDS AWARENS DAY AUGT 20NATNAL FAH HIV/AIDS AWARENS DAY AUGT 30NATNAL HIV/AIDS AND AGG AWARENS DAY SEPTEMPBER 18NATNAL GAY MEN'S HIV/AIDS AWARENS DAY SEPTEMBER 27NATNAL LATX AIDS AWARENS DAY OCTOBER 15WORLD AIDS DAY DECEMBER 1EVENT PLANNG GUI CONFERENCU.S. CONFERENCE ON HIV/AIDS (USCHA) NATNAL RYAN WHE CONFERENCE ON HIV CARE & TREATMENT AIDS 2020 (23RD INTERNATNAL AIDS CONFERENCE VIRTUAL) LEARNG OPPORTUNILEARNG OPPORTUNILEARNG OPPORTUNIWANT TO STAY ABREAST OF CHANG PREVENTN, RE, TREATMENT OR REARCH OR OTHER PUBLIC HEALTH ARENAS THAT AFFECT OUR LLECTIVE RPONSE TO THE HIV EPIMIC? OR ARE YOU NEW TO THIS FIELD? CURAT LEARNG OPPORTUNI FOR YOU, AND THE PEOPLE YOU SERVE AND LLABORATE WH.STAY UP TO DATE WH THE WEBARS, TWTER CHATS, NFERENC AND MORE THIS SECTN.MORE LEARNG OPPORTUNIBLOGGET TTED. FD SERVIC + PREPSEARCHGOESPAñOL ESPAñOL ES GET TTED. FD SERVIC + PREPSEARCHOPEN LOTOR SEARCHHIV SERVICES LOCATORSEARCH⨯CLOSEHOMEHIV BASICSOVERVIEWDATA AND TRENDSU.S. STATISTICSSECTN MENUGET TTED. FIND SERVICES + PREP.DATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSSEARCHDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSU.S. STATISTICS
• WHY ARE GAY MEN MORE AT RISK FOR HIV?
• 'IT'S A S' BRGS A LOST GENERATN OF GAY MEN TO LIFE
• IS AIDS A “GAY” DISEASE?

HIV AMONG GAY AND BISEXUAL MEN THE U.S.

Factors that fluence health out—cludg HIV-related stigma, homophobia, racism, discrimatn, poverty, limed accs to high-qualy health re, and other longstandg barriers—have ntributed to the unequal reach of HIV preventn and treatment; higher levels of HIV some muni; and ntued equi. Wh effective preventn and treatment tools at our disposal, the natn has a s--the-makg opportuny to end the domtic HIV epimic and elimate dispari HIV preventn and re among gay and bisexual men and other populatns disproportnately affected by HIV.

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).

HIV AND ALL GAY AND BISEXUAL MEN

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). 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.

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.

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.

DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN

” 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). 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).

NST T="UNFED"!=TYPEOF HTMLIMAGEELEMENT&&"LOADG" HTMLIMAGEELEMENT.PROTOTYPE;IF(T){NST T=DOCUMENT.QUERYSELECTORALL("IMG[DATA-MA-IMAGE]");FOR(LET E OF T){(E.SETATTRIBUTE("SRC",),E.REMOVEATTRIBUTE("DATA-SRC")),(E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET"));NST T=E.PARENTNO.QUERYSELECTORALL("SOURCE[DATA-SRCSET]");FOR(LET E OF T)E.SETATTRIBUTE("SRCSET",),E.REMOVEATTRIBUTE("DATA-SRCSET");PLETE&&(,E.PARENTNO.PARENTNO.QUERYSELECTOR("[DATA-PLACEHOLR-IMAGE]"))}}HIV BASICSOVERVIEWABOUT HIV & AIDSWHAT ARE HIV AND AIDS?HOW IS HIV TRANSMTED?WHO IS AT RISK FOR HIV?SYMPTOMS OF HIVDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSHISTORYHIV AND AIDS TIMELEMAKG A DIFFERENCESUPPORTG SOMEONE LIVG WH HIVSTANDG UP TO STIGMAGETTG INVOLVEDHIV PREVENTNUSG HIV MEDITN TO RCE RISKHIV TREATMENT AS PREVENTNPRE-EXPOSURE PROPHYLAXIS (PREP)POST-EXPOSURE PROPHYLAXIS (PEP)RCG SEXUAL RISKPREVENTG SEXUAL TRANSMISSN OF HIVRCG RISK OM ALHOL & DG USEALHOL AND HIV RISKSUBSTANCE USE AND HIV RISKRCG RISK OF PERATAL TRANSMISSNPREVENTG PERATAL TRANSMISSN OF HIVPOTENTIAL FUTURE OPTNSHIV VACCLONG-ACTG HIV PREVENTN TOOLSMICROBICISHIV TTGLEARN ABOUT HIV TTGWHO SHOULD GET TTED?HIV TTG LOTNSHIV TTG OVERVIEWUNRSTANDG HIV TT RULTSJT DIAGNOSED: WHAT'S NEXT?LIVG WH HIVTALKG ABOUT YOUR HIV STATSTARTG HIV CAREFD A PROVIRLOTE AN HIV CARE PROVIRTYP OF PROVIRSTAKE CHARGE OF YOUR CAREGETTG READY FOR YOUR FIRST VISWHAT TO EXPECT AT YOUR FIRST HIV CARE VISSTAYG HIV CAREPROVIR VISS AND LAB TTSMAKG CARE WORK FOR YOUSEEG YOUR HEALTH CARE PROVIRHIV LAB TTS AND RULTSRETURNG TO CAREHIV TREATMENTHIV TREATMENT OVERVIEWVIRAL SUPPRSN AND UNTECTABLE VIRAL LOAD TAKG YOUR HIV MEDICE AS PRCRIBEDTIPS ON TAKG YOUR HIV MEDITN EVERY DAYPAYG FOR HIV CARE AND TREATMENTOTHER RELATED HEALTH ISSUOTHER HEALTH ISSU OF SPECIAL CONCERN FOR PEOPLE LIVG WH HIVALHOL AND DG USECORONAVIS (COVID-19) AND PEOPLE WH HIVHEPATIS B & CIMMUNIZATNS AND PEOPLE WH HIVFLU AND PEOPLE WH HIVMENTAL HEALTHMPOX AND PEOPLE WH HIVOPPORTUNISTIC INFECTNSSEXUALLY TRANSMTED INFECTNSSMOKGHIV AND WOMEN'S HEALTH ISSULIVG WELL WH HIVTAKG CARE OF YOURSELFAGG WH HIVEMERGENCI AND DISASTERS AND HIVEMPLOYMENT AND HEALTHEXERCISE AND PHYSIL ACTIVYFOOD SAFETY AND NUTRNHOG AND HEALTHTRAVELG OUTSI THE U.S.YOUR LEGAL RIGHTSCIVIL RIGHTSWORKPLACE RIGHTSLIMS ON CONFINTIALYFERAL RPONSENATNAL HIV/AIDS STRATEGYNATNAL HIV/AIDS STRATEGY (2022-2025)PRR NATNAL HIV/AIDS STRATEGI (2010-2021)ENDG THE HIV EPIMICABOUT ENDG THE HIV EPIMIC THE U.S.OVERVIEWKEY STRATEGIPRRY JURISDICTNSHHS AGENCI INVOLVEDFUNDGTIMELELEARN MORE ABOUT EHEREADY, SET, PREPREADY, SET, PREPREADY, SET, PREP PHARMACIREADY, SET, PREP ROURCAHEADAHEAD: AMERI’S HIV EPIMIC ANALYSIS DASHBOARDFERAL ACTIVI & AGENCIHIV PREVENTN ACTIVIHIV TTG ACTIVIHIV CARE AND TREATMENT ACTIVIHIV REARCH ACTIVIACTIVI COMBATG HIV STIGMA AND DISCRIMATNPOLICI & ISSUTHE AFFORDABLE CARE ACT AND HIV/AIDSHIV CARE CONTUUMSYRGE SERVIC PROGRAMSFUNDGBUDGETFERAL FUNDG FOR HIV/AIDSMORY HIV/AIDS FUNDOVERVIEWBACKGROUNDFUND ACTIVITHE FUND ACTNPACHAABOUT PACHACHARTERMEMBERS & STAFFSUBMTEPRR PACHA MEETGS AND REMENDATNSCAMPAIGNSI AM A WORK OF ART CAMPAIGNAWARENS CAMPAIGNSPEPFAR & GLOBAL AIDSGLOBAL HIV/AIDS OVERVIEWPEPFARU.S. GOVERNMENT GLOBAL HIV/AIDS ACTIVIGLOBAL HIV/AIDS ORGANIZATNSEVENTSAWARENS DAYSNATNAL BLACK HIV/AIDS AWARENS DAY FEBARY 7HIV IS NOT A CRIME AWARENS DAY FEBARY 28NATNAL WOMEN AND GIRLS HIV/AIDS AWARENS DAY MARCH 10NATNAL NATIVE HIV/AIDS AWARENS DAY MARCH 20NATNAL YOUTH HIV & AIDS AWARENS DAY APRIL 10HIV VACCE AWARENS DAY MAY 18NATNAL ASIAN & PACIFIC ISLANR HIV/AIDS AWARENS DAY MAY 19HIV LONG-TERM SURVIVORS AWARENS DAY JUNE 5NATNAL HIV TTG DAY JUNE 27ZERO HIV STIGMA JULY 21SOUTHERN HIV/AIDS AWARENS DAY AUGT 20NATNAL FAH HIV/AIDS AWARENS DAY AUGT 30NATNAL HIV/AIDS AND AGG AWARENS DAY SEPTEMPBER 18NATNAL GAY MEN'S HIV/AIDS AWARENS DAY SEPTEMBER 27NATNAL LATX AIDS AWARENS DAY OCTOBER 15WORLD AIDS DAY DECEMBER 1EVENT PLANNG GUI CONFERENCU.S. CONFERENCE ON HIV/AIDS (USCHA) NATNAL RYAN WHE CONFERENCE ON HIV CARE & TREATMENT AIDS 2020 (23RD INTERNATNAL AIDS CONFERENCE VIRTUAL) LEARNG OPPORTUNILEARNG OPPORTUNILEARNG OPPORTUNIWANT TO STAY ABREAST OF CHANG PREVENTN, RE, TREATMENT OR REARCH OR OTHER PUBLIC HEALTH ARENAS THAT AFFECT OUR LLECTIVE RPONSE TO THE HIV EPIMIC? OR ARE YOU NEW TO THIS FIELD? CURAT LEARNG OPPORTUNI FOR YOU, AND THE PEOPLE YOU SERVE AND LLABORATE WH.STAY UP TO DATE WH THE WEBARS, TWTER CHATS, NFERENC AND MORE THIS SECTN.MORE LEARNG OPPORTUNIBLOGGET TTED. FD SERVIC + PREPSEARCHGOESPAñOL ESPAñOL ES GET TTED. FD SERVIC + PREPSEARCHOPEN LOTOR SEARCHHIV SERVICES LOCATORSEARCH⨯CLOSEHOMEHIV BASICSOVERVIEWDATA AND TRENDSU.S. STATISTICSSECTN MENUGET TTED. FIND SERVICES + PREP.DATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSSEARCHDATA & TRENDSU.S. STATISTICSIMPACT ON RACIAL AND ETHNIC MORIGLOBAL STATISTICSU.S. STATISTICS

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 lymphogranulma 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.

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). 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.

WHY ARE GAY MEN MORE AT RISK FOR HIV?

In their qualative study of masculy, Phoenix, Frosh, and Pattman (2003) found that boys as young as 11 years of age have found crilly important to prent themselv as mascule orr to avoid beg bullied and labeled as gay. Unfortunately, the cultural perceptn of gay and bisexual mal as ls mascule may lead to their assertns of masculy through engagement unprotected sexual behavrs (Halkis, Green, & Wilton, 2004; Harper, 2007). Scientific evince shows that gay men’s doubts about their masculy as well as endorsement of mascule characteristics are associated wh equent risky sexual behavrs, which crease exposure to HIV (Connell, 1995; Diaz, 1998).

'IT'S A S' BRGS A LOST GENERATN OF GAY MEN TO LIFE

Posive attus toward one’s sexual inty have been shown to be protective agast risky sexual behavrs (Rosar, Hunter, Maguen, Gwadz, & Smh, 2001), while elevated rat of ternalized homophobia have been lked to exacerbated sexual risk takg and other health risks.

IS AIDS A “GAY” DISEASE?

But like wh a lot of men who have sex wh men, pecially men who have sex wh men of lor, ’s like — like the ternalized issue — the homophobia wh our cultur — the whole issue wh beg an abomatn to God.

(2008) monstrated that among 465 HIV-posive men, ternalized homophobia was associated wh unprotected receptive anal terurse wh partners who were HIV-negative or of unknown HIV stat and was also associated wh poorer adherence to antiretroviral therapy. For gay and bisexual men of lor, the effects of sexual orientatn discrimatn on HIV risk may be nfound and exacerbated by other powerful stctural factors, cludg racism, lack of accs to enomic means, and poverty (Williams, Wyatt, Rell, Peterson, & Asuan-O’Brien, 2004).

Th, the synergistic social ndns of homophobia, racism, and poverty likely expla the even higher cince of new HIV fectns among racial ethnic mori, particularly Black and Lato gay and bisexual men (CDC, 2011b). Perhaps the effects of enomic standg on HIV prevalence among gay and bisexual men n also be unrstood relatn to ntextual factors, particularly the rol played by rintial neighborhoods (e. Yet is a likely hypothis that those who have accs to and navigate environments where there are high levels of gay prence are also likely to be exposed to HIV preventn msagg through publitns and advertisements, as well as through teractns wh other gay men social venu.

For those young gay men of lor who are socenomilly disadvantaged, accs to gayrelated health rourc may be more limed bee their neighborhoods of rince tend to be outsi the exclive cy center, where many gay cultural, health, and social tablishments tend to be loted (Halkis, Moeller, & Sinolfi, 2009a, 2009b). (2010) examed the relatn between gay neighborhood prence and sexual risk takg of young gay men and found that gay neighborhood prence was posively associated wh nsistent ndom e durg anal terurse. Taken together, the extant lerature suggts that the perpetuatn of the HIV epimic gay and bisexual men is not directed solely by person-level behavrs but is fluenced by a range of ntextual factors, rooted cultural, historil, and polil stctur this untry.

A holistic approach to the well-beg of gay men (Halkis, 2010b; Saen, Rer, Herick, Mimiaga, & Stall, 2010) should llectively nsir the bmedil, psychologil and social factors that create the health dispari this segment of the populatn.

As noted by the Instute of Medice (2011) and as supported by the ias prented this article, an approach to the totaly of gay men’s health mt nsir the role that social stctur play promisg gay men’s health.