Issue Brief on Addrsg HIV Preventn among Black/Ain Amerin Gay, Bisexual, and Other Men Who Have Sex wh Men: Highlights of Activi of the Centers for Disease Control and Preventn.
Contents:
- GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WH MEN (MSM)
- DIAGNOS OF HIV INFECTN THE UNED STAT AND DEPENNT AREAS, 2018: GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN
- GAY MEN (MSM)
- GAY MEN, BISEXUAL MEN AND OTHER MEN WHO HAVE SEX WH MEN
- QUEER DILEMMA: BEG GAY OR MSM
- DO GAY AND BISEXUAL MEN WHO NCEAL THEIR SAME-SEX BEHAVR PREFER DIFFERENT KDS OF HEALTH SERVIC? FDGS ACROSS FOUR CI TO RM CLIENT-CENTERED HIV PREVENTN CHA
- HIV AND ALL GAY AND BISEXUAL MEN
- HIGHLIGHTED CDC HIV PREVENTN ACTIVI CONCERNG HIV AND AIN AMERIN GAY AND BISEXUAL MEN
GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WH MEN (MSM)
STDs Gay, Bisexual and Other Men Who Have Sex Wh Men * difference between gay and msm *
The Special Foc Profil highlight trends and distributn of HIV 5 populatns of particular tert to HIV preventn programs state and lol health partments: (1) Transgenr Persons, (2) Gay, Bisexual, and Other Men Who Have Sex Wh Men, (3) Persons Who Inject Dgs, (4) Women, and (5) Children Aged <13, bisexual, and other men who have sex wh men (MSM) are the populatn most affected by HIV the Uned Stat. Stigma, homophobia, and discrimatn put MSM of all rac/ethnici at risk for multiple physil and mental health problems and n affect whether they seek and receive high-qualy health servic, cludg HIV ttg, treatment, and other preventn servic. In many settgs, providg ndoms and lubrints gay-iendly plac is much more effective than requirg MSM to purchase them om pharmaci or healthre settgs that they may be fearful of visg.
Internal and external homophobia and racism n lead to low self-teem, which n lead to creased risk behavr such as sexual aggrsn, difficulty negotiatg safer sex, and dg or alhol abe. A study of Lato gay men urban centers found that men who reported high-risk behavr also reported signifintly higher rat of fancial hardship, experienc of racism and homophobia, cince of domtic vlence and a history of ercive childhood sexual abe.
7 Hermanos Luna y Sol, an HIV preventn terventn for Lato gay/bisexual men San Francis, CA, als wh the mon history of opprsn among Lato gay men, cludg issu of homophobia, machismo, sexual abe, racism and separatn om fay and culture. Gay men, bisexual men and other men who have sex wh men (MSM), cludg transgenr men, may experience poorer health out than heterosexual men due to stigma, discrimatn, homophobia and transphobia.
DIAGNOS OF HIV INFECTN THE UNED STAT AND DEPENNT AREAS, 2018: GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WH MEN
Diagnos of HIV Infectn the Uned Stat and Depennt Areas, 2018: Gay, Bisexual, and Other Men Who Have Sex wh Men * difference between gay and msm *
Of note, data suggt that gay men are at creased risk of poor mental health [6] and substance e [7], which n crease their likelihood of experiencg poor sexual health out, cludg STI/HIV transmissn [5] date, much of the evince regardg MSM is based on those who attend sexual health clics [8], or nvenience surveys targetg MSM intifyg as gay and/or rec om gay-orientated venu [9], neher of which are reprentative of the diverse populatn of MSM [10].
We ed the same approach to exame the reportg of multiple poor health out wh and across three different health domas: physil, sexual, and mental health (Table 1) 1 Harmful behavurs and poor health out reported Natsal-3 ed to fe health domasFull size tableWhile Natsal-3 llected data on sexual inty, we do not prent timat for MSM stratified acrdg to their sexual inty due to a lack of statistil power to make meangful parisons, but for reference our tabl clu timat for the subset of MSM who intified as gay, cludg adjted odds rats relative to MSEW. 3% of 2 Sexual partner numbers the lifetime, past 5 years, and past year reported by men who have sex exclively wh women (MSEW), all men who have sex wh men (MSM), and MSM who intified as gay Natsal-3Full size tableMost MSM (69.
GAY MEN (MSM)
What are men who have sex wh men’s (MSM) HIV preventn needs? What do MSM need? Men who have sex wh men (MSM) are not a sgle homogeno group, but reprent a wi variety of people, liftyl and health needs. From middle class gay men, to homels naways, to jectn dg ers (IDUs) to rcerated men, MSM have many different inti and associated risks for HIV and other fect diseas. MSM refers to any man who has sex wh a man, whether he intifi as gay, bisexual or heterosexual. * difference between gay and msm *
MSM had higher tnal attament than MSEW, wh some evince of higher soc-enomic stat, but no difference area-level 3 Socmographic profile of men who have sex exclively wh women (MSEW), all men who have sex wh men (MSM), and MSM who intified as gay Natsal-3Full size tableHealth behavurs and outAlhol nsumptn was siar between MSM and MSEW (Table 4), but MSM were more likely to report beg a current smoker (aAOR:1. 75) 4 Health behavurs and out reported by men who have sex exclively wh women (MSEW), all men who have sex wh men (MSM) and MSM who intified as gay Natsal-3Full size tableSexual behavurs and sexual health outIn addn to MSM beg more likely than MSEW to report larger numbers of partners (Table 2), cludg reportg ten or more partners (aAOR:11.
50) 5 Sexual behavurs, risk perceptn, and sexual health out reported by men who have sex exclively wh women (MSEW), all men who have sex wh men (MSM), and MSM who intified as gay Natsal-3Full size tableMSM perceived greater STI/HIV risk than MSEW, although only a mory of MSM nsired themselv ‘que a lot’/‘greatly’ at risk of eher STIs or HIV. 4% of MSEW reportg harmful behavurs both 6 The extent that harmful behavursa clter wh and across health domas for (i) men reportg sex exclively wh women (MSEW), (ii) men reportg sex wh men (MSM), and (iii) and MSM who intified as gay Natsal-3Full size tableThere was no difference the number of poor physil health out reported by MSM and MSEW (aAOR:1.
GAY MEN, BISEXUAL MEN AND OTHER MEN WHO HAVE SEX WH MEN
To date, rearch on men who have sex wh men (MSM) has largely foced on their sexual health needs and on men reced om gay-orientated venu. Natnal probabily survey data provi a rare opportuny to exame the broar socmographic, behavural, and health profil of MSM, fed as men who reported ≥1 male sexual partner(s) the past 5 years, and th regardls of their sexual inty, parison to men reportg sex exclively wh women (MSEW) durg this time, and also the extent that health equali clter. Bra’s third Natnal Survey of Sexual Attus and Liftyl (Natsal-3), a probabily sample survey, terviewed 15,162 people aged 16–74 years (6,293 men) durg 2010–2012 g puter-assisted personal-terviewg wh a puter-assisted self-terview. We ed multivariable regrsn to pare MSM relative to MSEW their reportg of variabl, dividually and llectively, rrpondg to three domas: physil, mental, and sexual health. Among all men, 2.6 % (n = 190) were fed as MSM, of whom 52.5 % (95 % CI: 43.6 %–61.2 %) intified as gay. MSM were as likely as MSEW (n = 5,069) to perceive their health was ‘bad’/’very bad’, spe MSM beg more likely to report a long-standg illns/disabily/firmy (adjted odds rat, AOR: 1.46, 95 % CI:1.02–2.09), treatment for prsn/past year (2.75, 1.69–4.47), and substance e (e.g., recreatnal dg e/past year: 3.46, 2.22–5.40). MSM were more likely to report harmful sexual health behavurs, e.g., ndomls sex wh ≥2 partners/past year (3.52, 2.13–5.83), and poor sexual health out, cludg STI diagnosis/ (5.67, 2.67–12.04), poorer sexual functn (2.28, 1.57–3.33), both past year, and ever-experience of attempted non-volnal sex (6.51, 4.22–10.06). MSM were also more likely than MSEW to report poor health behavurs and out both wh and across the three health domas nsired. Of all MSM, 8.4 % had experienced poor health out all three domas – physil, mental, and sexual health - ntrast to 1.5 % of all MSEW. MSM are disproportnately affected by a broad range of harmful health behavurs and poor health out. Although often observed for a mory of MSM, many health equali were seen batn such that polici and practic aimed at improvg the health and well-beg of MSM require a holistic approach, regardls of clil specialty. * difference between gay and msm *
5% of all 7 The extent that poor health outa clter wh and across health domas for (i) men reportg sex exclively wh women (MSEW), (ii) men reportg sex wh men (MSM), and (iii) and MSM who intified as gay Natsal-3Full size tableSummary parg gay-intifyg MSM to MSEWWhen parg gay-intifyg MSM to MSEW, we observed siar patterns to those scribed above when parg all MSM to MSEW, reflectg how gay-intifyg MSM nstute half the sample of all MSM. However, the prevalence of the adverse health out studied was often higher for gay-intifyg MSM relative to all MSM (although nfince tervals overlap), and th aAORs were larger, e.
For the sexual health out studied, the differenc wh MSEW were siar, except that gay-intifyg MSM were as likely as MSEW to have poor sexual functn, while the aAOR for poor sexual functn was signifintly greater for all MSM relative to MSEW. In summary, and as evint om Tabl 6 and 7, the fdgs suggt margally greater clterg of poor health out (but not poor health behavurs) for gay-intifyg MSM than for all MSM, and turn, for MSEW. DiscsnNatnal probabily survey data show that only a small mory of men Bra are MSM terms of reportg sex wh men the past five years, and of the men, around half intify as gay.
QUEER DILEMMA: BEG GAY OR MSM
In Cha, addrsg dispari the HIV epimic among men who have sex wh men (MSM) requir targeted efforts to crease their engagement and retentn preventn. In an effort to advance MSM-iendly HIV servic wh Cha, and rmed by muny-based partnerships, we tted whether MSM who have ever vers never disclosed their same-sex behavr to healthre provirs (HCP) differ socmographic and behavral characteristics as well as the quali of sexual health servic each group would prefer to accs. We nducted a cross-sectnal survey among HIV-negative MSM who went to MSM-foced voluntary unselg and ttg clics four ci Cha. The survey was anonymo and llected rmatn on socmographic characteristics, ttg behavrs, sexual-health related behavr, and sexual health service mol preferenc. Of 357 rponnts, 68.1% participants had ever disclosed same-sex behavr to HCPs when seekg advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisn (aOR = 1.39; 95% CI: 1.05–1.84) were associated wh higher odds of past disclosure. The availabily of prehensive sexual health servic was one of the most valued characteristics of the ial sexual health clic. Those who ever disclosed and never disclosed differed signifintly their rankg of the importance of three out of ten dimensns: sexual health unselg servic available (M = 3.99 vs. M = 3.65, p = .002), gay inty support available (M = 3.91 vs. M = 3.62, p = .016) and clic llaborat wh a gay CBO (M = 3.81 vs. M = 3.56, p = .036). Our hypothis that MSM who had disclosed vers never disclosed same-sex behavr would differ the value they placed on different dimensns of sexual health service was partially borne out. As health thori Cha ci on implementatn mols for pre-exposure prophylaxis (PrEP) livery and specifilly wh which stutns to tegrate PrEP servic, the preferenc of target populatns should be nsired to velop prehensive, patient-centric and LGBT-iendly servic. * difference between gay and msm *
While many of the harmful health behavurs and poor health out studied were reported by a mory of MSM, this was often a larger proportn than observed among MSEW, and they were also more likely to be reported batn and across health domas, monstratg the nsirable health equaly that exists for MSM Bra, often regardls of whether or not MSM intify as gay. The abily to sample om the large proportn of MSM who did not intify as gay is a further strength, and shows that a broar group of MSM are reprented this study than prev studi, which have tend to sample om the gay scene clubs or sexual health clic atten, and so have reported greater sexual risk and dg e behavurs and adverse sexual health out [8-10, 20]. Our enavour is nsistent wh the ratnale for the broar amg of sexual health [3], and Public Health England’s recent actn plan for promotg the health and wellbeg of gay, bisexual and other MSM by takg to acunt their wir health issu and equali and the broar soc-enomic and cultural ntext.
DO GAY AND BISEXUAL MEN WHO NCEAL THEIR SAME-SEX BEHAVR PREFER DIFFERENT KDS OF HEALTH SERVIC? FDGS ACROSS FOUR CI TO RM CLIENT-CENTERED HIV PREVENTN CHA
Gay and bisexual men are more severely affected by HIV than any other group the Uned Stat (US). * difference between gay and msm *
However, the bimodal distributn of partner numbers we observed for MSM, wh a small but non-negligible proportn of MSM reportg very few partners, challeng stereotyp ferred om clil data and muny surveys of gay men [8-10]. Although this hypothis is nsistent wh fdgs om large surveys of gay men unrtaken the US and Atralia that observed very high reported prevalence of sexual functn problems [27, 28], is worth notg that the difference sexual functn was smaller when the analysis was limed to gay-intifyg MSM. Our fdg of a higher prevalence of ever experiencg attempted non-volnal sex among MSM (regardls of whether they intified as gay) than among MSEW also supports other studi [29, 30] others have prevly reported [6], we observed higher levels of poor mental health among MSM ntrast to MSEW, at least terms of the proportn reportg receivg treatment for prsn [31].
Furthermore, MSM and MSEW were often siar terms of their physil health, ntradictg prev rearch [32], although when we foced on gay-intifyg MSM, the differenc wh MSEW were often larger.
ConclnsThe data suggt that there is a small but non-negligible group of MSM – and not necsarily MSM who intify as gay - who are likely to benef om terventns that adopt a more holistic approach to improvg health and well-beg.
HIV AND ALL GAY AND BISEXUAL MEN
BackgroundIn many areas of the world where homosexualy remas illegal or stigmatized stctural and social ways, gay, bisexual and other men who have sex wh men (MSM) largely cle to disclose their sexualy and same-sex behavr to healthre provirs (HCPs) [1]. MethodsStudy sign and samplg methodsOur study team held a seri of stakeholr meetgs Cha wh gay muny lears, HIV preventn terventn staff at municipal Centers for Disease Control and Preventn (CDC), and antiretroviral and STI clic provirs to discs potential mols for sexual health servic for Che MSM.
Staff at gay-oriented CBOs reced participants through four methods: voluntary unsellg and ttg (VCT) clics wh posters, peer works, outreach at gay venu wh fliers, and onle through CBOs’ WeChat posts. The spir map prents sexual health servic that MSM valued when seeg HCPsFull size imageDiscsnWe examed whether disclosure of same-sex behavr to HCPs was associated wh mographic and sexual health factors among MSM who vised gay-oriented CBOs for HIV VCT servic four ci Cha, and relatedly, whether their past disclosure while seekg sexual health servic was associated wh their preferenc for hypothetil sexual health servic. Further rearch uld better scribe this important subpopulatn, to better unrstand the nnectn between never ttg for HIV and visg MSM-foced sexual health clic for MSMThose men who ever disclosed same-sex behavr placed a higher value on sexual health unselg servic, support for gay inty, and gay CBO oriented clic than those never who had never disclosed.
HIGHLIGHTED CDC HIV PREVENTN ACTIVI CONCERNG HIV AND AIN AMERIN GAY AND BISEXUAL MEN
Compared to MSM who had disclosed, they reported slightly lower preferenc for sexual health unselg, gay inty support, reputatn for HIV servic, llaboratn wh a gay CBO, and awarens among HCPs of clients’ same sex behavr. A few studi have shown that ignorance of LGBT liftyl and sexual practic, lack of appropriate language and probg, prenceptn of MSM clients’ sexual orientatn, and homophobic attus om HCPs are key barriers to disclosure [2, 25]. Seattle Sex Survey [SSS] (Heterosexual Men & Women)Urban Men’s Health Study [UMHS] (MSM)Seattle MSM RDD [SEA] (MSM)Years2003–20041996–19982003 & 2006Eligibily creriaAge 18–39Seattle rintsPrent analysis rtricted to those who reported exclively heterosexual partnershipsAge 18 or olrNew York Cy, Chigo, San Francis, or Los Angel rintsSame-sex behavr sce age 14 or self-intified as gay or bisexualAge 18 or olrSeattle rintsSame-sex behavr sce age 14Sample sizeN=1, 194 (Heterosexuals, n=926)N=2, 881 (Age<40, n=1, 621)N=800 (Age<40, n=342)Rponse rate24%not reported46% (2003) & 22% (2006)Cooperatn rate46%78%97% (2003) & 87% (2006)Partner-specific qutnsAsked about up to 5 most recent partners (vagal, oral, or anal sex)Asked about up to 4 most recent male partners the past year (any kd of sex)Asked about up to 3 most recent male anal sex partners the past yearThe SSS and the two SEA RDDs were nducted the mid-2000s, while the UMHS, which enrolled MSM om 4 U.