Health issu for gay men and other men who have sex wh men - Mayo Clic

aids and gay men

HIV and the syndrome , AIDS, began spreadg the Uned Stat the early 1980s. By the late 1980s had bee a public health crisis. Inially the U.S. ernment did ltle to addrs the epimic, due part to misnceptns that the disease only affected gay men. Activists me together to mand a rponse om the ernment and the ternatnal muny. By the mid-1990s, HIV/AIDS numbers were on the cle Ameri. Today, lns of people around the world are livg wh HIV and tens of thoands of people die of AIDS-related illns every year.

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HIV AND ALL GAY AND BISEXUAL MEN

The high percentage of gay and bisexual men who are livg wh HIV means that, as a group, they have a greater risk of beg exposed to HIV; browse lks here. * aids and gay men *

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). 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).

HIV AMONG GAY AND BISEXUAL MEN THE U.S.

Gay and bisexual men are more severely affected by HIV than any other group the Uned Stat (US). * aids and gay 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.

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.

DISCRIMATN AND HOMOPHOBIA FUEL THE HIV EPIMIC GAY AND BISEXUAL MEN

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. * aids and gay men *

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).

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Unrstand health ncerns for gay men and other men who have sex wh men, and learn how to promote good health. * aids and gay 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).

WHY ARE GAY MEN MORE AT RISK FOR HIV?

Differenc exist by race/ethnicy knowledge of HIV stat, preventn, treatment, and stigma among gay and bisexual men. * aids and gay men *

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.

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

What's behd the higher rat of fectn among gay men? Dr. David bunks myths and explas why some groups are and areas are more affected by HIV/AIDS than others. * aids and gay men *

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.

The HIV epimic ntu to disproportnately impact gay and bisexual men, transgenr women, youth 13-24 and muni of lor. * aids and gay men *

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).

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. 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).

* aids and gay men *

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.

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