Gay men’s health has for many years predominantly focused on HIV prevention and treatment. Despite being over two decades into the AIDS epidemic, it is clear that MSM, especially MSM of color, are still disproportionately affected by the disease. In 2008 the CDC released new data on HIV incidence using a new method of calculation. Subpopulation analyses revealed that in 2006, of new HIV infections in men, the majority occurred in MSM of whom 46 percent were white, 35 percent were black, and 19 percent were Hispanic. African American youth are especially vulnerable with 5,520 new HIV infections in the 13 to 29 age group, placing them at 1.6 times the rate of white MSM.[58, 59]
Millet at al. investigated the racial disparity in HIV rates among African American MSM by conducting a meta-analysis of published studies. This revealed that African American MSM reported lower risk behaviors than white MSM, such as less substance use and fewer sexual partners. There was no increase in unprotected sex compared with whites, but the rates of STD among African Americans were higher. The greater risk of HIV acquisition among African Americans appears, in part, due to the baseline higher prevalence in the community.
Other factors that may contribute are socioeconomic and insurance factors that are both related to the proportion of HIV-infected individuals who receive appropriate treatment for their condition, which can affect the reproductive rate of HIV, especially in closed communities. Currently, public health efforts to reduce HIV focus mainly on individual-level risk behavior reduction.
The dynamics of HIV in the black MSM community are clearly more complex and will require a community-based approach that takes into account social networks as well as improved access to treatment of STIs and HIV. The CDC and the Center on AIDS and Community Health (COACH) at the Academy for Educational Development (AED) have developed a series of evidence-based HIV prevention strategies, called the Diffusion of Effective Behavioral Interventions (DEBIs) to be introduced both an individual and community level. Several of these focus on the MSM community, including MSM of color, such as “Mpowerment,” “Many Men, Many Voices,” and “d-up: Defend Yourself!”
These interventions have been shown to be effective in reducing risk behaviors among MSM.[61, 62]
Lesbian, Gay, Bisexual, and Transgender Health
There are several STIs besides HIV that gay men may be at increased risk for, depending on individual sexual behavior. Anal sex has been a part of human culture for as long as sex in general, but the public health attention to the specific health risks and consequences engendered by this common practice have been scant. It has been well-described that some STIs, such as gonorrhea, chlamydia, lymphogranuloma venereum, and syphilis, may occur as asymptomatic or with atypical infections, thus making it more difficult for clinicians to recognize, treat, and control spread of these infections.[63, 64] The prevalence rates of syphilis, gonorrhea, chlamydia, hepatitis B, and hepatitis A are all higher in MSM.[65, 66, 67, 68, 69, 70] Oral-anal sexual contact among MSM has been linked to outbreaks of giardia and other intestinal parasites.[71, 72]
Focused vaccination campaigns in gay male communities have been effective at reducing the prevalence of hepatitis B. In the past few years, there have been well-documented outbreaks of sexual transmission of hepatitis C among MSM, especially MSM infected with HIV.[74, 75] Prior to this era, hepatitis C was thought to be transmitted primarily through exposure to blood (sharing needles, transfusions, and so on). In these clusters of sexual transmission, risk of hepatitis C acquisition was increased by rough sex, sex with multiple partners, specific practices like fisting, and coinfection with other STIs.
Gay Men’s Health
A. Anal Cancer - gay men are at increased risk; unrelated to HIV/AIDS, related to HPV
B. HIV Related Cancers
1. Kaposi’s Sarcoma (KS) - caused by HHV-8, antiretroviral therapies effective
2. Non-Hodgkin’s Lymphoma - increased incidence and association with HIV+
3. HIV+ men are at greater risk because:
a. Immunocompromised patients have higher incidence of cancer.
b. Decreased CD-4 count associated with increased progression to cancer.
C. HIV - while no longer the primary population effected by HIV, HIV/AIDS continues to have a profound effect both physically and psychologically on this community
1. LGBT Youth represent a subgroup of all MSM who are particularly likely to engage in high-risk behavior, and so are particularly at risk for HIV.
2. CDC (1999) identified youth (ages 13-24) as the single most likely group to contract an STD, with 30% of new HIV infections reported as MSM.
3. Significantly higher percentage of African American and Latino youth being infected with HIV than white youth.
4. Risks of female-female HIV transmission remains underresearched, although most HIV+ women report having both male and female sexual partners
D. Eating Disorders
1. Eating disorders are not uncommon in gay male culture where, in many parts of the community, there is high pressure to conform to physical and aesthetic ideals.
2. Study of 135 men treated for eating disorders at Massachusetts General Hospital found 42% of bulimic patients identified as homosexual or bisexual.
Rates of substance use and abuse, including alcohol, tobacco, and recreational drugs, are high in gay men. Although tobacco and alcohol are the two most widely used substances, increased attention has been given to crystal methamphetamine over the past few years because of its potential role in facilitating the spread of HIV, syphilis, hepatitis C, and other STIs. Crystal methamphetamine, colloquially known as “crystal,” “meth,” “Tina,” “speed,” or “ice,” is a powerful stimulant with strong addictive potential that can be smoked, snorted (intranasal), injected, or administered transrectally (as a suppository known as a “booty bump”).