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Help us improve your experience by providing feedback on this. Perry N. These approaches, rooted primarily in social-cognitive frameworks Halkitis, bhave resulted in maintaining new infections in the United States at a steady state for the last decade Centers for Disease Control and Prevention [CDC], b. In addition, the population of men who have sex with men MSM has continued to be the only risk category for which new infections are rising Hall et al. More recently, with the game-changing breakthroughs in the biomedical arena, attention has shifted to these biomedical prevention strategies, which include preexposure prophylaxis PrEP for gay, bisexual, and other MSM Grant et al.
Yet even these medical advances are fraught with their own complications, not least of which are matters of uptake and adherence. Of particular relevance to HIV prevention among gay and bisexual men are the social conditions that place us at heightened risk for acquiring HIV as compared to our heterosexual counterparts. In this article, consideration is given to the manner through which discrimination and homophobia, which may have been heightened because of the AIDS epidemic Halkitis,perpetuate HIV vulnerabilities for gay and bisexual men.
Such health vulnerabilities driven by homophobia are often exacerbated for gay and bisexual men of color, who are often further burdened by the social circumstances of racism and poverty. Since discrimination based on sexual identity is critical to the ideas being put forth, and since the HIV prevention needs of gay and bisexual men differ widely from those of non-gay or bisexual MSM Halkitis, bthe focus of this issue of the newsletter is on gay and bisexual men, and not MSM in general.
In the now historic document, which recently reached its 30th anniversary, the CDC reported five cases of Pneumocystis carinii pneumonia in young gay men who otherwise should have been healthy. I first became aware of nicknames for gay guys phenomenon as I sat on the beach reading The New York Times the summer before my freshman year at Columbia University. However, despite the fact that the disease no longer remains confined solely to gay and bisexual men, the reality is that this segment of the population is the one most affected by this epidemic.
This burden becomes abundantly clear when we consider the epidemiological data. Despite the fact that gay and bisexual men constitute approximately 2—4 percent of the U. As a result, our population continues to face stigma rarely encountered by our heterosexual counterparts. Experiences with oppression and homophobia, which tend to pervade family, school and community settings, are especially relevant for gay and bisexual young men, who are in the process of establishing their personal identities.
Unlike other marginalized groups e. In a seminal study, Ryan, Huebner, and Sanchez showed the powerful effects of homophobia perpetrated by family members. These researchers compared lesbian, gay and bisexual LGB young adults who were rejected with those who were supported by their families.
Rejected LGB youth were 8. For young gay and bisexual men, this form of nonacceptance starts in childhood and adolescence within the contexts of families. For example, the lifelong health risks may be even greater if the family victimization takes the form of sexual abuse; Mimiaga et al. An year-old Latino who was HIV-negative expressed how he experienced homophobia from his own sister:.
I came here [NYC], I never had worked. I went to high school one year here just to get the high school diploma and went to Hofstra University. My scholarship was paid for by my family and I was given a car for my graduation and everything was good and nicknames for gay guys soon as I told them I was gay. In their qualitative study of masculinity, Phoenix, Frosh, and Pattman found that boys as young as 11 years of age have found it critically important to present themselves as masculine in order to avoid being bullied and labeled as gay.
This is how a year-old HIV-negative White male participant of Project Desire described his struggles with internalized homophobia:. I grew up in such a heterosexual environment where that was just the norm. I was always the child that was given And it was outside the lines Others nested their experiences of homophobia in relation to organized religion, as demonstrated in the comments of one year-old HIV-negative Black man:. So that definitely was a brain bender. Gay and bisexual men experience homophobia throughout the course of their lives.
Thus, it is critical that we consider the well-being of gay and bisexual men by using a life course perspective Institute of Medicine, Many of the men with whom we have spoken are long-term survivors of the disease, having lived with AIDS for over 20 years.
Yet even those older men vividly describe how the experience of homophobia shaped their lives in the past and how it continues to affect their lives. Johnson et al. A year-old Latino man, who has been living with HIV for 24 years, described it as follows:. I think that being a gay person, even today we are being kicked around. Another, a year-old Black man living with HIV for 21 years, described his experiences in this manner:. Because society will keep telling you that something is wrong with you.
Thus, the synergistic social conditions of homophobia, racism, and poverty likely explain the even higher incidence of new HIV infections among racial ethnic minorities, particularly Black and Latino gay and bisexual men CDC, b. In a study of Latino men, Diaz et al. For many gay and bisexual men of color, economic inequalities add to the pernicious effects of oppression and homophobia. For example, in a seven-city study of HIV prevalence among young gay and bisexual men, Harawa et al. In this sample, however, such indicators of socioeconomic status as unemployment and lack of formal education were highly associated with HIV infection, suggesting socioeconomic inequalities suffered by the racial and ethnic minority men.
Perhaps the effects of economic standing on HIV prevalence among gay and bisexual men can also be understood in relation to contextual factors, particularly the roles played by residential neighborhoods e. Certainly person-level variables interact with sociopolitical variables to shape HIV risk-taking behavior among gay men.
Yet it is a likely hypothesis that those who have access to and navigate environments where there are high levels of gay presence are also likely to be exposed to HIV prevention messaging through publications and advertisements, as well as through interactions with other gay men in nicknames for gay guys venues. In addition, living in impoverished neighborhoods may bestow additional burdens on gay and bisexual men. Frye et al.
These matters are of particular concern in relation to homeless and unstably housed youth Marshall et al. Taken together, the extant literature suggests that the perpetuation of the HIV epidemic in gay and bisexual men is not directed solely by person-level behaviors but is influenced by a range of contextual factors, rooted in cultural, historical, and political structures in this country.
Specifically, we must combat the homophobia and discrimination that gay and bisexual men face from families, communities, and society at large. We must understand that such oppression not only perpetuates the HIV epidemic but also compromises the overall wellness of gay and bisexual men. In the end, our best hope for eradicating the HIV epidemic in gay and bisexual men will arise from the combined strength of biomedical, social, behavioral and legislative interventions.
Finally, for preventive efforts to be meaningful and effective, such approaches must understand the lives of gay and bisexual men, support us in development of strong and healthy identities, and help us in the creation of strong communities in which we will not only be cared for but also able to take care of ourselves and support each other. Author of over peer-reviewed academic manuscripts, Dr. He is the recipient of nicknames for gay guys awards from both professional and community-based organizations and is an elected fellow of the New York Academy of Medicine, the Society of Behavioral Medicine and APA.
Abdool, K. Effectiveness and safety of tenofvir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, Adimora, A. Altman, L. Rare cancer seen in 41 homosexuals. The New York Times, p.
Batchelor, W. AIDS The science and the limits of science. American Psychologist, 43, Brooks, R. A Camic, P. Qualitative research in psychology: Expanding perspectives in methodology and de. Washington, D. Centers for Disease Control and Prevention. Pneumocystis pneumonia—Los Angeles. Morbidity and Mortality Weekly Report, 30 21 Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morbidity and Mortality Weekly Report, 55 14 ,Nicknames for gay guys
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