Voluntary HIV Counseling and Testing for Gay, Bisexual Men and Men Who Have Sex With Men
Gay men, bisexual men and men who have sex with men (MSM) but don't identify as such continue to be at great risk of HIV infection. In 2003, they accounted for an estimated 57% of AIDS cases among men1
and 45% of all estimated HIV/AIDS cases.2
The public perception about gay men is that they are "white, middle class, college-educated and urban," but this group includes men of all races and ages, socio-economic and geographic backgrounds.
Factors to Consider When Promoting and Providing HIV Prevention and Treatment
A Second Wave
Increasing HIV infection rates and recent studies suggest that a second wave of this epidemic is occurring among this group. The more heavily affected communities are younger MSM and MSM of color. A CDC study in six cities found that among MSM ages 23-29, 32% of African American men3
and 14% of Latino men were HIV-positive, compared to 7% of Caucasian men.4
MSM of color now account for a majority of AIDS cases reported among MSM.2
MSM in the Asian and Pacific Islander community make up the largest proportion of AIDS cases (72%) compared to other communities of color.5
Research shows young MSM continue to practice high risk behavior, highlighting the need to continue appropriate prevention efforts for each generation.
Experts believe that reducing social stigma is essential to effectively stopping the epidemic.6
Negative public views regarding people with HIV/AIDS hinder discussions and disclosure regarding HIV status. For example, a study among gay men found that 83% who were HIV-negative and 74% who didn't know their status preferred partners who were HIV-negative. In addition, many individuals must contend with other social prejudices, such as homophobia and racism, as well as fear of legal and moral retribution related to sexual and drug use behaviors and immigration status. Some individuals don't test or return for their results for fear that a positive result will damage their self-image and their family and social relationships.6
Sexual Behavior and Orientation
For many MSM, a gay or bisexual identity is an important part of self-identification, while for others it is a question of sexual practice rather than identity. In fact, some MSM identify as heterosexual and may not relate to prevention messages directed towards self-identified gay men.7
While this may signal internalized homophobia, it is important to focus on connecting individuals with the desired services and working on maintaining safer sex practices. Some programs incorporate interventions that help men who are questioning their sexual identity develop a positive self-image and build supportive social networks.
Misconceptions About Treatment
Many gay men and MSM today tend to practice unprotected sex because they are overly optimistic about the benefits of new combination therapies. Some hold the mistaken perception that HIV-positive people who have an undetectable viral load can't transmit HIV.6
Suggestions for Effective Services and Campaign Messages
- This is a culturally diverse population, and prevention efforts must be tailored to reach each specific target group as there is no single approach that will effectively reach all groups.
- Some MSM may identify as heterosexual or may not disclose this behavior. Make sure your services and messages are inclusive of various sexual identities.
- Don't assume that interventions that worked with older men will be effective with younger men.
- Address relevant social issues such as HIV-related stigma, disclosure issues, immigration-related issues and homophobia.
- Address the role of substance use and addiction in meeting and having sex with other men.
- Consider implementing prevention and testing campaigns in venues where MSM socialize, such as schools, nightclubs, chat rooms, affinity groups and other popular hangouts.
- As you design and implement services, collaborate with trusted agencies, schools, businesses, religious institutions, etc.
- HIV testing and counseling programs should develop referral protocols with facilities that can provide medical, mental and social services to the populations they serve, so as to create a continuum of care.
- Provide staff training as needed.
- The Henry J. Kaiser Family Foundation, The HIV/AIDS Epidemic in the United States, March 2004.
- CDC, HIV/AIDS Surveillance Report, Vol. 15, December 2004.
- The Henry J. Kaiser Family Foundation, African Americans and HIV/AIDS, February 2005.
- The Henry J. Kaiser Family Foundation, Key Facts: Latinos and HIV/AIDS, February 2005.
- Centers for Disease Control and Prevention. (2004). HIV/AIDS Surveillance Report. Vol. 16, 21.
- CDC, Best Practices in Prevention Services for Persons Living with HIV, December 2004.
- CDC, Fact Sheet: HIV/AIDS among Hispanics, November 2004.