1. Advancing a Sexual Health Framework For Gay, Bisexual and Other MSM In the United States Richard J. Wolitski, PhD Deputy Director Behavioral and Social Science National HIV Prevention Conference August 16, 2011National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of HIV/AIDS Prevention
2. Wolitski & Fenton. (2011). AIDS and Behavior, 15, S9-S17.
3. It’s NOT Getting BetterWhen It Comes to the Sexual Health Of MSM in the United States
4. Su et al., (2011). Annals of Internal Medicine, 155, 145-151
5. Su et al., (2011). Annals of Internal Medicine, 155, 145-151
6. More than 30,000 MSM newly infected in 2009Includes both MSM and MSM-IDU.
7. Estimated Number of New HIV Infections, 2009
8. Estimated New HIV infections, 2009, by Transmission category
9. HIV Incidence Among MSM 13-29 by Race/Ethnicit y and Year, United States, 2006-2009 8000 7000 6000 5000HIV Incidence 4000 Black/African American All Other 3000 2000 1000 0 2006 2007 2008 2009 Year
10. • Clearly we’ve got to do better
11. Health Disparities affecting MSM • There is growing recognition that MSM are at risk for multiple health disparities. • These disparities are the result of combinations of individual, cultural, behavioral, and biomedical factors as well as discrimination, and stigma. • Childhood sexual abuse, substance use, mental health disorders, STDs, and partner violence exist at higher levels among MSM, and have been shown to be associated with increased HIV risk. • The combined effects of these problems may be greater than their individual effects.
12. A Sexual Health Approach • Contextualizes the issue – Broader health framework – Recognizes prejudice and discrimination • Addresses sexualit y as an inextricable part of health – Recognizes physical, emotional and social aspects of human sexuality – Holistic rather than reductionist
13. A Sexual Health Approach • Emphasizes wellness rather than disease • Focuses on positive and respectful relationships – Not coercive – Fully consensual – Importance of relationships • Takes a syndemics approach to prevention
14. Role of Sexual Dysfunction• MSM experience higher rates of some t ypes of sexual dysfunction – Twice as many MSM medical students experienced erectile dysfunction (ED) than did non-MSM students (24% vs 12%)• Use of drugs to treat ED is associated with sexual risk behavior• Sexual compulsivit y associated with increased sexual risk behavior• Sexual dysfunction associated with poorer adherence to HIV treatment and transmission risk among MSM living with HIV
15. Role of Health Care Providers• Need to train and support health care providers to work with MSM, provide culturally appropriate services, and create welcoming practices – Some providers report discomfort, negative attitudes, and low self- efficacy with regard to treating sexual minority patients – Too many fail to address sexual health issues, even with HIV+ MSM – As a result, some MSM delay seeking HIV/STI services • Uncomfortable with their own homosexuality • Reluctant to disclose sexual orientation • Have received judgmental or suboptimal services
16. “ Homophobia isa public health problem” ---Rafael Mazin
17. Role of Structural and Policy Change Efforts • Need to prevent negative effects on homophobia and discrimination on sexual health of MSM – Shown to negatively affect access to health care, mental health social support, physical health and safety
18. Role of Structural and Policy Change Efforts• Need to eliminate stigma and discrimination – Working with general public and schools – Provide comprehensive sex education that is appropriate for gay, straight, and questioning students – Need laws and policies that promote basic human rights • Protect from hate crimes • Equal access to health insurance • Legally recognizing long-term relationships
19. NCHHSTP MSM HIV/STIPrevention and Health Framework • Expanding engagement with key partners • Improving collection, analysis and timely reporting of data • Expanding evidence- based interventions • Rigorously evaluating effectiveness of interventions
20. Final Thoughts• Scale and effectiveness of public health response to sexual health among MSM has been lacking – Spending not proportionate to burden – Programs have felt hampered by “no promo homo” restrictions – Single-disease oriented approach has failed to recognize: • Connections between multiple sexual health and other health issues • Address underlying causes of poor sexual health • Value sexual health and relationships of gay, bisexual and other MSM• A sexual health approach needs to respect and value the sexual relationships and rights of all people, including those who are living with HIV
21. Thank You!For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: email@example.com Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position ofthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention