Achieving Optimal Health Care for Gay Men

By Isaiah Webster III, Senior Manager, Health Equity/Prevention, NASTAD

Cross-posted from HRC.org

National Gay Men's HIV/AIDS Awareness Day

Source: Centers for Disease Control and Prevention (CDC)

National Gay Men’s HIV/AIDS Awareness Day is September 27. It’s an opportunity to reflect on those we have lost, and focus attention on the fact that HIV still impacts the lives of gay men more than any other group in the United States.

Just like any other social disease, HIV/AIDS takes advantage of those who lack access to information, prevention tools and medical advances that are readily available. The epidemic began as a crisis for all gay men, but in the last 15 years, it has shifted to become a disproportionate burden for certain subgroups of gay men–especially Black and Latino gay men, less affluent gay men, and gay men who live in rural communities. Among young gay men of color, the HIV/AIDS epidemic is as severe as it’s ever been.
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To end the HIV/AIDS epidemic requires a united front from gay men of all classes and colors. It commands the belief that HIV/AIDS remains a beast that gay men must collectively fight and defeat.

On October 1, the open enrollment period begins for public health exchanges being instituted as a result of the Affordable Care Act (ACA). For millions of gay men, this will mean access to affordable health insurance, and for many of these men, it will also mean seeing a primary care physician for the very first time. This presents the public health community with a unique opportunity to discuss and ensure optimal care for gay men and other men who have sex with men (MSM).

Now is the time for gay men to determine how the ACA implementation will impact their health care coverage. If uninsured, gay men should visit healthcare.gov to learn about the exchanges and to sign up, or visit their state’s health insurance marketplace.

The National HIV/AIDS Strategy (NHAS) promotes HIV screening as a part of routine health care, and stresses the importance of removing stigma and discrimination as barriers to high-quality health care. In an ideal environment, physicians would utilize annual check-ups to have detailed conversations with their patients about sexual risks, and recommend which screenings they should have based on this assessment.

To achieve optimal care, gay male clients must feel comfortable enough with their doctor to disclose their sexual orientation or, at a minimum, fully acknowledge any sexual behavior that may have adverse effects on their health. Conversely, clinicians have to be open-minded and prepared to discuss a range of health issues. Doctors who are skittish about discussing anal health, uninformed about HIV biomedical advances or judgmental about certain sexual behaviors are insufficient care-givers for gay men/MSM.
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The lack of optimal care is an issue for all gay men, but it’s heightened among Black and Latino gay men, who are at a higher risk for HIV, STDs and viral hepatitis because of a litany of health disparities.

Given the importance of reducing stigma to ending the HIV epidemic, with support from the MAC AIDS Fund, the National Alliance of State and Territorial AIDS Directors (NASTAD) launched an initiative in 2011 to assess the role of stigma in the epidemic among Black and Latino gay men. Founded in 1992, NASTAD represents the nation’s chief state health agency staff who have programmatic responsibility for administering HIV/AIDS and viral hepatitis healthcare, prevention, education, and supportive service programs funded by state and federal governments.) The NASTAD findings showed the pervasiveness of stigma in four levels assessed–HIV/AIDS, gender performance, homophobia and racism–and the effects of stigma on the HIV prevention-to-care continuum.

As a result of NASTAD’s stigma work, the organization released Optimal Care Checklists (OCCs) for gay men and the clinicians that care for them. The OCCs advise gay male patients on how to discuss their health care needs with their physician; conversely, they remind doctors to have in-depth conversations with their gay male patients, suggesting questions to ask and screenings to offer.

For gay male patients, ask your doctor:

  • Am I using condoms correctly?
  • Should I douche every time I bottom?
  • What does it mean if I notice blood in my stool after sex?

For physicians, when providing care to gay men/MSM, consider:

  • The 4 “P”s when taking a sexual health history: partners, practices, past history of STDs, and protection from STDs
  • Suggesting vaccinations as appropriate, especially for Hepatitis A and Human Papillomavirus (HPV)
  • Becoming conversant about biomedical interventions like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP)

State and territorial health departments have the motivation and the guidance via the NHAS to advance better health outcomes for gay men. Doctors have a moral obligation to attend to the needs of their patients. And collectively, gay men have the tools and resources to mobilize their community and demand better holistic health care. The time is now.