In order to decrease new cases of HIV and AIDS, we need to successfully engage young gay and bi men in primary care and address the fundamental social conditions contributing to their increased risk for HIV. Between 2006 and 2009, there was an estimated 54.5% increase in new infections among gay and bi men in Philadelphia. This increase was driven by new infections among African American men who have sex with men between the ages of 13-24. A paper by Stall et. al in 2009 estimated that if current trends continued half of the young black gay and bi men will have HIV by the age of 35. They also estimated that half of all men who have sex with men (MSM) would be HIV-positive by the age of 50. These numbers are dire. We must do a better job at meeting the medical and social needs of young gay and bi men.
The following recommendations range from large systemic changes to improving interpersonal exchanges within health care settings. These recommendations are informed by both the analysis of the focus group discussions and the current literature (see report for a full list of the cited research).
Increasing access to and engagement with primary care for YMSM is essential. Engagement in primary care is an especially important tool in the HIV prevention “toolbox” in this age of biomedical interventions like pre-exposure prophylaxis and “treatment as prevention”. HIV-negative YMSM should be linked to appropriate interventions and have regular sexual health screenings. YMSM who are regularly tested and engaged in health care will have a better chance of being linked to HIV care and treatment, should they acquire HIV. Programs that engage YMSM in health care should address their complex needs, including mental health, substance use, chronic health conditions, and social needs, in developmentally appropriate ways.
A combination of routine testing in all primary care settings and targeted community-based testing is necessary. Risk-based testing alone may miss high-risk individuals who are reluctant to disclose same-sex attraction and/or their sexual behaviors or substance use.
Comprehensive evidence-based sexual health education, inclusive of all gender identities and sexual orientations, is needed in the Philadelphia school district. Young people need sexual health education that promotes not only their health but their well-being.
HIV testing protocols should address concerns about confidentiality. HIV testing programs ought to consider who provides the counselling and testing, where testing occurs, and how to address concerns about confidentiality and privacy. It may be beneficial to include information about privacy protections and confidential testing protocols in outreach and marketing materials, in order to address those concerns before they can become barriers to testing.
Special attention should be paid to creating welcoming and accepting organizational cultures. Health care organizations need to prioritize the barriers, challenges and concerns of YMSM. YMSM want to go to providers who can relate to their experiences and accept them as they are.
Relevant information about local services, sexual health, and HIV/STD testing should be online in the places YMSM are likely to find it. Reliable online content will help many YMSM, especially those who are reluctant or unable to access services in the “gay” community. More local research is needed to better understand how Philadelphia’s youth access online health information.
Community level efforts are needed to address HIV stigma and discrimination of LGBTQ individuals, which persist and act as a barrier to open communication about the sexual health needs of YMSM.
Public health programs and health care organizations must be sensitive to the effects of stigma and discrimination on YMSM; especially minority YMSM who face not only stigma because of their sexuality and/or gender expression, but also live in a society with pervasive structural racism.
Please share your ideas, insights and opinions about the recommendations and how we can better meet the needs of young gay and bi men in Philadelphia.