20 HIV

It is projected that more than half of all sexually active people in the US will contract an STD (sexually transmitted disease) by age 25, making STDs a major point of concern when it comes to population health (U.S. Department of Health & Human Services, April 2022). STDs are spread through sexual contact – including genital skin-to-skin contact as well as vaginal, oral, and anal sex (U.S. Department of Health & Human Services, April 2022).  Common STDs include syphilis, chlamydia, gonorrhea, HPV, and Hepatitis.

One of the most common STDs is HIV (human immunodeficiency virus). Although HIV can be spread through vaginal or anal intercourse, it can also be spread via contaminated needles or contact with other bodily fluids. Approximately 1 in 7 men with HIV are completely unaware they are infected (U.S. Department of Health & Human Services, June 2022). Symptoms that men might experience are burning or itching of the penis, discharge, pain around the pelvis, sores or blisters on the penis, anus or mouth, or pain and burning with urine or bowel movements (Urology Care Foundation, 2022). Some sexually transmitted diseases can be cured with medication, but others, such as HIV, cannot. In turn, medication is prescribed to manage symptoms and prevent the spread. Anyone who engages in unprotected sex is at risk of contracting an STD, but certain behaviors increase men’s chance of being diagnosed. Improper condom use and participation in anal intercourse drastically increase one’s susceptibility. Additionally, gay, bisexual, and men who have sex with men (MSM) are at a greater risk of contracting HIV than heterosexual men (U.S. Department of Health & Human Services, April 2022).

In addition to correct and consistent condom use, another important preventative measure against HIV is getting tested regularly. Limiting sexual partners also decreases one’s chances because it limits potential exposure to the disease. Finally, knowing your partner will allow you to build a healthy sexual relationship with them while also making sure you stay safe and STD free together.

Men’s Health Gap

Currently, 81% of all new HIV cases in the United States are male patients. Moreover, men who identify as gay, bisexual, or otherwise MSM account for 86% of these male diagnoses (U.S. Department of Health & Human Services, June 2022).  Understanding men’s sexual behavior due to their physical, social, and economic power in sexual relationships is critical for decreasing the prevalence of HIV (Barker, G., & Das, A., 2004).

In the United States, men are expected to uphold a high level of masculinity in order to maintain their socially constructed gender role in society. In efforts to fulfill this cultural norm, men make poorer dietary choices, visit the doctor less, and engage in riskier behaviors. Combatting these toxic performances of masculinities, engaging men in their own health and advocating for gender equality when it comes to health can help to bridge the disparities that currently exist in men’s health. This will allow for a closing of the men’s health gap, allowing for equality in healthcare.

A Society of Stigmas

Since HIV was introduced in the 1980s, society has labeled and stigmatized it as a “gay disease”. This inaccurate assumption neglects to consider heterosexual men as a group largely impacted. As a consequence of this, heterosexual men may not feel at risk for disease, neglecting regular testing, and ultimately causing them to present with a more advanced diagnosis. Participants from a previously mentioned study revealed concerns regarding their sexual health (including STDs) stem from cultural concerns and stigmas regarding masculinity and expected male sexual behavior (Azmi, 2022). Decreasing this stigma would relieve some of the pressure men feel to uphold the masculinity norms present today. In turn, this would increase their likelihood to explore preventative STD measures, confide in their provider, and increase knowledge regarding sexual health as a whole.

Education

A key component when it comes to sexual health among men is education about HIV risks, symptoms, and treatment. Education on sexual health practices and diseases would not only increase the likelihood that men visit their physician for proper treatment but would also decrease the prevalence of STIs/unsafe sex as a whole. A study conducted by Azmi and colleagues in 2014 analyzes men’s sexual and reproductive health concerns and health seeking practices. According to the study, 34.1% of participants did not have any formal education, while 19.6% did not complete primary level schooling. This lack of education contributes to the misconceptions and overall lack of understanding of the participants on sexual health and sexually transmitted diseases.

Additionally, other studies have shown that men with higher education and SES are more likely to protect themselves against STDs have more knowledge on the topic, and seek treatment more frequently than those less educated. This finding is critical for improving sexual health among men. Another study conducted by Huang and colleagues in 2014 revealed that less stigmatized men with a full-time were more likely to have obtained free condoms, highlighting the impact of education on HIV risk reduction. The study focused on men who have sex with men, and also highlighted that stigma plays a role on the sexual care men seek (Huang, 2014).

 It is important to note the structural factors that contribute to HIV risk, specifically among Black men. Poverty, unemployment, and incarceration in combination with the institutionalized racial discrimination Black men face in the US all contribute to the HIV knowledge and care (or lack of) they receive (Raj,2012).  With the HIV/AIDS rates being higher for these populations, it is important to construct interventions that are targeted to these populations.

Sexual Orientation

Sexual orientation is another component intertwined with a man’s risk for contracting HIV. In order to understand this relationship, it is important to understand key terms regarding the components of sexual health. Sexual orientation concealment relates to denying or not discussing one’s true sexual identity. Most of the time this comes from a fear of judgment, which presents an internal obstacle for the individual, especially when discussing men’s health. This fear of judgement can prevent men from obtaining education on and getting treatment for sexual health concerns. Internalized homophobia can result from sexual orientation concealment. It occurs when an individual who identifies as a sexual minority accepts negative attitudes regarding their own sexual identity. Gender expression refers to the way an individual expresses their gender identity, whether it be in the way they dress, act, or behave. According to a study by Ramos and colleagues in 2021, of the 13 million people in the US that identify as lesbian, bisexual, transgender, gay or queer, approximately 4% identify as sexual minority men (SMM).

An Intersectional Approach

Some researchers consider intersectionality theory to describe the social categories that are intertwined to contribute to sexual health topics among sexual minority men of color. Specifically, a study conducted by Ramos and colleagues in 2021 addressed sexual orientation concealment, internalized homophobia, and gender expression on sexual identity and HIV risk.

The association between internalized homophobia and HIV knowledge vary according to the participant’s gender expression, as did the association between sexual orientation concealment and transactional sex. Internalized homophobia may influence sexual risk behaviors (such as transactional sex) (Ramos, 2021). This stems from the cultural masculinity norm that men face and the stigma that men in the LGBTQ community receive. As consequence of this, sexual concealment reduces a man’s likelihood in confiding in a medical health professional about their sexual health status, which can negatively impact their health. Almost 50% of SMM have never discussed their sexual orientation to their provider, emphasizing the importance in improving the patient provider relationship (Ramos, 2021). Through this research, Ramos and colleagues expose the implications that homophobia, societal norms, and discrimination play on the health of gay and bisexual men and the importance of abolishing stigmatization when discussing men’s sexual health as a whole.

Another key component addressed in the study is the importance of a strong patient provider bond, including trust. If a male patient does not trust their provider, they are less likely to come to this provider regarding knowledge and education on sexual health practices. Furthermore, if they possess qualities of sexual concealment and internalized homophobia and do not trust their provider, their likelihood of obtaining knowledge and confiding in their provider is even less likely. This is supported by the fact that as sexual concealment increases, health literacy decreases (Ramos, 2021). According to the previously mentioned Ramos study, the lack of culturally and medically competent providers on LGBTQ+ issues exacerbate the mistrust and misinformation provided to men about health risks regarding HIV. It also perpetuates discrimination and racism among mineralized groups, contributing to experiences of internalized homophobia (Ramos, 2021).

Looking Forward

Belonging to multiple intersecting identities, SMM of color endure ongoing marginalization. Understanding what contributes to this marginalization will allow us to bring about equality and acceptance for individuals of all identities, ultimately improving men’s health in all aspects. There is a plethora of research within this field, but in order to completely grasp the disparities that men face, more case studies of SMM of color would be highly beneficial. This would allow firsthand experiences to be unpacked, increasing awareness of the stigmas that plague society. For example, if a man sought care for a potential sexual health concern but had a bad experience with his physician, this could drive him away from seeking care again in the future. Understanding what drove him away and educating healthcare workers on how to foster the patient-provider bond would help to mediate this issue. Additionally, programs should be introduced in early education in order to inform adolescents of all things regarding HIV, stigmas boys and men face in society today, and how to deal with such issues.

Simple actions such as the distribution of condoms, testing and treatment for STIs, and HIV testing have proven to decrease HIV transmission, and can be implemented to benefit the male populations and their partners. In particular, for large metropolitan cities, providing these services would be more effective to reach the community on a larger scale. In order for this to be possible, HIV funding must increase on the national level. Individuals must also rally and educate stakeholders in order to obtain funding, especially in areas with a lower average SES.

Gaps remain present in regard to research on successful intervention methods (specifically community based) that would promote HIV prevention and education. These intervention methods would function best in locations that at-risk populations visits frequently. It would be effective to implement programs that account for the structural factors that heighten HIV risk within individuals. This could be a linkage between HIV testing and counseling programs with public housing programs and job placement programs (Raj, 2012) which would provide resources for those who might not otherwise have access to them.

Policy efforts remain one of the toughest battles when it comes to social issues that contribute to health. Some national policy efforts such as the CDC’s Heightened National Response to the HIV/AIDS Crisis Among African Americans and the President’s National HIV/AIDS Strategy recognize the need for intervention in groups such as MSM, women and youth (Raj, 2012). Although intervention is necessary across the population, these policies neglect heterosexual men. This subsequently contributes to the gaps within men’s health and further engrains the stigmatization that exists within American society.

References

Azmi, R., Mahmud, I., Islam, K. F., Hasan, M. T., & Rashid, S. F. (2022). Married men’s
sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study. Journal of Health, Population and Nutrition, 41(1), NA. https://link.gale.com/apps/doc/A715620295/AONE?u=clemsonu_main&sid=bookmark-AONE&xid=695535a8

Barker, G., & Das, A. (2004). Men and sexual and reproductive health: the social revolution. International Journal of Men’s Health, 3(3), 147+. https://link.gale.com/apps/doc/A131937366/AONE?u=clemsonu_main&sid=bookmark-AONE&xid=9eff5964

Huang, D., Hu, Y., Wu, G., Jia, Y., Lu, R., Xiao, Y., Raymond, H. F., McFarland, W., Ruan, Y., Ma, W., & Sun, J. (2014). HIV prevention services and testing utilization behaviors among men who have sex with men at elevated risk for HIV in Chongqing, China. BioMed Research International, 2014, 174870. https://doi-org.libproxy.clemson.edu/10.1155/2014/174870

Raj A, Bowleg L. Heterosexual Risk for HIV Among Black Men in the United States: A Call to Action Against a Neglected Crisis in Black Communities. American Journal of Men’s Health. 2012;6(3):178-181. doi:10.1177/1557988311416496

Raj A, Bowleg L. Shared Communities, Structural Contexts, and HIV Risk: Prioritizing the HIV Risk and Prevention Needs of Black Heterosexual Men. American Journal of Public Health 2012;102, S173_S177, https://doi.org/10.2105/AJPH.2011.300342

Ramos, S. R., Lardier, D. T., Jr, Opara, I., Turpin, R. E., Boyd, D. T., Gutierrez, J. I., Jr, Williams, C. N., Nelson, L. E., & Kershaw, T. (2021). Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis. The Journal of the Association of Nurses in AIDS Care: JANAC, 32(4), 495–511. https://doi.org/10.1097/JNC.0000000000000274

Rasberry, C. N., Morris, E., Lesesne, C. A., Kroupa, E., Topete, P., Carver, L. H., & Robin, L. (2015). Communicating with School Nurses About Sexual Orientation and Sexual Health. Journal of School Nursing, 31(5), 334–344. https://doi-org.libproxy.clemson.edu/10.1177/1059840514557160

Stangl, A. L., Pliakas, T., Izazola-Licea, J. A., Ayala, G., Beattie, T. S., Ferguson, L., Orza, L., Mathur, S., Pulerwitz, J., Iovita, A., & Bendaud, V. (2022, February). Removing the societal and legal impediments to the HIV response: An evidence-based framework for 2025 and Beyond. PLOS ONE. Retrieved November 3, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0264249

U.S. Department of Health & Human Services. (2022, April 12). Gay men and STDS. Centers for Disease Control and Prevention. https://www.cdc.gov/std/life-stages-populations/stdfact-msm.htm

U.S. Department of Health & Human Services. (2022, June 28). Men – the numbers HIV diagnosis. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/gender/men/index.html

Urology Care Foundation. (2022). What are sexually transmitted infections (STIs) or diseases (STDs)? Sexually Transmitted Infections. https://www.urologyhealth.org/urology-a-z/s/sexually-transmitted-infections