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HIV and Gay Men's Health

 

For 20 years now, public health campaigns directed at gay men have dealt with HIV/AIDS. These last years have been marked by the introduction of effective therapies (HAART) that have transformed HIV infection in Europe, Australia, Canada and the USA. Infection has changed from a pessimistic prognosis to an essentially chronic disease. This has considerably the attitudes towards HIV infection. In the same period high-risk practises have increased and we can observe the return of STD's. Gay culture has evolved considerably with a resurgence of sexual activity, the development of websites for contacting other gay men and the appearance of barebacking. In the face of these phenomena and the non-use of condoms, associations and government institutions are trying different responses, like gay health.

Several studies on health issues and the factors that affect the vulnerability of gay men to HIV infection (addictions and mental, economic and social health) have been published in Australia, Canada, the UK and the USA. This research has revealed several factors specific to the gay community. That is why in 1999 the American Public Health Association (APHA) sponsored a resolution calling for more research into the relationship between disease and sexual orientation. In June 2001, the he American Journal of Public Health published a special issue on gay and lesbian health.

At the same time, several gay community leaders and activists in HIV prevention have launched appeals reaffirming the importance of gay men's health and well-being as an innovative approach in fighting HIV infection. Many of these leaders believe that we are now in the post-AIDS era in the sense that, because of the considerable decline in the contamination rate since the eighties and the arrival of HAART, we are no longer in a state of in crisis. This research and reflection leads to the conclusion that in order to continue the fight against HIV infection, we must refocus our efforts on a global response to the concerns of gay men. This means tackling HIV within the broader context of physical, mental and sexual health.

These ideas have brought profound changes in anti-HIV intervention programmes in the gay community in several countries. In Canada the National Reference Group has proposed a new strategic action plan for HIV prevention among gay men. The program recommends the revitalization of HIV prevention by repositioning it within the context of gay health (2001). Since then, several organisations fighting AIDS have developed resource centres for gay men. In Canada, the main association, Sero-Zero, is in the process of transforming itself into a health centre, especially for gay men. The Gay Men's Health Crisis (New York) and the AIDS Project (Los Angeles) have announced the creation of The Institute for Gay Men's Health (1). This phenomenon affects not only associations fighting AIDS but also the gay and lesbian associative world; for instance, in Scotland where the LGBT Health Scotland (2) has been created, and in non-English speaking countries like Switzerland with the association Dialogai (3) or Spain with Asociacio Stop-sida de la Coordinadora Gai-lesbiana.

In France, the situation has evolved rapidly. We observe the same phenomena regarding the evolution of the HIV epidemic: a decrease in condom use, an increase in risk-taking, STD's, a growing fatigue in the associative network and the fragility of the discourse of prevention. For 20 years now HIV infection has sustained itself within the gay community, unlike the situation among drug users. This amounts to a partial failure of prevention policies.

For several months now, Warning has been studying the approach to gay health developed abroad. We have led several interviews on this topic and we have introduced one of the leaders in the field, Eric Rofes, at a public meeting in the Parisian bookshop Les Mots Ó la Bouche. Because of the positive and enthusiastic public response, Warning is organising an international conference on HIV and gay health on 28 and 29 November 2005. You are invited !

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Physical, psychological, spiritual and social health (Dialogai, Switzerland)

“The first studies undertaken within the framework of the gay health project among gay men in Geneva demonstrate that they have a holistic view of health. They spontaneously say that their mental state (psychological health) and their state of mind (spiritual health) influence their physical state (physical health) and vice versa.

 

The fact is that people who feel good about themselves, who are happy with their appearance, often feel better mentally. Feeling good about ourselves depends on our physical, psychological and spiritual state, on the way we see ourselves (whatever our state of health might be) and the way others see us.

 

To accept being gay and to respect ourselves are at the centre of the preoccupations of gay men.

 

Being different, belonging to a minority, being gay, fearing discrimination, facing real discrimination, having a different life-style and different sexual practices, frequenting specific places, all have an influence on our health and the quality of our life (social health). Even if the image of gay men has evolved positively within our society in recent years, in reality we still do not live in a world that welcomes us and treats us in the same way as heterosexuals. Not being able to say who we are and whom we love and living in fear of being discriminated against has a negative affect on our health”.

Why use the term “ gay health”?

This term describes a holistic vision of health. It is based on the definition given by the World Health Organization in 1946 : Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In 1972, WHO officially recognized the concept of sexual health.

 

“Dealing with HIV prevention in such a way as to isolate it from other aspects relative to the health of gay men and from various determinants influencing gay men's health has proved less effective” (National Reference Group, Canada). That is why the new approach is a global one. “Gay health” denotes diverse aspects of health: emotional, mental, physical and spiritual health as well as the relation between these different aspects of health and the consequences in terms of infections, in particular as related to HIV. We have to consider the relation between the health and well-being of gay men and factors that are interpersonal, cultural or social, and structural in nature.

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