Gay/Bi/Trans Men’s Health – What Next?

[LifeLube has been asking folks around the country to weigh in on what a 2009 Gay Men's Health Agenda would look like. Click here to read some of the ideas that have been circulated. Stewart's piece below is the latest entry into the conversation. Please feel free to comment here on his post - share your own ideas, or spout off on whether you agree or disagree with him - or, you could send in a full post of your own here. We will be happy to publish it!]

Stewart Landers asks,
"Gay/Bi/Trans Men’s Health -
What Next?"

The development of a clear, communal voice for the gay men’s health movement continues to be our single greatest challenge.

Now that we are two years into the post-Eric Rofes period of the gay men’s health movement, it is a good time think about what we know, what we need to know and how we can continue the only grassroots movement dedicated to thinking about, working for and advancing our collective health.

The development of a clear, communal voice for the gay men’s health movement continues to be our single greatest challenge. There is no voice in this country speaking on behalf of gay men’s health. However, this is not the same thing as a lack of leadership. In fact, due to Eric’s work and the work of many movement activists, there many leaders in gay men’s health around the country including researchers, activists, executive directors, public health practitioners, trainers, and writers working in this area. Yet, there isn’t a consistent voice or source for information when the media seek a response to the latest “gay men are spreading such-and-such now” report. I propose that the gay men’s health summit leadership bite the bullet and form the National Gay Men’s Health Collaborative, find some grant money, have a high-end designer create some snazzy letterhead and establish a formal national presence.

Eric resisted this, arguing that creating a formal institution would, inevitably, replace grassroots, de-centralized thinking, organizing and decision-making with centralized, top-down thinking focused more on the needs of an organization rather than the health of gay men. Also, organizations inherently tend to be more conservative and he may have been concerned that sex-positive messages and thinking that was inclusive of the S&M, Nudist, Bear, Kink and communities would be stifled.

In the absence of a clear voice, we often have no voice or the voices of contrarians or conservatives, who the media love to haul out to show not all gays (or black or latinos) are liberals (1)

What is the agenda for such a group or for the movement generally besides just having such a voice?

Well, it would be shortcutting a true grassroots process to suggest any agenda as the agenda, but in the spirit of making each of our voices heard, here are some ideas:

- We need more documentation and understanding of how naturally-occurring activities provide resiliency and support to the gay/bi/trans male communities. This includes everything from Gay Men’s Choruses to Men’s Naked Yoga to Bear Circuit Parties.

- There should be a coordinated effort to study resiliency factors for gay/bi/trans men across the lifespan. In other words, what supports at the individual, family, community and society level help gay/bi/trans men lead healthy lives from birth through old age? What are our “families of choice” and how are they evolving? These may include “traditional” networks of friends or the more recent movement to parent through adoption, alternative insemination, and use of surrogates.

- More research, policies and programs that address the needs of bisexual men, as well as “men who have sex with men” (MSM) and “men who have sex with men and women” (MSMW) who don’t identify as gay or bisexual. As more population- based data become available, we are learning that of men who have sex with men somewhat less than half identify as gay. Thus, it is likely that a majority of men who have sex with men have a sexual orientation identity other than gay or no “sexual orientation identity” at all. What are the health issues of these men? How do their family supports and structures differ from gay men?

- And let’s talk about microbicides, microbicides, microbicides, non-occupational PEP (post-exposure prophylaxis) and PrEP (pre-exposure prophylaxis), and microbicides. Did I mention microbicides? We need a range of non-behavioral prevention strategies to stop the spread of HIV/AIDS. Traditional prevention remains important, especially for younger men who are likely to and able to make a lifelong commitment to safe sex (probably at least half of us, if not more.) However, for the sluts (2), we need something that will stop infection even when engaging in unprotected intercourse. It’s that simple.

- We need a broad, inclusive and non-homophobic system of substance abuse treatment across the United States. Every community and population group in the U.S. needs this. However, data continue to indicate higher rates of substance abuse among gay and bisexual men compared to their straight counterparts. Of course, we need to work “upstream” to address the homophobia that pervades society to reduce the conditions that lead to substance use. However, we also need treatment systems that are adequate to the task of supporting gay/bi/trans men through the recovery process. These treatment systems may help reduce transmission of HIV as well. However, we can’t depend on HIV resources to fully address the “syndemics” of HIV and substance abuse (along with depression and anxiety.) Each of these need to be addressed separately and in coordination if we are to provide effective, holistic help to people in need.

- While we’re at it, let’s build the international movement for gay/bi/trans men’s health. Working internationally is complicated, exhausting and potentially dangerous. However, it is urgent to bring our best thinking and whatever resources that are available to bear on supporting and learning from our gay/bi/trans men live across the globe.

I’ve not specifically mentioned the area of research on health disparities, a part of my own work the past several years. Having accurate, population-based, up-to-date information about disparities between gay/bisexual/trans their straight counterparts, is needed to properly develop and deliver public health interventions in areas as diverse as obesity, health aging, cancer prevention, oral health, etc. Further, the same is true for differences based on racial and ethnic disparities among gay, bisexual and trans men.

While work in these areas has begun, we can’t be complacent in assuming they will continue or that there are adequate resources to do the job right.

However, I’ve chosen to emphasize a few areas of critical need that are primarily assets-based approaches to help us prevent disease and build health, rather than measuring and treating illness. I suspect these ideas could keep us busy for a few decades at least. I look forward to hearing the ideas of others and working on them collaboratively with all of you.

Stay healthy!

Stewart

Stewart Landers is a public health researcher and administrator as well as a committed advocate for LGBT health. You can read more of his blogs at the Landers Health Report

(1) Eric always encouraged activists to read, absorb and debate ideas when formulating actions. In that spirit, I recommend Derrick Bell’s “Faces At The Bottom Of The Well” for a series of essays on how a progressive black message and agenda is marginalized by mainstream society.
(2) Just kidding! As a long-term HIV positive man who became infected when there was some uncertainty about transmission (though condoms were already being encouraged, informally), I appreciate that not all poz guys are sluts. Just the ones that I know. Just kidding!