Addressing the Needs of Gay Men, and MSM, in the South

In smaller cities, towns, and rural communities, even gay-identified men continue to live in and with communities and families of birth, a pattern which encourages secrecy, invisibility, and social isolation.

The Southern AIDS Coalition contributes the following statement to the 2009 Gay Men's Health Agenda dialogue.


In our publication of June 21, 2008, entitled the Southern AIDS Manifesto: Update 2008, we explore several challenges and disparities that relate to gay men (and the broader category referred to as "MSM") in the South.

Consistent with national data, gay men and MSM continue to have the highest proportion of HIV transmission in the South, yet "efforts to prevent transmission in MSM receive less attention. Therefore, those most at risk of HIV infection receive less funding and focus, resulting in poor health.

The Manifesto Update goes on to discuss particular barriers that effect gay men receiving healthcare, prevention training and support. Many of these barriers are due to a large number of men in the South living outside of metropolitan centers that historically support openly gay communities (since there are fewer such metros in the South.)

"In smaller cities, towns, and rural communities, even gay-identified men continue to live in and with communities and families of birth, a pattern which encourages secrecy, invisibility, and social isolation," states the Manifesto. This is compounded by a lack of gay-specific social infrastructure, socially supported relationship stability, legally supported stability (including legal coupling, legal family-building), religious inclusion and in a large number of cases, the additional complexities of living in the South as a person of color and/or a person living in poverty. These same dynamics -- centered around stigma -- often arise in (our relatively few) largely populated Southern cities, as well.

In creating an effective national strategy which strives for optimum health in gay men, there is an immediate need for more accurate data. How many gay men are living in the South, how many gay men in the United States, and what is the true HIV infection rate in gay men, for instance, a statistic as simple as how many ('x' out of 10, or 'x' per 100,000) gay men are living with HIV? When the CDC now estimates 53% of all new HIV infections are in the category of "MSM," is this number to be not questioned, even in light of recent data inaccuracies? Or is this 53% way too low?

Many states report extraordinarily high behavioral data called NIR ('No Identified Risk'), which often buries the true numbers of gay men living with HIV, lowering the percentage significantly, and results in a drastic under-funding of prevention programs and other gross inequities.

Why does this happen? Gay men are often sent the message that "MSM" has replaced "gay" and they are not allowed to identify as "gay," at least in a social services setting. Disease intervention specialists (the data collectors) often impose their way into an interview, intent on assuming an intimidating or condescending posture, which alienates the interviewee and sabotages the very data they came to collect, particularly among gay men and among people of color.

One SAC member from Louisiana states, "Many times the person administering the test is uncomfortable, indifferent and judgmental about risk factors which also contribute to the NIR category. This is especially true of state employees who work in STD clinics and hospitals. This is where the majority of our NIR numbers are coming from." Other identity and confidentiality issues, compliance barriers and broken trust contribute to the NIR category, which again, significantly drives down the true numbers of HIV infection in gay men.

It could be said that when the U.S. finally does reach an accurate census of gay men, and HIV infection rates among gay men, surely we will begin to see an equitable focus on HIV prevention, we will then see more gay-specific HIV interventions (that is to say, interventions which affirm and dignify the gay community and culture, rather than censure it). In addition, we may also begin to see MSM-specific interventions (that is to say, interventions for those men who don't identify as "gay.")

But why wait? We need such interventions now.

And let's add to the mix: drug treatment, mental health, social and emotional support systems, organized rural networks, STD prevention, suicide prevention, safe schooling (for young bullied students who identify differently), religious entitlement, building new families and family health -- these are real issues in our Southern communities, and elsewhere, currently being addressed. When a strategic action plan is put in place for optimum health for all gay men and women, we will no doubt see improvement on all fronts.

[Click here to read previous input into the 2009 Gay Men's Health Agenda. The feedback we have received will be featured in the closing plenary of the National Gay Men's Health Summit - starting tomorrow - and will be a means of moving the community forward in the new year around issues that are important to all of us. The dialogue continues. Please feel free to send in apost of your own here. We will be happy to publish it! ]