Down Low Gay Men

Gay Men Transmitting HIV

When HIV and AIDS first came to prominence in the 1980's, it was commonly assumed and projected that HIV / AIDS was an issue mostly with gay men. Of course, this has turned out not to be the case as people of all genders, sexualities and so forth are catching and spreading HIV and/or AIDS every day. However, it is most definitely a problem with gay men and that issues persists to this very day. Indeed, that will be focus of this report. Topics that will be discussed will be current statistics, current studies and evidence, current social determinants, the challenges of healthcare delivery as it relates to this issue and the construct diagnoses that will need to be looped into this issue. While the aggregate level of knowledge and education is spreading through all demographics, there are still some lagging indicators and behaviors that are causing issues.

Facts & Studies

While the percentage of gay men in New York or even New York City is fairly average as compared to the rest of the population, it has to be factored in that New York City, along with Los Angeles, is one of the two major metropolitan areas with more than ten million people. As such, the amount of gay people in the New York/New Jersey and Long Island areas is north of half a million. However, how one defines and quantifies "gay" can vary a bit because some people are gay, some are bisexual while others are one of the former two but are behaving as such on the "down low" despite portending and representing something else to their families or reviewers of demographic data. This explains the wide-ranging estimates of how many men are truly gay as the range is anywhere from two percent to ten percent (Stephens-Davidowitz, 2013). The HIV / AIDS epidemic in New York is at least in part fueled by homophobia and discrimination and this is leading to poorer health outcomes for gay men in the New York metropolitan area (Halkitis, 2015).

To add to the above, there are the Social Determinants of Health (SDOH) as described by the Health People 2020 website. Economic stability and education are both a little compromised due to the aforementioned discrimination and homophobia that still exists in the United States. This is even true in New York City, which is often accepted and considered to be more tolerant than other areas. The social and community context is much better in New York than it is in other parts of the country and a lot better than it was in the United States in the 1990's and 1980's when HIV and AIDS first emerged as a threat. Being gay is still deemed to be a mental illness or affliction by a lot of people and this is at least one factor (but certainly not the only one) that leads to people being sneaky, secretive and not getting the healthcare advice and perspective that they need. Indeed, while there are gay men who engage in illegal (e.g. prositituion, etc.) behavior while infected (knowingly or unknowingly) and so forth, there are plenty of gay men that lead regular lives that are still sort of forced into the shows due to the social, religious and other stigmas that are out there (Healthy People 2020, 2015; CDC, 2015).

This leads to the general challenges in healthcare delivery, those being availability, accessibility, affordability, appropriateness, adequacy and acceptability. Due to the social and cultural paradigms that gay men exist in, some or all of those can be a moderate to major issue for gay men. For example, even while affordability may not be an issue for many gay men, it is absolutely a challenge to get the best care when honest answers require the divulging of things like sexual behavior, sexual preferences, engaging in "down low" activities and so forth. Once a person contracts HIV or AIDS, the stakes and the importance of these factors gets a lot higher. While AIDS is fast becoming a condition that is simply chronic and not fatal, this is only true when adequate healthcare is accessible and things like money, social stigmas and not even knowing in the first place can all lead to problems. Of course, some of the aggravating factors involved are completely or at least partially human-created. However, those other factors can and so exist and they need to be removed as an issue if possible. The strengths of the gay community is that they are very united and share a common challenge. However, the risks to their health are easy to see and the specter of HIV and AIDS is just one of the challenges that exist. One of the problems (although certainly not the only one) is the social and cultural stigma that creeps into healthcare when it comes to the treatment and healthcare for gay men (CDC, 2015; Levesque, Harris & Russell, 2013).

The current HIV / AIDS problem with men, even in New York City, is largely about education. Indeed, it is not unlike obesity, diabetes and other things that are largely preventable. While there are social, cultural and religious stigmas associated with those other afflictions, gay men would seem to have it a lot worse and in more than one way. There is a cacophony of people that suggest that being gay is a mental illness and/or that it is a choice. To be sure, the activities and behaviors that gay men common exhibit and flaunt run directly against the grain of what is "acceptable" in today's society. However, so long as only consenting adults are involved and so long as no reasonable laws (key word is "reasonable") are not being violated, then that is not the business of anyone who would want to be a prude or nosy. This should extend into the healthcare realm. Even if a nurse is a diehard Christian that believe being gay is wrong, that should have no bearing on the quality and manifestation of care that is given. That being said, if the patient concedes to engaging in risky behavior, the objective and neutral facts about that behavior should be shared. For example, calling "down low" behavior "sinful" or "immoral" would be less than wise but explaining how it can expose the down law partner and/or the patient's own family to risk is certainly not beyond the pale and this should happen. There is a difference between being non-judgemental and not calling something risky and unethical when it is admitted to. It would be akin to saying that using heroin is "not a big deal"…because it is.