Gay, bisexual, and other men who have sex with men: time to end the fixation with HIVBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4739 (Published 02 September 2016) Cite this as: BMJ 2016;354:i4739
All rapid responses
The authors of this editorial rightly point out the many health disparities between men who have sex with men and their counterparts. In particular, the striking differences in mental health are well noted. As suggested by the authors, it is only with a collective approach to LGBT healthcare encompassing sexual and mental health, recreational drug and self-perceived quality of life, that holistic care in this group will be truly achieved.
Whilst replacing the outdated HIV prevention-focused approach to LGBT healthcare with a ‘syndemic’ approach is paramount, it is important not to understate the role of HIV centred public health campaigns in the this community. With 5% of MSM in the UK among the ages of 15-44 living with HIV (1) (accounting for 65% of all males living with the disease), a number much higher in areas such as London and only increasing, a top priority of LGBT healthcare - especially public health - should be prevent any further incidence of HIV. And although a more holistic approach to LGBT healthcare should be implemented in primary care, in mental health and in substance use services as the authors suggest, public health policy may need to keep its focus on HIV prevention within the LGBT community to achieve the goal of reduced incidence.
What’s more, many public health campaigns are able to address the behavioural, psychological and social elements of HIV prevention through their targeting and placement. Meaning this syndemic approach can be applied to HIV prevention -centred activities as well as LGBT healthcare as a whole (2).
Quite correctly, the authors suggest that transforming social attitudes and sex education in schools will play a most important role in the modification of LGBT healthcare. HIV focused health campaigns are particularly important to the large proportion of the current sexually active MSM, who have missed out on the improving sex education and awareness in school. Without which, those most at risk of contracting HIV have been left very uneducated.
I wholly agree with the authors that the current HIV prevention model of LGBT healthcare must be replaced with an approach that addresses the obvious disparities within the group. However, the HIV prevention centred nature of public health campaigns targeted at this same group is something that, for now, maybe should not be lost.
Callum James Riley
Medical Student, Imperial College School of Medicine
(1) Skingsley A, Yin Z, Kirwan P, Croxford S, Chau C, Conti S, Presanis A, Nardone A, Were J, Ogaz D, Furegato M, Hibbert M, Aghaizu A, Murphy G, Tosswill J, Hughes G, Anderson J, Gill ON< Delpech VC and contributors (2015). HIV in the UK – Stituation Report 2015: data to end 2014. Public Health England, London.
(2) Halkitis PN, Wolitski RJ, Millett GA, (2013) A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. The American Psychologist, PMID: 23688093
Competing interests: No competing interests