The second paper in The Lancet Series on HIV in MSM focuses on clinical care, and says that optimum clinical care for sexual and gender minorities is a fundamental human right. “MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information,” say the authors, led by Dr Ken Mayer, Fenway Health, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted diseases associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity that can result in depression, anxiety, substance use, and other adverse outcomes.
The authors note that studies of the life experiences of MSM suggest that causes of psychological distress and risk-taking behaviour may result from early childhood experiences such as physical and emotional abuse by family or peers, resulting in debilitating outcomes. Despite all the above, the authors acknowledge that most MSM lead healthy and productive lives.
Yet because MSM vary in sociodemographic and behavioural characteristics, they have a wide range of health needs. However, in most countries health-care providers do not get specific training about issues facing MSM, resulting in an absence of friendly and comfortable health-care settings for these patients.
The authors say: “Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support.”
“The health needs of MSM are related to the circumstances of their environments, and clinical providers need to interact with them in ways that promote the disclosure of actionable health information, since screening and care can be best guided by information about behaviour rather than by biased assumptions based on stereotypes,” conclude the authors. “Optimum clinical care for sexual and gender minorities is a fundamental human right, and the support of health-care professionals is needed for its provision.”
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