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Primary care of gay men and men who have sex with men

Author
Harvey J Makadon, MD
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Lee Park, MD, MPH

INTRODUCTION

Much of the care of gay men reflects standards of recommended care of all men [1]. However, there are unique features regarding both medical and behavioral health of gay men of importance to practicing clinicians [2,3]. In addition, gay men may have particular concerns about access to care, insurance coverage, and the clinical office environment that should be considered as part of ensuring equal access to care [4,5]. (See "Preventive care in adults: Recommendations".)

Healthy People 2020, a document that outlines health goals for the current decade in the United States, highlighted areas of concern regarding health care disparities impacting gay men [6]. In particular, gay men are at higher risk of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), especially among communities of color. The Centers for Disease Control and Prevention (CDC) reported that 66 percent of new cases of HIV in the United States were in men who have sex with men (MSM) in 2011, including MSM who use injectable drugs [7]. In England, while the total number of STI diagnoses decreased overall from 2013 to 2014, diagnoses in MSM increased [8,9]. In addition, gay men across a large age spectrum are more likely to attempt suicide, be homeless, and have high rates of tobacco, alcohol, and other drug use. Older gay men face additional barriers to health because of isolation and lack of supportive services.

Despite identified disparities, education about the care of gay men is sorely lacking in the context of medical education [10-12].

TERMINOLOGY AND IDENTITY

The population that has come to be referred to as "gay" in the West is not a descriptive term that would be recognized by all men who have sex with men (MSM). While gay culture is increasingly open and discussed, the world of MSM consists of a diverse population that often may respond differently depending on how communications in clinical settings are framed [13].

Sexual orientation is generally thought of as having three components: identity, behavior, and desire. "Gay" is generally used to describe how people identify themselves, while "men who have sex with men" (MSM) describes a behavior. MSM may identify themselves as gay, bisexual, queer, same-gender loving, or heterosexual. Additionally, some who are just beginning to come out may experience desire to be intimate with other men, but may not yet have been sexually active with men or even identify as being gay.

                     

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Literature review current through: Nov 2016. | This topic last updated: Tue Sep 29 00:00:00 GMT+00:00 2015.
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