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Examining Health Disparities Based On Sexual Orientation

Ruzanna Harutyunyan's picture

The Massachusetts Department of Public Health (DPH) today released a report that shows that the burden of HIV/AIDS remains squarely on the shoulders of gay/bisexual men and other men who have sex with men. The study also highlights that a significant percentage of the newly diagnosed gay or bisexual men were men of color.

The report Inequitable Impact: The HIV/AIDS Epidemic Among Gay and Bisexual Men and Other Men Who Have Sex With Men in Massachusetts is the second annual World AIDS Day report issued by DPH focusing on the epidemic in the Commonwealth. The report notes that progress has been made in reducing transmission on HIV in Massachusetts, particularly among injection drug users and heterosexual men and women. However, less success has been seen in reducing infection rates among men who have sex with men (MSM).

More than 50% of HIV infections reported during 2004 and 2006 were among gay/bisexual men and other men who have sex with men. This illustrates the magnitude of the burden of infection given that only 4 to 9% of Massachusetts men reported on health surveys that they had had sex with men during the past year.

DPH Commissioner John Auerbach said there are encouraging signs in the report, such as the increased use of condoms by adult men who have sex with men. Fifty-six percent (56%) of men who responded to a 2005-06 health survey reported regular condom use, up from 36% in 2000.

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“Condoms save lives, so it is a good sign that we are seeing an increase in condom use,” said Commissioner Auerbach. “However, it is clear given the data in this report that more needs to be done with respect to reaching men who have sex with men with important HIV prevention messages,” he said.

Commissioner Auerbach noted that strategies to reach men who have sex with men are often complicated by continued stigma and discrimination facing gay and bisexual men. Stigma and discrimination have been shown to contribute to other health problems such as drug and alcohol abuse and mental illness, as well as to the elevated risk of becoming a victim of violence. And patients worried about facing discrimination may be less likely to disclose their sexual practices to or to seek care from health care providers.

The Commonwealth, with the financial support of the federal Centers for Disease Control and Prevention, is working to increase population-specific opportunities to be screened and counseled for HIV and other sexually transmitted infections. The Department also aims to reduce the number of persons who are unaware of their HIV status through expanded availability of rapid HIV tests and through the implementation of routine screening protocols in hospital emergency rooms, community health centers, and private medical practices.

Massachusetts health officials said they are using the report released today to take stock and make adjustments to their prevention, screening, HIV/AIDS surveillance and treatment programs.

One change, that will take place in January, is the integration of two bureaus within DPH to better coordinate HIV/AIDS activities in the department. DPH will merge the HIV/AIDS Bureau and the Communicable Disease Control Bureau to make more efficient use of clinical and programmatic resources. The new Bureau of Infectious Disease Prevention, Response, and Services will unite various areas of epidemiologic, medical, prevention, and policy work at DPH to address multiple, intersecting infectious diseases. One goal of this merger is the integration of service delivery models that currently are divided into disease specific categories. Such a move makes sense given that patients may be at risk of more than one infection. For example, recent Massachusetts STD data show that the number of infectious syphilis cases has increased over the past two years by 67%, with heightened prevalence among men who have sex with men — and 50% of MSM diagnosed with syphilis are also HIV positive.

“This new structure represents the growing trend toward consolidation of services related to HIV/AIDS programs,” said Kevin Cranston, director of the Department’s HIV/AIDS Bureau, and future director of the newly created bureau. “This type of integration is particularly important given the findings of this report. We need to maximize our efforts especially among the MSM population to address what we have been seeing throughout this epidemic. While we have made hard-fought progress, the message of prevention is missing too many men in Massachusetts.”