1. Advancing
a Sexual Health Framework
For Gay, Bisexual and Other MSM
In the United States
Richard J. Wolitski, PhD
Deputy Director
Behavioral and Social Science
National HIV Prevention Conference
August 16, 2011
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

2. Wolitski & Fenton. (2011). AIDS and
Behavior, 15, S9-S17.

4. It’s NOT Getting Better
When It Comes to the Sexual Health
Of MSM in the United States

5. Su et al., (2011). Annals of Internal Medicine, 155, 145-151

6. Su et al., (2011). Annals of Internal Medicine, 155, 145-151

7. More than 30,000 MSM
newly infected in 2009
Includes both MSM and MSM-IDU.

8. Estimated Number of New HIV Infections, 2009

9. Estimated New HIV infections, 2009, by
Transmission category

10. HIV Incidence Among MSM 13-29 by Race/Ethnicit y
and Year, United States, 2006-2009
8000
7000
6000
5000
HIV Incidence
4000
Black/African American
All Other
3000
2000
1000
0
2006 2007 2008 2009
Year

11. • Clearly we’ve got to do better

12. Health Disparities affecting MSM
• There is growing recognition that MSM are
at risk for multiple health disparities.
• These disparities are the result of
combinations of individual, cultural,
behavioral, and biomedical factors as well
as discrimination, and stigma.
• Childhood sexual abuse, substance use,
mental health disorders, STDs, and
partner violence exist at higher levels
among MSM, and have been shown to be
associated with increased HIV risk.
• The combined effects of these problems
may be greater than their individual
effects.

13. A Sexual Health Approach
• Contextualizes the issue
– Broader health framework
– Recognizes prejudice and discrimination
• Addresses sexualit y as an
inextricable part of health
– Recognizes physical, emotional and social
aspects of human sexuality
– Holistic rather than reductionist

14. A Sexual Health Approach
• Emphasizes wellness rather than
disease
• Focuses on positive and respectful
relationships
– Not coercive
– Fully consensual
– Importance of relationships
• Takes a syndemics approach to
prevention

15. Role of Sexual Dysfunction
• MSM experience higher rates of some t ypes of sexual
dysfunction
– Twice as many MSM medical students experienced erectile
dysfunction (ED) than did non-MSM students (24% vs 12%)
• Use of drugs to treat ED is associated with sexual risk
behavior
• Sexual compulsivit y associated with increased sexual
risk behavior
• Sexual dysfunction associated with poorer adherence
to HIV treatment and transmission risk among MSM
living with HIV

16. Role of Health Care Providers
• Need to train and support health care providers to
work with MSM, provide culturally appropriate
services, and create welcoming practices
– Some providers report discomfort, negative attitudes, and low self-
efficacy with regard to treating sexual minority patients
– Too many fail to address sexual health issues, even with HIV+ MSM
– As a result, some MSM delay seeking HIV/STI services
• Uncomfortable with their own homosexuality
• Reluctant to disclose sexual orientation
• Have received judgmental or suboptimal services

17. “ Homophobia is
a public health problem”
---Rafael Mazin

18. Role of Structural and Policy Change Efforts
• Need to prevent negative
effects on homophobia and
discrimination on sexual health
of MSM
– Shown to negatively affect access to
health care, mental health social
support, physical health and safety

19. Role of Structural and Policy Change Efforts
• Need to eliminate stigma and discrimination
– Working with general public and schools
– Provide comprehensive sex education that is appropriate for gay,
straight, and questioning students
– Need laws and policies that promote basic human rights
• Protect from hate crimes
• Equal access to health insurance
• Legally recognizing long-term relationships

20. NCHHSTP MSM HIV/STI
Prevention and Health Framework
• Expanding engagement
with key partners
• Improving collection,
analysis and timely
reporting of data
• Expanding evidence-
based interventions
• Rigorously evaluating
effectiveness of
interventions

21. Final Thoughts
• Scale and effectiveness of public health response to
sexual health among MSM has been lacking
– Spending not proportionate to burden
– Programs have felt hampered by “no promo homo” restrictions
– Single-disease oriented approach has failed to recognize:
• Connections between multiple sexual health and other health issues
• Address underlying causes of poor sexual health
• Value sexual health and relationships of gay, bisexual and other MSM
• A sexual health approach needs to respect and value
the sexual relationships and rights of all people,
including those who are living with HIV

22. Thank You!
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention