"Mental Health and MSM youth" Top2Btm MSM Symposium Presentation

Published: May 23, 2011

She had a guillotine for a vag: “Womb fear”
‘Probably no male human being is spared the terrifying shock of threatened castration at the sight of the female genitals’. Sigmund Freud

“Encouraging gay people to renounce their sexuality: Freedom is possible”

• YMSM aged 15-24 have the lowest utilization of any medical office visits, and this has decreased over period 1995-2005 Lisa B AIDS Pt Care 2011. Radcliffe et al AIDS patient care and STDs 2010
• We are missing opportunities to counsel and provide testing and linkage of care to those at risk or infected with HIV

• Why higher infection rates in YMSM: ? personal experience with HIV, less fear of HIV, lack of awareness
about HIV status, propensity towards depression and substance abuse. Salomon et al AIDS Behav 2009
• EXPLORE study: More likely to report depressive symptoms and less likely to use counseling or medication for psychiatric conditions. They were more likely to report heavy alcohol and drug use. Reported more often engaging in unprotected insertive and receptive Anal intercourse
• Psychiatrically ill adolescents are more likely to be sexually active, to engage in unprotected sex and to have more partners than pts without psychiatric illness Benton et al Curr Psych Rep 2010
• Therefore identify psych illness to prevent HIV transmission

Stigma and sexual risk
• Important to know in order to design effective stigma informed secondary prevention programmes among young MSM
• Sexual minority stigma, HIV stigma, dual stigma
• Young African American MSM may be further marginalized by cultural norms emphasizing masculinity and traditional family views = “layers of stigma” Vanable et al AIDS 2006

• Multiple forms of HIV stigma: personalized prejudice or discrimination, negative self image,
concerns about public attitudes towards HIV, fears regarding disclosure of HIV status
• Higher levels of HIV stigma: associated with negative outcomes: depression, poor self esteem, lack of social support and romantic loneliness
• Sexual minority stigma is associated with a host of psychological and behavioural health problems including: Depression, Anxiety, Suicidality and Substance Abuse

• More social avoidance by others related to sexuality rather than HIV status. More shame related to HIV than to their sexuality. Radcliffe et all AIDS Pt Care and STDs 2010
• Individuals reporting higher levels of HIV stigma reported more unprotected sex while under the influence of drugs and alcohol. Those endorsing more HIV stigma reported more receptive anal intercourse
• Individuals endorsing higher levels of sexual minority stigma engaged in less insertive anal intercourse.

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