Gay Health Beyond HIV Prevention and the PEC Deck

Looking for a hot, healthy, well-adjusted man?

Whether it be in the bars, baths, on-line chat rooms or personal ads, today more than ever before, gay men are portraying themselves as near-perfect specimens of manliness.

So, are gay men suddenly healthier than ever, or is health, like beauty, in the eye of the beholder?

Consider the following personal ads:

GWM 32, VGL, 6ft, 180 lbs, muscular, blo/blu, social drinker, n/s, enjoys dancing, healthy. Seeks other guys for hot times.

25, 5'10", 145, bl/br, lean, healthy, seeking dominant top for discreet encounters. NS, ND.

30s top guy. Rugby player build. Healthy, clean, discrete. Want HIV neg. bottoms for bb sex.

Healthy 47 yo Asian male looking for a kind, down to earth man for friendship with potential for more. Enjoy the outdoors, eating out, theater, and quiet nights at home. Serious replies only.

Four gay men looking for sex, love and fun. All claim to be "healthy," but just what does healthy mean, and whose definition of "health" are they using?

For years, the term Gay Health has been considered an oxymoron. It conjures up images of gay men dying of AIDS, or the multitude of nauseating HIV medications that will (maybe) bring HIV positive people back to good "health" (no Virginia, protease inhibitors are NOT a cure!) Today, however, there is a different story.

In this "post-AIDS" era, where frequent deaths and a crisis mentality have passed (or are possibly in remission, with another wave of deaths around the corner), Gay Health is an emerging concept that has the potential to holistically embrace the complex and often contradictory issues facing gay men on the physical, mental, emotional and spiritual planes.

In this article I will question our existing perceptions of gay health, and explore the possibilities that the concept affords gay men.

What is a healthy gay man?

How would YOU define a healthy gay man? Do you have a ready-made answer? Consider the following questions that long-time gay community organizer and author, Eric Rofes, posed at a recent Summit on Gay Men's Health in Boulder, Colorado:

"Is [a healthy gay man] someone who is physically fit, but not too skinny and not too muscle bound? Can a gay man be considered healthy if he's overweight? Smokes? Is HIV positive? Is he someone who never drinks alcohol or uses drugs? Would you consider someone to be healthy if he regularly took allergy medication? Anti-depressants? Ecstasy?...Can you be into SM? Can you be attracted to much younger men?... Can you be a healthy gay man and be transgendered?"

Does that change your definition of health at all?

Look back at the four fictitious personal ads at the beginning of this article. Anyone who has dabbled with personal ads, and many gay men have, will know that a "little" bit of exaggeration is common. Those perfect abs may be hidden under a layer of "protective insulation" and those golden locks may come from a bottle, but how does "health" fit into all of this? When someone labels himself as healthy, whose definition of health is he using? Each of the men considers himself to be healthy. Do you agree? Which of the four would you consider to be healthiest? Here is some more information about each of them.

Jason, the thirty two year old muscle stud goes to the gym 6 days a week and spends over $500 a month on nutritional supplements, fake and bake tanning, and body waxing. He enjoys dancing, and usually treats himself to a tab or two of ecstasy when he goes out partying. Is he secure in his body? Is he obsessed with looking good? Is his drug use safe and by choice, or does he do it to conform or to escape from the realities of his life?

Dean, the twenty five year old is HIV positive, on HIV medications and has not had any complications from his HIV, he exercises regularly, eats well, loves the outdoors, and can only "get off" by being tied up and spanked. Can someone with HIV be truly healthy? Does he truly enjoy being tied up and spanked, or is this is an indicator of low self-worth or past abuse?

Marc, the guy in his thirties has a partner of seven years. They have a "don't ask, don't tell" relationship, and go for regular HIV testing. Their last HIV test was six months ago. Is he really comfortable with "don't ask, don't tell" or has he bought into the stereotype that gay men can't be monogamous? Can you really know for certain that someone is HIV negative? What about the window period? Does his partner know he has bareback sex with other men?

Li, the forty seven year old came to Canada as a refugee in the mid 1980s. He frequently suffers from nightmares related to his past, and takes a prescription sleeping pill each night. He is thirty pounds overweight, but jogs regularly to try and look like the fit guys he wants to attract. Are the nightmares an indicator of unresolved abuse? Could they develop into more severe mental health issues? Is it healthy to exercise to look good for others?

Now which of the four would you consider to be the healthiest? Physically? Emotionally? Mentally? Spiritually? Why? Which is the least healthiest? Why? What did you base your assessment on?

What is Gay Men's Health?

I define Gay Men's Health as a balance between the physical, mental, emotional and spiritual components of a gay man. Each of these components contributes to the health, or well-being, of the individual. If any one of these elements is out of alignment, poor health may result. Do you agree or disagree with this definition? If you disagree, is it okay to disagree, or do we need a common definition?

To understand how the millennial version of gay health came to be, it is necessary to look at the historic roots of gay men's health, culture, and community. Prior to the Stonewall Riots in 1969, gay culture was predominantly underground, and up until 1973 homosexuality was classified as a mental illness by American Psychiatric Association. Despite the fact "being gay" is no longer considered a mental illness, twenty years of HIV stigmatization means that in the minds of many people (both gay and straight), gay is still equated with illness.

During the 1980s, gay health issues became publicly visible due to the HIV epidemic. The "issues" however, were singular, and the focus was on basic survival. Without government support, and with mainstream disgust, gay men and their allies rallied together to address HIV infections and to support gay men dying from AIDS. Organizations such as AIDS Vancouver and BCPWA formed to respond to the emerging health crisis. HIV prevention strategies were developed and used a fear-based approach to try and scare gay men into using condoms "every time." This strategy was largely effective in reducing the rate of new HIV infections for as long as gay men saw their friends and lovers dying around them.

By 1996, things had changed. New HIV drugs called for renewed hope, the death rate dropped, and a younger generation of gay men unfamiliar with the realities of living with HIV started to come out. The fear-based prevention strategies that had once been so effective in reducing HIV transmission were now a liability. They didn't address the complex underlying issues that contribute to HIV vulnerability, and more importantly, their paternalistic tone provoked a "fuck you, don't tell me what to do" reaction from some gay men.

As HIV prevention educators struggled with how to repackage the "use a condom" message, a "new" idea emerged. Instead of trying to change the sexual behaviors of gay men by invoking fear, shame, and guilt (I'm not even going to start on that topic), why not treat us as the complex human beings that we are? Instead of trying to police our most intimate moments, why not actually empower and support us in taking charge of our own bodies, minds, and spirits? While it is still vitally important to educate gay men about HIV transmission and to provide easy access to condoms, there are a number of equally important health issues to be addressed. Research and experience reveals a number of health issues facing gay men. So what are they, and how are they being addressed?

In addition to HIV/AIDS, there are many other health issues that gay men may deal with in their lives:

• Hepatitis A
• Societal and internalized homophobia (leading to shame, guilt, and low self-esteem)
• HPV (anal warts)
• Social isolation
• Lack of safe spaces
• Lack of access to ppropriate health care (non-homophobic and understanding of gay health concerns)
• Mental health concerns including depression and anxiety)
• Drug and alcohol over-use and addiction
• Stigmatization (racism, and ther isms)
• Sexually transmitted infections (STIs)
• Body image
• Sexual and domestic abuse (current nd childhood)
• Anal health and hygiene
• The divide between HIV+ and HIVgay men
• Feeling that HIV is nevitable
• Navigating non-traditional relationships in a heterosexist world
• High suicide rates amongst ay eens (13 times higher than in the general populace)
• Negotiating safer sex... again, and again.
• Unresolved issues of multiple grief and loss (from death of friends/lovers)

...and the list goes on!

Addressing the health needs of gay men

Okay, so the list is big and the task of addressing all of the issues is daunting. How do we even begin to approach gay men's health? We need to look beyond the box that we're stuck in, and realize that to achieve a health gay community (and surely that's what we want!?), we need to have healthy gay men. The health issues of gay men have been glossed over for too long. It's time that the gay men of today rally together and begin to focus on our own health, both individually and collectively. Volunteering time and talents, raising funds, and writing letters are all a step in the right direction. HIV may appear to be less of a threat today than it was ten years ago, but it's still very prevalent, and there's fear of another wave of deaths. Young gay teens are being bullied and committing suicide. Gay men are getting drunk and high and putting themselves at risk for addiction, sexually transmitted infections, HIV, and depression. Whose idea of a health community is that?

People have stopped and listened to the voices of gay men. Jason the muscle stud desperately wants counseling – he's finally admitted that he's not happy with his body and considers others to be better than him. He says that he uses drugs to feel good about himself, and to let go of his inhibitions. Dean, the 25 year old, has accepted having HIV, but admits that he got it from a guy he dated when he first came out, and who abused him over a two year period. He's also admitted to having "bumps" (anal warts) in his anus that he's been too embarrassed to tell anyone about. Marc, in the "don't ask, don't tell" relationship admits that he is scared to talk to his partner about extra-marital sex. He hasn't used condoms with his partner since the second year in their relationship. He can't keep an erection with a condom on, so doesn't use them with casual partners. He's paranoid that he's putting himself and his partner at risk for HIV, but he keeps finding himself in the same situation over and over again. Li is incredibly lonely, having left his family behind him when he came to Canada. The nightmares became worse after his first Canadian lover left him for a "younger model". He has used a sleeping pill every night for the past ten years, and although he doesn't like to depend on them, he's afraid to stop. Four gay men all in need of different types of health care. A culture of fabulousness prevents them from admitting their issues to themselves or to others. If and when they do decide to take action, who do they call? Where do they go? Does anybody care? There are a handful of good resources available, but they are not enough. More health care providers are needed in a broader range of areas, but a change must also occur within individuals, and the community at large. Would a culture based on love and respect really be such a bad thing?

Jason, Dean, Marc and Li may be fictitious, but they are a very real portrayal of the gay men and the issues to be found in our communities throughout BC and Canada. Gay men's health issues have been devalued for too long - it's time to take action, the community is ready. The vision for a healthier gay community exists. Leaders are getting the ball rolling; now, dear government, show us the money. For those of you gay men with your heads in the sand... stand up, look around you, and get involved! As cliched as it may sound, together we CAN make a difference.

And meanwhile... the party goes on, the phone lines and Internet chat rooms are full and we're silenced by the deafening fabulousness of it all.

by Andrew Barker