_____________________________________________ Promoting the Health of Gender and Sexual Minorities
following the start of HIV/AIDS prevention programs, data has indicated a rise in reports of unprotected anal sex. Also, young men who have sex with men are reportedly at par- ticular risk for HIV because they are more likely to engage in high-risk behaviors [8; 121]. The effect of behavioral changes on HIV transmission has not been determined. According to the CDC, from 2021 to 2022, HIV diagnoses increased 5% among gay and bisexual men overall, but trends varied for different groups of gay and bisexual men [122]. From 2021 through 2022, the largest number of diagnoses of HIV infection was among gay and bisexual men 25 to 34 years of age. Of 37,981 men diagnosed with HIV infection in 2022, Black/African American gay and bisexual men accounted for the largest number (14,553 or 38%) of HIV diagnoses , followed by 12,167 Hispanic/Latino men (32%), and 9,112 White gay and bisexual men (24%). Three percent (1,056) of multiracial men were diagnosed, 2% (795) of Asian men, 1% (215) American Indian/Alaska Native gay and bisexual men (1%), and less than 1% (83) Native Hawaiian/Other Pacific Islander gay and bisexual men [122; 123; 124]. Many Black/ African American and Hispanic/Latino gay and bisexual men, particularly young men, do not know that they are infected [122; 123; 124]. Research has suggested that non-gay-identified men may be more responsive to intervention education than gay-identified men. This has been attributed to less exposure to prior intervention messages, leading to a greater impact from initial exposure [125]. Additional research is needed to identify which behavioral strategies (e.g., reducing unprotected anal sex, having oral sex instead of anal sex, using condoms) most effectively reduce transmission of STIs and HIV/AIDS among gay men [125]. An increasing number of HIV cases among heterosexual Black women has drawn attention in the media to a phenomenon known as the “down low.” While this phenomenon is too complex to address fully here, the term is used to describe the behavior of men who have sex with men as well as with women, but who do not identify themselves as gay or bisexual [126]. Often, their female partners are unaware that these men are also having sex with men. While the term is thought to have originated in the African American com- munity, the behaviors associated with the term are not new and not specific to Black men who have sex with men [126]. The media has linked the “down low” to the Black AIDS epidemic, but the CDC has reported that there is no data to confirm or refute publicized accounts of HIV risk behavior associated with these men [126]. STIs are thought to be more common among women who have sex with women than among sexually active women who are heterosexual. Transmission risk may vary by the specific STI and sexual practice (e.g., oral-genital sex, penetrative sex items) [127]. Although disease incidence among these women appears to be less than among the heterosexual female popula- tion, HPV and other organisms are transmissible woman to woman [8]. Transmission of HPV can occur with skin-to-skin or skin-to-mucosa contact, which can occur during sex between
women [127]. HPV has also been associated with the develop- ment of genital warts and invasive cervical cancer. The CDC has recommended that all women undergo Pap test screening according to national guidelines, regardless of sexual preference or sexual practices [127].
According to the Centers for Disease Control and Prevention, women who have sex with women, particularly adolescents and young women as well as women with both male and female partners, might be at increased risk for STIs and HIV on the
basis of reported risk behaviors. A continuum of sexual behaviors reported by these patients indicates the need for providers to not assume lower risk for women who have sex with women, highlighting the importance of an open discussion about sexual health. (https://www.cdc.gov/std/treatment-guidelines/wsw. htm. Last accessed September 27, 2024.) Level of Evidence : Expert Opinion/Consensus Statement To address racial, ethnic, and geographic disparities that have contributed to HIV prevention gaps, the U.S. Department of Health and Human Services launched the Ending the HIV Epidemic in the U.S. (EHE) initiative in 2019. The goal of the initiative is to reduce new HIV infections in the United States by 90% by 2030 [128]. In July 2021, the CDC awarded $117 million in EHE funding to state and local health depart- ments to rebuild and expand HIV prevention and treatment efforts in 57 priority jurisdictions. The jurisdictions include 50 local areas that account for more than half of new HIV diagnoses, and seven states with a substantial rural burden [128]. Approved EHE funding across all U.S. federal agencies was $613 million for fiscal year 2023 [128]. Although there are now more options than ever before to reduce the risk of acquiring or transmitting HIV, some options are more effective than others. Combining prevention strate- gies may be most effective [124]. Mental Health The LGBTQIA population may be at increased risk for mental distress, mental disorders, substance abuse, and suicide because of their exposure to stressors related to society’s antigay atti- tudes [8; 31]. Studies examining the prevalence rates for suicide ideation have shown that the rates are elevated among gay and bisexual men as well as among lesbians, and particularly those who grow up in religious households as well as those for whom religion is important [8; 129; 130; 131].
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