AIDS and Behavior

, Volume 15, Supplement 1, pp 9–17 | Cite as

Sexual Health, HIV, and Sexually Transmitted Infections among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States

  • Richard J. WolitskiEmail author
  • Kevin A. Fenton
Original Paper


The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM’s sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.


Homosexuality, male Sexuality HIV infections/epidemiology Sexually transmitted diseases/epidemiology Health promotion Health policy 



The authors are grateful to John Douglas for information he provided on sexually transmitted infections among MSM and his leadership on sexual health issues at CDC.


  1. 1.
    World Health Organization. Defining sexual health: report of a technical consultation on sexual health 28–31 January 2002, Geneva. Geneva: World Health Organization; 2006.Google Scholar
  2. 2.
    Pan American Health Organization, World Health Organization. Promotion of sexual health: recommendations for action. Antigua Guatemala, Guatemala. 2000. Accessed 30 Dec 2010.
  3. 3.
    U.S. Public Health Service. The surgeon general call to action to promote sexual health and responsible sexual behaviors. Washington; 2001.Google Scholar
  4. 4.
    Clarke P, Ebel C, Catotti DN, Stewart S. The psychosocial impact of human papillomavirus infection: implications for health care providers. Int J STD AIDS. 1996;7:197–200.PubMedGoogle Scholar
  5. 5.
    Courtenay-Quirk C, Wolitski RJ, Parsons JT, Gomez CA. Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men. AIDS Educ Prev. 2006;18:56–67.PubMedGoogle Scholar
  6. 6.
    Courtenay-Quirk C, Zhang J, Wolitski RJ. Intentional abstinence among homeless and unstably housed persons living with HIV/AIDS. AIDS Behav. 2009;13:1119–28.PubMedGoogle Scholar
  7. 7.
    Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behavior of homeless and unstably housed persons living with HIV. AIDS Behav. 2009;13:1222–32.PubMedGoogle Scholar
  8. 8.
    Remien RH, Carballo-Dieguez A, Wagner G. Intimacy and sexual risk behaviour in serodiscordant male couples. AIDS Care. 1995;7:429–38.PubMedGoogle Scholar
  9. 9.
    van der Straten A, Vernon KA, Knight KR, Gomez CA, Padian NS. Managing HIV among serodiscordant heterosexual couples: serostatus, stigma and sex. AIDS Care. 1998;10:533–48.PubMedGoogle Scholar
  10. 10.
    Jeynes C, Chung MC, Challenor R. ‘Shame on you’—the psychosocial impact of genital warts. Int J STD AIDS. 2009;20:557–60.PubMedGoogle Scholar
  11. 11.
    Schiltz MA, Sandfort TGM. HIV-positive people, risk and sexual behaviour. Soc Sci Med. 2000;50:1571–88.PubMedGoogle Scholar
  12. 12.
    Nack A. Damaged goods: women managing the stigma of STDs. Deviant Behav. 2000;21:95–121.Google Scholar
  13. 13.
    Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006;10:473–82.PubMedGoogle Scholar
  14. 14.
    Halkitis PN, Gomez CA, Wolitski RJ. HIV+ sex. Washington: American Psychological Association; 2005.Google Scholar
  15. 15.
    Crosby RA, Head S, Moore G, Troutman A. Is suspicion of genital herpes infection associated with avoiding sex? A clinic-based study. Sex Health. 2008;5:279–83.PubMedGoogle Scholar
  16. 16.
    O’Leary A, Wolitski RJ. Moral agency and the sexual transmission of HIV. Psychol Bull. 2009;135:478–94.PubMedGoogle Scholar
  17. 17.
    Parsons JT, Schrimshaw EW, Bimbi DS, et al. Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men. AIDS. 2005;19:S87–97.PubMedGoogle Scholar
  18. 18.
    Hart TA, Wolitski RJ, Purcell DW, Parsons JT, Gomez CA. Partner awareness of the serostatus of HIV-seropositive men who have sex with men: impact of unprotected sexual behavior. AIDS Behav. 2005;9:155–66.PubMedGoogle Scholar
  19. 19.
    Klitzman R, Bayer R. Truth and lies in the age of AIDS. Baltimore: The Johns Hopkins University Press; 2003.Google Scholar
  20. 20.
    Maw RD, Reitano M, Roy M. An international survey of patients with genital warts: perceptions regarding treatment and impact on lifestyle. Int J STD AIDS. 1998;9:571–8.PubMedGoogle Scholar
  21. 21.
    Shah D, Button JC. The relationship between psychological factors and recurrent genital herpes simplex virus. Br J Health Psychol. 1998;3:191–213.Google Scholar
  22. 22.
    Swanson JM, Chenitz WC. Regaining a valued self: the process of adaptation to living with genital herpes. Qual Health Res. 1993;3:270–97.Google Scholar
  23. 23.
    Manne S, Sandler I. Coping to adjustment to genital herpes. J Behav Med. 1984;7:391–410.PubMedGoogle Scholar
  24. 24.
    Frye V, Fortin P, MacKenzie S, et al. Managing identity impacts associated with disclosure of HIV status: a qualitative investigation. AIDS Care. 2009;21:1071–8.PubMedGoogle Scholar
  25. 25.
    Crandall CS, Coleman R. AIDS-related stigmatization and the disruption of social relationships. J Soc Pers Relatsh. 1992;9:163–77.Google Scholar
  26. 26.
    Wall KM, Khosropour CM, Sullivan PS. Offering of HIV screening to men who have sex with men by their health care providers and associated factors. J Int Assoc Physicians AIDS Care. 2010;9:284–8.Google Scholar
  27. 27.
    Nelson KM, Thiede H, Hawes SE, et al. Why the wait? Delayed diagnosis among men who have sex with men. J Urban Health. 2010;87:642–55.PubMedGoogle Scholar
  28. 28.
    Eliason MJ, Schope R. Does “Don’t Ask, Don’t Tell” apply to health care? Lesbian, gay, and bisexual people’s disclosure to health care providers. J Gay Lesbian Med Assoc. 2001;5:125–34.Google Scholar
  29. 29.
    Stall RD, Hays RB, Waldo CR, Ekstrand M, McFarland W. The Gay ‘90 s: a review of research in the 1990’s on sexual behavior and HIV risk among men who have sex with men. AIDS. 2000;14:S101–14.PubMedGoogle Scholar
  30. 30.
    Hospers HJ, Kok G. Determinants of safe and risk-taking sexual behavior among gay men: a review. AIDS Educ Prev. 1995;7:74–94.PubMedGoogle Scholar
  31. 31.
    Koblin BA, Husnik MJ, Colfax G, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20:731–9.PubMedGoogle Scholar
  32. 32.
    Coleman E, Rosser BRS, Strapko N. Sexual intimacy dysfunction among homosexual men and women. Psychiatr Med. 1992;10:257–71.PubMedGoogle Scholar
  33. 33.
    Stall R, Mills T, Williamson J, et al. Co-occurring psychosocial health problems among urban men who have sex with men are associated with increased vulnerability to the HIV/AIDS epidemic. Am J Public Health. 2003;93:939–42.PubMedGoogle Scholar
  34. 34.
    Hirshfield S, Chiasson MA, Wagmiller RL, et al. Sexual dysfunction in an internet sample of U.S. men who have sex with men. J Sex Med. 2010;7:3104–14.PubMedGoogle Scholar
  35. 35.
    O’Leary A, Purcell D, Remien RH, Gomez C. Childhood sexual abuse and sexual transmission risk behaviour among HIV-positive men who have sex with men. AIDS Care. 2003;15:17–26.PubMedGoogle Scholar
  36. 36.
    Centers for Disease Control and Prevention. Addressing social determinants of health: accelerating the prevention and control of HIV/AIDS, viral hepatitis, STD and TB. External Consultation Meeting Report. Atlanta: Centers for Disease Control and Prevention; 2009. Accessed 13 February 2011.
  37. 37.
    Wilkinson R, Marmot M. Social determinants of health: the solid facts. Copenhagen: World Health Organization; 2003. Accessed 13 February 2011.
  38. 38.
    Marmot M, Bell R. The socioeconomically disadvantaged. In: Levey BS, Sidel VW, editors. Social injustice and public health. New York: Oxford University Press; 2006. p. 25–45.Google Scholar
  39. 39.
    House J, Williams D. Understanding and reducing socioeconomic and racial/ethnic disparities in health. In: Smedley BD, Syme LS, editors. Promoting health: intervention strategies from social and behavioral research. Washington: National Academy Press; 2000. p. 81–124.Google Scholar
  40. 40.
    King G, Williams DR. Race and health: a multidimensional approach to African-American health. In: Amick BC, Levine S, Tarlov AR, Walsh DC, editors. Society and health. New York: Oxford University Press; 1995. p. 93–130.Google Scholar
  41. 41.
    Wolitski RJ, Stall R, Valdiserri RO. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008.Google Scholar
  42. 42.
    Hartzenbuehler ML, McLaughlin KA, Keyes KM, Hassin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations. Am J Public Health. 2010;100:452–9.Google Scholar
  43. 43.
    Herek GM, Chopp R, Strohl D. Sexual stigma: putting sexual minority health issues in context. In: Meyer IH, Northridge ME, editors. The health of sexual minorities: public health perspectives on lesbian, gay, bisexual, and transgender populations. New York: Springer Science + Business Media, LLC; 2007. p. 171–208.Google Scholar
  44. 44.
    Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008;98:989–95.PubMedGoogle Scholar
  45. 45.
    Diaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 2001;91:927–32.PubMedGoogle Scholar
  46. 46.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.PubMedGoogle Scholar
  47. 47.
    McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction. 2009;104:1333–45.PubMedGoogle Scholar
  48. 48.
    Dean L, Meyer IH, Robinson K, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4:101–51.Google Scholar
  49. 49.
    Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. Am J Public Health. 2001;91:933–9.PubMedGoogle Scholar
  50. 50.
    Cochran SD, Sullivan JG, Mays VM. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71:53–61.PubMedGoogle Scholar
  51. 51.
    Valdiserri RO. Sexually transmitted infections among gay and bisexual men. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008. p. 159–93.Google Scholar
  52. 52.
    Rhodes SD, Yee LJ. Hepatitis A, B, and C virus infections among men who have sex with men in the United States: transmission, epidemiology, and intervention. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008. p. 194–219.Google Scholar
  53. 53.
    Douglas JM Jr, Peterman TA, Fenton KA. Syphilis among men who have sex with men: challenges to syphilis elimination in the United States. Sex Transm Dis. 2005;32:S80–3.PubMedGoogle Scholar
  54. 54.
    Xu F, Sternberg MR, Markowitz LE. Men who have sex with men in the United States: demographic and behavioral characteristics among prevalence of HIV and HSV-2 infection. Sex Transm Dis. 2010;37:399–405.PubMedGoogle Scholar
  55. 55.
    Purcell DW, Johnson C, Lansky A, et al. Calculating HIV and syphilis rates for risk groups: estimating the national population size of MSM. In Program and abstracts of the 2010 National STD Prevention Conference; 10 Mar 2010; Atlanta. Late breaker paper 22896.Google Scholar
  56. 56.
    Nieuwenhuis RF, Ossewaarde JM, Gotz HM, et al. Resurgence of lymphogranuloma venereum in Western Europe: an outbreak of Chlamydia trachomatis serovar L-2 proctitis in The Netherlands among men who have sex with men. Clin Infect Dis. 2004;39:996–1003.PubMedGoogle Scholar
  57. 57.
    Van der Bij AK, Spaargaren J, Morre SA, et al. Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study. Clin Infect Dis. 2006;42:186–94.PubMedGoogle Scholar
  58. 58.
    Cohen DE, Russell CJ, Golub SA, Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS Patient Care STDs. 2006;20:557–64.PubMedGoogle Scholar
  59. 59.
    Urbanus AT, van de Laar TJ, Stolte IG, et al. Hepatitis C virus infections among HIV-infected men who have sex with men: an expanding epidemic. AIDS. 2009;23:F1–7.PubMedGoogle Scholar
  60. 60.
    Centers for Disease Control and Prevention. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. Morb Mortal Wkly Rep. 2008;57:985–9.Google Scholar
  61. 61.
    Ciesielski CA. Sexually transmitted diseases in men who have sex with men: an epidemiological review. Curr Infect Dis Rep. 2003;5:145–52.PubMedGoogle Scholar
  62. 62.
    Xia Q, Osmond DH, Tholandi M, et al. HIV prevalence and sexual risk behaviors among men who have sex with men. J Acquir Immune Defic Syndr. 2006;41:238–45.PubMedGoogle Scholar
  63. 63.
    Mimiaga MJ, Noonan E, Donnell D, et al. Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr. 2009;51:340–8.PubMedGoogle Scholar
  64. 64.
    Centers for Disease Control and Prevention. Prevalence and awareness of HIV infection among men who have sex with men—21 cities, United States, 2008. Morb Mortal Wkly Rep. 2010;59:1201–7.Google Scholar
  65. 65.
    Fenton KA, Imrie J. Increasing rates of sexually transmitted diseases in homosexual men in Western Europe and the United States: Why? Infect Dis Clin N Am. 2005;19:311–31.Google Scholar
  66. 66.
    Sullivan PS, Hamouda O, Delpech V, et al. Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol. 2009;19:423–31.PubMedGoogle Scholar
  67. 67.
    Wolitski RJ, Valdiserri RO, Denning PH, Levine WC. Are we headed for a resurgence of the HIV epidemic among men who have sex with men? Am J Public Health. 2001;91:883–8.PubMedGoogle Scholar
  68. 68.
    Aral SO, Fenton KA, Holmes KK. Sexually transmitted diseases in the USA: temporal trends. Sex Transm Infect. 2007;83:257–66.PubMedGoogle Scholar
  69. 69.
    Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–9.PubMedGoogle Scholar
  70. 70.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2008. Atlanta: Department of Health and Human Services; June 2010. Accessed 30 Dec 2010.
  71. 71.
    Centers for Disease Control and Prevention. Trends in HIV/AIDS diagnoses among men who have sex with men—33 states, 2001–2006. Morb Mortal Wkly Rep. 2008;57:681–6.Google Scholar
  72. 72.
    Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2008. Atlanta: Department of Health and Human Services; Nov 2009.Google Scholar
  73. 73.
    Centers for Disease Control and Prevention. Trends in primary and secondary syphilis and HIV infections in men who have sex with men—San Francisco and Los Angeles, California, 1998–2002. Morb Mortal Wkly Rep. 2004;53:575–8.Google Scholar
  74. 74.
    Centers for Disease Control and Prevention. Primary and secondary syphilis among men who have sex with men—New York City, 2001. Morb Mortal Wkly Rep. 2002;51:853–6.Google Scholar
  75. 75.
    Kerani RP, Handsfield H, Stenger MS, et al. Rising rates of syphilis in the era of syphilis elimination. Sex Transm Dis. 2007;34:154–61.PubMedGoogle Scholar
  76. 76.
    Schmitt K, Bulecza S, George D, Burns TE, Jordahl L. Florida’s multifaceted response for increases in syphilis among MSM: the Miami-Ft. Lauderdale Initiative. Sex Transm Dis. 2005;32:S19–23.PubMedGoogle Scholar
  77. 77.
    Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2007 Supplement, Gonococcal Isolate Surveillance Project (GISP) Annual Report 2007. Atlanta: U.S. Department of Health and Human Services, CDC; 2009.Google Scholar
  78. 78.
    Kent CK, Chaw JK, Wong W, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis. 2005;41:67–74.PubMedGoogle Scholar
  79. 79.
    Gunn RA, O’Brien CJ, Lee MA, Gilchick RA. Gonorrhea screening among men who have sex with men: value of multiple anatomic site testing, San Diego, California, 1997–2003. Sex Transm Dis. 2008;35:845–8.PubMedGoogle Scholar
  80. 80.
    Le Vu S, Le Stat Y, Barin F, et al. Population-based HIV-1 incidence in France, 2003–2008: a modeling analysis. Lancet. 2010;10:682–7.Google Scholar
  81. 81.
    Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med. 2007;4:1901–11.Google Scholar
  82. 82.
    Caceres CF, Konda K, Segura ER, Lyerla R. Epidemiology of male same-sex behaviour and associated sexual health indicators in low- and middle-income countries: 2003–2007 estimates. Sex Transm Infect. 2008;84:i49–56.PubMedGoogle Scholar
  83. 83.
    Breyer BN, Smith JF, Eisenberg ML, et al. The impact of sexual orientation on sexuality and sexual practices in North American medical students. Int J Soc Sex Med. 2010;7:2391–400.Google Scholar
  84. 84.
    Bancroft J, Carnes L, Janssen E, Goodrich D, Long JS. Erectile and ejaculatory problems in gay and heterosexual men. Arch Sex Behav. 2005;34:285–97.PubMedGoogle Scholar
  85. 85.
    Rosser BRS, Metz ME, Bockting WO, Buroker T. Sexual difficulties, concerns, and satisfaction in homosexual men: an empirical study with implications for HIV prevention. J Sex Marital Ther. 1997;23:61–73.PubMedGoogle Scholar
  86. 86.
    Sandfort TGM, deKeizer M. Sexual problems in gay men: an overview of empirical research. Annu Rev Sex Res. 2001;12:93–120.PubMedGoogle Scholar
  87. 87.
    Mao L, Newman CE, Kidd MR, Saltman DC, Rogers GD, Kippax SC. Self-reported sexual difficulties and their association with depression and other factors among gay men attending high HIV-caseload general practices in Australia. J Sex Med. 2009;6:1378–85.PubMedGoogle Scholar
  88. 88.
    Purcell DW, Wolitski RJ, Hoff CC, Parsons JT, Woods WJ, Halkitis PN. Predictors of the use of Viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men. AIDS. 2005;19:S57–66.PubMedGoogle Scholar
  89. 89.
    Rosen RC, Catania JA, Ehrnhardt AA, et al. The Bolger conference on PDE-5 inhibition and HIV risk: implications for health policy and prevention. J Sex Med. 2006;3:960–75.PubMedGoogle Scholar
  90. 90.
    Marks G, Richardson JL, Milam J, Bolan R, Stoyanoff S, McCutchan A. Use of erectile dysfunction medication and unsafe sex among HIV+ men who have sex with men in care. Int J STD AIDS. 2005;16:271–2.PubMedGoogle Scholar
  91. 91.
    Cove J, Petrak J. Factors associated with sexual problems in HIV-positive gay men. Int J STD AIDS. 2004;15:732–6.PubMedGoogle Scholar
  92. 92.
    Grov C, Parsons JT, Bimbi DS. Sexual compulsivity and sexual risk in gay and bisexual men. Arch Sex Behav. 2010;39:940–9.PubMedGoogle Scholar
  93. 93.
    O’Leary A, Wolitski RJ, Remien RH, et al. Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men. AIDS. 2005;19:S67–75.PubMedGoogle Scholar
  94. 94.
    Halkitis PN, Green KA, Remien RH, et al. Seroconcordant sexual partnerings of HIV-seropositive men who have sex with men. AIDS. 2005;19:S77–86.PubMedGoogle Scholar
  95. 95.
    Kalichman SC, Greenberg J, Abel GG. HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention. AIDS Care. 1997;9:441–50.PubMedGoogle Scholar
  96. 96.
    Smolenski DJ, Ross MW, Risser JMH, Rosser BRS. Sexual compulsivity and high-risk sex among Latino men: the role of internalized homonegativity and gay organizations. AIDS Care. 2009;21:42–9.PubMedGoogle Scholar
  97. 97.
    WL Jeffries IV, Zsembik BA, Peek CW, Uphold CR. A longitudinal analysis of sociodemographic and health correlates of sexual health among HIV-infected men in the United States. Sex Health. 2009;6:285–92.Google Scholar
  98. 98.
    Richardson D, Lamba H, Goldmeier D, Nalabanda A, Harris JRW. Factors associated with sexual dysfunction in men with HIV infection. Int J STD AIDS. 2006;17:764–7.PubMedGoogle Scholar
  99. 99.
    Schrooten W, Colebunders R, Youle M, et al. Sexual dysfunction associated with protease inhibitor containing highly active antiretroviral treatment. AIDS. 2001;15:1019–23.PubMedGoogle Scholar
  100. 100.
    Lallemand F, Salhi Y, Linard F, Giami A, Rozenbaum W. Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors. J Acquir Immune Defic Syndr. 2002;30:187–90.PubMedGoogle Scholar
  101. 101.
    Trotta MP, Ammassari A, Murri R, et al. Self-reported sexual dysfunction is frequent among HIV-infected persons and is associated with suboptimal adherence to antiretrovirals. AIDS Patient Care STDs. 2008;22:291–9.PubMedGoogle Scholar
  102. 102.
    Harrison AE. Primary care of lesbian and gay patients: educating ourselves and our students. Fam Med. 1996;28:10–23.PubMedGoogle Scholar
  103. 103.
    Mimiaga MJ, Reisner SL, Bland S, et al. Health system and personal barriers resulting in decreased utilization of HIV and STD testing services among at-risk black men who have sex with men in Massachusetts. AIDS Patient Care STDs. 2009;23:825–35.PubMedGoogle Scholar
  104. 104.
    Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions among medical culture and healthcare among black men who have sex with men. J Natl Med Assoc. 2004;96:97–107.PubMedGoogle Scholar
  105. 105.
    Ramchand R, Fox CE. Access to optimal care among gay and bisexual men: identifying barriers and promoting culturally competent care. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008. p. 355–78.Google Scholar
  106. 106.
    Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health. 2010;31:457–77.PubMedGoogle Scholar
  107. 107.
    Hinchliff S, Gott M, Galena E. ‘I daresay I might find it embarrassing’: general practitioners’ perspectives on discussing sexual health issues with lesbian and gay patients. Health Soc Care Commun. 2005;13:345–53.Google Scholar
  108. 108.
    Kaiser Family Foundation. National Survey of Physicians Part I: doctors on disparities in medical care. 2002. Accessed 13 February 2011.
  109. 109.
    Mimiaga MJ, Reisner SL, Goldhammer H, Tetu AM, Belanoff C, Mayer KH. Sources of human immunodeficiency virus and sexually transmitted disease information and responses to prevention messages among Massachusetts men who have sex with men. Am J Health Promot. 2010;24:170–7.PubMedGoogle Scholar
  110. 110.
    Margolis AD, Wolitski RJ, Parsons JT, Gomez CA. Are healthcare providers talking to HIV-seropositive patients about safer sex? AIDS. 2001;15:2335–7.PubMedGoogle Scholar
  111. 111.
    Marks G, Richardson JL, Crepaz N, et al. Are HIV care providers talking with patients about safer sex and disclosure? A multi-clinic assessment. AIDS. 2002;16:1953–7.PubMedGoogle Scholar
  112. 112.
    Metsch LR, Pereyra M, del Rio C, et al. Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities. Am J Public Health. 2004;94:1186–92.PubMedGoogle Scholar
  113. 113.
    Hoover KW, Butler M, Workowski K, et al. STD screening of HIV-infected MSM in HIV clinics. Sex Transm Dis. 2010;37:771–6.PubMedGoogle Scholar
  114. 114.
    Dibble SL, Eliason MJ, Christiansen MAD. Chronic illness care for lesbian, gay and bisexual individuals. Nurs Clin N Am. 2007;42:655–74.Google Scholar
  115. 115.
    Garofalo R, Katz E. Health care issues of gay and lesbian youth. Curr Opin Pediatr. 2001;13:298–302.PubMedGoogle Scholar
  116. 116.
    Johnson CV, Mimiaga MJ, Bradford J. Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: introduction. J Homosex. 2008;54:213–24.PubMedGoogle Scholar
  117. 117.
    Sharpe TT, Harrison KM, Dean HD. Summary of CDC consultation to address social determinants of health for the prevention of disparities in HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis. Public Health Rep. 2010;125:11–5.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  1. 1.Division of HIV/AIDS PreventionNational Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.National Center for HIV, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations