Mental Health and Sexual Health

  • Rusi JaspalEmail author


In this chapter, the reciprocal relationship between mental health and sexual health is outlined. Social stigma and its impact for identity processes are considered. Following a discussion of key empirical research into mental and sexual health among gay men, a model for predicting health outcomes and preventing poor mental and sexual health in this population is described. This chapter explores the epidemiological, psychological and socio-structural factors that can impinge on health outcomes in gay men.


Mental health HIV Sexual health Psychological trauma 


  1. Adams, C., Zacharia, S., Masters, L., Coffey, C., & Catalan, P. (2016). Mental health problems in people living with HIV: Changes in the last two decades—The London experience 1990–2014. AIDS Care, 28(Suppl. 1), 56–59.Google Scholar
  2. Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., … iPrex Study Team. (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine, 4, 151ra25.Google Scholar
  3. BHIVA. (2012). Standards of care for people living with HIV 2013. London: Mediscript Limited.Google Scholar
  4. Bourne, A., Dodds, C., Keogh, P., & Weatherburn, P. (2016). Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV. Journal of Health Psychology, 21(11), 2562–2571.CrossRefGoogle Scholar
  5. Breakwell, G. M. (1986). Coping with threatened identities. London: Methuen.Google Scholar
  6. Brown, A. E, Mohammed, H., Ogaz, D., Kirwan, P. D., Yung, M., Nash, S. G., … Gill, O. N. (2017). Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: Testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveillance, 22(25), 30553.
  7. Cohen, J. M., Blasey, C., Taylor, C. B., Weiss, B. J., & Newman, M. G. (2016). Anxiety and related in disorders and concealment in sexual minority young adults. Behavior Therapy, 47(1), 91–101.CrossRefGoogle Scholar
  8. Courtenay-Quirk, C., Wolitski, R. J., Parsons, J. T., Gomez, C. A., & Seropositive Urban Men’s Study Team. (2006). Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men. AIDS Education and Prevention, 18(1), 56–67.Google Scholar
  9. Daramilas, C., & Jaspal, R. (2016). HIV diagnosis and identity processes among men who have sex with men (MSM) in London, Athens and New York. Social Psychological Review, 18(2), 6–16.Google Scholar
  10. Ferlatte, O., Dulai, J., Hottes, T. S., Trussler, T., & Marchard, R. (2015). Suicide related ideation and behavior among Canadian gay and bisexual men: A syndemic analysis. BMC Public Health, 15, 597. Scholar
  11. Gamarel, K. E., Reisner, S. L., Parsons, J. T., & Golub, S. A. (2012). Association between socioeconomic position discrimination and psychological distress: Findings from a community-based sample of gay and bisexual men in New York City. American Journal of Public Health, 102(11), 2094–2101.Google Scholar
  12. Guasp, A. (2013). Gay Men’s Health Survey. London: Stonewall. Accessed on 29 March 2019.
  13. Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., … Clayton, P. J. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51.CrossRefGoogle Scholar
  14. Hart, T. A., Noor, S. W., Tulloch, T. G., Sivagnanasunderam, B., Vernon, J. R. G., Pantalone, D. W., . . . Calzavara, L. (2019). The gender nonconformity teasing scale for gay and bisexual men. Psychology of Men & Masculinities, 20(3), 445–457.CrossRefGoogle Scholar
  15. Hatzenbuehler, M. L., Nolen-Hoeksema, S., & Erickson, S. J. (2008). Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology, 27(4), 455–462.Google Scholar
  16. Hickson, F., Melendez-Torres, G. J., Reid, D., & Weatherburn, P. (2017). HIV, sexual risk and ethnicity among gay and bisexual men in England: Survey evidence for persisting health inequalities. Sexually Transmitted Infections, 93(7), 508–513.CrossRefGoogle Scholar
  17. Hughes, E., Bassi, S., Gilbody, S., Bland, M., & Martin, F. (2016). Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: A systematic review and meta-analysis. Lancet Psychiatry, 3(1), 40–48.CrossRefGoogle Scholar
  18. Jaspal, R. (2018a). Enhancing sexual health, self-identity and wellbeing among men who have sex with men: A guide for practitioners. London: Jessica Kingsley Publishers.Google Scholar
  19. Jaspal, R. (2018b). Perceptions of HIV testing venues among men who have sex with men in London and the Midlands, UK. Journal of Gay & Lesbian Social Services, 30(4), 336–355.CrossRefGoogle Scholar
  20. Jaspal, R., & Cinnirella, M. (2010). Media representations of British Muslims and hybridised threats to identity. Contemporary Islam: Dynamics of Muslim Life, 4(3), 289–310.Google Scholar
  21. Jaspal, R., & Daramilas, C. (2016). Perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative and HIV-positive men who have sex with men. Cogent Medicine, 3, 1256850. Scholar
  22. Jaspal, R., Lopes, B., Bayley, J., & Papaloukas, P. (2019). A structural equation model to predict the acceptability of pre-exposure prophylaxis in men who have sex with men in Leicester, UK. HIV Medicine, 20(1), 11–18.Google Scholar
  23. Jaspal, R., Lopes, B., Jamal, Z., Paccoud, I., & Sekhon, P. (2017). Sexual abuse and HIV risk behaviour among black and minority ethnic men who have sex with men in the UK. Mental Health, Religion & Culture, 20(8), 841–853.CrossRefGoogle Scholar
  24. Jaspal, R., Lopes, B., & Rehman, Z. (2019, September 6). Depressive psychopathology in black & minority ethnic gay, lesbian & bisexual people in the UK. Paper presented at the 33rd Annual Conference of the European Health Psychology Society.
  25. Jaspal, R., & Nerlich, B. (2017). Polarised reporting about HIV prevention: Social representations of pre-exposure prophylaxis (PrEP) in the UK press. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 21(5), 478–497.Google Scholar
  26. Jaspal, R., & Williamson, I. (2017). Identity management strategies among HIV-positive Colombian gay men in London. Culture, Health and Sexuality: An International Journal for Research, Intervention and Care, 19(2), 1374–1388.CrossRefGoogle Scholar
  27. Joffe, H. (2007). Identity, self-control, and risk. In G. Moloney & I. Walker (Eds.), Social representations and identity. New York: Palgrave Macmillan.Google Scholar
  28. Krumme, A. A., Kaigamba, F., Binagwaho, A., Murray, M. B., Rich, M. L., & Franke, M. F. (2015). Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. Journal of Epidemiology & Community Health, 69, 284–289.CrossRefGoogle Scholar
  29. Marmara, J., Hosking, W., & Lyons, A. (2018). Body image disturbances as predictors of reduced mental health among Australian gay men: Being in a relationship does not serve as a protective factor. Archives of Sexual Behavior, 47, 2467–2479.Google Scholar
  30. McCall, H., Adams, N., Mason, D., & Willis, J. (2015). What is chemsex and why does it matter? British Medical Journal, 351, 2.
  31. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefGoogle Scholar
  32. Meyer, I. H., Dietrich, J., & Schwartz, S. (2008). Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. American Journal of Public Health, 98(6), 1004–1006.Google Scholar
  33. Millett, G. A., Peterson, J. L., Flores, S. A., Hart, T. A., Jeffries, W. L., 4th, Wilson, P. A., … Remis, R. S. (2012). Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. The Lancet, 380(9839), 341–348.CrossRefGoogle Scholar
  34. Pachankis, J. E., Sullivan, T. J., Feinstein, B. A., & Newcomb, M. E. (2018). Young adult gay and bisexual men’s stigma experiences and mental health: An 8-year longitudinal study. Developmental Psychology, 54(7), 1381–1393.CrossRefGoogle Scholar
  35. Public Health England. (2015). National HIV surveillance data tables. Accessed on 29 March 2019.
  36. Public Health England. (2017, June 9). Sexually transmitted infections and Chlamydia screening in England 2016. Health Protection Report, 11(20). Accessed on 29 March 2019.
  37. Punyacharoensin, N., Edmunds, W. J., De Angelis, D., Delpech, V., Hart, G., Elford, J., … White, R. G. (2016). Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: A mathematical modelling study. Lancet HIV, 3, e94–104.CrossRefGoogle Scholar
  38. Robinson, P., Turk, D., Jilka, S., & Cella, M. (2019). Measuring attitudes towards mental health using social media: Investigating stigma and trivialisation. Social Psychiatry and Psychiatric Epidemiology, 54(1), 51–58.Google Scholar
  39. Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., van Lunzen, J., … the PARTNER study group. (2016). Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 316(2), 1–11.CrossRefGoogle Scholar
  40. Salfas, B., Rendina, H. J., & Parsons, J. T. (2018). What is the role of the community? Examining minority stress processes among gay and bisexual men. Stigma and Health. Advance online publication. Scholar
  41. Salway, T., Ferlatte, O., Purdie, A., Shoveller, J., Trussler, T., & Gilbert, M. (2018). Healthcare engagement among gay and bisexual men with recent suicide ideation or attempts. American Journal of Orthopsychiatry, 88(6), 713–722.Google Scholar
  42. Sandfort, T. G., Bakker, F., Schellevis, F. G., & Vanwesenbeeck, I. (2006). Sexual orientation and mental and physical health status: Findings from a Dutch population survey. American Journal of Public Health, 96(6), 1119–1125.Google Scholar
  43. Sattler, F. A., & Christiansen, H. (2017). How do discrepancies between victimization and rejection expectations in gay and bisexual men relate to mental health problems? Frontiers in Psychology, 8, 857.
  44. Sin, N. L., & DiMatteo, M. R. (2014). Depression treatment enhances adherence to antiretroviral therapy: A meta-analysis. Annals of Behavioral Medicine, 47(3), 259–269.CrossRefGoogle Scholar
  45. Soni, S., Bond, K., Fox, E., Grieve, A. P., & Sethi, G. (2008). Black and minority ethnic men who have sex with men: A London genitourinary medicine clinic experience. International Journal of STD and AIDS, 19(9), 617–619.Google Scholar
  46. Sweeney, S. M., & Venables, P. A. (2016). The association of HIV-related stigma to HIV medication adherence: A systematic review and synthesis of the literature. AIDS & Behavior, 20(1), 29–50.CrossRefGoogle Scholar
  47. The Insight Start Study Group. (2015). Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine, 373, 795–807.Google Scholar
  48. UNAIDS. (2017). Ending AIDS: Progress towards the 90-90-90 targets. Joint United Nations Programme on HIV/AIDS (UNAIDS). Accessed on 13 September 2017.
  49. United Kingdom Collaborative HIV Cohort Study Group. (2012). Uptake and outcome of combination antiretroviral therapy in men who have sex with men according to ethnic group: The UK CHIC Study. Journal of Acquired Immune Deficiency Syndromes, 59(5), 523–529.Google Scholar
  50. Williamson, I., Papaloukas, P., Jaspal, R., & Lund, B. (2018). Here’s this glorious pill: Gay and bisexual men in the English Midlands navigate risk and responsibility in the age of pre-exposure prophylaxis. Critical Public Health.
  51. Wilkinson, A. L., Draper, B. L., Pedrana, A. E., Holt, M., Hellard, M. E., & Stoové, M. (2018). Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses. Sexually Transmitted Infections, 94, 309–314.Google Scholar
  52. World Health Organization. (2001). Strengthening mental health promotion (Fact sheet No. 220). Geneva: World Health Organization.Google Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.De Montfort UniversityLeicesterUK

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