Gay men and primary care: the issues discussed in JAMA editorial

Authors in a special men’s health edition of the Journal of the American Medical Association published on November 14^th, examine ways in which the healthcare needs of gay men can be addressed in primary care. Although the article was written with United States' general practice in mind, some of its recommendations nevertheless seem appropriate for the United Kingdom, particularly as there are proposals for the routine care of HIV-positive individuals to be transferred to general practice, and because many gay men presenting with symptoms of HIV to general practice often have their diagnosis missed.

For the past quarter of a century, healthcare providers working with gay men (or men who have sex with other men and do not identify as gay or bisexual) have been preoccupied with HIV. Even though potent anti-HIV therapy can mean a longer, healthier life, HIV remains a significant health concern for gay men in the United States and other western countries today. In the US, an estimated 200,000 men became infected with HIV due to sex with another man, and it’s estimated that a further 20,000 men will acquire the infection due to sex with another man in 2006. Although the number of HIV infections in the UK is smaller, gay men are still the group most affected by HIV, and there has been a steady increase in the number of new infections involving gay men in the UK each year since the late 1990s onwards.

But despite the attention given to HIV, the authors stress the importance of remembering that, even in city’s with large gay populations and a high HIV prevalence, the overwhelming majority of gay men remain HIV-negative. They also stress that it is equally important to remember that all gay men, regardless of their HIV status, have healthcare needs that are the same as other men, and that primary healthcare services that are devoid of prejudice, judgment and homophobia need to be provided to ensure that gay men access the care and treatment that they need.

Yet the authors note that gay men are likely to have some healthcare needs addition to those of most heterosexual men. These include regular screening for sexually transmitted infections, hepatitis A and B vaccination, screening for cancerous and pre-cancerous cell changes in the anus caused by strains of the human papilloma virus, problematic drug or alcohol problems, increased mental health needs, support dealing with stigma, and help forming a positive identity in the face of prejudice and discrimination, particularly during the “coming out process.”

“Straightforward, non-judgmental” discussions should, the authors recommend, take place in primary care regarding these issues. The authors also emphasise that GP practices should also ensure that they have an environment that makes gay men feel comfortable. For example, there should be “inclusive” health information provided and questions about “next of kin” should not be restricted to blood relatives or opposite-sex partners.

The authors conclude, “much work remains to determine how to help gay men and non-gay-identified MSM engage in healthy lives that include embracing a positive image and minimising sexual risk. Despite the complexities involved and the need for further research, clinicians can listen to these patients openly and without judgment and become better educated about current recommendations for the care of gay or other MSM.”