Homosexual Males and HIV: Issues of Risky Sexual Behaviour and Barriers to Testing

Homosexual male and Human Immunodeficiency Virus

The human immunodeficiency virus (HIV) is an infection that is progressive in nature and causes immune system failure that allows the carrier to be susceptible to more life-threatening diseases. Men who have sex with men (MSM) have higher incidences of HIV than men who have sex with women. The Centers for Disease Control and Prevention (2017) reported that men who have sex with men make up seventy percent of newly diagnoses of HIV in the United States, making them the population most affected by HIV. Legal, ethical, and psychosocial aspects are variables that would affect the population of MSM in acquiring HIV. Implemented strategies such as targeted yet non-identify testing to allow privacy, testing options in a variety of areas, and education of sexual behaviors could increase HIV testing (Nelson, Pantalone, Gamarel, Carey, & Simoni, 2018). When compared to heterosexual males, homosexual males demonstrate an increased incidence of human immunodeficiency virus due to risky sexual behavior and barriers to being tested.

Background

Statistical Background

Men who have sex with men make up two to five percent of the population (Tarmann, 2019). However, this figure may well be underestimated. The decision of the U.S. Supreme Court to provide marriages between members of the same sex with the same constitutional protection as traditional marriages were supposed to increase tolerance among Americans. Nonetheless, they are still many homophobic people in the United States. Despite improved attitudes toward homosexuality, numerous people who are afraid to acknowledge their belonging to sexual minorities. Many of them would not respond to an anonymous survey so determining an actual statistic is rather difficult. Furthermore, sexual minorities often oppress the self by having internalized homophobia, which is negative attitudes toward homosexuality and themselves (Katz-Wise, Rosario, & Tsappis, 2016). Therefore, it is impossible to pinpoint the number of gays in the United States.

Legal Concern

A legal concern with the MSM would be encountering being denied the purchase of wedding cakes. Since the legalization of same-sex marriage in all American states there have been several cases where bakeries have refused gay couples to purchase a wedding cake. For instance, in July 2012, Charlie Craig and David Mullins decided to order a cake for their wedding from the popular Lakewood, Colorado pastry chef Jack Philips, the owner of Masterpiece Cakeshop (Smith & Graves, 2018). Phillips, a deeply religious Christian, refused to make a special cake, offering Craig and Mullins to buy one of his ready-made ones. In December 2017, the case came to the U.S. Supreme Court, and in 2018, the Supreme Court ruled in favor of Philips with seven votes to two. The text of the court decision states that the baker's case is a particular case and cannot be used to discriminate against members of the homosexual community (Smith & Graves, 2018). Thus, the U.S. Supreme Court decided that individuals can legally refuse to service same-sex couples due to their religious beliefs.

Ethical Concern

An ethical issue arises when the MSM population is subjected to conversion therapy. Conversion therapy is a set of techniques aimed at changing the sexual orientation of a person from homosexual to heterosexual. The ethics and effectiveness of such procedures are highly controversial. Most medical professionals warn that attempts to change a person's sexual orientation are inefficient and pose a potential danger to the psyche as cited in Moleiro & Pinto (2014). Moreover, conversion therapy is a broad term that encompasses many methods, many of which are be extremely dangerous. In particular, conversion therapy often includes not only spiritual interventions and conversational therapies, but also medications and extreme physical methods such as electroshock therapy, methods of suggestion of repulsion, and even corrective rape (Marven, 2019). All these methods share the unethical assumption that belonging to homosexual people is a condition that requires treatment.

Psychosocial Concern

A psychosocial concern with the population of MSM would be the stigmatization. This term means linking some quality, usually a negative one, with an individual person or a group of people even when the connection is absent or not proven. The source of stereotypes is stigmatization which is an integral part. For example, men who have sex with men are sometimes equated with pedophiles. Although the World Health Organization and other respected and influential organizations do not consider homosexuality as an illness, some individuals are still of the opinion that homosexuality is a psychological deviation. Due to stigmatization, gays face harassment, bullying, and exclusion in schools and colleges (Mallory, Brown, Russell, & Sears, 2017). Hence, stereotypes and rejection can cause significant psychological trauma for homosexuals.

Health Concern

Description of Health Concern

Human Immunodeficiency Virus (HIV) is a virus that kills the cells that provide immunity against infection, leaving the person more susceptible to more diseases and infections (Centers for Disease Control and Prevention, 2019). HIV begins to damage the immune system by destroying CD4 cells. CD4 cells are white blood cell which are responsible for protecting the body from infections. Using the CD4 cells, HIV multiplies and then spreads the disease throughout the body. This process is carried out in seven stages and is known as the HIV life cycle (National Institute of Allergy and Infectious Diseases, 2019). The HIV infected body contains too few cells to defeat the infection and too many cells that cause the immune system that fights the infection to stop functioning. This is one of the main reasons why HIV patients develop so many other infections and diseases.

In 2017, 38,739 people were diagnosed with HIV in the United States (Centers for Disease Control and Prevention, 2019). Overall, it is estimated that there are approximately 1.15 million adult and adolescent Americans living with HIV. Homosexuals remain one of the most vulnerable social groups for HIV infection. Homosexual and bisexual men account for over seventy percent of HIV diagnoses among males (Centers for Disease Control and Prevention, 2019). Men who have sex with men account for two-thirds of all HIV diagnoses. Consequently, a homosexual lifestyle is associated with an extremely high degree of risk and often leads to illness and even death.

Risk Factors

The primary risk factor that causes males who have sex with males to have increased incidences of HIV is risky sexual behavior. Firstly, gay men have a considerably higher number of sexual partners throughout their life (Friedman, 2014). Secondly, men who have sex with men are not at risk of experiencing pregnancy. And lastly, they are less likely to use a condom during sexual intercourse (Hernández-Romieu, Siegler, Sullivan, Crosby, & Rosenberg, 2014), which also increases the risk of transmission However, risky sexual behavior is not the only risk factor that increases the spread of HIV among homosexual men.  

MSM have a higher incidence of HIV due to barriers to being tested. The crucial barrier to HIV testing identified by homosexual males was a lack of awareness regarding testing for HIV (Pharr, Lough, & Ezeanolue, 2015). Another significant barrier to HIV testing is stigma and discrimination. MSM have the anxiety of being exposed to the society in getting HIV-related services. In addition, if the diagnosis is confirmed, MSM worry that close people will learn about their status and stop communication (Pharr, Lough, & Ezeanolue, 2015). Thus, barriers of being tested are another critical factor that provokes HIV among MSM.

Etiology

HIV is an incurable virus that is transmitted through bodily fluids. In the United States, HIV is mainly spread through anal or vaginal sex without the use of a condom (Centers for Disease Control and Prevention, 2019). The source of infection is infected people, regardless of the stage of the disease and the clinical manifestations of the disease. Besides the main route of sexual transmission, one can get the virus through the blood. For example, HIV can be transmitted through transfusion of blood and its components, or from mother to child (World Health Organization, 2019). Therefore, different bodily fluids can transmit HIV. 

Signs and Symptoms Associated with Health Concern

Signs and symptoms of HIV depend on the stage of the disease process. Most of those who are infected with HIV will not experience any symptoms. Sometimes a few weeks after infection, a condition like the flu develops, namely an increase in temperature and the appearance of rashes on the skin (World Health Organization, 2019). It’s often the case that a person with HIV will feel healthy years after being infected, this period is known as the latent stage. Following these stages, the total duration of which may vary, the symptomatic chronic phase of HIV infection begins. It is characterized by various infections of a viral, bacterial, and fungal nature, which are treated with conventional therapeutic agents. Then these changes become more severe and cease to respond to standard methods of treatment. A person loses body weight and has a fever, night sweats, and diarrhea (World Health Organization, 2019).The severity and progression of the disease will increase immunosuppression; therefore, the person will develop infections that will ultimately lead to death.

Evidence-Based Management

Although HIV is incurable, it is managed by a combination of HIV medications. To date, there is no vaccine against HIV, which makes this disease relatively dangerous. Without medical intervention, the virus causes the death of the patient. Nevertheless, it should be noted that with specialized therapy, life expectancy can be extended to indicators of the general population (Trickey et al., 2017). One of the most effective technologies is antiretroviral therapy (ART). As a rule, a treatment regimen consists of a combination of several, usually three or more ART drugs (World Health Organization, 2019). They must be taken at the same time to reduce the concentration of the virus in the blood, increase the number of CD4 cells, and prevent the development of the virus resistance to ARV drugs (World Health Organization, 2019).

Plan of Care

The plan of care for the MSM population would be developing alternative tools for HIV testing. It was identified that barriers to HIV testing are an essential risk factor leading to higher rates of HIV disease among homosexual individuals. The different testing options and services provided, including a community-based approach to testing and home testing, can help alleviate many of the logistical, structural, and social barriers to HIV testing (United Nations Programme on HIV and AIDS, 2018). Firstly, new testing approaches should include methods that are suitable for people living far from health care providers. Secondly, they should have no time limits, which is especially important for men. Lastly, they should be free from the stigma and discrimination that often accompany traditional HIV services.

Conclusion

Considering the above, it can be concluded that men who have sex with men are a vulnerable population in many regards, including legal, ethical, and psychosocial that would result in a disproportion HIV health disparity. Two primary reasons for increased incidents of human immunodeficiency virus among homosexual males are risky sexual behavior and barriers of being tested.  The role of the nurse is vital in decreasing incidences of HIV for those populations that are most vulnerable. One of the most effective ways would be developing alternative tools for HIV testing.

References

• Centers for Disease Control and Prevention (2019, October 18). HIV and gay and bisexual men.
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• Marven, L. (2019, June 19). Conversion therapy is sexual violence. Retrieved from https://www.nsvrc.org/blogs/conversion-therapy-sexual-violence
• Moleiro, C., & Pinto, N. (2015). Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems. Frontiers in Psychology, 6, 1511. doi:10.3389/fpsyg.2015.01511
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• Nelson, K. M., Pantalone, D. W., Gamarel, K. E., Carey, M. P., Simoni, J. M., (2018). Correlates of never testing for HIV among sexually active internet-recruited gay, bisexual, and other men who have sex with men in the United States. AIDS Patient Care and STDs, 32(1), 9-15. doi:10.1089/apc.2017.0244
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