In the seminal 1998 American Psychologist article, Walter Batchelor warned that “AIDS still attacks homosexual and bisexual men in great numbers” (p. However, despite the fact that the disease no longer remains confined solely to gay and bisexual men, the reality is that this segment of the population is the one most affected by this epidemic. Two generations later, GRID has evolved into what we have come to know as HIV/AIDS. With bewilderment and fear, I read Robert Altman’s (1981) account of “doctors in New York and California have diagnosed among homosexual men 41 cases of a rare and often rapidly fatal form of cancer.” In the following years, I witnessed the eruption of the disease, which in its early years was given the name GRID (gayrelated immunodeficiency disease) because of its omnipresence in the gay population (Shilts, 2007 Weeks & Alcamo, 2010). I first became aware of this phenomenon as I sat on the beach reading The New York Times the summer before my freshman year at Columbia University. In the now historic document, which recently reached its 30th anniversary, the CDC (1981) reported five cases of Pneumocystis carinii pneumonia in young gay men who otherwise should have been healthy. This topic will be considered from the theoretical perspective of minority stress theory, with attention to (a) how clinicians can effectively address these social burdens with their clients, (b) the work of AIDS service organizations, and (c) policy in light of the National HIV/AIDS Strategy for the United States (Office of National AIDS Policy, 2010). Since discrimination based on sexual identity is critical to the ideas being put forth, and since the HIV prevention needs of gay and bisexual men differ widely from those of non-gay or bisexual MSM (Halkitis, 2010b), the focus of this issue of the newsletter is on gay and bisexual men, and not MSM in general. Such health vulnerabilities driven by homophobia are often exacerbated for gay and bisexual men of color, who are often further burdened by the social circumstances of racism and poverty. In this article, consideration is given to the manner through which discrimination and homophobia, which may have been heightened because of the AIDS epidemic (Halkitis, 1999), perpetuate HIV vulnerabilities for gay and bisexual men. Of particular relevance to HIV prevention among gay and bisexual men are the social conditions that place us at heightened risk for acquiring HIV as compared to our heterosexual counterparts. Despite clear evidence for the social determinants of HIV transmission and the beneficial effects of structural interventions (Adimora & Auerbach, 2010), there have been limited efforts targeting these social inequalities, which place gay and bisexual men at greater risk for the acquisition of HIV disease. The CDC recently delineated the significance of social determinants of health, stating that “while effective interventions that address individual risk factors and behaviors exist, to ensure good health in all communities requires a broader portfolio that looks at social and environmental factors as well” (CDC, 2010, p. In response to these alarming health disparities among gay and bisexual men, there has been a call to broaden the prevention lens to examine the influence of multiple social and contextual factors influencing health behaviors (Halkitis & Cahill, 2011). Yet even these medical advances are fraught with their own complications, not least of which are matters of uptake and adherence. In this biomedical approach, the early detection and treatment of HIV have been recommended policy for the last several years (CDC, 2006 Workowski & Berman, 2006) as a way to decrease community viral load. More recently, with the game-changing breakthroughs in the biomedical arena, attention has shifted to these biomedical prevention strategies, which include preexposure prophylaxis (PrEP) for gay, bisexual, and other MSM (Grant et al., 2010) and vaginal microbicides for women (Abdool et al., 2010). In fact, gay, bisexual, and other MSM acquire HIV at rates 44 times greater than other men and 40 times greater than women (CDC, 2011a). In addition, the population of men who have sex with men (MSM) has continued to be the only risk category for which new infections are rising (Hall et al., 2008). These approaches, rooted primarily in social-cognitive frameworks (Halkitis, 2010b), have resulted in maintaining new infections in the United States at a steady state for the last decade (Centers for Disease Control and Prevention, 2011b). Over the last 30 years, efforts to prevent new HIV infections among gay and bisexual men have been guided by paradigms that hold individuals responsible for their health behaviors. Steinhardt School of Culture, Education and Human Development, New York University
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