The AIDS crisis in the U.S. redefined healthcare for gay, bisexual and men who have sex with men as trauma-based emergency care. Prior to the current range of PrEP (pre-exposure prophylaxis) drugs, an HIV diagnosis, with full-blown AIDS the next phase, was often a death sentence. But in this era of PrEP, are gay, bi, and trans men, and men who have sex with men (MSM), getting appropriate healthcare for their non-HIV needs?
The recent mpox outbreak suggests that healthcare for GBT men and MSM is still limited to crisis management and that stigmas attach to this group of men that do not attach to cis-het men. Everyone failed men with mpox — including the federal government, which was revealed to have no control over its own vaccine stockpile, and the Centers for Disease Control and Prevention (CDC), which was slow to respond to the needs of the GBT community during the height of the outbreak last year.
GBT men and MSM are at constant risk of a plethora of avoidable and controllable health issues, including heart disease, diabetes and cancer. For this series PGN spoke with GBT men between the ages of 23 and 75 about their health, the health crises they had faced, and about how well they felt the healthcare system was treating them and addressing their needs within their sexual orientation and gender identity. PGN also spoke with healthcare providers about what’s needed to provide the best care for GBT men.
PGN discovered that even going to a healthcare provider was still difficult for most men and that the attitude overall was that they didn’t “need” to go to the doctor unless they were ill. In addition, dealing with medical professionals who were not GBT themselves was difficult and uncomfortable and at times, felt discriminatory, and even abusive for many men. Yet studies show that preventative care is a life-saver for men and that even small changes in lifestyle can increase both life expectancy for men and quality of life — making regular healthcare essential to good health.
Studies are disturbingly clear: despite a myriad of advances in medical science and available treatment protocols, men live sicker lives and die younger than women, on average by over five years. More babies assigned male at birth are born every year, yet by as early as age 35, women outnumber men demographically. This gap only widens with age: 57% of all those ages 65 and older are female; 65% of people over age 80 are women.
Women are twice as likely to get preventative health care. Basic preventative health care is blood pressure, cholesterol and blood sugar checks, sigmoidoscopy and colonoscopy, flu shots, and annual or semi-annual dental checkup. Men are more likely to have high blood pressure and diabetes, both of which can lead to serious health concerns and in some cases death.
Men not getting necessary preventive care leads to missed opportunities for early detection and treatment for a range of conditions, including the top two causes of death for men: cardiovascular disease and cancer.
Social and cultural differences also play a part. Men are more likely to have high-risk jobs, die of heart disease more often and at a younger age (men are 50% more likely than women to die of heart disease), commit suicide more often than women, and be less socially connected; all are contributing factors to illness and death that are largely avoidable. Since men tend to avoid medical care far more often than women, getting men to report symptoms (including depression) and go for regular follow-up for chronic medical problems (high blood pressure) could increase quality of life and life expectancy.
The CDC leads with STIs as their main concern for “gay, bisexual, and other men who have sex with men.” CDC says, “For all men, heart disease and cancer are the leading causes of death. However, compared to other men, gay, bisexual and other men who have sex with men are additionally affected by: Higher rates of HIV and other sexually transmitted diseases (STDs); tobacco and drug use; depression.”
The CDC explains: “Prevalence of HIV among sexual partners of gay, bisexual, and other men who have sex with men is 40 times that of sexual partners of heterosexual men; receptive anal sex is 18 times more risky for HIV acquisition than receptive vaginal sex; gay, bisexual, and other men who have sex with men on average have a greater number of lifetime sexual partners.”
But CDC also says other factors related to being GBT can negatively impact men’s health and ability to receive appropriate care. PGN found that GBT men agreed with this assessment. The CDC states risk factors including “Homophobia; stigma (negative and usually unfair beliefs); discrimination (unfairly treating a person or group of people differently); lack of access to culturally- and orientation-appropriate medical and support services; heightened concerns about confidentiality; fear of losing your job; fear of talking about your sexual practices or orientation.”
Michelangelo Signorile has been one of the best-known queer journalists and gay activists in the U.S. for decades. His 1993 book “Queer in America: Sex, The Media, and the Closets of Power” jettisoned him from co-founding editor of the groundbreaking OutWeek magazine to mainstream media. As host of the Michelangelo Signorile Show on SiriusXM every day from 3 to 6, he’s the only national queer voice in the country that people are listening to daily. Even Secretary Pete doesn’t have such a captive audience.
In an interview with PGN, Signorile talked at length about gay men’s health, about how little we discuss this as a community and a society, his concerns about educating men about various threats to their health, including but not limited to HIV and healthcare access. Signorile also talked about his diagnosis and treatment for prostate cancer.
Signorile was diagnosed with prostate cancer in September of 2021 at the age of 60 after several months of tests, beginning with the common PSA blood test that is an early, non-invasive check for prostate cancer. Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis.
Signorile said the two weeks it took for the results of a biopsy to come back were “among the worst two weeks of anxiety I’ve ever had. And then when the doctor called with the news, my heart sank. I was terrified my life was going to dramatically change, only having read some of the worst-case scenarios online.”
Most prostate cancers grow very slowly. The current medical standard is to do surveillance and do PSA tests every few months. Prostate cancer is not a death sentence in most cases, but early detection and monitoring are key. The American Cancer Society notes that “prostate cancer is the most common cancer among men, but it can often be treated successfully.” Risk factors include age and race. Prostate cancer is rare in men younger than 40, but the chance of having prostate cancer rises rapidly after age 50, and ACS says about 6 in 10 cases of prostate cancer are in men older than 60.
Prostate cancer also develops more often in Black men and in Caribbean men of African ancestry than in men of other races. Black men who get prostate cancer tend to be younger. Prostate cancer is also most common in the U.S. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease.
For Signorile, the diagnosis meant not just researching and deciding on a treatment plan, but speaking out about his diagnosis. He said, “My entire life as a queer activist and journalist, and certainly as an AIDS activist, has been about being open and using my own experience to help inform others.”
He said, “There was no way I could not be public about it. I knew that I could inform many, as I had so many fears myself that dissipated once I learned about prostate cancer and about treatments — and I considered myself relatively informed — so going public was something I knew would do a world of good in getting people to get tested and treated, and overcome fears. Cancer, and treatments for it, need to be demystified.”
Next week: are gay, bi and MSM being failed by the healthcare system?