Structural change in gay communities in developed countries: impact on STI/HIV prevention and research
Issues: Since the mid-1990s, sexual risk behaviors and STI/HIV rates have risen among men who have sex with men (MSM) in developed countries. While studies have identified individual-level factors impeding STI/HIV prevention, few have investigated the impact of structural factors on MSM-focused STI/HIV prevention.
Methods: In 2007, we used a structured focus group format to interview 29 STI/HIV prevention experts, researchers, and gay community leaders from 19 cities in Western Europe, Eastern Europe, North America, Australasia and South Africa. Participants were asked: 1) to describe changes, if any, in their urban gay communities; 2) to identify potential factors influencing those changes; and 3) to discuss the possible impact on future STI/HIV prevention services for MSM.
Results: Across almost all cities, participants reported a consistent pattern. While the size of the gay population in developed cities appears stable or growing, gay physical communities appear in decline. Identified changes include: 1) integration of heterosexuals into historically gay-identified neighborhoods and movement of gay persons into suburbs; 2) decreased infrastructure including number of and attendance at gay bars/clubs; 3) declining participation in gay events; 4) less volunteerism in gay or HIV/AIDS organizations; and 5) an overall decline in gay community visibility. Participants attributed the structural change to gay neighborhood gentrification/urban economics, the dominance of the online gay community, and increasing civil rights/declining discrimination.
Conclusions: Changes at the community level have important implications for STI/HIV prevention. As segments of the gay community diverge, prevention strategies should rely less on community-based interventions as STI/HIV prevention and health services based in gay neighborhoods are likely to become under-utilized. To promote STI/HIV prevention in MSM, new strategies should be considered such as over-the-counter testing supplemented by web-based support services. Findings of informants suggest that a multi-factorial, ecological approach to studying this challenge is needed for future STI/HIV prevention directives.
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