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Research notes how geographic location could influence HIV transmission among gay, bisexual men

There is an established link between levels of homophobic discrimination and depression, substance abuse and HIV vulnerability in gay men. And these may be affected by where you are.

Recent research in Culture, Health & Sexuality by Keene et al introduces a new spatial dimension by looking at degrees of sexual minority stigma and health in different cities. Their insights show how geographic location could influence HIV transmission among gay and bisexual men.

Many gay men migrate to large cities in pursuit of known accepting communities with visible gay spaces for open socializing and sexualizing, far from stigmatized home towns. However, at least in the US, the majority of citizens live in small cities and most HIV cases occur outside the 12 major US cities. Keene et al set out to discover more about gay migrations to and from small cities spaces and how stigma impacts mobility and sexual health.

Twenty-nine gay and bisexual men living in two small Connecticut cities were interviewed in relation to sexual networking, travel, risk behaviors and health. Connecticut is a progressive state with legalized gay marriage and a supportive cultural and political network. Many described their journey to Connecticut as freedom from critical family and community and an opportunity to express themselves in a sympathetic environment. On the other hand the acceptance seemed limited to contained ‘safe zones’, usually gay bars, and participants had to exercise caution about public displays of affection or revealing sexual identity outside these spaces. Others reported racial segregations and town vs. gown divides in the gay community, hence ‘safe zones’ were not equally accessible to all.

As a result many gay men aspired to leave Connecticut for a bigger pond and greater freedom, as one participant exclaimed: “In New York, I let my hair down because New York – I love New York … I mean you know you just be yourself.” Others went on regular sabbatical to larger cities for a break from the constraints of “the local dive bar”.

The behaviors showed a trend of abandonment of more cautious sexual norms by engaging in risky sexual encounters with relative strangers.

The authors conclude that gay mobility may “invoke a vacation mentality free from the constraints of local scrutiny and judgment…(the)…intersection of sex and mobility might circumvent one’s otherwise health-promoting goals formed in a specific place, thus leading to decreases in protective behavior and increases in sexual risk”.

The authors note promising interventions such as use of pre-exposure prophylaxis as a way to reduce HIV transmission and stress the importance of spatial dynamics in understanding and improving health outcomes for the sexually stigmatized.

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