The Numbers Don't Lie

Most gay men are astonishingly resilient.

Posted Oct 04, 2017

As we mark another October LGBT History Month, it doesn’t take scientists telling us gay men to convince us of something we know all too well: being beaten up and put down leads to depression and other psychosocial problems—and can lead us to treat ourselves in ways that guarantee the bullies win. 

“Something horrible is happening during adolescence to young gay men,” said Ron Stall, Ph.D., director of the University of Pittsburgh’s Center for LGBT Health Research, in an interview.

Said Stall, “By the age of 18 we can demonstrate that young men who have sex with men are far more likely to suffer from a long list of psychosocial health problems, which we believe is driven by marginalization and violence victimization at a very young age. These young men don’t understand what’s happening to themselves. There’s no community. Sometimes if a boy who is beaten up by schoolyard bullies because he is perceived to be a sissy, goes to his dad to tell about getting beaten up on the playground, he risks also being beaten up by his dad.” 

Clearly, there is real harm from the messages gay boys receive telling them they are somehow not normal, maybe not even fully human—from churches claiming the attraction they may feel to other boys, the exact same way straight boys feel toward girls, is an “objective disorder” that inclines them “toward an intrinsic moral evil,” as the Catholic church has put it, to their government telling them they are second-class citizens.

But it has become equally clear that positive messages and role models can bolster younger gay men’s self-esteem and thereby reduce their risk for substance abuse, HIV, and other self-destructive behaviors that disproportionately afflict gay men. 

This new awareness is driving an entirely new approach to gay men’s health. Instead of focusing on our “deficits,” it builds on the resilience and strength virtually all gay men demonstrate simply by surviving to adulthood. It uses our strengths as its starting point, rather than assuming weaknesses simply because we’re gay. And it offers examples of gay men who are successfully managing their challenges—whether it’s grieving a loss, or anxiety, living with HIV, or any of a myriad of large and small traumas that can upset our balance and maybe even lead us to do something we could regret later. 

“Doesn’t it make more sense,” Ron Stall asked, “to look at the people who have thrived, who are resilient, and learn not from what went wrong but what went right? Look at the guys who went through horrible situations and learned and grew. Learn from them rather than holding up the guys who exemplify the societal stereotype of gay men as failures.” 

Stall and his colleagues in their research have identified four interconnected “epidemics” of psychosocial health conditions that disproportionately afflict gay and bisexual men, each one making the others worse: childhood sexual abuse, partner violence, depression, and drug use. Together, their insidious effects are referred to as “syndemics.”

Men who are most strongly affected by any one of these tend to be at high risk for HIV and substance abuse. Those of us from lower income or culturally marginalized ethnic groups are especially vulnerable to syndemic effects. 

In one study, Stall found that 11 percent of 812 men who reported one problem—depression, for instance—had engaged in high-risk sex (defined as unprotected anal intercourse). Of 129 men who reported three or four problems, 23 percent said they had high-risk sex. 

The usual reaction to such numbers is a comment about “reckless” gay men. But look again. 

Framed another way, the numbers tell us something quite astonishing that can’t be ignored: 89 percent of the men reporting one problem did not engage in high-risk sex. Likewise, more than three-quarters of the men with three or four problems did not engage in high-risk sex.

The numbers make it abundantly clear: the overwhelming majority of gay men— even those of us dealing with multiple mental health challenges, when only one is enough to undermine us—actually do take care of, protect, and value ourselves. 

How can it be? In the face of overwhelming pressures and struggles that can give gay men all the reasons we might want to harm or medicate ourselves, or worse, how is it that most of us don’t? 

Ron Stall attributes the surprising findings to gay men’s resilience. “We’re so focused on risk factors to the point that we forget about resilience,” he said. 

Stall believes “a smarter way to go” in thinking about HIV prevention, for example, would be to look at the guys who are thriving in spite of their adversities, how they pulled that off, see what lessons their experience offers, and apply it to the interventions aimed at supporting gay and bisexual men’s health and mental health. 

Stall and his colleagues describe gay men’s resilience as “an untapped resource” in addressing the high rates of psychosocial health problems—such as depression, substance abuse, and victimization— that also drive HIV risk. 

“Harnessing these natural strengths and resiliencies,” they write, “may enhance HIV prevention and intervention programs, thereby providing the additional effectiveness needed to reverse the trends in HIV infection among men who have sex with men.” 

John-Manuel Andriote/photo
Source: John-Manuel Andriote/photo

Research suggests our journey toward being resilient gay men begins by accepting our sexual orientation. As Ron Stall put it in our interview, “Guys who do the best job of resolving internalized homophobia are the least likely to have current victimization, substance abuse, and compulsive sex.”

Put a bit differently, Stall said, “Getting a population of people not to hate themselves is good for their health. This is not rocket science.”