PicturedRon Stall at the Man Alive Summit.
According to research done by Ron Stall, Ph.D., social and cultural forces shape the behaviors that place gay men at higher risk for HIV infection.
Stall was Test Positive Aware Network's key speaker for the annual Man Alive 2005 health summit held at the Hyatt Regency Chicago Nov. 5. Stall, of the University of Pittsburgh, has published many papers on the different aspects of the AIDS epidemic.
Stall spoke of what he calls the 'knee and naval problem,' where too much emphasis in HIV/AIDS studies focus on sexual risk, ignoring other variables for which gay men have higher prevalence rates of infection. These other variables include demographics, early adverse events such as childhood sexual abuse, mental health, access to healthcare, social and sexual practices and an individual's connection to the AIDS epidemic.
'In our analysis, I noticed a lot of these epidemics are interconnected,' Stall said.
In an urban men's health study conducted in 1996 through 1997, a needs assessment was given that included all of the problems that affect gay men. 'Overall, we tried to get the whole body,' Stall said.
The study was an assessment of a population-based sample of 2,881 MSM [ men who have sex with men ] in 92 zip codes where one in seven MSM were estimated to live.
'When we did the analysis, we were kind of taken aback,' Stall said, adding that the study discovered high rates of depression, attempted suicide, childhood sexual abuse, substance use and abuse and partner violence in connection with HIV infection.
'We have four epidemics intertwining and making each other worse,' Stall said. 'They [ epidemics ] are driving the AIDS epidemic.'
A majority of those surveyed were white college graduates. Stall expressed disappointment in not being able to get a larger minority sample, and said a lot more work needs to be done in that area.
Since prevention efforts that focus on gay men's sexual risks have been very effective in reducing infection, Stall said, also focusing on the psychosocial health problems that impact gay men could prove to be even more effective. Stall added a mix of structural and clinical interventions is the best route in terms of prevention.
'If we try to raise one of the health boats without raising all of them, nothing is going to get done,' he said.