This section is devoted to the primary care of cisgender (that is, non-transgender) gay, bisexual, and other MSM regardless of their sexual identity. Most health-related research that focuses on MSM categorizes men based on their sexual behavior as MSM, rather than their self-reported identification as gay, bisexual, or other identities. Although sexual identity is not always congruent with sexual behavior, identity is important to recognize in order to optimize health and health care, especially when there is a difference on the basis of sexual identity (for example, gay- vs bisexual-identified men).
The size of the MSM population in the United States is not known with certainty due to variability in the definition of sexual orientation used in surveys and the possibility that some survey respondents do not disclose nonheterosexual orientations because of concerns about discrimination. Nevertheless, based on available data, it is estimated that at least 2.2% of American adult men identify as gay, and an additional 1.4% of men identify as bisexual. The proportion of men who engage in sex with other men or experience sexual attraction to other men is estimated to be higher, with 7.3% and 6.2% of adult men reporting some same-sex attraction and sexual behavior, respectively, in one national survey.
Although social acceptance of nonheterosexual orientations is increasing, gay, bisexual, and other MSM may still experience stigma and discrimination based on their sexual orientation and/or gender expression, with significant impacts on health. In one national survey of LGBT Americans, discriminatory experiences were commonly reported: 39% of respondents endorsed experiences of rejection by family or friends, 30% had been physically attacked or threatened, 23% had been treated poorly in public, and 21% reported being treated unfairly at work. These experiences may contribute to adverse health outcomes among MSM and other SGM populations. One model of how this occurs centers on the concept of minority stress. In this model, stressors (such as experiences of prejudice, expectations of rejection, the cognitive burden of deciding whether to come out in different circumstances, and internalized homophobia) lead to anxiety, depression, and maladaptive coping behaviors, including substance use disorders and condomless sexual behavior that increases the risk for HIV and STIs. In adolescents, family rejection has been linked to increased risk of depression, homelessness, suicide attempts, illegal drug use, sexual risk-taking, and HIV/STI acquisition. Avoidance of—or delays in—seeking health care due to concerns about discrimination in medical settings may also contribute to adverse health outcomes in MSM.
et al. Sexual behavior, sexual attraction, and sexual orientation among adults aged 18-44 in the United States: data from the 2011-2013 National Survey of Family Growth. Natl Health Stat Report. 2016 Jan 7;(88):1–14.
et al. Age cohort differences in the developmental milestones of gay men. J Homosex. 2008;54(4):381–99.