Social Work with People Practicing Same-Sex ... - ILGA Europe

1 Rosser BR, Bockting WO, et
al. The relationship between
homosexuality, internalized homonegativity,
and mental health in men
who have sex with men. Abstract. J
Homosex. 2008;55(2):185-203.
2 Research peformed in Massachusets
and presented at the 136-th Annual
Meeting of American Public Health
Association (25029 October 2008)
by the group of researchers (Joseph
R. Merighi, Deborah Chassler, et
al.), was designed to study the
association between sexual identity
and regular contacts with health
specialist. The results showed that
MSM, who identified themselves as
heterosexuals, compared to those
who considered themselves gays
or bisexuals, were 60% less likely
to have regular contacts with
health specialists; MSM, who used
drugs in the past 30 days were 54%
less likely to have contacts with
health specialists; and MSM, who
had more social support were 32%
more likely to have contacts with
health specialists. Authors make
a conclusion that the research
result underscore the impact of
sexual identity, illicit drug use
and presence of social support on
medical aid appealability among
MSM.
3 Steve W. Cole, Margaret E.
Kemedy et al. Accelerated Course
of Human Immunodeficiency
Virus Infection in Gay Men Who
Conceal Their Homosexual Identity.
Psychosomatic Medicine 58:219-
231 (1996)
4 It was proven that suppression of
a free expression of emotions and
information about oneself, which
can potentially be life threatenting,
can increase the activity of
sympathetic nervous system,
which in its turn has a suppressive
action on the immune system (the
amount of circulating lymphocytes
and monocytes, production of
antibodies, immediate and delayed
reactions of hypersensitivity).
The studies in which participants
could freely release a psychological
material (thoughts and feelings
related to the traumatizing
life experience) demonstrated
improvement in some aspects of
physical health (e.g., visits to the
doctors) and functioning of immune
system (e.g., control over latent
viruses, production of antibodies
and lymph proliferation), as well as
reduced activity of the sympathetic
nervous system.
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growing-up, feeling of comfort related to sexual orientation, openness towards other
people and socialization with people, who are equal by status. According to the
authors of this study ”service providers should contribute to sexual health and avoid
interventions that strengthen internalized homonegativitiy” 1 .
The research data indicate that MSM, who are not associated with the gay community,
do not receive prevention information and protection means, and this significantly
increase the risk of HIV and STI infection. A fear of discrimination by health care workers
makes homosexual people reluctant to seek for medical services 2 . Many MSM do not
want to get tested for HIV, especially in small towns, due to a real or perceived threat of
information leakage that will lead to the disclosure of their sexual orientation.
MSM Living with HIV/AIDS:
Non-recognition of Oneself and Homophobia
as the Chronic Stress Factors
HIV diagnosis is a major stress factor. This diagnosis is associated with such
psychological/mental conditions as despair, anxiety, depression, suicidal thoughts,
feeling of hopelessness and loss of the sense of life. More and more data appear in
the scientific literature arguing that psychological stress (in this case — a dual stress
caused by internalized homophobia and HIV related stigma) impacts the immune
system weakening its defence capacity.
Psychosomatic Medicine magazine 3 published the data Los Angeles research, which was
performed to determine the impact of internal suppression of one's own homosexuality
(internalized homophobia) on the progression of HIV infection among 80 HIV
infected gay men. It was assumed that a psychological suppression is influencing the
health status 4 . The hidden homosexual identity was measured with a 5-score scale,
in accordance with which the research participants tried to determine the degree of
their homosexuality by the following categories (in relation to other homosexuals):
“definitely closed”, “closed most of the time” or “fully open”. The obtained results
cannot explain the progression of HIV infection to a critically low CD4 count, the time
of AIDS diagnosis and death of AIDS using such characteristics as age, HIV infection
status at the onset of the research, treatment (e.g., antiretroviral therapy), behaviour
that could have an impact on health (e.g., sexual practices), alcohol and recreational
drugs use, smoking, sport exercises and sleep. In general, the sampling was homogenous
by such aspects as gender and nationality. According to the research data, HIV
infection was progressing more quickly among those participants who concealed their
homosexual identity compared to those, who did not do it. The time of reduction of the
level of lymphocytes, period of disease progression to AIDS stage and AIDS associated
deaths were significantly longer among those, who were less secretive. HIV infection
was progressing much slower among those, who were “open most of the time”. This
testifies to the fact that only moderate and high levels of “concealment“ can be linked
to a significant acceleration of disease progression. However, in spite of this evidence
the research authors indicate that, first of all, the cohort sampling for the research was
representative only for all HIV positive gays in Los Angeles, but it is unclear, whether
the research conclusions can be applied to all gays, and secondly, the “observational
character of this research does not allow making any definite conclusions about the
mechanism that may link a concealed homosexual identity to the accelerated progression
of HIV infection. In particular, these results do not mean that coming out will improve
one's physical health”. In the end of their article the authors write: “These results find
their parallel with the data of research among 222 HIV infected gays, that demonstrated
an increased rate of infectious and neoplastic (tumour) diseases on the background of a
higher level of “concealment“. The data of both researches coincide with previous studies
that found the link between a psychological suppression and disorders in the activation of
sympathetic nervous system, immune system functioning and physical health.“