Strategic framework to
promote the health and
wellbeing of gay,
bisexual and other men
who have sex with men
Dr Justin Varney
National Lead for Adults and Older People’s
Health and Wellbeing
Justin.varney@phe.gov.uk
Context
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Significant health inequalities affecting gay, bisexual and other men who
have sex with men (MSM) reiterated in the Public Health Outcomes
Framework LGBT Companion Document
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Men who have sex with men remain disproportionately affected by HIV and
sexually transmitted diseases
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Significantly higher rates of mental ill health, poor wellbeing and higher
rates of use of alcohol, cigarettes and drugs
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The Framework draws together a trio of interconnected and overlapping
inequalities in sexual health, mental health and use of drugs, alcohol and
cigarettes and maps the evidence base to make recommendations for
interventions to reduce the inequality and support local and national
government, the NHS, Voluntary and Community Sector, Communities,
Families and Individuals in reducing the gap.
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First in a series of minority health frameworks
Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Process and Engagement
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Evidence mapping through direct and commissioned topic overview reports
on published and grey literature.
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Two initial listening events in Spring 2014.
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Community and academic engagement through large expert advisory group
who have commented on drafts during the Framework’s development.
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Public consultation through .Gov consultation portal over two weeks.
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Launch date: 27th June at House of Lords reception
Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
The Vision
For gay, bisexual and
other men who have
sex with men, to enjoy
long, healthy lives and
have respectful and
fulfilling social and
sexual relationships.
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Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
What does success look like by 2020?
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halve the number of new HIV infections in MSM from 3,000 in 2012 to 1,500 in 2020
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halve the proportion of MSM with poor mental health, measured through self-reports
of feeling recently unhappy/depressed from 21% in 2011 to 10% in 2020
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reduce the proportion of MSM who report concern about their alcohol use by a fifth,
from 21% in 2011 to 17% in 2020
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reduce the proportion* of MSM reporting the use of harmful illicit substances,
including those associated with ‘chemsex’, by 2020.
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reduce the proportion of MSM who smoke to be no more than 10% higher than the
rest of the male population by 2020
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Reduce significantly self-reported incidents of homophobic and biphobic bullying in
schools from 55% in 2011
Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
The Approach
People
Places
Communities
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Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Starting well
A safe and secure home, a balanced diet and physical activity, and
feeling supported and accepted is vital for the health and wellbeing of all
young people as they transition from infancy, to childhood, adolescence
and beyond.
Key issues:
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85% of gay, bisexual and other MSM reporting no education in same sex
relationships while at school, and a survey found that MSM aged 16-24
consistently know less about HIV than those aged 25-54yrs.
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Younger MSM have higher rates of STI and HIV than older MSM
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Homophobic, biphobic and transphobic bullying remains a significant issue,
over 55% of lgb students reported being bullied in school
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MSM aged 18-19 years were 2.4 times more likely to smoke & almost twice as
likely to drink alcohol two times a week or more compared to heterosexual
men
Living well
There is a diverse population of gay and bisexual and other MSM, with
clear evidence of inequalities across a range of health outcomes and these
being even more pronounced amongst those with multiple minority
identities e.g. gay & black.
Key issues:
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HIV incidence continuing to increase amongst MSM, partially due to increased
diagnosis, one in twenty are estimated to be living with HIV and 1/3rd were born
abroad
MSM are twice as likely to be depressed when compared to other men
MSM are twice as likely to be alcohol dependent when compared to other men
Population surveys of MSM demonstrate disabled men were three times more
likely to self-harm and three times more likely to have attempted to take their
own life compared to MSM without disability.
8 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Ageing well
Older MSM constitute men at very different phases of their lives, ranging
from MSM in employment, living well in retirement and those requiring
support at home or in care. Many will have experienced far more acute
stigma and discrimination than today’s cohort of young MSM, and as a
result, may have come out in later life, or carry this experience of stigma
with them creating additional barriers to accessing services.
Key issues:
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Older MSM remain at risk of STIs. In 2012, 14% of diagnoses of chlamydia,
gonorrhoea, syphilis, HSV and HPV in MSM were reported among men aged
45 years and over in the UK; this compares to 8% in heterosexual men. Around
28% of all MSM HIV infections are in men over 45yrs.
Health and social services may not be responsive to needs of older LGB
Higher rates of poverty and social isolation older MSM at higher risk of
depression
9 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Evidence base for interventions
Sexual health:
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Good quality, inclusive sex and relationship education
Regular HIV and sexual health testing
Condom use
Early diagnosis and treatment
Treatment as prevention (TasP)
Mental health
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Training for supportive parenting, teachers and carers
Interventions to reduce bullying in schools and workplaces
Training for service providers and visibly inclusive
approaches
Drugs, Alcohol & tobacco:
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Culturally competent treatment pathways and services with
training and imagery that is inclusive and supports
engagement
10 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Recommendations
Recommendations laid out in sections for Starting well,
Living well, Ageing well, and Places focused on health
service providers, and finally Communities.
Framed in context of:
• Individual gay and bisexual men
and other MSM
• Families, guardians and carers
• National Partners
• Public Health England
• Local Government
• Community Sector
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11 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Recommendations
Core themes:
• Improved data collection and analysis
• Increased training across professional groups
• Specific consideration of gay, bisexual and other MSM needs
• Scale up existing evidence based implementations such as regular
sexual health and HIV testing
• Engagement with the community and strengthening community
recognition and engagement with the issues
• Visible role models and champions
Levers to support implementation
• Legislative levers – Equality Act & Inequality Duties
• National LGBT Strategic Partnership with DH & NHS England
• New LGBT academic network
12 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Implementation
Public Health England will establish is committed to supporting the
implementation of this framework.
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PHE will establish an implementation advisory group with appropriate representation from the LGBT
community, national stakeholders and teams within PHE whose have the opportunity to implement
and integrate the framework in their work.
PHE will hold bilateral meetings with the relevant government departments and national bodies to
consider the recommendations made at a national level. PHE will work with the Government
Equalities Office to find synergy with the cross-government LGBT action plan.
PHE will continue to work closely with, the Local Government Association, NHS England, Clinical
commissioning Groups, Local Authorities and Health and Wellbeing Boards and relevant voluntary
sector partners to energise action to reduce the inequalities affecting MSM
PHE will continue to work with NHS England’s Equality and Diversity Council working group on sexual
identity data, to support the implementation of monitoring across the NHS.
PHE will pump prime an LGBT academic network to provide continuing academic insight and advice to
the implementation of the framework
PHE will publish an annual implementation update on the framework, including a report on progress
against the ambition indicators.
13 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework
Strategic framework to
promote the health and
wellbeing of gay,
bisexual and other men
who have sex with men
Dr Justin Varney
National Lead for Adults and Older People’s
Health and Wellbeing
Justin.varney@phe.gov.uk