Sexuality and health

Most of the health promotion campaigns targeting male aging feature images of older men with female partners, playing with family and grandchildren, or relaxing with other heterosexual couples in the safety of their retirement villas. Few, if any, show images of two older men holding hands, kissing, or attending seniors’ events with other same sex couples. The absence of any reference to older gay and bisexual men is indicative of the pressures and barriers these men face in engaging with campaigns and services that, at best, have not considered their needs or, at worst, have no idea they exist. To take one example: in Australia, over 20,000 men are diagnosed with prostate cancer each year and over 3,300 die of the disease. While there is material addressing the effect of treatment on men’s sexual health, the sexuality in question is assumed to be heterosexual. There is little specific health information for gay and bisexual men about the effects of prostate cancer on same sex sexuality, relationships and sexual practices and, in particular, on the debilitating side-effect of various treatments. 

The consequences of this invisibility are many. At one level, the assumption that everyone is heterosexual can feed into more overt forms of discrimination that actively devalue gay and bisexual men. At another, it leads to some gay and bisexual men delaying seeking help in anticipation of discrimination and reduced standards of care or to others hiding their sexuality and the details of their lives in the hope that service providers will misrecognise them as “straight”.  In some cases a delay in seeking treatment will mean that gay and bisexual men present when an illness is more advanced, leading to a poorer prognosis and recovery. Pretending  to be heterosexual can take a great deal of fear and effort, which may lead to anxiety, depression and an overall reduction in gay and bisexual men’s health and wellbeing. 

Just as a narrow emphasis on heterosexuality excludes gay and bisexual men, a narrow emphasis on traditional gender roles can have a negative impact on all men, irrespective of their sexuality. Heterosexual men are often pressured into rejecting any type of behaviour that might be seen as feminine, from displays of emotion to being overly concerned about their health. This emphasis on “manly” behaviour not only works to separate men from women but also to separate real (read straight) men from gay men.  Ironically, research suggests that some gay men adopt masculine roles, both to challenge popular depictions of gay men as effeminate or camp and to “out-man” heterosexual men. The health seeking behaviours of all men are undermined by conservative notions of sexuality and gender. It is important that healthy aging campaigns and services targeting men address the full range of male sexualities and genders without valuing one type of masculinity or male behaviour over another.

One of the major issues for gay and bisexual men is whether or not to come out when joining in programs or accessing health services. For older gay and bisexual men who have lived through a period of widespread discrimination, coming out to health professionals may be difficult and traumatic. It is vital that individual service providers have an understanding of not only different sexualities but also of the particular pressures facing older gay men. At the same time it is important that health care organisations and public health campaigns show that they are aware and inclusive of gay and bisexual men. This involves more than gay, lesbian and bisexual (GLB) sensitivity training for individual staff. It also involves changing culture and attitides, including GLB-sensitive intake and assessment, GLB-sensitive posters and campaign materials and strategies for ensuring the safety of GLB clients when accessing services or participating in programs.

For more information on the issues raised in this article go to:

• Dr Catherine Barrett, Manager GLBTI (gay, lesbian, bisexual, transgender and intersex) Aging, Gay and Lesbian Health Victoria (GLHV) C.Barrett@latrobe.edu.au for information on GLBTI- inclusive practice and the issues facing older gay and bisexual men.

• Gay and Lesbian Health Victoria, www.glhv.org.au including a GLBTI clearing house and information on GLBTI-sensitivity training.

• Vintage Men, a confidential support group for mature gay and bisexual men and their friends www.vintagemen.org.

• Gamma Project, provides telephone and in-person counselling for bisexual men and their partners (03) 9899 0509, 1800 807 660.

• Gay and Lesbian Switchboard, a telephone counselling service for GLBTI people (03) 9663 2939, 1800 184 527.

• Prostate cancer: The Prostate Cancer Foundation in association with The Australian Research Centre in Sex, Health and Society is developing materials and training for service provider addressing the needs of gay and bisexual men following a diagnosis of prostate cancer and the effects of treatment.  

Authors:
William Leonard, Director Gay and Lesbian Health Victoria and Professor Gary Dowsett, Acting Director, The Australian Research Centre in Sex, Health and Sexuality, La Trobe University.