Heterosexual mens fact sheet

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Since there has been discussions lately about where or if Heterosexuals even deserve to be heard at confernces. Here is info that’s not being heard loud enough. Misunderstanding, discrimination and HIV stigma.
Heterosexual men may be reluctant to access testing and
education programs at HIV-related organizations because they
are concerned they might be labeled as gay or in the closet.
Heterosexual men living with HIV can feel excluded from HIV
clinics that brand their sites as safe and inclusive spaces for
gay and bisexual men, which may be less about homophobia,
and more about wanting a safe space for connection with and
support from their community.[4]
HIV criminalization. Straight men often are blamed for the HIV
epidemic among heterosexual women, and may carry guilt,
shame and fear of criminal charges. Between 2008 and 2016
in the US, there were 279 cases of HIV criminalization. This
occurs when a person is prosecuted for not disclosing their
HIV status to a partner. The majority of prosecutions are of
heterosexual men.[5]
Religion. Religion is an important part of many heterosexual
men’s lives, yet sometimes the church may be the place where
they are exposed to the beliefs that HIV is a punishment from
God, and homosexuality and sex outside of marriage are sins.
[6] These religious views may deter open dialogue around HIV,
such as HIV testing and prevention, or disclosing HIV status.
Addressing issues that impact heterosexual men as a whole
person—body, mind and spirit—can be more effective than
addressing HIV transmission mode. Health inequalities
and structural barriers, not necessarily sexual risk taking
behaviors, make men more likely to contract HIV and less
likely to seek and have access to HIV programs.[3]
Fighting stigma
Family, relationships and intimacy. It is important for
heterosexual men to explore their identity as a father, a
romantic partner and a member of a family unit.[7] Men
view intimacy in many different ways, including being able
to communicate with their partner, being transparent and
comfortable expressing their feelings, spending quality
time with their partners, and having healthy and satisfying
sexual lives.[8] Men and boys may need support developing
communication skills with their partners.
Social injustice and resilience. The largest proportion of
heterosexual HIV cases occur among Black men in the
Southeast. This is also true for other race/ethnic groups
except American Indian/Alaska Native where the largest
number is in the West. The second largest number of cases
among Black, Latino, and White men occur in the Northeast
US. Latino men, the second largest race/ethnic group with
HIV also are most affected in the South and Northeast US.
Black and Latino men also face disproportionate rates of
unemployment, racism, incarceration and lack of education,
which can be more pressing issues to contend with than
HIV and healthcare. Despite these challenges, many Black
men have supportive communities, are highly resilient and
persevere. HIV prevention and care services can support Black
men by partnering with educational and vocational services
to bolster men’s efforts to survive and thrive amid their
adversities.[8]
Incarceration and post-incarceration services. Programs for
heterosexual men should address the impact of incarceration
on men, their partners, family and community. Sex with
men, sexual assault and injection drug use are risks while
incarcerated. People living with HIV (PLWH) may face treatment
interruption both in prison and jail, and upon release—which
can increase their viral loads and infectivity. Programs can
provide education and risk reduction for men affected by
incarceration,[9] as well as support finding employment,
healthcare and housing upon release.[3]
Heterosexual men are affected by HIV
HIV is a concern for heterosexual men, as almost 14% of new male HIV cases in 2016 occurred among heterosexuals,
through sex with a woman (9.5%) and injecting drug use (3.9%). Most of those cases were among Black (63%) and Latino
(22%) men, and men living in the Southeast (62%) and Northeast (19%) of the US.[1]
These statistics, however, may not give us an accurate picture of HIV among heterosexual men. Because sexuality is
complex, some heterosexually-identified men may have sex with men, but still identify as straight.[2] The CDC tracks HIV
infections through means of infection, not by a person’s identity. Therefore, a heterosexual man who tells his healthcare
provider he ever had a sexual encounter with a man is categorized under “men who have sex with men,” and if he says he
has ever injected a drug, is categorized under “people who inject drugs (PWID).”
Because of this, heterosexual men are seldom mentioned or addressed in the world of HIV prevention, care and research—
where men are classified based on federal guidance and misconceptions, and not on men’s own identity.[3] This may be
helpful for tracking the HIV epidemic, but it hampers service organizations who want to serve straight men who are at risk
for or living with HIV, because funding for programs is linked to mode of transmission.
Prepared by Joshua Middleton and Reverend William Francis Community Engagement (CE) Core | March 2018
What do heterosexual men
want and need around HIV?
Holistic approachTalking about health. Many men don’t feel comfortable talking
about their sexual health and behaviors with their doctors,
and doctors typically don’t ask these questions. Cultural
male stereotypes and seeing the bulk of health services and
promotions focused on women, hamper men’s willingness
to seek out health care services, including HIV testing.[10]
Healthcare providers need to take a proactive role engaging
men, and provide a non-judgmental, safe environment where
men can feel free and safe to talk about their sexual health.
HIV testing. Providers and clinics need greater awareness that
heterosexual men can be at risk for HIV, and should offer all
men HIV testing, pre-exposure prophylaxis (PrEP) and post-
exposure prophylaxis (PEP). Half of heterosexual men living
with HIV were diagnosed 5 years or more after they were
infected, later than any other population. Providers should talk
to men of every age about HIV and HIV risk reduction, and let
them know that HIV testing is a part of routine healthcare.[11]
HIV treatment and PrEP. PLWH who are on antiretroviral
treatment and have undetectable viral loads do not transmit
the virus to their partners.[5] PrEP, a medication for people
who do not have HIV, can be used by men and women
to protect themselves from HIV safely. These medical
breakthroughs can help heterosexual men avoid HIV
transmission, safely have children, reduce stress and worry,
and increase trust and sexual pleasure in relationships.
There has been resistance in the HIV community to track,
fund, research and provide HIV services for heterosexual men,
perhaps due to the focus on the mode of transmission and
reluctance to acknowledge men’s own heterosexual identity.
[3] For example, for the past five years there have been more
new HIV cases from heterosexual transmission than from
injecting drug use transmission among men,[1] yet programs
and services for PWID far outnumber those for straight men.
Programs for heterosexual men should collaborate with
mainstream organizations, as straight men are less likely
to use HIV-specific services. Programs should reach out to
places where straight men go, such as the grocery store,
gym, barbershops, sporting events, clubs, churches, colleges,
vocational services. Heterosexual men prefer to hear messages
from other straight men in community locations.[12]
Programs, providers and researchers can do a better job
of supporting Black men’s strengths and stop highlighting
weaknesses. Increasing HIV testing, education, care and
treatment, including PrEP for heterosexual men, can help
address HIV. Increasing quality education, job and housing
opportunities, as well as providing safe spaces for Black men
that foster social support can also address HIV.[7]
It is time to recognize and fully address HIV among
heterosexual men. Organizations, health departments and
clinics should consider the needs of
heterosexual men when planning their
budgets, and include men in program
planning, service delivery, research
and policymaking. Straight men can
help fight stigma and invisibility by
speaking up, disclosing their status,
working in HIV organizations and
taking their place at the table to
advocate for funding and programs.
1. Centers for Disease Control and Prevention. HIV
Surveillance Report, 2016. November 2017; vol.
28.
2. Carrillo H, Hoffman A. From MSM to
heteroflexibilities: Non-exclusive straight male
identities and their implications for HIV prevention
and health promotion. Global Public
Health. 2016;11:923-36.
3. Bowleg L, Raj A. Shared communities, structural
contexts, and HIV risk: prioritizing the HIV risk
and prevention needs of Black heterosexual
men. American Journal of Public Health.
2012;102:S173-S177.
4. Kou N, Djiometio JN, Agha A, et al. Examining
the health and health service utilization
of heterosexual men with HIV: a community-
informed scoping review. AIDS Care. 2017;29:552-
558.
5. Halkitis PM, Pomeranz JL. It’s time to repeal HIV
criminalization laws. Huffington Post. August 1,
2017.
6. Wilson PA, Wittlin NM, Muñoz-Laboy M, et al.
Ideologies of Black churches in New York City and
the public health crisis of HIV among Black men
who have sex with men. Global Public Health.
2011;6: S227–S242.
7. Abrahams C, Jones D, Viera A, et al. The forgotten
population in HIV prevention: Heterosexual Black/
African American men: Key findings and strategies.
Harm Reduction Coalition position paper.
December 2009.
8. Teti M, Martin AE, Ranade R, et al. “I’m
a keep rising. I’m a keep going forward,
regardless”: Exploring Black men’s resilience
amid sociostructural challenges and stressors.
Qualitative Health Research. 2012; 22:524–533.
9. Valera P, Chang Y, Lian Z. HIV risk inside US
prisons: A systematic review of risk reduction
interventions conducted in US prisons. AIDS Care,
2017;29:943-952.
10. Marcell AV, Morgan AR, Sanders R. The
socioecology of sexual and reproductive health
care use among young urban minority males.
Journal of Adolescent Health. 2017;60:402-410.
11. CDC. HIV testing. CDC National HIV Surveillance
System, 2015.
12. Murray A, Toledo L, Brown EE, et al. “We
as Black men have to encourage each other:»
Facilitators and barriers associated with HIV
testing among Black/African American men in rural
Florida. Journal of Health Care for the Poor and
Underserved. 2017;28:487-498.
Says who?
Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Many Fact Sheets
are available in Spanish. ©2018, University of CA. Comments and questions about this Fact Sheet may be e-mailed to CAPS.web@ucsf.edu.
Special thanks to the following reviewers of this Fact Sheet: Tony Antoniou, Lisa Bowleg, Derek Canas, Hector Carrillo, Todd Genre, Barbara Green Ajufo, Davina Jones,
Steve Kogan, Steven Lamm, Daryl Mangosing, Arik Marcell, Ashley Murray, Bob Siedle-Khan, Michelle Teti, Pamela Valera, Bill Woods
Resources and programs
Making a difference
“Until we all
come together,
HIV is not
going to end.”
-Rev. Francis
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