HIV This Week

Simon Rosser BR, West W, Weinmeyer R. Are gay communities dying or just in transition? Results from an international consultation examining possible structural change in gay communities. AIDS Care. 2008 May;20(5):588-95.

This study sought to identify how urban gay communities are undergoing structural change, reasons for that change, and implications for HIV prevention planning. Key informants (N=29) at the AIDS Impact Conference from 17 cities in 14 countries completed surveys and participated in a facilitated structured dialog about whether gay communities are changing, and if so, how they are changing. In all cities, the virtual gay community was identified as currently larger than the offline physical community. Most cities identified that while the gay population in their cities appeared stable or growing, the gay community appeared in decline. Measures included greater integration of heterosexuals into historically gay-identified neighbourhoods and movement of gay persons into suburbs, decreased number of gay bars/clubs, less attendance at gay events, less volunteerism in gay or HIV/AIDS organizations, and the overall declining visibility of gay communities. Participants attributed structural change to multiple factors including gay neighbourhood gentrification, achievement of civil rights, less discrimination, a vibrant virtual community, and changes in drug use. Consistent with social assimilation, gay infrastructure, visibility, and community identification appears to be decreasing across cities. HIV prevention planning, interventions, treatment services, and policies need to be re-conceptualized for men who have sex with men in the future. Four recommendations for future HIV prevention and research are detailed.

Editors’ note: Applying an ecological model of health behaviour (intra-individual, interpersonal, institutional/organisational, community, structural) to understanding the resurgent HIV epidemic among gay men living primarily in the global north reveals that many ingredients of successful early HIV prevention (community activism, community-appropriate interventions, and a sense of solidarity against the virus) are ill adapted to current realities of increasingly virtual gay communities. Structural changes in gay communities have reduced the effectiveness of HIV prevention making it high time to take stock, rethink, and tailor effective strategies to reduce HIV incidence among men who have sex with men.