Gay Health


  • Men who have sex with men, or MSM, is a clinical term that refers to sexual behavior alone, regardless of sexual orientation, as MSM may include men who identify as gay, bisexual, or heterosexual. Sexual orientation is independent of gender identity.
  • MSM are less likely to access health care and are disproportionately impacted by mental health issues, substance use and abuse, and sexually transmitted infections (STI).
  • Health disparities exist between patients in the LGBTQ community and those of heterosexual orientation. Sexual minority groups tend to fare worse across all realms.


  • Structural barriers of an unwelcoming health care system and minority stress (e.g., fear, stigma, internalized homophobia) experienced by LGBTQ people likely contribute to health disparities.
  • LGBTQ individuals may hide their orientation out of fear of stigma and discrimination, so it is important to ask all patients about sexual orientation and behavior in a nonjudgmental environment.
  • Although this chapter reviews the important topics that effect this population disproportionately, primary care of MSM foremost is about delivering the same level of care to all patients, regardless of sexual orientation.

General Prevention

  • The majority of screening guidelines are the same for MSM as they are for non-MSM age- and sex-matched populations.
  • Centers for Disease Control and Prevention (CDC) and the United States Preventative Services Task Force (USPSTF) suggest at least annual screening for HIV, syphilis, gonorrhea, and chlamydia as detailed below, with increased frequency and other screening tests based on the level of risk of the patient’s behavioral practices.
  • CDC recommends testing for hepatitis B serology at least at the initial visit and vaccination for MSM who are seronegative or for whom vaccination status cannot be ascertained (1)[A]. However, in 2022, the Advisory Committee on Immunization Practices (ACIP) expanded hepatitis B vaccination recommendations to include all adults aged 19 to 59 years.
  • Screening for hepatitis C is recommended in all patients between the ages of 18 and 79 years at least once in a lifetime. Annual screening for hepatitis C is only recommended in MSM with HIV.
  • Screening for hepatitis A is not recommended. However, hepatitis A vaccination is recommended for MSM.
  • Annual digital anorectal examination (DARE) is recommended as a screening for anal cancer, but there is insufficient evidence to recommend obtaining anal cytology in all MSM patients.
  • ACIP recommends routine vaccination schedules be followed for MSM patients, including vaccination against (i) hepatitis A and B viruses; (ii) human papillomavirus (HPV) for all patients between 11 and 26 years old with additional consideration for MSM patients outside this age category; (iii) serogroup B meningococcal vaccine (MenB) and quadrivalent meningococcal vaccine against serogroups A, C, W, and Y (MenACWY); and (iv) smallpox monkeypox virus, live nonreplicating, if high prevalence in geographical area.
  • Cultivating a nonjudgmental, welcoming environment is the cornerstone of prevention of disease for the LGBTQ community. Consider accessing community or web-based resources to create an LGBTQ safe zone for clinical practice sites.

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