An Update on Syndemic Theory Among Urban Gay Men

There is now substantial epidemiological evidence to show that gay men suffer from higher prevalence rates of a cluster of infectious and non-infectious diseases than do heterosexual men, but relatively little in the way of theory to explain the emergence of these epidemics. This presentation will present evidence to show how socialization experiences of young men being reared in an environment in which homosexuality is deeply stigmatizing produces men are at increased susceptibility to depression, substance use and abuse, violence and HIV/STI infections in adulthood. A theoretical paradigm will be presented to organize the evidence that we now have on gay men's health. The theory holds that the variables of social isolation, internalized homophobia, self censoring and proto-gay social skills predict increased vulnerability to a wide set of psychosocial conditions in adulthood, as do access to strengths and stressors found within urban gay communities themselves. Finally, in adulthood, empirical evidence will be presented to show that these epidemics interact to increase susceptibility of HIV infection, and as such, are a classic case of syndemic production. The theory holds relevance to other marginalized communities by showing how social and cultural processes result in the production of poor health at the level of individuals and communities.