Operating without a Safety Net: Gay Male Adolescents' Responses to Marginalization and Migration and Implications for Theory of Syndemic Production of Health Disparities

Background

Stall, et al. (2008) has proposed a theory of “syndemic production” of health disparities among gay men in the U.S., linking high rates of depression, substance use, HIV/AIDS as intertwined epidemics that are socially produced through two overarching dynamics: marginalization and migration. Although the theory proposes a developmental trajectory, it has been largely based on epidemiological studies of adult gay men and has not been examined using qualitative data from gay male adolescents.

Methods

We conducted interviews with 54 HIV-positive gay and bisexual male adolescents, ages 17-24 (57% African American, 22% Latino, 13% White, 7% mixed race), at four sites in the U.S. An iterative process of data reduction allowed for cross-case analyses and a summary of emergent themes.

Results

Data reveal narrative links between (a) marginalization during adolescence, (b) subsequent search for other gay men in geographic and virtual communities, (c) a range of resilience and risk factors associated with migration to such communities, and (d) health behaviors described as responses to past feelings of isolation, lack of support, and newfound freedoms. Migration occurred within geographical contexts as well as on the internet. Resilience and risk factors were both described as present within gay-identified communities.

Conclusions

These findings advance the use of a syndemic framework for investigating causes of health disparities among gay men in the U.S. by confirming the salient factors that impact the development of gay male adolescents and their attendant health issues. This study provides examples of developmental trajectories among adolescent and young gay men that help explain the early onset of health disparities among some adolescents, but also the development of risk factors that may follow some gay men into adulthood.