Impact of urban neighborhoods on the health of gay, bisexual and other men who have sex with men

Background: Gay, bisexual and other men who have sex with men (MSM) experience elevated rates of adverse physical and mental health outcomes, including depression and HIV/AIDS. How the neighborhood environment impacts these outcomes is largely unknown. Methods: Twenty MSM living in New York City (NYC) participated in in-depth interviews, mapped their social, residential/home and sexual neighborhoods and discussed the impact of these spaces on their behavior and health. Thematic analysis of transcripts and maps were conducted. Findings: The average age was 34 and participants self-identified as Latino (30%), African-American (30%), multiracial (20%), white (15%), or Asian-American (5%). All had been living in NYC for 1+ years, 8 were born in NYC and 2 were foreign-born. Periods after migration to NYC and/or the gay enclaves of Manhattan from outer boroughs were often characterized by higher levels of sexual risk. Sexual neighborhoods manifested in a range of spaces, including social venues, traditional gay enclaves, subway routes, internet, cruising venues, or location of friends/family networks. Sexual and social neighborhood overlap existed on a continuum ranging from complete separation to complete integration. Men who lived in gay enclaves typically described them as their sexual neighborhoods. Some men who lived in neighborhoods described by the participants as not gay-friendly, typically outside of Manhattan, also described robust sexual networks in these neighborhoods. Discussion: Results offer initial, context-specific understanding of the relationship between space, well-being and sexual behavior among urban gay men. Ultimately, these findings may inform the development of health and well-being outreach and programming.