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date: 19 June 2018

Gay Men: Practice Interventions

Abstract and Keywords

This chapter explores salient concepts of social work practice with gay men. These concepts are described within a life cycle context. The illuminated concepts have been identified based on the biopsychosocial and spiritual developments in the social work literature related to this population since the printing of the 19th edition of the Encyclopedia of Social Work.

Keywords: childhood, adolescence, sexual orientation, HIV/AIDS

The goal of social work practice with gay men is essentially the same goal for every social work client, which is concretized in the preamble of the NASW Code of Ethics: “to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty…” (http://www.socialworkers.org/pubs/code/code.asp). Because of the unrelenting homophobia and heterosexism some gay men experience, they are particularly at risk for greater vulnerability and oppression because of their sexual orientation. Many people erroneously assert that homosexuality is a choice. The biological and social sciences have concluded that sexual orientation, while including a range of expressions, is fundamentally a fixed trait for most gay men (Friedman & Downey, 1993; Speers & Potter, 2000).

The homophobia and heterosexism that many gay men experience are marked and occur at an early age. Some of these men respond by internalizing the oppressive beliefs. This behavior is conceptualized as internalized homophobia. The stressors associated with internalized homophobia may be in addition to the other challenging sources of external oppression, which may include their family members and society at large. Despite the United States Supreme Court 2003 ruling in Lawrence v. Texas that sodomy laws are unconstitutional and unenforceable, Virginia, Oklahoma, and North Carolina continue to attempt to enforce their sodomy laws. These efforts indicate that some members of society believe that certain rights of gay men should be limited. Many gay men experience this as oppression and feel at risk for societal condemnation and retribution.

Since the publication of the 19th edition of the Encyclopedia of Social Work, burgeoning issues that affect gay men such as HIV disease, additional forms of drug use, gay marriage, adoptions by gay men, research related to aging, and health disparities among gay men of color (Diaz, Ayala, & Bein, 2004; Government Accounting Office, 2000; Wilson & Yoshikawa, 2007) have emerged as topics for social work consideration. Given the various challenges gay men experience, social work researchers and practitioners are encouraged to understand the various oppressions members of this population experience. This chapter on social work practice with gay men will focus on these topics using the life cycle as a paradigm.

Childhood

Most gay men report knowing that they are homosexual as early six or seven years of age (Dawood, Pillard, Horvath, Revelle, & Bailey, 2000; Miller, 2000). However, during those ages, many cannot verbalize the sexual awareness they have sensed. They do know they are somehow different from their peers. This difference is manifest as a negative connotation while they develop a wider social network and gender norms become established. “Acting like a boy” or “acting like a girl” have established inherent expectations as each gender is supposed to adhere to the various norms and gender scripts. For boys who transgress those norms, there is a social cost. Many boys can recall being called hurtful words like sissy, queer, or faggot. Moreover, they experience these taunts as painful even though they may not know the definition of the words.

Some gay men as children experience an additional burden of oppression by their parents, siblings, or other family members. Their experience of oppression may be heightened if their family members adhere to gender norms or is influenced by religious dogma (Miller, 2007) that publicly endorses homophobic or heterosexist messaging. The boys who hear those messages are made to feel inferior. Further, many of them have no one to deflect the taunts or defend them. How these boys respond to the taunts is predicated on many factors and has bearing on how they facilitate and negotiate their adult gay male relationships (Rose, 2005). Exploring how gay men experienced their childhood and their beginning understanding of their sexual orientation is a potential therapeutic goal. Should social workers happen to be working with boys, who are being taunted because of suspicions that they are not meeting their gender expectation, the workers are encouraged to advocate for the boys in the schools and other various systems the boys find themselves (LaSala, 2006). Some boys are able to develop and express adaptive strategies to confront the oppressions, while others engage in less adaptive responses. Understanding the clients' perspective of those events is an important clinical intervention. While these boys are attempting to cope with the stigma and castigation in their lives, they must also attend the developmental tasks of moving through childhood to adolescence.

Adolescence

As adolescents, gay men engage in normal tasks associated with adolescent development. Some are beginning to further develop an understanding of their sexual identity, while others are just discovering it. It is during their adolescence that in addition to the tasks of separation and individuation, they are negotiating social networks (Crespi & Sabatelli, 1993; Meeus, Iedema, Maassen, & Engels, 2005). For heterosexual adolescents, there are associated norms, which makes their development more normative. Dating and other social groupings that occur are socially sanctioned. While there are norms available for heterosexual adolescents to model, very few, if any, socialization norms for homosexual adolescents are available. For some gay adolescents, the absence of such norms produces feelings of isolation and stigmatization. It is during this time that gay teens attempt and successfully complete suicide, or engage in behaviors that have potentially lethal consequences (Gibson, 1989; Ritter & Terndrup, 2002). Moreover, the rates of HIV infections are higher among adolescents. Further, African American adolescents are more likely to engage in sexual behaviors while inconsistently using condoms, as well as have higher rates of HIV infections when compared with their white or Latino counterparts (Centers for Disease Control and Prevention (CDC), 2005a; Pleck, Sonenstein, & Ku, 1991). Many surmise that increased rates of condomless sexual encounters are directly correlated to increased substance use, sexual encounters with age discrepant sexual partners, thrill seeking, and the absence of direct experience of the first two decades of the AIDS epidemic in the United States (Halkitis, Shrem, & Martin, 2005).

Exploring the adolescent sexual development of gay male clients is an important treatment goal. By addressing how these men experienced their sexual initiation and their subsequent sexual experiences, the social worker gains a deeper understanding of their clients' sexual orientation experience. This understanding may help social workers garner clues (a) to assess how client initiated and maximized their general coping strategies and (b) to understand how they began to construct their identity as young gay men. These assessment strategies may provide additional insight of their client's coping strategies as adult men.

Early Through Middle Adult Years

There is a wide variation of experiences gay men encounter as they negotiate their late adolescence and young adult phases of life. There are also a variety of coping strategies and developmental tasks that such men continue to accomplish. Some men have adaptive coping strategies that are aided by socioeconomic strata, culture, and oftentimes race. Incidence and prevalence rates of HIV disease and drug use are two such exemplars.

Some gay men must confront issues of HIV disease and substance use issues. There have been many pharmacological advances related to HIV disease. With the advent of the Highly Active Antiretroviral Therapies, death rates from HIV disease have been markedly reduced in certain segments of gay men. For example, the San Francisco Department of Health in the summer of 2007 declared that HIV disease was no longer an epidemic for the city, but rather an endemic concern. However for African Americans and Latinos in northern California or in other regions of the country infection rates are still at epidemic proportions (CDC, 2007).

African Americans continue to be overburdened by HIV disease. In 2005, African Americans made up 13% of the U.S. population. According to CDC (2007), African Americans constitute 49% of all the known AIDS cases. HIV/AIDS is particularly burdensome for African American gay men. Data from a five-city study revealed that 46% of the African American men who have sex with men in the sample were HIV positive. Further, 67% of those infected were unaware of their HIV status (CDC, 2005a). HIV disease morbidity and mortality rates indicate that African Americans have shorter survival times and experience death more often because of HIV/AIDS than do their white counterparts (CDC, 2005a, 2005b). The CDC (2007) suggests that the higher mortality and morbidity rates are due to structural and societal barriers. These structural barriers warrant innovative approaches that address the social contexts in which African American gay men are living.

In addition to HIV disease, gay men must confront substance abuse. Early in the epidemic, many gay men used the club drugs. These drugs were often associated with risky sexual behavior. In the current prevalence and incidence rates of HIV transmission, the increased use of methamphetamines as a stimulant during sexual encounters is linked to unprotected anal intercourse (Patterson, Semple, Zians, & Strathdee, 2005). Moreover, with the advent of erectile dysfunction medication, many gay men are combining the drugs to achieve more intense sexual experiences. These experiences include participating in both anal receptive and penetrative sexual practices with partners in a sexual dyad or in-group sexual encounters (Fisher, Malow, Rosenberg, Reynolds, Farrell, & Jaffe, 2006).

Understanding the motivations of drug use and unsafe sex practices will help social work practitioners combat increasing HIV infection rates. Some studies suggest that African American gay men engage in drug use for specific reasons, most notably to avoid the reality of HIV risk in their lives, to enhance their sexual pleasure (Halkitis et al., 2005), and to facilitate closeness and intimacy (Guss, 2002). There is empirical support to understand the relationship between drug use and HIV prevalence in gay white male populations. However, there is a dearth of such research for gay men of color. Because the majority of HIV case management is provided by social workers, additional social work research targeted to gay men of color is warranted.

While HIV disease and drug use is a significant problem for many gay men, it is a not problem for all gay men. Many gay men regularly get tested for HIV disease and remain HIV negative. Moreover, there are gay men who may have had a substance abuse history and have successfully negotiated a way to establish and maintain sobriety or have never experienced an addiction to substances (Stall & Purcell, 2000). As workers have been reminded to start where “the client is” (Jokel, 1937) conducting assessments to understand the diverse concerns of their clients is salient starting point.

Understanding how some gay men successfully navigate their primary emotional relationships may be an important therapeutic task for clients in their adult years. Since the completion of the 19th edition of the Encyclopedia of Social Work, the concept of gay marriage has emerged as a divisive, yet salient topic for many people, especially gay men. Gay marriage is a marriage between two persons of the same sex. Many people see the issue of gay marriage as a civil rights issue. The supporters of gay marriage link the inability for two gay people to be married in all fifty states to the federal prohibition of black and white people to intermarry before 1967. Because of the passage of the Defense of Marriage Act in 1996, marriage has been defined as the union between one man and one woman for the purposes of federal law (See 1 U.S.C. § 7.). No act or agency of the U.S. federal government currently recognizes same-sex marriage.

However, the Defense of Marriage Act does not prevent individual states from defining marriage as they see fit. In 2004, Massachusetts recognized same-sex marriage. Beginning January 1, 2008 Connecticut, Vermont, New Jersey, California, and New Hampshire will permit legal unions that will offer all the rights and responsibilities of marriage under state law to same-sex couples. Also beginning January 1, 2008, Maine, Hawaii, the District of Columbia, Oregon, and Washington will permit legal unions for same-sex couples that offer varying subsets of the rights and responsibilities of marriage under the laws of those jurisdictions. These changes to state laws provide some gay men with an option to legalize their relationships and provide some legal protections to their partners and their family members, including their children.

There are gay men who are interested in raising children. However some confront multiple challenges while pursuing this goal. Some of the challenges include fighting the homophobic and heterosexist thinking related to the provision of child care. Social work research has developed an empirical body of research that articulates best practices for both foster care and adoption professions. Social work research has also emerged to support gay men and lesbians engaged in the adoption process. The research includes describing best practices in preparing future guardians and parents for the three phases of adoption—preplacement, placement, and post placement. Additionally, social work research has articulated suggestions for adoption professionals working with gays and lesbians such as finding other adopters in similar circumstances (Matthews & Cramer, 2006). Helping practitioners understand the various assessment domains that are salient for competent assessments with prospective foster or adoptive parents who identify as lesbian or gay (Mallon, 2007) is another social work practice research development. Social work practice research revealed genealogical visions of state foster-care and adoption work can be expanded by the experiences of gay men and lesbians (Hicks, 2006).

Whether or not gay men have been officially recognized as the legal caregivers of children, many have the experience of care giving. The emotional and psychological concerns of providing such care are emerging as a domain for social work services. Some gay men are required to provide such services for their partners who become ill. While HIV provides a certain set of concerns mostly related to the associated stigma of the disease, gay men are susceptible to chronic and terminal conditions consistent with the heterosexual population. Moreover, some men are faced with caring for their elderly parents. With the aging of their parents, gay men must also confront their own aging and impending mortality. How such men are able to manage these life course developments will vary. However, it is a service area for which social workers must be equipped. Many schools of social work have developed specialty training in gerontology, which is subsequently producing an emerging body of knowledge describing the needs and best practices for this aging population.

Finally, this entry would not be complete if there was not a word related to spirituality and gay men. For many readers it may come as a surprise that spirituality is a construct that is relevant in the lives of some gay men. While research has shown that religious dogma in certain sects condemn homosexuality, spirituality is a phenomenon that is both differentiated from religion and has demonstrated efficacy in providing support for gay men as they confront various life challenges. Spirituality has also been shown to be a support for men as they cope with drug addiction, HIV disease, and other life tasks that are important and difficult (Cotton et al., 2006; Martin, 2006; Miller, 2007).

The service needs of gay men have developed markedly since the previous edition of this volume. Social work research, practice, and education continue to evolve. The goal is for the profession to continue to strive match its extraordinary resources with the needs of continuingly stigmatized population.

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