Throughout the last 30 years, the HIV epidemic in the United States has adversely affected the lives of gay men. Starting with the earliest cases in the 1980s, this population has borne the brunt of this disease. Close to 500,000 lives have been lost, and to this day, gay, bisexual and other men having sex with men (MSM) account for 50 percent of all infections and 50 percent of recent infections in the United States. In recent years, rates of seroconversion have been most pronounced in young African American and Latino men. In effect, since 1981, no less than three generations of gay men have been affected.

Much of the behavioral research conducted during the last 2 decades has focused on the role of individual- or person-level determinants of HIV risk behavior. The direct result has been the development of interventions and programs seeking to effect change on the person level. Yet what has become abundantly clear to those of us working in the field is that these programs fall short by failing to address the structural, systemic, and/or societal factors that place gay men at heightened risk. It is these broader factors that we address in this issue of Psychology & AIDS Exchange.

The overall focus of this issue is on the psychosocial stressors that gay men experience that heighten their vulnerability to HIV. Attention is paid to the role that homophobia plays in fueling the HIV epidemic in all gay men and how this form of discrimination, when compounded by racism and economic inequalities, exacerbates risk states. We examine the extant literature that supports these ideas and consider how a theory of multiple minority stress may guide our understanding going forward. In addition, this issue provides insights for clinicians on how to work with their clients, and we consider implications of research findings for public policy.

We hope that the ideas presented in this issue of Psychology & AIDS Exchange foster a dialogue that allows us to consider and develop programs that move beyond the focus on individual behaviors. We also hope future endeavors will embrace the understanding that structural and policy changes are critical for reducing the rates of HIV transmission among gay men. In this regard, we call for a more holistic approach to HIV prevention that treats gay men as more than sexual beings, as well as an approach to gay men’s health that embraces but is not defined solely by sexual health.

Perry N. Halkitis, PhD, MS
Chair, APA Committee on Psychology and AIDS