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Saturday 10 October 2015


Dr Peter Saxton: It's time for health equality

Posted in: Health & HIV, Features
By Dr Peter Saxton - 19th August 2015

Two years on from marriage equality, Dr Peter Saxton from the Gay Men’s Sexual Health research group says it’s time to assert our right to health equality.


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We must assert our right to health equality. Our communities continue to experience poorer health than the general population, especially in mental health, drug and alcohol use, HIV and sexual health. How do we remedy this? We must insist on inclusive institutions: this means our government, our universities, our schools, our marae, our DHBs and medical services, our employers, our sports bodies and our councils. We should ask why, with equality being such a modern buzzword, there are so few programmes and organisations unapologetically dedicated to our wellbeing. We must encourage educators to graduate health professionals who can provide culturally competent and relevant care for our communities. We must be counted, from census to the GP’s waiting room. We must expect no less. We must make society understand that we expect no less, because we are not less valued members of society.

We should also inspire and care for each other. Demonstrate the spirit of inclusiveness by first celebrating the diversity within our own communities. And until we have secured health equality, we should ask ourselves what role we can each play to hasten it then sustain it for every new generation.

Gay and bisexual men have especially high HIV and sexual health needs. These are getting worse, not better. Avoiding this subject for fear of stereotyping gay men or tarnishing the important gains from Marriage Equality is understandable but the wrong response. Instead of silence, we need to understand it, own it and respond effectively to it. Our poorer HIV and STI statistics have three main drivers: the higher transmission efficiency of receptive anal intercourse, the higher underlying prevalence of HIV and many STIs among our sexual partners, and the more tightly connected network of our sexual partnerships. Together these drivers interact and mean that the first time a young gay man has sex he is already at heightened risk of HIV and STIs than his heterosexual peers.

We should require sex education to equip gay and bisexual youth for this reality. We should lobby Pharmac and our representatives to fully fund HPV (human papillomavirus), hepatitis A and hepatitis B vaccinations. We should advocate for adequately funded peer-based HIV and STI prevention, diagnosis and treatment services. We must continually address risk-taking determinants such as substance use, mental health and lack of self-confidence. We should ask why there still isn’t a single dedicated accessible one-stop-shop integrated health centre offering exceptional quality care for our communities.

At the same time we can champion what healthy sexual cultures can look like. Enjoy sex. Sex is also relational, so it is never just about satisfying one person’s preferences. Take care not to exploit inequalities in experience, knowledge, education, language and wealth between each other. In our small communities the transmission of a single STI can ripple out to many other gay and bisexual men extremely rapidly. If you are a sexually active gay or bisexual man this means we are all connected in some way to each other’s behaviours. Get better at demonstrating not just self care and mutual care but care for all those gay and bisexual men who might inherit the health consequences of your private actions. Conversely, reject nihilism about our communities’ sexual health future. There is nothing inevitable about HIV infection. It is entirely within our ability to control these epidemics if we’re collectively willing to take effective action.

- Dr Peter Saxton
Gay Men’s Sexual Health (GMSH) research group, University of Auckland



Dr Peter Saxton - 19th August 2015

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