Strategic framework to promote the health and wellbeing of gay, bisexual and other men who have sex with men Dr Justin Varney National Lead for Adults and Older People’s Health and Wellbeing Justin.varney@phe.gov.uk

Context Significant health inequalities affecting gay, bisexual and other men who have sex with men (MSM) reiterated in the Public Health Outcomes Framework LGBT Companion Document Men who have sex with men remain disproportionately affected by HIV and sexually transmitted diseases Significantly higher rates of mental ill health, poor wellbeing and higher rates of use of alcohol, cigarettes and drugs The Framework draws together a trio of interconnected and overlapping inequalities in sexual health, mental health and use of drugs, alcohol and cigarettes and maps the evidence base to make recommendations for interventions to reduce the inequality and support local and national government, the NHS, Voluntary and Community Sector, Communities, Families and Individuals in reducing the gap. First in a series of minority health frameworks Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework

Process and Engagement Evidence mapping through direct and commissioned topic overview reports on published and grey literature. Two initial listening events in Spring 2014. Community and academic engagement through large expert advisory group who have commented on drafts during the Framework’s development. Public consultation through .Gov consultation portal over two weeks. Launch date: 27th June at House of Lords reception Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework

The Vision For gay, bisexual and other men who have sex with men, to enjoy long, healthy lives and have respectful and fulfilling social and sexual relationships. .

What does success look like by 2020? halve the number of new HIV infections in MSM from 3,000 in 2012 to 1,500 in 2020 halve the proportion of MSM with poor mental health, measured through self-reports of feeling recently unhappy/depressed from 21% in 2011 to 10% in 2020 reduce the proportion of MSM who report concern about their alcohol use by a fifth, from 21% in 2011 to 17% in 2020 reduce the proportion* of MSM reporting the use of harmful illicit substances, including those associated with ‘chemsex’, by 2020. reduce the proportion of MSM who smoke to be no more than 10% higher than the rest of the male population by 2020 Reduce significantly self-reported incidents of homophobic and biphobic bullying in schools from 55% in 2011 

The Approach People Places Communities

Starting well Key issues: A safe and secure home, a balanced diet and physical activity, and feeling supported and accepted is vital for the health and wellbeing of all young people as they transition from infancy, to childhood, adolescence and beyond. Key issues: 85% of gay, bisexual and other MSM reporting no education in same sex relationships while at school, and a survey found that MSM aged 16-24 consistently know less about HIV than those aged 25-54yrs. Younger MSM have higher rates of STI and HIV than older MSM Homophobic, biphobic and transphobic bullying remains a significant issue, over 55% of lgb students reported being bullied in school MSM aged 18-19 years were 2.4 times more likely to smoke & almost twice as likely to drink alcohol two times a week or more compared to heterosexual men

Living well Key issues: There is a diverse population of gay and bisexual and other MSM, with clear evidence of inequalities across a range of health outcomes and these being even more pronounced amongst those with multiple minority identities e.g. gay & black. Key issues: HIV incidence continuing to increase amongst MSM, partially due to increased diagnosis, one in twenty are estimated to be living with HIV and 1/3rd were born abroad MSM are twice as likely to be depressed when compared to other men MSM are twice as likely to be alcohol dependent when compared to other men Population surveys of MSM demonstrate disabled men  were three times more likely to self-harm and three times more likely to have attempted to take their own life compared to MSM without disability. Sources: King (2008), GP Patient survey (2012-13), Buffin (2012)

Ageing well Key issues: Older MSM constitute men at very different phases of their lives, ranging from MSM in employment, living well in retirement and those requiring support at home or in care. Many will have experienced far more acute stigma and discrimination than today’s cohort of young MSM, and as a result, may have come out in later life, or carry this experience of stigma with them creating additional barriers to accessing services. Key issues: Older MSM remain at risk of STIs. In 2012, 14% of diagnoses of chlamydia, gonorrhoea, syphilis, HSV and HPV in MSM were reported among men aged 45 years and over in the UK; this compares to 8% in heterosexual men. Around 28% of all MSM HIV infections are in men over 45yrs. Health and social services may not be responsive to needs of older LGB Higher rates of poverty and social isolation older MSM at higher risk of depression

Evidence base for interventions Sexual health: Good quality, inclusive sex and relationship education Regular HIV and sexual health testing Condom use Early diagnosis and treatment Treatment as prevention (TasP) Mental health Training for supportive parenting, teachers and carers Interventions to reduce bullying in schools and workplaces Training for service providers and visibly inclusive approaches Drugs, Alcohol & tobacco: Culturally competent treatment pathways and services with training and imagery that is inclusive and supports engagement

Recommendations Recommendations laid out in sections for Starting well, Living well, Ageing well, and Places focused on health service providers, and finally Communities. Framed in context of: Individual gay and bisexual men and other MSM Families, guardians and carers National Partners Public Health England Local Government Community Sector 11 Gay and Bisexual and other Men who have sex with Men Health and Wellbeing Framework

Recommendations Core themes: Improved data collection and analysis Increased training across professional groups Specific consideration of gay, bisexual and other MSM needs Scale up existing evidence based implementations such as regular sexual health and HIV testing Engagement with the community and strengthening community recognition and engagement with the issues Visible role models and champions Levers to support implementation Legislative levers – Equality Act & Inequality Duties National LGBT Strategic Partnership with DH & NHS England New LGBT academic network

Implementation Public Health England will establish is committed to supporting the implementation of this framework. PHE will establish an implementation advisory group with appropriate representation from the LGBT community, national stakeholders and teams within PHE whose have the opportunity to implement and integrate the framework in their work. PHE will hold bilateral meetings with the relevant government departments and national bodies to consider the recommendations made at a national level. PHE will work with the Government Equalities Office to find synergy with the cross-government LGBT action plan. PHE will continue to work closely with, the Local Government Association, NHS England, Clinical commissioning Groups, Local Authorities and Health and Wellbeing Boards and relevant voluntary sector partners to energise action to reduce the inequalities affecting MSM PHE will continue to work with NHS England’s Equality and Diversity Council working group on sexual identity data, to support the implementation of monitoring across the NHS.  PHE will pump prime an LGBT academic network to provide continuing academic insight and advice to the implementation of the framework   PHE will publish an annual implementation update on the framework, including a report on progress against the ambition indicators.

Strategic framework to promote the health and wellbeing of gay, bisexual and other men who have sex with men Dr Justin Varney National Lead for Adults and Older People’s Health and Wellbeing Justin.varney@phe.gov.uk