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A socioecological approach, borrowed from the field of child development, as applied in public health, examines multiple levels of influence (i.e., macrosocietal forces, public policies, as well as influences at the neighborhood, institution, community, family, dyad, individual, biologic and genetic levels) on health behavior and health outcomes. We propose that three theoretical approaches-socioecological (also called social ecological), intersectionality, and lifecourse-may enhance our understanding of how syndemic adverse health outcomes among MSM are produced. Thus the larger social and physical environments (conceptualized as systems of oppression and opportunity) are hypothesized to play a fundamental causal role in the adverse health outcomes that characterize the health profiles of many MSM.
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Such experiences may be compounded among MSM of color, 1 who live within a system of oppression related to race/ethnicity that contributes to adverse health outcomes. Some have proposed that these outcomes are syndemic and causally associated with adverse childhood and adolescent developmental experiences-experiences reflective of societal oppression of gay men. Gay, bisexual, and other men who have sex with men (MSM henceforth) experience significantly higher levels of HIV/AIDS, drug and alcohol use, anxiety and depression, and other mental and physical health problems, as compared with the general population of men. Overall, these findings suggest the need for further investigation into the role of macro-level social forces on the emotional, behavioral, and physical health of urban MSM. They also observed that those who co-resided with a sex partner had larger networks of people to depend on for social and financial support, but had the same size sexual networks as those who did not live with a partner. The third study, using egocentric network analysis with a sample of African American MSM in Baltimore, found that sexual partners were more likely to be found through face-to-face means than the Internet. The second study, using qualitative interviews, observed complex interactions between neighborhood-level social environments and individual-level racial and sexual identity among MSM in New York City. The first study, using cross-sectional data, looked at migration of MSM to the gay resort area of South Florida, and found that amount of time lived in the area was associated with risk behaviors and HIV infection. From this perspective, we present preliminary data from three related studies that suggest ways in which social contexts may influence the health of MSM.
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This image, originally posted to Flickr, was reviewed on 12 December 2012 by the administrator or reviewer File Upload Bot (Magnus Manske), who confirmed that it was available on Flickr under the stated license on that date.Adopting socioecological, intersectionality, and lifecourse theoretical frameworks may enhance our understanding of the production of syndemic adverse health outcomes among gay, bisexual and other men who have sex with men (MSM). You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.