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A Review of “Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States”

In this collection of essays, editors Richard Wolitski, Ron Stall, and Ronald O. Valdiserri document the story of health disparities affecting men who have sex with men (MSM) in the United States. Featuring a wide range of scholars who present clearly written and thoroughly researched essays, this volume includes several hypotheses about the causes of health disparities and attempts to offer some solutions. This is a big undertaking, and Wolitski, Stall, and Valdiserri ground the reader with a superb introductory chapter that serves as an overview and an outline to the book’s two halves. The first half, “Evidence of Health Disparities Affecting Gay and Bisexual Men,” makes the case that men who have sex with men, as compared to the general male population, are more likely to suffer childhood sexual abuse, be the victim of intimate partner violence, experience a hate crime, suffer from psychiatric disorders, attempt suicide, and are at greater risk of contracting sexually transmitted diseases (including Hepatitis A, B, C, and HIV). The authors examine the underlying causes of these disparities, which include discrimination and stigma. In the chapter “Alcohol, Tobacco, and Drug Use among Gay and Bisexual Men,” the authors David G. Ostrow and Ron Stall undertake an extensive review of the literature examining high rates of substance use and substance use disorders among men who have sex with men as well as the adverse consequences of substance abuse. (This chapter alone could easily be expanded into its own book.) The second half, “Cross-Cutting Issues,” builds upon the foundation laid in the first half with a series of wide-ranging essays. In one, “Interacting Epidemics and Gay Men’s Health: A Theory of Syndemic Production among Urban Gay Men,” the authors Ron Stall, Mark Friedman, and Joseph A. Catania examine the trajectory in the lives of some gay men who make their way to the big city. What are the risks/benefits of life in the “gay ghetto”? Some men find it life affirming. For others, particularly for men of a racial/ethnic minority or men who are poor, the urban gay center can be a harsh, unwelcoming, and discriminatory place. In this particularly insightful chapter, the authors explore how gay men can (and do) marginalize other gay men. Other notable essays examine issues at both ends of the age spectrum: