Decisions about if, when, and how to share one’s sexual identity or sexual attraction are often ongoing in the lives of gay, bisexual, queer, and two-spirit men. Whether men share their sexuality all the time, sometimes, or never, negotiating “the closet” shapes many aspects of their lives from social networks to health care access. In this blog, I will review what we know about gay men’s experiences in and out of the “closet”, and how these experiences impact health and wellbeing across the life course.
All aspects of men’s identities, and the communities in which they live, shape their decision to, and experience of, coming out about their sexuality. Men may also negotiate coming out about their gender, mental health needs, or living with HIV which may impact subsequent coming out decisions (1). Decisions about whether or not to come out may be shaped by concerns about safety, employability, existing identities, relationship status, access to community support, fear, and anxiety. Decisions about coming out must also be understood within a historical context. In their work on the life course model, Hammack et al. (2008) argue that men’s process of understanding their identities and the ways they express it have been shaped by the social and cultural environments when they grew up (2).
Some men may come out to everyone in their life, whereas other men come out in certain contexts but not others. Meyer’s (2007) minority stress theory suggests there is ongoing stress associated with decisions related to identity management (3). For example, men may consciously conceal their partner is a man, or certain knowledge or skills others may associate with being gay.
Coming out and health
Several theories reviewed in this blog help to reveal the many ways in which coming out impacts health. First off, heterosexism and queer theory analysis reveal a structural context which puts the burden on individual men to come out about their sexuality, gender or HIV status. Health care systems and providers tend to assume men to be heterosexual, cisgender and HIV-negative unless they are told otherwise. As a result of these assumptions, care is often oriented to the needs of heterosexual, cisgender, HIV-negative men leaving many men without appropriate care (4). The result is that men have to disclose an aspect of their identity in order to get the care that is right for them. However, while some men feel comfortable disclosing their identities, the Sex Now survey shows 48% of Canadian gay men are not out to their primary health care providers (5).
Assumptions regarding sexuality, gender and HIV status also are reflected in training and education. As a result, health care providers are not always equipped with the tools to have open and knowledgeable conversations about sexuality, gender, HIV status and sexual history. These concerns about coming out in primary care settings also pertain to other health and social services, such as seniors’ homes and long-term care facilities for people of all ages (6).
Being out can also shape men’s connection to community. Syndemics theory portrays circumstances wherein men who are out may lose support from communities they grew up in, and gain support from other communities if they are able to find them. For example, some men may migrate away from the communities they grew up in if the communities’ reaction is hostile. Upon arriving in a new place, these men may encounter new communities that affirm gay men. Community connection is often seen as a crucial resource for coping with minority stress, and for resilience.
As Kitzinger (1997) has argued, it is crucial that we identify and respond to the problem of the oppressive systems at play, and not solely on those who experience oppression (7). Canadian evidence that suggests coming out remains a challenge, particularly with service providers. In a society where men do not feel comfortable coming out, we must consider how we can provide holistic and specific services to ensure men are getting appropriate care whether or not they are out. An approach that offers care to meet these men’s needs will strengthen health and wellbeing for both out individuals who do not want to disclose to a provider, and to those men who are not out to anyone. This kind of approach may also help to affirm and increase visibility of some aspects of the lives of bisexual, gay and queer men.
Coming out happens at different points throughout men’s lives, with men increasingly coming out at younger ages. Many men have had coming out experiences, and these experiences continue to impact their day-to-day lives, as well as their health and wellbeing. Supporting positive sexual identity development processes and affirming coming out experiences for those who leave the closet needs to be multifaceted. And yet, it is also imperative that we continue to work towards ensuring services, including long-term care homes, sexual health clinics and schools, are providing care that will meet the needs of gay, bisexual, queer men whether or not these individuals are out.
(1) Institute of Medicine, 2011 – The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding via http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx
(2) Phillip Hammack and Betram Cohler, 2009 – Narrative, Identity, and the Politics of Exclusion: Social Change and the Gay and Lesbian Life Course. Abstract available via http://link.springer.com/article/10.1007%2Fs13178-011-0060-3
(3) Ilan Meyer, 2007 – Prejudice and Discrimination as Social Stressors in The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations.
(4) Dahan, Feldman, & Hermoni, 2008 - Is patients’ sexual orientation a blind spot of family physicians?
(6) Global 16X9, 2014 – Back in The Closet via https://www.youtube.com/watch?v=7F4KeHwqvuo&feature=share
(7) Celia Kitzinger, 1997 - The Social Construction of Lesbianism.
For a review of heterosexism, queer theory and/or syndemics, please visit my blog archives.