One of the indescribable aspects of being a member of a minority group is knowing that things are better than they have ever been and, simultaneously, not good enough.
The LGBTQ community has won the right to same-sex marriage and achieved unprecedented visibility in politics, media and entertainment. Yet we still lag far behind the straight and cis population when it comes to mental health, substance abuse and HIV rates.
Travis Salway is an epidemiologist trying to close this gap. In 2014, he discovered that in Canada, suicide had surpassed HIV as the leading cause of death among gay and bisexual men. More recently, he’s been advocating to outlaw conversion therapy and offer mental health screenings at clinics that diagnose and treat sexually transmitted diseases. HuffPost talked to Salway about these persistent challenges and the fight for health equity.
How did you find out that more gay and bisexual men were dying of suicide than of causes related to HIV?
I had been working in HIV prevention for years, motivated by the fact that new HIV infections weren’t coming down among gay men. One of the theories we were exploring was that social isolation, depression, drug addiction and other social factors were leading to sexual behavior associated with HIV transmission. These same factors, of course, can also lead someone to suicide.
I pulled the suicide statistics among gay and bisexual men and was really shocked at how high they were. Though HIV mortality rates had been declining for years, suicide rates remained stable or even increased. So we think that the mortality lines have crossed for gay and bisexual men, with suicide likely having surpassed HIV as a leading cause of death.
Gay Suicides Are On The Rise. Epidemiologist Travis Salway Explains Why do suicide rates remain so high among the LGBTQ population?
The predominant theory is called “minority stress.” The idea is that sexual minorities accumulate stressors in multiple forms. That includes overt things like beatings and name-calling, but also quieter things like avoiding a family gathering because you don’t want to have an awkward conversation with your uncle. Even if no one ever says it, you get the message that you’re wrong.
Minority stress continues even after you’ve left the closet. All of us, all the time, have to decide when to come out. Even if you’re in a big city, Castro-style environment where everyone is all “yay gay,” there’s still cognitive stress every time you make that decision.
A look at the disparities in suicide rates between straight and LGBT populations, with data based on... A look at the disparities in suicide rates between straight and LGBT populations, with data based on a Canadian survey. Over time, minority stress leads to problems like rumination — thinking negative thoughts over and over again. It can lead to a sense of hopelessness. Some people cope by self-medicating with drugs or alcohol. Some withdraw in social situations and use substances to connect.
And we’re now learning that sexual minorities have structural risks that go beyond spending their adolescence in the closet. Marriage, children, access to jobs and support networks are all different for sexual minorities in ways that are relevant for suicide. People who have steady partners, for example, are generally less likely to kill themselves. Gay and bisexual men are less likely to be in long-term relationships and tend to start dating much later in life. That may be another risk factor in suicide.