General Practitioners and general practice staff have a role to play in HIV prevention and other health care for gay and bisexual men. Significant health gains can be achieved with only a small investment of time and resources. Each case of HIV transmission has severe human and financial costs, which may be preventable.

This leaflet is only an introduction to what can be achieved. To help you make changes in your practice, use the booklet, Small Effort, Big Change, as a practical planning tool (copies can be ordered from Gay Men's Health Wiltshire and Swindon).

Why target gay men?

Doesn't AIDS affect every group in the population equally nowadays? There has been an assumption that gay men no longer need HIV education because of the unprecedented success of informal peer education in the gay communities in the 1980s. However, both epidemiology and official guidance indicate that gay men continue to remain at highest risk of HIV infection in the UK.

Health opportunities Research has identified some problems in the relations between gay men and their general practitioners. It is important to improve these relations because of the central role of GPs in health care which means they can provide a vital safety net for HIV prevention for gay men.

Equity We are not suggesting special treatment for gay men, only the same quality of care as everyone is entitled to, but applied in a way that is sensitive to cultural differences.

Low visibility Research shows that most gay men do not confide in GPs about sexual health matters. Your practice probably has more gay and bisexual men registered than you know about. So you may underestimate the importance of the sexual health needs of gay men.

The cost Making your services 'gay-friendly' is cheap because all it takes is some changes to existing protocols. The learning your practice staff gain in people-friendliness is transferable and thus valuable for other patient groups.

Scepticism about health promotion We know that some GPs have doubts about their role in health promotion whilst others are actively developing their health promotion services. We're not expecting GPs or practice staff to take on more work. The emphasis is on relatively small changes to make consultation and referrals more appropriate.

Resources GPs may not realise what services already exist in most districts. We have produced a booklet, Small Effort, Big Change, which offers practical guidance on working with gay men.

Example benefits
Here are a few situations involving gay or bisexual men, each with an example of what can be achieved with some simple measures:

• Isolation A potentially suicidal gay teenager confides in you and learns about a local counselling agency which helps him resolve his anxieties

• Infection A young man at high risk. of Hepatitis B infection is vaccinated.

• HIV transmission A patient who occasionally lapses from his own personal safer sex rules is referred to a safer sex workshop which strengthens his resolve.

• Successful referral A bisexual married man is reassured about the con-fidentiality of GUM services, screened, and counselled for other STDs.

Key referrals for gay men
Much has changed since the early days of HIV and AIDS. There is now a wealth of specialised information and support available. However, not everyone knows how to access this information or support. Some patients don't know it exists. By contrast, so much is written about HIV and AIDS that some patients don't know where to begin or which sources of information are safe to trust.

As with other areas of primary care, general practitioners are not expected to be specialists. You don't need detailed knowledge of the range of referrals for gay and bisexual men. All you need know is that a very wide range of information and support is available; and you can get regularly updated referral lists with minimum cost or effort.

The local gay men's health project (or alternatively, the local health promotion unit) can usually provide your practice team with regularly updated information about confidential helplines, and directories of HIV prevention services, and support and self-help groups.

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