Sexual & General Health

Guides for GPs and general practice staff

Small Effort, Big Change


This guide provides the primary care team with a low-cost action plan for improving trust and communication between gay men and their GPs and thus achieving important health gains.

This version, part of the Gay Men's Health Wiltshire and Swindon web site, is based on the original booklet which is available from Gay Men's Health. An on-line version of our summarising leaflet, One Small Step is also available on-line.

Why do anything different?

Over the past 15 years gay men have become a particular concern for health providers because of HIV/AIDS. In the UK the prevalence and incidence of HIV amongst gay men remains the highest. This epidemic has highlighted that, in order to stem the epidemic in gay men, health services need to be accessible and appropriate.

Various studies have concluded that gay men are not turning to their GPs for a number of reasons, even though GPs are a key gate-holder to health advice and services[1]. The findings from these studies have been incorporated into this guide.

Gay men, due to social stigma and life experience, quite rationally, make assumptions about health services and GPs which are reinforced by the general treatment of gay men in society. These assumptions need to be addressed in order for gay men to feel comfortable in accessing your service and receiving appropriate diagnosis and treatment.

Many of the recommendations within this booklet will also be of benefit to other general patient groups.

A health opportunity

Gay men's HIV prevention needs are best met by a combination of informal gay community peer education and formal gay men's health promotion services[2]. However, it is not safe to assume that this education is reaching every gay man at risk.

Although GPs cannot be expected to be major players in educating gay men about safer sex and HIV prevention, they can provide a vital safety net for some of their patients that no one else can.

Each incident of HIV transmission carries immense human and financial costs. As a recent editorial in the BMJ made clear, nothing can be more dangerous for HIV prevention than assuming that gay men no longer need support in sustaining their change towards safer sexual practices[3].

With only a little extra effort the practice team can make a few changes that between them may not only help prevent one or two cases of HIV transmission, but also deliver a number of other collateral benefits, such as a reduced incidence of other sexually transmitted diseases like Hepatitis A and B.

What this guide will do

This is a comprehensive guide to adapting your practice to the diverse needs of gay men, with little cost, but high value health care benefits.

Next: what are gay men's concerns?

1. See, for instance Mansfield (1989), Turner (1994), Rendell (1994) and Wadsworth (1992).
2. For a discussion of the importance of such gay community networks and initiatives see King (1993) and Scott (1995).
3. See Stall (1994).