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Hello, Friends. I have an interview today with Dr. Perry Halkitis who is a public health psychologist, researcher, educator, and advocate focusing on mental health and health disparities in the LGBTQ population. Perry has several books out, most recent of which is called “Out in Time: The Public Lives of Gay Men from Stonewall to the Queer Generation“. 

Getting to know Dr. Perry Halkitis

Perry opens by telling us a bit about himself and his history. A child of Greek immigrants and a 1st generation scholar, Perry talks about the interesting journey which led to where he is today. Being given the opportunity to take further study, he pursued a Ph.D. in applied statistics and quantitative methods and was working as an applied statistician in the early ’90s. However, this was also the period of time when the aids epidemic was taking hold and as a gay man in New York City, Perry was seeing the devastation of the disease all around. This influenced Perry’s career path and in the mid-’90s he decided to change course and started focusing on research around HIV. Perry’s work over the past couple of decades has been focused on the health of gay men. Perry describes his story as one of a person who combined his own skills with what was going on in real life – had there not been an aids epidemic, his career path would have been very different.

Perry opens up about his own experiences with coming out as a gay man in the 1980’s and how on paper it should have been a very difficult time given the decade he was in and the fact that he came from a traditional Greek family. In reality, it turned out to be a beautiful experience for Perry, who was met by his family and friends with amazing support and love. Perry talks about how his own coming out experience was remarkably easy thanks to this, but recognizes how this is far from a typical experience for men of his generation, or indeed today. We talk about the benefits of having a supportive network and how much of an impact it can have on an individual. Perry talks about how the purpose of his latest book was to talk about the commonalities and differences of coming out for gay men across three generations and includes stories from men who’ve had a vast range of different experiences.

Perry talks a bit more about his career path and how he had thought of becoming a medical doctor, or clinical psychologist, but in the end, his heart was in research. We talk about how Perry has combined his interest in statistics to look at larger factors and trends and how this is an important perspective to take. Perry talks more about a research center he runs called CHIBPS which works on LGBTQ health issues and has a primary aim to translate the theory and research into practice in order to make a difference to peoples lives in a positive way. Perry talks passionately about the work they do and how it is community-based, seeking out the best people and information in order to create the most relevant guidelines and practice and being able to put it into action. While academic papers are important, the real impact comes in the community, by talking to those in the field and acting on the research and knowledge you gain from the people. Perry talks more about this and how they keep their work very relevant and very real.

Dr. Halkitis on Health Disparities

Moving on, we talk a little bit about the different terms relevant to Perry’s work and in particular, talk about health disparities and what they are. Perry explains health disparities as health conditions that disproportionately affect populations. For example, if HIV was an “equal opportunity” bad disease, then everybody in the population would have an equal chance of getting it. But in fact, Perry explains that this is not the case. What we know is that gay men, maybe making up around 5 percent of the population, have 60 percent of the disease – that is a health disparity. African-Americans, 14 percent of the population, 60 percent of the disease – that’s a health disparity. “A health disparity is an overburdening of a health situation in segments of the population.”  Perry describes how we see multiple health disparities that coexist with each other in marginalized populations, populations that are often discriminated against. He has spent the past 20 years talking about how HIV and substance use and mental health challenges function synergistically in gay men and cause an increase in the likelihood that gay men are going to acquire HIV.

It’s not just because, oh they’re not using a condom, or they’re not being safe, or they don’t know the rules. It’s because they’re experiencing mental health burdens. It’s experiencing psychosocial stressors. They’re living in a society where they’re put upon and discriminated against and these things enhance the risk.

We chat about this and also how the environment shapes the way our brain functions and how in reality it’s a puzzle with many moving pieces. Moving on, Perry talks about how the concept of health disparities have changed over time. He describes how for so long gay mens health was all about HIV and nothing else. But gay mens health is more than that. As time has gone by and HIV has been brought under control, the health disparities for gay men have shifted with other issues coming to the forefront. Gay men continue to have high rates of substance use and depression, and also have higher rates of exposure to HPV infection. The health disparities still exist but they manifest in different ways to what they did. We talk about this in depth and Perry describes a comprehensive report by the Institute of Medicine the National Academies which documented the extent that LGBTQ people experience disparities and the lack of preparation of the health care profession, particularly with respect to the primary care physicians who actually provide the care that LGBTQ people need.

We talk further about how HIV is still very prominent in the media when it comes to gay mens health and how many other aspects are overlooked. However, Perry explains how there is much excitement at the moment over the possibility of trying to get HIV under control, and yet there are still structural inequalities and great health disparities that exist, even within the gay community (such as black gay men being more at risk of HIV). We talk about the concept of “othering” – i.e. being part of a group that isn’t the majority – and how this impacts mental health and increases risk. Perry also explains further what he means by “structural inequalities”, which refers to laws and policies in society that do not treat people equally, along with experiences of discrimination, poverty and racism. For example, a gay black man in New York City or L.A. is going to have a very different experience to a gay black man in Mississippi, which has oppressive laws and a Christian ethos where homosexuality is still considered very taboo. Such factors are naturally going to have worse health outcomes for individuals.

Perry talks about how people don’t just wake up one morning and decide they’re going to exhibit risky behaviors or become addicted to something or they’re going to acquire HIV…life’s circumstances get them there and often those life circumstances are shaped by the environments that they’re living in. We talk about this more and how these individuals will often avoid treatment through fear of being discriminated against – Perry shares a story from his cousin whos health professional assumed that he had gonorrhea, before any tests were conducted, because of his “lifestyle”. This was not the case at all – the professional’s natural reaction was to point the finger, assuming irresponsible behavior, without paying any notion to the fact that people make decisions in their lives, sometimes irrationally, because they are living under circumstances that are dire. Perry talks about the need to equalize the playing field and have economic equality and how this is becoming an important theme within politic. People are starting to understand that health equity, equal access for everybody, and social justice are the drivers that make us have similar health outcomes instead of these large health disparities that we are seeing.

Continuing, we talk a bit about being professionally neutral when conducting research and education in the field and Perry explains the concept of being objective and how as soon as you become interested in a topic, you lose an element of objectivity. However, that doesn’t mean all is lost. Perry explains the importance of scientific rigor and listening to what the science is actually telling you even if it’s not what you expected or wanted to hear. We talk about this in detail.

Personal and societal responsibility

We talk about the pressures from society and the line of responsibility between personal and societal accountability – at some point, you do need to take responsibility for your actions. Perry explains how he feels it’s about resilience and people who have had some adversity and have some resilience are better to be able to manage social pressures and say no more effectively. He talks about how society doesn’t do a good job at teaching children to be resilient and we need to equip people with skills around resilience that would allow them to have more self-efficacy in themselves and their ability to manage their own behaviors.

However, we still live in a society which has a subset population who have antiquated views, such as considering the LGBTQ community as having a mental illness or sickness. We talk about this more and how there are still people in high standing positions in society that fuel these beliefs. Perry shares some of his experiences and highlights how he responds to varying comments and opinions that he has come across. He explains how there is room for everyone in our world, with all kinds of people celebrating in all different way – we’re not monolithic, and society needs to recognize that.

The role of social media

We talk about how the visibility of the LGBTQ community has shifted within the last decade thanks to social media and wider coverage in the media in general. Perry talks about the differences between when he came out in the early 80s, compared to today. Then there was no internet and he had to figure out how to navigate the space.

I thought I was the only gay person in the world for most of my life

Today, with social media and the internet, it’s possible to access so many other communities from all around the world, taking away that loneliness that so many LGBTQ people feel. It’s empowering and had Perry had that facility he would have known a lot earlier on that he wasn’t alone in his journey. However, while the internet can be an incredible tool, it also has a darker side which we have to be mindful of. We talk more on this and how the representation of the LGBTQ community has improved in the media in general and is much more realistic. Perry talks about the positive impact of this on the LGBTQ community and how this increased visibility helps to normalize things, reducing stress and reducing loneliness.

The less you feel like an ‘other’, the less lonely you feel, the less mental health problems you experience.

Perry talks about this more and how we need to move past labeling people and recognize that we are all ‘people’ at the end of the day. We need to reduce the drama and stress surround conversation so it becomes a natural part of daily life. Increased visibility and improved representation in the media is a big step in the right direction.

Advice from Dr. Halkitis

Moving on, Perry offers some advice for individuals in marginalized communities who might have first-hand experience of these disparities to help ensure they receive the appropriate care and support they need. First of all, we need to have zero tolerance for anything that is discriminatory. Any act of discrimination needs to be called out – it is unacceptable and we need to teach people how to call this out. Perry’s second piece of advice is to not bottle things up as this will impact your health in a negative way. Thirdly, continue to be a voice for the rights of the population and speak up – “we can be as loud as the counter-argument…and there’s more of us”. And finally, everybody should talk to a mental health provider at some point. If you feel like you need support, don’t be afraid to seek out help. We discuss this more, along with the benefits of being able to seek out therapy online.

Perry closes with the message that while aspects do get easier, things are still not great for the LGBTQ community. We need to stand up, be vigilant and take action to help make positive change and stand up for everybody’s rights. Furthermore, he highlights the need for work globally in fighting for the rights of LGBTQ communities all around the world, where there is still extreme amounts of persecution and discrimination.

I’d like to thank Dr. Perry Halkitis for coming on the show and talking so passionately with us. If you would like to find out more about Dr. Halkitis’ work or anything he has spoken about on the show, you can head over to his website. You can also reach out to Perry on Twitter! His latest book, “Out in Time: The Public Lives of Gay Men from Stonewall to the Queer Generation” is out now! 

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