Q&A with Jesus Ramirez-Valles, Ph.D., MPH

September 2011 | Jesus Ramirez-Valles, Ph.D., MPH

Dr. Jesus Ramirez-Valles, a professor of public health at the University of Illinois-Chicago, discusses the health challenges of older gay men of color living with HIV/AIDS.

What are some of the health challenges faced by older gay men as opposed to their heterosexual peers?

There are several challenges that older gay men face. First, older gay men, unlike heterosexual men, encounter the stigma of homosexuality, which causes stress that accumulates throughout their lives. Older heterosexual men have had no need over the course of their lives to explain themselves to their families, workplaces, or health care facilities; they can assume that their needs will be understood.

Older gay men have lower social support, and the support they do have tends to be fragile. For older gay men, friends and peers are the most important source of support, whereas spouses and children are the main support for older heterosexual men. There’s a difference in these relationships—spouses and children are legally recognized, whereas friends and peers are not usually recognized under law. Institutional support from health care agencies, government or aging services is also lacking.

Also, our society stigmatizes older men as unproductive or useless. Because gay culture can be so centered on physical attraction, older gay men experience ageism within their own community. Our gay culture is so youth-oriented and alcohol-oriented, and we don’t have a path for older gay men to age into. Heterosexual men have a path to aging—they can become fathers, grandfathers and patriarchs. They have a role in society as they age, but gay men don’t have that kind of role.

Substance abuse is another important health issue in the gay community. Alcohol and drug use are problems that don’t go away when we turn 50.

Older gay men living with HIV/AIDS also experience the stigma that comes along with the disease. But even more stressful than HIV stigma is having experienced the loss of their friends and the sense that they’ve lost a part of their lives. In my interviews with older gay men, I often hear questions or statements such as: “HIV stole a part of my life,” “Why is this happening to us?”or “Why do we have to deal with losing our friends?”

How do factors such as race/ethnicity compound these health challenges?

One of the greatest challenges we face right now with the aging gay population is that we don’t have a clue about what is happening with older African American men, older Latino men, older Asian American men. We have not documented through research what’s happening with them as they age. We think that they experience “layered stigma”—that is, they experience discrimination based on being LGBT, then they experience racism in society as a whole and within the LGBT community. And, as they grow older, they experience ageism. So, they have more challenges than older white gay men.

We also don’t know what is happening with their social supports. I’m making some generalizations right now, but white mainstream culture is individual-oriented, more “pull yourself up by the bootstraps.” But African American and Latino cultures are more family- and collective-oriented. Older gay African American and Latino men may go back to their families as they age, both to support their families and receive support. I don’t know that they go back in the closet as they age, as many older LGBT people do as they need care, but their gay identity may fade because it is not as important as taking care of their families.

Tell us a bit about your research on older gay men.

Our purpose is to investigate how the stress from stigma affects the health of older gay men and what resources they have to cope with that stress. We are looking at layered stigma—the compound effects of ethnicity, race, age, HIV status, and sexual orientation. The study is also looking at two factors that we think might help older gay men—community involvement and social support (primarily from peers). The study will compare three major groups of older gay men—white men, African American men and Latinos—as well as those living with HIV/AIDS.

Why did you decide to take on this particular research study?

I’m Latino, from Mexico and have been doing research with gay communities for all of my professional career. What I find unacceptable is the lack of knowledge about older gay African American and Latino men. The LGBT population as a whole is aging at a tremendous pace, and social services and health care organizations are not prepared to deal with this. And they are really not prepared to deal with older African American or Latino men man living with HIV/AIDS. We can’t leave these groups to struggle alone. As a society we need to know how they are aging, and how to serve them. They have done their part—they are the ones who opened up society to allow people like me to have careers and to live the way we choose. Now it’s our turn to support their health and well-being.

What do you hope to accomplish through this study?

I’ll start with the larger picture. I want to continue fighting homophobia. There are still terrible stereotypes about older gay men—they’re unproductive or unattractive. I also want to make the field of gerontology “queer,” and to end the heteronormativity of the field. I want to open up affirming spaces for LGBT people as they age.

The practical goal is to create intervention and prevention strategies for these populations that are based on research and on the reality of older African American and Latino men’s lives. We need solutions based on science, not on “this is what we always have done.”

I believe that our communities should not sit comfortably doing nothing. We need to challenge ourselves, and one of our biggest challenges is integrating older gay men of color into our communities and giving them the support they need.

Jesus Ramirez-Valles is a scholar, filmmaker, and an advocate of Latino and GLBT health. He is author of the book entitled Compañeros: Latino Activists in the Face of AIDS (2011, University of Illinois Press) and creator of a documentary Tal Como Somos/Just As We Are on the lives of Latino gay men, transgender persons, and people living with HIV/AIDS. He is also the author of the blog Gayby Boomers: The Gayest Generation. Dr. Ramirez-Valles has received awards from the National Institutes of Health and the Rockefeller Foundation. For more than 20 years he has worked in public health in both the United States and Latin America on a variety of projects ranging from reproductive health, substance abuse to HIV prevention and economic development with women, youth, and gay male populations. Also, he serves as a council member in the National Institute for Minority Health and Health Disparities and is a Trustee for the Society for Public Health Education. He was born in Mexico, obtained his doctoral degree from the University of Michigan and is a professor of public health at the University of Illinois-Chicago.