What Is the State of Health Research On Gay, Bisexual and Other Men Who Have Sex with Men? A Systematic Review of the Literature
Health research studies on sexual minority men have employed various measures of sexual orientation. Currently, there are three common ways in which sexual orientation is operationalized in health research: self-reported identity (gay/bisexual/heterosexual), sexual behavior (with same and/or opposite sex partners) and sexual attraction. However, the use and definition of these measures widely vary across studies. This can lead to confusion about how to interpret research findings regarding health outcomes for sexual minority men. The purpose of this systematic literature review was to 1) identify how sexual orientation is measured in health research on sexual minority men, 2) to examine the types of health outcomes in relation to the dimension of sexual orientation measured, and 3) to critically examine how varying definitions and measures of sexual orientation may impact the study outcomes.
A comprehensive search strategy was used to locate studies for the review. To be included, the study must be 1) a quantitative design, that 2) sampled sexual minority men, and 3) focused on a health topic. The research must be 4) published in peer-reviewed journal, 5) in English, 6) in 2010. The electronic search was conducted across multiple databases, such as CINAHL, Embase, PsychINFO, and PubMed. Key words included: gay, bisexual*, homosexual*, men who have sex with men, non-gay and resulted in 3905 references. After removing duplicates (n=1710), two authors independently assessed each article for inclusion and described reasons for exclusion. In cases of disagreement, all authors worked to build consensus. Detailed data extraction of each eligible study (n= 250) was conducted with EPPI-Reviewer 4 software. Data included: dimension of sexual orientation measure, health outcome, sample size, country of research, sampling methods, study design, sample racial makeup, and youth/adolescent focus.
The majority of studies included in this review used behavior (66.8%) and identity (50.40%) to measure men’s sexual orientation (Some used more than one measure). This was followed by attraction (4.8%) and a composite of two or more measures (5.2%). These measures of sexual orientation were employed to study over 34 health outcomes, including sexual health, drug/alcohol use, and mental health. HIV and sexual risk were the majority of the health outcomes examined. Behavior was most often used in sexual health studies, while identity was more often used for mental health outcomes. However, these measures of sexual orientation were not always defined or articulated, and researchers often failed to report why they chose the particular measure of sexual orientation. The study revealed at least 12 other ways in which men’s sexual orientation was measured. Nearly half of the studies (44%) did not identify the racial/ethnic makeup of the samples.
These results highlight the complexity and diversity in the ways in which sexual orientation is operationalized in studying health outcomes among sexual minority men. This study suggests social work practitioners and researchers critically appraise how measurement of male sexual orientation may impact the findings on health outcomes. Finally, this study stresses the importance of researchers clearly defining sexual orientation and articulating the rationale for their measures.