It had been three years since I’d met up with my first boyfriend – let’s call him Steven. When he walked into a Brixton pub in June, it was a shock. I’d first met him well over a decade ago, and back then he was sporty, a bit of a health freak: other than the usual occasional student alcohol binge, relatively strait-laced. This Steven had dilated pupils, red marks on his arms, and his head jerked erratically as he spoke manically. He was addicted to crystal meth, and had an abusive relationship with other drugs and alcohol.
Steven’s story is all too revealing about a silent health crisis afflicting gay men. The words “health crisis” in conjunction with “gay men” normally conjures up the HIV catastrophe that decimated the gay and bisexual community in the 1980s. In the developed world, HIV is no longer the death sentence it once was, although the treatment can cause health complications, and in the UK an estimated 6,500 men who have sex with men live with undiagnosed infections. A far greater menace is mental distress – impossible to disentangle from a society riddled with homophobia – and the drug and alcohol abuse that can follow.
Steven has been clean for 66 days, has enthusiastically taken to treatment and volunteers at his local support group. But why – like so many gay men – did he succumb to addiction? When Steven came out, at the age of 15 years old, his parents drove him to a pseudo-clinic run by fundamentalist Christians to be cured of his homosexuality. But he doesn’t speak with bitterness. “I know they love me and they were doing the best they could,” he says. “They didn’t know what I needed, so they looked to their own experience, a culture that taught that if you were gay it was a disaster. You’d be lonely, you’d get Aids, you’d find life difficult. They felt they were trying to support me.”
The problem was far broader than his family, though. Coming out as a teenager in the early 00s meant almost inevitable bullying at school, a lack of awareness of where to find positive role models, and homophobic voices amplified by the media. “Taken together, it meant I was isolated and thought that I was the problem.” Internalising that shame at such a young age inflicts long-term damage – and explains much of his current turmoil.
It’s an issue covered by the former Attitude editor Matthew Todd in his utterly brilliant – and disturbing – recent book Straight Jacket. He identifies a number of problems that most gay men, if they were honest, would at least recognise: “Disproportionately high levels of depression, self-harm and suicide; not uncommon problems with emotional intimacy … and now a small but significant subculture of men who are using, some injecting, seriously dangerous drugs, which despite accusations of hysteria from the gatekeepers of the gay PR machine, are killing too many people.” He lists a disturbing number of gay friends, acquaintances and people in the public eye who struggled with addictions and took their own lives.
The statistics are indeed alarming. According to Stonewall research in 2014, 52% of young LGBT people report they have, at some point, self-harmed; a staggering 44% have considered suicide; and 42% have sought medical help for mental distress. Alcohol and drug abuse are often damaging forms of self-medication to deal with this underlying distress. A recent study by the LGBT Foundation found that drug use among LGB people is seven times higher than the general population, binge drinking is twice as common among gay and bisexual men, and substance dependency is significantly higher.
Why? As Todd puts it: “It is a shame with which we were saddled as children, to which we continue to be culturally subjected.” The problem gay people have isn’t their sexuality, but rather society’s attitude to it. It is “our experience of growing up in a society that still does not fully accept that people can be anything other than heterosexual and cisgendered [born into the physical gender you feel you are]”. There’s the weight of centuries of hatred and bigotry, with legally enforced discrimination only dismantled in very recent times. All gay and bisexual men – as well as women and trans people – grow up hearing homophobic and transphobic abuse. “Gay” is a word used in the playground as the repository for all that is bad. Popular films and TV programmes have largely lacked sympathetic, well-rounded LGBT characters, often resorting to crude homophobic tropes. Even the inability to hold hands with someone you love in almost any public space is a reminder that a depressingly large chunk of the population still rejects you. Coming out – a process that isn’t a one-off, but a wearingly repetitive event in different contexts – involves constant stress. And for those who think it’s all inevitably getting better, since the EU referendum, there’s been a 147% rise in homophobic hate crimes.
Society has damaged – and continues to damage – LGBT people. That’s not to overstate the case (and focusing on my experience as a gay man): being gay does not mean being in a state of misery. As Todd puts it, there are lots of contented, successful gay people, and progress in recent times has been astonishing, including equal marriage. Coming out is like coming up for air for the vast majority of LGBT people: the alternative is so much more miserable. But this is a health crisis that is not spoken about enough: the toxic combination of mental distress, drugs and alcohol abuse.
It is a crisis that is not being dealt with. Despite the government’s promises to grant mental and physical health parity of esteem, last year Mind reported an 8% real terms drop in mental health services funding since 2010. Cuts, according to health thinktank the King’s Fund, have contributed to “widespread evidence of poor-quality care”. Many LGBT services in particular have been devastated: as the TUC pointed out in 2014, they were “already coping on a shoestring. Some have faced drops in up to 50%.”
Because of our internalised shame, LGBT people often find it difficult to talk about the problems we collectively face. The danger is always of reinforcing the damaging stereotypes that have already caused so much distress. But we have to confront a crisis that is damaging health and taking people’s lives. Society has to take responsibility, too: it is its continued refusal to treat LGBT people as equals that is causing so much pain.