© Springer Nature Switzerland AG 2021
E. M. Lund et al. (eds.), Violence Against LGBTQ+ Persons,
Violence Against Gay Men
JessicaEsposito, Maggi A.Price, andJoeliKatz
Gay men experience violence at dispropor-
tionate rates. This disparity is driven by state-
sanctioned structural violence, homophobia,
and problematic masculine norms. The pres-
ent chapter reviews the historical legacies of
violence against gay men and provides an
overview of research on current prevalence
rates. The authors introduce multiple theoreti-
cal frameworks (e.g., minority stress theory)
to elucidate the experiences of gay men with
multiple marginalized identities. Common
risk factors (e.g., gender nonconformity) and
forms of violence (e.g., intimate partner vio-
lence) in this population are discussed.
Subsequently, barriers to reporting violence
and the consequences associated with vio-
lence are reviewed. The chapter concludes
with a discussion of practice and policy rec-
ommendations and implications.
Violence Against Gay Men
Violence affects gay men at disproportionate
rates (National Coalition of Anti-Violence
Programs [NCAVP], 2016) and is supported by a
larger cultural landscape of homophobia and
hegemonic masculine norms of physical aggres-
sion and toughness. Gay men with multiple mar-
ginalized identities, such as gay men living with
HIV, contend with stress related to their disad-
vantaged statuses and thus face heightened risk
of stigma-based violence (Kertzner, Meyer, Frost,
& Stirratt, 2009). This chapter focuses on vio-
lence against gay men in general as well as high-
lights unique vulnerabilities of gay men with
multiple marginalized identities.
In this chapter, we explore historical lega-
cies of violence against gay men and frame this
violence in the context of stigma-related stress.
We begin with a history of violence against gay
men in the USA, contextualizing interpersonal
J. R. Scheer (*)
Center for Interdisciplinary Research on AIDS,
Department of Social and Behavioral Sciences, Yale
School of Public Health, New Haven, CT, USA
A. S. Breslow
PRIME Center for Health Equity, Albert Einstein
College of Medicine; Health Equity Research Lab,
Department of Psychiatry, Cambridge Health
Alliance/Harvard Medical School,
Cambridge, MA, USA
VA NewYork Harbor Healthcare System,
New York, NY, USA
M. A. Price
School of Social Work, Boston College, Chestnut
Hill, MA, USA
J. Katz New York City’s Mayor’s Ofce of Contract
Services, New York, NY, USA
anti- gay violence as a logical consequence of
institutional exclusion, violence, and erasure.
Next, we describe unique experiences of gay
men who not only experience sexual orienta-
tion-based prejudice but also face additional
challenges related to their multiple stigmatized
identities. We then highlight minority- and non-
minority-specic forms of violence commonly
experienced among gay men and note determi-
nants of violence in this population. In addi-
tion, we discuss gay men’s exposure to intimate
partner violence (IPV), including a sexual and
gender minority (SGM)-specic form of
IPV.Given that many gay men also perpetrate
violence in partnerships, we review recent lit-
erature on correlates of IPV perpetration. We
then discuss barriers many gay men encounter
in reporting violence.
Next, we use syndemic theory as a framework
for better understanding how stigma and discrim-
ination perpetuate co-occurring epidemics of vio-
lence exposure and health risks among gay men.
In addition, we focus on clinical practices and
treatment recommendations for working with
violence-exposed gay men. Finally, we review
the research on contemporary anti-violence advo-
cacy by and for gay men, including intersectional
approaches to responding to violence against gay
men with multiple marginalized identities.
History ofSystemic Violence
Against Gay Men
The alarming prevalence of individual acts of
violence against gay men is not random, nor does
it occur in a vacuum. Rather, violence against gay
men persists due to a historical legacy of sys-
temic violence, or state-sanctioned exclusion,
discrimination, and physical harm committed by
governing bodies or defended and protected by
Criminalization ofGay Men
Systemic violence against gay men has occurred
in the form of criminalization: the practice of
transforming individuals of particular groups into
criminal subjects, rendering their activities, identi-
ties, or desires illegal. Gay men have been crimi-
nalized since the founding of the USA, facing both
threats of violent criminal prosecution (e.g., cas-
tration) and subsequent stigma, discrimination,
and violence (Herek, 2007). Beginning with the
Jamestown colony in the early 1600s, colonial
governments adapted British buggery laws: regu-
lations later known in the USA as sodomy laws
that criminalized certain sexual behaviors such as
anal and oral sex, bestiality, and sexual intercourse
between two men. Although not regularly
enforced, sodomy laws rendered same-sex sexual
intercourse a capital offense punishable by death,
perhaps the starkest example of systemic violence
against gay men. Sodomy laws persisted through
the end of the 1900s. Before Illinois repealed its
sodomy laws in 1961, every US state continued to
criminalize sexual behavior between men. Sodomy
laws were federally critiqued in two major cases
brought before the Supreme Court, Bowers v.
Hardwick in 1986 and Lawrence v. Texas in 2003,
nally decriminalizing gay sex on a national level
(Herek, 2007). Although these laws were not regu-
larly enforced, their very threat of violent punish-
ment for sexual behavior between men created a
social environment in which interpersonal vio-
lence against gay men was fostered, condoned,
and systemically justied (Leslie, 2000). A second
iteration of legal prosecution against gay men
came in the late twentieth century when most
states instituted HIV criminal laws: specic state-
level statutes applying misdemeanor and felony
convictions for actual or potential HIV transmis-
sion risk behavior (Mykhalovskiy, 2011).
Systemic violence against gay men has also
occurred in the form of unnecessary, often harm-
ful, medical and psychiatric intervention to “x”
same-sex desire in the late nineteenth and early
twentieth centuries. Historically, the eld of psy-
chiatry conceptualized homosexuality as a medi-
cal and/or mental illness: a sexual or genital
“inversion” to be “cured” through psychiatric and
J. R. Scheer et al.
medical procedures. Homosexuality was codied
as a psychiatric diagnosis in the rst editions of
the Diagnostic and Statistical Manual (DSM):
described in the DSM-I as an illness “primarily in
terms of society and conformity with the prevail-
ing cultural milieu” (American Psychiatric
Association, 1952) and in the DSM-II as “deeply
ingrained maladaptive patterns of behavior”
(American Psychiatric Association, 1968).
During this era, gay men faced violent interven-
tion, including electroconvulsive therapy, psy-
chosurgery, and chemical castration (Comstock,
1992). These interventions exacerbated other
forms of violence against gay men, such as IPV,
rendering gay men both a criminal underclass
and a diseased community (Shapiro & Powell,
2017). It was not until 1973, due to protest from
gay rights activists, that the American Psychiatric
Association replaced the diagnosis of “homosex-
uality” with “sexual orientation disturbance,”
thus depathologizing same-sex desire.
A third form of systemic violence against gay
men has occurred in the form of judicative bias,
or legal protection of perpetrators of violence
against gay men (Lee, 2008). Across multiple
well-known cases in the late twentieth century,
perpetrators of violence against gay men had
their charges acquitted and/or sentences reduced
due to the sexual orientation of their victims. In
1988, for example, a then 18-year-old man
Richard Lee Bednarski murdered two gay men in
a Texas park. Claiming the men had made sexual
advances, Bednarski received a more lenient sen-
tence because the judge deemed the men he mur-
dered had acted inappropriately and obscenely.
Another famous case was that of Stephen Bright,
a then 33-year-old man who murdered a gay man
in his home after meeting the man in a bar. Bright
strangled the man after he allegedly made a sex-
ual advance and was later charged with second-
degree murder. In court, however, Bright claimed
he was so disturbed by the man’s sexual advance
that he entered a state of “gay panic.” He was
acquitted of the murder charge, setting a legal
precedent for the “gay panic defense” and fram-
ing gay victims of violence as guilty sexual pred-
ators (Lee, 2008).
The same “gay panic defense” was success-
fully re-employed in multiple cases until 1998,
when two men were charged for the brutal mur-
der of Matthew Shepard, a gay HIV-positive man
living in Wyoming. During the trial, a defense
lawyer put forward a “gay panic defense” similar
to Bright’s a decade prior. Unlike Bright’s case,
the 1998 defendant was charged with felony mur-
der and sentenced to two life terms without
parole. This outcome radically shifted advocacy
around violence against gay men, leading eventu-
ally to the 2009 passing of the Matthew Shepard
and James Byrd Jr. Hate Crimes Prevention Act,
codifying sexual orientation-based violence as
prosecutable under hate crime legislation.
Framing Violence Against Gay Men
intheContext ofMinority Stress
SGM individuals face general risk factors associ-
ated with violence (e.g., homelessness) as well as
minority-specic risk factors (i.e., minority
stressors; Meyer, 2003). According to minority
stress theory (Meyer, 2003), gay men experience
distal minority stressors, such as workplace dis-
crimination, which often maintain and exacer-
bate gay men’s proximal stressors, including
maladaptive interpersonal and self-schemas (e.g.,
chronic feelings of exclusion; Pachankis,
Goldfried, & Ramrattan, 2008).
Unique Considerations forGay Men
withMultiple Stigmatized Identities
Gay men with multiple stigmatized identities
face challenges in addition to sexual orientation-
based prejudice. For example, gay men of color
experience multiple forms of discrimination
(e.g., racism and homophobia), as well as rac-
ism within SGM communities and heterosex-
ism within communities of color (Balsam,
Molina, Beadnell, Simoni, & Walters, 2011). In
SGM communities, gay men of color encounter
10 Violence Against Gay Men
racism in relationships, dating apps, and com-
munity events (Choi, Han, Paul, & Ayala,
2011). Further, discrimination based on race,
immigrant status, and sexual orientation
increases overall acculturative stress and men-
tal health issues among Latino gay men
(Polanco-Roman & Miranda, 2013).
Heterosexist stigma remains widespread in
communities of color (Balsam etal., 2011). For
example, Latinx cultural views may construe
same-sex sexual behavior as a gender-role vio-
lation (Domanico & Crawford, 2000). Similarly,
sexual minority orientations threaten the con-
tinuation of family lineage in Asian cultures
(Greene, 1994), and given the importance of
religion, homosexuality is considered sinful in
many African American communities (Nemoto
etal., 2003). Indeed, heterosexism in communi-
ties of color contributes to internalized stigma
and identity concealment among gay men of
color (Moradi, DeBlaere, & Huang, 2010) and
pressure to choose between one’s racial/ethnic
and sexual orientation identity (Nemoto etal.,
2003). These intersecting issues exacerbate gay
men’s risk for violence victimization and/or
Common Forms ofViolence
Exposure Among Gay Men
Gay men withstand homophobic victimization,
such as hate crimes and verbal threats, as well as
non-bias victimization, such as physical and sex-
ual assault (Katz-Wise & Hyde, 2012).
Homophobic victimization is rooted in hetero-
sexism, or the ideological system that denies,
denigrates, and stigmatizes non-heterosexuality
(Katz-Wise & Hyde, 2012). Violence or illegal
acts committed against individuals based on their
sexual orientation represent hate crimes, includ-
ing murder, rape, aggravated assault, and prop-
erty vandalism (Willis, 2004). These crimes
differ from hate incidents (i.e., biased actions not
involving physical assault, such as nonphysical
forms of bullying; Willis, 2004).
Gay men disproportionately experience
homophobic victimization compared to other
sexual minority populations, including queer,
bisexual, and lesbian individuals (NCAVP, 2016).
Specically, of those who reported hate crimes in
2016, 47% were gay men, compared to those
who identied as lesbian (17%), queer (8%), and
bisexual (8%; NCAVP, 2016). Gay men most
often report homophobic victimization that
occurs in public places and is committed by a
group (Gruenewald, 2012). Gay men also experi-
ence stalking, robbery, violent assault, and sexual
and verbal harassment more often than other sex-
ual minority groups (Katz-Wise & Hyde, 2012).
Racial disparities in homophobic victimiza-
tion exist among gay men. For instance, com-
pared to White gay men, gay men of color
disproportionately experience violence based on
sexual orientation (Berrill & Gregory, 1992).
Moreover, in 2016, of the 1036 hate incidents
reported, most survivors identied as gay men
and people of color (NCAVP, 2016). Among
youth populations, Black gay youth report higher
levels of homophobic victimization compared to
White or Latino youth (Garofalo, Mustanski,
Johnson, & Emerson, 2010).
In addition to homophobic victimization, many
gay men experience nonminority-specic forms
of victimization (e.g., childhood sexual abuse;
Lloyd & Operario, 2012). Although nonminority-
specic victimization experiences do not explic-
itly relate to anti-gay bias, these experiences
may still be motivated by it. Sexual minorities,
including gay men, report higher rates of
adverse childhood events (e.g., physical abuse)
than heterosexual men and women (Andersen &
Blosnich, 2013). Many gay men report more
family-related psychological, physical, and sex-
ual abuse during childhood than their hetero-
sexual siblings of the same sex (Balsam,
Rothblum, & Beauchaine, 2005). In fact, esti-
mates of childhood sexual abuse among gay
men reach as high as 47% (O’Cleirigh, Safren,
& Mayer, 2012). This risk of sexual victimiza-
J. R. Scheer et al.
tion continues throughout development as gay
men also report higher rates of sexual violence
in adulthood compared to heterosexual men
(Balsam etal., 2005).
Gender Nonconformity asaRisk
Gender nonconformity is a unique risk factor
for elevated minority- and nonminority-specic
victimization among gay men. Gender noncon-
formity refers to gender expressions or behav-
iors incongruent with expectations based on
birth- assigned sex and reects a particular
social deviance for men (Alanko etal., 2010).
The devaluing of traditionally female attributes
contributes to male gender roles being more
rigidly dened than female gender roles, which
might allow for gender nonconformity to go
unnoticed or even welcomed in cisgender
females (Kane, 2006). Parents often hold nega-
tive views about gender- nonconforming boys,
such as beliefs that they will be psychologically
maladjusted (Kane, 2006), which may lead to
physical, psychological, and sexual abuse by
parents (Roberts, Rosario, Corliss, Koenen, &
Homophobia and sexism drive elevated risk
of victimization among gay men across the
lifespan. Specically, gender-nonconforming
gay men report more childhood sexual abuse
exposure than gender-conforming gay men
(Sandfort, Melendez, & Diaz, 2007). In addi-
tion, gender nonconformity in childhood may
relate to elevated levels of victimization across
the lifespan, especially among boys (Bos, de
Haas, & Kuyper, 2016). For instance, among
gay men, self- reported gender nonconformity
in childhood predicts peer rejection and school
victimization (Sandfort, Bos, Knox, & Reddy,
2016). Moreover, studies suggest that gay men
who experience additional stress in their fami-
lies, including homophobic cultural or reli-
gious beliefs, report increased risk of childhood
physical and sexual abuse by family members
Intimate Partner Violence
Gay men experience IPV at substantially higher
rates than heterosexual men and women (Finneran
& Stephenson, 2013). Across studies, 26% to
33% of gay men experience some form of IPV in
their lifetime (Walters, Chen, & Breiding, 2013).
Many IPV organizations structure support for
cisgender heterosexual women; thus, many ser-
vices (e.g., domestic violence homeless shelters)
are inaccessible for gay male IPV survivors
(Walters etal., 2013).
A recent systematic review among gay men
demonstrated higher rates of IPV among gay men
of color, gay men with lower levels of education,
gay men living with HIV, and young gay men
(15–24 years; Finneran & Stephenson, 2013).
Many IPV-exposed gay men face higher risk of
HIV transmission, attributable to trouble negoti-
ating safer sex practices due to a decreased per-
ception of control over sex, fear of violence, and
unequal power (e.g., nancial) within the rela-
tionship (Heintz & Melendez, 2006).
IPV patterns among gay men differ from hetero-
sexual individuals given their experiences with
stigma-related stress (Scheer, Woulfe, &
Goodman, 2018; Woulfe & Goodman, 2018).
More specically, identity abuse refers to the
ways that abusers use homophobic, biphobic, and
transphobic societal and structural norms against
their gay male partners by discrediting, under-
mining, or devaluating their stigmatized sexual
identity (Guadalupe-Diaz & Anthony, 2017;
Woulfe & Goodman, 2018). Four domains of
identity abuse tactics include (1) disclosing a
partner’s sexual orientation status; (2) undermin-
ing, attacking, or denying a partner’s sexual iden-
tity; (3) using homophobic slurs or derogatory
language; and (4) isolating a partner from gay
male communities (Woulfe & Goodman, 2018).
The broader context of stigma may fuel abusive
power dynamics in intimate relationships among
10 Violence Against Gay Men
Though research on IPV perpetration is sparse,
gay and bisexual men (36%) have a twofold
higher frequency of perpetrating IPV compared
to heterosexual men (18%; Welles, Corbin, Rich,
Reed, & Raj, 2011). Many of the documented
correlates of IPV perpetration unique to gay men
include proximal minority stressors, such as
internalized homophobia and identity conceal-
ment (Edwards, Sylaska, & Neal, 2015). These
minority stressors can lead to IPV perpetration
through poor communication, low self-esteem,
and maladaptive coping mechanisms such as sub-
stance use (Klostermann, Kelley, Milletich, &
Mignone, 2011). Other risk factors for IPV per-
petration among gay men include greater confor-
mity to masculine norms, suppression of
emotional vulnerability, and positive HIV status
(Oringher & Samuelson, 2011).
Reporting Patterns ofViolence
Gay men, especially those with multiple margin-
alized identities, face barriers to reporting vio-
lence such as history of police violence and
difculty identifying violence exposure. Many
gay men report and seek help for IPV at lower
rates than heterosexual men and women due to
fear of heterosexism and rejection from providers
(Bartholomew, Regan, White, & Oram, 2008).
Gay men may also normalize physical and psy-
chological injuries as part of being a man (i.e.,
physical strength, power, manliness) and, conse-
quently, may actively work to conceal their IPV
experiences (Bacchus etal., 2017).
Many gay men also underreport homophobic-
related hate crimes to police because of real or
perceived maltreatment or stigma from law
enforcers (Berrill & Gregory, 1992). For instance,
many survivors of homophobic violence report
experiences of police misconduct after the inci-
dent of violence, including excessive force,
unjustied arrests, entrapment, and raids
(NCAVP, 2016). Law enforcement may also dis-
miss homophobic victimization reports (Herek,
2002). Gay men of color are even less likely than
White gay men to report homophobic-related
hate crimes (Zaykowski, 2010). Among those
who do report homophobic victimization, Black
gay men are 2.8 times more likely to experience
excessive force from police than those who do
not identify as Black (NCAVP, 2016). Likewise,
immigrant gay male survivors face considerable
structural barriers to safety, including immigra-
tion law, resulting in lower rates of reporting vio-
lence exposure to law enforcement or service
providers. Barriers also exist prior to immigra-
tion (e.g., social pressure to marry women) and
because of immigration (e.g., economic disad-
vantage; Erez, Adelman, & Gregory, 2009).
Consequences ofViolence Exposure
Among Gay Men
Violence against gay men plays a key role in the
proliferation of sexual orientation disparities in
health (e.g., suicidality, substance use, and HIV
infection), as highlighted by a major report by
the Institute of Medicine (Lloyd & Operario,
2012). A recent meta-analysis documented that
gay men with histories of childhood sexual abuse
were more likely to live with HIV, engage in
unprotected anal intercourse, and abuse sub-
stances (Lloyd & Operario, 2012). Homophobic
victimization exposure results in not only poor
physical health if the individual is injured but
also adverse mental health such as depression
and posttraumatic stress disorder (PTSD;
Boroughs, Bedoya, O’Cleirigh, & Safren, 2015).
Additionally, studies document associations
between witnessing violence, substance use, fear
of community violence, and depression among
young gay men of color living with HIV (Phillips
etal., 2014). Notably, homophobic victimization
may be more highly associated with negative
mental health outcomes than nonminority-spe-
cic forms of violence (McDevitt, Balboni,
Garcia, & Gu, 2001). Further, experiencing or
fearing homophobic victimization can cause gay
men to alter their behavior in signicant ways,
including sexual minority identity concealment,
which can lead to signicant mental health con-
sequences, such as shame and depression
J. R. Scheer et al.
Violence exposure, mental health issues, and
HIV status co-occur and mutually reinforce psy-
chosocial risks among gay men (Kurtz, Buttram,
Surratt, & Stall, 2012). Syndemic theory pro-
vides a framework for better understanding how
stigma and discrimination perpetuate these co-
occurring epidemics (Singer et al., 2006). For
instance, adverse social and structural conditions
give rise to the interconnected psychosocial epi-
demics such as substance use and violence expo-
sure among marginalized populations (Singer,
1994). Syndemic frameworks highlight how the
concentrated clustering of and interactions
between multiple psychosocial epidemics
adversely affect the health of particularly disad-
vantaged and marginalized populations, such as
gay men (Singer et al., 2006). Specically, the
interaction of violence exposure and health prob-
lems commonly arises because of adverse social
conditions (e.g., poverty, stigmatization) that put
socially devalued groups at heightened risk
(Singer etal., 2006).
Clinical Practice andTreatment
The current section addresses clinical practices
and treatment recommendations for working
with violence-exposed gay men. We begin with a
de-identied case study of Mr. L., which is based
on a collection of narratives of multiple gay men
with histories of sexual violence exposure in the
military to illustrate common themes. Next, we
use Mr. L’s narrative to further discuss clinical
issues and elucidate better practices, evaluation/
assessment techniques, current available treat-
ment modalities, and barriers to treatment.
Finally, we suggest treatment recommendations
and clinical considerations.
Case Study: Mr. L
Mr. L, a self-identied White, gay man, entered
the military at 18years old, shortly after becom-
ing sexually active. He was acutely aware that
disclosing his sexual identity could lead to dis-
crimination and violence and, therefore, chose to
conceal his identity. During his time in the mili-
tary, he was immediately targeted by heterosex-
ual service members, attacked, drugged, and
raped. Due to the military’s widely known
homophobic culture, Mr. L discretely hid his
physical wounds from the assault and created a
narrative that concealed his sexual orientation
and the assault to keep himself safe from further
abuse while he completed his military service.
After being discharged, he attempted to report
the assault and seek treatment for associated
mental health symptoms; however, he faced fur-
ther discrimination from various clinical provid-
ers. Subsequently, he discontinued psychiatric
appointments and disengaged from sharing his
traumatic experience and sexual identity with
others. For many years, Mr. L suffered in silence
from PTSD, anxiety, and depression. He contin-
ued to seek intermittent treatment focused on his
symptom presentation while making a conscious
choice to conceal his sexual identity and sexual
violence history. Over time, he became further
socially isolated and avoidant of relationships
with other men, experienced internalized
homophobia, and had employment difculty.
During his most recent pursuit of treatment, he
continued with a familiar pattern of approach-
avoidance with his new provider until his history
was appropriately evaluated and treated. As a
result, Mr. L became less isolative, depressed,
and anxious and more connected with himself
Some literature explores the possibility that trau-
matic events can also positively impact mental
health. Specically, trauma can act as a catalyst
that enhances well-being and relates to resilience,
meaning-making, growth, and positive change–
also known as posttraumatic growth (Tedeschi &
Calhoun, 1996). Posttraumatic growth is dened
as “positive personal change” which occurs
through “re-examination of core beliefs about the
assumptions about the world” (Tedeschi,
Calhoun, & Cann, 2007; p.403). Though a rela-
10 Violence Against Gay Men
tively new concept, posttraumatic growth has
been part of the human experience for centuries.
Although most research on traumatic events
focuses on the negative physical and psychologi-
cal inuences of trauma (Tedeschi & Calhoun,
1996), modern trauma research extends to include
posttraumatic growth. Posttraumatic growth is
observed after diverse experiences of trauma
(e.g., rape, bereavement, combat, natural disas-
ters) and occurs through changes in self, interper-
sonal relationships, and philosophy of life
(Tedeschi & Calhoun, 1996). Posttraumatic
growth is related to lower rates of depression and
increased well-being following an event that
“results in a struggle signicant enough to force
re-evaluation of worldview” (Boals & Schuettler,
Gay men experience stigma within mental health
systems, which create reporting barriers similar
to those experienced in the criminal justice sys-
tem. For example, Mr. L’s disclosure and initial
pursuit of treatment were met with discrimina-
tion and stigmatization, resulting in detrimental
effects on his well-being and ability to access
appropriate treatment. Although many clinicians
initially focus on building trust, this is paramount
for survivors of violence and sexual minority cli-
ents, given that trust in others is compromised
and many relationships are fraught with physical
and emotional pain. By prioritizing safety, clini-
cians can facilitate a reparative relational experi-
ence for survivors, which can have positive
implications for their mental health.
Within the therapeutic context, violence eval-
uation and assessment should be considered a
uid and ongoing process. Although many clini-
cians conduct an initial intake during the rst ses-
sion, it is important continually to revisit
evaluation methods as therapeutic trust further
develops and clients disclose more about them-
selves and their histories (Bess & Stabb, 2009).
During Mr. L’s most recent engagement in treat-
ment, he did not disclose his sexual identity or
assault history until a year into treatment with his
therapist, when trust, safety, and rapport were
Language is a tool that clinicians can use to
help build trust and safety. SGM-afrming
language (e.g., communicating that same-sex
sexuality is healthy) may allow SGM clients to
feel safe to share any/all aspects of themselves
(Mizock & Lewis, 2008). Questions related to
gathering a trauma history should be carefully
phrased and timed to allow space for discussion,
especially for those who have suffered systemic
and institutional marginalization.
Psychoeducation and transparency are essential
intervention tools when assessing or discussing
violence with gay men, as these techniques pri-
oritize equalizing the therapeutic relationship and
working collaboratively. Other important aspects
of the therapeutic process are noticing misattun-
ement with clients, processing ruptures, and
building toward repair to further develop safety
and trust within the therapeutic alliance as well as
generalize to other relationships.
It is also vital for clinicians to understand the
nuanced ways that posttrauma symptomatology
can manifest for each client. While PTSD symp-
toms may occur, other mental health symptoms
such as anxiety or depression may emerge. In
most cases, mental health symptoms appear
shortly after traumatic experiences; however,
symptoms may also have a delayed onset across
months or even years (Leahy, Holland, &
McGinn, 2011). Some individuals, much like Mr.
L, can experience remission of symptoms,
whereas others may experience symptoms for an
extended period of time (Leahy etal., 2011), call-
ing attention to the importance of recurring psy-
chological assessment during treatment.
Multiple evidence-based practices exist that
focus on improving trauma survivors’ mental
health. Several treatments with demonstrated
empirical support for their efcacy in treating
trauma-related mental health issues (e.g., PTSD)
include Exposure Therapy, which incorporates
J. R. Scheer et al.
principles of fear learning and shares procedural
similarities with extinction training (McLean &
Foa, 2011); Cognitive Processing Therapy, which
consists of two integrated components, cognitive
therapy and exposure in the form of writing and
reading about the potentially traumatic event
(Resick & Schnicke, 1992); and Eye Movement
Desensitization and Reprocessing, which allevi-
ates the distress associated with traumatic memo-
ries (Shapiro, 1989). These evidence-based
treatments are widely used across clinical set-
tings to help reduce PTSD and increase posttrau-
matic growth responses by helping individuals
process and habituate to their traumatic experi-
ences (Foa, Keane, & Friedman, 2000). Group
psychotherapy can also act as a supportive outlet
that enhances one’s sense of community, espe-
cially for minority individuals, as this treatment
focuses on building trust with other group mem-
bers who have similar experiences (Chouliara
etal., 2017). However, these modalities have not
been specically used with gay male survivors of
violence, despite the high prevalence of trauma
exposure within this population. As such, there is
strong need to adapt trauma-focused treatment to
become more SGM-afrming to treat effectively
both nonminority trauma and adverse outcomes
related to minority stress in this population
In light of minority stressors and subsequent
mental health consequences facing gay men and
other sexual minority populations, the American
Psychological Association developed profes-
sional guidelines that emphasize the importance
of adapting standard psychotherapy to help pro-
mote stigma coping among sexual minority cli-
ents (American Psychological Association, 2012;
Burton, Wang, & Pachankis, 2017). The ESTEEM
(Effective Skills to Empower Effective Men)
treatment model is the rst adaptation of cogni-
tive behavioral therapy with demonstrated ef-
cacy for reducing sexual orientation health
disparities among young gay and bisexual men,
including depression, anxiety, and sexual risk
behavior (Pachankis, 2014). ESTEEM is deliv-
ered across ten modules and guided by six prin-
ciples: (1) mood and anxiety symptoms are
normal responses to minority stress; (2) early and
ongoing experiences with minority stress can
teach sexual minority individuals powerful, nega-
tive lessons about themselves; (3) sexual minori-
ties can be empowered to effectively cope with
the unfair consequences of minority stress; (4)
sexual minorities possess unique strengths; (5)
same-sex sexuality is healthy; and (6) genuine
relationships are essential for the health of sexual
minorities (Burton etal., 2017; Pachankis, 2014).
It is critical for mental health professionals to
incorporate these principles into their practice
when working with gay male clients in effort to
reduce sexual orientation health disparities fac-
ing this population.
The current section explores contemporary
community- led efforts to understand, measure,
and curb violence against gay men. We begin
with a brief history of community advocacy fol-
lowed by a discussion of legal advocacy. Finally,
we discuss potentials for future, intersectional
approaches to anti-violence advocacy led by and
for gay men.
Community Advocacy In the later parts of the
twentieth century, gay men and allies began a sig-
nicant legacy of community-based advocacy to
curb violence against gay men. During the 1970s,
this occurred through the formation of gay-safe
streets patrols (e.g., San Francisco Street Patrol):
civilian coalitions who established a radical
infrastructure of community, rather than police,
violence prevention (Hanhardt, 2008). In the
1980s, gay and HIV-positive activists formed
community-specic anti-violence organizations
(e.g., Anti-Violence Project in NewYork City).
In 1995, this effort broadened when the NCAVP
10 Violence Against Gay Men
was formed, establishing the rst national organi-
zation addressing violence against SGM commu-
nities. Violence against gay men in recent US
history is informed and reinforced by systemic
and interpersonal HIV stigma; thus, effective
organizations and leaders are making concerted
efforts to center people living with HIV in their
analysis, intervention, and legal advocacy.
Community advocacy in the contemporary US
continues to be a leading force in both supporting
gay survivors of violence and spearheading vio-
lence prevention efforts (Hanhardt, 2008).
Legal Advocacy Gay men and allies have also
led legal battles to measure and curb rates of anti-
gay violence. The rise of community advocacy
and victim-rights groups led to the incorporation
of sexual orientation into hate crime legislation
(Herek, 1989). Alongside the ght for hate crime
legislation, legal scholars in the late twentieth cen-
tury began to address the historic lack of data col-
lection on violence against gay men, missing
largely due to issues of stigma, mistrust of police
particularly among gay men of color, and fear of
being outed as gay, engaging in sex work, and/or
living with HIV.Until 1984, most US jurisdictions
did not include anti-gay bias crimes in their sur-
veillance of hate crimes, thus erasing decades of
empirical evidence of anti-gay violence. At this
time, the National Gay & Lesbian Task Force con-
ducted the rst national study on anti-gay hate vio-
lence, nding that over 94% of respondents had
experienced some sort of violent victimization
whether primary or secondary (i.e., additional vic-
timization after a crime due to societal homopho-
bia; Berrill & Herek, 1990). Legal advocacy,
importantly, led to the demand that states begin to
count violence against gay men in order to address
it through system-level, evidence- based efforts.
The Future ofIntersectional Gay
The current political climate has inamed rhetoric
of hate and violence against gay men. This has
been associated with a demonstrated rise in hate
crimes and increased safety risk for gay men
(NCAVP, 2016), as well as a groundswell of com-
munity advocacy including collaborations with
anti-racist, women’s, and sex work organizations
and communities. In recent years, gay anti-vio-
lence advocacy has begun to incorporate an inter-
sectional framework in an effort to respond to
violence against multiply marginalized people
(e.g., SGMs of color; those living in poverty or
with disabilities). A relatively new eld termed
“Queer Criminology” has emerged with a focus
on intersectionality and developing systems of
safety and violence prevention that do not rely on
police or carceral punishment (Woods, 2014).
The future of gay anti-violence advocacy may
center community-based strategies to reduce vio-
lence rather than relying on potentially oppres-
sive systems for protection (Russell, 2017). A
leading example of this is the NewYork-based
group Safe Outside the System, an anti-violence
organization led by and for people of color striv-
ing for community safety and grassroots justice
strategies (Anderson-Zavala, Krueger-Henney,
Meiners, & Pour-Khorshid, 2017). Activists
today continue to push for alternative paradigms
to measure, interpret, and address violence
against gay men in the contemporary USA
This chapter provides an overview of both the
historical and contemporary disparity in violence
exposure faced by gay men. The disproportion-
ately high rate of violent victimization in the gay
male community was born out of a history of
state-sponsored homophobic violence that has
only recently begun to be addressed through leg-
islative change. This violence most commonly
manifests in the forms of IPV and homophobic
victimization, which have detrimental conse-
quences for physical and mental health. Barriers
to reporting, including anticipated stigma and
discrimination from law authorities and health-
care providers, compound these effects. Notably,
gay men with multiple marginalized identities
J. R. Scheer et al.
often face additional stigma-related experiences,
such as racism in the SGM community and
heightened homophobia in some cultural, reli-
gious, and ethnic communities.
Though the current political climate has
increased risk for violence among gay men, men-
tal healthcare providers, educators, policy mak-
ers, and advocates are increasingly working to
enhance their safety and well-being. Clinicians
can foster health and growth in their violence-
exposed gay male clients through SGM-afrming
and trauma-informed practices. Optimal care
necessarily involves the assessment of the myriad
ways in which stigma impacts the well-being of
gay men, ongoing trauma evaluation, and identity
afrmation. Finally, community and legal advo-
cates have made great strides such as adding sex-
ual orientation into hate crime legislation. These
efforts are increasingly intersectional in nature
and suggest a promising road forward in violence
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