The ROAM service, an NHS Lothian outreach service providing sexual health services to men having sex with men (MSM) in Lothian, recently celebrated its 21st birthday. MSM in Scotland have undergone the most extraordinary social changes in the past 21 years. We have seen the legalisation of gay marriage, equality in health, parental and employment rights and an increasing acceptance of gay (and to a lesser extent bisexual) men that extends from sport to soap operas .
We might now ask – do gay and bisexual men really need a “special” sexual health service? ROAM began as an outreach service, providing condoms and sexual health advice to men and male sex workers using public sex environments. This work continues for men who still lack the confidence to access mainstream services, but ROAM has developed to reflect changes in how men now interact and meet partners. Online outreach work through mobile phone apps and social media is combined with a range of well publicised “m-test” clinics across Lothian which welcome all MSM, whether single, in a relationship or married, for testing, vaccination and advice. M-test has brought forward innovative testing solutions by offering rapid HIV and syphilis finger prick testing, with these results available during the consultation. One of the m-test clinics is provided in partnership with the SX service, delivered by the charity Waverley Care, offering an accessible community testing venue.
What has not changed in 21 years since ROAM’s launch is the high rate of sexually transmitted infections (STIs). In contrast to the massive social changes we have seen, the rates of HIV infection in MSM, unlike most other groups, are stable or rising in almost all developed and developing nations – including the UK. STIs, in particular syphilis and gonorrhoea, continue to affect MSM disproportionately and rates of other health problems, from depression to tobacco, alcohol and recreational drug use are higher in MSM than in heterosexual men. Although much progress has been made, evidence suggests issues relating to discrimination and stigma faced by MSM continue to affect their lives.
ROAM’s work has expanded to include one-to-one work to support men with issues such as staying safe, risky use of alcohol or drugs in association with sex. ROAM will also be involved with new ways of preventing HIV, including Pre-exposure prophylaxis (PrEP) tablets, and with the provision of vaccination against HPV, which can be a cause of anal cancers in men. The world has changed and the lives of MSM in Scotland have changed immeasurably for the better over the past 21 years, but the service ROAM provides remains as important as ever.
Dr Dan Clutterbuck is Consultant in Genitourinary and HIV medicine at NHS Lothian