Unmet Health Needs Among Men who Have Sex With Men in an Era of Rising Authoritarianism: An Increasing Concern for Public Health

Men who have sex with men (MSM) continue to experience severe health disparities despite advancements in biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) and harm reduction initiatives. Systemic stigma, health care inequities, and structural neglect contribute to disproportionately high rates of HIV, sexually transmitted infections (STIs), substance use, and mental health challenges among MSM. The rise of authoritarian political movements in the United States exacerbates these disparities by restricting LGBTQIA+ health care access, defunding HIV prevention programs, and reinforcing stigmatizing narratives around MSM sexual health. In particular, chemsex-sexualized drug use involving substances such as methamphetamine (meth) and Gamma-hydroxybutyrate (GHB)-has emerged as a critical public health concern, significantly increasing HIV transmission risks and mental health issues. The failure of mainstream recovery programs to address the unique sociocultural and psychological drivers of chemsex contributes to persistent relapse rates. In addition, conservative political efforts to restrict PrEP access and erase LGBTQIA+ health content from federal policies further jeopardize MSM well-being. Public health professionals ought to prioritize targeted interventions that integrate culturally sensitive health care, harm reduction, and mental health support tailored to MSM needs. Future research should explore the long-term impacts of chemsex recovery, evaluate MSM-centered public health interventions, and assess the consequences of rising political repression on LGBTQIA+ health equity. Urgent policy action is required to counteract authoritarian threats to MSM health care, ensuring that public health efforts remain grounded in inclusivity, equity, and resilience. The fight for MSM health is fundamentally linked to broader struggles for democracy, bodily autonomy, and LGBTQIA+ survival.