Do you feel that homosexuality should be considered an acceptable alternative lifestyle or not? The question of nature or nurture stands at the very center of many complex issues. Why, for instance, do some children perform better on standardized tests than others do? What causes some Americans to be overweight, while others never gain an ounce?
Nowhere is the uncertainty of nature versus nurture more widely discussed than in issues surrounding human sexuality. What do teens think about the possible causes of homosexuality? Americans remain slightly more likely to oppose, rather than favor, formalized civil unions between gay and lesbian partners. Support for legal same-sex unions is highest among Americans living on the East and West coasts, among Democrats, among those with higher levels of education, and among younger generations. The issue was recently launched back into the news with The New York Times' decision to include commitment ceremony announcements for gay and lesbian partners along with its traditional wedding announcements in its Sunday paper.
Here, a method leveraging different categories of same-sex interests on Facebook, combined with a specific gay-oriented app Hornet , demonstrated significantly higher estimates than those officially reported. While there are biases in this approach, these data reinforce the need for multiple methods to be used to count the number of GBMSM especially in more stigmatizing settings to better inform mathematical models and the scale of HIV program coverage.
Moreover, these estimates can inform programs for those aged years; a group for which HIV incidence is the highest and HIV prevention program coverage, including the availability of pre-exposure prophylaxis PrEP , is lowest.
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Taken together, these results highlight the potential for social media to provide comparable estimates of the number of GBMSM across a large range of countries, including some with no reported estimates. Consensual sex between adult men remains stigmatized in much of the world. Same-sex practices and relationships are criminalized in over 70 countries, many of which are countries where the HIV epidemic is most generalized [ 1 ].
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Given pervasive social stigma around the world and punitive laws specifically affecting gay, bisexual, and other cisgender men who have sex with men GBMSM , it remains challenging to count the numbers of GBMSM to inform the content and scale of specific health programs, including HIV prevention, treatment, and care services [ 2 , 3 ]. The limited consensus reflects challenges in enumerating a diverse group of men comprising different sexual orientations and sexual practices over time.
Specifically, there are GBMSM who identify as gay, bisexual, straight, or do not identify with a particular sexuality at all. There are those that only have sex with men, or both men and women, and those that report sexual practices with people along the gender continuum [ 5 ]. Moreover, there are those that only have sexual attraction to other men; however, they have not had sex, or have had certain forms of sex, but not penetrative anal sex with men.
Finally, there is often conflation of sexual and gender identities, which complicates the enumeration of cisgender GBMSM because transgender women who have sex with men are sometimes inappropriately included within these counts [ 6 , 7 ]. These challenges are compounded by a pervasive stigma of homosexuality, and by the lack of consensus about the optimal questions and measures to enumerate men who have health risks associated with their sexual behaviors [ 8 ]. Population counts of GBMSM have included both in-person assessments, digital assessments, or surveys.
In the United Kingdom, the Annual Population Survey has been used to estimate the numbers of GBMSM in the population, and multiple nationally representative samples have been leveraged in the United States to generate estimates of population size [ 9 ]. However, in most settings, including the United States, there is a greater reliance on digital strategies given that sexual identity is not included on the United States national census. Small area estimation methods have also been used for estimating GBMSM population sizes at smaller geographic levels within the United States [ 10 ].
In the United Kingdom in , approximately 2. For example, investigators from the Other Foundation in South Africa reported that an estimated , people identified as gay, bisexual, or gender nonconforming [ 12 ].
In settings without methodologically sound national surveys, which represents most countries of the world, there is a great reliance on population size estimation strategies to assess the numbers of GBMSM. However, these approaches are collectively more difficult to implement in countries with stigmatizing settings where homosexuality may be criminalized, and where political will or leadership is absent.
This issue reinforces a data paradox: Additionally, high HIV service coverage goals may disincentivize accurate size estimates for countries with implausibly low or absent population estimates [ 15 ].
These estimates have significant variability in the quality of the underlying studies and representativeness. This lack of adequate data and resulting resource allocation might account for the increased mortality and morbidity among men living with HIV in countries with generalized HIV epidemics [ 17 ]. Given the need to reliably estimate the proportion of the male population who do not identify as heterosexual, or who are not exclusively behaviorally heterosexual, this study compares UNAIDS estimates where available to estimates of members of Hornet a social app geared towards gay men [ 19 ] and Facebook members with specific interests associated with GBMSM in 13 countries across five continents.
The overarching goal of this study was to assess the utility of using data on users of mobile phone apps and social media communities to obtain estimates of GBMSM population sizes. The number of unique active gay app users in who resided in each country were provided by the Hornet Gay Social Network Hornet [ 19 ]. Specifically, Facebook defines these variables as interests and behaviors [ 24 ]. While it is feasible to use both interests and behaviors to assess population size, this study used interests. Specifically, the following keywords were used to identify same-sex interests: Identified same-sex interests were subsequently assigned to one of eight thematic groups, representing men who have expressed an interest in or liked pages related to at least one included same-sex interest Multimedia Appendix 4.
Only same-sex interests endorsed by at least , Facebook users across all of Facebook were included in the analysis. No ads were created. During the process of planning advertisements, the Facebook Ads Manager interface displays an estimated number of users in the geographic area with those interests. Recent UNAIDS and national estimates are less than those reported by active Hornet app users in Brazil, Thailand, and Ukraine, with differences in estimates of 1,,, ,, and 66,, respectively. Gay, bisexual, and other cisgender men who have sex with men. The proportion of men reporting a same-sex interest within the category of Relationships ranged from 1.
Distribution of Facebook-identified same-sex interests by country. The proportion of males aged years reporting same-sex interests ranged from 4. Although there are several limitations to our approach, there is a clear signal towards higher estimates of GBMSM when digital approaches are utilized. While several studies have focused on the role dating apps and websites play in risk-taking behaviors among GBMSM [ 25 ], only recently has there been interest in leveraging apps to serve the HIV prevention, treatment, and care needs among GBMSM.
Our data suggest that same-sex dating apps and social media networks are promising data sources for designing population estimates and programmatic targets for GBMSM. The usage of the Internet is becoming increasingly normalized throughout the world, and this trend will only continue. Empirical and market-research data, generally derived from higher income settings, demonstrate that GBMSM are high utilizers of the Internet, often using the Internet to find partners, given limited venues and significant social stigma [ 26 - 30 ].
This trend towards online spaces has largely been attributed to stigma that same-sex behaviors face and the confidentiality that is afforded in online spaces [ 32 - 34 ], which enable users to more accurately report their attraction or in some instances, trace their behavior and eliminate biases in self-reported data. Although these studies were predominantly completed in higher income settings, similar results have been observed among GBMSM in Southern Africa and Nigeria [ 35 , 36 ].
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Given the significant usage of the Internet, online spaces likely represent an important approach for collecting same-sex attraction and behavioral data, especially in more stigmatizing settings. However, most men have their first sexual encounters with other men before the age of 18, and HIV incidence has been shown to be high among young GBMSM across settings [ 38 , 39 ].
Moreover, men under the age of 18 are generally not included in surveys or HIV prevention, treatment, and care programs, given the challenges in achieving consent [ 40 ]. Given that younger GBMSM are more likely to leverage virtual spaces, as evidenced by these data, the use of digital data for size estimation represents a strategy to inform the numbers and HIV prevention, treatment, and care needs of young GBMSM [ 41 ].
While the legal challenges of consent remain, especially in settings where same-sex practices are criminalized, there is a clear need to scale up evidence-based and human rights-affirming HIV prevention strategies for younger GBMSM, including condoms, lubricants, and preexposure prophylaxis PrEP.
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There are several limitations in the methods and results presented here. Moreover, the extent of specificity is likely subject to specific cultural contexts, thereby leading to overestimating the numbers of GBMSM with this metric. The metric used for Hornet was unique users with only one account allowed per device. While it is feasible to create multiple accounts on Facebook with unique email addresses, this likely represents a very low proportion of users.
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Although Internet usage is increasing rapidly, there is less access in many lower- and middle-income countries, which may underestimate the numbers of GBMSM. However, Internet access around the world continues to increase, especially due to the rapid increase in affordable smartphones, suggesting that the utility of social media-based estimates of population size will increase over time. Moreover, some of the respondents captured online in low- and middle-income countries may be expatriates rather than GBMSM from that country.
Therefore, the upward trajectory in these estimates of the LGBT adult population provides an important social indicator relating to this key aspect of contemporary American society. These results are based on telephone interviews with a random sample of , U.
Estimates for years are based on similar sample sizes, with the estimate for about half as large. Margins of error for population subgroups are larger depending on sample size. All reported margins of sampling error include computed design effects for weighting. Landline and cellular telephone numbers are selected using random-digit-dial methods. Learn more about how Gallup Daily tracking works.
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