Actually the use of the word 'gay' in the derogatory sense doesn't have to mean homosexual - an old English definition for the word 'gay' is weird, strange, odd etc. The homosexual community whined when a radio presenter used the word 'gay' as an insult but he was saved having to apologise because of the other meaning of the word.
Regarding the US vs third world countries: money doesn't mean anything, take Cuba's health system, it's about as good as the US's, is free for all citizens but costs one tenth of the price!
Russia and China also have better literacy rates than the US.