Apparent consumption and socio‐economic distribution of nutrients in an urban settlement: Hong Kong†

Data relating to the Hong Kong population of 1971 show that with the exception of fats and calcium, the apparent consumption of food was comparable to that of populations in advanced industrial societies. An analysis of the socio‐economic distribution of calcium, energy and animal protein consumption reveals a clear gradation of intake from lower socio‐economic groups to higher socio‐economic groups. In this analysis it is shown that the level of intake of calcium and energy are well below current recommended dietary allowances. It is likely that the recommended allowances are conservative estimates of daily requirements and that some biological adaptation to low calcium and energy intake occurs. By present standards clinical manifestations of malnutrition are rare.     

Heteronormativity and ‘troubled’ masculinities among men who have sex with men in Addis Ababa

In most societies, heterosexuality is the dominant way of expressing sexuality and masculinity and those men outside of it are stigmatised and discriminated against. This paper explores the sexual lives of men who have sex with men and the personal and social conflicts that arise as they attempt to both live up to societal expectations and manage their sexual desires. It critically explores how an overriding heteronormativity structures and influences men's perception and understanding of sexuality and masculinity/femininity. The paper draws on data from 24 in-depth/life history interviews, one focus group discussion and ethnographic observation conducted between July 2006 and June 2007. The study reveals that powerful and dominating beliefs about heteronormativity and masculinity result in men who have sex with men dealing with a number of issues of personal conflict and contradiction resulting in uncertainty, resentment, ambivalence, worry and discomfort. Heteronormativity or the expectations of parents, community and society at large is far more influential on the sexuality of men who have sex with men than their own individual desires and needs. The paper concludes that there is little room for individuality for Ethiopian men who have sex with men with their sexual bodies ‘belonging’ to parents, families and to society at large.     

An ‘elephant in the room’? Stigma and hepatitis C transmission among HIV‐positive ‘serosorting’ gay men

Recent research has highlighted concerns about sexually transmitted infection with hepatitis C virus (HCV) in populations of HIV‐positive men who have sex with men. This paper presents results from a qualitative pilot study exploring the experience of stigma in HIV/HCV co‐infected men. The preliminary findings suggest that HCV infection can be experienced as more stigmatising than HIV among gay and other men who have sex with men. This hierarchical stigmatisation complicates the disclosure of HCV infection, threatening the ‘safety’ of HIV serosorted unprotected sexual practice. Further research is required to explore the effect of stigma on HIV/HCV co‐infected men, but these preliminary findings suggest that heath promotion initiatives are needed to counter hepatitis C stigma by raising awareness and facilitating greater empathetic ownership of hepatitis C as a gay community issue.     

‘It's like the treasure’: beliefs associated with semen among young HIV‐positive and HIV‐negative gay men

This paper examines cultural and social meanings associated with semen, along with related issues of unprotected receptive anal intercourse, HIV seroconversion, treatment optimism and viraemia. The findings are derived from qualitative interviews conducted with 12 HIV‐positive young gay men and 12 HIV‐negative counterparts who participated in a prospective cohort study in Vancouver, Canada. Focussing on the narratives of young gay men, the analysis reveals a diverse range of knowledge, values and functions of semen, especially in relation to its exchange. Beliefs about semen appeared to differ by HIV serostatus and were linked with intimacy, identity and pleasure, particularly among the HIV‐positive men. Against dominant representations of semen in relation to issues of loss, anxiety and infertility, this unique study sheds much needed light on its role within the cultural construction of sexuality among gay men. As such, these narratives are of direct importance to primary and secondary HIV prevention, including condom promotion and the development of rectal microbicides.     

‘They think that gays have money’: gender identity and transactional sex among Black men who have sex with men in four South African townships

Transactional sex has not been studied much among men who have sex with men in Africa. Consequently, little is understood about attitudes towards the practice, the circumstances that give rise to it or how transactional sex relationships are managed. We conducted in-depth interviews with 81 Black men aged 20–44 from four low-resourced townships in Tshwane, South Africa. We found that transactional sex was a widely used strategy for initiating and sustaining relationships with regular and casual partners, and was motivated by both the need for subsistence and for consumption. Alcohol-based exchanges in particular provided men in the townships with a covert and safe platform to communicate erotic, sexual and romantic attraction to other men, and bars and other drinking places were a popular venue for meeting potential sexual partners. The majority of ‘feminine-identifying’ men had engaged in transactional sex as the providers of money and material goods compared to men who identified as either ‘masculine’ or as ‘both masculine and feminine’. Surprisingly, however, this did not necessarily give them greater control in these relationships. Our study provides an initial foray into a complex sociosexual phenomenon and suggests that gender identity is an important construct for understanding transactional sex relationships among men in Africa.     

‘Men who use the Internet to seek sex with men’: Rethinking sexuality in the transnational context of HIV prevention

ABSTRACT

MISM (i.e. men who use the Internet to seek sex with men) has emerged in public health literature as a population in need of HIV prevention. In this paper, we argue for the importance of rethinking the dominant notions of the MISM category to uncover its ethnocentric and heteronormative bias. To accomplish this, we conducted a historical, epistemological and transnational analysis of social sciences and health research literature (n?=?146) published on MISM between 2000 and 2014. We critically unravel the normative underpinnings of ‘westernised’ knowledge upon which the MISM category is based. We argue that the essentialist approach of Western scholarship can homogenise MISM by narrowly referring to behavioural aspects of sexuality, thereby rendering multiple sexualities/desires invisible. Furthermore, we argue that a Eurocentric bias, which underlies the MISM category, may hinder our awareness of the transnational dynamics of sexual minority communities, identities, histories and cultures. We propose the conceptualisation of MISM as hybrid cultural subjects that go beyond transnational and social boundaries, and generate conclusions about the future of the MISM category for HIV prevention and health promotion.     

‘Bus fare please’: the economics of sex and gifts among young people in urban South Africa

In South Africa, young people's sexual relationships are often underpinned by an economic exchange: gifts or favours for sex. Studies have pointed out the negative consequences of the exchanges that are often characterized by large age differences or power imbalances. Perhaps more pervasive but largely ignored, gift giving in like‐age relationships may also be associated with sexual leverage, an exchange which somehow entitles one partner physical and sexual rights to the other's body. The circumstances surrounding gifts and favours may shape young women and men's sexual experiences, their ability to negotiate the circumstances of those encounters, and the possibility of concluding or remoulding a relationship into another form. Using focus group discussions collected in the Durban metropolitan area among young people aged 14–22, this paper examines the economic context of gift giving or receiving and its relationship to patterns of risky sexual behaviour. Findings suggest that gift giving among like‐age adolescents is common and important in shaping sexual relationships. Young people associate money or cash with prostitution, but do not consider gifts as such. Types of gifts and their meaning varied considerably by racial group and by gender.     

Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status

Abstract

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV ‘risk’ actually means in different cultures and contexts. A ‘socially situated’ approach to HIV risk moves beyond its scientific conceptualisation as an objective ‘fact’, revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of ‘difference’, a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of ‘risk’ arise and, thus, where couples’ sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.     

‘HIV and work don't go together’: Employment as a social determinant of HIV outcomes among men who have sex with men and transgender women in the Dominican Republic

Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV in the Dominican Republic. Little is known about their experiences living with HIV as a chronic condition. We explored employment as a social determinant of well-being with HIV. We conducted 42 qualitative in-depth interviews with MSM (n?=?16) and transgender women (n?=?5) living with HIV; each participant completed 2 interviews to facilitate depth and iterative analysis. We used narrative analysis and systematic coding to identify salient themes related to employment and the HIV experience and developed a conceptual model of the pathways between HIV stigma, unemployment, and HIV outcomes. Early life experiences, including rejection from families and school, resulted in limited work opportunities, especially among transgender women. Following HIV diagnosis, participants across all socio-economic levels lost jobs and/or were unable to get jobs due to illegal HIV testing and HIV stigma and discrimination. Not being able to work impacted mental health, engagement in HIV care, and overall well-being. We conclude that lack of employment is a salient concern among MSM and transgender women living with HIV. Holistic, multi-level programmes that address illegal HIV testing and discriminatory hiring practices are urgently needed to facilitate engagement in care and long-term well-being.     

‘Loob’ and ‘labas’: Spatial constructions of safety and risk amid the COVID-19 pandemic in the Philippines

This article argues that local constructions of risky and safe spaces, as articulated by the notions ‘loob’ (inside) and ‘labas’ (outside), informed popular and political responses to the COVID-19 pandemic in the Philippines, leading to an overemphasis on staying at home and, conversely, a general avoidance or fear of outdoor spaces that was at times reinforced by public health authorities. Practices and policies related to the pandemic response rendered this binary opposition between ‘loob’ and ‘labas’ visible, from regulations concerning the use of personal protective equipment to restrictions of access to outdoor spaces. While this emergent form of bodily proxemics was contested and negotiated over time, its tenacity throughout the pandemic underscores the importance of understanding how people spatialize risk in times of health crises.     

‘It's raining stones’: stigma,violence and HIV vulnerability among men who have sex with men in Dakar,Senegal

Research in many countries has highlighted the vulnerability of men who have sex with men to HIV and other sexually transmitted infections (STIs). Yet in Africa, such men have received little attention in HIV/AIDS programming and service delivery because of the widespread denial and stigmatization of male homosexual behaviour. In Dakar, Senegal, a study conducted by researchers from Cheikh Anta Diop University, the Senegal National Council Against AIDS, and the Horizons Program elicited quantitative and qualitative data about the needs, behaviours, knowledge, and attitudes of men who have sex with men. Findings reveal that respondents have distinct identities and social roles that go beyond sexual practices, that sex with men is driven by many reasons, including love, pleasure, and economic exchange, and that respondents' lives are often characterized by stigma, violence and rejection. The data also highlight that many men are at risk of HIV because of unprotected sex with other men, a history of STI symptoms, and poor knowledge of STIs. The study underscores the need for non‐stigmatizing, sexual health information and services.     

Being both and acting ‘man’: exploring patterns of masculinisation among young same-sex-attracted men in Thailand

Twenty-five same-sex-attracted rural young Thai men were interviewed three times to investigate how their sexual subjectivity changed over an 18-month period after they completed high school and moved into a new life-phase. Many young men grew up with strong gender-based understandings of homosexuality, in which a masculine (top) partner is seen as complementing a feminine (bottom) partner. The discursive division between the masculine and feminine domains became increasingly blurred in the actual practice of dating, forcing the young men to develop new understandings of homosexuality and same-sex relations. The shift from a rural to urban environment, the use of the Internet and the experience of falling in love played important roles in this experimentation with new, increasingly masculine presentations of the self, also influenced by a modern urban masculine aesthetic. The paper concludes that the encounter between ‘traditional’ gender-based homosexuality and new ideas, in which masculine object-choice is important in defining sexual identity leads to a variety of fluid ideas and expressions. This process created confusion among some, and opportunities for exploration of new ways of defining sexual subjectivities among others.     

The Miami,Florida, Young Men’s Survey: HIV prevalence and risk behaviors among urban young men who have sex with men who have ever runaway

Youth in urban areas with a history of running away from home often have special needs. Importantly, risk factors for HIV/AIDS might be associated with such a history. We assessed the association between having a history of running away from home and the occurrence of HIV infection and risk behavior among young men who have sex with men (YMSM), aged 15–22 years. A cross-sectional epidemiologic and behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of a national Young Men’s Survey. Of 488 YMSM, the prevalence of HIV infection among those with a history of running away from home was 10.5% (adjusted odds ratio=3.4; 95% Cl 1.5–7.8). YMSM who had ever run away were more likely to be HIV infected, be out of school, and have ever had vaginal or anal sex with females, been forced to have sex, injected drugs, and used needles for self-tattooing or body piercing. The prevalence of HIV infection and associated risk behaviors among runaways was high, highlighting the ongoing need for prevention and social support services for youth with a history of running away from home.     

‘It's my inner strength’: spirituality,religion and HIV in the lives of young African American men who have sex with men

Young black men who have sex with men account for 48% of 13–29-year-old HIV-positive men who have sex with men in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men's lives. Towards this goal, we conducted 31 interviews with 18–30-year-old men who have sex with men in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions, (2) the continued importance of spirituality among men who have sex with men, (3) homophobia and stigmatisation in traditional black churches, (4) tension between being a man who has sex with men and being a Christian, (5) religion and spirituality's impact on men's sense of personal empowerment and coping abilities and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive men who have sex with men may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial.     

‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City

In the USA, gay and other men who have sex with men and transgender women are disproportionately affected by HIV. Uptake of pre-exposure prophylaxis (PrEP), anti-retroviral therapy to prevent HIV-negative individuals from seroconverting if exposed to HIV, by members of this population remains low, particularly among African-Americans. We conducted two focus groups to assess responses to an online social media campaign focusing on PrEP use in New York City. We designed, produced and disseminated the campaign to address knowledge of PrEP; its physical and psychological side effects; and psychosocial barriers related to PrEP adherence and sex shaming. Focus group participants demonstrated a relatively high knowledge of PrEP, although considerable concern remained about side effects, particularly among Black participants. Participants suggested that stigma against PrEP users was declining as PrEP use became more common, but stigma remained, particularly for those not using condoms. Many focus group participants reported distrust of medical providers and were critical of the commodification of HIV prevention by the pharmaceutical industry. Participants reported that those in romantic relationships confronted unique issues regarding PrEP, namely suspicions of infidelity. Finally, Black participants spoke of the need for more tailored and sensitive representations of Black gay men in future programmes and interventions.     

What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.     

‘I’m more aware of my HIV risk than anything else’: syndemics of syphilis and HIV among gay men in Winnipeg

Despite decreased rates of HIV infection in Winnipeg, syphilis incidence continues to rise. Communities of men who have sex with men shoulder much of this burden of illness. This qualitative study aimed to better understand the co-evolution of HIV and syphilis in Winnipeg through a series of interviews with gay men. Eighteen individuals were recruited through advertising in sexual health centres and through subsequent snowball sampling. Thematic interpretive analysis and inductive reasoning were used to find individual and shared group meanings. We found that HIV formed the contextual ground on which sexual decision-making was made, with three main themes emerging during interviews: 1) bacterial STI transience being contrasted against HIV permanence; 2) syphilis being ‘dirty’ versus HIV carrying significant stigma, though being spared the label of uncleanliness; and 3) the role of pleasure and intimacy in sexual health decision-making. Based on these findings, we recommend further exploration to develop more effective strategies around syphilis prevention, in particular with regards to the longer-term illness ramifications and its relationship to HIV transmission.     

Cross-sectional observation of the relationship of depressive symptoms with lifestyles and parents’ status among Japanese junior high school students

Objectives

Students’ depressive symptoms might be related to their own risk factors and to their parents’ status. The objective of this cross-sectional study was to examine the relationship of depressive symptoms with lifestyle variables and parents’ psychological and socio-demographic status among Japanese junior high school students.

Methods

Of 477 students and their parents, 409 (85.7 %) students and 314 (65.8 %) parents participated in the study. Students answered self-reported questionnaire on depressive symptoms, their heights and weights, subjective stress, body dissatisfaction, lifestyles including sleep duration and extracurricular physical activity in school and other physical activity outside the school, and nutritional intake. Parents responded to questionnaire on depressive symptoms and socio-demographic status.

Results

The prevalence of depressive symptoms was 24.9 %. Students with depressive symptoms were more likely to have stress. Students in shorter and longer sleep duration groups were more likely to have depressive symptoms. The students with depressive symptoms had smaller amount of energy intake than did those without depressive symptoms. Multiple logistic regression analysis revealed significant relationships between students’ depressive symptoms and some independent variables. Sex, subjective stress, “almost-never”-categorized extracurricular physical activity in school and other physical activity outside the school, and having a parent with depressive symptoms were significantly associated with students’ depressive symptoms.

Conclusion

Reducing mental stress and taking care of lifestyles, especially, “almost-everyday”-categorized extracurricular physical activity in school and other physical activity outside the school, may have benefits for students’ mental health, and having a parent with depressive symptoms may be associated with students’ depressive symptoms.