'The black dog just came and sat on my face and built a kennel': Gay men making sense of 'depression'

This article reports on in-depth interviews with gay men about their experiences and understanding of depression. It is a key outcome of the collaboration between social researchers, general practitioners and community partners to investigate the management of depression in gay men in primary care settings. As part of the qualitative arm of the project in-depth interviews were conducted with 40 gay men in Sydney and Adelaide (Australia). The approach to discourse analysis is informed by Hallidayan systemic functional linguistics. Six constructions of depression were identified: (1) depression as a constellation of symptoms; (2) symptoms constructed as experience; (3) depression as agent; (4) depression as mental processes; (5) not meeting social expectations; and (6) engaging with psychiatric discourse: constructing alternative positions. Gay men draw on the biomedical model of depression as low mood and loss of pleasure as well as on constructions of depression in terms of social experience. The biomedical model of depression is, however, not positioned as unproblematic. Rather, gay men align or disalign with this discourse according to their own experience, thereby enacting diverse masculinities. Gay men's discourses of depression are inextricably linked to the community activism of gay men and their community organizations in the context of the HIV epidemic, as well as a synergy between gay men and their doctors.     

Gender‐specific health implications of minority stress among lesbians and gay men

Objectives : Lesbians and gay men are exposed to unique minority stressors. We examined the health implications of one type of distal minority stressor (victimisation) and one type of proximal minority stressor (sexual identity concealment due to anticipated stigma) among lesbians and gay men. Gender‐specific health implications were assessed. Methods : Data were collected via an online survey involving an Australian sample of 1,470 gay men and 1,264 lesbians. Survey questions assessed demographics, experiences of different forms of sexual identity‐related victimisation and sexual identity concealment in a variety of contexts. Health outcomes included self‐reported general health, illicit drug use, frequency of alcohol consumption, smoking status, and weight status. Results : Gay men reported higher rates of victimisation and identity concealment than lesbians. Controlling for demographic differences, experiences of victimisation were associated with poorer self‐rated health, illicit drug use, and smoking among both gay men and lesbians. In contrast, identity concealment was linked with poorer health outcomes among lesbians only. Conclusions : Our findings offer new insights into the potential antecedents of the health inequalities that have previously been reported for these populations.     

Original Research: Confronting the Culture of Medicine: Gay Men's Experiences with Primary Care Physicians

Objective: To explore gay men's perspectives on primary health care. Design: Employing grounded theory methodology, structured interviews with 11 self-identified gay men from upper New York State were coded via the constant comparative approach. Measurement: Participants were asked open-ended questions about their past health care experiences, perceptions of the field of medicine, and thoughts regarding their relationships with their primary care providers. Results: Analysis suggested that gay men experience the field of medicine at two levels. At the macrolevel, medicine was thought to be homophobic and heterosexist, creating an unwelcoming environment for gay men. Participants believed that medicine was functioning in a state of ignorance because sexuality issues were not a priority in the training or practice of physicians. At the microlevel, gay men sought to build mutually comfortable physician–patient relationships based on open and honest communication. Participants differed in their beliefs of how the relevance of their gay identity related to health care needs. Disclosure of gay identity was not always seen as necessary for care, but being open in this regard was preferred. Conclusions: Gay men must navigate the medical field's cultural barriers to develop meaningful and stable relationships with their providers in order to receive appropriate care.     

Social factors associated with Major Depressive Disorder in homosexually active, gay men attending general practices in urban Australia

Objectives : Social factors associated with Major Depressive Disorder (MDD) were identified among gay men attending high HIV caseload general practices in Sydney and Adelaide.
Methods : Men who visited four participating practices were invited to self-complete a survey. A self-screening tool (PHQ-9), based on the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV), was used to measure depressive disorders.
Results : The rate of MDD (PHQ-9 score 10 or above) among the 195 HIV-positive gay men was significantly higher than that among the 314 non-HIV-positive gay men (31.8% vs 20.1%, p=0.002). Current MDD was independently associated with younger age, lower income, recent major adverse life events, adopting denial and isolation as coping strategies, less social support, less gay community involvement and recent sexual problems. HIV-status, however, was not independently associated with MDD.
Conclusion : Socio-economic hardship, interpersonal isolation and personal withdrawal were significantly and independently associated with major depression in this population of gay men.
Implications : The study provides further evidence of health inequity affecting gay men in Australia. Structural health promotion approaches focused on homophobia and discrimination, as well as community-engaged primary health care responses are called for to mitigate this inequity.     

"It's one of the better drugs to use": perceptions of cocaine use among gay and bisexual Asian American men

Research on drug use among gay and bisexual men has primarily focused on examining the link between drug use- most notably, methamphetamine-sexual practices, and risk of HIV transmission. Drawing on in-depth qualitative data from 40 interviews with gay and bisexual Asian American men, we examine perceptions and meanings associated with cocaine use in the San Francisco Bay Area gay community. We found that the participants, in contrast to their negative perceptions of methamphetamine use, believed that cocaine enhanced sociability and was acceptable for use in most social situations. Furthermore, participants perceived little connection between cocaine use and risky sexual practices, emphasizing the drug's safety relative to other illicit substances. Based on these findings, we suggest that an increase in the favorability of cocaine use might be an unintended consequence of methamphetamine prevention campaigns targeting the gay community, with their emphasis on the harmful effects of drug use, unsafe sex, and HIV risk.     

Increase in unprotected anal intercourse with casual partners among Sydney gay men in 1996–98

We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in anti-retroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n=2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.     

Sexual practices in a broad cross–sectional sample of Sydney gay men

Abstract: The aim of this study was to provide current data on the sexual practices in a broad cross–sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo–Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV–positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or noncon–cordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross–sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.     

An exploration of religion and spirituality among young,HIV-infected gay and bisexual men in the USA

Although religion and spirituality can promote healthy behaviours and mental well-being, negative religious experiences may harm sexual minority men’s health. Despite increasing vulnerability to HIV infection among young gay and bisexual men, few studies examine how religion and spirituality might affect them. To this end, we interviewed young gay and bisexual men who were diagnosed with HIV infection during January 2006–June 2009. Questionnaires assessed religious service attendance, disclosure of sexuality within religious communities, and beliefs about homosexuality being sinful. A subset described religious and spiritual experiences in qualitative interviews. We calculated the prevalence of religion- and spirituality-related factors and identified themes within qualitative interviews. Among men completing questionnaires, 66% currently attended religious services, 16% believed they could disclose their sexuality at church, and 37% believed homosexuality was sinful. Participants who completed qualitative interviews commonly discussed religious attendance and negative experiences within religious settings. They often expressed their spirituality through prayer, and some used it to cope with adverse experiences. These data suggest that religion and spirituality are notable factors that shape young, HIV-infected gay and bisexual men’s social contexts. Programmes and interventions that constructively engage with religious institutions and are sensitive to spiritual beliefs may promote these men’s health.     

Sex in two cities--gay men, risk and HIV in Perth and Sydney

After massive and sustained reductions in HIV risk behaviour amongst Australian gay men in the 1980's and early 1990's, since 1996 there have been signs of small but significant increases in unprotected analintercourse. Gay communities are responding to a post crisis context. However, is this response constant across different locations? This paper investigates changes in sexual negotiation and behaviour amongst gay men in the relatively small Australian city of Perth between 1998 and 2002 and compares these results to similar studies in Sydney, an Australian HIV epicentre city. A number of important similarities and differences between the Perth and Sydney samples are identified, particularly in casual contexts and disclosure of HIV status, identifying that isolated or smaller cities may experience similar phenomena to larger cities, but these may be due to different reasons. The findings point to the need for complementary qualitative research and cautions health promotion practitioners to test their assumptions when developing responses to prevent HIV transmission.     

Enacting and imagining gay men: the looping effects of behavioural HIV surveillance in Australia

The response to HIV in many countries is informed by routine behavioural surveillance of affected populations, yet the impact of this surveillance is rarely considered. In Australia, the Gay Community Periodic Surveys (GCPS) recruit 8000 men each year, surveying sexual practices, drug use and health service utilisation, in line with international guidelines. Using actor–network theory and Ian Hacking’s concept of ‘looping effects’, this article considers how knowledge of gay men is produced by behavioural surveillance, the interdependencies between the surveillance network and its subjects, and the potential for unintended consequences as a result of the mass participation of gay men in the surveillance network. The case of the GCPS is used to show how behavioural surveillance relies on a large, complex assemblage of human and non-human actors, with an emphasis on standardisation and repetition to make its practices durable. The distance of surveillance from gay men’s practices means that the network relies on an imaginary of gay men to create survey tools and to interpret data. This imaginary may be communicated to gay men during their participation in the surveillance, particularly when they are engaging with the surveillance questionnaire. This has the potential to affect their subjectivity and the practices the surveys seek to monitor. Considering the implications of this analysis, it is argued that HIV prevention could be improved if we consider how behavioural surveillance produces knowledge of gay men and the ways in which gay men affect and are affected by surveillance.     

HIV generations? Generational discourse in interviews with Australian general practitioners and their HIV positive gay male patients

The introduction of highly active antiretroviral therapy (HAART) is typically represented as a turning point in the social and medical history of HIV/AIDS, leading to a conceptual division into pre- and post-HAART eras. This paper explores how generational discourse is produced in interviews with general practitioners (GPs) and their HIV positive gay male patients in making sense of this moment and related changes in the Australian HIV epidemic. A theme of ‘HIV generations’ was identified in in-depth interviews with GPs who have HIV medication prescribing rights (based in Sydney, Adelaide and rural-coastal New South Wales) and the HIV positive gay men who attend their practices. In a closer analysis, generational discourse was identified across the interviews with GPs, characterising pre- and post-HAART HIV generations through three main features: treatment histories, socioeconomic status, and modes of survivorship. While generational discourse was less common in the accounts of HIV positive gay men, many of their examples wove together two narrative forms – ‘a different time’ and ‘difference today’ – suggesting that concepts of time and inequity are deeply embedded in these men’s understandings of the HIV experience. Our analysis indicates that generational concepts play a significant role in shaping both professional and ‘lay’ understandings of changes and patterns in the HIV epidemic.     

Crystal methamphetamine and sexual sociality in an urban gay subculture: an elective affinity

This paper draws on 49 qualitative interviews to explore the contextual antecedents of methamphetamine use in a sample of gay and bisexual Manhattan men. The paper distinguishes itself from the public health literature on crystal methamphetamine use in this population by shifting the analytic focus from individual-level factors of drug use to the role of social context. While individual-level factors--including self esteem and social awkwardness--are related to methamphetamine use, we argue that these factors arise in and are exacerbated by interactional pressures attendant to Manhattan's gay sexual subculture, which revolve around the expectation of peak sexual performance. Because methamphetamine is associated with increased self-esteem, increased libido, greater sexual endurance, diminished sexual inhibition, and a higher threshold for pain, the drug is used strategically by gay and bisexual men to negotiate sexual sociality and increase sexual pleasure. Hence, we suggest that there exists an elective affinity between Manhattan's gay sexual subculture and the particular pharmacological effects of methamphetamine-whereby the former strongly favours the latter as a systematic pattern of response. In turn, this relationship is linked to unsafe sexual practices or the social conditions that put gay men 'at risk of risk' of HIV infection.     

What’s In an Identity Label? Correlates of Sociodemographics,Psychosocial Characteristics,and Sexual Behavior Among African American Men Who Have Sex With Men

African American men who have sex with men (AAMSM) are vastly overrepresented among people with HIV/AIDS. Using data from 595 AAMSM in Philadelphia, we explored differences in sociodemographics, psychosocial characteristics related to beliefs about ethnicity, sexuality and masculinity, and sexual behavior with men and women by self-reported sexual identity (gay, bisexual, down low, straight). Roughly equivalent numbers identified as gay (40.6 %) and bisexual (41.3 %), while fewer identified as straight (7.6 %) or down low (10.5 %), with significant differences in age, income, history of incarceration, HIV status, alcohol and drug problems, childhood sexual abuse, and connection to the gay community evident among these groups. Analysis of psychosocial characteristics theorized to be related to identity and sexual behavior indicated significant differences in masculinity, homophobia, and outness as MSM. Gay and straight men appeared to be poles on a continuum of frequency of sexual behavior, with bisexual and down low men being sometimes more similar to gay men and sometimes more similar to straight men. The percentage of men having total intercourse of any kind was highest among down low and lowest among gay men. Gay men had less intercourse with women, but more receptive anal intercourse with men than the other identities. There were no significant differences by identity in frequency of condomless insertive anal intercourse with men, but gay men had significantly more condomless receptive anal intercourse. There were significant differences by identity for condomless vaginal and anal intercourse with women. This study demonstrates the importance of exploring differences in types of sex behavior for AAMSM by considering sexual identity.     

How has the sexual behaviour of gay men changed since the onset of AIDS: 1986-2003

OBJECTIVE: To report changes in sexual behaviour among gay men in Sydney from 1986 to 2003. METHODS: Baseline data from four studies of gay men in Sydney were used: the Social Aspects of the Prevention of AIDS study (1986/87: 91 HIV-positive and 444 HIV-negative men); the Sydney Men and Sexual Health cohort (1993-95: 237 HIV-positive and 910 HIV-negative men); the Health in Men cohort of HIV-negative gay men (2001-03: 1,148 men); the Positive Health cohort of HIV-positive gay men (2001/02: 237 men). Each sample was recruited and interviewed using similar methods. RESULTS: Fewer HIV-positive men had sex with casual partners over time (76.9% in 1986/87 to 63.7% in 2001/02; p = 0.001), but more HIV-negative men had sex with 10 or more casual partners in the previous six months (27.7% in 1986/87 to 37.7% in 2001-03; p = 0.012). The proportions engaging in particular sex practices with casual partners changed over time: anal intercourse without condoms that included ejaculation in the rectum fell from 29.4% among HIV-positive men and 32.4% among other men in 1986/87 to 17.8% and 10.0% respectively in 1993-95 (p = 0.034 and p < 0.001 respectively), but increased to 37.7% and 18.4% respectively in 2001-03 (p-values < 0.001); rimming one's partner increased from 36.8% among HIV-positive men and 17.6% among other men in 1986/87 to 63.6% and 52.3% respectively in 2001-03 (p = 0.001 and p < 0.001 respectively). CONCLUSION: Gay men's sexual behaviour with casual partners has changed over time, perhaps partly in response to HIV and partly as a general expansion of sexual repertoires. These changes have implications for gay men's health.     

Inappropriate lubricant use with condoms by homosexual men.

Use of condoms has been advocated as an important method of reducing the risk of human immunodeficiency virus (HIV) transmission among high-risk groups such as homosexual and bisexual men, prostitutes, intravenous drug users, adolescents, and hemophiliacs. Despite risk-reduction education campaigns directed to gay men since the early 1980s, evidence shows continued deficits in condom-use skills and knowledge among gay men. Because most failures in the use of condoms are attributed to errors in use, increasing knowledge and skills in condom use is important in preventing HIV infection. Two groups of homosexual and bisexual men were sampled, those entering a risk-reduction education program and participants in a Gay Pride event. They were surveyed on their current sex practices and their efforts to reduce their risk of HIV infection. They were asked about their numbers of sex partners, specific sexual behaviors, use of condoms, types of condoms used, and lubricants used for genital-anal sex. The characteristics of those surveyed were similar to those of respondents in other studies of risk reduction among gay men. The use of an oil-based lubricant with condoms has been shown to weaken latex and to increase the likelihood of condom breakage, which use of water-based lubricants does not. Among respondents who reported having genital-anal sex, 60 percent reported use of an oil-based lubricant with a condom at least once during the year before the survey. Gay men in sexually exclusive relationships engaged in less consistent use of condoms for receptive genital-anal sex than did single gay men.(ABSTRACT TRUNCATED AT 250 WORDS)     

Lay beliefs and the management of disease amongst West Indians with diabetes

This paper presents the findings of an exploratory study into lay beliefs and management of the chronic disease diabetes mellitus as well as the service use experiences of West Indians with the disease. In the United Kingdom, there is a higher prevalence of diabetes and higher mortality rates from this disease amongst West Indians when compared with their white counterparts. The project fieldwork was conducted in four sites; in general practice and out-patient diabetic clinics in London and Cambridge. In-depth interviews were held with 12 Caucasian and 12 West Indian diabetic patients and key informant interviews were held with a total of 13 health professionals on the diabetic care team. The study showed important differences between West Indians and Caucasians regarding knowledge and beliefs about diabetes as well its management. With the exception of two Pentecostal Christian women in the West Indian subsample, there was no evidence that these beliefs or practices conflicted with medical advice. However, the West Indian interviewees stated that the dietary advice provided did not take into account their traditional foods or cooking methods and as a result they experienced difficulties in following this advice. West Indians also expressed a general distrust of doctors and the majority had developed a range of strategies which they used to negotiate consultations with doctors and the heath service.     

萍乡市男男同性恋性病艾滋病哨点监测结果分析

目的了解男同人群的性相关危险因素特点,找出有效的途径或策略,进一步有效控制艾滋病的流行。方法问卷调查与实验室检测。结果总共监测310名男同,其中酒吧会所监测占30.97%,网络监测占69.03%;90%被监测男同是高中以上文化程度;最近一年患性病的占14.19%;310人当中HIV感染者8例,感染率为2.58%;网络招募人中HIV感染为3.27%。艾滋病知识知晓率为98.71%;有将近15%的感染者有过商业性行为(包括3名感染者);有商业性行为的男男同性恋艾滋病感染率与没有商业性行为的男男同性恋的艾滋病感染率两者比较有明显差异;与女性发生性关系的时候有三分之一不使用安全套,每次都会使用的不到一半,最近一次与女性发生性关系有三分之一没有使用安全套。结论男同容易将艾滋病性病进行婚内、外传播;男同存在掌握相关HIV防治知识与实际防范结果背离现象;网络加大了男同交往的频率和范围,也加大了艾滋病传播风险;同性商业性行为风险性更高;男同的双性性关系及无保护性性交在艾滋病传播中起到一个非常重要的桥梁作用;今后要把宣传干预重点放在双性恋、男性性商业服务人群、男同配偶或性伴、甚至青年妇女、青年学生身上。     

Beliefs related to breast health practices: the perceptions of South Asian women living in Canada

Breast cancer is becoming a major concern for many South Asian women. Clinical observations of women from a South Asian community living in Canada revealed an under use of early detection strategies. The purpose of this qualitative ethnoscience study was to examine breast health practices from the perspective of South Asian women to provide a foundation for the development of culturally suitable breast health services for this group. Open-ended interviews were conducted with a convenience sample of 50 South Asian women over the age of 30 who had not been diagnosed with breast cancer. Adequate representation of the main religious groups (i.e. Sikh, Hindu, Muslim and Christian) was ensured through sampling techniques. Analysis of translated interviews involved identification of themes and the development of a taxonomy to represent relationships among emerging cultural themes and domains. Four central domains of beliefs related to breast health practices were identified: beliefs about a woman's calling, beliefs about cancer, beliefs about taking care of your breasts and beliefs about accessing services. These beliefs hold important implications for how health promotion strategies should be structured and offered, In particular, attention must be paid to the language that is used to talk about breast cancer, the importance of the role of the family in women's health decisions and traditions related to using narratives to share information and advice.     

Post-exposure prophylaxis for HIV infection in gay and bisexual men: Implications for the future of HIV prevention

Objective: To assess the psychological and behavioral characteristics of gay and bisexual men who intend to use antiretroviral post-exposure prophylaxis (PEP) to prevent HIV infection.Methods: Gay and bisexual men who had not tested HIV seropositive and were not in long-term exclusive sexual relationships (n = 327) completed anonymous surveys consisting of demographic characteristics, gay community acculturation, experience with and attitudes toward PEP, substance use, and sexual behavior in the past 6 months.Setting: A large annual Gay Pride festival in Atlanta, Georgia.Results: There were 8 (3%) men who had already used PEP and 85 (26%) who planned to use PEP to prevent themselves from becoming HIV infected. Compared to the 242 (74%) men who did not indicate plans to use PEP, those planning to use PEP were younger, less well educated, more likely to have used illicit substances in the past 6 months, and were more likely to have a history of injection drug use. Men intending to use PEP were also more likely to have practiced unprotected anal and oral intercourse as the receptive partner and were more likely to have multiple anal intercourse partners with whom they were receptive.Conclusions: Gay and bisexual men are generally supportive of the immediate use of PEP and a significant number of men are planning to use PEP, particularly less educated men who use multiple substances and practice the highest-risk sexual behaviors. Concurrent behavioral interventions must, therefore, be considered critical in the advancement of PEP.