Karyn Fulcher | University of Victoria (original) (raw)

Papers by Karyn Fulcher

International Journal of Mental Health and Addiction

International Journal of Environmental Research and Public Health

Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex... more Crystal methamphetamine (CM) disproportionately impacts gay, bisexual, and other men who have sex with men (gbMSM). However, not all gbMSM are interested in changing their substance use. The present study aimed to examine whether participant-preferred service characteristics were associated with their readiness to change. We surveyed gbMSM who used CM in the past six months, aged 18 plus years, on dating platforms. Participants rated service-design characteristics from “very unimportant” to “very important”. Multivariable regression tested service preference ratings across levels of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES-8D). Among 291 participants, 38.7% reported their CM use was not problematic, 19.5% were not ready to take any action to reduce or stop using CM, and 41.7% were ready to take action. On average, participants rated inclusive, culturally-appropriate, out-patient counselling-based interventions as most important. Participants with greate...

Background This study examined the perceived difficulty of getting help with substance use among ... more Background This study examined the perceived difficulty of getting help with substance use among sexual and gender minorities who have sex with men (SGMSM) who use methamphetamine during the early COVID-19 period. Methods SGMSM, aged 18+, who reported sex with a man and methamphetamine use in the past 6 months were recruited to complete an online survey using online advertisements. Ordinal regression models examined predictors of greater perceived difficulty of getting help. Explanatory variables included participant characteristics (i.e., age, HIV status, ethnicity, sexuality, gender, region, income) and variables assessing patterns of methamphetamine use (i.e., frequency, % time methamphetamine is used alone and during sex; perceived need for help) and patterns of healthcare access (i.e., regular provider, past substance use service utilization). Results Of 376 participants, most were gay-identified (76.6%), white (72.3%), cisgender (93.6%), and had annual incomes of less than $60...

Substance Abuse Treatment, Prevention, and Policy, 2021

NPT Qualitative Questions HIV Negative. [HIV Negative] ARV-based Prevention Interview Guide. The ... more NPT Qualitative Questions HIV Negative. [HIV Negative] ARV-based Prevention Interview Guide. The interview guide used with HIV negative participants in the Momentum Study who had experience using ARV prevention strategies. (DOCX 27 kb)

BMC Public Health, 2019

Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided ... more Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. Methods: We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. Results: Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. Conclusions: These findings indicate that notions of "safety" and "risk" based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men's current prevention needs. Interventions should advance gay men's communication and self-advocacy skills in order to optimize these strategies.

Sex Education, 2017

It is generally accepted that hearing homophobic language can be detrimental to the well-being of... more It is generally accepted that hearing homophobic language can be detrimental to the well-being of same-sex attracted young people. Writing Themselves In 3, a survey of Australian same-sex attracted young people, found that almost half of the respondents reported hearing such language on a regular basis, and considered it offensive. Less is known however about heterosexual young people's experiences. Homophobic language use is often assumed to be motivated by prejudice, but this topic has not been well studied. Using interviews and an online discussion with young people aged 16-21 years, this study explored heterosexual young people's perspectives on homophobic language use at school. Contrary to the framing often used in anti-homophobia education, the meaning of this form of language was seen to largely depend on the context in which it was employed, frequently functioning to reinforce masculine gender norms, particularly for popular male students. Furthermore, while many heterosexual participants in this study used homophobic language regularly, they did not see themselves as homophobic and viewed school policies against the use of homophobic language as largely ineffective. Findings suggest that heterosexual young people may respond more favourably to anti-homophobia education if these programmes acknowledge the variety of meanings and functions of language commonly understood to be homophobic in character.

Culture, Health & Sexuality, 2018

From a health perspective, group sex parties represent risk environments, as multiple sexual part... more From a health perspective, group sex parties represent risk environments, as multiple sexual partners and polysubstance use associated with these parties may present risk practices for sexually transmitted infection (STI) transmission. At the same time, group sex parties exemplify sex as recreation, expressed in contemporary sociological theory as sex as leisure or play. In this paper, we report on the findings of an exploratory qualitative study conducted with group sex party attendees and hosts/organisers in a mid-sized Canadian city. Thematic analysis of semi-structured interviews with thirteen individuals identified several sexual communities based on gender composition, sexual orientation, and sexual practice, with variation among and within groups in terms of sexual consent and STI disclosure. All the interviewees discussed at length issues of harm reduction and consent, suggesting that these factors contribute to participants' group sex party experiences regardless of their sexual community. These insights highlight the potential use of group sex parties as avenues to understanding the integration of harm reduction practices with the pursuit of sexual pleasure, information applicable in the context of a wide range of sexuality education programmes.

Sex- and Gender-Based Analysis in Public Health

The Canadian Journal of Human Sexuality

Individuals in Canada may obtain prescription contraception from a family doctor, a walk-in clini... more Individuals in Canada may obtain prescription contraception from a family doctor, a walk-in clinic, or sexual health clinic. While there are guidelines for best practice in contraceptive care, the quality of this care varies widely. Access to any contraceptive care is also a concern, partly due to increasing pressures on physicians’ time. These issues have led to calls to expand contraceptive care into the purview of nurses and other qualified health professionals, a ‘task-sharing’ approach. Here, we use data from semi-structured interviews with providers and patients at a sexual health clinic in British Columbia to examine the benefits of such an approach as implemented in this particular clinic. We conducted semi-structured interviews with physicians, nurses, volunteer peer contraceptive educators, and patients about their experience providing or obtaining care at the clinic, and thematically analyzed the resulting data. Interviewees identified four key benefits in the clinic’s ap...

The Canadian Journal of Human Sexuality

Extensive research has been conducted on the contraceptive decision-making that patients engage i... more Extensive research has been conducted on the contraceptive decision-making that patients engage in during their appointment with healthcare providers and the approaches used by providers during this process, but less information is available on what happens prior to the appointment that may contribute to patients’ decisions. Here, we use data from semi-structured interviews with 17 patients at a sexual health clinic about their experience obtaining contraception to explore the process of choosing a method. Participants were recruited through posters in the clinic waiting room and via information posted on the clinic’s social media feeds. Interviews were thematically analyzed, and two main themes identified. The first theme was the importance of seeking out information online and from social networks prior to seeing a provider, to the extent that most participants had settled on a method prior to their discussion with a physician. The second theme was the priorities identified by par...

The Canadian Journal of Human Sexuality

Introduction: COVID-19 has had a profound effect on every aspect of contemporary life, including ... more Introduction: COVID-19 has had a profound effect on every aspect of contemporary life, including sexuality. Physical distancing measures and limitations on large gatherings explicitly restrict in-person group sex events. We sought to understand how the pandemic and associated public health control measures have affected group sex practitioners and activities. Methods: We used a community-based participatory research approach. In fall 2019, we recruited a Community Advisory Board (CAB) of group sex key informants via community agencies, social media, and relevant websites (e.g., FetLife, Squirt). To be eligible, participants had to be at least 18 years old and have recently participated in a local group sex event (i.e. sex, broadly defined, with more than 3 people). Ethics approval was secured for the CAB as a longitudinal focus group study. Focus group meetings were audio recorded, transcribed, and thematically analyzed. In December 2019, participants were asked about definitions of...

BMC Public Health, 2019

Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided ... more Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. Methods: We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. Results: Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. Conclusions: These findings indicate that notions of “safety” and “risk” based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men’s current prevention needs. Interventions should advance gay men’s communication and self-advocacy skills in order to optimize these strategies.

From a health perspective, group sex parties represent risk environments, as multiple sexual part... more From a health perspective, group sex parties represent risk environments,
as multiple sexual partners and polysubstance use
associated with these parties may present risk practices for sexually
transmitted infection (STI) transmission. At the same time,
group sex parties exemplify sex as recreation, expressed in contemporary
sociological theory as sex as leisure or play. In this
paper, we report on the findings of an exploratory qualitative
study conducted with group sex party attendees and hosts/organisers
in a mid-sized Canadian city. Thematic analysis of semi-structured
interviews with thirteen individuals identified several sexual
communities based on gender composition, sexual orientation,
and sexual practice, with variation among and within groups in
terms of sexual consent and STI disclosure. All the interviewees
discussed at length issues of harm reduction and consent, suggesting
that these factors contribute to participants’ group sex
party experiences regardless of their sexual community. These
insights highlight the potential use of group sex parties as avenues
to understanding the integration of harm reduction practices
with the pursuit of sexual pleasure, information applicable in
the context of a wide range of sexuality education programmes.

It is generally accepted that hearing homophobic language can be detrimental to the well-being of... more It is generally accepted that hearing homophobic language can be detrimental to the well-being of same-sex attracted young people. Writing Themselves In 3, a survey of Australian same-sex attracted young people, found that almost half of the respondents reported hearing such language on a regular basis, and considered it offensive. Less is known however about heterosexual young people's experiences. Homophobic language use is often assumed to be motivated by prejudice, but this topic has not been well studied. Using interviews and an online discussion with young people aged 16–21 years, this study explored heterosexual young people's perspectives on homophobic language use at school. Contrary to the framing often used in anti-homophobia education, the meaning of this form of language was seen to largely depend on the context in which it was employed, frequently functioning to reinforce masculine gender norms, particularly for popular male students. Furthermore, while many heterosexual participants in this study used homophobic language regularly, they did not see themselves as homophobic and viewed school policies against the use of homophobic language as largely ineffective. Findings suggest that heterosexual young people may respond more favourably to anti-homophobia education if these programmes acknowledge the variety of meanings and functions of language commonly understood to be homophobic in character.

Culture, Health & Sexuality, 2013

International Journal of Mental Health and Addiction

International Journal of Environmental Research and Public Health

Substance Abuse Treatment, Prevention, and Policy, 2021

BMC Public Health, 2019

Sex Education, 2017

Culture, Health & Sexuality, 2018

Sex- and Gender-Based Analysis in Public Health

The Canadian Journal of Human Sexuality

BMC Public Health, 2019

Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided ... more Background: The emergence of biomedical and seroadaptive HIV prevention strategies has coincided with a decline in condom use among gay men. Methods: We undertook a social ecological analysis of condom use and perceptions using nineteen semi-structured interviews with HIV negative gay men in Vancouver, Canada who used HAART-based prevention strategies. Results: Contributors to inconsistent condom use were found at various levels of the social ecological model. Ongoing concern regarding HIV transmission and belief in the proven efficacy of condoms motivated contextual use. When condoms were not used, participants utilized seroadaptive and biomedical prevention strategies to mitigate risk. Conclusions: These findings indicate that notions of “safety” and “risk” based on consistent condom use are eroding as other modes of prevention gain visibility. Community-based and public health interventions will need to shift prevention messaging from advocacy for universal condom use toward combination prevention in order to meet gay men’s current prevention needs. Interventions should advance gay men’s communication and self-advocacy skills in order to optimize these strategies.

From a health perspective, group sex parties represent risk environments, as multiple sexual part... more From a health perspective, group sex parties represent risk environments,
as multiple sexual partners and polysubstance use
associated with these parties may present risk practices for sexually
transmitted infection (STI) transmission. At the same time,
group sex parties exemplify sex as recreation, expressed in contemporary
sociological theory as sex as leisure or play. In this
paper, we report on the findings of an exploratory qualitative
study conducted with group sex party attendees and hosts/organisers
in a mid-sized Canadian city. Thematic analysis of semi-structured
interviews with thirteen individuals identified several sexual
communities based on gender composition, sexual orientation,
and sexual practice, with variation among and within groups in
terms of sexual consent and STI disclosure. All the interviewees
discussed at length issues of harm reduction and consent, suggesting
that these factors contribute to participants’ group sex
party experiences regardless of their sexual community. These
insights highlight the potential use of group sex parties as avenues
to understanding the integration of harm reduction practices
with the pursuit of sexual pleasure, information applicable in
the context of a wide range of sexuality education programmes.

It is generally accepted that hearing homophobic language can be detrimental to the well-being of... more It is generally accepted that hearing homophobic language can be detrimental to the well-being of same-sex attracted young people. Writing Themselves In 3, a survey of Australian same-sex attracted young people, found that almost half of the respondents reported hearing such language on a regular basis, and considered it offensive. Less is known however about heterosexual young people's experiences. Homophobic language use is often assumed to be motivated by prejudice, but this topic has not been well studied. Using interviews and an online discussion with young people aged 16–21 years, this study explored heterosexual young people's perspectives on homophobic language use at school. Contrary to the framing often used in anti-homophobia education, the meaning of this form of language was seen to largely depend on the context in which it was employed, frequently functioning to reinforce masculine gender norms, particularly for popular male students. Furthermore, while many heterosexual participants in this study used homophobic language regularly, they did not see themselves as homophobic and viewed school policies against the use of homophobic language as largely ineffective. Findings suggest that heterosexual young people may respond more favourably to anti-homophobia education if these programmes acknowledge the variety of meanings and functions of language commonly understood to be homophobic in character.

Culture, Health & Sexuality, 2013