Health and romance: Understanding unprotected sex in relationships between gay men (original) (raw)
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Managing unprotected anal intercourse The perspective of gay men who have not tested HIV positive
In the last year, approximately one third of HIV-uninfected gay men engaged in unprotected anal intercourse (UAI, ie. anal intercourse without the protection of a condom) with another man. This would not be any cause for concern if about 2% had not become HIV infected doing so (one in fifty of those who engage in UAI, or 1,500 men; see Hickson et al., 1997). Understanding why men have UAI is essential if HIV prevention is to be effective. Since sex between men accounts for at least three quarters of new HIV infections occurring in England, it will only be through a reduction in HIV acquired in this way that a significant reduction will be made in our national HIV incidence (in England, every year, approximately 2,000 new infections occur among 49,000,000 people). This paper reports original research data generated by Sigma Research as part of a rolling programme of HIV health promotion facilitation. The data concerns unprotected anal intercourse between men and HIV. All the data comes from men who were resident in England in1997, had sex with a man in the last year and had not, at the time of interview, been diagnosed HIV positive. This research builds on earlier work (Hickson, Davies & Weatherburn, 1998) and is complementary to other ongoing investigations of the perspective of men with diagnosed HIV infection (Keogh & Beardsell, 1997). It is intended as a contribution to an integrated picture of UAI among gay men (see for example Keogh et al., 1998; Keogh et al., 1999). The methods used in the current research included both face-to-face interviews and selfcompletion surveys. Therefore, this paper includes data in the form of numbers and proportions, as well as narrative accounts in the men's own words. It is hoped that, through more detailed knowledge of the circumstances under which UAI occurs, and the reasons why it occurs, more HIV health promoters are more able to work with a greater diversity of gay men, more effectively, and more sensitively. The paper is being distributed through the CHAPS Partnership, an Englandwide HIV health promotion planning programme coordinated by the Terrence Higgins Trust.
Constructing Sexual HealthGay Men and ‘Risk’ in the Context of a Public Sex Environment
Journal of Health Psychology, 1999
This article outlines the importance of conceptualizing 'sexual health' as a pluralistic and context-bound phenomenon. It explores gay men's sexual decision making in the particular context of public parks. Twenty gay men from Glasgow, Scotland, took part in semistructured, in-depth interviews. Interpretative Phenomenological Analysis (IPA) was employed to analyse transcripts for recurrent themes-these represent shared understandings across participants. Risk reduction, danger and safety figured frequently in men's accounts of sex and sexual decision making. However, the risks men reported related more directly to the threat of attack or arrest rather than the avoidance of sexually transmitted infections. Indeed, danger itself was occasionally something to be sought and enjoyed. Given these findings, we discuss the appropriateness of traditional health psychological approaches to understanding sexual health. It is hoped that this approach can highlight some issues that a true psychology of sexual health must address in order to represent sexual decision making more accurately and to be useful with respect to both service provision and theoretical development.
Gay and bisexual mens sexual partnerships and variations in risk behaviour
In epidemiological studies that focus on gay men's sexual risk behaviour the context in which it occurs is often ignored. Increasingly, knowledge of the type and nature of the partnerships is seen to be important when assessing sexual risk behaviour. For this study, gay and bisexual men were recruited through community groups, gay bars and bathhouses to complete a questionnaire on sexual practices with primary and casual same-sex partners. Partnerships were grouped as primary (162%, n = 110), casual (40.0%, n = 187) and both primary and casual (162% n = 76). In these configurations 40.0%, 13.3% and 31.4% respectively reported at least one episode of unprotected sex in the previous three months. In the subgroup of men with both primary and casual partners a number varied their behaviour significantly with partner type. Most important, the pattern was for men to refrain from risky activities with their casual partners. However, for some men a reverse pattern of risk was reported. These findings emphasize that, for HIV education and prevention, there is a need to address the diversity of mens' relationships, to recognize the diversity of behaviour within relationships and to open discussion about the factors that influence condom use.
Critical Public Health, 2018
Pre-exposure prophylaxis (PrEP) is currently being trialed for seronegative gay and other men who have sex with men (GMSM) at risk of HIV infection in England. However, research from other countries where PrEP is available shows limited literacy and uptake by GMSM at risk of HIV. We collected focus group data from 18 GMSM (13 HIV− and 5 HIV+) from Leicester, an ethnically diverse city in the English Midlands. Data were analysed using thematic analysis and three themes are presented. The first theme 'I can't get my head around people like that': Representations of PrEP users within and beyond gay communities explores how PrEP users are vilified by some GMSM and the wider media. The second theme, 'There's a culture of anti-trust': PrEP, stigma and the interpersonal politics of HIV disclosure discusses how PrEP influences HIV disclosure and sexual decision-making in casual sero-discordant sexual encounters in a context where seropositive men experienced pervasive HIV stigma and HIV− men were suspicious of HIV+ sexual partners. In the final theme, 'I'm still suspicious': Discourses of doubt and distrust participants voiced concern over the safety of PrEP and the motives of drug companies, healthcare agencies and PrEP activists. We consider these findings through a critical lens of wider theorising around the relationship between public health agencies and GMSM communities and consider the impact of these perspectives on likely engagement with PrEP in an English context. We call for more critically informed and nuanced ways of promoting health and well-being amongst men from these communities.
Risk and reflexion: findings from the United Kingdom Gay Men's Sex Survey 2004
2011
Survey design and recruitment collaborators: A huge debt of thanks are due to the following 130 agencies who collaborated on Vital Statistics, the Gay Men's Sex Survey in 2004. They include agencies who suggested content for the survey, requested booklets for local distribution directly from Sigma, and agencies who got their booklets from a third party (identified by agency stamps on completed booklets). Website addresses are given for agencies who promoted the survey online via their webpages (some of who also distributed booklets). Our apologies for any errors or omissions. Booklet design: Design by Clifford Singer at Edition. Printing by Formation. Booklet distribution: Coordination by Michael Stephens and Gary Hammond. Thanks to the 113 agencies (listed above) that distributed the booklet version of the questionnaire.
Knowledge and practice of sexual safety in Melbourne gay men in the nineties
Australian Journal of Public Health, 1994
Despite the impact of education programs, the ability of gay men to sustain sexual safety still comes under public scrutiny. A self-administered questionnaire was distributed in 1990 to a convenience sample of 284 gay-identified Melbourne men recruited from gay groups, health clinics, gay pubs and nightclubs, sex-on-premises venues, and the social networks of these men. The questionnaire measured the perceived safety of various sexual practices and the practice of unprotected anal intercourse over the previous three months. These results were compared with results from other Australian studies. Whereas nearly all the men were sexually active, only a small proportion considered activities such as oral sex without ejaculation and anal sex with condoms to be 'totally safe'. The majority considered these activities to be 'more safe than unsafe', suggesting a risk-reduction rather than a 'no-risk' approach to sex. C:omparisons with other Australian studies suggest that gay men are becoming more confident in the safety of sexual activities labelled as 'safe' by the AIDS Council. There was no elevated practice of unprotected anal sex at 'sex-on-premises' venues. Most men who had anal sex used condoms all of the time, whether sexual partnerships were 'once only' or were 'ongoing', suggesting that 'condoms always' is still a viable option in various partnerships. There was some evidence that a minority of men abandoned condoms in ongoing partnerships. If specific education campaigns are developed to promote 'negotiated safety' in partnerships, then such campaigns should not contradict the 'condoms always' strategy.
Predictors of high risk sexual behaviour in gay and bisexual men
Sozial- und Pr�ventivmedizin SPM, 1992
Gay and bisexual men are known to have made substantial adjustments to their sexual behaviour in response to AIDS t. Nevertheless studies continue to report a high frequency of homosexually active men engaging in potentially risky sexual activity, particularly, unprotected receptive anal sex 2. An understanding of such behaviour is required in order to design appropriate health educational interventions. The Health Belief Model 3 draws attention to a number of social-psychological factors that may be important influences upon health behaviour, and that may also suggest how to target health interventions. Thus one central variable of the HBM is the individual's perception of personal risk in relation to a disease such as AIDS in determining readiness to change behaviour 4. Related to perception of risk is the individual's level of knowledge about HIV transmission. The model also suggests that the greater the perceived seriousness or threat of a disease, the greater the likelihood of change 5. Another factor central to the HBM is the perception of costs and benefits of changing behaviour. In particular gay men may have strong attitudes regarding the costs and benefits associated with adopting safer sex 6. Individuals' sense of control over health, general self-confidence or self esteem have been suggested as elements additional to the HBM that may also be important influences upon behavioural change in this area 6. The HBM also indicates that a range of external cues may be stimuli to change. One factor that may be particularly important is degree of contact with the AIDS epidemic v. This paper reports on aspects of the sexual behaviour of a sample of homosexually active men in England. Results from a longitudinal study are used to examine the extent to which high risk sexual behaviour may be predicted by the following variables from the HBM: perceptions of risk, level of knowledge about HIV transmission, perceived severity and threat from the AIDS epidemic, perceived costs and benefits of adopting safer sex including views about condom use, personal sense of control over health generally and specifically in relation to HIV, self confidence and self esteem and contact with the AIDS epidemic. In addition the influence of mens' current partnerships is examined. Whilst not included within the normal range of variables of the HBM, relationships may be expected to play a potential role in influencing high risk sexual behaviour.
Sexual practices in a broad cross–sectional sample of Sydney gay men
Australian and New Zealand Journal of Public Health, 1977
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 nonconcordant 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. (Aust N Z
Revaluation of Risk Among Gay Men
AIDS Education and Prevention, 2003
This article reviews recent studies investigating sexual practice among gay and homosexually active men in Australia. The concept of ethics, understood as practical techniques adopted for the achievement of certain implicit and explicit goals, provides a framework for understanding the relation between gay men's engagement with medicine and their sexual practice over time. I argue that rather than producing straightforward complacency, the introduction of highly active antiretroviral therapy provided the conditions of emergence of a partial revaluation of risk among many gay men. "Negotiated safety" and "barebacking" might be understood as historically situated prevention ethics, scientifically plausible in some circumstances. Though emerging prevention ethics pose challenges for education, the strategy of enabling gay men, in conversation with health authorities, to be responsible for evaluating risk, has been remarkably effective. Enhancing the viability of prevention ethics begs attention to the quality and availability of public contexts within which embodied and lived experience can be brought into articulation with medical knowledge, raising the value of what is here described as "counterpublic health."
Gay Men's Knowledge of HIV Transmission and ‘Safe’ Sex: A Question of Accuracy
Australian Journal of Social Issues, 1990
The study described in this paper is part of a project assessing the impact of the HIV epidemic on 535 men who have sex with men. These men were surveyed about their knowledge of HIV, their sexual practices, other issues concerning the transmission of HIV, and AIDS. This paper focuses on these men's beliefs about HIV transmission, their perceptions of the safety of a number of sexual and social practices, and the factors influencing these perceptions. The findings indicate, in general, that the men surveyed were moderately well informed about HIV transmission. Some twenty percent of the men were well-informed about both 'safe' and 'unsafe' sexual practices, a small number were ill-informed and the remainder, the majority, were wellinformed about some aspects and ill;i(lformed about others. The data suggest that information from the mainstream and gay press is not only differentially available but that information is processed and interpreted by the men in different ways. Variables which influence the manner in which information is interpreted are place of residence (locale), awareness of gay community posters and pamphlets, and the men's sexual practice; these are associated with cautiousness or rashness in the men's judgments of safety and risk. The Social Aspects of the Prevention of AIDS (SAPA) study is a programme of research designed to supply background information for education strategies in HIV IAIDS prevention. Its focus is on the sexual and social lives of gay and bisexual men, the information environment in which they live, their responses to the human immunodeficiency virus (HIV) epidemic, and the impact of strategies designed to change high-risk sexual behaviours. This paper deals with one aspects of that study: the beliefs that gay and bisexual men hold about HIV transmission, the acquired immune deficiency syndrome (AIDS) and safe sex, and the factors which are implicated in the formation of those beliefs and opinions. The data come from Study A in the SAPA programme, a survey of