Autocastration and autopenectomy in a patient with transsexualism and schizophrenia

Previous research focusing on changes in gay male sexual practices as a result of AIDS often avoids taking into consideration the meanings which sexual practices have within the gay community. As an alternative, the present study used a content‐analysis of personals advertisements within the personals section of The Village Voice to assess changes in the language gay men use to refer to their sexuality between the years 1978, 1982, 1985, and 1988. A significant increase in personals advertisements suggesting a concern with health is noted from 1982 to 1985. This increase continues from 1985 to 1988. Corresponding in time with these changes are increases in the number of personals advertisements which express a rejection of “stereotypical” presentations of self within the gay community. This rejection is seen as an attempt at self‐affirmation of characteristics perceived by gay men themselves as being desirable at particular historical moments. Implications for the basis of future policy interventions in reaction to AIDS are discussed. Finally, the utility of personals advertisement columns as an indicator of the meanings which people of various sexual preferences attach to their sexuality is discussed.     

Negative Consequences

Abstract

This article reports the results of a qualitative study of self-identified HIV-Negative gay/bisexual men living in urban gay communities. The study explored the effects of living through nearly two decades of the AIDS pandemic. Most researchers have focused on those who are HIV-Positive. Those whose serostatus is HIV-Negative are rarely included, but are greatly affected by this disease. An increasing number of these men, especially younger men, are seroconverting. Forty-seven gay men returned a questionnaire asking about feelings on being HIV-Negative, dealing with grief, sexual practices, and relationship and caregiver issues. Many HIV-Negative gay men reported psychological problems such as depression and unresolved grief. Therapists and AIDS prevention educators need to attend to the special needs of this overlooked population.     

Midlife and Older Gay Men Living with HIV/AIDS: The Influence of Resiliency and Psychosocial Stress Factors on Health Needs

HIV/AIDS research has mostly focused on younger gay men. This cross-sectional study originated from a larger study of 316 respondents to include a subsample of 38 midlife and older gay men living with HIV/AIDS. The study explores physical and mental health utilization rates, including physical and mental health status. Resiliency, internal health locus of control beliefs, and psychosocial stressors of age and sexual orientation discrimination, stigma, and internalized homophobia were also examined. A total of 65.8% of the HIV/AIDS participants received no mental health services the past year, despite reporting higher mental health distress. Of those reporting an HIV status, 10.5% indicated having no health visits in the preceding year and more delays in seeking care when needed and unmet health needs for which services were not sought. Participants reporting higher resiliency indicated less mental health distress and better health access indicators. Stigma and internalized homophobia negatively affected resiliency. Implications for practitioners working with midlife and older gay men are provided.     

Redefining Sex and Intimacy: The Sexual Self-Images,Outlooks, and Relationships of Gay Men Living with HIV/AIDS

This paper examines how gay men living with HIV disease come to terms with the profound sexual implications of their illness. Based on interviews with 25 gay men diagnosed with HIV/AIDS, this paper highlights (a) the disruptions that these men experience in their sexual feelings and self-images as a result of their illness; (b) the challenges they encounter in negotiating and sustaining sexual relationships; (c) the declines they experience in their sexual attractiveness, desire, and capacities as their illness advances; and (d) the changed meanings they give to sex and self as they come to terms with the erotic implications of their illness and try to preserve valued, intimate identities. In focusing on these themes, this paper offers an “insider's view” into key dimensions of the moral experience of gay men with HIV/AIDS. It also illustrates how the moral experience of these men shifts over the course of their illness, especially in response to the changes and challenges that arise in their intimate relationships and subcultural networks. On a broader, analytic level, this paper addresses a research question that has been neglected in previous studies of the experience of illness—that is, how does serious illness affect the sexuality of diagnosed individuals, particularly their construction of sexual and intimate identities? Through examining this question, this paper contributes to and extends the growing interactionist literature on the consequences of illness for self.     

Supervision of trainees: Tending the professional self

This article seeks to demonstrage how self psychological concepts can be applied to the process of training psychotherapists in a variety of clinical and community settings. The author examines the role of clinical supervision in the development, consolidation, and maintenance of a cohesive professional self. The role of selfobject experience, needs, transference, and countertransference as manifested in the supervisory relationship is elaborated. Supervisor and supervisee form a self-selfobject unit, through which the trainee's anxieties and vulnerabilities can be managed. This selfobject matrix enables maintenance of self-esteem, expansion of cognitive understanding, and structure building in the arena of the professional self. To achieve these ends, the supervisor forms an empathic alliance with the internal, subjective experience of the therapist. The importance of focusing on the self experience and selfobject needs of the therapist in training via an empathic mode of observation is illustrated by several examples and vignettes. The application of theory to practice is emphasized, with examples chosen from a variety of clinical settings and modalities.     

ANTICIPATORY AND ACTUALIZED IDENTITIES: A Cultural Analysis of the Transition from AIDS Disability to Work

Throughout the course of their lives, many people living with HIV/AIDS have prematurely retired onto AIDS disability. A new trend, however, has swept across the nation. Where once people were getting sick, leaving work, and embracing inevitable death, now, with advances in medical technology, many people with HIV/AIDS are renewing their lease on life and discovering a desire to go back to work. To learn how gay men's identities are impacted as they transition from AIDS disability back to the labor market, I conducted three months of fieldwork at an employment placement agency in San Francisco. During fieldwork I distributed informal questionnaires to 120 gay men and then formally interviewed 10 additional gay men who had either transitioned or were considering transitioning from AIDS disability back to work. Analyses reveal that cultural, structural, and medical contradictions typify the return to work. As gay men experience and live through these contradictions, their identities split into anticipatory and actualized components. By facilitating a reassessment of meanings and values, anticipatory identities cognitively and emotionally prepare individuals as they brave the road back to work. This version of identity represents a romanticized confluence of worker (role) identity, gay (status/master) identity, and overall sense of self (self-concept). Personal experiences with stigma, shame, and discrimination along with complexities of the workplace and medical services, however, prevent the maturation of anticipatory identities when seeking reemployment. This results in loosely coupled and situationally informed actualized identities . The relationship between these two identities suggests that many people living with HIV/AIDS—and indeed others who experience stressful life transitions—face complex choices between quality-of-life issues and the ability to survive according to external cultural and structural constraints.     

Toward a More Optimal Selfobject Milieu: Family Psychotherapy from the Perspective of Self Psychology

This paper applies the theory of self psychology to the understanding and treatment of families. The healthy family is viewed as a reliable source of selfobject experience for its members, while problems in or between family members are seen as due to a lack of adequate selfobject experience for one or more members. Causes of selfobject failures or misattunements in the family are examined, with an emphasis on the influence of previous relational experiences on current needs, capacities, and experiences of others. Curative factors in this form of family therapy are then outlined, and a treatment approach designed to help family members become better able to provide empathically attuned responses to each other is described, with a case example used to illustrate key points.     

Counseling Gay Males with AIDS:

As the incidence of acquired immune deficiency syndrome (AIDS) increases, persona with AIDS will present themselves for counseling in both the private and public sector. Counselors will therefore need to be aware of psychical issues affecting gay men who have the virus. This article highlights some of these critical issues. Specifically, the author discusses informational needs, management of distressing feelings, hope and denial, physical intimacy, and psychosocial interventions     

Marketing the Damaged Self: The Construction of Identity in Advertisements Directed Towards People with HIV/AIDS

This paper explores the identities projected in advertisements directed towards HIV positive individuals and people with AIDS. Fifty such advertisements were collected from three popular American magazines for gay men over a period of seven months. Analysis of the ads reveals a paradoxical presentation of people with HIV/AIDS, which offers simultaneous conflicting images of hope and fear, power and weakness, innocence and guilt. An interactive sociolinguistic model through which this contradictory discourse might be understood is presented, drawing on Goffman's insights on stigma management and the presentation of the self in social interaction. Advertisements directed towards people with HIV/AIDS, it is suggested, present a contradictory discourse in which the advertisers are positioned as 'the wise', offering to mediate the conflicting identities of the stigmatized. The identity values enacted in this contradictory discourse are further measured against American conceptions of communication and the self as observed by Carbaugh and others. The possible consequences of these positionings on the roles made available to people with HIV/AIDS in the wider social context are discussed.     

Chapter 7: Lesbians and Gays of Color and HIV/AIDS:

Motivated by a desire to determine if the human service literature reflected the "changing face of AIDS," we reviewed 40 articles addressing needs and issues of gays and lesbians of color. Our review of the multidisciplinary literature confirmed our initial assumption that, despite considerable discussion about the particular needs of lesbians and gay HIV-infected people of color, we could not find an extensive qualitative or quantitative body of research about those needs. An additional finding was the total neglect of minority lesbians and their need for HIV-prevention information. The articles specific to minority gay men were few in number. The majority of studies reviewed dealth quite generally with the risk of HIV transmission among people of color, without specific reference to sexual orientation.     

Chapter 6: Gay Latinos and AIDS:

AIDS education, prevention strategies, and support services for gay and bisexual Latinos have traditionally been inadequate, even though surveillance data demonstrate that the risk of contracting AIDS is two and one-half times greater for gay or bisexual Latino men than for their white counterparts. Language, culture, disproportionate poverty, and different definitions of gay or bisexual identity in Latino communities must be considered when addressing AIDS issues among Latino groups in the United States. It should not be assumed that outreach, education and prevention programs which may be appropriate for whites or African Americans will be appropriate for Latinos. This article offers a theoretical framework for developing a culturally-sensitive AIDS prevention program for gay and bisexual Latino men.     

Firm friends: exploring the supportive components in gay men's workplace friendships

Research shows that friendships are among the most important sources of support for gay men. Despite insights into how friends can be significant providers of emotional, practical and affirmational support, particularly when gay men 'come out' or experience discrimination on the basis of sexual orientation, scholars have rarely considered the role of work friends in supporting gay men in the workplace. This is remarkable given that work organisations remain challenging arenas for sexual minority employees to fashion a meaningful sense of self. Drawing on in-depth interview data with twenty-eight gay men employed in the UK, this article argues that gay men can rely on work friends for different forms of support in helping them to negotiate and sustain a viable sense of self. The findings show how the gender and sexuality of organisation influences which men and women are available as work friends, and the types of support they might give. Also, the affirmational support received from work friends is important not only for validating participants' sexual identities, but also identities of class and parenthood. The study aims to complicate stereotypes of men's workplace friendships as sources of support used largely for advancing careers and personal gain.     

The Adolescent Sexual Development of African American Gay Men with AIDS: Implications for Community-Based Practice

ABSTRACT

This qualitative study describes the adolescent sexual development of ten African American gay men living with AIDS. The informants retrospectively describe the challenges of being a gay adolescent in a mostly heterosexist and homophobic environment. They report unsupportive homophobic and heterosexist family members, community members and school officials. They also describe their burgeoning sexual orientation, sexual initiation as well as consensual and non-consensual sexual experiences with their peers. Additionally, several informants describe seeking sexual experiences with adult men. Later they suggest the adult men became their primary sources of emotional and psychological support. Implications for community practice, intervention and research with both African American gay adolescents and adult men living with AIDS are discussed.     

Not All Men,Situations, and Actions Are Equal

SUMMARY

Since 1985, annual surveys conducted in the French gay press show that gay men in France have made considerable changes in their sexual behavior due to the AIDS epidemic. However, risky behavior still occurs. In this article, some ideas which have been assumed concerning residual risk among gay men are tested. The research questions were: (1) Should all unprotected acts of anal intercourse be considered risky? (2) Has a phenomenon of relapse really occurred among gay men in France? and, (3) Are risks only limited to men who are on the margin of the gay community? Before answering these questions, major landmarks in HIV prevention for gay men in France are reviewed. Then, on the basis of the results of the 1995 Gay Press Surrey, subjects' perception of the degree to which they are socially accepted, and the diversity of homosexual lifestyles are presented, finally, we describe how respondents have adjusted to HIV-risk at a time when there has been much talk about the re-emergence of risk behaviors and a resurgence of the AIDS epidemic among homosexual men.     

“And then AIDS came along”: A life course turning point and sub-cohorts of older gay men

Research on life course turning points focuses on heterosexuals. Scholars acknowledge that the early AIDS epidemic was a period of crisis for current older gay men, and that this period has shaped and will likely continue to impact their lives. However, few studies have considered the range of early AIDS-related experiences within this group. In this article, I use a life course perspective and in-depth interviews with 40 gay men (60+) in Atlanta to address the following questions: (1) How did current older gay men's experiences vary during the AIDS years? (2) What social factors shaped this variation? I identified three AIDS-related sub-cohorts, which were defined by how participants' social and spatial relationships to urban gay communities influenced their experiences of personal loss, community loss, personal support, and community support between 1981 and 1996. The results suggest that scholars and service providers interested in how early life experiences impact later life should consider the divergent early AIDS-related experiences within the group “older gay men.”     

HIV/AIDS Projects with and for Gay Men in Northern Thailand

Abstract

In this paper I look at three HIV/AIDS projects which were run by and for gay men, transsexuals and men who have sex with men (MSM) in northern Thailand in the early 1990s. These three projects were very different in format and in context, ranging from a rural village AIDS association to an urban drag beauty contest. The projects were located in settings as different as gay bars and cruising areas, shopping malls and rural villages. Aspects of the three Thai projects have important implications for those working in HIV/AIDS prevention and in the care and support of people living with HIV/AIDS (PLWHAs) across cultures, particularly in relation to education, outreach and counselling programs.     

Gay, Lesbian, and Bisexual Aging into the Twenty-First Century: An Overview and Introduction

This paper provides an introduction and overview for the papers in the special issue of this Journal devoted to the latter half of life among gay men, lesbians, and bisexuals. Key issues are highlighted in terms of their impact on gay, lesbian, and bisexual cultural communities: the impact of the large aging population of baby boomers; the significance of age as a social organizer; and the areas of research included in this special issue (intimacy and relationships, HIV and AIDS among elders, and the identities and needs of those growing into middle and later life).     

Chapter 10: Issues in HIV/AIDS Service Delivery to High Risk Youth

Homeless and runaway youth engage in behavior that puts them at risk for infection with HIV, the virus that causes AIDS. Prevalence of HIV disease in homeless and runaway youth is higher than it is among other adolescents. In addition, homeless and runaway youth are often forced to engage in sex as a means of survival. Although they engage in high risk behavior, AIDS education programs have neglected them as a target group for education. To some extent, they have been included in other more general categories of persons with AIDS risk behaviors, such as men who have sex with men or intravenous drug users. However, the number of adolescents receiving age-specific HIV/AIDS information is far below the number infected (Hein et al., 1992). Often high risk youth are disenfranchised, having been forced from home by their families after disclosing their gay or lesbian identities. Lacking a political voice and having no spokesperson, they represent a group with complex unmet needs. These youth typically have immediate needs for food, shelter, and clothing. In addition, they often need medical management, mental health and drug counseling, crisis management, and HIV/AIDS information. These needs are often overwhelming to the agencies that serve youth. This article examines the barriers and issues that exist in providing services to high risk youth. Then, suggsetions for removing those barriers by empowering both service providers and youth are offered. Some of the suggestions are based upon the authors' own experience in providing HIV/AIDS in-service training to service providers to high risk youth. The article makes recommendations for policy on youth and HIV/AIDS.     

Context is Everything

SUMMARY

As we approach the third decade of AIDS, HIV prevention in the United States confronts expanding public concern about continuing infections among gay men. This paper provides a brief history of HIV prevention efforts among gay men in the United States, as well as a succinct analysis of its successes and failures. By focusing on lessons learned from work in the 1980s-as well as lessons which have not yet' been learned-the author suggests future directions in HIVprevention for gay men which emphasize critical analysis of epidemiological trends, and countering the merging of gay identity with HIV infection. Supporting men to gain greater authority and responsibility¹ for their sexual community-building and redevelopment is necessary for lowering the infection rate among successive generations of gay men.