Righting anachronistic exclusions: The ethics of blood donation by men who have sex with men

ABSTRACT

Recently, the FDA announced that it would soon lift the long-standing lifetime ban on blood donation by men who have sex with men (MSM). Reexamining blood donation by MSM, it is clear that there are several ethical goods that must be balanced. Through balancing the primary duty to safety with the imperatives to craft a policy that is formally equal, upholds the public's trust, and is nondiscriminatory, an ethical blood donation deferral guideline may be advanced, both for MSM and the population at large.     

Continuity in social policy behaviours: the case of voluntary blood donorship

Using voluntary blood donation as a case example, the study on which this article is based explored not only the extent, or breadth, of community involvement in social policy behaviours, but also the continuity, or depth, of this commitment. Demographic and motivational data were collected through a postal questionnaire returned by 1,784 persons who had voluntary donated blood at least once in metropolitan Toronto between 1974 and 1978. An empirical distinction was also drawn between the 'active' and the 'lapsed' donor. The study found that while certain sectors of society were probably disproportionately represented among those who close to undertake voluntary social behaviours, the continuity of these actions could not be statistically associated with demographic or socio-economic variables. However, it did find that donors initially motivated by 'external' considerations such as convenience of location were more likely to lapse, while those for whom moral considerations and a sense of community were most important were more likely to continue as active donors. The general conclusion suggests that manipulating the context may be useful to broaden the initial participatory base in voluntary actions, but to produce continuity in this involvement the challenge must be phrased in moral language.     

Not just maternalism: marriage and fatherhood in American welfare policy

The United States' 1996 welfare reforms are often interpreted as a historical break in transitioning from supporting motherhood to commodifiying women's labor. However, this cannot account for welfare reform's emphasis upon heterosexual marriage and fatherhood promotion. The paper traces continuities and shifts in over a century of familial regulation through American welfare policy, specifying the place of marriage promotion within welfare policy. Up until 1996, families were key sites of intervention through which the American welfare state was erected, especially through single women as mothers - not wives. However, as of the 1960s, concern with African American men's "failed" familial commitments turned policymakers toward concern over marriage promotion for women and men. While marriage "disincentives" for aid recipients were lifted in the 1960s, the 1996 reforms structured a new form of nuclear family governance actively promoting marriage rooted in, but distinct from, the previous. Given the historical absence of welfare policies available to poor men, Temporary Assistance for Needy Families' (TANF) marriage promotion policies have positioned poor women as nodes connecting the state to poor men, simultaneously structuring poor women as breadwinners, mothers, and wives. Recent welfare reform has also started to target poor men directly, especially in fatherhood and marriage promotion initiatives. The article highlights how, in addition to workfare policies, marriage promotion is a neoliberal policy shifting risk to the shoulders of the poor, aiming to produce "strong families" for the purposes of social security.     

Erasing mothers with disabilities through Canadian family-related policy

Through public policy the Canadian state claims to empower disadvantaged groups such as disabled mothers and their families. Equality means accommodation of difference and a fair share of society's resources according to the principles of Section 15 in the Charter of Rights and Freedoms. Through an examination of family-related policy, procedures and financing this paper shows how women with disabilities have been disadvantaged in regard to mothering. The author argues that where disabled mothers have experienced discrimination, they have been restricted in their rights as Canadian citizens.     

Income support policy in Canada and the UK: different,but much the same

This paper examines linkages between women’s experiences in accessing information, services and public policy relating to income support in Canada and the UK. Drawing on narrative interviews, the author finds mothers with disabilities are often embedded in complex relations of care, experiencing both embodied and social barriers. Additionally, by employing critical discourse analysis, it is clear that policy in both contexts is written not only inaccessibly and confusingly, but is directed toward an able‐bodied, independent, resource‐rich ideal citizen. Thus, policy in both contexts is disabling and pathologizing. There are differences in resources that are written into the policy and available through the UK network of Citizen’s Advice Bureaus that would indicate that the UK offers a breadth of services and avenues for advocacy that are unavailable in Canada. Further, the Canadian policy appears to be more adversarial and surveillance‐based than the UK policy.     

Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men

Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.     

"No secrets" and beyond: recent elder abuse policy in England

This paper provides an overview of English elder abuse policy including guidelines developed for adult protection by their Department of Health in 2000, a report released from the House of Commons Health Committee in 2004 on elder abuse, related policy changes affecting older adults, the mentally incapacitated, and social care regulations, and the launching of public awareness campaigns. In contrast to the U.S., English policy subsumes elder abuse within the larger category of vulnerable adult protection, steers clear of mandatory reporting, emphasizes abuse by formal caregivers rather than domestic violence, relies on a multi-agency approach to investigation and intervention, and supports more remedial, less punitive regulatory oversight.     

How do we value our children today? as reflected by children's health,health care and policy?

SUMMARY. The importance of children in their own right and of their healthy development for the health of society, have been affirmed at an international level by the United Nations Convention on the Rights of the Child in 1989 and by the Children Act 1989 in the United Kingdom. In the UK fifteen years ago, the report of the Court Committee set out a framework for Child Health Services based on the same recognition of the value of children. This paper describes how in spite of the far-reaching recommendations made by the Court Committee, the health of children in this country is far from satisfactory; how health policy and services have failed to meet their health care needs; and how other recent legislation such as the NHS and Community Care Act may well lead to further difficulties in working for the best interests of the child.     

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.     

Body image, body satisfaction, and unsafe anal intercourse among men who have sex with men

Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of UAI (AOR = 0.33; 95% CI = 0.13, 0.85); body satisfaction was not found to mediate this association. 13.3% of men who reported overweight/obese body image had engaged in UAI compared with 21.6% of those who reported average weight and 8.2% of those who reported underweight (p < .05). Compared with MSM in exclusive relationships, MSM in non exclusive relationships had increased odds of UAI (AOR = 5.78; 95% CI = 2.96, 11.29) as did men who were not partnered (AOR = 3.20; 95% CI = 1.72, 5.93). These findings highlight the importance of including body image in sexual behavior models of MSM to better understand body image's role in influencing sexual risk and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) transmission.     

Bisexual and homosexual behavior and HIV risk among Chinese‐, Filipino‐, and Korean‐American men

Seventy bisexually or homosexually active men primarily of Chinese‐, Filipino‐, and Korean‐American backgrounds participated in extensive interviews focusing on acculturation and sexuality. Impressionistic data showed higher involvement in gay culture than Asian culture, a shift away from the complexity of bisexual lifestyles, and two patterns of exogenous selection of male partners. The findings suggest that Asian‐American men who had sex with men were more likely than comparison groups to comply with safer sex; acculturation to Asian society enhanced this compliance, but identification with Western Protestantism, or traditional Latin homosexual roles, was related to higher risk behavior. The reported behavior of the men who had sex with both men and women did not substantiate fears that bisexuals were a conduit for transmitting the virus from the gay to the heterosexual community. Impressionistic data suggested that a combination of inaccurate information about HIV transmission, unfounded trust of partners, poor assertiveness skills, and guilt may result in sexual risk taking. Suggestions for prevention included providing explicit information in ethnic and mainstream media, emphasizing risks of heterosexual transmission, providing electronic interactive learning situations that allow privacy rather than face‐to‐face interaction, and organizing support groups that affirm the men's dual identity as Asian‐American and gay or bisexual.     

Understanding men's health and illness: a gender-relations approach to policy, research, and practice

Men's health has emerged as an important public concern that may require new kinds of healthcare interventions and increased resources. Considerable uncertainty and confusion surround prevailing understandings of men's health, particularly those generated by media debate and public policy, and health research has often operated on oversimplified assumptions about men and masculinity. A more useful way of understanding men's health is to adopt a gender-relations approach. This means examining health concerns in the context of men's and women's interactions with each other, and their positions in the larger, multidimensional structure of gender relations. Such an approach raises the issue of differences among men, which is a key issue in recent research on masculinity and an important health issue. The gender-relations approach offers new ways of addressing practical issues of healthcare for men in college environments.     

A comparison of HIV risk practices among unprotected sex-seeking older and younger men who have sex with other men

Purpose: In recent years, much attention has been devoted to understanding the HIV risk behaviors of younger men who have sex with men (MSM). Recent data suggest that HIV is becoming an increasing problem for older adults, but little attention has been devoted to understanding their HIV risk behaviors or the factors that underlie their risk taking. This study provides a comparison of these issues among younger and older MSM. Methods: The data come from a subset of younger (ages 18–39, n?=?113) and older (ages 50+, n?=?109) men participating in a national study of 332 men who use the Internet to find other men for unprotected sex. Men were sampled randomly from 16 websites. Data were collected via telephone interviews conducted in 2008 and 2009. Results: Younger and older men reported comparable involvement in HIV risk, including involvement in unprotected sex, proportion of sex acts involving internal ejaculation, number of times having anonymous sex, and number of times having multiple-partner sex. Generally speaking, the factors underlying the risk practices of younger and older men were quite different (e.g. self-esteem and condom use self-efficacy for younger men, versus HIV serostatus and depression for older men). Conclusions: Older MSM using the Internet to find partners for unprotected sex engage in high rates of behaviors that place them at risk for contracting or transmitting HIV. They were just as likely as their younger counterparts to practice these behaviors. The factors “fueling” involvement in risk generally differ for older and younger men, thereby warranting the development of age-specific HIV interventions that can take into account the unique life circumstances and needs of older MSM.     

Re-assembling climate change policy: Materialism,posthumanism, and the policy assemblage

National and international policy-makers have addressed threats to environmental sustainability from climate change and other environmental degradation for over 30 years. However, it is questionable whether current policies are socially, politically, economically, and scientifically capable of adequately resolving these threats to the planet and living organisms. In this paper we theorize and develop the concept of a “policy assemblage” from within a new materialist ontology, to interrogate critically four policy perspectives on climate change: “liberal environmentalism”; the United Nations policy statements on sustainable development; “green capitalism” (also known as “climate capitalism”) and finally “no-growth economics.” A materialist analysis of interactions between climate change and policies enables us to establish what each policy can do, what it ignores or omits, and consequently its adequacy to address environmental sustainability in the face of climate change. None, we conclude, is adequate or appropriate to address climate change successfully. We then use this conceptual tool to establish a “posthuman” policy on climate change. Humans, from this perspective, are part of the environment, not separate from or in opposition to it, but possess unique capacities that we suggest are now necessary to address climate change. This ontology supplies the starting point from which to establish sociologically a scientifically, socially, and politically adequate posthuman climate change policy. We offer suggestions for the constituent elements of such a policy.     

Disabled men and fathering: opportunities and constraints

Over the last decade in the UK and elsewhere, fathers have become a visible presence in research and social welfare policy and practice agendas. While there is an increasing awareness of the heterogeneity of fathering contexts and experiences, disability as a dimension of difference among fathers has received little attention. This is so across all relevant bodies of research, including those on fathering, masculinities, disability, and parenting. In this paper, we seek to contribute to filling this gap by exploring the experiences of disabled men in relation to their fathering experiences. We draw on the findings from two qualitative research projects conducted in the UK, one on the experiences of disabled parents (mothers and fathers), the other on the experiences of disabled fathers. The findings suggest that the experience of impairment and disability positions men in relation to fathering in ways which can be both constraining of their fathering practices, as well as opportunistic in terms of re-articulating more ‘traditional’ fathering identities and practices. We suggest that while disability intersects with other important social divisions, there is a need for further research focused on the shared experiences of disabled fathers, particularly to inform family and child welfare policy and practice agendas.     

From nationalism to continentalism: Twenty years of energy policy in Canada

This article offers a theoretical framework for understanding the Canadian energy policy of the last two decades. Starting with a review of the Canadian literature on the topic, the article reviews the main constitutional features of Canadian federalism, which attributes complementary powers to both the central government and the energy-producing provinces, in this strategic area of economic activity. He suggests that major changes in the international environment and new domestic determinants, such as the aboriginal issue, brought about a breakdown of Canada's traditional equilibrium between national and provincial jurisdictions. The article also discusses the main implications of the North American Free Trade Agreement since its implementation in 1989, concluding that a thorough process of “globalization” of the energy market is well under way between Canada and the United States.     

Playing politics with policy: A conversation with Steven J. Pfohl

In this conversation, Stephen J. Pfohl and Maureen E. Kelleher discuss Pfohl’s experience as the chair of the Massachusetts Juvenile Justice Advisory Committee. During Pfohl’s tenure, the committee looked at the highly visible and politicized problem of violent teenagers. Pfohl reflects on the experience of chairing a committee made up of diverse representatives, leading them through a policy study process, and delivering a report with policy recommendations to the governor. He also shares insights into the political aspects of policy making. She has consulted with state agencies on various children’s policy issues, and her most recent work on institutional abuse appears inChild Welfare.     

Women and men as conservers, users and managers of agrobiodiversity: A feminist social–ecological approach

This feminist socio-ecological heuristic studies agrobiodiversity management, conservation and utilisation by men and women. Four approaches are characterised for an analysis of institutions, local knowledge, household economics and commodity chains. They are in turn linked to unveil their potential contributions towards a better understanding women's handling of, interests in and dependence on agrobiodiversity. The conceptualisation of a feminist framework aims at better informed research into the relationships between women, men and plants and is illustrated by examples from South Asia. Insights derived from a feminist socio-ecological perspective on agricultural biodiversity serve to generate gender-relevant policy recommendations towards establishing sustainable farming systems.     

‘Survival Employment’: Gender and Deskilling among African Immigrants in Canada

Recent research points to a growing gap between immigrant and native‐born outcomes in the Canadian labour market at the same time as selection processes emphasize recruiting highly educated newcomers. Drawing on interviews with well‐educated men and women who migrated from countries in sub‐Saharan Africa, this paper explores the gendered processes that produce weak economic integration in Canada. Three‐quarters of research participants experienced downward occupational mobility, with the majority employed in low‐skilled, low‐wage, insecure forms of “survival employment”. In a gendered labour market, where common demands for “Canadian experience”, “Canadian credentials” and “Canadian accents” were uneven across different sectors of the labour market, women faced particular difficulties finding “survival employment”; in the long run, however, women’s greater investment in additional post‐secondary education within Canada placed them in a somewhat better position than men. The policy implications of this study are fourfold: first, we raise questions about the efficacy of Canadian immigration policies that prioritize the recruitment of well‐educated immigrants without addressing the multiple barriers that result in deskillling; second, we question government policies and settlement practices that undermine more equitable economic integration of immigrants; third, we address the importance of tackling the “everyday racism” that immigrants experience in the Canadian labour market; and finally, we suggest the need to re‐think narrowly defined notions of economic integration in light of the gendered nature of contemporary labour markets, and immigrants’ own definitions of what constitutes meaningful integration.     

Inverse association between total testosterone concentrations,incident hypertension and blood pressure

Background.?Studies on the relationship between testosterone concentrations and blood pressure have yielded inconsistent results. Therefore, this study investigated the prospective association of total testosterone (TT) concentrations with risk of incident hypertension and blood pressure change in 1484 men aged 20–79 years.

Methods.?Data from the population-based Study of Health in Pomerania, Germany, were used. Serum TT concentrations, measured by chemiluminescent enzyme immunoassays, were categorised into age-specific quartiles. Generalised Estimating Equation (GEE) models, adjusted for age, waist circumference, physical activity, smoking and alcohol consumption were specified.

Results.?During a median follow-up time of 5.0 years, the prevalence of hypertension increased from 50.6% to 57.1%. TT concentrations were significantly lower in men with baseline and incident hypertension. Analyses revealed that men with baseline TT concentrations in the lowest quartile had an increased risk of incident hypertension (odds ratio (OR), 1.19 (95% CI, 1.10–1.28)) compared to men with higher TT concentrations. Furthermore, we found a significant inverse association of TT concentrations and blood pressure, showing that men with baseline TT concentrations in the lowest quartile showed the slightest change in systolic blood pressure (?6.01?mmHg), diastolic blood pressure (?2.11?mmHg) and pulse pressure (?3.98?mmHg). Sensitivity analyses in a subpopulation of men without antihypertensive medication confirmed these findings.

Conclusion.?These results show that low male TT concentrations are predictive of hypertension, suggesting TT as a potential biomarker of increased cardiovascular risk.