Gay Men's Knowledge of HIV Transmission and ‘Safe’ Sex: A Question of Accuracy

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 well-informed about some aspects and ill-informed 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.     

SOURCES OF INFORMATION ABOUT HIV/AIDS,TRUST OF SOURCES AND PERCEIVED RISK OF INFECTION

The relationship between sources of information about AIDS/HIV, trust of the sources, how informed about AIDS people thought they were, and perceived risk to self and others were examined using three samples. One included young heterosexual students (113 females and 91 males), while the others included slightly older heterosexuals (74 females and 73 males) and homosexuals (82 males) from the general community. Homosexual men were the only group who trusted the same sources from which they received the most information (eg gay publications and AIDS organisations). Heterosexuals trusted expert sources the most, but the students received most information from magazines aimed at their peer groups and the heterosexuals in the community sample received most information from the print media. For the students, perceived personal risk was influenced most by perceived risk to male friends and people with the same sexual practices, whereas for the community samples it was influenced most by perceived risk to people with the same practices. The results suggest a strong peer influence on perceptions of personal risk of HIV infection.     

Reaching Men who have Sex with Men in Australia. An Overview of AIDS Education: Community Intervention and Community Attachment Strategies

This paper outlines the principles underlying the Australian AIDS strategy and offers an explanation for its success in reducing the spread of the human immunodeficiency virus (HIV) among homosexual and bisexual men in Australia's gay communities. A brief outline of the AIDS education activities offered by the gay-community AIDS organisations is followed by results from the Social Aspects of the Prevention of AIDS (SAPA) research project based at Macquarie University. This research confirms the importance of the community-intervention strategies utilised by gay AIDS organisations. The paper then assesses progress in the development of community-attachment strategies for men who have sex with men but who are not attached to organised gay communities.     

SexualPrejudice and Gender: Do Heterosexuals' Attitudes Toward Lesbians and Gay Men Differ?

This article explores the question of whether and how heterosexuals' attitudes toward lesbians differ from their attitudes toward gay men. Data from a 1997 national survey are presented to show that heterosexual women generally hold similar attitudes toward gay men and lesbians, whereas heterosexual men are more likely to make distinctions according to gender. Moreover, men's attitudes toward lesbians are susceptible to situational manipulations. Nevertheless, the underlying unity of attitudes toward lesbians and gay men is demonstrated by the fact that they are highly correlated for both heterosexual men and women. It is suggested that heterosexuals' attitudes toward gay people are organized both in terms of minority group politics and personal sexual and gender identity and that attitudes toward lesbians are most likelyto be differentiated from attitudes toward gay men in the latter realm.     

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults

ABSTRACT

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008–2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack–cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65–70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.     

Associations between HIV stigma and social support for people living with HIV in Hyderabad,India

The present study examined the association between social support and Human Immunodeficiency Virus (HIV) stigma through a survey of 150 people living with HIV (PLWH) in Hyderabad, India. Survey items to assess social support were adapted from the HIV Cost Services and Utilization Survey. HIV stigma was measured using Zelaya and Jeyaseelan scales that were previously validated in India. Multiple linear regression analysis revealed an inverse association between social support and HIV stigma across both stigma scales. Depression further intensified the level of stigma faced by PLWH who had lower levels of social support. Third-gender individuals experienced significantly higher HIV stigma and lower social support than cisgender men. Social support must be used as a protective factor in current HIV stigma reduction interventions. Findings highlight the need to adopt a gender-sensitive social support framework in HIV care policies to better address HIV stigma in the Indian context.     

Sexual Communication and Seroadaptation Practices in HIV-Negative Midlife and Older Men Who Have Sex With Men

Advances in treatments have increased the longevity of people with HIV. The high prevalence of HIV among men who have sex with men (MSM) creates a greater risk for exposure that increases with age. Seroadaptation, which includes serosorting (sexual behavior and condom use based on knowing the serostatus of self and partners) and strategic sexual positioning (choosing receptive versus insertive anal sex), is sometimes used as an HIV risk-reduction strategy. This study examined seroadaptation, sexual communication, and HIV-risk behaviors in 420 sexually active HIV-negative MSM aged 40–81 years in South Florida via anonymous pen-and-paper questionnaire. Recreational drug use and serosorting (i.e., not using condoms if the partner said he was HIV-negative) were associated with higher risk for unprotected receptive anal intercourse. Younger age, greater number of partners, and serosorting were associated with higher risk for unprotected insertive anal intercourse. Understanding these behaviors in this group might help guide HIV-prevention efforts. Future research may examine the role of HIV-prevention medication (PrEP) in influencing sexual behavior in midlife and older MSM.     

Sexual Orientation and Demand for the Arts*

Objective. We establish and try to explain a gay affinity for the arts. Methods. Using logit analysis on the General Social Survey, we test whether demographics, creativity, gender nonconformity, and sexual repression can explain differences between lesbians, gay men, and bisexuals (LGBs) and others in attendance at art museums, classical music concerts, and dance performances. Results. LGBs' higher education and probability of being childless city‐dwellers explain one‐third of the substantial attendance differences. However, LGBs do not demonstrate higher innate creativity through greater amateur production of art; gay men's affinity for the arts appears no stronger than lesbians', casting doubt on the gender nonconformity explanation; and LGB‐straight attendance differences are as large among young as older respondents, despite supposed declines in the special functions of arts attendance since gay liberation. Conclusions. LGBs are much more likely to attend the arts than demographically similar heterosexuals, but we find little support for three conventional explanations.     

Social Identity and Attitudes toward HIV Pre-exposure Prophylaxis: A Structural Equation Model

Abstract

This study focuses on the role of social identity and prejudice as causal variables in public attitudes toward pre-exposure prophylaxis (PrEP) in a UK sample. In all, 222 participants participated in an experimental vignette study with a 2?×?2?×?2 design with between-participants factors of ethnicity, sexual orientation and gender, and completed measures of attitudes toward gay men, Black Africans, and PrEP. Kruskal–Wallis tests showed significant effects of gender on attitudes toward gay men and Black Africans; of ethnicity on attitudes toward gay men and PrEP; and of religion on attitudes toward gay men. A univariate analysis of variance (ANOVA) revealed more positive attitudes toward PrEP when it was presented as benefitting men (vs. women). Structural equation modeling showed that the relationship between the independent variables of gender, ethnicity, and religion and the dependent variable of attitudes toward PrEP was mediated by attitudes toward gay men and Black Africans. Individuals must perceive the principal beneficiaries of PrEP (i.e., gay men and Black Africans) positively to endorse PrEP for these groups, and sexism may reduce public acceptability of PrEP for women. Future research should use representative samples and alternative experimental manipulations, and include strength of social identification as an independent variable.     

End-of-Life Preparations among Lesbian,Gay, Bisexual,and Transgender People: Integrative Review of Prevalent Behaviors

Proactively making end-of-life (EOL) preparations is important to ensure high quality EOL care. Critical to preparation is the discussion of preferences with one’s primary health care providers. Lesbian, gay, bisexual, and transgender (LGBT) people often experience discrimination from health care providers that will detrimentally affect their ability to communicate their care preferences. Structural barriers, such as those based on sexual orientation and gender identity, may impede timely and quality care when one is most in need. The aim of this study was to examine the prevalence of EOL preparatory behaviors among LGBT people, with particular focus on transgender individuals. Eight survey instruments with 30 prevalence estimates found in the literature were analyzed. EOL discussions between LGBT people and their primary health care providers were rare (10%). Transgender people were found to be even less prepared for EOL; they were 50–70% less likely than their LGB counterparts to have a will, a living will or to have appointed a healthcare proxy. A need exists for future mixed-methods research focused on LGBT populations accompanied by the cultural sensitivity needed to ensure their wishes are honored at the EOL.     

Comparing Supports for LGBT Aging in Rural Versus Urban Areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n?=?1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.     

SOURCES OF INFORMATION ABOUT HIV/AIDS AND PERCEIVED RISK OF INFECTION AMONG HETEROSEXUAL YOUNG ADULTS: 1989 AND 1994

This paper reports a study of sources of information about HIV/AIDS and trust of the sources among heterosexuals in 1989 (113 females and 91 males) and 1994 (185 females and 66 males). We also examined whether perceived personal risk of HIV infection was predicted by sources of information about HIV/AIDS, trust of the sources, how informed about AIDS people believed they were, and perceived risk of infection to others, as well as whether there was a relationship between perceived personal risk and safe sex behaviour. Participants received most of their information about AIDS/HIV from magazines, newspapers, and television, but placed most trust on sources such as doctors and HIV/AIDS organisations. Perceived personal risk was influenced most by perceived risk to friends and to people with the same sexual practices. In the 1994 sample, perceived personal risk was correlated with the amount of condom use among participants with sexual experience. These results indicate ther has been relative stability across a five-year period. They also point to the continuing discrepancy among young heterosexuals between the most-used and most-trusted sources of information, as well as to the importance of peer influence on perceptions of personal risk of HIV infection.     

Decomposing trends in attitudes toward gay marriage, 1988–2006

Objective. The objective of this article is to examine the trend in attitudes toward gay marriage through the analysis of data from the General Social Survey. Methods. Using linear decomposition techniques, I explain the change in attitudes toward gay marriage from 1988 to 2006. Results. Attitudes significantly liberalized over time; 71 percent opposed gay marriage in 1988, but by 2006, this figure dropped to 52 percent. Approximately two-thirds of this change was due to an intracohort change effect, or individuals' modifying their views over time, and one-third was due to a cohort succession effect, or later cohorts replacing earlier ones. This pattern was replicated across many subgroups of the U.S. public, including age, sex, residential, educational, and religious groups. Conclusion. The results suggest that the use of the “equality/tolerance” framing of gay marriage by its supporters and other societal events or “moments” may have convinced some people who used to disapprove of gay marriage in 1988 to approve of it by 2006.     

Older bisexual people: Implications for social work from the ‘Looking Both Ways’ study

There is a growing social work literature about lesbian, gay, bisexual, and transgender (LGBT) older people. However, research and guidance are predominantly based on the experiences of older gay men and, to a lesser extent, older lesbians. There is little to help practitioners work with older bisexual people. The Looking Both Ways study aimed to contribute to this gap in knowledge. We undertook in-depth purposely sampled qualitative interviews with 12 people aged over 50, all of whom have bisexual relationship histories and half of whom also currently identify as bisexual. There were three main findings. First, biphobia (prejudice against bisexual people) impacts on older people with bisexual histories in ways that may affect their well-being in later life. Second, concerns around receiving care are similar in some ways and different in others from the concerns of lesbians and gay men. Third, people with bisexual relationship histories may have developed strong support networks and resilience, factors that may be very beneficial in later life. Three recommendations for social work professionals were identified: 1) understand biphobia, 2) recognize the legitimacy of concerns about receiving care, and 3) ask about support networks rather than assuming family support.     

Addressing risk factors of cognitive impairment in adults aging with HIV: a social work model

With advances in life-extending medications and later- life infections, the number of older adults with HIV is increasing. Unfortunately, the synergistic effects of aging with HIV may place many people at risk of developing cognitive impairments which can disrupt everyday functioning. Fortunately, cognitive reserve may be maintained, or in some cases improved, by taking action to prevent or mitigate such loss. Preventative and treatment strategies that support biopsychosocial aspects of cognition include reducing alcohol and substance use; improving nutrition; diminishing the effects of comorbidities; increasing social contact; reducing depression and stress levels; engaging in cognitively stimulating activities; applying cognitive remediation therapies; and incorporating psychopharmacological interventions. Such strategies can improve the physiological integrity and health of the brain, thus supporting neuroplasticity and increasing cognitive reserve. Social workers are in a favorable position to recognize cognitive decline in clients and recommend or administer solutions to address such problems. A model for social workers advocating for older clients with HIV who have cognitive problems is provided.     

Long-term planning and decision-making among midlife and older gay men and lesbians

This article examines the issues of long-term planning and decision-making among midlife and older gay men and lesbian caregivers. Using a qualitative methodology, in-depth interviews were conducted with 19 gay men and lesbians over 50. Participants reported on their long-term planning and decision-making processes. All but four persons reported that their partners had advance directives, but the majority of caregivers did not have advance directives for themselves. Concerns about informal family dynamics and interactions with formal systems were expressed, along with financial and ownership issues. It is important for social workers to intervene across individual, organizational, and community levels in advocacy for the needs of older gay men and lesbian clients.     

Impacts of HIV/AIDS on poor and socially marginalised former commercial plasma donors in rural central China: social work implications

Little is known about the impact of HIV/AIDS on people who acquired the virus through former commercial plasma donations in the mid-1990s in rural Central China. The objective of this study was to examine socioeconomic impacts associated with HIV/AIDS on poor farm workers and their families, with a particular focus on economic hardships and social exclusion. The findings from 30 interviews reveal the profound effects of deteriorating health on labour power loss. The well-being of people living with HIV/AIDS was immensely affected by the loss of income, debts due to health-related expenses and a lack of alternate sources of income. Social exclusion and HIV/AIDS-related stigma remain significant issues in a workplace, funerals, and weddings. This article highlights the economic impacts of HIV/AIDS on China’s rural population and provides recommendations for social workers to mitigate the impacts of social exclusion on vulnerable rural households in China.     

Political Culture,Public Opinion,and Policy (Non)Diffusion: The Case of Gay‐ and Lesbian‐Related Issues in Arkansas*

Objectives. Just after three in four Arkansas voters endorsed a state constitutional amendment barring state recognition of same‐sex marriages, a comprehensive state‐level survey allowed a closer look into the attitudes of Arkansans on a variety of gay‐ and lesbian‐related issues. When placed in the context of Arkansas's political culture and ideological patters, this serves as a case study of the relationship between public opinion, specific policy issues, and the diffusion (or nondiffusion) of policies in an individual state. Methods. The 2005 Arkansas Poll included a battery of questions gauging citizens' attitudes on gay/lesbian individuals and the morality of same‐sex relations, same‐sex partner recognition, bans on gay adoption and foster parenting, bans on gays openly serving in the U.S. military, and expansion of civil rights laws to bar discrimination on the basis of sexual orientation, among other policies. This article reports those survey results and employs regression/logistic analysis in analyzing them. Results. The results reveal that while Arkansans are uncomfortable with homosexuality, they are surprisingly hesitant to prescribe state‐sanctioned discrimination. Conclusions. This tightrope between libertarianism and angst about homosexuality that resulted in policy nondiffusion until three years after the data reported here is reflective of the state's political culture, which combines traditionalistic and individualistic elements.     

Long-Term Planning and Decision-Making Among Midlife and Older Gay Men and Lesbians

Abstract

This article examines the issues of long-term planning and decision-making among midlife and older gay men and lesbian caregivers. Using a qualitative methodology, in-depth interviews were conducted with 19 gay men and lesbians over 50. Participants reported on their long-term planning and decision-making processes. All but four persons reported that their partners had advance directives, but the majority of caregivers did not have advance directives for themselves. Concerns about informal family dynamics and interactions with formal systems were expressed, along with financial and ownership issues. It is important for social workers to intervene across individual, organizational, and community levels in advocacy for the needs of older gay men and lesbian clients.     

Student School Engagement Among Sexual Minority Students: Understanding the Contributors to Predicting Academic Outcomes

ABSTRACT

Hierarchical multiple regression is used to examine whether student school engagement predicts grade point average (GPA) and fear-based truancy among 315 sexual minority youth aged 13 to 24 years. Results indicate that student school engagement is a significant predictor of GPA, and this relationship is strongest in the presence of a gay–straight alliance. Having an adult ally at school is associated with a decrease in fear-based truancy, while student school engagement predicts a decrease in fear-based truancy only for youth who have higher levels of subjective fear at school. Implications for future research and for practice among school-based helping professionals are discussed.