Gay Men and HIV

SUMMARY

This paper reports on the results of qualitative studies examining the personal experiences of sex and sexual negotiation for British gay men who are diagnosed HIV positive and those who know or presume themselves to be uninfected. These are contrasted with the results of a study of representations of HIV and AIDS within an international review of community health promotion literature aimed at gay men. The paper highlights the disparity between specific community responses to the epidemic as engendered in the cultural production of health promotion materials and the individual experience of HIV, suggesting a! paradigm for a community response to the epidemic which reflects the personal experience of gay men both infected and uninfected.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

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 Men

Summary

This report presents the findings from four ethnographic studies of older gay men (Brown, 1997; Brown, Sarosy, Cook & Quarto, 1997; Cook, 1991; Quarto, 1996; Sarosy, 1996). There were 69 total participants who ranged in age from 36 to 79 years; most were from 50 to 65 years of age. The purpose of these studies was to examine how older gay men have adjusted, psychologically and socially, to their sexual orientation and aging process. Participants reported that they spend 50% time or more with gay friends within their own age cohorts. Many reported being involved with the gay community in some capacity, while about 15% had no involvement with the gay community. Most participants were in regular contact with their families. Most stated that their families were aware of their sexual orientation. Most of the participants reported experiencing discrimination due to sexual orientation, and one third had experienced discrimination within the gay community based on age or ethnicity. With regard to sex life, the studies found an overall lowered frequency of sexual activity. Participants felt that HIV/AIDS has had a devastating impact on older gay men, interrupting the normal aging process for those who have contracted it and prematurely aging those who care for them. The studies' findings identified the qualities of healthy adaptation to aging for older gay males: having satisfying relationship, self-acceptance as one ages, good health, an active life with a variety of interests, and financial security.     

HIV/AIDS and constructs of gay community: Researching educational practice within community-based health promotion for gay men

This paper reports on the methodology of a comparative study of three gay communities in Australia as they struggle with HIV/AIDS. The study focused on the pedagogy and practice of HIV/AIDS education for disease prevention and for health maintenance for people living with HIV/AIDS, through the investigation of three problematics: (1) constructs of 'community'; (2) the centrality of gay community-based health educators; and (3) the relations of gay men within and to their communities. The study was conceived of as a critical ethnography involving a three-part sample in the three sites and using three related research methods: (1) individual and group interviews; (2) textual analysis; and (3) participant observation. The theoretical bases for the study and its design lay in notions of 'performativity', community and adult education, organizational and institutional processes, and the idea of a 'post-AIDS' sociality. The methodology is explained in detail, as are various consultative processes embedded in the design to facilitate and enable a productive relationship with the communities researched.     

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.     

Health Strategies of HIV-Infected,Homosexually Active Men in Sydney,Australia

Drawing from a sample of gay and bisexual men who participated in large-scale surveys, and exploring issues derived from a smaller-scale study on working-class gay men, this close-focus study explores the relation between sexual identity, attachment to gay community and responses to HIV infection. Ten long-term HIV-infected, homosexually active men were interviewed using the open-ended life history method. A typology of four health strategies desribes these men's relations to medicine and the type and range of responses developed. These strategies are informed by class background, form and degree of attachment to the gay community, and age. Implications are discussed for existing AIDS service organizations, and for the possible future development of health services within gay and lesbian communities.     

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).     

Predictors of High-Risk Sexual Behavior Among Individuals Living with HIV Disease and AIDS

An important focus of the 1996 World Aids Conference related to the extent of unprotected sex among gay men, particularly those in their twenties. This paper will use logistic analysis to explore the extent of unsafe sexual practices among individuals living in Bexar County, Texas, who are HIV+ assymptomatic, HIV+ symptomatic, or have AIDS. Using survey research data, we assess the significance and impact of various independent factors on whether respondents reported they did or did not engage in unprotected sex. The most striking finding is that unprotected sexual activity is prevalent regardless of demographic and/or status differences among respondents. Findings reinforce the use of community planning processes, which emphasize the importance of sound behavioral and social science combined with efforts to include the affected constituency to create effective HIV prevention programs.     

The Second Closet: A Qualitative Study of HIV Stigma Among Seropositive Gay Men in a Southern U.S. City

ABSTRACT

Objectives: Stigma connected with HIV/AIDS has decreased considerably since the early epidemic yet affects those living with HIV in many ways. Little research, particularly qualitative research, concerning HIV stigma from the perspective of gay men has emerged. The present qualitative study aimed to fill this evidence gap by examining how HIV stigma is perceived and experienced by gay men who have become HIV-infected and how they respond to this stigma. Methods: Thematic analysis of 19 gay men's narratives identified six main themes. Results: Encountering HIV stigmatization was common and was linked to the physical stigmata identifying respondents as HIV-positive. Overwhelmingly, they found stigmatization to be most intensely felt within gay communities. One profound theme was internalized HIV stigma, referring to respondents’ internalized negative feelings about their HIV status. A related theme was the closeted nature of HIV. Lastly, regarding how the men dealt with the HIV diagnosis and experiences of HIV stigma, a theme of adaptation became clear. Conclusions: Although exploratory, the results can serve as a beginning framework for understanding and assisting seropositive gay men who experience HIV stigma. The findings are important because it is realistic to expect that in a climate in which HIV has become increasingly invisible and closeted and in which infections are on the rise, gay and bisexual men will be increasingly affected and infected by HIV.     

Research with Gay Drug Users and the Interface with HIV

Abstract

Studying the co-occurrence of drug use and sexual risk behaviors among gay men poses special challenges for research. The importance of conducting such research, however, is underscored by current trends in the gay community, including increases in methamphetamine and club drug use. This increase has been associated with high-risk behavior for the transmission of HIV and other diseases (e.g., hepatitis B and hepatitis C). The author describes methodological issues related to initiating and conducting research among gay male drug users, and discusses how such research can guide more effective prevention, treatment, and policy initiatives related to drug abuse and HIV/AIDS.     

Greater involvement of people living with HIV/AIDS in South Africa

This study reports on a pilot project, the greater involvement of people living with HIV/AIDS Workplace Model, which places trained fieldworkers living openly with HIV/AIDS in selected partner organisations sectors, where they set up, review or enrich workplace policies and programmes. The project adds credibility to partners' HIV/AIDS programmes and creates a supportive environment for people living with HIV/AIDS (PLWHA) and others to speak about HIV/AIDS. Eleven men and women living with HIV, aged between 30 and 45, and with varied life experiences and education levels, shared a willingness to speak about their HIV status in their workplace. They worked in very different environments but their collective experiences showed that PLWHA can add value to workplace HIV/AIDS programmes in a way that is relevant, effective, efficient, sustainable and ethical. They made companies and communities more aware of the intense need for HIV/AIDS policies and encouraged care and support for infected and affected people.     

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.     

Influence of Social Support on Gay Men Living with HIV

This article examines the social support networks of gay men living with HIV. Many people do not realize that HIV is still a significant health concern. The rate of HIV infection has not decreased substantially in over 15 years, and in the United States alone health care practitioners see approximately 40,000 cases per year. Some of the literature on this topic suggests that gay men with HIV receive more social support from friends than from family members. Research also suggests that these men sometimes experience losses of social support after they are diagnosed as HIV positive. Five gay men with HIV participated in in-depth interviews for this study. During these interviews 14 open-ended questions were posed with several of these questions having follow-up probes/questions. The questions focused on specific aspects of the participant's support network. Participants' responses to the interview questions were transcribed and content analyzed for relevant themes. Results indicated that whereas many of the men maintained their supportive contacts with family members and friends, others experienced changes in their support networks after they were diagnosed as HIV positive. Further results revealed that all men interviewed were satisfied with the level of support they received from the people in their support networks.     

A Korean Gay Man in the United States:

An increasing number of Koreans are immigrating to the U.S. Little information exists for human service professionals to draw from to help Korean gay men adjust to living in America. This discussion provides a historical overview of homosexuality in Korea with insights into contemporary Korean culture. An interview with a young Korean gay man living in the U.S. illustrates the concerns and problems these men experience as they struggle to adapt to gay life in this country. Racism from the gay community and alienation from the Korean American community are salient characteristics of the problems experienced by Korean gay immigrants. To better serve the needs of these men, helping professionals must develop relationships based on trust and friendship, understand Korean attitudes toward homosexuality, and be knowledgeable of how Confucian gender ideology influences same sex relationships involving Korean gay men living in this country.     

Impairments and perceived competence in persons living with HIV/AIDS

Medical advances have transformed HIV/AIDS from a short-term terminal illness to a long-term chronic condition. Consequently, the disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities and wider community participation. These changes have necessitated rehabilitation interventions for persons with HIV/AIDS to focus on issues related to enabling participation in all spheres of everyday activities. However, limited information is available on the impairments prevalent in the emergent population of people living with HIV/AIDS and on the impact of these impairments on the person's functional performance and participation in various occupations of daily living. The present study attempted to explore these issues as they are experienced by the emergent population of people living with HIV/AIDS. The purpose of the study was: (1) to explore occupational functioning across various activities, (2) to describe the various impairments prevalent in this population, and (3) to examine the impact of these impairments on the person's perceived occupational competence. Two instruments, the Sign and symptom checklist for persons with HIV disease and the Occupational Self-Assessment were administered to a sample of 35 individuals (Mean age=42.8 yrs.) living in supportive living facilities. Impairments most commonly identified by the participants included: fatigue; fear/worries; difficulty concentrating; muscle aches; and depression. The two primary areas of occupational functioning where participants reported experiencing moderate to severe difficulty included: managing finances and physically engaging in activities which were reported by 67.7% and 35.5% of the participants respectively. No statistically significant correlation was observed between various measures of impairments and the overall measure of perceived occupational competence for the sample of individuals living with HIV/AIDS included in this study.     

HIV Risk in Gay and Lesbian Adolescents

Adolescents, regardless of sexual orientations, are not increased risk for HIV infection. Although the number of infected adolescents remains small, the number of adolescent AIDS cases is approximately doubling each year. This suggests that the rate of HIV infection among adolescents is expanding in a similar fashion to that seen among gay men in the early years of the epidemic. The purpose of this paper is to provide a framework for understanding the problems of HIV infection as it related to the gay and lesbian adolescent. This framework is grounded in developmental theory, though key social, political, economic, and policy factors which are believed to contribute to the infection of HIV among gay and lesbian adolescents will also be presented. It will be argued that social practitioners who are working in the HIV and AIDS arena would do well to reexamine the paradigm, which governs existing practice methodology.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.