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.     

Exploring the Gay Community Question: Neighborhood and Network Influences on the Experience of Community among Urban Gay Men

The reported declining significance of gay neighborhoods has raised questions about the role of gay enclaves as a locus for community building. Using Wellman and Leighton's community “lost,” “saved,” and “liberated” frameworks, we examine the degree to which gay enclave residence and network socializing are associated with experiences of gay community among men in the New York City area. Multilevel models indicate that enclave residence is neither directly nor indirectly associated with perceived community cohesion or community attachment. Increased socializing with gay men and heterosexuals were, respectively, positively and negatively associated with our community outcomes. Increased socializing with lesbians was associated with greater community attachment, while socializing with bisexuals was associated with greater perceived community cohesion. Our findings lend support for a “gay community liberated” perspective; experiences of gay community are shaped principally by network relations rather than residential proximity to gay institutions.     

Relational Health and Masculine Gender-Role Conflict in the Friendships and Community Relationships of Bisexual,Gay, and Straight Men

This study examined how men's masculine gender-role conflict and the importance men placed on interpersonal relationships in defining their self-identities predicted their relational health experiences in same-sex, dyadic friendships and community relationships. Using an Internet sample of 283 self-identified bisexual, gay, and straight men, results of hierarchical linear regression analyses indicated that for men across sexual orientations, the more importance men placed on interpersonal relationships with other men, the greater the degree of relational health they experienced in dyadic friendships. Additionally, for bisexual and gay men in dyadic friendships with other men, gender-role conflict was inversely related to the relational health of their friendships. In the domain of community relationships, the importance that bisexual and straight men placed on interpersonal relationships in defining their self-identities and levels of gender-role conflict predicted relational health experiences. For gay men, however, feelings of masculine gender-role conflict, alone, predicted poorer relational health in community relationships. Study limitations, clinical implications for practice, and future research directions are discussed.     

Anal Cancer Screening: Barriers and Facilitators Among Ethnically Diverse Gay, Bisexual, Transgender, and Other Men Who Have Sex With Men

Knowledge and beliefs about anal cancer screening among gay and other men who have sex with men remains unclear, despite data that suggests significant risk for intra-anal HPV-related cancers. Nevertheless, community-based screening activities may be most effective when stake-holder perspectives are addressed. We conducted four focus groups among 16 male and 3 female health care advocates experienced in working with diverse gay and other men who have sex with men in Los Angeles. Barriers to anal cancer screening included lack of awareness, stigma, psychological and physical discomfort, the anus as hidden/private, primary concern with HIV, and men's lack of healthcare seeking. Facilitators were community screening sites, novel strategies such as home testing, health care system changes and targeted educational campaigns, which may increase anal cancer awareness and screening among ethnically diverse men who have sex with men.     

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Black gay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their White male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV-related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of young Black men who have sex with men (YBMSM) on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16 to 29. Cross-sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing, and health promotion behaviors. Closeness with the gay community was associated with greater pre-exposure prophylaxis (PrEP) knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.     

Anal Cancer Screening: Barriers and Facilitators Among Ethnically Diverse Gay,Bisexual, Transgender,and Other Men Who Have Sex With Men

ABSTRACT

Knowledge and beliefs about anal cancer screening among gay and other men who have sex with men remains unclear, despite data that suggests significant risk for intra-anal HPV-related cancers. Nevertheless, community-based screening activities may be most effective when stakeholder perspectives are addressed. We conducted four focus groups among 16 male and 3 female health care advocates experienced in working with diverse gay and other men who have sex with men in Los Angeles. Barriers to anal cancer screening included lack of awareness, stigma, psychological and physical discomfort, the anus as hidden/private, primary concern with HIV, and men's lack of healthcare seeking. Facilitators were community screening sites, novel strategies such as home testing, health care system changes and targeted educational campaigns, which may increase anal cancer awareness and screening among ethnically diverse men who have sex with men.     

Attachment Style,Rules Regarding Sex,and Couple Satisfaction: A Study of Gay Male Couples

This article explores the characteristics of open and closed relationships in 170 gay men according to their levels of satisfaction, their attachment styles, and the rules of having sex outside their relationships for open couples. We found no significant difference between open or closed relationships in levels of satisfaction or attachment styles. However, we found that gay men in open relationships who have explicit rules about having sex with other men are significantly more satisfied that those gay men with no rules. A content analysis of the rules is presented and implications for therapy are drawn from the findings.     

Romantic Attachment and Life Satisfaction in a Sample of Gay Men and Lesbians in Chile

ABSTRACT

This study intended to assess the relationship between romantic attachment and life satisfaction (LS) in a gay men and lesbian sample in Chile. It also aimed to identify the effect of attachment dimensions on life satisfaction for both gay men and lesbians. Through a cross-sectional study with a non-experimental design, a total of 460 homosexual adults completed the Experiences in Close Relationships and the Life Orientation Test, Revised Version. According to the results obtained, greater attachment insecurity (e.g., attachment anxiety and attachment avoidance) was linked to lower levels of LS in both gay men and lesbians. Furthermore, the model was found to be more predictive for lesbians than for gay men. Implication of these results are discussed.     

Community and drug use among gay men: the role of neighborhoods and networks

Gay neighborhoods serve as vital places for gay men's socializing, yet few studies have examined their contributions to gay men's health-either directly or indirectly via residents' social networks. Drawing from theoretical perspectives on community and networks, we test hypotheses concerning whether gay neighborhoods and social network factors are associated with patterns of recent illicit drug use among a sample of 740 urban gay men from New York City. Higher odds of drug use were observed among individuals who resided in gay neighborhoods, had networks composed predominantly of other gay men, and had increased socialization with gay men. Network factors did not mediate associations between gay neighborhoods and drug use. These findings highlight the need to better contextualize the health risks faced by gay men by accounting for both neighborhood and network structures.     

Asian Girls are Prettier: Gendered Presentations as Stigma Management among Gay Asian Men

Despite the well‐documented cases of racism toward gay Asian men in the gay community, there is currently little research on how gay Asian men manage racial stigma. In this article, I examine the racial stigma management strategies of gay Asian men. I examine the nature of gay racial stigma toward gay Asian men and find that they use gendered presentations to counter the stereotype that they are more feminine than gay white men. While some gay Asian men engender a hypermasculine presentation, others use a hyperfeminine presentation to trade a more‐stigmatized status for one that is less stigmatizing. More important, these men actively embrace stereotypes to successfully make these transitions. This article demonstrates that stigmatized groups can manage stigma by highlighting their spoiled identities rather than attempting to minimize them.     

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.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Community and Individual Factors Associated with Cigarette Smoking Among Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) have higher rates of cigarette smoking than their heterosexual counterparts, yet few studies have examined factors associated with cigarette smoking among YMSM. The present study sought to understand how different types of gay community connection (i.e., gay community identification and involvement, gay bar/club attendance) were associated with smoking among YMSM recruited through venue-based sampling in Los Angeles, California (N = 526). Structural equation modeling was used to isolate direct and indirect effects of gay community connection on smoking through cognitive and psychological mediators (i.e., psychological distress, health values, internalized homophobia). Findings indicate YMSM cigarette smoking prevention and intervention must be tailored to address the direct and indirect influences of the gay community.     

Monogamy,the Protective Fallacy: Sexual versus Emotional Exclusivity and the Implication for Sexual Health Risk

The authors examined the hypothesis that many individuals define monogamy based on emotional rather than sexual fidelity. Participants, 373 heterosexual college students and 282 gay men, read three vignettes of decreasing mitigation in which they imagined committing an act of infidelity against a hypothetical partner and where half the participants were cued to their emotional attachment toward the partner. Despite the infidelity, relationships in the emotional attachment–cued vignettes were rated as monogamous to a greater degree than relationships in the vignettes where emotional attachment was not cued. In addition, over one-third of the participants in our study reported infidelity in their current self-defined monogamous relationships yet also reported feeling more protected from sexual health risks and reported less condom use than individuals who defined their relationship as nonmonogamous. The implications for monogamy as a protective fallacy are discussed.     

Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York city and Los Angeles

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxy-methamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.     

Experiences of the Orthodox Community Among Orthodox Jewish Gay Men

Sense of community includes elements such as sense of belonging, mutual interdependence, trust, shared goals and values, and shared history. It is associated with benefits for both the members and the community and is believed to be stronger in religious minority groups. This qualitative study describes the experiences of the Jewish Orthodox community among Orthodox Jewish gay men. In-depth interviews were conducted with 22 men about their experiences of being gay in their Orthodox communities. A content analysis revealed four themes: community as a home, community as a comprehensive provider, community as a strict behavior regulator, and community as punitive toward gay men. Findings suggest that Orthodox Jewish gay men have mixed feelings about their community; being satisfied with a community that provides for all their needs, but also living in constant fear of the negative consequences they and their families may endure if their homosexuality will be revealed. Recommendations for social work practice are provided.     

Jewish Gay Men's Accounts of Negotiating Cultural,Religious, and Sexual Identity

Abstract

Research on the construction of lesbian and gay identity has represented this process as carrying considerable potential for in-trapsychic and interpersonal stress and conflict. This process may be rendered even more psychologically challenging for those whose identities feature salient components that are not easily reconciled with a lesbian or gay identity. An example of this is the simultaneous holding of Jewish and gay identities. This paper reports findings from a qualitative study of 21 Jewish gay men in Britain. Participants were interviewed about the development of their gay identity, the relationship between their gay identity and their Jewish identity, the psychological and social implications of holding these identities, and strategies for managing any difficulties associated with this. Data were subjected to interpretative phenomenological analysis. All but one of the men reported experiences of identity conflict, arising mainly from the perceived incompatibility of Jewish and gay identities. This was said to have impacted negatively upon their psychological well-being. Those who had received negative reactions to the disclosure of sexual identity within Jewish contexts often attributed this to an anti-gay stance within Judaism and a concern with ensuring the continuation of the Jewish people. Various strategies were said to have been used to manage identity threat, including compartmentalizing Jewish and gay identity and revising the content or salience of Jewish identity. Recommendations are offered for psychological interventions which could help Jewish gay men manage identity conflict.     

Lesbian Blood Drives as Community-Building Activism in the 1980s

As gay men began voluntarily withdrawing from blood donation in the early 1980s, lesbians in community with gay men in several U.S. cities organized drives to replenish the blood supply. These drives were sometimes the continuation of previously established drives by gay–lesbian organizations or faith communities, sometimes new initiatives in response to HIV/AIDS. However, after the initial publicity, mention of lesbian blood drives in print is both scarce and brief. Focusing on drives organized from 1983 to 1992 by a group known as San Diego Blood Sisters, this article is an initial step in documenting lesbian blood drives to inform and enrich conversations about histories of responses to HIV/AIDS, theoretical discussions of how community connections in the lesbian, gay, bisexual, transgender, and queer spectrum are enacted and understood, and emerging research on intersections of gender and sexuality as they are expressed through blood donorship.     

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.     

Gay marriages and communities of sexual orientation

This article focuses on gay male couples as they exist within friendship networks of other gay men. By comparing homosexual men who are part of a gay community with those who are less integrated into a gay community, we attempt to show that the sexual liaisons of the former are more “marriage-like.” Gays committed to a community of other homosexual men were found to live more often with their lovers, be more sexually faithful to their lovers, and to have more emotionally intimate relationships. Also, they were found more likely to associate with other gay couples. Commitment to a gay community was not found to be associated with length of a liaison, and it seemed that when respondents defined emotional intimacy in terms of sexual exclusiveness there may have been a tendency for disruption of relationships. The gay community validates the sexual liaisons of gay men in the same way that the heterosexual world validates the pairings of heterosexuals and transforms their subinstitutional sexual liaisons into the institution of marriage.