New Drugs and HIV Risk Taking

Abstract

Many workers in HIV-prevention and mental health have feared that publicity surrounding new drugs for treating HIV would cause HIV-negative gay men to lapse from safer sex. However, a recent informal survey of health workers and therapists in New York City suggests that although information about the new drugs has shifted the thinking of many negative men, it hasn't changed their behavior a great deal as yet. Anecdotal evidence of minor behavior change is described, along with medical data concerning how dangerous unsafe sex with an infected person undergoing combination drug therapy may be.     

The Sexual Superhighway Revisited

Abstract

Among gay men, serious health risks (unsafe sex, compulsivity) are associated with seeking sex on the Internet. To better understand the repercussions of this activity from a user's perspective, qualitative interviews with 22 gay men reporting Internet use for sexual purposes were submitted to Interpretative Phenomenological Analysis. The repercussions perceived clustered around themes of sociability (making contact and meeting consequences), sexuality (discovering and deviating), identity (becoming and concealing), and dependency. Findings may help improve the relevance and appeal of online interventions with gay men and sensitize professionals to health issues not traditionally reported in the scientific and clinical literature on gay men and Internet use.     

It's All a Matter of Attitude

Abstract

Studies have consistently documented an incidence rate of between 25% and 50% for domestic violence in gay and lesbian relationships. These numbers suggest that the gay and lesbian community is dealing with a significant mental health issue, one that is not being adequately addressed. If mental health professionals can be taught ways to assess for domestic violence in their work with sexual minorities, those persons being abused can learn strategies for ensuring their physical safety.     

Introduction: Queering Later Life

Summary

The field of sexual trauma developed from the sociopolitical movements of the feminist, rape, and child protection movements. As thinking in the field developed, however, it has been difficult to integrate the perspective of the male survivor of sexual trauma into these perspectives. Gay men, in particular, have been notably absent from the literature, except when their abuse history is discussed as an etiology for their sexuality. It is clear that gay men suffer violence and oppression in the form of homophobia—an abuse with a sexual focus. Integrating the experience of gay men who have suffered trauma into perspectives regarding sexual trauma offers a possibility to enhance understanding about, as well as prevention efforts against, the sexual abuse of children. This includes expanding definitions and vocabulary regarding sexual trauma, as well as recognizing the impact on mental health professionals of working with survivors of sexual trauma.     

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.     

Lesbian Health

ABSTRACT

Health care research suggests that lesbians may face unique physical and mental health risks, yet few studies make use of gender and sexuality theories to explain lesbian health. In this study, a social constructionist view of sexuality is used to examine the impact of lesbian identity on well-being. Drawing from nineteen intensive interviews with women who self-identify as lesbians, the results show that individuals' sexual identities change over time and are affected by their social environments. The data also demonstrate that sexual identity and social context have implications for well-being. Specifically, hostile environments, which are characterized by animosity toward gay men, lesbians, and others who do not conform to heteronormative gender expectations, are associated with distress over lesbian identity and with physical and mental health problems. By contrast, supportive environments, which many women report finding through feminism, facilitate the construction of a positive lesbian identity and enhance well-being.     

Using action methods to counter social isolation and shame among gay men

ABSTRACT

Despite legal and cultural amelioration of homophobia, shame and internalized homophobia persist with concomitant adverse health and mental health consequences. J. L. Moreno's system of psychodrama, sociometry, and group psychotherapy offers approaches that help counter shame and internalized homophobia and increase peer support among diverse groups of gay men. Sociometric tools help create safety, establish group cohesion, build interpersonal connections, and strengthen identification and a sense of universality. The technique of doubling increases empathy. Explorations conducted during brief enactments using psychodramatic techniques heighten appreciation for diversity in the community while promoting self-acceptance and increased self-efficacy. Group sharing guidelines help strengthen mutual identification and mitigate shame and social isolation.     

Coming Out Issues of Gay and Lesbian Mental Health Professionals in Voluntary and Involuntary Settings

Abstract

Mental health professionals are increasingly called upon to provide consultation and treatment in settings different from the traditional outpatient and hospital inpatient settings. This paper provides an overview of the unique problems posed when considering self-disclosure by gay or lesbian mental health professionals working with institutionalized populations. A review of literature concerning self-disclosure to patients in outpatient settings is provided and applied to institutionalized settings. Benefits of, as well as cautionary notes regarding, self-disclosure of homosexuality by mental health staff are reviewed.     

Context is Everything

SUMMARY

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

Psychotherapy with Lesbian and Gay Clients from an Adult Life Course Perspective

Abstract

A life course perspective of gay and lesbian adulthood enriches our understanding of clinical presentations and modifies our conception of psychotherapy. The author describes shifts in his psychotherapeutic orientation characterized by an increasing recognition of the importance of social, cultural, and historical forces that shape gay and lesbian mental health. Given the uncharted nature of many gay and lesbian lives across adulthood, existential questions about the meaning of life choices are often present in the consulting room. Therapists working with gay and lesbian clients embark on an empathic journey informed by treatment skills as well as our joint participation in a world of significant social change.     

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.     

Psychological Distress in Older Portuguese Gay and Bisexual Men: The Mediating Role of LGBT Community Connectedness

Abstract

Objectives: Examining Psychological Distress (PD) among older Portuguese gay and bisexual men (GBM), and the mediator role of LGBT community connectedness (LGBTCC) of minority stress variables on PD. Methods: We performed a mediation analysis with LGBTCC as mediator between minority stress variables and PD with a sample of 110 elderly GBM. Results: We found moderate PD levels; LGBTCC was a significant mediator between concealment of sexual orientation and PD, but not between internalized stigma and expectations of rejection and PD. Conclusions: More attention is needed to Older Portuguese GBM’s mental health. LGBTCC is an important ameliorating factor for older GBM.     

Desire,Cultural Dissonance,and Incentives for Remaining HIV-Negative

SUMMARY

This article, written from the personal observations of an HIVprevention coordinator in San Francisco, discusses some of the current challenges for gay and bisexual men'S primary HIVprevention efforts. Psychological issues of personal motivation and identity formation are lopked at within the framework of gay culture, pop culture, and the larger heterosexual culture emphasizing their influence on the lives of HIVnegative men. The article also looks at age-specific dimensions comparing the needs of adult men with those of much younger gay and bisexual men. Renewed energy and fresh ideas will be called for to make HIVprevention interventions relevant to the lives of these men. Though the examples and qualitative data cited are from San Francisco, similar phenomena are noted from other cities with gay networks within the U.S. and internationally, suggesting that the: experience of San Francisco men will be relevant to prevention providers in any other locales.     

A Sociohistorical Analysis of Gay Men's Procreative Consciousness

SUMMARY

This qualitative study argues that an understanding of gay men's thoughts about fatherhood must be situated within a socially constructed historical context that is rapidly changing how gay men think about the possibility of creating families. Analysis draws on 39 interviews with gay men about their reproductive decision-making. Two samples of gay men were recruited-19 childless gay men ranging in age from 19–53 years, and 20 gay fathers who became a parent through non-heterosexual means, aged 33–55 years. Findings reveal how gay men's procreative consciousness and fathering desires are intimately tied to the social and historical context by which they came of age. Private thoughts about fatherhood and reproductive decision-making are better understood within a sociohistorical framework that can grasp how institutional relations shape how gay men navigate the reproductive arena.     

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.     

Discrimination Against Gay Men,Lesbians, and Transgender People Working in Education

Abstract

This paper explores the workplace experiences of 120 gay men, lesbians, and transgender people who were employed as teachers, academics, and educators. The data, drawn from a larger collaborative research project, explored the workplace experiences of 900 gay men, lesbians, and transgender people. Homophobic harassment and treatment were widespread amongst the lesbian, gay men, and transgender teachers, academics, and educators. The paper will utilize the stories of those who experienced discrimination to explicate the issues confronting gay men, lesbians, and transgender people who work in the education system.     

Reparative Therapy for Gays and Lesbians

Abstract

In recent years there has been much public controversy about “conversion or reparative therapies” designed to change homosexuals into heterosexuals. Various national mental health associations have taken a stand against these therapies. Social service professionals who work with gay and lesbian clients need to develop beliefs about the mutability of sexual orientation that reflect sound research findings.     

Perceived barriers to mental health treatment among men enrolled in a responsible fatherhood program

ABSTRACT

Low-income men may experience elevated risk for mental health concerns and be less likely to seek treatment; this may be due in part to perceived barriers to accessing and receiving treatment. Men who enrolled in a community based responsible fatherhood program self-identified their health and mental health conditions. Although participants reported serious health conditions at rates consistent with the general population, we found higher than expected rates of depression, anxiety, or other mental health conditions and explored perceived barriers to mental health treatment among this sample. Findings suggest that low income men face a variety of perceived psychosocial and structural barriers impacting access to and compliance with mental health treatment.     

African American Gay Men and Lesbians: Examining the Complexity of Gay Identity Development

Abstract

This article addresses the concept of gay and lesbian identity development with respect to African American gay men and lesbians. The authors suggest that the integration of one's gay identity and the coming out process are uniquely constructed for African American gay men and lesbians, who may be multiply challenged by racial prejudice, limited acceptance by the African American community, and a lack of integration into the larger, White gay community. Race, African American culture, a continuum of gay cultures, gender, and individual characteristics are suggested as salient variables that distinguish the gay identity experience of African American gays from that proposed by most gay identity models.     

Anti-Effeminacy Moderates the Relationship Between Masculinity and Internalized Heterosexism Among Gay Men

Internalized heterosexism (IH) is linked to negative mental health outcomes among people who are lesbian, gay, and bisexual. This study examined whether anti-effeminacy moderates the relationship between masculinity and IH among gay men in the United States. The participants were 239 gay men who completed measures of masculinity, anti-effeminacy, and IH. Results indicated that anti-effeminacy and masculinity predicted IH and that anti-effeminacy moderated the relationship between masculinity and IH. These findings suggest that, to reduce IH and its deleterious mental health effects, counselors should work with their male clients who are gay to reduce their anti-effeminacy and sexism.