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Bauer L, Wienke A, Führer A. Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion. BMC MEDICAL EDUCATION 2024; 24:703. [PMID: 38937730 PMCID: PMC11212417 DOI: 10.1186/s12909-024-05684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.
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Affiliation(s)
- Lena Bauer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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2
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Wells N, Murphy D, Ellard J, Philpot S, Prestage G. Experiences of, and motivations for, disclosing HIV to social and familial networks: considering the social and relational domains of HIV disclosure. CULTURE, HEALTH & SEXUALITY 2023; 25:1483-1497. [PMID: 36639148 DOI: 10.1080/13691058.2022.2161638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
For people living with HIV, decisions about when, how and who to tell about their HIV status can involve navigating complex social, legal and health domains. With a focus on disclosure to broader social and familial networks, we explored the experiences of, and motivations for, HIV (non-)disclosure among recently diagnosed people living with HIV in Australia. Semi-structured interviews were conducted with 35 people diagnosed with HIV from 2016 onwards, of whom 25 completed follow-up interviews. Participants commonly reported anticipating negative responses and rejection from others when considering whether to disclose their HIV status. Some participants also took on the role of ensuring others' wellbeing when disclosing (or not), even as they themselves needed emotional support. Finally, some participants felt it important to be open about their HIV status to raise awareness of HIV and challenge HIV-related stigma. Our findings highlight the complex relational and social contexts that shape HIV disclosure. In addition to supporting individual people living with HIV when disclosing, we argue that educational programmes that target the broader, HIV-negative population are needed to shift the social landscape in which people living with HIV disclose.
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Affiliation(s)
- Nathanael Wells
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Dean Murphy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Steven Philpot
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Sydney, New South Wales, Australia
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3
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Wells N, Murphy D, Ellard J, Philpot SP, Prestage G. HIV Diagnosis as Both Biographical Disruption and Biographical Reinforcement: Experiences of HIV Diagnoses Among Recently Diagnosed People Living With HIV. QUALITATIVE HEALTH RESEARCH 2023; 33:165-175. [PMID: 36633974 DOI: 10.1177/10497323221146467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite the potential for HIV treatments to transform the health needs of people living with HIV, receiving a positive HIV diagnosis can be a difficult experience and feelings of shock, distress and concerns for the future are commonly reported. Drawing on Michael Bury's conceptualisation of 'biographical disruption', we utilised semi-structured interviews to explore experiences of HIV diagnoses among 34 people diagnosed with HIV between 2016 and 2020 and living in Australia. Interviews were conducted between January 2018 and August 2021. Despite significant advances in biomedical HIV treatments and prevention, participants commonly experienced HIV diagnosis as emotionally challenging. For those with limited HIV awareness, HIV was commonly understood as a likely fatal condition. For some participants, receiving a positive diagnosis also engendered a degree of uncertainty as to their anticipated life trajectory, particularly its impact on future sexual and romantic relationships, options for starting a family and migration opportunities. For some gay and bisexual male participants, receiving a positive diagnosis almost confirmed a life trajectory that they had worked to avoid and their own sometimes-negative attitudes toward people living with HIV were internalised, making adjusting to diagnosis more complex. While all participants reported challenges in adjusting to an HIV diagnosis, some ultimately came to experience living with HIV as bringing about unexpected and welcome changes to their lives. Our findings highlight the complex and intersecting medical, social and emotional needs of people living with HIV when receiving and adjusting to a positive HIV diagnosis.
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Affiliation(s)
- Nathanael Wells
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Dean Murphy
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Jeanne Ellard
- 110434Australian Research Centre in Sex, Health, and Society, Melbourne, VIC, Australia
| | - Steven P Philpot
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Garrett Prestage
- HIV Epidemiology and Prevention Program, 2786Kirby Institute, University of NSW, Sydney, NSW, Australia
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4
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Wu Y, Meyers K, Xie L. HIV risk management among sexual minority men in China: context, lived experience, and implications for pre-exposure prophylaxis implementation. CULTURE, HEALTH & SEXUALITY 2022; 24:797-811. [PMID: 33600269 PMCID: PMC8371052 DOI: 10.1080/13691058.2021.1885740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/01/2021] [Indexed: 05/25/2023]
Abstract
This study examined the social context and lived experience of HIV risk management among sexual minority men in China. An interpretative phenomenological analysis of 25 in-depth interviews with participants in five Chinese cities was undertaken. Findings show how men managed HIV risk in the context of high risk perception and anxiety, and strong perceived social discrimination and marginalisation. Men's choice of risk management strategies was influenced by their often-negative perceptions of gay community, social norms around condom use, and prior lived experience. Results underscore the importance of considering these contexts when planning pre-exposure prophylaxis (PrEP) implementation in China and highlight the need for strategies to address potential PrEP-related stigma among sexual minority men.
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Affiliation(s)
- Yumeng Wu
- Aaron Diamond AIDS Research Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Lu Xie
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, China
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5
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Dong W, Muessig KE, Knudtson KA, Gilbertson A, Rennie S, Soni K, Hightow-Weidman LB. Moral practices shaping HIV disclosure among young gay and bisexual men living with HIV in the context of biomedical advance. CULTURE, HEALTH & SEXUALITY 2021; 23:1641-1655. [PMID: 32748729 PMCID: PMC9426661 DOI: 10.1080/13691058.2020.1790039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/28/2020] [Indexed: 05/25/2023]
Abstract
Biomedical advances in diagnostics, treatment and prevention increase the means available to reduce HIV transmission risk. Subsequent shifts in HIV status disclosure obligation and ethics may impact how those living with HIV view, enact and experience disclosure. We analysed focus group and interview data to explore how these changes are reflected in disclosure decision-making to sexual partners among young gay and bisexual men living with HIV in the USA. Three interrelated themes were identified: engaging with partners' varying HIV knowledge; attribution of blame; and negotiating disclosure-related harms. Participants experienced blame from partners that questioned the timing of HIV testing, status disclosure and sex events without regards for viral suppression or use of pre-exposure prophylaxis. Substantial HIV stigma was described in response to disclosure, mitigated in some cases by partners' higher HIV knowledge. Overall, an uneven diffusion of HIV treatment and prevention knowledge and continuing HIV stigma seemed to limit the translation of biomedical advances into improved disclosure experiences. Our findings suggest that young gay and bisexual men living with HIV may continue to perform much of the moral labour involved in disclosure by managing others' reactions, correcting inaccurate sexual health information, and negotiating the risks of disclosure-related harm.
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Affiliation(s)
- Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kelly A. Knudtson
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Adam Gilbertson
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stuart Rennie
- Department of Social Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Center for Bioethics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Karina Soni
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lisa B. Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, USA
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6
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Soffer M. Biomedicalization, Stigma, and "Re-Gaying" HIV/AIDS in the Israeli Media. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2813-2823. [PMID: 34519884 DOI: 10.1007/s10508-021-02061-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
HIV and AIDS are not merely biomedical conditions-they are socially constructed phenomena. Media coverage plays a prominent role in the public's understanding of HIV/AIDS. "Biomediatization" denotes the coproduction of HIV/AIDS by biomedicine and mass media. Nevertheless, despite the importance of the media in the social construction of HIV/AIDS, research on HIV/AIDS coverage in the Israeli media is negligible. This study examined the social construction of HIV/AIDS in Israel. The sample includes all items (88 texts and videos) published in three of the top news websites in a 1-year period that mentioned HIV or AIDS. Thematic analysis was employed. Three themes were identified. "The biomedicalization of HIV/AIDS" depicted HIV/AIDS as a one-faceted, biological phenomenon that concerns the body of the individual and is a public health issue. The second theme, "HIV/AIDS and stigma," consisted of subthemes: "acknowledging stigma" and "constructing stigma." In the former, the stigma ascribed to HIV/AIDS was acknowledged and discussed. The latter revealed various mechanisms employed by the media to construct and perpetuate HIV/AIDS stigma. The third theme we identified, "re-gaying HIV/AIDS," concerned the various venues through which HIV/AIDS is associated with gay men. The findings show that HIV/AIDS was depicted as a biomedical condition that concerns the individual. The implications of our study include a need to change the rhetoric of HIV/AIDS in the Israeli media such that it will address the complex issues of power and inequality that HIV/AIDS entails.
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Affiliation(s)
- Michal Soffer
- School of Social Work, Faculty of Sociassl Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 349883, Haifa, Israel.
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Pazzini M, Ignácz ZS, Tuppat J. Underlying factors related to HIV/AIDS prevention: investigating the willingness to take pre-exposure prophylaxis among men-who-have-sex-with-men in Germany. AIDS Res Ther 2021; 18:61. [PMID: 34535178 PMCID: PMC8447767 DOI: 10.1186/s12981-021-00386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study investigates the willingness of men-who-have-sex-with-men (MSM) to use HIV pre-exposure prophylaxis (PrEP). Research in the HIV/AIDS field typically relies on clinical and epidemiological studies, thereby often excluding social dimensions of the illness as well as factors explaining its prevention. The current study analyzes HIV-prevention through an interdisciplinary theoretical approach. It aims to comprehensively understand the mechanisms associated with the willingness to take PrEP among MSM in terms of psychological, social, behavioral, cultural, and demographic factors. METHODS We analyze data from the survey "Gay Men and AIDS" conducted in Germany in 2013 prior to market approval for PrEP. Analyses were performed using the statistical software SPSS 25.0, while results were visualized using the R programming language. RESULTS We find that perceived risk of infection, social norms (anticipated HIV-stigma), practices (e.g. regular condomless sex), and socio-demographic factors (young age, being single) all have a positive effect on the willingness to take PrEP, while education reveals a negative, and income no effect. CONCLUSIONS Results indicate that beyond well-established socio-psychological mechanisms of health behavior, social factors play a crucial role in understanding the willingness of PrEP uptake. This study enriches existing health behavior theories with sociological concepts such as social norms and social practices.
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8
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Bedert M, Davidovich U, de Bree G, van Bilsen W, van Sighem A, Zuilhof W, Brinkman K, van der Valk M, de Wit J. Understanding Reasons for HIV Late Diagnosis: A Qualitative Study Among HIV-Positive Individuals in Amsterdam, The Netherlands. AIDS Behav 2021; 25:2898-2906. [PMID: 33788120 PMCID: PMC8373722 DOI: 10.1007/s10461-021-03239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Since the introduction of effective anti-retroviral therapy, early diagnosis and treatment of HIV have become increasingly important from individual and public health perspectives. People who are diagnosed with a CD4 count below 350 cells/µL blood are today considered to be “late” diagnoses. In an effort to understand the reasons for late diagnosis, we conducted in-depth interviews (n = 14) in Amsterdam, the Netherlands. Two main factors were identified: psychosocial factors and health-system factors. Psychosocial factors relate to people’s personal relationship with health professionals, low risk perception, fear related to the outcome of testing, and trauma from observed past experiences of living with HIV. Health-system factors relate to institutional barriers and missed opportunities during client-provider interactions. We conclude that in order to mitigate late diagnosis, the social and institutional context within which HIV testing is conducted should be addressed.
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Affiliation(s)
- Maarten Bedert
- Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Wim Zuilhof
- SOA AIDS Nederland, Amsterdam, The Netherlands
| | - Kees Brinkman
- Onze Lieve Vrouwenziekenhuis, Amsterdam, The Netherlands
| | - Marc van der Valk
- Amsterdam UMC, Location AMC & DC Klinieken Valeriusplein, Amsterdam, The Netherlands
| | - John de Wit
- Utrecht University, Utrecht, The Netherlands
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9
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Grace D, Nath R, Parry R, Connell J, Wong J, Grennan T. '… if U equals U what does the second U mean?': sexual minority men's accounts of HIV undetectability and untransmittable scepticism. CULTURE, HEALTH & SEXUALITY 2021; 23:1270-1286. [PMID: 32701019 DOI: 10.1080/13691058.2020.1776397] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
The everyday meaning and use of HIV 'undetectability' raises significant questions about the social and sexual significance of this state of viral suppression. We conducted in-depth, semi-structured interviews with 25 sexual minority men living in Vancouver, Canada, including men living with HIV. Interviews were audio-recorded, transcribed verbatim and analysed using grounded theory. Most participants understood being undetectable to signify that someone living with HIV is at a 'low,' 'lower,' or 'slim to no' risk of sexually transmitting HIV, as opposed to meaning 'uninfectious' or 'untransmittable'. Men discussed how undetectability was communicated in-person and online, including via sexual networking apps, and revealed how it is sometimes confused or conflated with another biomedical advance in HIV-prevention, namely pre-exposure prophylaxis (PrEP). HIV-negative men expressed significant scientific scepticism, a reluctance to incorporate a partner's low viral load or undetectable HIV status into their sexual decision-making, and an enduring fear associated with knowingly having sex with someone who is HIV-positive. We describe this as a form of untransmittable scepticism. While international campaigns have worked to communicate the scientific message that 'undetectable equals untransmittable' (U = U), the sexual stigma attached to HIV remains durable among some gay, bisexual, queer and other men who have sex with men.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ronita Nath
- BC Centre for Disease Control, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robin Parry
- BC Centre for Disease Control, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - James Connell
- BC Centre for Disease Control, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jason Wong
- BC Centre for Disease Control, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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10
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Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany.
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
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11
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Rijneveld CJ. The Biomedical Closet? Undetectability among HIV-positive Gay Men in India. Med Anthropol 2021; 40:718-731. [PMID: 33956539 DOI: 10.1080/01459740.2021.1916741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The discourse of Undetectability, referring to the effect of HIV viral suppression on forward sexual transmission, is at the heart of the current paradigm of Treatment-as-Prevention and is invested with hopes of eliminating stigma. But ethnographic examination of the way HIV-positive gay and bisexual men in four major Indian cities experience Undetectability reveals a more complicated picture. Rather than resolve the problem of HIV stigma, Undetectability enables new ways of managing it, including ethical non-disclosure in the face of social danger. This reveals three paradoxes inherent in the universalism of Treatment-as-Prevention and its reliance on biomedical solutions.
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Affiliation(s)
- Cornelis J Rijneveld
- School of Oriental and African Studies London, London, United Kingdom of Great Britain and Northern Ireland
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12
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McDaid L, Flowers P, Ferlatte O, Young I, Patterson S, Gilbert M. Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research. CULTURE, HEALTH & SEXUALITY 2021; 23:207-223. [PMID: 32118515 DOI: 10.1080/13691058.2019.1700307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Good sexual health requires navigating intimate relationships within diverse power dynamics and sexual cultures, coupled with the complexities of increasing biomedicalisation of sexual health. Understanding this is important for the implementation of biomedical HIV prevention. We propose a socially nuanced conceptual framework for sexual health literacy developed through a consensus building workshop with experts in the field. We use rigorous qualitative data analysis to illustrate the functionality of the framework by reference to two complementary studies. The first collected data from five focus groups (FGs) in 2012 (n = 22), with gay, bisexual and other men who have sex with men aged 18-75 years and 20 in-depth interviews in 2013 with men aged 19-60 years. The second included 12 FGs in 2014/15 with 55 patients/service providers involved in the use/implementation of HIV self-testing or HIV prevention/care. Sexual health literacy goes well beyond individual health literacy and is enabled through complex community practices and multi-sectoral services. It is affected by emerging (and older) technologies and demands tailored approaches for specific groups and needs. The framework serves as a starting point for how sexual health literacy should be understood in the evaluation of sustainable and equitable implementation of biomedical sexual healthcare and prevention internationally.
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Affiliation(s)
- Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Olivier Ferlatte
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mark Gilbert
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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Villa EOO. El suicidio en disputa: aproximación crítica a la asociación entre suicidio y sexualidades no heteronormativas. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumen El presente artículo tiene como objetivo problematizar la manera en cómo los grupos sociales con sexualidades no heteronormativas han sido asociados con el suicidio y las consecuencias de esta asociación en los ámbitos académicos y sociales. La justificación de esta reflexión consiste en indicar que esta vinculación tiene implicaciones más allá de las posiciones teóricas de los investigadores, reconociendo que la asociación produce efectos sobre cómo es significada socialmente la sexualidad. Para ello, el artículo se divide en cuatro apartados. En los dos primeros apartados se analiza la manera en que la noción de riesgo epidemiológico se convierte en un rasgo identitario en las poblaciones con sexualidades no heteronormativas. En el tercer apartado se propone una reflexión sobre la investigación académica acerca de la asociación entre género y suicidio. Y en el último apartado, se expone una propuesta de interpretación del comportamiento suicida desde la perspectiva de género que problematice el sentido afectivo y político de la asociación.
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Palacios R, Mathias A. Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic. Colomb Med (Cali) 2020; 51:e4276. [PMID: 33012888 PMCID: PMC7518725 DOI: 10.25100/cm.v51i2.4276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.
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Affiliation(s)
- Ricardo Palacios
- Instituto Butantan, Clinical Trials and Pharmacovigilance Center, São Paulo, Brazil
| | - Augusto Mathias
- Universidade de São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, Brazil
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15
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Gaspar M, Marshall Z, Rodrigues R, Adam BD, Brennan DJ, Hart TA, Grace D. A tale of two epidemics: gay men's mental health and the biomedicalisation of HIV prevention and care in Toronto. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1056-1070. [PMID: 30838679 DOI: 10.1111/1467-9566.12884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is mounting urgency regarding the mental health of gay, bisexual and other men who have sex with men (GBM). We examined how GBM are understanding the relationship between HIV and their mental health given the increasing biomedicalisation of HIV prevention and care. Our Grounded Theory analysis derived from qualitative interviews with 24 GBM living in Toronto, Canada, including both HIV-negative and HIV-positive men. Participants understood biomedical advances, such as undetectable viral load and pre-exposure prophylaxis (PrEP), as providing some relief from HIV-related distress. However, they offered ambivalent perspectives on the biomedicalisation of HIV. Some considered non-HIV-specific stressors (e.g. unemployment, racial discrimination) more significant than HIV-related concerns. These men expressed HIV-related distress as being under control due to biomedical advances or as always negligible when compared to non-HIV-specific stressors. Others emphasised the ongoing mental health implications of HIV (e.g. enduring risk and stigma). We describe a tension between optimistic responses to biomedicine's ability to ease the psychosocial burdens associated with HIV and the inability for biomedicine to address the social and economic determinants driving the dual epidemics of HIV and mental distress amongst GBM. We argue for more socio-material analysis over further sexual behavioural analysis of GBM mental health disparities.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Canada
| | | | | | - Barry D Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Canada
- Ontario HIV Treatment Network, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Canada
- School of Social Work, McGill University, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Canada
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Quinn K, Bowleg L, Dickson-Gomez J. "The fear of being Black plus the fear of being gay": The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med 2019; 232:86-93. [PMID: 31075752 PMCID: PMC6588433 DOI: 10.1016/j.socscimed.2019.04.042] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/12/2019] [Accepted: 04/28/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Katherine Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Lisa Bowleg
- Department of Psychology, George Washington University, Washington, DC, USA; Washington DC Columbia Center for AIDS Research (DC CFAR), Social and Behavioral Sciences Core, USA
| | - Julia Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA; Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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Young I, Davis M, Flowers P, McDaid LM. Navigating HIV citizenship: identities, risks and biological citizenship in the treatment as prevention era. HEALTH, RISK & SOCIETY 2019; 21:1-16. [PMID: 31105468 PMCID: PMC6494283 DOI: 10.1080/13698575.2019.1572869] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs - and bodies - were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa M. McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Gaspar M, Grennan T, Salit I, Grace D. Confronting comorbidity risks within HIV biographies: gay men’s integration of HPV-associated anal cancer risk into their narratives of living with HIV. HEALTH RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1519114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Troy Grennan
- Provincial HIV/STI Program, British Columbia Centre for Disease Control, Vancouver, Canada
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Irving Salit
- Department of Medicine, University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Murphy DA, de Wit JBF, Donohoe S, Adam PCG. The need to know: HIV status disclosure expectations and practices among non-HIV-positive gay and bisexual men in Australia. AIDS Care 2018; 27 Suppl 1:90-8. [PMID: 26616130 PMCID: PMC4685622 DOI: 10.1080/09540121.2015.1062077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although there is evidence of increasing overall rates of HIV status disclosure among gay and bisexual men, little is known about men's disclosure expectations and practices. In this study, we investigate the importance non-HIV-positive men in Australia vest in knowing the HIV status of their sexual partners, and the extent to which they restrict sex to partners of the same HIV status, and their HIV disclosure expectations. Data were collected through a national, online self-report survey. Of the 1044 men included in the study, 914 were HIV negative and 130 were untested. Participants completed the assessment of socio-demographic characteristics, HIV status preferences, and disclosure expectations and practices. Participants also completed reliable multi-item measures of perceived risk of HIV transmission, expressed HIV-related stigma, and engagement with the gay community and the community of people living with HIV. A quarter (25.9%) of participants wanted to know the HIV status of all sexual partners, and one-third (37.2%) restricted sex to partners of similar HIV status. Three quarters (76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who expected HIV-negative men to disclose their HIV status. Less than half (41.7%) of participants reported that they consistently disclosed their HIV status to sexual partners. Multivariate linear regression analysis identified various covariates of disclosure expectations and practices, in particular of disclosure expectations regarding HIV-positive men. Men who expected HIV-positive partners to disclose their HIV status before sex more often lived outside capital cities, were less educated, were less likely to identify as gay, perceived more risk of HIV transmission from a range of sexual practices, were less engaged with the community of people living with HIV, and expressed more stigma towards HIV-positive people. These findings suggest that an HIV-status divide is emerging or already exists among gay men in Australia. HIV-negative and untested men who are most likely to sexually exclude HIV-positive men are less connected to the HIV epidemic and less educated about HIV risk and prevention.
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Affiliation(s)
- Dean A Murphy
- a Centre for Social Research in Health, UNSW , Sydney , Australia.,b National Drug Research Institute, Curtin University , Melbourne , Australia
| | - John B F de Wit
- a Centre for Social Research in Health, UNSW , Sydney , Australia.,c Department of Social and Organizational Psychology , Utrecht University , Utrecht , The Netherlands
| | - Simon Donohoe
- d Australian Federation of AIDS Organisations , Sydney , Australia
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Koester K, Amico RK, Gilmore H, Liu A, McMahan V, Mayer K, Hosek S, Grant R. Risk, safety and sex among male PrEP users: time for a new understanding. CULTURE, HEALTH & SEXUALITY 2017; 19:1301-1313. [PMID: 28415911 DOI: 10.1080/13691058.2017.1310927] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Recent advances in biomedical HIV prevention have led to optimistic projections of a dramatic worldwide reduction of new infections by 2030. This optimism is counterbalanced by concerns that the protective benefits of one such technology, HIV pre-exposure prophylaxis (PrEP), may be negated by increases in other behaviours that offset these benefits (risk compensation). To contribute to a deeper understanding of concepts of safety and risk in the context of HIV PrEP, we draw on the narrative accounts of 61 male PrEP users who participated in the inaugural PrEP demonstration project: the iPrEx open-label extension study. We conducted in-depth interviews with a purposeful sample of iPrEx participants. Overall, participants did not report significant changes to their sexual practices once they had begun taking PrEP. Rather, participants reported experiencing a sense of relief or reprieve from HIV-related stress. This unburdening of fear did not necessarily lead to condomless sex. Instead, men expressed feeling a sense of security and less free-floating fear of HIV. We contend that no longer living under the threat of HIV is a significant benefit that has not been adequately explored in HIV prevention research.
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Affiliation(s)
- Kimberly Koester
- a Center for AIDS Prevention Studies, Medicine , University of California , San Francisco , CA , USA
| | - Rivet K Amico
- b Department of Health, Behavior and Health Education , University of Michigan , Ann Arbor , MI , USA
| | - Hailey Gilmore
- c San Francisco Department of Public Health , San Francisco , CA , USA
| | - Albert Liu
- c San Francisco Department of Public Health , San Francisco , CA , USA
| | - Vanessa McMahan
- d Gladstone Institute of Virology and Immunology , University of California , San Francisco , CA , USA
| | - Kenneth Mayer
- e The Fenway Institute , Boston , MA , USA
- f Department of Medicine , Brown University , Boston , MA , USA
| | - Sybil Hosek
- g Department of Psychiatry , John H. Stroger Hospital of Cook County , Chicago , IL , USA
| | - Robert Grant
- d Gladstone Institute of Virology and Immunology , University of California , San Francisco , CA , USA
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Abstract
In this article I consider the field of HIV treatment and prevention in light of poststructural feminist critiques of the self-evidence of matter. Both HIV and poststructural feminist theory are viewed in relation to the current state of HIV scientific research of which it has been said: ‘ much remains left to the imagination’ (McCune, 2001, emphasis added). Importantly, it is in the absence of ‘real’ knowledge of bodily matter and virus, that imagination is presumed by science as a fall back. Paradoxically, recent debate within feminist theory provides an almost perverse counter to this way of characterizing the struggle against HIV. Rather than considering imagination as something outside or external to the ‘real’, there is now substantial argument suggesting that imagination is always already present and inherent to the ‘real’. In the course of this paper, these differing positions of science and feminist theory are used to challenge and extend each other. The empirical matter of HIV medical science is shown as evidence of matter beyond the normative insistence of (human) language. On this basis, a theory of performativity - devised by Judith Butler and extended by Karen Barad - is argued as grounds for a methodologically expanded science.
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Young I, Flowers P, McDaid L. Can a pill prevent HIV? Negotiating the biomedicalisation of HIV prevention. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:411-25. [PMID: 26498141 PMCID: PMC5102670 DOI: 10.1111/1467-9566.12372] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as 'vulnerable' to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV-related knowledge. Finally, we found that rather than seeing TasP or PrEP as 'liberating' through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self-governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated.
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Affiliation(s)
- Ingrid Young
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowUK
| | - Paul Flowers
- School of Health and Life SciencesGlasgow Caledonian UniversityUK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowUK
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Grace D, Chown SA, Kwag M, Steinberg M, Lim E, Gilbert M. Becoming "Undetectable": Longitudinal Narratives of Gay Men's Sex Lives After a Recent HIV Diagnosis. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:333-349. [PMID: 26241383 DOI: 10.1521/aeap.2015.27.4.333] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We explore gay men's sex life narratives following their diagnosis with an acute or recent HIV infection. All participants received an acute (n = 13) or recent (n = 12) HIV diagnosis and completed a series of self-administered questionnaires and in-depth qualitative interviews over a one-year period or longer. Over the course of four qualitative interviews, participants frequently spoke of the role of medications (e.g., decisions to start treatment) and changing viral loads (e.g., discourses of becoming "undetectable") in relation to their sex lives since being diagnosed with HIV. Many men talked about milestones relating to initiating medication and viral load as informing their shifting sexual behaviors and identities as HIV-positive--or "undetectable"--gay men. The narratives of our participants provide insight regarding complex negotiations and processes of decision-making over time related to sex, counseling needs, treatment initiation, viral load, and the significance of undetectability as an emergent identity.
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Affiliation(s)
- Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah A Chown
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Michael Kwag
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Elgin Lim
- Positive Living Society of British Columbia, Vancouver, Canada
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25
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Prestage G, Hurley M, Brown G. "Cum play" among gay men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1347-1356. [PMID: 23519589 DOI: 10.1007/s10508-013-0074-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/08/2012] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
The exchange of semen, often referred to as "cum play," has featured in gay literature and may be a unique aspect of many gay men's sexual behavior. We investigated the prevalence of "cum play" and its context among 1153 HIV-negative and 147 HIV-positive Australian gay men in an online survey. Receptive cum play (partner ejaculating or rubbing his semen over participant's anus, or participant using partner's semen as lubricant) was reported by one in six HIV-negative and one quarter of HIV-positive men on the same occasion of protected anal intercourse with a casual partner (PAIC). HIV-negative men who engaged in receptive cum play during PAIC often believed that their partner was HIV seroconcordant and tended to trust that partner. They were also generally more optimistic about the likelihood of HIV transmission, and they often only used condoms at their partners' instigation. Cum play was not uncommon and highlights the narrowness (or danger) of focusing on condom use without considering the implications of broader sexual practices and their meaning for sexual health promotion. "Safe sex" for some gay and bisexual men does not necessarily mean consistent commitment to condom use or to avoiding semen exchange. Many feel confident in their knowledge of their partner's HIV serostatus and only use condoms with these partners at their partner's request. Their commitment to safe sex may not necessarily be compromised by their practice of cum play, but the extent to which this could represent a risk for HIV transmission depends on the reliability of their assessment of their partners' HIV serostatus.
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Affiliation(s)
- Garrett Prestage
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, VIC, Australia,
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26
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Flowers P, Davis M. Obstinate essentialism: identity transformations amongst gay men living with HIV. PSYCHOLOGY & SEXUALITY 2013. [DOI: 10.1080/19419899.2012.679364] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Community-based HIV prevention interventions that combat anti-gay stigma for men who have sex with men and for transgender women. J Public Health Policy 2012; 34:69-81. [PMID: 23151921 DOI: 10.1057/jphp.2012.59] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Men who have sex with men (MSM) have been disproportionately affected by HIV since the onset of the epidemic. Public health discourse about prevention has traditionally focused on individual risk behavior and less on the socio-structural factors that place MSM at increased risk of infection. Anti-gay bias and stigma are key structural drivers of HIV and must therefore be treated as a public health threat. Community-based prevention intervention programs that affirm the healthy formation of gay and transgender identities are strongly needed. Gay affirming school-based interventions and resiliency-focused social marketing campaigns have shown positive impact on health outcomes and should be implemented on a broader scale to challenge anti-gay stigma.
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Flowers P, Knussen C, Duncan B. Re-appraising HIV Testing among Scottish Gay Men: The Impact of New HIV Treatments. J Health Psychol 2012; 6:665-78. [PMID: 22049469 DOI: 10.1177/135910530100600605] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups (n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from 'death sentence' to 'life sentence'. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.
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Gray L, MacDonald C, Mackie B, Paton D, Johnston D, Baker MG. Community responses to communication campaigns for influenza A (H1N1): a focus group study. BMC Public Health 2012; 12:205. [PMID: 22429559 PMCID: PMC3324376 DOI: 10.1186/1471-2458-12-205] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 03/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background This research was a part of a contestable rapid response initiative launched by the Health Research Council of New Zealand and the Ministry of Health in response to the 2009 influenza A pandemic. The aim was to provide health authorities in New Zealand with evidence-based practical information to guide the development and delivery of effective health messages for H1N1 and other health campaigns. This study contributed to the initiative by providing qualitative data about community responses to key health messages in the 2009 and 2010 H1N1 campaigns, the impact of messages on behavioural change and the differential impact on vulnerable groups in New Zealand. Methods Qualitative data were collected on community responses to key health messages in the 2009 and 2010 Ministry of Health H1N1 campaigns, the impact of messages on behaviour and the differential impact on vulnerable groups. Eight focus groups were held in the winter of 2010 with 80 participants from groups identified by the Ministry of Health as vulnerable to the H1N1 virus, such as people with chronic health conditions, pregnant women, children, Pacific Peoples and Māori. Because this study was part of a rapid response initiative, focus groups were selected as the most efficient means of data collection in the time available. For Māori, focus group discussion (hui) is a culturally appropriate methodology. Results Thematic analysis of data identified four major themes: personal and community risk, building community strategies, responsibility and information sources. People wanted messages about specific actions that they could take to protect themselves and their families and to mitigate any consequences. They wanted transparent and factual communication where both good and bad news is conveyed by people who they could trust. Conclusions The responses from all groups endorsed the need for community based risk management including information dissemination. Engaging with communities will be essential to facilitate preparedness and build community resilience to future pandemic events. This research provides an illustration of the complexities of how people understand and respond to health messages related to the H1N1 pandemic. The importance of the differences identified in the analysis is not the differences per se but highlight problems with a "one size fits all" pandemic warning strategy.
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Affiliation(s)
- Lesley Gray
- Dept of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
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Davis M, Flowers P. Love and HIV serodiscordance in gay men's accounts of life with their regular partners. CULTURE, HEALTH & SEXUALITY 2011; 13:737-749. [PMID: 21331963 DOI: 10.1080/13691058.2011.552986] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could 'invest' more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.
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Affiliation(s)
- Mark Davis
- Department of Political and Social Inquiry, Monash University, Melbourne, Australia.
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Papadopoulos D. In the ruins of representation: Identity, individuality, subjectification. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2011; 47:139-65. [PMID: 17535457 DOI: 10.1348/014466607x187037] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper explores a threefold shift in our understanding of identity formation and self-relationality: from an essentialist understanding of identity, to discursive and constructivist approaches, to, finally, the notion of embodied subjectification. The main target of this paper is to historicize these ideas and to localize them in the current social and political conditions of North-Atlantic societies. The core argument is that these three steps in reformulating the concept of identity correspond to an emerging form of subjectivity, affirmative subjectivity, which is bound to the proliferation of the post-Fordist reorganization of the social and political realm. The three theoretical shifts and their social situatedness will be illustrated through a rereading of some ideas from Lev S. Vygotsky's late theory, Michel Foucault's account of government and Jacques Rancière's political philosophy.
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Flowers P, Langdridge D. Offending the other: Deconstructing narratives of deviance and pathology. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2010; 46:679-90; discussion 691-5. [PMID: 17535454 DOI: 10.1348/014466607x177713] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Narratives of homophobia and the repathologization of gay men now emerge and coalesce in often unconsidered ways. Within this paper, we present a deconstructive analysis of a recent paper published within the British Journal of Social Psychology (Crossley, 2004) and highlight how a narrative of repathology emerges through the selective appropriation of particular textual sources. By employing pathological constructions of sexual conduct between men; focusing upon singular homogenized constructions of gay men and simplistic constructions of health promotion and through a process of reconstructing HIV as a gay plague and it is possible to embroider a moral tale which constitutes a further deviant 'othering' of gay men. We contend that by employing (functional) discourses of 'unconscious motivation', together with a constellation of disclaimers, caveats and tokenistic pluralization, it becomes possible for psychologists to engage in homophobic knowledge production whilst maintaining an identity as a (dis)interested professional. Our analysis raises issues pertinent to all social psychologists engaged in 'suspicious' research on 'the other'. To this end, we expand our critique by employing ideas from Ricoeur's hermeneutic phenomenology to provide more general discussion of ethical and constructive ways of engaging in textual analyses of persons outside one's own tradition.
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Peel E, Thomson M. Editorial Introduction: Lesbian, Gay, Bisexual, Trans and Queer Health Psychology: Historical Development and Future Possibilities. FEMINISM & PSYCHOLOGY 2009. [DOI: 10.1177/0959353509342691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elizabeth Peel
- School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK,
| | - Michael Thomson
- School of Law, Keele University, Staffordshire, ST5
5BG, UK,
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HIV/AIDS in its third decade: Renewed critique in social and cultural analysis – An introduction. SOCIAL THEORY & HEALTH 2009. [DOI: 10.1057/sth.2009.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Körner H, Hendry O, Kippax S. Safe sex after post-exposure prophylaxis for HIV: Intentions, challenges and ambivalences in narratives of gay men. AIDS Care 2007; 18:879-87. [PMID: 17012076 DOI: 10.1080/09540120500307909] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper draws on findings from an on-going prospective cohort study, with a quantitative and a qualitative arm, to monitor the implementation of non-occupational post-exposure prophylaxis (PEP) in Australia. The aim of the qualitative arm was to explore in-depth details of exposures to HIV and participants' understanding of 'risk'. Of the 328 patients who were enrolled in the study from March 1999 to July 2001, 88 (27%) participated in the qualitative arm. Interviews were conducted in a semi-structured style and explored the event that precipitated the request for PEP, participants' understanding of safe sex, their physical and psychological experience of the treatment and the impact that the availability of PEP may have on their sexual practices in the future. One theme running through the interviews was a determination to either maintain existing high levels of safe sex or to increase safe sex practices in those men who perceived PEP as 'a wake up call'. This determination was motivated by the experience of taking combination therapies and reflection on a potentially HIV-positive future. However, there were also tensions and ambivalences in the narratives. PEP was promoted as an adjunct to safe sex, not as an alternative. This is how PEP was understood by the men in this study.
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Affiliation(s)
- H Körner
- National Centre in HIV Social Research, University of New South Wales, Sydney, Australia.
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Radley A, Cheek J, Ritter C. The making of health:: a reflection on the first 10 years in the life of a journal. Health (London) 2006; 10:389-400. [PMID: 16973677 DOI: 10.1177/1363459306067309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This introduction to the Tenth Anniversary Issue surveys articles that have been published in health: since its launch. Reviewing the original aims of the journal, the editors discuss some of the main issues that authors have raised, both about health and illness. Focusing upon articles that have been published in this particular journal, we discuss the way that new medical technologies--particularly global ones--have shaped ideas about disease and its treatment, and in consequence about what 'good health' should be. Related to the growth in medical and other technology--not least the rise of the Internet during the life of this journal--is the number of articles that discuss the rights of patients and the establishment of what might be termed an 'illness culture'. We conclude that there continues to be more to health than it being the background to illness or disease, and ask the question: should the 'taken for grantedness' of health be taken for granted any longer?
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Davis M, Hart G, Bolding G, Sherr L, Elford J. E-dating, identity and HIV prevention: theorising sexualities, risk and network society. SOCIOLOGY OF HEALTH & ILLNESS 2006; 28:457-78. [PMID: 16669808 DOI: 10.1111/j.1467-9566.2006.00501.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society.
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Affiliation(s)
- Mark Davis
- Institute of Health Sciences, St Bartholomew School of Nursing and Midwifery, City University London, UK.
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Grove NJ, Zwi AB. Our health and theirs: Forced migration, othering, and public health. Soc Sci Med 2006; 62:1931-42. [PMID: 16242227 DOI: 10.1016/j.socscimed.2005.08.061] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 08/26/2005] [Indexed: 11/20/2022]
Abstract
This paper uses 'othering' theory to explore how forced migrants are received in developed countries and considers the implications of this for public health. It identifies a variety of mechanisms by which refugees, asylum seekers and irregular migrants are positioned as 'the other' and are defined and treated as separate, distant and disconnected from the host communities in receiving countries. The paper examines how this process has the potential to affect health outcomes both for individuals and communities and concludes that public health must engage with and challenge this othering discourse. It argues that public health practitioners have a critical role to play in reframing thinking about health services and health policies for forced migrants, by promoting inclusion and by helping shape a narrative which integrates and values the experiences of this population.
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Affiliation(s)
- Natalie J Grove
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052, Australia.
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Körner H, Hendry O, Kippax S. Negotiating risk and social relations in the context of post-exposure prophylaxis for HIV: Narratives of gay men. HEALTH RISK & SOCIETY 2005. [DOI: 10.1080/13698570500390218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brown G, Maycock B, Burns S. Your picture is your bait: use and meaning of cyberspace among gay men. JOURNAL OF SEX RESEARCH 2005; 42:63-73. [PMID: 15795806 DOI: 10.1080/00224490509552258] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The Internet is seen by many as a form of cyberspace or environment in which to interact and socialise. This research project drew from the data of a quantitative and qualitative study of gay men in Perth, Western Australia. We examined gay men's usage patterns of chat rooms and other social aspects of the Internet to meet sexual partners. We then reviewed in detail the meanings gay men have for the various Internet environments, and the range of friendship, relationship, casual, or esoteric sex-seeking goals. We argue that gay men view and engage with the Internet differently from how they view and engage with other more traditional gay spaces. This different approach influences how interaction between the men, either online or face-to-face, progresses and how assumptions and expectations are built. This has implications for how sexual health promotion interventions determine the appropriate role and relationship they have with these online social spaces.
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Affiliation(s)
- Graham Brown
- Western Australian Centre for Health Promotion Research, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia.
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Rosengarten M, Imrie J, Flowers P, Davis MD, Hart GJ. After the euphoria: HIV medical technologies from the perspective of their prescribers. SOCIOLOGY OF HEALTH & ILLNESS 2004; 26:575-596. [PMID: 15283778 DOI: 10.1111/j.0141-9889.2004.00406.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral combination therapies and associated tests from the perspective of their prescribers. The prescribers were interviewed during the later part of 2002 at three London HIV clinics. Their comments, considered in light of other recent studies in the field, suggest that current therapies are part of a transitional phase in the epidemic which informs the identification and negotiation of known risks and uncertainty. An undetermined but extended life expectancy, afforded by anti-retroviral therapies, is understood against risk of iatrogenic diseases and/or viral drug resistance. The tension arising in this situation of unwanted and even uncertain phenomena poses ethical dilemmas and affects doctor/patient relations. Indeed, it also contributes to a reconfiguring of the lived experience of managing HIV. While the new technologies have offered considerable advances in the medical management of HIV, they are altering the nature of HIV medicine both materially and socially. The scenario is further complicated by the uneven allocation of resources and different patient health and disease states. The heterogeneity of resources, disease states and technological effects points to the need for ongoing and extended evaluation as the relationship between these and the everyday practice of medicine continues to change.
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Affiliation(s)
- Marsha Rosengarten
- Department of Sexually Transmitted Diseases, University College, London.
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Gillett J. Media activism and Internet use by people with HIV/AIDS. SOCIOLOGY OF HEALTH & ILLNESS 2003; 25:608-624. [PMID: 12919448 DOI: 10.1111/1467-9566.00361] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper seeks to understand better the media practices of people who are directly affected by an illness or health problem. Internet sites that have been created by people with HIV/AIDS are examined as a strategy for self-representation. This analysis identifies four prominent 'organising themes' in Internet sites: autobiography; expertise; self promotion; and dissent. It is argued that there is a connection between media activism within the contemporary AIDS movement and Internet use among people with HIV/AIDS. This paper discusses the potential of the Internet, as a form of media activism, to raise the private troubles of people with health problems as public issues through a revitalisation of the public sphere in contemporary post-industrial societies.
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Affiliation(s)
- James Gillett
- Health Studies Programme and the Department of Sociology, McMaster University, Hamilton, Ontario, Canada.
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Race KD. Revaluation of risk among gay men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2003; 15:369-381. [PMID: 14516021 DOI: 10.1521/aeap.15.5.369.23822] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article reviews recent studies investigating sexual practice among gay and homosexually active men in Australia. The concept of ethics, understood as practical techniques adopted for the achievement of certain implicit and explicit goals, provides a framework for understanding the relation between gay men's engagement with medicine and their sexual practice over time. I argue that rather than producing straightforward complacency, the introduction of highly active antiretroviral therapy provided the conditions of emergence of a partial revaluation of risk among many gay men. "Negotiated safety" and "barebacking" might be understood as historically situated prevention ethics, scientifically plausible in some circumstances. Though emerging prevention ethics pose challenges for education, the strategy of enabling gay men, in conversation with health authorities, to be responsible for evaluating risk, has been remarkably effective. Enhancing the viability of prevention ethics begs attention to the quality and availability of public contexts within which embodied and lived experience can be brought into articulation with medical knowledge, raising the value of what is here described as "counterpublic health."
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Affiliation(s)
- Kane D Race
- National Centre in HIV Social Research, University of New South Wales, Australia.
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Davis MDM, Hart G, Imrie J, Davidson O, Williams I, Stephenson J. 'HIV is HIV to me': The meanings of treatment, viral load and reinfection for gay men living with HIV. HEALTH RISK & SOCIETY 2002. [DOI: 10.1080/13698570210288] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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