Psychiatric disorder in HIV infection

Objective: This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men. Method: A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIVt) (79 CDC stage 1 1/1 11 and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version lllR (DIS-IIIR). Results: Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuseldependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis. Conclusions: Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men, In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis, The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.

Suicidal ideation, suicide attempts, and HIV infection

A cross-sectional study was performed to investigate the prevalence and predictors of suicidal ideation and past suicide attempt in an Australian sample of human imumunodeficiency virus (HIV)-positive and HIV-negative homosexual and bisexual men. Sixty-five HIV-negative and 164 HIV-positive men participated. A suicidal ideation score was derived from using five items selected from the Beck Depression Inventory and the General Health Questionnaire (28-item version). Lifetime and current prevalence rates of psychiatric disorder were evaluated with the Diagnostic Interview Schedule Version-III-R. The HIV-positive (Centers for Disease Control and Prevention [CDC] Stage IV) men (n=85) had significantly higher total suicidal ideation scores than the asymptomatic HIV-positive men (CDC Stage II/III) (n=79) and the HIV-negative men. High rates of past suicide attempt were detected in the HIV-negative (29%) and HIV-positive men (21%). Factors associated with suicidal ideation included being HIV-positive, the presence of current psychiatric disorder, higher neuroticism scores, external locus of control, and current unemployment. In the HIV-positive group analyzed separately, higher suicidal ideation was discriminated by the adjustment to HIV diagnosis (greater hopelessness and lower fighting spirit), disease factors (greater number of current acquired immunodeficiency syndrome [AIDS]-related conditions), and background variables (neuroticism). Significant predictors of a past attempted suicide were a positive lifetime history of psychiatric disorder (particularly depression diagnoses), a lifetime history of injection drug use, and a family history of suicide attempts. The findings indicate increased levels of suicidal ideation in symptomatic HIV-positive men and highlight the role that multiple psychosocial factors associated with suicidal ideation and attempted suicide play in this population.

Post-traumatic stress disorder in response to HIV infection

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Queer

The word “queer” is a slippery one; its etymology is uncertain, and academic and popular usage attributes conflicting meanings to the word. By the mid-nineteenth century, “queer” was used as a pejorative term for a (male) homosexual. This negative connotation continues when it becomes a term for homophobic abuse. In recent years, “queer” has taken on additional uses: as an all encompassing term for culturally marginalised sexualities – gay, lesbian, trans, bi, and intersex (“GLBTI”) – and as a theoretical strategy which deconstructs binary oppositions that govern identity formation. Tracing its history, the Oxford English Dictionary notes that the earliest references to “queer” may have appeared in the sixteenth century. These early examples of queer carried negative connotations such as “vulgar,” “bad,” “worthless,” “strange,” or “odd” and such associations continued until the mid-twentieth century. The early nineteenth century, and perhaps earlier, employed “queer” as a verb, meaning to “to put out of order,” “to spoil”, “to interfere with”. The adjectival form also began to emerge during this time to refer to a person’s condition as being “not normal,” “out of sorts” or to cause a person “to feel queer” meaning “to disconcert, perturb, unsettle.” According to Eve Sedgwick (1993), “the word ‘queer’ itself means across – it comes from the Indo-European root – twerkw, which also yields the German quer (traverse), Latin torquere (to twist), English athwart . . . it is relational and strange.” Despite the gaps in the lineage and changes in usage, meaning and grammatical form, “queer” as a political and theoretical strategy has benefited from its diverse origins. It refuses to settle comfortably into a single classification, preferring instead to traverse several categories that would otherwise attempt to stabilise notions of chromosomal sex, gender and sexuality.

Queer/error : gay media systems and processes of abjection

Gay community media functions as a system with three nodes, in which the flows of information and capital theoretically benefit all parties: the gay community gains a sense of cohesion and citizenship through media; the gay media outlets profit from advertisers’ capital; and advertisers recoup their investments in lucrative ‘pink dollar’ revenue. But if a necessary corollary of all communication systems is error or noise, where—and what—are the errors in this system? In this paper we argue that the ‘error’ in the gay media system is Queerness, and that the gay media system ejects (in a process of Kristevan abjection) these Queer identities in order to function successfully. We examine the ways in which Queer identities are excluded from representation in such media through a discourse and content analysis of The Sydney Star Observer (Australia’s largest gay and lesbian paper). First, we analyse the way Queer bodies are excluded from the discourses that construct and reinforce both the ideal gay male body and the notions of homosexual essence required for that body to be meaningful. We then argue that abject Queerness returns in the SSO’s discourses of public health through the conspicuous absence of the AIDS-inflicted body (which we read as the epitome of the abject Queer), since this absence paradoxically conjures up a trace of that which the system tries to expel. We conclude by arguing that because the ‘Queer error’ is integral to the SSO, gay community media should practise a politics of Queer inclusion rather than exclusion.

How to tell the difference between a positive image and a stereotype: reading Priscilla, Queen of the Desert

This paper intervenes in critical discussions about the representation of homosexuality. Rejecting the ‘manifest content’ of films, it turns to cultural history to map those public discourses which close down the ways in which films can be discussed. With relation to The Adventures of Priscilla, Queen of the Desert, it examines discussions of the film in Australian newspapers (both queer and mainstream) and finds that while there is disagreement about the interpretation to be made of the film, the terms within which those interpretations can be made are quite rigid. A matrix based on similarity, difference and value provides a series of positions and a vocabulary (transgression, assimilation, positive images and stereotypes) through which to make sense of this film. The article suggests that this matrix, and the idea that similarity and difference provide a suitable axis for making sense of homosexual identity, are problematic in discussing homosexual representation.

Review of "Violence, Prejudice and Sexuality" by Stephen Tomsen (Routledge, New York and London, 2009)

Tomsen’s book Violence, Prejudice and Sexuality engages with important questions about sexuality and anti homosexual sentiment that criminologists have grappled with for some time. Tomsen’s work refines these questions in the context of essentialism, and notes how this concept has enabled only very specific ways of thinking about and analysing violence, prejudice, and sexuality. Indeed, thinking about the nexus between these three concepts are now almost taken for granted. As Tomsen demonstrates in his discussion of historical understandings of sexual desire, although social constructionism and queer perspectives have challenged essentialist notions of sexuality, research has in many respects upheld a binary understanding of heterosexuality as normal and homosexuality as abnormal. Interestingly, essentialist binaries like this have been conveniently employed in more recent times when activists align with minority status to gain basic human rights. While no one could deny the importance of access to rights and justice, Tomsen notes the danger inherent in arguments like this that draw on essentialism. He argues we are working through similar dichotomies of heterosexuality as normal and homosexuality as abnormal set up in very early research on sexual desire. The key difference now is that, in the rush towards public and political citizenship, ‘heterosexuals are recast as “perpetrators” and homosexuals as “victims”’ (Tomsen 2009: 16). Violence, Prejudice and Sexuality importantly notes this is no less an essentialist dichotomy and no less divisive....

Queer, student, activism

Queer student activists are a visible aspect of Australian tertiary communities. I explore the findings of interviews with eight queer student activists, whom were active between 2003 and 2006, in which they discuss their understandings of queer student activism and the way they see the university setting shaping their activism. These findings illustrate how the intersections of queer, student, activism, and their associated contexts, create a particular type of activism. This article thus contributes to queer history by demonstrating how one specific cultural subset does queer activism.

A potential HIV epidemic among male street laborers in urban Vietnam

Background: Mass migration to Asian cities is a defining phenomenon of the present age, as hundreds of millions of people move from rural areas or between cities in search of economic prosperity. Although many do prosper, large numbers of people experience significant social disadvantage. This is especially the case among poorly educated, migrant unskilled unregistered male laborers who do much of the manual work throughout the cities. These men are at significant risk for many health problems, including HIV infection. However, to date there has been little research in developing countries to explain the determinants of this risk, and thereby to suggest feasible preventive strategies. Objectives and Methodology: Using combined qualitative and quantitative methods, the aim of this study was to explore the social contexts that affect health vulnerabilities and to develop conceptual models to predict risk behaviors for HIV [illicit drug use, unsafe sex, and non-testing for HIV] among male street laborers in Hanoi, Vietnam. Qualitative Research: Sixteen qualitative interviews revealed a complex variety of life experiences, beliefs and knowledge deficits that render these mostly poor and minimally educated men vulnerable to health problems including HIV infection. This study formed a conceptual model of numerous stressors related to migrants’ life experiences in urban space, including physical, financial and social factors. A wide range of coping strategies were adopted to deal with stressors – including problem-focused coping (PFC) and emotion-focused coping (EFC), pro-social and anti-social, active and passive. These men reported difficulty in coping with stressors because they had weak social networks and lacked support from formal systems. A second conceptual model emerged that highlighted equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological dimensions such as tedium, distress, fatalism and revenge, were important. There were strong effects of collective decision-making and fear of social isolation on shaping risk behaviors. These exploratory qualitative interviews helped to develop a culturally appropriate instrument for the quantitative survey and informed theoretical models of the factors that affect risk behaviors for HIV infection. Quantitative Research: The Information-Motivation-Behavioral Skills (IMB) model was adopted as the theoretical framework for a large-scale survey. It was modified to suit the contexts of these Vietnamese men. By doing a social mapping technique, 450 male street laborers were interviewed in Hanoi, Vietnam. The survey revealed that the risk of acquiring and transmitting HIV was high among these men. One in every 12 men reported homosexual or bisexual behavior. These men on average had 3 partners within the preceding year, and condom use was inconsistent. One third had had sex with commercial sex workers (CSW) and only 30% of them reported condom use; 17% used illicit drugs sometimes, with 66.7% of them frequently sharing injecting equipment with peers. Despite the risks, only 19.8% of men had been tested for HIV during the previous 12 months. These men have limited HIV knowledge and only moderate motivation and perceived behavioral skills for protective behavior. Although rural-to-urban migration was not associated with sexual risk behavior, three elements of the IMB model and depression associated with the process of mobility were significant determinants of sexual behavior. A modified model that incorporated IMB elements and psychosocial stress was found to be a better fit than the original IMB model alone in predicting protected sex behavior among the men. Men who were less psychologically and socially stressed, better informed and motivated for HIV prevention were more likely to demonstrate behavioral skills, and in turn were more likely to engage in safer sexual behavior. With regard to drug use, although the conventional model accounted for slightly less variance than the modified IMB model, data were of better fit for the conventional model. Multivariate analyses revealed that men who originated from urban areas, those who were homo- or bi-sexually identified and had better knowledge and skills for HIV prevention were more likely to access HIV testing, while men who had more sexual partners and those who did not use a condom for sex with CSW were least likely to take a test. The modified IMB model provided a better fit than the conventional model, as it explained a greater variance in HIV testing. Conclusions and Implications: This research helps to highlight a potential hidden HIV epidemic among street male, unskilled, unregistered laborers. This group has multiple vulnerabilities to HIV infection through both their partners and peers. However, most do not know their HIV status and have limited knowledge about preventing infection. This is the first application of a modified IMB model of risk behaviors for HIV such as drug use, condom use, and uptake of HIV testing to research with male street laborers in urban settings. The study demonstrated that while the extended IMB model had better fit than the conventional version in explaining the behaviors of safe sex and HIV testing, it was not so for drug use. The results provide interesting directions for future research and suggest ways to effectively design intervention strategies. The findings should shed light on culturally appropriate HIV preventive education and support programs for these men. As Vietnam has much in common with other developing countries in Southeast Asia, this research provides evidence for policy and practice that may be useful for public health systems in similar countries.

An HIV epidemic is ready to emerge in the Philippines

Background: The state of the HIV epidemic in the Philippines has been described as "low and slow", which is in stark contrast to many other countries in the region. A review of the conditions for HIV spread in the Philippines is necessary. Methods: We evaluated the current epidemiology, trends in behaviour and public health response in the Philippines to identify factors that could account for the current HIV epidemic, as well as to review conditions that may be of concern for facilitating an emerging epidemic. Results: The past control of HIV in the Philippines cannot be attributed to any single factor, nor is it necessarily a result of the actions of the Filipino government or other stakeholders. Likely reasons for the epidemic's slow development include: the country's geography is complicated; injecting drug use is relatively uncommon; a culture of sexual conservatism exists; sex workers tend to have few clients; anal sex is relatively uncommon; and circumcision rates are relatively high. In contrast, there are numerous factors suggesting that HIV is increasing and ready to emerge at high rates, including: the lowest documented rates of condom use in Asia; increasing casual sexual activity; returning overseas Filipino workers from high-prevalence settings; widespread misconceptions about HIV/AIDS; and high needle-sharing rates among injecting drug users. There was a three-fold increase in the rate of HIV diagnoses in the Philippines between 2003 and 2008, and this has continued over the past year. HIV diagnoses rates have noticeably increased among men, particularly among bisexual and homosexual men (114% and 214% respective increases over 2003-2008). The average age of diagnosis has also significantly decreased, from approximately 36 to 29 years. Conclusions: Young adults, men who have sex with men, commercial sex workers, injecting drug users, overseas Filipino workers, and the sexual partners of people in these groups are particularly vulnerable to HIV infection. There is no guarantee that a large HIV epidemic will be avoided in the near future. Indeed, an expanding HIV epidemic is likely to be only a matter of time as the components for such an epidemic are already present in the Philippines.

Pleasures, perversities, and partnerships : the historical emergence of LGBT-police relationships

Relationships between LGBT people and police have been turbulent for some time now, and have been variously characterized as supportive (McGhee, 2004) and antagonistic (Radford, Betts, & Ostermeyer, 2006). These relationships were, and continue to be, influenced by a range of political, legal, cultural, and social factors. This chapter will examine historical and social science accounts of LGBT-police histories to chart the historical peaks and troughs in these relationships. The discussion demonstrates how, in Western contexts, we oscillate between historical moments of police criminalizing homosexual perversity and contemporary landscapes of partnership between police and LGBT people. However, the chapter challenges the notion that it is possible to trace this as a lineal progression from a painful past to a more productive present. Rather, it focuses on specific moments, marked by pain or pleasure or both, and how these moments emerge and re-emerge in ways that shaped LGBT-police landscapes in potted, uneven ways. The chapter concludes noting how, although certain ideas and police practices may shift towards more progressive notions of partnership policing, we cannot just take away the history that emerged out of mistrust and pain.

Risks for HIV infection among male street laborers in urban Vietnam

Risks for HIV infection remain unknown in male street laborers. This research investigates patterns of self-reported risk behaviors among these men in urban Vietnam. In a cross-sectional survey using a social mapping technique, 450 men, mostly low-skilled and unregistered migrant laborers across 13 districts in Hanoi were approached for interviews. The study revealed that male street laborers were at high risk of acquiring and transmitting HIV. One in every 12 men reported homosexual or bisexual behavior. These men on average had three sexual partners within the preceding year, and condom use was inconsistent. Close to 95 % of the men had reported sexual encounters with regular partners. One-third with commercial sex workers (CSW) and 24.2 % with casual partners, but just under one-third had ever used condoms with regular partners and CSWs and very few (17.6 %) with casual partners at their last sexual encounter. 17.11 % used illicit drugs sometimes, with 66.7 % of them frequently sharing injecting equipment with peers. These men had limited HIV knowledge; 51.4 % incorrectly believed that, once you trust your partner, you no longer need to use condoms and 42.4 % believed that you can tell by looking at someone if they have HIV. Access to HIV prevention was also limited; only 19.8 % of men had been tested for HIV during the previous 12 months, almost 10 % of whom neither returned for the result nor knew their HIV status. The study provides interesting directions for future research and suggests ways to effectively design prevention strategies for these men.

A prostitute's progress : male prostitution in scientific discourse

This paper examines discourses of male prostitution through an analysis of scientific texts. A contrast is drawn between nineteenth-century understandings of male prostitution and twentieth-century accounts of male prostitution. In contrast to female prostitution, male prostitution was not regarded as a significant social problem throughout the nineteenth century, despite its close association with gender deviation and social disorder. Changing conceptions of sexuality, linked with the emergence of the ‘adolescent’, drew scientific attention to male prostitution during the 1940s and 1950s. Research suggested that male prostitution was a problem associated with the development of sexual identity. Through the application of scientific techniques, which tagged and differentiated male prostitute populations, a language developed about male prostitution that allowed for normative assessments and judgements to be made concerning particular classes of male prostitute. The paper highlights how a broad distinction emerged between public prostitutes, regarded as heterosexual/masculine, and private prostitutes, regarded as homosexual/effeminate. This distinction altered the way in which male prostitution was understood and governed, allowing for male prostitution to be constituted as a public health concern.

Integrating LGBTIQ health personnel in the workplace: A literature review

Aim Lesbian, Gay, Bisexual, Transgender (LGBTIQ) issues have attracted attention in the popular media. The purpose of this study was to explore the workplace acceptance and experiences of LGBTIQ health and medical practitioners. Methods A systematic search of academic databases and reference lists from selected papers were the sources of the data. Inclusion criteria were research papers published in English, which focused on workplace acceptance and experiences of LGBTIQ health personnel. Both authors abstracted data from all eligible papers. Results Thirty-three papers were included in this review. Evidence indicated that LGBTIQ health personnel experienced discrimination from their patients, heterosexual colleagues and within the LGBTIQ community. Positive contribution of LGBTIQ health personnel include improved patient care and role models for LGBTIQ peers. Inclusive policy is required for LGBTIQ health personnel workforce retention. Conclusions There has been improvement in the acceptance and experiences of LGBTIQ health personnel in recent times. An inclusive workplace policy of LGBTIQ embraces and celebrates the value of diversity.