Body image, media influences, sexual risk, and sexuality in men

This thesis examined the relationships between men's body image, different media influences, sexual orientation, and sexual risk taking. In comparison to heterosexuals, gay men were significantly less satisfied with their bodies. Media influences predicted men's body image, and gay men demonstrated greater internalisation of media messages compared to heterosexual men. Based on four case studies the portfolio demonstrates that motivational interviewing might be a useful approach to manage ambivalence and resistance to clients presenting with an anxiety disorder or a parent-child relational issue.

The health and well-being of Sudanese young men in Melbourne

The health and well-being needs of young refugee men from Sudan are not adequately addressed by settlement services. To address this, I recommend using Ubuntu and Afrocentric approaches that emphasise dialogue. I have highlighted the problem areas where attention and action is needed for them to realise their full potential.

Explanations for mixed-orientation marriage : a comparative study of previously married and never-married gay men

Despite a large body of literature on the development of sexual orientation, little is known about why some men who marry women have (or develop) a homosexual orientation. In the current study, a selfselected sample of 43 never-married gay men and 26 gay men who were married to a woman completed a self-report questionnaire. As well as obtaining descriptive information from the 26 men about their marriages and reason for marrying, hypotheses were tested, based on five possible explanations for gay men’s marriages: (a) internalised homophobia; (b) religious intolerance (c) confusion created because of childhood/adolescent sexual experiences; (d) poor psychological adjustment; and (e) differences in strength of sexual preference. The two most frequent reasons for marriage were that it “seemed natural”, and a desire to have children and “family life”. The attitudes to gay men and lesbians held currently by the married group were significantly more positive than their reports of their attitudes around the time their marriage commenced, and the level of childhood sexual experiences with adults or older adolescents was significantly associated with the extent of their unsafe sexual practices with men (prior, during and/or after marriage). Marrieds described their families’ religious beliefs as more fundamentalist than never-marrieds. Family adaptability and family cohesion and the degree to which respondents reported having experienced child maltreatment did not distinguished between marrieds and never-marrieds, however these variables did predict the level of self-depreciation. No differences were found between marrieds and never-marrieds’ ratings of their sexual orientation and identity, homophobia, or self-depreciation. The results highlight how little is understood of the reasons why gay men marry, and the need to develop an adequate theoretical model.

The impact of racism upon the health and wellbeing of young Australians

The Institute for Citizenship and Globalisation at Deakin University has worked in partnership with the Foundation for Young Australians to conduct this research project into the impact of racism upon the health and wellbeing of young Australians. The research has been carried out in eighteen Australian secondary schools in Victoria, New South Wales, Northern Territory and Queensland. Students aged 15-18 were surveyed and interviewed in both the government and Catholic education systems in order to ascertain the experience of racism and racist behaviours among Australian youth and their impact on health and wellbeing. The scope of the research brief included the nature of the racist experience, its setting, the individual and institutional responses and its reporting. The research also aimed to examine the impact of the experience of racism upon the health and wellbeing of Australian youth. A glossary of terms is included in Appendix 1 to assist with the reading of this Report.

Defining moments in men's lives : a study of personal narratives

This study explores the defining moments in six men’s lives. The empirical dimension of the research is built around the personal narratives these men tell of their lives across a series of four interviews. The central research theme is the notion of the defining moment as a key element in the processes of establishing how men understand and interpret the events and incidents that have shaped their lives. In the context of this study, the defining moment is seen as the moment or period in time when an individual gives definition to a specific event or experience, as a transition point with (potentially) life-altering consequences. Some of the thematic structures presented include relationships with significant adults (parents, teachers), masculinity, self-harm, schooling, mental illness, isolation, loneliness, stress and relationships with peers. In my pursuit of a methodology that could accommodate the aims of this study, I explored the process of meaning through the qualitative paradigm. Drawing on the principles of qualitative research, as applied through narrative inquiry, I deployed a semi-structured interview format to collect the lived experiences of participants. By privileging the stories that individuals tell of their experiences, the narrative method recognises that data are inexorably located in the contextual and contingent. The experiences and narratives that are presented in this thesis are built around the authentic voices of participants. The study presents a warrant for working with men’s defining moments to disrupt, alter and redefine their attitudes and behaviours in order to improve their lives. Based on the insights gleaned through this study, I argue that there are defining times/points in people’s lives where their experiences can be life altering. When these experiences involve uncertainty, anxiety, stress and other pernicious effects, their longer-term consequences can be devastating. The study confirms existing research, that men are reluctant to seek help or reveal their insecurities during such times, therefore making them particularly vulnerable to defining moments. The conclusion of this thesis establishes some broad recommendations pertaining to working effectively with men and their defining moments. I focus particular attention on the place of schooling and education in helping individuals recognise and respond to the early symptoms of what is potentially a life-altering experience. Schools and, by association, teachers need to be actively and strategically involved in this process. To this end, I argue the need for targeted interventions that are both sensitive and timely. In their engagements with young males, parents, teachers, coaches and mentors need to be particularly attuned to their silent screams for help.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Prostate cancer : Anglo-Australian heterosexual perspectives

Prostate cancer is one of the most prominent diseases in men’s health. It is inherently 'male', given the exclusivity of the prostate gland to men’s bodies and its physiological connection to testosterone and male sexuality. The biomedical complexities of prostate cancer continue to be unravelled and researched and are often connected to identifying causes, the virtues of screening and treatment modalities. However, despite the biological male 'sex' link, most of the prostate cancer research is not connected with research on gender relations, men and masculinities. The net outcome is that men’s lives and illness experiences are absent in much of the prostate cancer research. This PhD thesis Prostate cancer: Anglo-Australian heterosexual perspectives, is an ethnographic study of thirty-five Anglo-Australian men diagnosed with prostate cancer. Participants shared their experiences of living with prostate cancer in the context of health promotion, health services and in relation to their sexuality and intimate relationships. Through participant photographic novella and in-depth semi-structured interviews, rich cultural insights are provided. A social constructionist gender analysis is used in this research that shows how the social constructions of masculinity interconnect and occasionally collide with prostate cancer throughout the illness trajectory.

Pride and prejudice : facilitating change in the attitudes of students toward gay men and lesbians

Issue addressed: As one of the most significant sites of homophobia is the school, a six week school based program designed to help students explore their attitudes to gays and lesbians was developed called 'Pride and Prejudice'. This paper reports on the initial data from the evaluation of this program. Methods: In order to evaluate the usefulness of the program, a group of year 10 students at a state secondary school participated in the Pride and Prejudice program. Students' attitudes to gay men and lesbians and their social connectedness, self esteem, attitudes to race and beliefs about gender roles were measured before and after their participation. Results: Attitudes held by students toward gay men and lesbians were significantly more positive after the program. The level of attendance during the program significantly predicted the change in attitudes toward gay men but not to lesbians. Conclusion: School based programs delivered to individual classes in which students are given the opportunity to explore their attitudes toward lesbians and gay men may be a useful part of a strategy to reduce homophobia. So what?: Health promoting schools now have a tool available for enabling students to reflect on their attitudes toward gay men and lesbians. It is hoped that school wide implementation of such a program will eventually lead to a reduction in the discrimination same sex attracted youth often experience.

Lived experience of gay men caring for others with HIV/AIDS : living, loving and dying in the era of HIV/AIDS

This thesis explored gay male carers’ experience of caring for their partner, brother or friend who had HIV/AIDS. Through using phenomenological methodology (van Manen, 1990), the day-to-day caring experiences were uncovered. The data gathered were then analysed through a nursing ‘lens’, with the concept of stigma as an anchoring point. The dual stigmas of homophobia and AIDS phobia impacted on the daily lives of these men as they cared for their loved one. The research identified six themes. These were: 1) the relationship; 2) coping with HIV and AIDS; 3) the corporal impact of HIV/AIDS; 4) experiences of carers including the absence of others; 5) living daily with the virus: Demands of people living with HIV/AIDS (PLWHA); and 6) saying goodbye, but wanting to keep the memory alive. The caring these men undertook, for which they were frequently unprepared, was intensive and complex, but because of their commitment and love they battled on. Because of a sense of shame associated with AIDS phobia on the part of the PLWHA, the carer often had to undertake this care in isolation, without support from family, friends or home health care agencies. The carers struggled with not only the demands of day-to-day care, but also with non-acceptance from family, both of the nature of the relationship with their partner and of their homosexuality. Family members were forced, often with great difficulty, to acknowledge the close commitment the men had to each other. Recognition that one had a terminal disease, HIV/AIDS was also required. The fear of potential transmission was high among carers, friends and family members. Notably, there was an absence of blame on the part of the carer towards his partner for contracting HIV/AIDS. The physical decline and marking of the body further stigmatised the PLWHA, which added to carers’ burdens. They endeavoured to minimise the physical decline in their partner, so he could continue to pass as healthy, and attempted to make the day-to-day living as normal as possible. The methods of combating weight loss and opportunistic infections meant frequent medical appointments, complex intensive medical procedures and help with personal care, which was undertaken at home largely without support from health care staff. Carers frequently struggled also with their partner’s denial of being ill. One strategy all carers used was to escape with their partners from their everyday life in Melbourne and attempt metaphorically to leave the HIV/AIDS behind; this was a time when they could rekindle their life together as it was before HIV/AIDS came into their lives. Some carers chose to holiday without their partner, to give themselves a break from the day-to-day caring, while others planned and took holidays with their partner. The decline of the health in the PLWHA meant that family members had to recognise and accept both the nature of the relationship and the presence of the disease. This recognition and acceptance often came only when the partner was very ill, even at the point of dying. Carers and their partners discussed the potential use of euthanasia, as a means of ending the final phase of life with some dignity. One carer and his partner used euthanasia, despite its illegal status. The main concern for all carers was providing comfort and a reduction in the pain associated with HIV/AIDS for the partner. The widespread grief associated with HIV/AIDS was evident amongst these carers. All had known other gay men who had died, some carers own partner had died, or was about to die. There was an overwhelming sense of grief, which at times was repressed as a means of coping day-to-day. All carers felt it was important and necessary to remember those lost to HIV/AIDS through the various public memorials, as they did not want their partner to be just another faceless person lost to this disease. This phenomenological study of carers’ experience highlights the need for health care workers to be aware of the differing strategies that gay men use to cope with HIV/AIDS. While it may seem that the carers are coping with care of their partner, the outer façade is not always an accurate portrayal of the true situation. Health care workers should enquire as to the assistance these carers need from health care services in order to continue to care for their loved one. Such assistance can be the simple recognition of the partner and acceptance of them as part of the PLWHA’s network; this inclusion and acceptance is half the battle.

"I will start treatment when I think the time is right":HIV-positive gay men talk about their decision not to access antiretroviral therapy.

In a qualitative study, 20 HIV-infected Australian gay men were interviewed about their decision not to access antiretroviral drug therapy. The main reasons given for the decision were fear of side effects; fear of long-term damage to body organs; the inconvenience of the treatment regimens; belief that the regimen's demands would be a threat to morale; and belief that there was no reason to start therapy in the absence of AIDS-related symptoms. Actions taken by the men to monitor and maintain their health included seeing a doctor regularly; having regular T-cell and viral load tests; and trying to maintain a positive outlook by not letting HIV/AIDS 'take over' their lives. Almost half the men considered they had been subjected to unreasonable pressure to access therapy and there was considerable pride at having resisted this pressure. The findings suggest that the men disagreed with the biomedical model for managing HIV/AIDS only on the question of if and when to access therapy. They also suggest that underlying the men's dissent from the biomedical model was a different mode of thinking than is required by the model: while the model demands thinking that is abstract, the men focused strongly on factors close to the 'here and now' of immediate experience. The practical implications of the findings are explored.

Gay men from heterosexual marriages : attitudes, behaviors, childhood experiences and reasons for marriage

In the current study, the attitudes, behaviors and experiences of 26 gay or bisexual men who were married to a woman are examined. Data are provided on childhood family background and experiences, sexual practices with men, reasons for entering marriage, and the “coming out” process. The frequency of childhood sexual experiences was associated with unsafe sexual practices with other men in adulthood. Attitudes toward lesbians and gay men were more negative now than at the time of marriage. The two most frequent reasons for marriage were that it seemed natural, and a desire for children and family life. The results support the hypothesis that internalised homophobia is a factor that leads men into mixed-orientation marriages. Cognitive consistency theory is used to explain the eventual marriage breakdown.

Explaining gay men's unrealistic optimism about becoming infected with HIV

Among the self-justifications that gay men use when deciding to have unprotected intercourse is the thought that they are at less risk than most gay men. Two explanatory models of such 'unrealistic optimism' (UO) have been proposed: while the motivational account holds that UO serves the function of bringing comfort, the cognitive account holds that UO serves no particular function, being simply a by-product of normal cognitive strategies. This study tested the prediction, derived from the motivational account, that highlighting the salience of the self-other comparison should increase UO. Gay men uninfected with HIV (n = 122) estimated both their own risk of contracting various health problems - among them, becoming infected with HIV - and that of the average gay man. The purported aim of collecting the data was varied, so as to either make the self-other comparison central to the aim or render one of the two types of estimate irrelevant to the aim. No effect on UO was found. It seems that the cognitive account provides a better explanation than does the motivational account of at least that form of UO measured in this study. Implications for AIDS education are discussed.