Sexual protection behavior in HIV-positive gay men: testing a modified information-motivation-behavioral skills model.

This study on determinants of sexual protection behavior among HIV-positive gay men used the empirically tested information-motivation-behavioral skills (IMB) model. HIV-specific variables were added to the model to determine factors decisive for condom use with steady and casual partners. Data were collected using an anonymous, standardized self-administered questionnaire. Study participants were recruited at HIV outpatient clinics associated with the Eurosupport Study Group and the Swiss HIV Cohort Study. To identify factors associated with condom use, backward elimination regression analyses were performed. Overall, 838 HIV-infected gay men from 14 European countries were included in this analysis. About 53% of them reported at least one sexual contact with a steady partner; 62.5% had sex with a casual partner during the last 6 months. Forty-three percent always used condoms with steady partners and 44% with casual partners. High self-efficacy and subjective norms in favor of condom-use were associated with increased condom use with casual and steady partners, whereas feeling depressed was associated with decreased condom use with casual partners. Condoms were used less often with HIV-positive partners. Self-efficacy as an important behavioral skill to perform protection behavior was influenced by lower perceived vulnerability, higher subjective norms, and more positive safer sex attitudes. The IMB-model constructs appeared to be valid; however, not all the model predictors could be determined as hypothesized. Besides the original IMB constructs, HIV-specific variables, including sexual partners' serostatus and mental health, explained condom use. Such factors should be considered in clinical interventions to promote "positive prevention."

Dementia, lesbians and gay men: Alzheimer's Australia

This paper was commissioned by Alzheimer's Australia to promote an informed discussion about the issues affecting lesbians or gay men with dementia or caring for someone with dementia. It addresses the issues associated with the interaction between service providers and lesbian and gay men with dementia and their family carers, including the complexity of family relationships and barriers that may affect care provision and quality of life.The focus of this paper is on lesbian and gay seniors, including their same-sex partners. Not all people with dementia are seniors; however younger lesbians and gay men living with dementia may have a number of similar concerns and needs to those of lesbian and gay seniors. This paper also includes information about the needs of younger lesbians and gay men who are supporting a heterosexual family member living with dementia.Some issues and concerns identified in this paper are shared by transgender people, as well as additional specific issues such as the impact of medical interventions on ageing, including surgical changes and hormone treatments over a long period of time. This paper encompasses the needs of those members of the transgender community to the extent to which they identify themselves as gay or lesbian, but does not address the specific needs of transgender people.This paper seeks to contextualise the issues involved and inform readers by way of discussion and case examples.Full paper available at: http://www.apo.org.au/node/23373

'You show me yours, I'll show you mine': the negotiation of shifts from textual to visual modes in computer-mediated interaction among gay men

This article explores the way users of an online gay chat room negotiate the exchange of photographs and the conduct of video conferencing sessions and how this negotiation changes the way participants manage their interactions and claim and impute social identities. Different modes of communication provide users with different resources for the control of information, affecting not just what users are able to reveal, but also what they are able to conceal. Thus, the shift from a purely textual mode for interacting to one involving visual images fundamentally changes the kinds of identities and relationships available to users. At the same time, the strategies users employ to negotiate these shifts of mode can alter the resources available in different modes. The kinds of social actions made possible through different modes, it is argued, are not just a matter of the modes themselves but also of how modes are introduced into the ongoing flow of interaction.

Constructing risk across timescales and trajectories: Gay men's stories of sexual encounters

This paper explores the way risk is constructed in the stories gay men tell of their sexual experiences. It focuses on how tellers use such stories to portray themselves both as rational actors and as legitimate members of their social groups by reconstructing the ‘orderliness’ of sexual encounters. An analysis of a corpus of stories derived from a diary study of gay male sexual behaviour in Hong Kong using current theories of discourse analysis reveals how narrators organize their experiences along two primary vectors of engagement: a sequential vector along which the trajectory of the sexual encounter is presented as a chain of occurrences, each occurrence contingent upon previous ones and warranting subsequent ones, and a hierarchical vector along which processes perceived on longer timescales are portrayed as exerting pressure on the ways processes on shorter timescales unfold. Examining how men portray these vectors in their accounts of risk behaviour can help us better understand both the situatedness of risk behaviour and the ways it is linked to larger social practices, identity projects and community histories

Disclosure, discrimination and desire: experiences of Black and South Asian gay men in Britain

Using findings from a qualitative investigation based on in-depth email interviews with 47 Black and South Asian gay men in Britain, this paper explores the cross-cutting identities and discourses in relation to being both gay and from an ethnic minority background. Taking an intersectional approach, detailed accounts of identity negotiation, cultural pressures, experiences of discrimination and exclusion and the relationship between minority ethnic gay men and mainstream White gay culture are presented and explored. The major findings common to both groups were: cultural barriers limiting disclosure of sexuality to family and wider social networks; experiences of discrimination by White gay men that included exclusion as well as objectification; a lack of positive gay role models and imagery relating to men from minority ethnic backgrounds. Among South Asian gay men, a major theme was regret at being unable to fulfil family expectations regarding marriage and children, while among Black gay men, there was a strong belief that same-sex behaviour subverted cultural notions related to how masculinity is configured. The paper concludes by highlighting the importance of social location, particularly education and income, when examining the intersection of ethnicity and sexuality in future research.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

"What do other people think?" - The role of prejudice and social norms in the expression of opinions against gay men

It is generally acknowledged that it is no longer socially acceptable to espouse prejudiced beliefs, yet prejudiced attitudes and discriminatory behaviours still occur. The present study sought to determine when and by whom prejudiced attitudes would be expressed. Specifically, an experiment was conducted to examine the impact of injunctive social norms emanating from a social group with which participants identified and participants' level of homophobia on the expression of opinions about gay men. Participants were presented with information indicating that the majority of group members agreed with a number of prejudiced injunctive statements (pro-prejudice norm), that the majority disagreed with the statements (anti-prejudice norm), or they were given no information about other group members' opinions (control). Participants then reported their own responses to the same injunctive statements. Participants' levels of homophobia were assessed either before or after they were given the normative information. The results indicated that activation of a pro-prejudice injunctive norm for those higher in homophobia resulted in more prejudiced opinions being expressed in comparison to those who received no normative information or those who had a nonprejudiced norm activated. Those lower in homophobia expressed less prejudiced opinions than those higher in homophobia and this did not differ as a function of social norm. The results demonstrate how prejudice can come to be expressed even in the presence of a broad societal norm that suggests that is it wrong to express such opinions.