Evaluation of interventions for gay men: two desiderata

This paper was presented in a session at the AIDS Impact conference devoted to a debate on the methods that should be used to evaluate educational interventions. The paper highlights two desiderata for evaluation of interventions directed at gay men. First, the view is presented that there is no acceptable substitute for assessing the effect of an intervention on gay men's sexual behaviour (rather than, for example, their AIDS-related attitudes or beliefs). This view is justified in terms of (a) the differences that exist between AIDS-related thinking in the cold light of day and during actual sexual encounters; and (b) the often faulty nature of intuitions about the factors that contribute to sexual risk-taking and the ways in which it might be reduced. Second, it is argued that the randomized control study design represents the best means for ensuring that interventions will be as effective as possible. Criticisms which have been made of this design are discussed and the conclusion drawn that they do not amount to a strong case against it.

`I`m less at risk than most guys`: gay men`s unrealistic optimism about becoming infected with HIV

Among the self-justifications that gay men use when engaging in high-risk sex is the thought that they are less at risk than most gay men. Two explanatory models of such 'unrealistic optimism' (UO) have been proposed: while the motivational account holds that UO arises because it 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 investigated predictions derived from the motivational account. Gay men uninfected with HIV (n = 88) answered two test questions, requiring them to estimate, respectively, their own risk of becoming infected and that of the average gay man. The questions were presented in the two possible orders, and were either separated or not separated by unrelated filler material. The great majority of the men (89%) exhibited UO. Neither question order nor the interpolation of filler material affected responses to either test question. The results were inconsistent with the motivational account, but explicable in terms of the cognitive account. It seems that the cognitive account provides the better explanation of at least that form of UO measured in this study. Implications for AIDS educators are discussed.

One career, two identities : an assessment of gay men`s career trajectory

Most of the research on career development of sexual minorities focuses on lesbians. Gay men, on the other hand, have received little attention in the literature as it is assumed that they face fewer difficulties in career development because they are men. This paper redresses this gap by presenting an analysis of the impact of sexual identity on the career development of gay men, drawing on both a literature review of the literature on sexual identity, gay organizational studies and career development and the results of a recent interview study. In accord with other literature, the study demonstrates that gay men, like other sexual minorities, are confronted with a conflict between personal and career needs, and have to deal with society's expectations and intolerance towards homosexuality. Suggestions are given for research that will lead to a deeper understanding of the career decisions and attitudes of gay men.

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.

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.

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 lived experience of gay men caring for others whith HIV/AIDS : resilient coping skills

There is a dearth of research conducted on the relationship aspect of gay men caring for gay men. This Australian research conducted in 2002 investigated the emotional effects of HIV/AIDS on the gay male carers of gay men with the disease. This study was phenomenological inquiry and employed van Manen's approach to content analysis. Twelve participants for the study were recruited. The results produced emergent themes relating to coping with HIV/AIDS, living day-to-day with HIV/AIDS, coping with the last phase of AIDS towards death, saying goodbye and remembrance. This research highlights the resilient coping style of carers of persons living with HIV/AIDS. The research also gives rise to recommendations for practice and educational contexts in terms of the support and care considerations for persons living with HIV/AIDS and their carers.

Thought processes associated with reluctance in gay men to be tested for HIV

This study explored the thought processes that are associated with reluctance in gay men to be tested for HIV antibodies. The sample comprised 97 men who had not been tested for at least four years; 69 had never been tested. They were asked to imagine that someone had suggested that they be tested very soon and to identify, from the list provided, any negative thoughts prompted by this suggestion. The most commonly reported thoughts were that testing was unnecessary because risks had not been taken, that it was unnecessary because there were no symptoms, and that there was no urgency to be tested. Data were explored by means of factor analysis and comparisons across subgroups differing in risk level. The results are interpreted as indicating the use of rationalizations to buttress a decision not to be tested, the powerful influence on HIV decision-making exerted by salient perceptible features, and the ‘status quo bias’. Techniques that could be used to encourage testing in gay men are discussed.

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.