This thesis investigates the relationship between identity, behaviour and desire to examine the nature of research among homosexually active men. The hypothesis is that samples of such men necessarily reflect the definitions of sexuality and homosexuality, and their interpretation, by both the researchers themselves and their research subjects, meaning that the research process itself is marked by the subjectivity of the field of sexuality. The relationship between the observer and the observed is intrinsic to research into homosexual subjectivity and the samples obtained, therefore, represent particular kinds of sexual subjects in a particular social and sexual cultural milieu. Research in this field has given pre-eminence to behaviour over identity and desire, and, as such, has usually failed to account for these differences in sexual subjectivities. To investigate this problem, I have reviewed the relevant literature both on subjectivity and on methodological approaches to research among homosexual men, and I have appraised my own ideological and personal relationships with the subject matter. I have examined the nature of the samples of homosexual men I have obtained during my work as a researcher within the Sydney gay community and reanalysed these with regard to the particular problematic I have identified. These investigations and analyses have shown that there are numerous differences within and between the various samples of homosexual men obtained, indicating that methodological frameworks can determine the nature of the samples obtained. These differences in samples also appear to reflect differences in the ways of enacting homosexual desire among the men in the studies. However, they also parallel differences in the definitions and understandings of the target population by the researchers themselves. These differences reflect differences in definition and understanding both of homosexuality and of the population of gay men, but they also represent differing patterns in the ways of being and living ?gay?, differences in sexual subjectivity. ?Gayness? and homosexuality, as concepts in research, are both the subjective basis on which the research endeavour itself is based, as well as its representational outcome.

This thesis explores the psychosocial dynamics of sexual risk-taking in men who have sex with men, with particular focus on the dilemmas that gay men face in establishing trust in themselves and reasonable trust and intimacy with their sexual partners. As well, the practical function of this study is to analyze past and current social marketing efforts aimed at reducing the spread of HIV/AIDS, and to offer suggestions for how to approach a strategy to reduce HIV incidence in gay men and at the same time bolster efforts to assist men who have sex with men (MSM) in adhering to safer sex guidelines. In part, this thesis uses a sample of participants of the Vanguard Project cohort (St. Paul's Hospital, Vancouver, British Columbia), in order to explore the social meanings attributed by MSM towards sex, risk, intimacy, and attitudes toward HIV/AIDS. Through the use of first-person narratives, this thesis examines the concordance or discordance of MSM beliefs and behaviour with long-standing theoretical models of harm reduction methods concerning sexual risk. The study reveals that, in great measure, due to past life course events, many gay men suffer from a lack of trust in themselves, which results in a tendency to make irrational or unreasonable decisions concerning their long-term sexual health, and a lack of trust in other gay men. As welL through the misguided and often untruthful health models that advocate fewer sexual partners and rely upon the false assumption that all potential sex partners are carriers of contagion, the sense of mistrust has been reinforced. The lack of confidence in self and others further translates into a suspicion of the motives and/or efficacy of social institutions entrusted with community health development and maintenance, rendering their efforts even less effective. Moreover, traditional harm reduction messages, especially 'fear campaigns', often act as a deterrent, rather than as an incentive, to harm reduction. Of more appeal are supportive harm reduction messages delivered by someone whom the recipient trusts, especially when the social meanings of sex, risk, trust and intimacy are, for many gay men, less fixed and more contingent than for the population at large. This means that attempts to modify risky behaviour must acknowledge and negotiate multiple meanings, shifting values and changing social climates, as well as routine epidemiological concerns. The research identifies four key themes within a problematic of trust, risk and intimacy, and delineates the harm reduction social complexities experienced by gay men in the study group; these recurring themes deal with family and early sociahzation, internalized homophobia, contingency and instability of meanings of risk, trust and sex, and the toistworthiness of the messengers of harm reduction strategies. Out of these recurring themes come a number of recommendations for remedial programs aimed at both mid- and long-term reductions in HIV incidence. The recommendations are grounded in the recognition that homophobic and/or dysfunctional social conditions are, to a great extent, implicated in sexual risk behaviour, and therefore must be eliminated or ameliorated before meaningful harm reduction gains can be realized. The discussions with the gay men in the study reveal their need for positive role models and communal social support in their efforts to combat HIV infection, suggesting a need to rethink the meanings of what it is to be gay, a need to redevelop and revitalize what was once a vibrant and cohesive corrimunity, and bearing in mind the lessons of the past, a need to re-approach the task of sternming the tide of HIV infection in ways that are sensitive to the factors that adduce high-risk sexual behaviour.

This thesis explores the psychosocial dynamics of sexual risk-taking in men who have sex with men, with particular focus on the dilemmas that gay men face in establishing trust in themselves and reasonable trust and intimacy with their sexual partners. As well, the practical function of this study is to analyze past and current social marketing efforts aimed at reducing the spread of HIV/AIDS, and to offer suggestions for how to approach a strategy to reduce HIV incidence in gay men and at the same time bolster efforts to assist men who have sex with men (MSM) in adhering to safer sex guidelines. In part, this thesis uses a sample of participants of the Vanguard Project cohort (St. Paul's Hospital, Vancouver, British Columbia), in order to explore the social meanings attributed by MSM towards sex, risk, intimacy, and attitudes toward HIV/AIDS. Through the use of first-person narratives, this thesis examines the concordance or discordance of MSM beliefs and behaviour with long-standing theoretical models of harm reduction methods concerning sexual risk. The study reveals that, in great measure, due to past life course events, many gay men suffer from a lack of trust in themselves, which results in a tendency to make irrational or unreasonable decisions concerning their long-term sexual health, and a lack of trust in other gay men. As welL through the misguided and often untruthful health models that advocate fewer sexual partners and rely upon the false assumption that all potential sex partners are carriers of contagion, the sense of mistrust has been reinforced. The lack of confidence in self and others further translates into a suspicion of the motives and/or efficacy of social institutions entrusted with community health development and maintenance, rendering their efforts even less effective. Moreover, traditional harm reduction messages, especially 'fear campaigns', often act as a deterrent, rather than as an incentive, to harm reduction. Of more appeal are supportive harm reduction messages delivered by someone whom the recipient trusts, especially when the social meanings of sex, risk, trust and intimacy are, for many gay men, less fixed and more contingent than for the population at large. This means that attempts to modify risky behaviour must acknowledge and negotiate multiple meanings, shifting values and changing social climates, as well as routine epidemiological concerns. The research identifies four key themes within a problematic of trust, risk and intimacy, and delineates the harm reduction social complexities experienced by gay men in the study group; these recurring themes deal with family and early sociahzation, internalized homophobia, contingency and instability of meanings of risk, trust and sex, and the toistworthiness of the messengers of harm reduction strategies. Out of these recurring themes come a number of recommendations for remedial programs aimed at both mid- and long-term reductions in HIV incidence. The recommendations are grounded in the recognition that homophobic and/or dysfunctional social conditions are, to a great extent, implicated in sexual risk behaviour, and therefore must be eliminated or ameliorated before meaningful harm reduction gains can be realized. The discussions with the gay men in the study reveal their need for positive role models and communal social support in their efforts to combat HIV infection, suggesting a need to rethink the meanings of what it is to be gay, a need to redevelop and revitalize what was once a vibrant and cohesive corrimunity, and bearing in mind the lessons of the past, a need to re-approach the task of sternming the tide of HIV infection in ways that are sensitive to the factors that adduce high-risk sexual behaviour. / Arts, Faculty of / Sociology, Department of / Graduate

Background: Though there continues to be a significant amount of research aimed at understanding factors associated with participating in sexual risk behavior in populations of YBMSM, there has been far less research concerned with understanding how psychological distress may influence sexual risk behaviors and how emotional bond formation may affect the relationship between psychological distress and sexual risk behavior. This study aims to better understand the relationship between psychological distress and sexual risk behavior as well as the moderating effect of adult attachment insecurity on this relationship. Methods: Three data collection strategies were utilized to address the study aims: 1) cross-sectional (n = 228), 2) eight-week structured diary (n = 153), and 3) semi-structured interview (n = 30). The cross-sectional survey provided measurement information on adult attachment style using a modified version of the Experiences in Close Relationships Scale (ECR) that consists of the attachment avoidance and anxiety subscales, the Brief Symptoms Inventory (BSI) and the Kessler-10 (K10). Sexual risk was measured by assessing unprotected anal intercourse (UAI) and serodiscordant UAI in the last two months. The eight-week structured diary utilized weekly reports of UAI encounter vs. no UAI encounter, and serodiscordant UAI encounter vs. no serodiscordant UAI encounter. The K10 and the Profile of Moods (POMS) anxiety and depression subscales measured psychological distress. The semi-structured interview assessed childhood attachment. Regression analyses were used to analyze the cross-sectional data. Random effects and population average regression models were used to analyze the structured diary data. A thematic inductive analysis technique was utilized to analyze the qualitative data. Results: Overall, participants reported slightly elevated mean scores on the attachment anxiety subscale while scores on the attachment avoidance subscale remained low. Participants reported an average of two UAI partners in the last month and an average of 1.3 UAI encounters over the eight-week diary period. Psychological distress scores were slightly elevated in the cross-sectional survey and depression scores were elevated in the diary component. For Aim 1, men higher on attachment insecurity (anxiety and avoidance) had higher levels of general psychological distress, depression, and anxiety in comparison to men who were more secure. The qualitative data supported the quantitative findings and showed that subjective appraisal of traumatic events and sexual orientation disclosure may mediate the relationship between childhood attachment and adult mental health. For Aim 2, the quantitative findings suggested that attachment insecurity was not related to sexual risk behavior. However, the qualitative component suggested that participants who were anxious used sex as a means to try to create an emotional bond, while participants who were avoidant used sex as a means to feel good without wanting to create an emotional bond. Both anxious and avoidant men seemed to participate in more concurrent sexual relationships which could increase their likelihood of HIV/STI transmission. For Aim 3, men who were more depressed and had higher levels of general psychological distress were more likely to report a serodiscordant UAI encounter in a given week. The qualitative data supported the quantitative findings and suggested that men might use sex as a means of escape their negative mood. This model of "escapism" could have lead to participation in sexual practices that increased men's risk of HIV/STI transmission. For Aim 4, adult attachment insecurity did not moderate the relationship between psychological distress and sexual risk. The qualitative data suggested that secure attachment in childhood was important to adequately coping with stressful situations, which in turn promoted overall well-being. Conclusion: Study findings suggest that understanding adult attachment may lead to a better understanding of psychological distress and sexual risk behavior among YBMSM. The results highlight the importance of considering childhood and young adult emotional bond formation in the development of HIV/STI prevention intervention activities aimed at addressing the heightened rates of sexual risk behavior among YBMSM. This research could have valuable implications for the development of HIV/STI and mental health prevention interventions aimed at reducing sexual risk behaviors and promoting well-being in populations of YBMSM

No description available.

Background: The epidemic of HIV among MSM in China shows a hiking trend since 2003. The current intervention strategies in China lack effectiveness to curb the trend. It is imperative to review the interventions for HIV prevention among MSM in other countries to provide evidence for the future intervention design in China. Objectives: This study aimed to review the HIV prevention interventions among men who have sex with men(MSM) in order to identify appropriate intervention strategies and practices to be employed in China. Methods: Studies were searched in Pubmed database. Studies of interventions targeting MSM for HIV prevention among MSM in other countries were included in this systematic review. The search results were also filtered by the study type (i.e. RCT).The results and design of the studies were analyzed and discussed. Results: The studies in this review were analysed in terms of the study design, sampling method, retention and intervention strategies. High risk sexual activity, condom use, HIV testing and HIV knowledge were used as outcome measurements. The findings indicated that the interventions were in general effective in reducing the sexual risk behavior and increasing the intention to have a HIV test. The design of RCT offers stronger evidence of the intervention effects. The intervention strategies combined with internet were more personalized and confidential. Conclusions: Future intervention design in China could consider the strengths of interventions undertaken in other countries in order to improve the effectiveness and sustainability. In consideration of the context of China, this review made some suggestions for more effective implementation of interventions for HIV prevention among MSM in China. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Men who have sex with men (MSM) are a high risk group of human immunodeficiency virus (HIV) infection. Since 2003, HIV prevalence and incidence among MSM in China has increased alarmingly. And then numerous control measures targeting risk reduction of HIV infection among MSM have been implemented. However, previous studies varied in methodologies, prevention or interventions, and most studies only investigated one or several of control measures. Moreover, there are no existing systematic reviews on the effectiveness of integrated control measures against HIV infection. Therefore, this systematic review was conducted to assess the effectiveness of control measures against HIV infection among MSM in China, in terms of condom use, sexual behaviours, awareness of HIV knowledge, HIV counseling and testing, and HIV prevalence and incidence. Methods: A total of 154 articles were first retrieved from English database PubMed, and 114 articles from Chinese database CNKI. 19 English and Chinese articles that met the inclusion criteria were included in this systematically review. Results: The common control measures, including distribution and use of condoms and lubricant, high risk behavioural interventions, education of HIV knowledge, peer interventions, HIV testing and counseling, and MSM community or venue based interventions, are effective in increasing condom use in the anal sex, reducing risk sexual behaviours, improving awareness of HIV knowledge, and promoting the participation of HIV counseling and testing, which are all beneficial to prevent HIV infection among MSM. These findings may be influenced by the design of questions and the standard, and the response of MSM to questions. As for HIV prevalence and incidence, the effectiveness on them is uncertain, probably owing to inappropriate timing of conducting control measures, the short follow-up period, the small sample size or the scale of study. Future studies need to improve sampling method, and extend follow-up time and the study scale appropriately. Conclusion: Based on this systematic review, the control measures are effective in increasing condom use, reducing risk sexual behaviours, improving awareness of HIV knowledge and promoting the participation of HIV counseling and testing, while the effectiveness on HIV prevalence and incidence is uncertain among MSM in China. In future, more policy researches on HIV/AIDS burden, MSM and control measures are needed to provide an evidence base for policy change. In practice, policy makers and researchers need to promote structural control measures targeting different typologies of MSM. And the more effective way in conducting control measures needs the multi-sector cooperation, especially the cooperation between the governmental organizations and MSM community. / published_or_final_version / Public Health / Master / Master of Public Health

From the content analysis of 23 "classic" gay porn videos, produced by Falcon Studios, the emergence of the Falcon formula---a pornographic model of sex---is described in this thesis. This formula is analyzed with regard to the feminist critique of pornography and the assertions of gay advocates. Although the Falcon formula supports the feminist perspective with respect to the representations of sex practices, the linkage between femininity and getting fucked, as indicated by Dworkin, was not found in the selected Falcon videos. In fact, Falcon videos subvert this linkage by depicting masculine men fucking other masculine men. And, in accord with the claims of gay advocates, Falcon videos largely represent gay men having sex as opposed to straight men having homosexual sex. The Falcon formula appears to have developed not only in reaction to stigmatizing stereotypes of effeminate gay men and in reaction to the linkage between femininity and getting fucked, but also in response to the fantasy (of gay viewers) of being accepted into an exclusively male community.

As we enter the third decade of a devastating worldwide epidemic, much has been done to stem the flow of HIV/AIDS, in particular within North American and Western European urban centres. Successful prevention campaigns in the 1980s had the immediate impact of lowering the rate of HIV infection among gay men, and anti-retroviral drug therapies in the mid-1990s have literally brought thousands of gay men back from the brink. However, by the middle to late 1990s, epidemiological and anecdotal evidence has strongly suggested that gay men have begun to move away from the safer sex orthodoxy of the 1980s. / Forty gay men ranging in age from 21 to 55 were interviewed for this study in order to determine if they have changed their approach to safer sex strategies implemented in the mid-1980s. In contrast to approaches to risk behaviour that emphasize the Health Belief Model, with its focus on the rational individual, this dissertation focused on the social contexts that shape gay men's decisions. / This study found a number of factors that influenced gay men's sexual choices, including age and the changing role of community. Younger gay men, those who have come of age during the 1990s, have taken a different approach to the AIDS epidemic. None of the younger participants in this study had lost anyone to HIV. Furthermore, they were now part of a group of men who no longer considers a HIV diagnosis to be immediately fatal. New medications have definitely shifted their approach to AIDS. Finally, this group of gay men no longer feels defined by a gay community like older gay men interviewed for this study. They believe they are coming of age in a time and place where they have more choices in how they will define themselves as gay men. For older gay men, those who lost many lovers, friends, and acquaintances during the HIV epidemic, changes in gay men's sexual risk-taking are both surprising and inevitable. These men are dealing with issues of ageism, loss and lack of visibility in a changing gay community. / Although there are different age-related arguments for abandoning safer sex strategies, this study helps to explain why there is a definite shift in risk-taking behavior underway as we enter the third decade of HIV/AIDS. It suggests new challenges and approaches for AIDS service organizations to deal with a substantive change in gay men's sexual behaviour.

No description available.