The Swedish Sex Purchase Act was unique, when introduced in 1999. While it was legal to demand and collect payment for sexual services it became a crime to respond to such demands or offer payment. It is now part of Sweden’s foreign policy to ‘export’ this law, using gender equality arguments. Several countries have since followed. The law is often portrayed as a triumph of feminism and women’s political struggles. The law is gender neutral however and applies equally to e.g. MSM sex trade (Men who have Sex with Men), a phenomenon that the normal gender equality arguments do not capture. ‘Homosexual prostitution’ was initially argued in the legislative proceedings, to be so different from heterosexual prostitution, that the scientific investigator raised concerns if one-sided criminalisation was considered by legislators. Yet, this is what happened. This study traces exactly how this came to be, analysing legislative documents and debates, focusing on heteronormative reasonings. In the final round of legislation the question had entirely disappeared. MSM sex trade or culture was not even mentioned and can be seen as heteronormative collateral damage.

Following the wake of the AIDS-catastrophe in the beginning of the eighties, homosexual men or 'men who have sex with men' (MSM) have been barred from donating blood throughout the planet. In this thesis I look into the different discourses at play in the context of creating the legal framework for blood donation in Sweden. Genealogically tracing the emergence of the category of MSM and mapping how the category is brought to use in contemporary negotiations on blood safety, I scrutinize how scientific truth is established within blood transfusion practice. I argue that the rationality of risk group exclusion is contingent on economical grounds, and that the foucauldian concept of biopolitics could productively be used to understand this rationality. In particular, the concept of the 'biopolitics of blood' can be employed in order to understand the reluctance from the involved actors to acknowledge the heteronormative consequences of the legal framework of contemporary blood donation. / Sedan HIV-virusets uppkomst i början av åttiotalet har homosexuella män eller 'män som har sex med män' (MSM) uteslutits från blodgivning. I den här uppsatsen tittar jag på de sexualitetsdiskurser som cirkulerar i de sammanhang där dessa regler utvecklas. Genom att genealogiskt spåra uppkomsten av kategorin MSM och sedan följa hur den används i samtida förhandlingar om blodsäkerhet undersöker jag hur vetenskaplig sanning etableras inom svensk blodtransfusion. Jag menar att riskgruppslogiken till viss del vilar på ekonomiska grunder, samt att begreppet 'blodets biopolitik' produktivt kan användas för att förstå den motvilja som de inblandade aktörerna visar mot att erkänna de heteronormativa konsekvenser som dagens lagstiftning kring blodgivning har.

To date, traditional behavioral interventions have done little to reduce the prevalence and transmission of HIV among African American men who have sex with men (AAMSM), a highly at risk group. Some researchers theorize that the lack of success may be because these interventions do not address contextual factors among AAMSM. Community-based participatory research (CBPR) is one approach to research with the potential to lead to effective interventions in the future. CBPR is a collaborative, mixed-methods and multidisciplinary, approach to scientific inquiry, which is conducted with, and within, the community. The current study follows the CBPR approach to engage and develop a relationship with the African American communities in the Dallas/Fort Worth Metroplex. Contextual issues were discussed in order to identify emerging themes regarding HIV health related issues among AAMSM to provide the groundwork for continued CBPR research and future interventions with AAMSM in the Dallas/Fort Worth Metroplex. To accomplish this goal, researchers began the CBPR process by conducting interviews and focus groups with a sample of approximately 62 (34 from key informant interviews, 28 from focus groups [gender balanced]) AIDS service organization leaders and workers, advocates, medical doctors and community members with first-hand knowledge of HIV health issues in the AAMSM community. Transcripts of these interviews and focus groups were analyzed to identify emerging themes at the societal (religious doctrine, African American Culture, age-related norms and stigma), community (education, religious views/policy and community norms) and individual (disclosure, personal identity, sexual behavior/risk, accessing care and communication) levels. This data was used to create a holistic narrative report that will be used to direct the community advisory board (CAB) and guide future research and interventions.

Une équipe multidisciplinaire et intersectorielle a implanté en 2009 une recherche-intervention novatrice : Spot, un service de dépistage rapide du VIH en milieu communautaire offert aux hommes ayant des relations sexuelles avec d’autres hommes de Montréal. Une étude de cas a été menée afin de décrire le processus d’implantation de Spot et les facteurs contextuels qui l’ont affecté. L’analyse par théorisation ancrée des entrevues, l’observation participante et l’analyse documentaire ont permis d’identifier un processus d’implantation dynamique en plusieurs phases. Elles sont modulées par des facteurs liés aux motivations des acteurs à s’engager dans le projet, à la complexité des dynamiques partenariales et aux défis de la coordination en contexte d’équipe multidisciplinaire et intersectorielle et à d’autres facteurs ayant affecté l’organisation de l’équipe terrain et leurs pratiques au quotidien. Des motivations telles l’occasion unique de contribuer à la mise en place d’un projet de prévention novateur et pertinent, ont eu une influence favorable constante, ralliant les acteurs autour du projet et maintenant leur implication malgré les difficultés rencontrées. Sur le plan des dynamiques partenariales, une définition floue des rôles et tâches a ralenti l’implantation du projet, alors qu’une fois clarifiée, chacun a pu se sentir légitime et participer activement à la réussite de l’implantation. Des difficultés à la coordination du projet, entre autres concernant la gestion des fonds interinstitutionnels, sont un facteur ayant ralenti le processus d’implantation. Cette étude a permis de tirer des leçons sur l’implantation et la pérennisation d’un service de dépistage rapide du VIH en milieu communautaire gai. / In 2009, a multidisciplinary and intersectoral team implemented an innovative research-intervention project: Spot, a community-based rapid HIV testing service for men who have sex with men in Montreal. A case study was undertaken to describe the implementation process of Spot and the contextual factors that affected it. Grounded theory analysis of interviews, participant-observer, and a document analysis allowed the identification of a multistage dynamic implementation process. These stages were influenced by stakeholders’ motivations, the complexity of partnership dynamics, the challenges surrounding coordination and organization of staff members, as well as factors influencing staff members’ daily practices. Motivations like the unique opportunity to contribute to the implementation of an innovative and relevant prevention project, had a constant and positive influence, which united stakeholders in the project and maintained their involvement despite the difficulties. In terms of partnership dynamics, vague definitions of roles and tasks delayed the implementation of the project, although once clarified, everyone felt legitimate and actively participated in the success of the implantation. The management of interinstitutional funds was mentioned as one of the difficulties of coordinating the project and a factor that caused delays in the implementation process. This study allowed learning about the implementation and sustainability of a gay community-based rapid HIV testing service.

Our understanding of humoral immune response to human papillomavirus (HPV) infection has been mainly derived from studies in women. Very little is known about humoral immune response to HPV in men. There is also a growing interest in understanding the burden of HPV exposure in the subgroups of the male population, including men who have sex with women (MSW), men who have sex with men (MSM) and men who have sex with both men and women (MSMW). This dissertation was undertaken to understand and characterize humoral immune response, measured by detectable serum antibody IgG, to HPV 6, 11, 16 and 18 infection, to estimates seroprevalence of HPV 6, 11, 16 and 18, to determine the associations of sociodemographic and sexual behavioral factors with seroprevalence of individual HPV types, and to evaluate the role of serum antibodies in the subsequent acquisition of infection with the same HPV type, genetically related and un-related HPV types. Three studies that compose of this dissertation were conducted within the framework of two longitudinal studies of HPV infection in men: a single-site natural history study of male residents of Tucson, Arizona (the 1st study: N=285); and a multinational natural history study of healthy men residing in São Paulo, Brazil, Cuernavaca, Mexico, and Tampa, Florida (the 2nd study: N=1477; the 3rd study: N=2187). Men were recruited using similar eligibility criteria in both natural history studies and followed every 6 months for a maximum of 18 months in the single-site study and 48 months in the multi-national study. HPV DNA status was assessed using the PGMY09/11 L1 consensus primer system and the Linear Array HPV Genotyping Protocol. Testing of serum antibodies to HPV 6, 11, 16 and 18 was performed with virus-like particle-based ELISA assays. Data from our studies indicate that exposure to HPV 6, 11, 16 and 18, the four HPV types targeted in the currently license HPV vaccines, is common. Of 285 male residents of Tucson, Arizona, 28.8% of them were seropositive to HPV 16 and/or 18 at study entry. Similarly, approximately one third of 1477 participants of the multi-national male HPV natural history study were seropositive to at least one vaccine HPV type, with the percentage of 21.8% in U.S. site, 33.4% in Mexico site, and 49.1% in Brazil site. It is also noted that seroprevalence of individual vaccine HPV types is greatly elevated among men of different sexual practices. Seroprevalence of HPV 6, 11, 16 and/or 18 was twice as high among MSM and MSMW compared to MSW. Likewise, seroprevalence of individual HPV types was two fold or higher among MSW and MSMW. Our findings suggest that the predominant predictors of seropositivity to HPV 6, 11, 16 and 18 are age and same-sex sexual behaviors. Seroprevalence increased with age among young-to-middle-aged men with significant upward age trends observed for HPV 11, 16 and 18. MSM, compared to MSW, more likely to be seropositive to HPV 16 or 18. Similarly, men who practiced same-sex anal sex, compared to those who did not, were significantly more likely to be seropositive to HPV 6, 11, 16 and 18, respectively. Among 276 men free of HPV 16 at enrollment in Tucson, We did not detect statistically significant associations between the baseline serum antibodies to HPV 16 and/or 18 and subsequent risk of infection with homogeneous HPV types or related-HPV types. Of 2187 men residing in three countries who tested HPV 16 negative at enrollment, the risk of subsequent HPV 16 infection was not associated with enrollment HPV 16 serum antibodies status. Our data provide important estimates of population exposure to vaccine HPV types for future studies modeling potential vaccine impact and vaccine cost effectiveness in men. Our findings also support strategic vaccination of males as an effective preventive measure for HPV-related diseases and cancers in men and their sex partners, men and women alike.

Une équipe multidisciplinaire et intersectorielle a implanté en 2009 une recherche-intervention novatrice : Spot, un service de dépistage rapide du VIH en milieu communautaire offert aux hommes ayant des relations sexuelles avec d’autres hommes de Montréal. Une étude de cas a été menée afin de décrire le processus d’implantation de Spot et les facteurs contextuels qui l’ont affecté. L’analyse par théorisation ancrée des entrevues, l’observation participante et l’analyse documentaire ont permis d’identifier un processus d’implantation dynamique en plusieurs phases. Elles sont modulées par des facteurs liés aux motivations des acteurs à s’engager dans le projet, à la complexité des dynamiques partenariales et aux défis de la coordination en contexte d’équipe multidisciplinaire et intersectorielle et à d’autres facteurs ayant affecté l’organisation de l’équipe terrain et leurs pratiques au quotidien. Des motivations telles l’occasion unique de contribuer à la mise en place d’un projet de prévention novateur et pertinent, ont eu une influence favorable constante, ralliant les acteurs autour du projet et maintenant leur implication malgré les difficultés rencontrées. Sur le plan des dynamiques partenariales, une définition floue des rôles et tâches a ralenti l’implantation du projet, alors qu’une fois clarifiée, chacun a pu se sentir légitime et participer activement à la réussite de l’implantation. Des difficultés à la coordination du projet, entre autres concernant la gestion des fonds interinstitutionnels, sont un facteur ayant ralenti le processus d’implantation. Cette étude a permis de tirer des leçons sur l’implantation et la pérennisation d’un service de dépistage rapide du VIH en milieu communautaire gai. / In 2009, a multidisciplinary and intersectoral team implemented an innovative research-intervention project: Spot, a community-based rapid HIV testing service for men who have sex with men in Montreal. A case study was undertaken to describe the implementation process of Spot and the contextual factors that affected it. Grounded theory analysis of interviews, participant-observer, and a document analysis allowed the identification of a multistage dynamic implementation process. These stages were influenced by stakeholders’ motivations, the complexity of partnership dynamics, the challenges surrounding coordination and organization of staff members, as well as factors influencing staff members’ daily practices. Motivations like the unique opportunity to contribute to the implementation of an innovative and relevant prevention project, had a constant and positive influence, which united stakeholders in the project and maintained their involvement despite the difficulties. In terms of partnership dynamics, vague definitions of roles and tasks delayed the implementation of the project, although once clarified, everyone felt legitimate and actively participated in the success of the implantation. The management of interinstitutional funds was mentioned as one of the difficulties of coordinating the project and a factor that caused delays in the implementation process. This study allowed learning about the implementation and sustainability of a gay community-based rapid HIV testing service.

Depuis 2007, la réglementation sur le cadre du dépistage en France évolue et se montre favorable à la création d’expérimentations de dépistage communautaire. Cette recherche propose une analyse psychosociale des expériences de dépistage dans le cadre de deux protocoles expérimentaux: ANRS Com’Test et ANRS DragTest. Les objectifs principaux des protocoles sont (1) l’étude de la faisabilité d’un dépistage rapide du VIH effectué par des acteurs communautaires non médicaux (association de lutte contre le sida Aides), auprès des hommes ayant des rapports sexuels avec des hommes, en utilisant les tests rapides d’orientation diagnostique et le counselling motivationnel (ANRS Com’Test), et (2) l’évaluation de la non infériorité de cette proposition en comparaison avec une offre classique (ANRS DragTest).L’objectif de cette étude est de comprendre les significations attribuées aux expériences vécues à partir d’une lecture ternaire (sujet-objet-contexte) et d’une articulation entre vécu et représentations sociales. La recherche s’appuie sur une méthodologie qualitative incluant d’une part une analyse longitudinale de l’expérience des acteurs associatifs, et d’autre part une analyse transversale du vécu des personnes dépistées. La triangulation des matériaux de recueil et des méthodes d’analyse apporte un double regard sur les données. En effet, les résultats montrent à la fois la mobilisation des univers de références communs, et l’implication de l’expérience vécue dans la construction et la communication de l’expérience. / Since 2007, regulation on the part of the screening in France evolves and is favourable to the creation of community screening experiments. From a psychosocial perspective, this study analyzes screening experiences in two experimental protocols’ context: ANRS Com’Test and ANRS DragTest. The main objectives of the protocols are (1) to study the feasibility of a rapid HIV testing performed by non-medical community actors (association against Aids AIDES) among men who have sex with men, using rapid testing policy diagnostic and motivational counselling (ANRS Com'Test), and (2) to evaluate the non-inferiority of the proposal in comparison with a conventional supply (ANRS DragTest).The purpose of this study is to understand the lived experience’s meaning from a ternary reading (subject-object-context) and a link between experience and social representations. Research is based on a qualitative methodology, both including a longitudinal analysis of community actors involved, and also a cross-sectional analysis of those screened’ lived experiences. Triangulation of material collection and analytical methods brings a dual perspective on the data. Analyzes are showing both the mobilization of common references universes, and the involvement of lived experience in the construction and communication of experience.

Contexte. L’émergence de la pandémie de COVID-19 a suscité des comparaisons avec d’autres épidémies, et en particulier celle du VIH/sida. Ces parallèles historiques ont toutefois leurs limites, notamment au Québec, où l’histoire des premières années de la réponse au sida a peu été étudiée, y compris au sein de sa population la plus touchée : les homosexuels. Ce projet de recherche documente cette histoire à partir du point de vue de ses principaux acteurs, en s’interrogeant notamment sur un potentiel « retard » de la mobilisation et sur l’impact des questions d’identité sexuelle sur les temporalités de cette réponse. Méthodologie. Cette étude qualitative s’appuie sur une démarche socio-historique. Dans cet esprit, les données mobilisées sont tant des sources documentaires et archivistiques que des sources orales. En effet, en plus d’une revue de la littérature, des fonds de la collection « sida » des Archives gaies du Québec ont été examinés et des entrevues semi-dirigées ont été menées auprès de quinze intervenants issus des milieux politique, communautaire, scientifique et médiatique ayant joué un rôle actif dans cette mobilisation. Résultats. Le projet a permis de déterminer comment s’est construite la réponse à cette épidémie au Québec. Il ressort d’abord que la mobilisation de professionnels de la santé a devancé celle des communautés touchées. Par ailleurs, les premiers groupes communautaires de lutte contre le sida ont été créés au sein d’organisations homosexuelles en 1983, mais la lutte communautaire contre le sida s’est dissociée du mouvement homosexuel dès 1985. À partir de 1987, un morcellement des organismes communautaires est survenu en raison de tensions linguistiques, identitaires et directionnelles. En ce qui concerne le milieu politique québécois, il est resté en retrait dans les premières années de l’épidémie, et il a fallu attendre 7 ans avant qu’il ne mette en place une politique structurée de lutte contre le sida dans la province. L’étude a également permis de faire ressortir des spécificités de la réponse québécoise à l’épidémie. Conclusion. L’analyse de la réponse à l’épidémie du sida au Québec éclaire sous un nouveau jour la notion de retard dans la mobilisation contre le VIH/sida qui a été observée dans presque tous les pays industrialisés. / Background. The emergence of the COVID-19 pandemic has prompted comparisons with other epidemics, like that of HIV/AIDS. However, these historical parallels have their limits, particularly in Québec, where the history of the early years of the AIDS response has barely been studied, including within its most affected population: homosexuals. The research project documents this history from the point of view of its main actors, by questioning the potential “delay” of the mobilization and the impact of sexual identity on the temporalities of this response. Methods. This qualitative study is based on a social history approach. For this reason, the data stems both from documentary and archival sources, as well as oral sources. Indeed, in addition to a literature review, the “AIDS” collection of the Archives gaies du Québec was examined, and semi-structured interviews were conducted with fifteen individuals from the political, community, scientific and media sectors who played an active role in this mobilization. Results. The project established how the response to this epidemic was developed in the province. Firstly, it appears the mobilization of health professionals preceded that of the affected communities. In addition, the first community-based AIDS groups were created in 1983 within homosexual organizations, but they separated from the homosexual movement in 1985. From 1987 onwards, a fragmentation of organizations occurred due to linguistic, identity and directional tensions. As for the Québec political milieu, it remained in the background in the early years of the epidemic, and it took seven years before it implemented a structured policy to fight AIDS in the province. The study also highlighted specificities of the Québec response to the epidemic. Conclusion. The analysis of the response to the AIDS epidemic in Québec sheds a new light on the notion of delay in the mobilization against HIV/AIDS that was observed in almost all industrialized countries.

Evidence of male sex work has a history as long as female sex work. There is century old evidence of male Sumarians and Greeks selling sex to other men. Men are today still selling sex to other men. This study showed that the elimination of sex work is practically impossible, and could only be accomplished by the gross denial of basic human rights. Male sex workers have not received the same attention from researchers as have their female counterparts. This is so despite the large numbers of male sex workers in cities all over the world who potentially contribute to the worldwide sexually transmitted infection rates. It is known that wherever indiscriminate sexual activities take place, the risk of transmission of infections are greater. The activities between the male sex worker and his client(s) determine the health problems they are exposed to. The purpose of this research was to determine what transpires between male sex workers and their client(s) in order to provide the sex workers with knowledge to better take care of their own health as well as the health of their clients. A qualitative research design was used to collect data by means of in-depth interviews and participant observation sessions. Research strategies that were also used included: description, ethnography, phenomenology, and the biographic methods of qualitative research. The research revealed that men who have sex with men (MSM) were exposed to forty-nine different preventable sexually transmitted infections including HIV/AIDS, trauma, violence, and alcohol and drug abuse. All these conditions relate to the lifestyle and activities of male sex workers. Recommendations were made regarding the removal of factors that hinder the delivery of programmes on safer sex to MSM. A booklet on safer sex for MSM was compiled by the researcher and distributed to all informants upon completion of the research. The neglected topic of male sex work was highlighted and health practitioners and other decision makers can now use the information in this thesis to make a contribution towards the better management of male sex work in South Africa in the interest of public health. / Health Studies / D.Litt et Phil. (Health Studies)

The term 'men who have sex with men' (MSM) as commonly used by HIV/AIDS researchers and policy makers is said to describe an obvious group of men. Or does it? While MSM disrupts the homosexual/heterosexual dichotomy through focusing on sexual practices rather than sexual identity, it remains entrenched in binary understandings of sex and gender. Influenced by queer and trans theories, a genderqueer methodology is employed to examine what discourses are deployed when MSM are categorized as a seemingly homogenous group. Who are the “men” in MSM and what are the material consequences of MSM discourse in HIV/AIDS work? Guided by feminist poststructural and Foucauldian theories, this study highlights how MSM discourse functions to exclude trans, intersex, and other non-normative sexed and gendered people while considering the potentially deadly effects of this discourse on those outside of MSM categorizations particularly focusing on its use in the Canadian Guidelines on STIs.