abstract: The Centers for Disease Control and Prevention (2017) note that gay, bisexual, and other men who have sex with men (collectively referred to as MSM) face more barriers to accessing health care compared to other men. Such barriers include, lack of cultural- and sexual identity-appropriate medical and support services, concerns about confidentiality, and fear of discussing sexual practices or orientation in a medical setting. In comparison to other MSM populations, Latino MSM (LMSM) report having the least amount of access to health care (McKirnan et al., 2012). The purpose of the present study is to elucidate how individual- (i.e., age, education level, and income level), community- (i.e., social support and neighborhood collective efficacy), and sociocultural-level factors (i.e., immigration status, heterosexual self-presentation, sexual identity commitment, sexual identity exploration, and ethnic identity affirmation and belonging) may relate with perceived access to healthcare. It is hypothesized that ethnic identity affirmation and belonging will moderate relations between the aforementioned predictors and perceived access to health care based on increasing evidence that ethnic identity, or one’s sense of affirmation and belonging to one’s ethnic group, may be a health protective factor. Among a sample of 469 LMSM, this study found that there were several predictors across all three levels (i.e., individual, community, and sociocultural) of perceived access to healthcare. Additionally, data supported evidence that ethnic identity affirmation and belonging (Phinney, 2003) acts as a moderator of other predictors of perceived access to healthcare in this sample. These findings can inform outreach interventions of researchers and healthcare providers about psychosocial and cultural barriers and facilitators of access to healthcare. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2020

Background. Despite the prevalence of sex work and strip clubs across Canadian urban geographies, few studies explore the occupational health and safety outcomes related to indoor male sex work, let alone male stripping whereby men dance for men. Moreover, the sexual service negotiation process in the sex work industry remains to be explored. In knowing that sexual practices with high HIV/STI rates occur in strip clubs (e.g., condomless oral, vaginal, and anal sex), as well as widespread psychoactive substance use among strippers, the purpose of this study was to explore the cultural features of male strippers’ work that impact their health and safety outcomes. Methodology. For this study, we recruited 14 male strippers working with male clients in a Canadian city. Critical ethnography was our espoused methodology. Through field observations, informal conversations, questionnaires, and semi-structured qualitative interviews, we explored the process of sexual transactions between strippers and clients. We used a postmodern angle to interpret our findings through the works of Deleuze, Guattari, and Foucault. Findings. The male strip club is a social matrix produced by the intersection of motivational forces: the motivation to gain money, pleasure, or intimacy, and the motivation to abide by socio-cultural and legal norms. It is upon a matrix of financial necessity and socio-cultural and legal constraints that sex work transactions unfold in the club. Moreover, the club’s health and safety conditions and strippers’ transaction outcomes result from intersecting motivations. Finally, sexual service negotiation is a process of configuring motivational forces between social agents. The motivation for financial gain revealed itself to be the strongest and most consistent force; the focus on capital gain generated asymmetrical connections between strippers, clients, and business entrepreneurs, resulting in specific health and safety outcomes. Conclusion. The Canadian legal and political context surrounding male sex work negatively impacts male strippers’ occupational health and safety conditions by disabling safe connections with clients. Further, the emphasis on money-making activities encourages strippers to value financial gain over their physical and mental integrity. In short, the male strip club work environment is configured in a manner whereby capital gain is prioritized and strippers’ health and safety is undermined.

Background: Nurses work closely with patients to improve care and alleviate suffering among PLHIV. However, the segregation of MSM in society and the criminalization of same-sex behaviours have caused great havoc causing deaths and suffering in developing countries for more than three decades since the scourge of HIV/AIDS emerged. Aim: The study aimed to illuminate the caring encounters in nursing management of HIV/AIDS among MSM living in Nairobi, Kenya. Method: Five semi-structured interviews were conducted to nurses and data analysed through thematic analysis. Results: Four themes were constructed; the importance of holistic care approach, operanalization of empowerment, the need for sensitization, and living in segregation. Eight sub-themes were formulated: achieving positive patient ́s wellbeing, effective nurse-patient relationship, improving health awareness, provision of social support, conflicts of values, judgmental nurses, rejection of MSM in the society, and rampant discrimination of MSM. Conclusion: Sensitized nurses on MSM sexual behaviours provide holistic care and empower MSM in the management of HIV/AIDS, unlike the ones who still hold onto homophobic prejudice based on religious, cultural and personal beliefs. The study recommends the training of nurses to be aware of the harmful societal attitudes, beliefs, rejection, and discrimination that hinders the effective management of HIV/AIDS. / Bakgrund: Sjuksköterskor arbetar nära medpatienterna för att förbättra omvårdnad och lindra lidandet bland de som lever med HIV/AIDS. Dock orsakar segregeringen av MSM i samhället och kriminaliseringen av samkönat sexbeteende avsevärt kaos vilket orsakar död och lidande i utvecklingsländer i mer än tre decennier sedan plågan av HIV/AIDS börjande. Syfte: Studien syftar till att belysa bemötande vid omvårdnaden vid hanteringen av HIV/AIDS bland MSM som bor i Nairobi, Kenya. Metod: Fem semistrukturerade intervjuer utfördes med sjuksköterskor och data analyserades medelst tematisk analys. Resultat: Fyra teman identifierades: vikten av holistiskt tillvägagångssätt vid omvårdnad, operalisering av bemyndigande, behovet av sensibilisering, och att leva i segregering. Åtta underteman formulerades: att uppnå positivt välbefinnande hos patienter, effektiva sjuksköterska-patient-förhållanden, förbättra hälsomedvetenhet, tillhandahållande av socialt stöd, värdekonflikter, fördömande sjuksköterskor, förkastande av MSM i samhället, och utbredd diskriminering av MSM. Slutsats: Sensibiliserade sjuksköterskor avseende sexuella beteenden hos MSM tillhandahåller holistisk omvårdnad och bemyndigar MSM i hanterandet av HIV/AIDS, till skillnad från de som håller fast vid homofobiska fördomar baserade på religiösa, kulturella och personliga övertygelser. Studien rekommenderar att utbildningen av sjuksköterskor uppmärksammar skadliga sociala attityder, övertygelse, förkastelse, och diskriminering som hindrar effektiv hantering av HIV/AIDS.

The purpose of this study was to investigate the relationships among cultural/spiritual beliefs, risk behaviors, and disclosure among Hispanic/Latino men who have sex with men and women (MSMW). Minority men who have sex with men are disproportionately affected by HIV, in particular MSM who are Hispanic/Latino or African American. Limited research is available on the link between Hispanic/Latino MSMW, their cultural/spiritual beliefs, risk behavior, and disclosure about risk behaviors to friends and family. The data were obtained from the SJS Project, which used survey methods to gather data on participants from all 50 states and Puerto Rico. Among the participants in this project, 354 indicated that Hispanic/Latino was their only race/ethnicity, 264 identified as gay (MSM), 23 identified as bisexual (MSMW) and 67 identified as some other sexuality, and thus were not included in the analysis. Chi-square analysis and multiple linear regression were used to analyze the data and test the hypotheses. Among the bisexual group, the results showed no relationship between the independent variable, cultural/spiritual beliefs, and the dependent variable, disclosure. Among the gay group, the results showed a moderate relationship on one item of the independent variable, cultural/spiritual belief, and one item of the dependent variable, self-disclosure. Thus there is a relationship between disclosing to friends, family and the neighborhood and feeling supported by family among the gay group. It is expected that these findings will inform public health practitioners who have an interest in creating and implementing HIV prevention programs geared toward the Hispanic/Latino members of the LGBT community and Hispanics/Latinos.

Les hommes ayant des rapports sexuels avec des hommes (HSH) sont les plus touchés par le VIH. La prévention du VIH dans cette population doit aujourd'hui se diversifier grâce à divers outils visant à réduire le risque : traitement des personnes séropositives, traitement préventif chez les personnes séronégatives, et comportements de réduction des risques sexuels. Le dépistage du VIH est alors un enjeu crucial de la prévention.La diversification de l'offre de dépistage en France, notamment grâce au dépistage rapide et communautaire, est un résultat majeur de cette thèse. D'autres problématiques sont également investiguées : le recours au dépistage du VIH chez les HSH vivant au Cameroun et l'intérêt pour la recherche en prévention chez les HSH en France.Tous ces résultats sont confrontés les uns aux autres et sont mis en perspective, en termes de recherches à mener mais aussi en termes de recommandations pour les politiques de prévention à destination des HSH. / Men who have sex with men (MSM) are the most affected by HIV. In this population, HIV prevention must be diversified, using several tools aiming to reduce risks: treatment of HIV positive persons, preventive treatment among HIV negative persons and, sexual risk reduction behaviours. HIV testing thus becomes the cornerstone of HIV prevention.Diversifying HIV testing is one of the most important results of this thesis. Other questions are also addressed: access to HIV testing among MSM living in Cameroon and interest in prevention research among MSM in France.The discussion of all these results leads to several perspectives in terms of researches that should be conducted, but also in terms of recommendations for prevention policies towards MSM.

Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable health outcomes. Although men who have sex with men (MSM) are at elevated risk for HIV infection in India in comparison with the general population, there is a lack of MSM-focused research—particularly regarding stigma and mental health outcomes. This dissertation aimed to explore the influence of sexual stigma, gender non-conformity stigma and HIV-related stigma on depression and life satisfaction among MSM in South India. This study used a cross-sectional survey design and was conducted with MSM (n=200) in two locations in Tamil Nadu, South India: Chennai (urban) and Kumbakonam (semi-urban). Due to multicollinearity between sexual stigma and gender non-conformity stigma, the stronger predictor of each outcome (gender non-conformity stigma) was included in regression models. Results were analyzed to identify the associations between independent (gender non-conformity stigma, HIV-related stigma), moderator (social support, resilient coping) and dependent (depression, life satisfaction) variables. Due to significant differences between locations across a substantial number of variables, block regression analyses were conducted separately for each location. Higher levels of depression were predicted by gender non-conformity stigma in both locations, and also by HIV-related stigma in Kumbakonam. Lower levels of depression in both locations were predicted by higher levels of social support and resilient coping. Higher life satisfaction was predicted by social support and resilient coping in both Chennai and Kumbakonam. Lower life satisfaction was predicted by gender non-conformity stigma and HIV-related stigma in Kumbakonam, but not in Chennai. Social support and resilient coping did not moderate the impact of stigma(s) on depression or life satisfaction in either location. The results indicate that the majority of participants experienced stigmatization based on same-sex sexual behaviour and/or gender non-conformity. Another striking finding of the study was the alarmingly high rates of depression, whereby over half of participants in each region reported moderate to severe depression scores. Practice and policy implications include the development, implementation and evaluation of: multi-level stigma reduction interventions that account for socio-environmental and contextual factors; mental health interventions that promote resiliency and build social support; and policy initiatives to advance human rights protection.

Marginalization and stigmatization heighten the vulnerability of sexual minorities to inequitable health outcomes. Although men who have sex with men (MSM) are at elevated risk for HIV infection in India in comparison with the general population, there is a lack of MSM-focused research—particularly regarding stigma and mental health outcomes. This dissertation aimed to explore the influence of sexual stigma, gender non-conformity stigma and HIV-related stigma on depression and life satisfaction among MSM in South India. This study used a cross-sectional survey design and was conducted with MSM (n=200) in two locations in Tamil Nadu, South India: Chennai (urban) and Kumbakonam (semi-urban). Due to multicollinearity between sexual stigma and gender non-conformity stigma, the stronger predictor of each outcome (gender non-conformity stigma) was included in regression models. Results were analyzed to identify the associations between independent (gender non-conformity stigma, HIV-related stigma), moderator (social support, resilient coping) and dependent (depression, life satisfaction) variables. Due to significant differences between locations across a substantial number of variables, block regression analyses were conducted separately for each location. Higher levels of depression were predicted by gender non-conformity stigma in both locations, and also by HIV-related stigma in Kumbakonam. Lower levels of depression in both locations were predicted by higher levels of social support and resilient coping. Higher life satisfaction was predicted by social support and resilient coping in both Chennai and Kumbakonam. Lower life satisfaction was predicted by gender non-conformity stigma and HIV-related stigma in Kumbakonam, but not in Chennai. Social support and resilient coping did not moderate the impact of stigma(s) on depression or life satisfaction in either location. The results indicate that the majority of participants experienced stigmatization based on same-sex sexual behaviour and/or gender non-conformity. Another striking finding of the study was the alarmingly high rates of depression, whereby over half of participants in each region reported moderate to severe depression scores. Practice and policy implications include the development, implementation and evaluation of: multi-level stigma reduction interventions that account for socio-environmental and contextual factors; mental health interventions that promote resiliency and build social support; and policy initiatives to advance human rights protection.

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.

Syftet med denna studie är att utifrån ett socialkonstruktionistiskt perspektiv undersöka på vilka sätt fenomenet kemsex skildras i dags- och veckopress och hur information från stödmottagning för sexuell hälsa är utformad. Kemsex är en typ av sexualiserat drogbruk och förekommer främst bland män som har sex med män. Det är ett komplext fenomen och en del av problematiken är att fenomenet berör olika discipliner. Att det berör olika discipliner resulterar i att målgruppens potentiella problematik kan beröra såväl missbruk som risktagande inom sex. Inom det sociala arbetet har fenomenet nyligen uppmärksammats av både professionella och i tidningsartiklar, men det finns en avsaknad av kunskap. Denna avsaknad av kunskap leder också till förutfattade meningar om både målgruppen och fenomenet. Dessutom stigmatiseras målgruppen då de både är en minoritetsgrupp och ägnar sig åt icke-normativt sex som innefattar droger. Studiens teoretiska ramverk innefattar därför teorier om normer, avvikelse och interaktion i förhållande till sex, samt teorier inom skadereducerande arbete. Tillvägagångssättet är en dokumentstudie av dags- och veckopress, samt hemsidan av Sexperternas samtalsmottagning. Analysmetoden är en latent tematisk analys, som inneburit en djupgående bearbetning av materialet som utmynnat i tre huvudteman. Resultatet visar på att det finns en övervägande negativ syn på kemsex i tidningsartiklar, men att Sexperternas hemsida och professionella strävar efter ett icke-dömande förhållningssätt. Det empiriska materialet beskriver endast kemsex i relation till män som har sex med män.

La PrEP pourrait avoir un impact sur la perception du risque du VIH et ainsi influencer les comportements sexuels d’hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec d’autres hommes (gbHARSAH). Les buts de l’étude étaient 1) de comparer les caractéristiques sociodémographiques, les habitudes de vie, les comportements sexuels et relationnels, les antécédents d’infections transmissibles sexuellement et des facteurs psychosociaux liés à la prise de risque d’hommes gbHARSAH en fonction de la perception du risque du VIH et 2) d’examiner l’association entre cette perception du risque et les relations anales sans condom (RASC) selon l'utilisation de la PrEP. Cette étude descriptive corrélative consistait en une analyse secondaire de l’étude ENGAGE réalisée auprès de 945 hommes gbHARSAH. Comparativement au groupe qui se percevait moins à risque du VIH (n = 773), celui qui se percevait plus à risque (n = 172) différait quant aux comportements sexuels. Dans l’analyse non stratifiée, le risque perçu élevé du VIH était associé aux RASC (RC = 2,87; 95 % IC = 1,84 - 4,47) et l’utilisation de la PrEP était associée aux RASC (RC = 12,75; 95 % IC = 3,43 - 47,41). Dans l’analyse stratifiée, parmi les hommes qui n’étaient pas sous PrEP, seule l’association entre le risque perçu élevé du VIH et des RASC était maintenue (RC = 2,91; 95 % IC = 1,86 - 4,57). Cette étude montre l’influence de la perception du risque sur les comportements sexuels, suggérant ainsi la pertinence d’une approche globale de la prévention du VIH. / PrEP may impact self-perceived risk for HIV infection and influence the sexual behaviors among gay, bisexual and other men who have sex with men (gbMSM). The aims of this study were 1) to compare the sociodemographic characteristics and lifestyles, sexual and relational behaviors, history of sexually transmitted and blood-borne infections, and psychosocial factors related to risk-taking behaviors of gbMSM according to self-perceived risk for HIV infection, and 2) to examine the association between self-perceived risk for HIV infection and condomless anal intercourse (CAI) according to PrEP use. This descriptive and correlational study was a secondary analysis of data collected by the ENGAGE study which involved 945 gbMSM. Compared with gbMSM with lower self-perceived risk for HIV (n = 773), those with higher self-perceived risk (n = 172) differed in terms of sexual behaviors. An unstratified analysis showed high self-perceived risk for HIV infection to be associated with CAI (aOR: 2.87, 95% CI: 1.84–4.47) and PrEP use to be associated with CAI (aOR: 12.75, 95% CI: 3.43–47.41). A stratified analysis by PrEP use showed that, among gbMSM who did not use PrEP, only the association between high self-perceived risk for HIV infection and CAI was maintained (aOR: 2.91, 95% CI: 1.86–4.57). This study reveals the influence of risk perception on sexual behaviors and highlights the importance of a global approach to prevention of HIV infection.