Eamonn McKeown

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.

HIV infection among ethnic minority and migrant men who have sex with men in Britain

Objective: To examine human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) from different ethnic and migrant groups living in Britain. Methods: In 2007–2008, a diverse national sample of MSM living in Britain was recruited through Web sites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey that included questions on HIV testing, HIV status, and sexual behavior. Results: Nine hundred and ninety-one ethnic minority MSM, 207 men born in Central or Eastern Europe (CEE), 136 men born in South or Central America, and 11,944 white British men were included in the analysis. Self-reported HIV seropositivity was low for men of South Asian, Chinese, and “other Asian” ethnicity (range, 0.0%–5.8%) and for men born in CEE (4.5%) but elevated for men born in South or Central America (18.7%), compared with white British men (13.1%) (P < 0.001). There were no significant differences between these groups in high-risk sexual behavior (P = 0.8). After adjusting for confounding factors in a multivariable model, substantial differences in the odds of HIV infection remained for South Asian and Chinese MSM as well as for migrants from CEE, but not for other groups, compared with white British men; for example, South Asian men, adjusted odds ratio 0.43, 95% confidence interval 0.23, 0.79, P = 0.007. Conclusion: There were marked differences in self-reported HIV seropositivity between ethnic minority, key migrant, and white British MSM in this study but not in high-risk sexual behavior. This highlights the importance of health promotion targeting MSM from all ethnic and migrant groups in Britain.

The development and psychometric properties of a measure of clinicians’ attitudes to depression: the revised Depression Attitude Questionnaire (R-DAQ)

BackgroundDepression is a common mental disorder associated with substantial disability. It is inadequately recognised and managed, and clinicians’ attitudes to this condition and its treatment may play a part in this. Most research in this area has used the Depression Attitude Questionnaire (DAQ), but analyses have shown this measure to exhibit problems in psychometric properties and suitability for the health professionals and settings where depression recognition may occur.MethodsWe revised the DAQ using a pooled review of findings from studies using this measure, together with a Delphi study which sought the opinions of a panel of relevant experts based in the UK, USA, Australia, and European countries (n = 24) using 3 rounds of questioning to consider attitude dimensions, content, and item wording. After item generation, revision and consensus (agreement >70%) using the Delphi panel, the revised DAQ (R-DAQ) was tested with 1193 health care providers to determine its psychometric properties. Finally the test-retest reliability of the R-DAQ was examined with 38 participants.ResultsThe 22-item R-DAQ scale showed good internal consistency: Cronbach’s alpha coefficient was 0.84; and satisfactory test-retest reliability: intraclass correlation coefficient was 0.62 (95% C.I. 0.37 to 0.78). Exploratory factor analysis favoured a three-factor structure (professional confidence, therapeutic optimism/pessimism, and a generalist perspective), which accounted for 45.3% of the variance.ConclusionsThe R-DAQ provides a revised tool for examining clinicians’ views and understanding of depression. It addresses important weaknesses in the original measure whilst retaining items and dimensions that appeared valid. This revised scale is likely to be useful in examining attitudes across the health professional workforce and beyond the confines of the UK, and may be valuable for the purpose of evaluating training that aims to address clinicians’ attitudes to depression. It incorporates key dimensions of attitudes with a modest number of items making it applicable to use in busy clinical settings.

The experiences of ethnic minority MSM using NHS sexual health clinics in Britain

Objective To compare the experiences of ethnic minority and white British men who have sex with men (MSM) who attend NHS sexual health clinics in Britain. Methods In 2007–2008, a national sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs and other venues. Men completed an online survey, which included questions about their experience of attending an NHS sexual health clinic. Results Analysis is restricted to 363 ethnic minority MSM and 4776 white British MSM who had attended an NHS sexual health clinic in the 12 months before the survey. Compared with white British men, men from an Indian, Pakistani or Bangladeshi background were more likely to be very anxious about attending the clinic (adjusted OR (aOR) 2.58, 95% CI 1.63 to 4.07), express concerns about being overheard at reception (aOR 1.68, 95% CI 1.10 to 2.58), be uncomfortable in the waiting area (aOR 2.08, 95% CI 1.35 to 3.22) or be afraid that people in their community would find out that they have sex with men (aOR 7.70, 95% CI 4.49 to 13.22). The adjusted ORs for being afraid that people in their community would find out that they have sex with men were also elevated for black Caribbean, black African, Chinese and other Asian men. Conclusion Sexual health clinics should be aware that some ethnic minority MSM, particularly those from an Indian, Pakistani or Bangladeshi background, have heightened concerns about clinic attendance and confidentiality compared with white British MSM.

Art engagement and mental health: experiences of service users of a community-based arts programme at Tate Modern, London.

OBJECTIVES To examine the experiences of mental health service users who took part in an arts-based programme at Tate Modern, a major London art gallery. STUDY DESIGN Exploratory qualitative design. METHODS Data were collected using in-depth semi-structured interviews with 10 mental health service users who had taken part in a community-based programme at Tate Modern. Additionally, six art educators from Tate Modern were interviewed. Concepts that emerged from the text were identified using thematic analysis. RESULTS All participants valued the gallery-based programme. The three overarching thematic areas were: the symbolic and physical context in which the programme workshops were located; the relational and social context of the programme workshops; and reflections on the relationship between the arts-based programme and subsequent mental health. CONCLUSIONS Art galleries are increasingly seen to function as vehicles for popular education with mental health service users. This study adds to the growing body of evidence related to how mental health service users experience and reflect on arts-related programmes targeted at them. This study indicates that emphasis on how users experience gallery-based programmes may contribute to a more nuanced understanding of the relationship between art and mental health.

Effectiveness of probiotic in preventing and treating antibiotic-associated diarrhoea and/or Clostridium difficile-associated diarrhoea in patients with spinal cord injury: a protocol of systematic review of randomised controlled trials

BackgroundProbiotics may prevent antibiotic-associated and Clostridium difficile-associated diarrhoea (AAD/CDAD). Many spinal cord injury centre (SCIC) practitioners consider probiotics generically and may not realise that efficacy can be strain-, dose- and disease-specific. In order to confirm these effects and fully evaluate the extent of probiotic effectiveness in these patients, a systematic review and meta-analysis is indicated.MethodsThe following databases will be searched for relevant studies: Cochrane Library; Centre for Reviews and Dissemination (CRD) Database; CINAHL; PsycINFO; Embase; Medline; AMED; International Clinical Trials Registry Platform Search Portal and ISRCTN Registry and will hand search a list of conference proceedings. Any randomised controlled trials without restriction of publication status will be included with treatment of AAD/CDAD. Outcomes will include the effect of probiotic on the occurrence of AAD/CDAD and duration of diarrhoea, intensive care unit admission, hospital mortality and length of hospital stay. Two reviewers will independently screen the titles, abstracts or even full texts and extract data. Two other reviewers will assess study quality. Revman 5.1 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The Cochrane Collaboration’s tool will be used to assess the risk of bias.DiscussionThis systematic review protocol will provide information on probiotic therapy for AAD and CDAD in spinal cord injury (SCI) population. The results will be disseminated through peer-reviewed publication or conference presentation.Systematic review registrationPROSPERO CRD42015016976

Barebacking and sexual position

Bareback sex continues to fuel the HIV epidemic among men who have sex with men but despite the fact that much academic attention has been focused on the sexual behaviour of this population few authors have considered the significance of sexual position. In order to explore this relatively under-examined factor, interviews were conducted with 13 HIV-negative and unknown status gay men who had recently engaged in bareback sex. Using Interpretative Phenomenological Analysis and through the lens of sexual position, the findings were organized across three super-ordinal themes. There were some areas in which there was little difference between the mens experiences of engaging in bareback as tops or bottoms (for instance, how participants connected with barebacking partners). In other areas, however, there were clear differences in mens experiences according to sexual position, particularly in the interpersonal dynamic between tops and bottoms during bareback sex encounters, which, it is argued, were acted out in accordance with a barebacking ‘sexual script’. There were further differences by position in how individuals overcame ‘cognitive dissonance’ by invoking strategies to make their engagement in bareback sex safer and in the meanings men ascribed to bareback sex and semen exchange. These findings provide valuable insights for those working with MSM around HIV prevention.

Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland

Review of dietetic service provision and activity in spinal cord injury centres: a multicentre survey in the UK and Republic of Ireland

PWE-420 An international multi-centre survey to assess resources allocation and nutritional practices in spinal cord injury centres

Introduction There is still uncertainty about the resource distribution between spinal cord injury centre (SCICs) and this may have implications to the quality of patient care.1The present study aimed to review the service provision in SCICs; to establish and compare how much time dietitians spend in direct and indirect contact with patients, and to document current nutritional screening practices. Method All 12 SCICs in the United Kingdom and the Republic of Ireland were surveyed by questionnaire in April 2014. Data collected included the number of whole-time-equivalent staff available, whether they use of nutrition screening tools. A work sampling tool was used to capture dietetic activity for a period of one week. Results Eight (66.7%) SCICs responded (390/531 of total beds) and the average numbers (median) of patients per whole-time-equivalent staff, including consultants (18), nurses (1.3), dietitians (93.4), physiotherapists (5.9), occupational therapists (10) were recorded and comapred with previous published figures (Table 1). Six out of eight SCICs used a validated nutritional screening tool. Thirty-two work sampling tool were analysed, dietitians spend 39.1% of the working day in direct patient-related activities. Dietetic staffing levels are varied and below clinical recommendations in 6 out of 8 SCICs.Abstract PWE-420 Table 1 Human resources allocation in participating SCICs Conclusion The resources allocated to nutritional care in SCICs appear to be limited. This suggests malnutrition may continue to be under-recongnised and under-treated. To address the complex nutritional needs of this special population group, there is a clear need to establish staffing level for dietitians. Information collected from the present study could contribute to the supply analysis of future workforce planning exercise. Disclosure of interest None Declared. References Wong S, et al. Spinal Cord. 2012;50:132–135 NHS England. NHS standard contract for spinal cord injuries (all ages). NHS England, Redditch. 2013. http://www.england.nhs.uk/wp-366content/uploads/2013/06/d13-spinal-cord.pdf[accessed 07.02.2015]

MAKING IT THEIR OWN: PATTERNS OF READING AND WRITING IN A NEWLY-LITERATE PAPUA NEW GUINEAN COMMUNITY

This chapter examines the ways in which literacy is used in the daily life in one rural village community in Simbu in the Papua New Guinea highlands.1 An ethnographic perspective enables us to see how literacy is incorporated into already existing concepts and conventions regarding aspects of village cultural and social life. The material presented here relates to how the uses of reading and writing are strongly associated with local notions of self-promotion, economic relations and decoration. At the same time, I will show that the panoply of literacy uses in these contexts are overlaid and to a large extent governed by literacy’s associations with modernity. The chapter first provides a general overview of the kinds of reading practices that occur in the village setting, noting that many of these practices do not correspond to the ways in which agencies responsible for imparting literacy, particularly the local school, intend. The ensuing sections demonstrate how uses of writing in the village are shaped by local concepts of prestige, chance and reciprocity. These are not intended to be seen as discrete and mutually exclusive but rather as general, albeit overlapping, social phenomena which help illuminate the processes by which literacy has been added to the communicative repertoire.