Gary W. Dowsett

Sustaining safe sex : a longitudinal study of a sample of homosexual men

ObjectiveTo assess the maintenance of safe sexual practice. (We use the term ‘safe’ sex throughout the paper, since ‘safe’ is the term adopted by the Australian National Committee on AIDS.) DesignMaintenance was assessed by comparing sexual behaviour with both regular and casual partners reported in a 1986/1987 survey (time 1) with behaviour reported in a second survey in 1991 (time 2). MethodThe 145 homosexually active participants were a non-clinical sample recruited in 1986/1987 by advertisement and followed-up in 1991. A structured questionnaire was administered at both times. Items included questions about the nature of the mens sexual relationships and their sexual practices. ResultsOur findings indicate that the majority of men had sustained safe sex practices. HIV prevention strategies adopted included condom use, avoidance of anal intercourse and negotiated safety (i.e., the negotiated practice of unprotected anal intercourse within regular partnerships of concordant serostatus). ConclusionsNegotiated safety is not the same as relapse.

Some Considerations on Sexuality and Gender in the Context of AIDS

Abstract Gender has become a major conceptual tool for understanding the evolving HIV pandemic globally. As such, it has provided a powerful way to see the structure of relations between men and women as central to various epidemics, and added weight to our understanding of HIV infection as not simply an individual experience of disease. Yet, as a concept, gender has its blind spots. This paper argues that there are four issues central to our understanding of how the HIV pandemic moves and develops that are not necessarily best understood through an analysis that uses gender alone, namely: womens vulnerability, mens culpability, young peoples sexual interests and marginalised sexual cultures. The paper proposes using sexuality as a framework for analysing these issues and seeks to utilise developments in critical sexuality research to add to gender as a way to increase the capacity to respond to the HIV/AIDS crisis.

`Taking it Like a Man': Masculinity and Barebacking Online

Gay mens use of the internet for social and sexual purposes is now so common that some predict an end to gay bars. In New York City, where this study took place, the use of the internet by men to meet other men seeking sex without condoms, called bareback sex, has created concerns among public health and gay community HIV/AIDS workers. This study of six popular bareback internet sites seeks to understand the nature of this new online sexual culture, initially by investigating the sites themselves through the methodology of cyber-cartography. That investigation suggested that masculinity as an analytic in gender studies might offer some value in understanding what was happening on these sites. Issues of race and ethnicity also emerged to challenge any singular notion of masculinity. This paper suggests that masculinity itself might need some recalibration, and that we may also need to rethink these sites as evolving ethical sexual cultures.

Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer.

OBJECTIVE To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment. METHODS Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries. RESULTS There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04). CONCLUSION This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.

Sexual Pleasure and Intimacy Among Men Who Engage in “Bareback Sex”

An ethnically diverse sample of 120 mostly gay-identified men who engaged in “bareback” intercourse was recruited via the Internet in New York City. By study design three quarters of participants were HIV-uninfected and engaged in condomless receptive anal intercourse. In the course of face-to-face in-depth interviews, participants were asked what led them to have their first bareback experience as well as to continue with the behavior. Qualitative analysis identified the pivotal role that sexual pleasure and intimacy have in this population and how drives for sexual satisfaction, adventure, intimacy, and love overpower health concerns and condom use recommendations. Men interested in bareback sex use a variety of defense mechanisms to account for, justify, and exonerate their behavior. HIV-prevention interventions have paid insufficient attention to libidinal drives, a crucial element of psychological functioning.

Facing the Epidemic: Changes in the Sexual Lives of Gay and Bisexual Men in Australia and their Implications for AIDS Prevention Strategies

A 1986-87 field survey of 535 gay and bisexual men in Australia examined changes in social relationships and in sexual conduct in response to the HIV epidemic. Results show the framework of sexual relationships changing little, though many men have moved between types of relationships. Reducing the incidence of sexual contact and being more selective about partners are common. Widespread change towards safe sex is reported; the repertoire is contracting. Variables describing large-scale social structure, immediate milieu, and the HIV/AIDS situation are differently linked to changes in relationships and changes in sexual conduct. Relationship change is linked with cultural strain about homosexuality. Adopting safe sex is strongest among groups closest to the epidemic and well supported in gay identity, but weak among men reporting themselves “monogamous.” Generally “targeting” strategies are not supported. Prevention work must deal with divergent responses to the epidemic, and focus on the use as well as the transmission of safe sex information.

Changing gender relations among young people: The global challenge for HIV/AIDS prevention

Abstract The worldwide epidemic of human immunodeficiency virus (HIV) has affected different populations in different countries. Yet, every country has recognized the particular vulnerability of its young people to possible infection. This vulnerability is commonly thought to relate in the main to young peoples assumed universal interest in sexual experimentation. Various studies have demonstrated not only both worrying levels of sexual risk-taking among some young people, but also significant care being taken by others in relation to HIV/AIDS risk. Young people are clearly not a singularity, but rather live their lives in varying social and cultural circumstances that have a bearing on their sexual activities and their ideas about sex. This paper reports on a comparative study of the social and contextual factors affecting young peoples risk-related sexual behaviour in seven developing countries. The study was commissioned by the World Health Organizations former Global Programme on AIDS and overseen ...

Sex, love, friendship, belonging and place: Is there a role for ‘Gay Community’ in HIV prevention today?

The decade since highly active anti‐retroviral therapy (HAART) arrived has been a time of change for gay men in the West. HIV incidence rates have been levelling off—and in some cities, increasing markedly—for the first time since the early years of the pandemic. New sexual subcultures have found expression, including Internet chat rooms, ‘poz‐only’ sex parties, ‘barebacking’ and crystal methamphetamine use. These circumstances force a re‐evaluation of HIV prevention targeting gay communities. We examine the antecedents of current HIV‐prevention dilemmas in findings from a qualitative study of gay men who were personally and professionally engaged in HIV/AIDS in Sydney, Australia, in 1997–1998, immediately after the ‘protease moment’. The mens lives were characterized by constant and difficult negotiation of gay subjectivities. They did not find a place of uniform belonging in the gay community; rather, ambivalence—toward the gay community and HIV prevention—and fragmentation emerged as themes. Our findings suggest that by the late 1990s, the ethos of safe sex developed in the early HIV/AIDS period was no longer a unifying cultural value. We explore the conditions that led to this shift and the implications for HIV prevention in the 21st century.

E-health: potential benefits and challenges in providing and accessing sexual health services

BackgroundE-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location.DiscussionThe paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services. There are important issues in relation to utilising and providing online sexual health services. For healthcare providers, e-health can act as an opportunity to enhance their clients’ sexual health care by facilitating communication with full privacy and confidentiality, reducing administrative costs and improving efficiency and flexibility as well as market sexual health services and products. Sexual health is one of the common health topics which both younger and older people explore on the internet and they increasingly prefer sexual health education to be interactive, non-discriminate and anonymous. This commentary presents and discusses the benefits of e-sexual health and provides recommendations towards addressing some of the emerging challenges.Future directionsThe provision of sexual health services can be enhanced through E-health technology. Doing this can empower consumers to engage with information technology to enhance their sexual health knowledge and quality of life and address some of the stigma associated with diversity in sexualities and sexual health experiences. In addition, e-sexual health may better support and enhance the relationship between consumers and their health care providers across different locations. However, a systematic and focused approach to research and the application of findings in policy and practice is required to ensure that E-health benefits all population groups and the information is current and clinically valid and effective, including preventative approaches for various client groups with diverse needs.

Investigating combination HIV prevention: isolated interventions or complex system

Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High‐income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non‐linear and multiplying rather than additive effects.