Gillian Abel

‘When you come to it you feel like a dork asking a guy to put a condom on’: is sex education addressing young people's understandings of risk?

Traditionally, school‐based sex education has provided information‐based programmes, with the assumption that young people make rational decisions with regard to the use of condoms. However, these programmes fail to take into account contextual issues and developing subjectivities. This paper presents the talk of 42 young people from a New Zealand secondary school who were questioned in‐depth about the sex education programme they had received. They discussed a programme that concentrated on the ‘dangers’ and ‘risks’ of sexual intercourse and that failed to enhance negotiation skills or take into account the contexts in which sex occurred for many young people. Although participants were well aware of the public health discourses of the importance of condom use, the implications of putting these discourses into practice held the potential for ‘risks’ of a greater magnitude in the reality of their everyday life. The ‘risk’ to reputation and subjectivity overrode any ‘risks’ that may have occurred through non‐use of condoms. This highlights the need for sex education programmes to put greater effort into developing skills of assertiveness, communication and empowerment.

Peers, Networks or Relationships: strategies for understanding social dynamics as determinants of smoking behaviour

Location within social networks is said to be a major determinant of risktaking behaviour among adolescents. This paper examines some of the techniques that can be used, with regard to the specific risk behaviour of smoking. We draw on previous research done in the USA and Scotland using the Negopy software package to examine social networks of adolescents. From this we argue that the different techniques currently used make comparisons of smoking among adolescents problematic and that social network analysis should involve other research techniques to uncover issues which are not illuminated by using a software package alone. These techniques should include the production of sociograms, the use of cluster analysis and the use of qualitative data gained from in-depth interviews or focus group discussions. If health promotion programmes aimed at reducing smoking initiation in adolescents are to be effective, a better understanding of social networks is essential.

Young people's use of condoms and their perceived vulnerability to sexually transmitted infections

Objective: Although sexually transmitted infections (STIs) are most prevalent among young people, they do not use condoms consistently to prevent infection. This study examined young peoples perceptions of vulnerability to STIs and pregnancy.

The Impact of Decriminalisation on the Number of Sex Workers in New Zealand

In 2003, New Zealand decriminalised sex work through the enactment of the Prostitution Reform Act. Many opponents to this legislation predicted that there would be increasing numbers of people entering sex work, especially in the street-based sector. The debates within the New Zealand media following the legislation were predominantly moralistic and there were calls for the recriminalisation of the street-based sector. This study estimated the number of sex workers post-decriminalisation in five locations in New Zealand: the three main cities in which sex work takes place as well as two smaller cities. These estimations were compared to existing estimations prior to and at the time of decriminalisation. The research suggests that the Prostitution Reform Act has had little impact on the number of people working in the sex industry.

A decade of decriminalization: Sex work ‘down under’ but not underground

New Zealand was the first country to decriminalize sex work. This article provides a reflective commentary on decriminalization, its implementation and its impacts in New Zealand. New Zealand Prostitutes’ Collective (NZPC) was the key player in getting decriminalization on the policy agenda and their effective networking played an essential role to the successful campaign for legislative change. There were contentious clauses within the Prostitution Reform Act (PRA) which were of concern to NZPC and others. However, the research which informed the review of the Act has shown that decriminalization has been successful in making the industry safer and improving the human rights of sex workers within all sectors of the industry. The PRA provides several protections for sex workers, which means that their human rights and citizenship can be safeguarded. Yet there has been little movement towards decriminalization in other countries and reluctance by some to draw on New Zealand’s experience. Indeed, it cannot be claimed that decriminalization will be experienced in the same way in other countries. New Zealand is a small island with a population of just over four million and movement across its borders is more restricted than countries that are part of the European Union. Nevertheless, other countries may find the arguments used to get legislative change in New Zealand useful within their own context.

‘I can’t get my husband to go and have a colonoscopy’: Gender and screening for colorectal cancer

It is anticipated that a colorectal cancer (CRC) screening programme will be introduced in New Zealand making it the first screening programme in this country to include both males and females. In-depth interviews were carried out with 80 participants (53 females and 27 males) about their knowledge and attitudes to screening programmes in general, as well as their understanding and perceptions of CRC screening in particular. The study highlighted the perceived marginalization of men’s health with a sense that women had advocated for, and therefore monopolized, screening while men’s health had been left unattended. There were also perceptions of women’s responsibility for ensuring men’s access to health services. There are arguments that such perceptions disempower or ‘infantalize’ men which have no long term benefits. While health is perceived as being a feminine matter, it may be difficult to encourage men to engage in preventative behaviours, such as taking up the offer of screening. This article also highlights the heterogeneity of men, where different performances of masculinities were presented. A stereotypical ‘staunch’ or ‘macho image’ discourse was evident in some of the interviews where much emphasis was on maintaining and controlling bodily boundaries. Letting the barrier of embodied ‘staunchness’ down to access health services is a threat to identity. What is required for successful implementation of the CRC screening programme is a normalization of men’s health help-seeking, taking into account the fact that men are not homogenous. Studies in relation to men’s health need to attend to cultural diversity which is likely to present a challenge to individualism. Critical studies of men would be enhanced by more engagement with the work of black male scholars.

On a fast-track into adulthood: an exploration of transitions into adulthood for street-based sex workers in New Zealand

There have been many debates in the literature about the extended transition to adulthood many young people are experiencing in late modern times. However, not all young people make this prolonged transition and, for some, resources within their family and community networks are insufficient to enable an extended transition into stable, independent adult roles. The findings presented in this paper are drawn from a large participatory research project investigating the impact of decriminalisation on the health and safety practices of sex workers in New Zealand. This paper utilises the talk of 17 street-based sex workers who entered the industry under the age of 18 years, as well as using data from a survey of 772 sex workers in New Zealand. For young people entering the industry prior to the age of 18, the period of adolescence was short-lived and their inability to gain support through either their family or the government meant that they opted to work in the sex industry to survive. Unsupported transitions into adulthood are characterised by a high degree of risk with limited employment options. This research highlights the need for policy-makers to develop holistic, multi-sectorial policies for young people which are not based on age-specific frameworks.

‘The street's got its advantages’: Movement between sectors of the sex industry in a decriminalised environment

This article explores the movement of sex workers between sectors of the sex industry in New Zealands decriminalised environment and motivations for working in these different venues. We argue for contextual, risk environment approaches to understanding risks associated with the different sectors and how these risks might influence the movement of sex workers between sectors. By doing so we also address arguments made by policy makers in different countries, with different ways of regulating sex work, for the eradication of the street-based sector of the sex industry. The findings are drawn from a survey of 772 sex workers and in-depth qualitative interviews with 58 sex workers in New Zealand. Findings suggest there is a growing private sector but little change in the size of the street-based sector following decriminalisation. Street-based sex workers argue the need to maximise earnings and that this is only possible from the street environment. They are prepared to make the trade-off of more money for less safety, something which managed sex workers are not prepared to do. This article demonstrates the relativity of risk perceptions and concludes that attempts to eradicate the street-based sector of the sex industry through more stringent regulatory practices are unrealistic and will only serve to place this vulnerable segment of the sex worker population at greater risk. It argues that in addition to decriminalisation, other social and economic policies are required to address risk and develop more enabling environments within the diverse sectors of the sex industry.

“I’m taking control”: how people living with HIV/AIDS manage stigma in health interactions

ABSTRACT Despite international efforts, stigma is still a significant issue for people living with HIV/AIDS (PLWHA). This paper explores the stigma encountered in health interactions, focusing on strategies PLWHA use to manage and reduce it. It is hoped that our findings will improve future interactions by contributing towards a more understanding practitioner–patient relationship. The data have been drawn from a small qualitative study conducted in Christchurch, New Zealand. Fourteen participants took part in semi-structured face-to-face interviews in 2013 and 11 of these participants were then interviewed again in 2014. Codes and themes were developed through inductive thematic analysis of the interview transcripts. Our findings identified that whilst the majority of participants had positive experiences, nearly all had faced stigma during their health interactions. Most of these encounters were due to healthcare workers holding exaggerated fears of transmission or not maintaining confidentiality and privacy. The main way that participants managed this stigma was through seeking control in their interactions. This overarching strategy could be further divided into three key themes: selective disclosure of their HIV status, self-advocacy and developing their HIV knowledge. We discuss these findings in the context of the current literature, comparing our results to strategies that have been previously identified in social settings.

The work of negotiating HIV as a chronic condition: a qualitative analysis

ABSTRACT Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death.