Jeffery Adams

Men Who Have Sex With Men Account for Nonuse of Condoms

Despite several decades of health promotion activity targeted at men who have sex with men (MSM), rates for nonuse of condoms for anal sex among MSM worldwide and in New Zealand have been increasing in recent times. In this article we report on the first local qualitative investigation undertaken in Auckland, New Zealand, of how members of a particular group of MSM account for nonuse of condoms for anal sex with other men. We collected qualitative data from 22 MSM (17 face-to-face interviews, and three online interviews involving 5 men). Thematic analysis led to the identification of five patterns that account for the nonuse of condoms: (a) substance use, (b) psychological aspects, (c) difficulties using condoms, (d) condoms in relationships, and (e) managing risk. We conclude that although this information generally confirms the findings in the wider research literature, it is also important in the local context as the first research that can be used with confidence in developing and refining health promotion initiatives to address this issue.

Gay Men’s Explanations of Health and How to Improve It:

Little is known about the health views of gay men. In this article we report on how gay men explained health and the ways they discussed how health for gay men can be improved. We conducted a thematic analysis of data collected from 45 gay men in 11 focus groups and identified that health was mainly explained in individual terms, as were the ways to improve health (personal health care services and health promotion). The second way health was explained drew on social and community factors, with the societal acceptance of gay men being reported as essential for health improvements. These individual and social/community approaches were in tension; overall, the individualized approaches dominated. In line with other theorizing in health, we argue that appropriate policy and service provision to meet the health needs of gay men require greater acknowledgment of the social and community explanations of health and ways of improving health.

Evaluation Training to Build Capability in the Community and Public Health Workforce

Increasingly, staff members in community and public health programs and projects are required to undertake evaluation activities. There is, however, limited capacity for, and understanding of, evaluation within this workforce. Building the capability of individual workers and thereby contributing to the overall capacity among the community and public health workforce has been advocated as one solution. In this article, the Easy Evaluation initiative, which seeks to increase the evaluation capability of individual workers and the capacity of the community and public health workforce in New Zealand, is discussed. The theoretical foundations of the evaluation approach (theory-driven evaluation) taught and of the teaching philosophy (adult learning and experiential learning) used are described, along with course content, teaching activities, and participant activities. Although our observations and experiences are that the workshop model is successful in increasing knowledge and skills of participants (building capability), additional support is required for organizations to build evaluation capacity.

Condom use in men who have sex with men: A literature review

Abstract The aim of this paper is to present a review of the literature on the key issues impacting on the decisions, by men who have sex with men, to use, or not use, condoms for anal intercourse. 250 publications were accessed, reviewed, read and sorted; 200 of these were research based and 50 were opinion pieces of work. In addition, 240 of the 250 had undergone a peer review process. The review presented here shows that men who have sex with men communities are a heterogeneous group and their reasons for engaging in unprotected anal intercourse are inter-related and diverse. Six main themes related to sexual risk behaviour and condom use were identified: the availability of HIV treatments, physical issues, psychosocial issues, intentional practices, internet and substance use. Nurses need to understand these factors if they are to effect positive changes in condom use and address the complex challenges inherent in tackling increased rates of HIV infection.

Resiliency and mental health and well-being among lesbian, gay and bisexual people

Reports concerning the mental well-being of lesbian, gay and bisexual (LGB) people mostly focus on mental health issues, negative events and stress, and very few focus on strategies LGB use to achieve well-being. To address this gap, we report on a qualitative project involving 93 LGB people who completed an online survey. Participants provided accounts of resilience, particularly in relation to the ways in which they were caring for themselves. They were engaged in a wide variety of activities that supported their well-being related to social connections, self-care, interests and hobbies, and professional help. Despite this, we argue that there is a compelling need to ensure a wider mental health promotion focus is adopted to support LGB people lead mentally healthy lives.

Resisting the ‘condom every time for anal sex’ health education message

Objective: Ensuring men who have sex with men (MSM) adopt and maintain condom use for anal sex is a challenging health education goal. In order to inform the development of social marketing practices to encourage safe-sex practices, the views of MSM about a key HIV health education message (‘using a condom every time for anal sex’) were sought. Design: Individual and paired interviews were conducted face-to-face and online, with a total of 22 MSM who identified as low users of condoms. Transcripts of interviews were analysed thematically. Setting: Online and various locations in Auckland, New Zealand. Results: Two main themes were identified in relation to the men’s views of the condom every time message: (a) awareness and appropriateness of the message; and (b) resistance to the message. The men interviewed reported a contradictory view with respect to the condom every time message. While it is viewed as an appropriate message for MSM as a group, for some individual men, particularly those in relationships, the message has little resonance. One solution offered was for the sexual practices of such men to be recognized and for appropriate and more relevant health education messages to be developed. Conclusion: Addressing the gulf between professional and (some) lay understandings of what is appropriate for messages that seek to encourage men to adopt and to maintain condom use, and therefore reduce the chances of HIV infection, remains a significant challenge for health promotion agencies.

Gay Men Talking About Health: Are Sexuality and Health Interlinked?

Defining and describing health has traditionally been the role of medical experts. Although a rich literature has recently established the importance of lay accounts of health, one important gap relates to gay men’s accounts of health. Data from 11 focus groups involving 45 gay men were thematically analyzed to investigate gay men’s views of health. Two contrasting positions on a possible relationship between sexuality and health—there is no link or there is a definite link—were identified. In addition, five key ways gay men talked about health were identified: health is the absence of disease, is functional ability, is fitness and exercise, is psychological, and is multifaceted. Although there are similarities in the ways gay and other men talk about health, important differences exist, which suggest that issues of sexuality need to be considered by health policy and service planners so that responsive health services can be provided.

Mental health issues for lesbian, gay, bisexual and transgender people: a qualitative study

International research clearly demonstrates that lesbian, gay, bisexual men and women and transgender (LGBT) people experience poorer mental health than heterosexual people. Despite this robust evidence, one important gap in New Zealand is an understanding of the mental health issues of this group. A qualitative research project was commissioned to address this. Data from interviews with 17 key informants and a qualitative online survey completed by 124 LGBT people were thematically analysed. An overarching theme of macro-social environment was identified, along with two other themes: social acceptance and connection experienced by LGBT individuals and the provision of mental health services and other support. These themes were pertinent across the LGBT groupings, but at times in uneven and different ways. In order to develop useful mental health policy and service provision for LGBT people, greater account of social explanations for poor mental health is indicated, along with appropriate mental health service provision.

Aren't Labels for Pickle Jars, Not People? Negotiating Identity and Community in Talk About 'Being Gay'

Understanding how people in any given population think about and experience their sexuality is fundamental to developing and implementing good health policy, research, and practice. Yet despite several decades of focus on sexual identity and HIV risk within health research, gay men as a category are often treated in an uncomplicated way. This article reports on focus group discussions held with 45 gay and other men who have sex with men in New Zealand to identify how they talked about issues of gay identity and gay community/ies. The men negotiated and renegotiated their gay identity and being gay was reported as just one part of most men’s lives. Many men did not like to be labeled as gay and downplayed aspects of their gay identity. Only a few men proclaimed being gay. Men reported very mixed experiences with the gay community/ies. Understanding how men experience being gay, provides information vital to enhancing policy, research and practice responses to gay men’s health issues. A major challenge for health service provision to appropriately engage with men who have sex with other men but resist being labeled as gay was identified.

Living in your own home and being socially connected at 95 years and beyond: a qualitative study.

Background: Being socially connected is linked to positively influencing older people’s ability to remain living in their own homes and has shown to support independence and enhance well-being. Aim: To explore how individuals aged 95 years and older living in their own home remain socially connected. Methods: Informed by a critical gerontological approach, semi-structured interviews with eight women and two men aged between 96 and 100 years were undertaken. Following transcription, data were thematically analysed. Results: Three main themes illuminating social connectedness were identified: “Keeping company: staying connected with family and friends”, “Doing things together: engaging with paid and unpaid helpers” and “Having pride and enjoyment: continuing with hobbies and interests”. Conclusion: It is important that health professionals and social service providers recognise the importance of social connectedness, and provide a range of options to support continuing social connectedness and community engagement for older people.