Patrick O'Byrne

Desire, drug use and unsafe sex: a qualitative examination of gay men who attend gay circuit parties

Recently, there has been an increase in research dedicated to the topic of drug/alcohol use and unsafe sex among gay men. Findings of this work suggest that drug/alcohol use is particularly common within gay circuit parties (GCPs). More recently, this work has begun to suggest that further exploration is needed to understand the desires of gay men who use drugs and alcohol and who engage in unsafe sex. Based on the foregoing, an ethnographic study was undertaken with the goal of better understanding the role of desire in the sequence of drugs/alcohol and unsafe sex. This research was guided theoretically by Deleuze and Guattaris work on desire. Using this theoretical orientation, the results revealed that some GCP-goers intentionally use drugs/alcohol to form connections.

Understanding Disgust in Nursing: Abjection, Self, and the Other

From the seeming chaos of war zones and emergency rooms to the ritualized order of forensic psychiatric settings and sexual health clinics, nurses often experience feelings of disgust and repulsion in their practice. For these intense feelings to occur, an abject object must exist. Cadaverous, sick, disabled bodies, troubled minds, wounds, vomit, feces, and so forth are all part of nursing work and threaten the clean and proper bodies of nurses. The unclean side of nursing is rarely accounted for in academic literature: it is silenced. Using a theoretical approach, the objective of this paper is to demonstrate how fruitful the concept of abjection is in understanding nurses’ reactions of disgust and repulsion regarding particular patients or clinical situations.

The art of public health nursing: using confession technè in the sexual health domain.

Aim.  This paper explores the sexual health interview from a critical perspective, and to demonstrate how the confession ritual involved in this interview is implicated in the construction of subjectivities (meaning identities) as well as in fostering self-surveillance (self-regulation). Background.  The concept of public health depends primarily on several surveillance tools that monitor both the incidence and prevalence rates of certain diseases. Within the subgroup of infectious diseases, sexually transmitted infections comprise a group that is closely monitored. As a result, surveillance techniques, including policing sexual practices, are part of the public health workers mandate. Method.  Using a Foucauldian perspective, we demonstrate that confession is a political technology in the sexual health domain. Findings.  As one group of frontline workers in the field of sexual health, nurses are responsible for data collection through methods such as interviewing clients. Nurses play an integral role in the sexual health experience of clients as well as in the construction of the clients subjectivity. We strongly believe that a Foucauldian perspective could be useful in explaining certain current client behavioural trends (for example, an avoidance by at-risk groups of interactions with nurses in sexual health clinics) being observed in sexual health clinics across the Western hemisphere. Conclusion.  Clinicians need to be aware of the confessional nature of their questions and provide requested services rather than impose services that they determine to be important and relevant. By appreciating that the sexual health interview is an invasive and embarrassing sexual confession, healthcare providers and policy-makers may be better able to design and implement more user-oriented, population-sensitive sexual health services.

Nondisclosure Prosecutions and HIV Prevention: Results From an Ottawa-Based Gay Men's Sex Survey

Patrick O’Byrne, RN, PhD, is an Associate Professor, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Alyssa Bryan, RN, MScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. Cory Woodyatt, BA, BScN (student), is a Research Assistant, University of Ottawa, Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada. In 1998, the Supreme Court of Canada ruled that people living with HIV had a legal obligation to disclose their serostatus prior to the onset of activities that posed a ‘‘significant risk’’ for HIV transmission. As part of this ruling, the Supreme Court (1998) indicated that nondisclosure prosecutions would not undermine HIV-prevention efforts. This ruling, however, was made without any research on the effect of the law on HIV prevention. Accordingly, because the number of nondisclosure prosecutions is increasing in Canada (Mykhalovskiy, 2011), self-identifying gay, bisexual, and other men who have sex with men (MSM) in Ottawa were given self-administered surveys about their sexual practices and sexually transmitted infection (STI) and HIV testing practices. In total, 441 surveys were collected to help better tailor sexual health services for gay, bisexual, and other MSM in this region. In this paper, we present results detailing the relationships between perceptions about nondisclosure prosecutions and STI/HIV testing practices. We also provide comparisons of the self-reported sexual practices of the survey respondents. While this paper presents and discusses data that are Canada-specific, nondisclosure prosecutions are common in the United States as well (American Civil Liberties Union, 2008).

HIV criminal prosecutions and public health: an examination of the empirical research

Objectives To review the extant literature on HIV criminal laws, and to determine the impact of these laws on public health practice. Methods The available research on this topic was obtained and reviewed. Results The extant literature addressed three main topics: peoples awareness of HIV criminal laws; peoples perceptions of HIV criminal laws; and the potential effects of HIV criminal laws on peoples sexual, HIV-status disclosure and healthcare-seeking practices. Within these categories, the literature demonstrated a high level of awareness of HIV criminal laws, but a poor comprehension of these laws. For perceptions, on the whole, the quantitative research identified support for, while the qualitative literature indicated opposition to, these laws. Lastly, the behavioural effects of HIV criminal laws appear to be complex and non-linear. Conclusions A review of the extant literature from a public health perspective leads to the conclusion that HIV criminal laws undermine public health.

Drug use as boundary play: a qualitative exploration of gay circuit parties.

Research findings have revealed that gay circuit parties may be locations that are disproportionately responsible for the increasing rates of many STIs/HIV among gay/bisexual men. Theories have been put forth that this may be the case because circuit parties are locales of prevalent drug use and unsafe sex. To explore the relationship between these two phenomena, in-depth qualitative interviews were undertaken with 17 men who (1) have sex with other men, (2) attended gay circuit parties in Montréal, Canada, in 2007. These revealed that drugs (including alcohol) were used intentionally to engage in unsafe sex, and then to justify this behavior after the fact. This process we called boundary play.

Counselling about HIV serological status disclosure: nursing practice or law enforcement? a Foucauldian reflection

Recently, focus groups and qualitative interviews with nurses who provide frontline care for persons living with HIV highlighted the contentiousness surrounding the seemingly innocuous activity of counselling clients about HIV-status disclosure, hereafter disclosure counselling. These empirical studies highlighted that while some nurses felt they should instruct clients to disclose their HIV-positive status if HIV transmission were possible, other nurses were equally adamant that such counselling was outside the nursing scope of practice. A review of these opposing perceptions about disclosure counselling, including an examination of the empirical evidence which supports each point, revealed that the dichotomous arguments needed to be nuanced. The empirical evidence about serostatus disclosure neither supported nor refuted either of these assertions; rather, it substantiated parts of each. To create this understanding, both empirical and theoretical works are used. First, the results of empirical studies about serostatus disclosure, or lack thereof and HIV transmission is presented; as part of this, Marks and Crepazs HIV disclosure and exposure framework is examined. Second, the work of Michel Foucault on disciplinary and pastoral power is drawn from. The outcome is a nuanced understanding about the interrelationships between disclosure counselling and nursing practice and a final interpretation about what this understanding means for public health practice.

HIV Prevention in the Context of Care: HIV Testing and Public Health Practice

In this article, an argument is put forth that clinic-based HIV testing can function as an important aspect of public health HIV prevention. This assertion is not an outright declaration that all HIV testing is beneficial. Instead, it is the conclusion that the individual-focused initiative of HIV testing could, if structured properly, induce population-level HIV prevention benefits. This analysis was informed using the impact fraction model, the Anderson-May equation, current epidemiological information about HIV from Canada, the United States, and England, and the extant literature on the dynamics of HIV transmission. This conclusion could help inform the development of public and population health HIV testing and HIV prevention policies/practices.

The potential public health effects of a police announcement about HIV nondisclosure: a case scenario analysis.

In May 2010, a local police force released the details of an HIV-transmission-related criminal investigation. This involved the publication of the name and photograph of, and charges against a man who the police allege did not disclose his HIV status prior to engaging in sexual activities that pose a “significant risk” for HIV transmission. Presently, however, there are no public health analyses of this situation. Consequently, the available literature on Canadian criminal laws, HIV transmission within this jurisdiction, and HIV prevention are presented and discussed herein. The outcome of this analysis is the conclusion that the act of publicizing an HIV-related criminal investigation more likely inhibits than encourages STI/HIV testing among HIV-negative and HIV-positive men who have sex with men. It is the assertion here that this undertaking thus conflicts with the overall public health goals of HIV prevention, and should likely not occur in the future.

“Express testing” in STI clinics: extant literature and preliminary implementation data

In an era of stagnant resources for sexually transmitted infection (STI) and HIV testing clinics, and at a time of ongoing-and in some cases increasing-STI and HIV transmission, it is important to trial and evaluate novel STI/HIV testing strategies. Based on the extant literature, one such approach is express testing, which includes full STI/HIV testing (as per clinical indication and client request), altered pretest counseling, and no physical examination for both men and women. In this paper, we overview the available research about express testing, including the literature on less-invasive testing, the effects of risk reduction counseling HIV testin/HIV testing, available research on various HIV testing modalities, and the reasons people undergo such testing. Thereafter, we overview our express testing program, which includes a detailed review of our clinical processes (which are unique within the published literature). Lastly, we provide some preliminary pre-implementation data to support the proposed efficacy of express testing.