Peter Keogh

No aggregate change in homosexual HIV risk behaviour among gay men attending the Gay Pride festivals, United Kingdom, 1993-1995.

ObjectivesTo examine aggregate changes in homosexual HIV risk-taking among gay men attending the Gay Pride festival in the United Kingdom over a 3-year period during which HIV prevention activity targeted at this population increased considerably. DesignThree cross-sectional self-completion questionnaires at yearly intervals asking identical questions on sexual behaviour in the preceding year. SettingLesbian and Gay Pride festival held in London, June 1993, 1994 and 1995. ParticipantsMen attending the festival who were UK resident, had ever had sex with another man and who were willing to fill out a questionnaire (n = 1620, 1753 and 1168 in 1993, 1994 and 1995, respectively). Main outcome measuresSelf-reported numbers of sexual partners, sexual partners with whom anopenile intercourse occurred and sexual partners with whom anopenile intercourse occurred without a condom. ResultsOver the 3-year period there were no changes in the proportion of men engaging in any of the sexual behaviour measures. At each cross-section, one in three men (514 out of 1566, 511 out of 1612, 351 out of 1059 in 1993, 1994 and 1995, respectively) had engaged in anopenile intercourse without a condom with at least one male partner in the preceding year and one in 10 (162 out of 1566, 156 out of 1612, 103 out of 1059 in 1993, 1994 and 1995, respectively) had done so with more than one male partner. ConclusionDespite an increase in prevention work targeted at this population, aggregate levels of sexual risk-taking have remained very stable. A reassessment of the efficacy of current HIV prevention messages and methods with this population is urgently required.

Problems with sex among gay and bisexual men with diagnosed HIV in the United Kingdom

BackgroundA significant research literature exists that details the sexual health and sexual behaviour of gay and bisexual men who have diagnosed HIV. However, much of this research has focussed on HIV transmission risk behaviours among this group, rather than seeking to understand their sexual health and sexual well-being more broadly. There have been growing calls for interventions to support people with diagnosed HIV to achieve health and well-being, including sexual health and well-being. A detailed understanding of the problems people in this group face, and how they might be overcome, is required to facilitate such interventions.MethodsOne thousand two hundred and seventeen gay and bisexual men with diagnosed HIV were recruited by convenience sampling through charitable AIDS service organisations, genitourinary medicine clinics and local authority agencies to complete a survey of their health and social care needs. Respondents were asked to report any problems they had with regards to sex during the 12 months prior to survey completion. They were also asked to describe what support might help them to overcome any problems they experienced.ResultsOverall, 70.5% of the gay and bisexual men with diagnosed HIV completing the survey reported one or more problems with sex within the previous 12 months. Most commonly reported problems include loss of libido (44.0%, n=540), poor self-image or low self confidence (43.9%, n=534), worries about passing HIV to potential sexual partners (37.3%, n=454), and fears of rejection from sexual partners (34.7%, n=422). Responses varied according to age, time since diagnosis, and whether or not the respondent was currently taking anti-retroviral therapy. Qualitative analysis of data relating to what support might help men overcome problems with sex indicate a need for therapeutic support to increase self esteem and confidence, clarity on criminalisation of HIV transmission, the tackling of HIV related stigma and help to achieve a higher quality (as opposed to quantity) of sex.ConclusionsThe findings indicate a need for the maintenance and expansion of services to meet the significant needs of people with diagnosed HIV, especially as these intersect with their ability to negotiate sex that is satisfying.

Relative Safety 2: Risk and unprotected anal intercourse among gay men diagnosed with HIV

In 1999 Sigma Research published Relative safety: an investigation of risk and unprotected anal intercourse among gay men diagnosed with HIV (Keogh et al. 1999). This study explored the social, psychological and cultural meanings associated with unprotected anal intercourse (UAI) among men with diagnosed HIV. It highlighted both the complexity of sexual interaction for men with diagnosed HIV, and the many potential costs and benefits perceived by them. Now, with more than 24,000 homosexually active men diagnosed with HIV in the UK (Health Protection Agency 2008), a figure that is set to increase in years to come, it is vital that agencies involved in HIV prevention interrogate their own beliefs about UAI and ensure that their interventions meet the needs of men with diagnosed HIV. . . . . The following chapter explains how the study was undertaken, outlines the broad topic areas addressed during the interviews, and describes the sample of men who took part. Chapter 3 outlines the range of harms that men with HIV perceive when engaging in UAI. Chapters 4 and 5 explore the ways in which men responded to these perceived harms, firstly those relating to the risk of onward HIV infection, or superinfection, and latterly those concerning the potential for harms to their personal and social identities. Chapter 6 considers the implications of these findings for health promotion interventions targeting men with HIV, and with homosexually active men more broadly.

How to Be a Healthy Homosexual: HIV Health Promotion and the Social Regulation of Gay Men in the United Kingdom

ABSTRACT Primary Objective: Health promotion has arisen as the main response to the problem of HIV prevention among gay men. Using the linked concepts of governmentality and health promotion as a neoliberal disciplinary technology, this article argues that health promotion in the time of AIDS has contributed to new forms of social regulation and governance for gay men. Methods and Procedures: This article presents an analysis of data from a study of U.K. HIV health promotion for gay men (interviews with health promoters and analyses of health promotion materials). Conclusions: This analysis of health promotion is helpful in describing an emerging form of governance dependent on incentive rather than censure (censure, pathology and “cure” are how we traditionally describe the use of medical knowledge in the regulation of homosexuality).

Pharmaceutical HIV prevention technologies in the UK: six domains for social science research

The development of pharmaceutical HIV prevention technologies (PPTs) over the last five years has generated intense interest from a range of stakeholders. There are concerns that these clinical and pharmaceutical interventions are proceeding with insufficient input of the social sciences. Hence key questions around implementation and evaluation remain unexplored whilst biomedical HIV prevention remains insufficiently critiqued or theorised from sociological as well as other social science perspectives. This paper presents the results of an expert symposium held in the UK to explore and build consensus on the role of the social sciences in researching and evaluating PPTs in this context. The symposium brought together UK social scientists from a variety of backgrounds. A position paper was produced and distributed in advance of the symposium and revised in the light this consultation phase. These exchanges and the emerging structure of this paper formed the basis for symposium panel presentations and break-out sessions. Recordings of all sessions were used to further refine the document which was also redrafted in light of ongoing comments from symposium participants. Six domains of enquiry for the social sciences were identified and discussed: self, identity and personal narrative; intimacy, risk and sex; communities, resistance and activism; systems, structures and institutions; economic considerations and analyses; and evaluation and outcomes. These are discussed in depth alongside overarching consensus points for social science research in this area as it moves forward.

Morality, responsibility and risk: negative gay men's perceived proximity to HIV

Abstract In order to examine the ways in which mens perceptions of their social surroundings influence how they experience and negotiate sexual risk, we conducted a qualitative study with 36 men who lived in London or Birmingham, had five or more male partners in the previous year and believed themselves to be HIV negative. Men were recruited into two sub-samples (18 men each). The high proximity group personally knew someone with HIV and had a positive sexual partner in the year prior to interview. The low proximity group had never personally known anyone with HIV and had never had a sexual partner who they knew or believed to be HIV positive. Data was collected via semi-structured interviews. Men in the low proximity groups used moral discourses to articulate beliefs and social norms around the disclosure of HIV which may act as a deterrent to sexual partners disclosing. Although most expected positive sexual partners to disclose, they had difficulty in articulating how they would respond to disclosure and how they would manage any consequent sexual risk. For the men in the high proximity group, living around HIV constituted a part of everyday life. Disclosure and discussion of HIV did not violate their social norms. The majority did not expect positive sexual partners to disclose to them and knew how they would respond to such disclosure if it occurred. Men in this group did not use moral discourses but talked practically about better and worse ways of managing disclosure. Proximity to HIV is mediated by strong social norms and self-perpetuating moral discourses which effectively creates a social divide between men who perceive themselves to be in low proximity to HIV and their HIV positive contacts and sexual partners. Men with perceived low proximity to HIV are appropriate as a target group for HIV prevention.

Addressing gay men's use of methamphetamine and other substances

Gay mens use of methamphetamine has aroused great anxiety. In some countries such as the USA and Australia as many as 40% of gay men use this drug, while use is lower in others such as the UK. However, across all these countries gay mens use of other substances such as alcohol, poppers and cannabis surpasses that of methamphetamine. Recent evidence from case-crossover studies suggests that use of not only methamphetamine but also of alcohol, cannabis, poppers, cocaine, amphetamines and Viagra is associated with increased risk behaviour during episodes of anal intercourse. However national drugs and alcohol strategies do not refer to gay men, drug treatment services tend to focus on opiates and do not target gay men, and HIV prevention for gay men rarely mentions use of substances other than methamphetamine. This is a missed opportunity given the evidence for the effectiveness or drug treatment and prevention interventions, and evidence that such interventions can be tailored to gay clients.

My Care, I Care: A study of what people with HIV value about NHS HIV services across London

Duration: January 2012 - March 2013 As part of a larger review of HIV services in London, the London Specialised Commissioning Group (SCG) commissioned Sigma Research to investigate the views of people with diagnosed HIV about the London NHS HIV services provided to them. The final report from the research, which included a large-scale self-completion survey and eight focus groups, is available to download here. It is also available in printed format, free to UK addresses here. Almost 1400 people with diagnosed HIV self-completion the survey which was available in HIV clinics and online from early February to the end of July 2012. The survey covered: demographics, current service use, motivations for service choice, aspirations for service development and broader social care needs. Sampling and recruitment were controlled in an attempt to ensure a sample broadly representative of the population of people using HIV clinical services in London and to ensure representation from all 28 London clinics. The survey was promoted online by HIV organisations and some HIV clinics. In addition paper copies of the survey were administered by dedicated fieldworkers in all the 28 specialist HIV out-patients clinics in Greater London. Eight focus groups with key groups of people with HIV were used to investigate in more detail motivations for service use, satisfaction with services and aspirations and suggestions for service development.

Lambeth LGBT Matters: The needs and experiences of lesbians, gay men, bisexual and trans men and women in Lambeth.

Duration: July 2005 - October 2006 The London Borough of Lambeth (LBL) has large and diverse lesbian, gay, bisexual and Trans (LGBT) communities. The Borough also has a large social and commercial LGBT scene. LBL is committed to countering racism, homophobia and discrimination and they have made progress in respect of race and ethnicity. However, their equalities record on LGBT communities is more patchy. The main reason appears to be a lack of information about the social care needs of LGBT residents and their experiences of discrimination and violence. This research investigated the social care needs of Lambeth LGBT people as well as their experiences of stigma, discrimination and victimisation. It also analysed the experiences of LGBT staff at the Council and assessed Lambeth’s equality policy and procedures in relation to the needs of LGBT residents and staff. The study used a range of methods including a large-scale survey of LGBT people who live, work, study or socialise in the Lambeth; focus groups with Lambeth residents and Council staff; and analysis of Lambeth’s policy and procedures through document reviews and stakeholder interviews. The final report is available in a long and a short version. The long version is 130 pages. It is aimed at Local Authority staff and those interested in assessing the capacity of statutory agencies to meet the needs of LGBT people. It contains detailed background information and literature reviews, the results of the survey and focus groups with LGBT people in Lambeth, full findings on the experiences of LGBT staff at Lambeth Council, and detailed analyses of Lambeth’s policies and procedures (corporate equalities, consultation, monitoring, procurement and human resources). It also includes detailed recommendations for all of these areas. The short version is 48 pages. It is aimed at those who want to know more about the experiences and needs of LGBT populations and communities generally. It contains an edited background and literature review, the full findings on the experiences of LGBT people in Lambeth (survey, interviews and focus groups) and recommendations based on these findings. London Borough of Lambeth are using this research to ensure that the practices and policies of Council staff and service providers reflect the experiences of LGBT people and to safeguard their LGBT staff from homophobic abuse or discrimination at work. They intend to draft a response to the report and a comprehensive work-plan around LGBT equality and need.

Non-condom related strategies to reduce the risk of HIV transmission: Perspectives and experiences of gay men with diagnosed HIV

Gay men with diagnosed HIV can adopt a number of strategies to reduce the risk of transmitting HIV to others, although research has typically focussed on condom use. Interviews with 42 HIV-positive gay men who reported recent engagement in anal intercourse without condoms explored their awareness of sexual risk and their perceptions of non-condom-related strategies to reduce it. In articulating men’s ambivalence for strategies that can only reduce the risk of transmission, rather than eliminating, the findings have implications for the consideration and integration of new biomedical interventions to reduce the likelihood of HIV transmission.