Robert Reynolds

Endangered territory, endangered identity : Oxford Street and the dissipation of gay life

Abstract Oxford Street in inner-city Sydney has been associated with gay identity, community and life since the early 1970s. In recent years, however, the street has declined as a gay precinct. This has engendered considerable anxiety among sections of the gay community, especially those activists and constituents with a substantial emotional investment in the idea of gay community and territory. These concerns have been especially acute around the issue of anti-gay violence on Oxford Street. The loss of gay space and the threat of violence are evocative concerns for they speak to the current dissipation of established patterns of gay life.

Alcohol and club drug use among same-sex attracted young people: associations with frequenting the lesbian and gay scene and other bars and nightclubs.

This study aimed to determine whether the lesbian and gay “scene” of bars and nightclubs is a more common site for club drug use than other bars and clubs. A cross-sectional, online survey was conducted with 254 same-sex attracted women and 318 men aged 18–25 in Sydney, Australia. Drug use was more likely in those who attended any venue type more frequently. Men, but not women, were more likely to report drug use in lesbian and gay venues than other venues. Club drug use may be more normalized within the lesbian and gay scene than elsewhere, particularly among young men. The studys limitations are noted.

The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations

Objectives HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of ‘key informants’ described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. Methods A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. Results The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. Conclusions While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs.

Alcohol and other drug use, club drug dependence and treatment seeking among lesbian, gay and bisexual young people in Sydney

INTRODUCTION AND AIMS Substance use and substance use problems are often more prevalent in same-sex attracted young people (SSAY), yet little to date has been published about substance use and problems in this population in Australia. This paper aimed to characterise patterns of alcohol use, club drug use and dependence, injecting drug use and engagement with treatment services, comparing lesbians, gay men, bisexual women and bisexual men. DESIGN AND METHODS A cross-sectional, online survey was conducted with 572 SSAY in Sydney, aged 18 to 25 years. The Alcohol Use Disorders Identification Test--Consumption questions (AUDIT-C) assessed hazardous alcohol use, and the Severity of Dependence Scale assessed club drug dependence. RESULTS Seventy per cent of respondents had AUDIT-C scores indicative of hazardous alcohol use, and 29% of respondents had used club drugs in the previous 6 months. Multivariate logistic regression showed that male respondents had a lower odds of hazardous alcohol use (adjusted odds ratio = 0.6, 95% confidence interval 0.4-0.9), but a higher odds of recent club drug use (adjusted odds ratio = 1.8, 95% confidence interval 1.2-2.7). Methamphetamine dependence was reported among half of respondents who reported use in the previous 6 months. Bisexual women were more likely than other respondents to have sought treatment for alcohol and other drug use, and overall treatment utilisation was low (6%). DISCUSSION AND CONCLUSIONS This study reports high rates of drinking and club drug use, and a possible underutilisation of alcohol and other drug treatment. The findings suggest that SSAY in Sydney may be at a high risk of alcohol- and drug-related harm.

No Ordinary Mainstream Illness: How HIV Doctors Perceive the Virus

Research has shown that social representations of HIV can constitute barriers to health workers’ willingness to provide HIV care. Considering a growing shortage in the HIV primary workforce in Western countries, we examine how HIV is perceived today by doctors involved in its care. In 1989 Sontag predicted that once the virus became better understood and treatable, the dehumanizing meanings that defined the early epidemic would vanish and HIV would turn into an ordinary illness. However, research shows that HIV still carries stigma, including in the health care sector. Drawing on qualitative interviews, we found that HIV doctors in Australia perceived HIV as a far-from-ordinary chronic illness because of its extraordinary history and its capacity to extend in multiple clinical and social directions. These rarely explored perspectives can contribute to the social reframing of HIV and to strategies to build a dedicated HIV workforce in Australia and elsewhere.

What moves a family doctor to specialise in HIV? Interviews with Australian policy key informants

The population of people living with HIV in Australia is increasing, requiring an expert primary care workforce to provide HIV clinical care into the future. Yet the numbers of family doctors or general practitioners (GPs) training as community-based HIV medication prescribers may be insufficient to replace those retiring, reducing hours or changing roles. We conducted semi-structured interviews between February and April, 2010, with 24 key informants holding senior roles in organisations that shape HIV-care policy to explore their perceptions of contemporary issues facing the HIV general practice workforce in Australia. Informed by interpretive description, our analysis explores how these key informants characterised GPs as being ‘moved’ by the clinical, professional and political dimensions of the role of the HIV general practice doctor. Each of these dimensions was represented as essential to the engagement of GPs in HIV as an area of special interest, although the political dimensions were often described as the most distinctive compared to other areas of general practice medicine. Our analysis explores how each of these dimensions contributes to shaping the contemporary culture of HIV medicine and suggests that such an approach could be useful for understanding how health professionals become engaged in other under-served areas of medical work.

At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

BackgroundHIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine.MethodsAs part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings.ResultsThe rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the ‘coalface’ and the ‘cutting edge’, and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change.ConclusionsApproaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce.

Homosexuality in midlife : narrative and identity

However impetuous and unwise, this book began at a dinner party at which were gathered a group of middle-aged gay men. One of the men present began to talk about his experience with commercial masseurs. This came as a surprise to the rest of us, because Ken was on record as disapproving of casual sex. Ken was known to be a romantic. He would sing the praises of those friends who had partners, and the longer they had been together, the more Ken admired them. He was distressed and disappointed whenever he heard of couples breaking up. Ken seemed to wish the same for himself and yet had never had a boyfriend, though he was notorious for having crushes on younger men and suffering from unrequited love. His dinner companions were pleased to learn that Ken was branching out in retirement, and his new interests aroused considerable curiosity. Ken’s story was a mixture of excitement, pleasure, reservations, discovery and self-criticism. Ken seemed pleased to be holding the floor on the matter of sex, which was a new role for him although he was a showman on many other topics. Ken was encouraged in his new interest by the rest of us, who were pleased to see Ken happy and, at long last, getting some sex–an activity that had given us a lot of pleasure. The discussion moved on to the changes that we had all experienced in our sex

Trauma and The Relational Dynamics of Life-History Interviewing

Abstract Practitioners of oral history and life-history interviewing often claim therapeutic benefits for their practice. This article questions these claims especially when interviews involve a traumatic dimension. The repetitive nature of trauma can undermine the best intentions of the oral historian requiring the interviewer to be alert to both conscious and unconscious dynamics of the interview.

Truth and sex in gay men's narratives

It is hard to ignore sex in contemporary western life. Historians and social theorists, from Foucault (1976/1979) to Anthony Giddens (1991, 1992), have noted the central place sex has assumed in modernity, especially in terms of self-identity. Sex continues to hold a privileged place in the western imagination–a quick tour of daytime chat shows is enough evidence of that. As Ken Plummer (1995) argues, we live in a world of sexual stories, with many of those stories claiming to tell us the truth about ourselves. Homosexuality has played a pivotal role in this explosion of knowledge about sexuality. Indeed, according to Gary Dowsett, “homosexuality is what makes sexuality complex” (1996, p. 273). Expanding upon this contention, Dowsett suggests that over the last century the discursive figure of the homosexual has been at the heart of our understandings of sexuality. This is a provocative argument, but one that makes intuitive sense. The discourse of homosexuality has shadowed the creation of contemporary knowledge about sexuality. In recent decades, following the groundbreaking work of McIntosh (1968), Altman (1971) and Weeks (1977), this dynamic relationship has been laid bare through the historical and theoretical dismantling of sexual categories. Yet Dowsett makes another provocative point. Sex itself has been startlingly absent in much social theory of sexuality (although he fails to