Gay Men Research Articles

Poppers, the Politics of Exemption and the Characteristics of Poppers Users in the annual English Festival Study, 2014–23

Abstract This paper explores the relationship between socio-demographic characteristics, self-reported alkyl nitrite (‘poppers’) use and sexual behaviours against a backdrop of UK policy change and ambiguity surrounding legal status. In 2024, the Advisory Council on the Misuse of Drugs recommended a unique, government-initiated, legal exemption from the Psychoactive Substances Act 2016 for poppers, because of its use by gay and bisexual men to reduce the risk of injury during anal sexual intercourse. Data from the annual convenience sample English Festival Study 2014–23 (n = 11,566) were used for Bayesian regression analyses of self-reported poppers use in three-time frames: lifetime, past year and past month use. Gay men were significantly more likely to report poppers use and particularly those reporting past-year participation in anal sex. Providing a critical analysis of recent trends in UK drug policy, the authors highlight how differential discrimination occurs within drug control where targeted exemption meets the politics of protected characteristics in UK law. This paper argues that poppers, therefore, provide a unique example in UK drug policy of how an apparent liberalization of legislative control could bolster the overarching drug prohibition regime while maintaining the appearance of rationality and fairness.

Implementation and Evaluation of a Home-Based Pre-Exposure Prophylaxis Monitoring Option: Protocol for a Randomized Controlled Trial.

HIV prevention is a public health priority. Despite progress in recent years, pre-exposure prophylaxis (PrEP) use remains suboptimal especially among groups disproportionately impacted by new HIV diagnoses such as gender and sexual minorities of color. Multiple barriers including a lack of PrEP providers and challenges with attending quarterly monitoring visits contribute to low PrEP uptake and retention. Home-based PrEP (HB-PrEP) services could reduce stigma, increase convenience, expand health system capacity for PrEP care, and improve PrEP retention. Home Option Testing for PrEP (HOT4PrEP) is a hybrid randomized controlled trial (RCT) that aims to examine whether HB-PrEP care is acceptable to PrEP users, feasible to implement in a sexual health clinic setting, and impacts PrEP retention. The RCT will recruit 458 persons currently taking or soon to initiate PrEP at a sexual health clinic in Seattle, Washington, and randomize them to continue the standard of care or have the option to use HB-PrEP for 2 of 3 triannual PrEP follow-up visits. Participants in the intervention arm will be sent home kits containing gonorrhea and chlamydia swabs and Tasso devices for blood self-collection. The primary outcome is PrEP retention between groups at 20 months; secondary outcomes include user satisfaction and acceptability, feasibility, self-reported PrEP adherence, and sexually transmitted infection (STI) incidence. Interviews with PrEP users and clinic staff will elucidate barriers and facilitators of implementation. The HOT4PrEP RCT began enrolling in March 2022, was on hold during the height of the US mpox epidemic, then resumed enrollment in December 2022. Of the first 100 enrollees, the median age is 34 years, and most are cisgender gay men (89/100, 89%) with at least some college education (91/100, 91%). Among the 49 participants randomized to the HB-PrEP option, 33 (67%) chose to self-collect samples at home at least once, of whom 27 (82%) successfully returned test kits for HIV and STI testing. Primary PrEP retention and qualitative analyses are ongoing. Implementation of HB-PrEP into a high-volume sexual health clinic seems to be feasible and acceptable to early RCT enrollees. This strategy has the potential to address individual and systemic barriers associated with initiating and persisting on PrEP, such as increasing sexual health agency and expanding clinical capacity to serve greater numbers of PrEP users. ClinicalTrials.gov NCT05856942; https://clinicaltrials.gov/study/NCT05856942. DERR1-10.2196/56587.

Mental health disparities across sexual orientations during the COVID-19 pandemic: Longitudinal analysis of a UK nationally representative cohort

ObjectivesDuring COVID-19, sexual minority groups may have experienced heightened mental health challenges, amplified by unique stressors and the effects of pandemic-related restrictions. This study investigates the differential impact of the pandemic on mental health across sexual orientations, leveraging population-representative data to explore these disparities. Study designProspective cohort design. MethodsData from the United Kingdom Household Longitudinal Study (waves 8–12) was used. Monthly COVID-19 incidence rates at the regional level were used to indicate pandemic severity. Mental health outcomes were evaluated using the Mental Component Score of the Short Form-12 (MCS-12) survey. To examine whether COVID-19 led to differential impacts across sexual orientation, fixed-effect longitudinal models were employed, controlling for individual and time-variant covariates. ResultsLesbian women experienced a significant mental health decline during the COVID-19 pandemic, with a 3.10 MCS-12 score decrease (95 % confidence interval (CI): -5.77 to -0.43) and an 11.0 % higher likelihood of depression (95%CI: -0.3 % to 22.3 %, p = 0.057) compared to heterosexual women. Conversely, the impact on the mental health of heterosexual women was negative but not significant (-0.22; 95%CI: -0.47 to -0.04). Bisexual individuals and other women showed non-significant mental health declines. For men, COVID-19's effect on heterosexuals was similarly non-significant (-0.21; 95%CI: -0.48 to 0.1), with no significant differences observed in gay, bisexual, and other men. ConclusionsSexual minority individuals, especially lesbian women, faced heightened mental health challenges during COVID-19, emphasizing the urgency for targeted interventions.

Identity Centrality and Leisure Behavior among Chinese Queer Individuals in the U.S

Research has suggested that various leisure contexts can shape lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals’ identities differently. The multiplicity of identities for Chinese LGBTQ+ individuals who migrate from China to the U.S. may be more salient and complicated given the potential changes in the cultural environment, acceptance of the LGBTQ+ community, and leisure experiences. The purpose of the study was to explore the leisure experiences of Chinese queer individuals living in the U.S. and the associated meanings they attribute to identity development. Data collection included semi-structured interviews with eleven Chinese LGT individuals, including seven gay men, two trans men, and two lesbian women. Through the theoretical lens of Identity Centrality, results revealed that participants engaged in various leisure activities to reinforce their sexual, gender, and leisure identities. The findings contributed to understanding the intersections of (im)migration, culture, and leisure in shaping the identity expression of Chinese queer immigrants.

Older, gay men's navigation of mental health and substance use challenges: A qualitative exploration

Older, gay men's navigation of mental health and substance use challenges: A qualitative exploration

Parents’ views on gay male teachers in early childhood education

ABSTRACT The stigma surrounding men’s sexuality in Early Childhood Education (ECE) is complex and part of a sexuality hierarchy within which homophobic, emasculating and disparaging undertones are often used to label male teachers in ECE as gay. In this paper the authors demonstrate the complex and gendered ways in which this stigma unfolds in a South African context and offer a decolonising gender perspective to highlight how the country’s socio-political context impacts on how parents respond to gay men in ECE. The parents in this study expressed tolerance and acceptance of gay men’s involvement in ECE. Notwithstanding, these diverse views, many parents’ tolerance and acceptance of gay men in ECE was found to be powerfully structured along a discriminatory heterosexist culture. Despite this, some parent’s acceptance of gay male teachers in ECE were underpinned by gender-progressive attitudes to focus on curtailing gender discrimination and promoting gender diversity and inclusivity at school.

Perceived Versus Actual Costs of HIV Pre-Exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States.

Gay, bisexual, and other men who have sex with men (GBMSM) account for the highest proportion of HIV diagnoses in the United States, with daily pre-exposure prophylaxis (PrEP) significantly reducing transmission risk. Since 2021, the Affordable Care Act rules have required PrEP and accompanying care visits to be free for most Americans; nevertheless, insurers have found ways to circumvent no-cost PrEP and some employers are receiving exemptions from including it in their formularies. Despite this, perceived costs and indirect expenses still hinder PrEP adoption. This study examines the differences between perceived and actual costs among GBMSM who have and have not used PrEP. We conducted a one-time online survey with 692 adults from six New England states between May 2020 and October 2021. Participants who had never used PrEP estimated its cost, while those with prior PrEP experience reported their actual expenses. Bivariate analysis and multi-variable logistic regression were used to assess the data. Results showed a 60% difference between perceived ($48) and actual ($30) median monthly costs. Higher perceived costs among nonusers were linked to race and income, while high actual costs for prior users were associated with insurance type, income, wealth, race, and self-rated consumer credit. This significant disparity in PrEP cost perceptions highlights the need for targeted outreach and messaging to improve PrEP uptake among at-risk populations who have not yet accessed it.

Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study

Background Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18–24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March − 16 April 2023) and post-implementation (period 1, 1 May − 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June − 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21–1.43; p < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9–18.1; p < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5–28.7, p < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.

Pelvic Floor Disorders Due to Anal Sexual Activity in Men and Women: A Narrative Review.

Recent evidence shows that consensual anal penetrative intercourse has become more prevalent, not only limited to gay, bisexual, and other men who have sex with men but also for women who are in a sexual relationship with men. The aim of this review was to study the influence of consensual anal intercourse on pelvic floor function and the role of pelvic floor physical therapy treatment in preventing or treating consensual anal intercourse-induced anodyspareunia and/or fecal incontinence. We reviewed 68 references that showed that anal penetrative intercourse is a risk factor for anodyspareunia and fecal incontinence in both men and women. This risk of anal intercourse may increase with emotional discomfort, an overactive pelvic floor, lack of lubrication, frequency of anal penetrative intercourse, and hard practice (BDSM: bondage and discipline, dominance and submission, sadism, and masochism). It seems that pelvic floor physical therapists play an essential role in preventing and treating pelvic floor dysfunctions due to anal intercourse, which can lead to anodyspareunia and fecal incontinence; the treatment includes education, pelvic floor training with and without biofeedback, electric stimulation, manual therapy, and dilatators. Further studies are warranted to enhance our understanding of the causes and treatment efficacy of pelvic floor dysfunctions due to anal penetrative intercourse.

Fucking Men, tsolia and mpares: translating camp talk for the Greek stage

ABSTRACT The premiere of Joe DiPietro’s Fucking Men in Greece, in November 2018, sparked intense interest, particularly in the local gay community. Adapted from Arthur Schnitzler’s controversial La Ronde, the play delves into the emotional and sexual dynamics of gay men within late capitalism, exploring themes such as promiscuity, fear of outing, HIV/AIDS, closeted lives, and the complex nature of relationships. Antónis Galéos translated the play, offering insights into Greece’s modern gay landscape. This article addresses the underexplored intersection of gender, sexuality, and theatre translation, focusing on the construction of gay identities through verbal camp. Using Keith Harvey’s descriptive framework on surface features of camp, it examines how verbal camp is translated into Greek, highlighting its impact on stage effects and on broader societal implications. This study aims to shed light on the nuanced construction of gay identities across languages and cultures, emphasizing visibility and representation within the local gay community.

Driving Under the Influence of Alcohol and Cannabis by Sexual Identity, Race, Ethnicity, and Gender: A Nationwide Analysis Using the 2016 to 2019 National Survey on Drug Use and Health.

Sexual minority populations experience higher rates of substance use and related problems, but little is known about their specific involvement in driving under the influence (DUI) of alcohol (DUIA) and cannabis (DUIC) incidents. Using data from the 2016 to 2019 National Survey on Drug Use and Health, we used logistic regression models to estimate the interactive effects of sexual identity, race/ethnicity, and gender on past-year DUIA among adults who used alcohol and DUIC among adults who used cannabis, accounting for covariates. Using model estimates and linear combinations, we calculated the predicted probabilities of each outcome and compared sexual identity differences within and across race/ethnicity and gender. With few exceptions, the predicted probabilities of DUIA and DUIC were significantly higher among sexual minority women than heterosexual women of similar race/ethnicity. The results were more variable among men with the probabilities of DUIA and DUIC being significantly higher for some groups of sexual minority men and some groups having probabilities equal to or lower than similar heterosexual men. Some of the largest sexual minority gaps in DUIA and DUIC were observed among Hispanic and Other lesbian women and Black gay men. Sexual minority individuals are more likely to report DUI than their heterosexual counterparts; however, the risk of DUI among sexual minority populations varies by racial/ethnic and gender subgroup. Our findings indicate the importance of applying an intersectional framework when addressing substance-use-related disparities and when designing effective DUI prevention interventions for sexual minority populations.

Group sex and behavior change associated with the 2022 Mpox outbreak among men who have sex with men in Southern California.

The Monkeypox (Mpox) outbreak disproportionately affected sexually active gay, bisexual, and other men who have sex with men. To understand community-level changes in sexual behavior, we surveyed individuals in a semi-urban area in Southern California. Participants were recruited between October 2022 to April 2023, using palm cards, and geolocation-focused online advertisements on social media and dating apps. Eligible participants were male, ≥18 years, reported sex with men, residents of San Bernardino or Riverside counties, California, Human Immunodeficiency Virus (HIV)-negative, currently not taking pre-exposure prophylaxis (PrEP). Descriptive analyses were performed. Chi-square, Fisher's exact, and Student's T-tests examined the association between group sex behaviors and demographics. We enrolled 91 gay, bisexual, and other men who have sex with men with a median age of 35 years (range 18-70 years). Nearly half reported having participated in group sex in the past year. Overall, 48.9% of group sex participants reported changing their sexual behaviors to prevent Mpox transmission, with limiting the number of sex partners being the most reported prevention strategy (47.6%). To prevent Mpox infection, participants that engage in group sex reported limiting the number of sex partners (34.4%), using condoms for anal sex (16.7%), avoiding crowded social venues (14.3%), and asking partners about Mpox symptoms before sex (9.5%). Survey participants reported modest sexual behavior changes in response to the Mpox outbreak. Group sex may increase the risk for Mpox, HIV, and other sexually transmitted infections; therefore, public health messages should include specific discussion of safer group sex practices in sexual health promotion.

Internalized Heterosexism, Hope, and Depressive Symptoms Among Gay and Bisexual Men

Sexual minority men (SMM), and bisexual men in particular, show elevated risks of depressive symptoms relative to heterosexual men. A breadth of research shows that internalized heterosexism, a primary minority stressor, partially explains the disproportionately high levels of depressive symptoms among SMM. However, it is less clear which factors buffer this relationship. The present study investigated whether hope and its subfactors, agency and pathways, moderated the relationship between internalized heterosexism and depressive symptoms, and whether this was contingent on sexual orientation (gay versus bisexual). An international sample of 412 mostly cisgender gay (59.7%) and bisexual men (40.3%) aged 18–81 years (M = 37.32 years, SD = 14.26) completed the Revised Internalized Homophobia Scale, the Adult Dispositional Hope Scale, and the Center for Epidemiological Studies Depression Scale. Results indicated that internalized heterosexism, hope, agency, and pathways were independently associated with depressive symptoms. Hope, agency, and pathways did not moderate the internalized heterosexism-depressive symptoms relationship, nor were these moderation relationships conditional on sexual orientation. Findings substantiate previous research suggesting that internalized heterosexism is a risk factor for depressive symptoms and hope, agency, and pathways are protective factors. Clinicians working with SMM should consider integrating strategies to mitigate internalized heterosexism and cultivate hope, and scholars should aim to expand research focused on the role of hope in influencing SMM’s mental health outcomes.

Framing silence: the Nazi persecution of gay men in Michel Dufranne and Milorad Vicanović-Maza’s graphic novel, Triangle rose (2011)

ABSTRACT Writer Michel Dufranne and illustrator Maza’s French-language graphic novel, Triangle rose, (2011) features a Berlin homosexual deported under Paragraph 175. In this frame narrative, the elderly survivor’s story never reaches its potential diegetic audience, Parisian students, including the protagonist’s great-grandson. The framed narrative represents the protagonist’s unarticulated memories. This narrative glitch reflects 1) the historic failure to acknowledge homosexuals as legitimate Nazi victims, and 2) ongoing homophobia in Berlin and Paris, resulting in shame, as conceptualized by Sara Ahmed and Ruth Leys. Portraylng the Nazi persecution of gay men, Triangle rose highlights an important, underrepresented chapter of National Socialist history.

Social relations among older gay men and trans women in Chile: Diverse, intimate, functional and reciprocal networks

Although LGTBIQ+ groups have experienced social transformations towards greater levels of respect and public presence in Chile in recent decades, the life trajectories of older people remain marginal in studies and surveys regarding sexual and gender diversity. In a society where homophobia is a current and oppressive attitude despite important advances, it is essential to examine the experiences of older LGBTIQ+ people, especially because they are vulnerable to dual discrimination in old age owing to a combination of homophobia and ageism. This study involved an analysis of social ties based on the Convoy Model, to understand how different life courses have influenced the structuring of social networks in old age among gay men and trans women in Chile. Framed within the context of broader research into four axes of diversity in ageing, this study reports the results of thirteen biographies of older people (ten gay men and three trans women). In-depth interviews were conducted using a biographical approach in which the social links that accompany the life course are deepened. A thematic analysis strategy was applied and the interview data were processed through NVivo. The findings show three concentric circles surrounding the participants: closest (made up of partner, immediate family and chosen family), closer (made up biological and extended family) and close (made up of peers and neighbours). The older people are integrated into social networks with diverse compositions, share closeness and intimacy, receive emotional, informational and instrumental social support, and are active providers of reciprocal support. However, the study notes certain risk factors, such as the difficulty of cohabiting and maintaining relationships with a partner. Participants living alone reported fearing an absence of instrumental support during more advanced stages of the ageing process.

Invasive Neisseria meningitidis subtype C in gay, bisexual and other men who have sex with men: a systematic review

IntroductionOutbreaks of invasive Neisseria meningitidis subtype C in networks of gay, bisexual and other men who have sex with men (MSM) have been reported. We aimed to explore any factors...

School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men ( n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Disparities in Telomere length by Sexual Orientation in Adults from the Genetic Epidemiology Research on Aging Cohort.

The weathering hypothesis proposes that marginalized people experience faster biologic aging due to cumulative stress which translates to chronic disease disparities. We assessed telomere length (TL) differences, an aging biomarker, by sexual orientation (bisexual, gay/lesbian, straight) among 102,258 individuals enrolled in the Resource for Genetic Epidemiology Research on Aging Cohort during 2008 through 2011 (mean age of 60.6 years, 58% female, and 7.6% bisexual/gay/lesbian). We used linear models to estimate differences in telomere length, stratified by sex/gender and adjusted for age (at salivary sample) and socio-demographic variables and Kitagawa-Blinder-Oaxaca decomposition to quantify contributions of participant factors on TL differences. Among females, there was no significant difference in age-adjusted telomere length by sexual orientation after adjustment for socio-demographics (ref: straight; bisexual 0.007, 95%CI: -0.03 to 0.04; lesbian: 0.005, 95%CI: -0.02 to 0.03). Among males, only gay (-0.04, 95%CI: -0.06 to -0.02) but not bisexual (-0.02, 95%CI: -0.06 to 0.02) men had significantly shorter age-adjusted telomere length compared to straight men after adjusting for socio-demographic variables. Decomposition analysis identified ever smoking and marital status as significant drivers of the gay-straight disparity. Studies confirming our findings are needed and the implications of shorter telomeres on gay men's health requires further investigation.

Exploration of Mental Health Elements in Chemsex Behavior: Interventions, Influencing Factors, and Attitudes towards Risk and Harm Reduction in Spain.

A qualitative descriptive phenomenological study was conducted in the community of Madrid, Spain to explore the depth of the chemsex phenomenon through a thematic analysis. Between April and June 2024, interviews were conducted with 15 MSM (gay, bisexual, and other men who have sex with men) who participate in these practices, using purposive and snowball sampling. three main themes were identified, namely, (T1) contextualization of the practice, (T2) factors associated with chemsex, and (T3) strategies and interventions for risk and harm reduction. Chemsex is a phenomenon that combines sexual practices with substance use in complex social environments, presenting significant risks to physical, mental, and sexual health. It is necessary to implement public health interventions to mitigate these risks.

Sisters, Bottoms, and “Exotic Combo”: Homonormative Misogyny and Respectable Masculinity of Middle-Class Gay Sex Workers in Hong Kong

This article brings together queer studies and masculinities studies to discuss how middle-class gay sex workers in Hong Kong manage the stigma of same-sex sex work. Based on 11 months of ethnographic fieldwork in a gay erotic massage parlor in Hong Kong, I examine how middle-class gay sex workers in Hong Kong deploy locally specific notions about gender, class, and border to mitigate their anxiety about sex work and to establish a form of gay masculinity. The middle-class gay masseurs claim a respectable self through narrating multiple disrespectable others—women streetwalker, bottom masseur, and lower-class migrant sex worker. In everyday banter, satire, and bawdy jokes around these three figures, masseurs invoke homonormativity through misogynistic discourses about migrant women, femininity, effeminacy, and penetration. In so doing, they simultaneously produce gay masculinity and gay misogyny, a process I term “homonormative misogyny.” In neoliberal Hong Kong, this form of gay respectability politics is emergent in an increasingly gentrified sexual economy.