Young Gay Men Research Articles

Moral barriers to HIV prevention and care for gay and bisexual men: Challenges in times of conservatism in Brazil.

This article examines narratives about promiscuity that are emphasized by some gay and bisexual men who are themselves living with HIV. We used semi-structured interviews to assess the processes, outcomes, and meanings of HIV diagnosis among 10 young gay and bisexual men aged between 18 and 30years old. Interviews were conducted in health service settings for the diagnosis and treatment of HIV and AIDS in Salvador, Brazil. Based on a socioculturally oriented approach, the narratives suggest that discourse about promiscuity seems to persist, or is even strengthened, in order to explain HIV infection among young gays/bisexual men and to emphasize a more restrained sexual life following HIV diagnosis. Despite the biotechnologies and biomedical advances, some difficulties and tensions also persist in the daily life of young people living with HIV. Difficulties in starting new relationships, dilemmas around responsibility for infection/transmission, fear and guilt are elements that stand out in these narratives, demonstrating that HIV discourses and practices may produce greater stigma and discrimination in current times, individualizing and blaming certain people for the infection/transmission of the virus, and marginalizing practices that do not conform to hegemonic heteronormativity.

The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men

ObjectivesGay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients’ perceptions of their provider’s sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients’ disclosure of sexual orientation to providers. MethodsData were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18–26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance. ResultsParticipants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics. ConclusionsFindings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men’s health. Practice implicationsDyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients’ sexual minority statuses.

Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships

Expectations and beliefs: How single young gay, bisexual and other men who have sex with men envision romantic relationships

Mental Health Service Utilization Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men in HIV Care: A Retrospective Cohort Study.

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) face multiple psychosocial stressors, and are disproportionately impacted by HIV. Mental health care engagement is a promising avenue for addressing these disparities. To date, rates of mental health service utilization have not been examined specifically in this population. We conducted a retrospective cohort study among YB-GBMSM receiving care in a Ryan White-funded HIV care center that includes co-located HIV and mental health services. Of 435 unique YB-GBMSM patients, mental health concerns were identified in n = 191 (43.9%). Depressive symptoms were the most common concerns identified, followed by substance use, anxiety, and trauma. Among patients with identified mental health concerns who were not previously in mental health care, 79.1% were referred to mental health care, 56.3% set an appointment with a mental health provider, 40.5% were linked to mental health care (attended an initial visit), and 19.6% remained engaged in mental health care. Younger YB-GBMSM (age 18-24 years), who received care in a more integrated pediatric/adolescent part of the center, were more likely to have an appointment set once a concern was identified (χ2 = 7.17; p = 0.007). Even in a setting with co-located HIV and mental health care services, we found significant gaps in engagement at each stage of a newly described mental health care continuum. Implications for intervention at the provider and systems levels are discussed.

Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries

BackgroundUpwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown. MethodsWe investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities. ResultsFindings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis. ConclusionsOur findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.

Exploring young Black gay, bisexual and other men who have sex with men’s PrEP knowledge in Toronto, Ontario, Canada

Despite significant advances in the HIV treatment and prevention landscape such as pre-exposure prophylaxis (PrEP), young Black-Canadian gay, bisexual and other sexual minority men continue to experience disproportionately high rates of HIV infection. While research has explored the factors associated with their higher HIV exposure and the efficacy of STI/HIV prevention programmes, there remains a paucity of research on their knowledge of HIV prevention strategies such as PrEP. We interviewed twenty-two young men and used a constructivist grounded theory approach to qualitatively analyse these young men’s PrEP knowledge. Intersectionality and the social ecological model allowed us to explore how social locations (e.g. race, sexual orientation), interacted with individual, interpersonal and community contexts to shape their understanding. Our analysis revealed two interrelated barriers to PrEP knowledge and uptake. The first centred on the ineffectiveness of institutions in disseminating PrEP information to participants. The second focused on the impact of participants’ social locations and perceptions of PrEP users based on their PrEP knowledge. Findings suggest the need for more targeted, culturally congruent PrEP dissemination strategies and PrEP prescription policies that acknowledge the various social locations and ecologies in which young Black gay, bisexual and other men who have sex with men reside.

Sex, lies, and videotape: A content and textual analysis of media coverage of the HIV criminal prosecution of Michael Johnson

Media coverage of HIV criminal cases has deployed sexualized and racialized tropes, and portrayed defendants as villains. Several media analyses of HIV criminal trials have been conducted, though only one was in the US, and none involved young Black gay men, who are disproportionately impacted by HIV. We conducted content and textual analyses of 91 media stories focused on the 2015 case of Michael Johnson, a Black gay college student living with HIV who was convicted under Missouri’s HIV non-disclosure laws. To capture both dominant and resistant meanings in news stories, we included mainstream news outlets, as well as HIV-related, African American and GLBT community-oriented outlets. Open and axial coding were carried out by a team of four researchers and thematic analysis was used to explore how media framed Johnson, his sexual activities, condom use, and alleged nondisclosure. Results showed that media stories portrayed Johnson as dishonest and sexually predatory by drawing on narratives of deception and framing him as the sole agentic actor in his sexual encounters. We argue that these media frames, coupled with what is included and excluded in media coverage negatively impacts public opinion of PLWH, reinforces HIV criminalization ideologies, and performs a disciplinary function in the lives of PLWH.

Perspectives from Young Partnered Gay, Bisexual, and Other Men Who Have Sex with Men on the Adaptation of Couples HIV Testing and Counseling (CHTC).

Young gay, bisexual, and other men who have sex with men (YGBMSM) are a priority population for HIV prevention efforts. Although there has been a growing focus on dyadic HIV prevention interventions for same-gender male couples, the unique needs of partnered YGBMSM have been largely overlooked. In this qualitative study, we explored partnered YGBMSM's perceptions of existing HIV prevention interventions to inform the design of a relationship-focused HIV prevention intervention. Between July and November 2018, we conducted in-depth interviews with 30 young partnered YGBMSM (mean age = 17.8, SD = 1.1). Participants described that interventions were needed to address skills regarding: (1) implicit versus explicit communication about sexual agreements; (2) boundary setting and identifying signs of abusive relationships; and (3) relationship dynamics (e.g., trust). Participants noted the absence of inclusive sexual education for them; thus, findings suggest that the provision of relationship skills training are requisites for HIV prevention interventions with YGBMSM in the US.

Interpersonal and Intrapersonal Influences on Sexual Satisfaction in Young Male Couples: Analyses of Actor-Partner Interdependence Models

ABSTRACT Very little research has examined sexual satisfaction in young gay, bisexual, queer, and other men who have sex with men (YMSM). Sexual satisfaction has important implications for individual wellbeing and is a central component of romantic relationship functioning and satisfaction. In order to fill this gap, this study examined interpersonal and intrapersonal factors associated with sexual satisfaction in a large sample of young male couples. Data for these analyses came from the baseline visits of two ongoing randomized controlled trials of 2GETHER, a relationship education and HIV prevention program for young male couples. Participants for the current analytic sample were 419 couples (individual N = 838) from across the United States who were diverse in terms of race/ethnicity, HIV status, and geographic region. Analyses found that relationship functioning (i.e., relationship satisfaction, communication) was positively associated with sexual satisfaction, while not having a specified relationship agreement (i.e., monogamy/non-monogamy agreement) was associated with less sexual satisfaction. Intrapersonal factors (i.e., depression, substance use) were associated with sexual satisfaction, but most of these effects became non-significant in a full multivariate model. Relationship functioning plays a central role in sexual satisfaction and should be addressed in couple-based programs to optimize relationship functioning and sexual health.

Sexuality, migration and family: understanding Jia and its impact on Chinese young gay men’s migration motives from a temporal perspective

ABSTRACT Based on analyses of the lived experiences and narratives of Chinese intranational migrant young gay men, this article investigates the complicated ways in which jia (family/home) motivates their migrations from a temporal perspective. I identify three temporal aspects of their migrations—life course, generation, and imagining the future. I also demonstrate the different ways in which jia motivates their migrations in relation to their past (pre-migratory experiences), their present (migratory experiences) and their future (narratives of an imagined future). I argue that by combining hetero – and homonormativity with the intersection of individualisation and familism, or, to use Yan’s term, neo-familism, the complicated role that jia plays in motivating Chinese young gay men’s migration can be better understood. By illustrating the intricate entanglements of sexuality, migration, and family, this article aims to challenge the North-centric conceptualizations of intranational queer migration and open up new possibilities to theorise queer migration from an East Asian perspective.

Peggy Ahwesh, Steve McQueen and Russell T. Davis: Reflections on the 1980s under lockdown

In lockdown as I finished my five-year project, on women experimental filmmakers from the 1970s and 1980s, I have been focusing on this past time that formed me. Watching films by artist/filmmakers that I love has helped to keep my anger at the present at bay. A parallel journey back in time has been playing out on TV via the high-profile voices of Steve McQueen and Russell T. Davis. Steve McQueen’s series, Small Axe pays tribute to the Black communities’ struggles, as the postwar era waned and the aggressively neo-liberal individualist world waxed. The anger and activism from an earlier period presciently planned for a 2020 screening speaks out at us from the TV, coinciding with Black Lives Matter, and begs the question of how exactly have things improved in the last 40 years? By contrast Russell T. Davis’ It’s a Sin, is a more sugar-coated dramatization of the 1980s in its treatment of the trauma of the AIDS generation and the impact of the disease on a small group of young gay men and allies in London. How do these different voices meet, mix and coalesce as both a vision from that era and a memory of that era?

Supporting Health Among Young Men Who Have Sex With Men and Transgender Women With HIV: Lessons Learned From Implementing the weCare Intervention.

Young gay, bisexual, and other men who have sex with men and transgender women with HIV, particularly those who are racial or ethnic minorities, often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, an mHealth (mobile health) intervention where cyberhealth educators utilize established social media platforms (e.g., Facebook, texting, and GPS-based mobile applications ["apps"]) designed for social and sexual networking) to improve HIV-related care engagement and health outcomes. As part of the process evaluation of weCare, we conducted 32 interviews with intervention participants (n = 18) and HIV clinic providers and staff (n = 14). This article highlights three key intervention characteristics that promoted care engagement, including that weCare is (1) targeted (e.g., using existing social media platforms, similarity between intervention participants and cyberhealth educator, and implementation within a supportive clinical environment), (2) tailored (e.g., bidirectional messaging and trusting relationship between participants and cyberhealth educators to direct interactions), and (3) personalized (e.g., addressing unique care needs through messaging content and flexibility in engagement with intervention). In addition, interviewees' recommendations for improving weCare focused on logistics, content, and the ways in which the intervention could be adapted to reach a larger audience. Quality improvement efforts to ensure that mHealth interventions are relevant for young gay, bisexual, and other men who have sex with men and transgender women are critical to ensure care engagement and support health outcomes.

Moral practices shaping HIV disclosure among young gay and bisexual men living with HIV in the context of biomedical advance

Biomedical advances in diagnostics, treatment and prevention increase the means available to reduce HIV transmission risk. Subsequent shifts in HIV status disclosure obligation and ethics may impact how those living with HIV view, enact and experience disclosure. We analysed focus group and interview data to explore how these changes are reflected in disclosure decision-making to sexual partners among young gay and bisexual men living with HIV in the USA. Three interrelated themes were identified: engaging with partners’ varying HIV knowledge; attribution of blame; and negotiating disclosure-related harms. Participants experienced blame from partners that questioned the timing of HIV testing, status disclosure and sex events without regards for viral suppression or use of pre-exposure prophylaxis. Substantial HIV stigma was described in response to disclosure, mitigated in some cases by partners’ higher HIV knowledge. Overall, an uneven diffusion of HIV treatment and prevention knowledge and continuing HIV stigma seemed to limit the translation of biomedical advances into improved disclosure experiences. Our findings suggest that young gay and bisexual men living with HIV may continue to perform much of the moral labour involved in disclosure by managing others’ reactions, correcting inaccurate sexual health information, and negotiating the risks of disclosure-related harm.

Healthcare usage and satisfaction among young adult gay men in New York city

Satisfaction greatly impacts decisions about where and how to access healthcare. This cross-sectional study uses data gathered from young adult gay men in New York City. Findings indicate that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare. Participants who disclosed their sexual orientation and were comfortable discussing sexual activity with their provider were more likely to agree that their healthcare needs were adequately addressed. The healthcare system does not fully address the healthcare needs of gay men. Preferences for coordination of care, nondisclosure of sexual orientation, and low levels of satisfaction with services further discourage healthcare usage among this population.

Learning from pornography: results of a mixed methods systematic review

ABSTRACT Researchers and media commentators often claim that young people are increasingly learning about sex through pornography, but evidence about this is unclear. This article reports on a mixed methods systematic review of research on pornography use for sexual learning. Ten articles were included that explicitly addressed how porn users describe the educational aspects of pornography. Thematic analysis located five key themes about ‘porn education’ in these articles: learning the mechanics of sex; learning concerning sexual identities and sexualities; inadequate information through pornography; wrong lessons from pornography; and a need for more relevant sex education. No articles attempted to measure or discuss whether people who access pornography have better (or worse) skills and knowledge about sex and sexual health than those who do not. Sex education is only discussed in relation to young people, neglecting attention to lifelong learning about sex and sexuality. According to this dataset, pornography use can offer useful information about the mechanics of sex, and this is particularly pertinent for young gay men. Many articles reveal that young people are often aware of the shortcomings of pornography as a source of information and guidance, and that improvements to sex and relationships education are necessary.

A Qualitative Study of Intimate Partner Violence Among Young Gay and Bisexual Men.

Intimate partner violence (IPV) is prevalent among young gay and bisexual men (YGBM) and is associated with physical and mental health problems, as well as deleterious psychosocial conditions. Most previous studies of IPV among YGBM have been quantitative in nature and have not examined the numerous subtypes of IPV, the chronicity of IPV experiences, and how is IPV manifested in the context of these same-sex relationships. Thus, a qualitative approach may be useful in exploring these multidimensional and understudied experiences. The present qualitative study sought to (a) explore dimensions of IPV victimization, perpetration, and bidirectional IPV among a sample of (n = 26) YGBM living in New York City and (b) explore the chronicity of IPV experiences among these YGBM. Participants were recruited from an ongoing cohort study of YGBM. Participants completed semistructured interviews that included questions about IPV victimization, perpetration, and bidirectional IPV. A modified version of the consensual qualitative research method was used to analyze the data. The YGBM in this study reported numerous forms of physical, psychological, sexual, and financial IPV victimization and perpetration. Bidirectional experiences of IPV were common. The various subtypes of IPV victimization and perpetration are explored in detail in this manuscript. In addition, many participants reported multiple experiences of abuse within the same relationship, and some participants experienced a pattern of abusive relationships over time. This study corroborates findings from quantitative studies, which indicate that IPV is a prevalent and significant health problem among YGBM, and one that warrants additional attention from researchers, practitioners, and policy-makers. Furthermore, this study adds rich qualitative data to the existing literature-data that can be used to help develop and refine future measures of IPV that are tailored for use with YGBM.

Between Exploration, Pleasure, and Performance: Sexual Enhancement Medication Use among Older Gay and Heterosexual Men

ABSTRACT Pharmaceutical marketing campaigns and biomedical discourses tend to oppose two types of sexual enhancement medication (SEM) use. While “therapeutic” use is associated with older heterosexual men in committed relationships, “recreational” use is associated with young gay men, and with the context of casual sex. However, little is known about the real objectives of older men (especially older gay men) who use SEM or the contexts in which they use such drugs. Furthermore, SEM conveys representations of masculinity and sexuality that focus on performance and youth, and the influence of these representations on SEM users remains unexplored. Based on semi-structured interviews conducted, in French, in 2015–2016, with 27 Canadian men (12 heterosexual, 15 gay) aged 65 to 84 years, we examined the context in which older men used such medication and the reasons why they used it, and we explored how older men’s notions of sexuality, masculinity, and aging influenced their experiences with SEM use. Our participants’ narratives focused on three themes: exploring sexual possibilities/improving one’s sex life, restoring sexual capacities, and masculinity and aging. This study improves our understanding of older men’s use of SEM and contributes to the deconstruction of normative models of older men’s masculinity and sexuality.

Belonging, Citizenship and Ambivalence among Young Gay, Bisexual and Queer Indian Singaporean Men

ABSTRACT This article explores the attitudes and experiences of young ethnic Indian gay, bisexual and queer (GBQ) men in Singapore, where the state’s investments in economic progress, racial governmentality and “traditional” family policies significantly influence sexual and cultural citizenship. Based on abductively analysed in-depth interviews conducted on a subset of a larger qualitative study involving Singaporean lesbian, gay, bisexual and queer young adults, this article uses the concept of sociological ambivalence – which attends to the tensions between social structures and participants’ lives – to understand everyday experiences at the intersections of ethnicity, sexuality, gender and youth status. Three themes were identified from participants’ experiences: significant feelings of racialised liminality and marginality; tensions between personal desires and family pressures to get married and have children; and strategies taken in response to complex marginality. While participants were broadly satisfied with the material aspects of life in Singapore, their responses signal significant frustration with societal and sexual racism, a deeply ambivalent sense of belonging, and the desire for emigration to mitigate conflicting responsibilities to themselves and their families. By examining belonging and citizenship through the lens of sociological ambivalence, this article makes a theoretical and empirical contribution towards limited knowledge about the experiences of marginalised populations in Singapore.

Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men.

Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.

Housing Instability, Depression, and HIV Viral Load Among Young Black Gay, Bisexual, and Other Men Who Have Sex With Men in Atlanta, Georgia.

Housing instability is common among sexual minority youth. Research suggests that psychological distress, such as depression, may mediate the association between housing instability and poor HIV-related outcomes, but this hypothesis remains underexplored. Housing instability was assessed using two variables (residential moves in 6 months, and self-reported homelessness at any time since age 15 years). We examined cross-sectional relationships between the housing instability variables and detectable HIV-1 viral load (VL) in a sample of young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV (N = 81) in Atlanta, GA, in 2015-2016. Additionally, we explored whether depressive symptoms mediated this relationship. Our exploratory study suggests that psychological distress may partially mediate the association between housing instability and detectable VL. In addition to structural interventions that ensure housing stability, increasing use of mental health services by unstably housed YB-GBMSM may improve VL suppression in this high-risk population.