Publications by authors named "Gary W Dowsett"

27 Publications

  • Page 1 of 1

Stigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex.

Int J Drug Policy 2021 Mar 25;94:103229. Epub 2021 Mar 25.

Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.

This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2021.103229DOI Listing
March 2021

Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex.

Int J Drug Policy 2021 Feb 15;93:103163. Epub 2021 Feb 15.

Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2054, Australia.

Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling "out of control", and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a "counterpublic health" underpinned by forms of "sex-based sociality", which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2021.103163DOI Listing
February 2021

'It's like getting an Uber for sex': social networking apps as spaces of risk and opportunity in the Philippines among men who have sex with men.

Health Sociol Rev 2020 11 16;29(3):264-278. Epub 2020 Sep 16.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

The HIV epidemic in the Philippines has been expanding rapidly, with most newly diagnosed cases occurring among 'men who have sex with men' (MSM). New social contexts of HIV are evident in the evolving phenomenon of more MSM seeking partners online via social networking applications ('apps'). This study examines findings from a virtual ethnography of app use among MSM, focus group discussions with community-based healthcare workers, and key informant interviews with healthcare workers, policymakers and researchers in Metro Manila. We argue that participants viewed the expanding epidemic and apps as intimately linked, regarding the apps as 'risky spaces' for 'risky behaviour'. However, such narratives neglected the agentive capabilities of the apps and how they have transformed sexual practice, creating new ways of being as sexual subjects, while perpetuating old imaginaries among healthcare workers of 'hard-to-reach' populations. Such narratives of 'risk' have led to new interventions by healthcare workers on the apps, viewing these technologies as opportunities to reach more MSM for health promotion. However, the interventions have created new complexities by reconfiguring boundaries with target populations. By conducting community-based outreach through encouraging behaviour change in one-to-one interactions with app users, the potential impact of these interventions is limited.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14461242.2020.1820366DOI Listing
November 2020

The significance and expectations of HIV cure research among people living with HIV in Australia.

PLoS One 2020 4;15(3):e0229733. Epub 2020 Mar 4.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Most people living with HIV (PLHIV) with reliable access to antiretroviral treatment (ART) have a life expectancy similar to uninfected populations. Despite this, HIV can negatively affect their social and psychological wellbeing. This study aimed to enhance understanding of the expectations PLHIV hold for HIV cure research and the implications this has for HIV cure research trials. We interviewed 20 Australian PLHIV about their expectations for HIV cure research outcomes and the impact a potential cure for HIV may have on their everyday lives. Data were analysed thematically, using both inductive and deductive approaches. The significance of a cure for HIV was expressed by participants as something that would offer relief from their sense of vigilance or uncertainty about their health into the future. A cure was also defined in social terms, as alleviation from worry about potential for onward HIV transmission, concerns for friends and family, and the negative impact of HIV-related stigma. Participants did not consider sustained medication-free viral suppression (or remission) as a cure for HIV because this did not offer certainty in remaining virus free in a way that would alleviate these fears and concerns. A cure was seen as complete elimination of HIV from the body. There is an ethical need to consider the expectations of PLHIV in design of, and recruitment for, HIV cure-related research. The language used to describe HIV cure research should differentiate the long-term aspiration of achieving complete elimination of HIV from the body and possible shorter-term therapeutic advances, such as achieving medication free viral suppression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229733PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055878PMC
June 2020

Destabilising the 'problem' of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use.

Int J Drug Policy 2020 04 14;78:102697. Epub 2020 Feb 14.

Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2054, Australia.

In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2020.102697DOI Listing
April 2020

Perceptions of HIV cure research among people living with HIV in Australia.

PLoS One 2018 24;13(8):e0202647. Epub 2018 Aug 24.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV's assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202647PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108463PMC
February 2019

Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs.

Sex Health 2018 04;15(2):135-143

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic. 3086, Australia.

Background This paper explores associations between use of party-and-play drugs, including crystal methamphetamine, and wellbeing among HIV positive gay and bisexual men (GBM) in Australia. This study considers whether use of drugs in a social or sex-based setting facilitates access to social and support networks, which may in turn support wellbeing.

Methods: A cross-sectional survey of Australian people living with HIV (PLHIV) was conducted. There were 714 participants (79.7%) who identified as GBM. Differences between party-and-play drug users and non-users were examined using bivariate and multinomial logistic regressions. Mediation analysis examined the indirect effect of drug use on wellbeing via social connectedness and support.

Results: One in three participants (29.7%) reported party-and-play drug use within the past 12 months. Only 5% reported regular use. There were no differences between users and non-users on self-reported measures of general health, wellbeing or general social support. Compared with non-users, party-and-play drug users reported higher levels of resilience and lower levels of perceived HIV-related stigma. This was associated with spending more time with other people living with HIV and friends in the gay and lesbian community.

Conclusions: While party-and-play drug use poses risks to the health of GBM, the social contexts in which these drugs are used may provide wellbeing benefits, particularly for HIV-positive GBM who may be subject to HIV-related stigma in other settings. Further research is needed to determine whether drug-use facilitates access to social networks or if people with more active social ties are more likely to engage in drug use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/SH17151DOI Listing
April 2018

The rush to risk when interrogating the relationship between methamphetamine use and sexual practice among gay and bisexual men.

Int J Drug Policy 2018 05 24;55:242-248. Epub 2017 Dec 24.

Centre for Social Research in Health University of New South Wales, Sydney, NSW 2052, Australia. Electronic address:

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugpo.2017.12.010DOI Listing
May 2018

HIV cure research: print and online media reporting in Australia.

J Virus Erad 2017 Oct 1;3(4):229-235. Epub 2017 Oct 1.

Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne.

Objectives: While still in its early stages, recent scientific research towards a cure for HIV has generated widespread media interest. The aim of this paper was to explore the ways in which this research has been represented in Australian print and online media and discuss implications of this.

Methods: A search of databases from four selected media outlets was conducted to identify published articles that directly discussed HIV cure research. Content analysis was used to explore the discursive framing of HIV cure research and identify the presence or absence of people living with HIV in articles.

Results: In total, 95 articles were identified that had been published in print or online between 2007 and 2015. Media reports tended to focus on research breakthroughs or the future potential of HIV cure research, rather than more immediate implications of research findings. While not inaccurate, this focus often implied the field of HIV cure research was more advanced than was generally the case. There was a notable absence of commentary from people living with HIV or community advocates in media reporting.

Conclusions: Media reporting may generate unrealistic expectations of HIV cure research. This raises ethical concerns that media reporting may inadvertently contribute to therapeutic or curative misconceptions among potential participants in HIV cure-related trials. To address this, scientists, HIV advocates and people living with HIV will need to work collaboratively to engage with reporters and media outlets to provide more consistent input and guidance into reporting about research towards a cure for HIV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632551PMC
October 2017

Association between sexually transmissible infection testing, numbers of partners and talking to partners and friends about sexual health: survey of young adults.

Sex Health 2017 08;14(4):378-382

Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

Background Young adults, aged 18-30 years, comprise the largest proportion of sexually transmissible infection (STI) notifications in Australia compared with other age groups. Understanding the influence of partner and friendship networks on their STI testing practices may enhance health promotion efforts to increase testing for this group.

Method: Participants aged 21-30 years, living in Australia for ≥3 years, were recruited within nightlife precincts in Melbourne, Australia. They completed a survey on demographic items, sexual health attitudes, sexual health knowledge and STI testing experiences and perceptions. Responses to items related to talking to partners and friends about STI testing were allocated partner and friend communication scores. Analyses included χ tests of independence and independent sample t-tests.

Results: Overall, 36.5% (61/167) of participants had tested for STIs in the previous 12 months. Of those who had tested for STIs, most had significantly higher numbers of sexual partners in the same period (P<0.05), and were significantly more likely to have felt at risk of STI acquisition (P<0.05). Significantly greater mean partner and friend communication scores were associated with higher numbers of sexual partners, feeling at risk of STIs, and testing for STIs in the previous 12 months (all P<0.05). There were no significant differences when participants were stratified by gender or age.

Conclusion: Talking to partners and friends about STI testing is associated with testing rates for young adults. Feeling at risk and increased numbers of sexual partners may be associated with the promotion of STI testing among friends and partners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/SH16076DOI Listing
August 2017

HIV Futures 8: Protocol for a Repeated Cross-sectional and Longitudinal Survey of People Living with HIV in Australia.

Front Public Health 2017 22;5:50. Epub 2017 Mar 22.

The Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne, VIC , Australia.

Introduction: More than 27,000 Australians currently live with HIV. Most of these people have access to quality clinical care and antiretroviral treatment (ART) and can expect good general health. However, HIV-related stigma is a problem and many people living with HIV experience poorer than average mental health. Issues of aging are also of increasing concern. This paper describes the methods and sample for the HIV Futures 8 study, a national survey of people living with HIV in Australia that aimed to identify factors that support health and well-being among this population. HIV Futures 8 forms part of a series of cross-sectional surveys (The "HIV Futures" studies) that have been repeated periodically since 1997. In the most recent survey, participants were able to opt into a prospective longitudinal study.

Materials And Equipment: HIV Futures 8 was open to people aged over 17 who were living with HIV. Data were collected in 2015/2016 using a self-complete survey that contained approximately 250 items related to physical and mental health, use of ART, HIV exposure and testing, financial security, social connectedness, relationships, life satisfaction, resilience, stigma, use of health and support services, and health literacy. To enable comparison of cross-sectional data over time, questionnaire items were consistent with those used in previous HIV Futures surveys. In HIV Futures 8, participants were invited to volunteer coded information that will allow longitudinal follow-up when participants complete subsequent HIV Futures surveys. The survey was advertised through the networks of HIV organizations, on social media and through HIV clinics and services. HIV Futures 8 was completed by 895 participants. This represents approximately 3.8% of the total number of people living with diagnosed HIV in Australia in 2014.

Expected Impact Of The Study On Public Health: Findings from HIV Futures 8 will contribute important insights into the complexity of factors that support physical and mental well-being among people living with HIV. The findings will also assist HIV services to align with broader public health goals related to increasing ART use and improving quality of life among people living with HIV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2017.00050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360733PMC
March 2017

Abjection. Objection. Subjection: rethinking the history of AIDS in Australian gay men's futures.

Authors:
Gary W Dowsett

Cult Health Sex 2017 Sep 30;19(9):935-947. Epub 2017 Jan 30.

a Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia.

In coining the term 'post-AIDS' some 20 years ago, I was noting the dissolution of a singular and unified experience of HIV and AIDS for gay communities that had been the case until that time. Not only were HIV-positive and HIV-negative gay men having increasingly different experiences, but divergent trajectories were opening up. Since then, many other factors have come into play, for example age and generation; the ascendancy of the biomedical and the technosexual; and the supremacy of neoliberal politics (including sexual politics). Now, if gay men are to survive as such - and there is a question about this - are there larger issues than HIV and AIDS that ought to command our attention? Or do we need to rethink how we situate HIV and AIDS within the larger framework of gay men's health and wellbeing. This might be just a question of politics, or it could be a question of theory. Are we finally returning to the original gay liberation agenda of the eradication of difference, or simply being traduced (seduced?) by our success at intimate citizenship?
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2016.1273392DOI Listing
September 2017

Gay and bisexual men's interest in marriage: an Australian perspective.

Cult Health Sex 2016 Dec 31;18(12):1347-1362. Epub 2016 May 31.

a Kirby Institute, UNSW Australia , Sydney , Australia.

Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the sample did not intend to marry their primary regular partner. Even among men who considered themselves to be in a 'relationship' with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2016.1184314DOI Listing
December 2016

Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer.

Arch Sex Behav 2017 Oct 21;46(7):2043-2057. Epub 2016 Apr 21.

Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an "invisible diversity" in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men's lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men's sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10508-016-0728-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547193PMC
October 2017

Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men with Heterosexual Men.

J Sex Med 2016 Mar 4;13(3):425-34. Epub 2016 Feb 4.

Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP).

Introduction: Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men.

Aim: HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support.

Method: One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments.

Main Outcome Measure: Functional Assessment of Cancer Therapy-Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors.

Results: GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R2Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R2Adj = .690).

Conclusion: These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this "hidden population" in PCa care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsxm.2015.12.026DOI Listing
March 2016

Investigating combination HIV prevention: isolated interventions or complex system.

J Int AIDS Soc 2015 14;18:20499. Epub 2015 Dec 14.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Introduction: Treatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects.

Discussion: Drawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these complex interactions, relationships and emergent effects.

Conclusions: Relying on the current linear but disconnected approaches to intervention research and evidence we will miss the potential to achieve and understand system-level synergies. Given the challenges in sustaining public health and HIV prevention investment, meeting the bold UNAIDS targets that have been set is likely to be dependent on achieving systems level synergies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680918PMC
http://dx.doi.org/10.7448/IAS.18.1.20499DOI Listing
August 2016

Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment.

Sex Med 2014 Aug;2(3):115-20

Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia.

Introduction: Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse.

Aim: The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED.

Methods: An international online survey was conducted in 2010-2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment.

Main Outcome Measures: The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment.

Results: Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and "versatile"). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment.

Conclusions: Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115-120.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/sm2.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184491PMC
August 2014

'And next, just for your enjoyment!': sex, technology and the constitution of desire.

Authors:
Gary W Dowsett

Cult Health Sex 2015 7;17(4):527-39. Epub 2014 Oct 7.

a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , Australia.

In the 1976 sci-fi film Logan's Run, actor Michael York, relaxing in a fetching caftan after a day hunting 'Runners', logs-in to the 'Circuit', a de- and re-materialisation technology that allows those seeking sex to select partners. Logan's first candidate, a young man, is passed over with a smile. The second is co-star Jenny Agutter; she is accepted and we join a sexual ride in the future. Online dating sites such as Gaydar® and RSVP® would seem to have a long way to go to achieve that, and Microsoft™ needs some fast apps development to get us there. Against this background, this paper examines some starting points in our fascination with technosex, long before the Internet, in books and magazines, the creative arts and other media and cultural forms. It focuses upon gay men's contribution to this fascination, and looks at the queering of heterosexuality and the part technology has played in that process. Online technologies are examined, particularly in relation to the 'publicisation' of sexual life and to shifts in sexual identity and practice related to changing processes of sexual objectification, self-objectification and subjectification. Finally, the transformation of sex into health and healthy sex is discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2014.961170DOI Listing
February 2016

The price of pulchritude, the cost of concupiscence: how to have sex in late modernity.

Authors:
Gary W Dowsett

Cult Health Sex 2015 1;17 Suppl 1:S5-19. Epub 2014 Oct 1.

a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , Australia.

Research and scholarship on sexuality has grown exponentially over the last 60 years; but what is this 'sexuality' that so fascinates us. During those 60 years, three academic traditions or paradigms have emerged and evolved to provide that main ways we understand sexuality. These are: (1) sexology; (2) sex research; and (3) critical sexuality studies. These paradigms do not always agree; at times, they are incommensurable in the picture of sexuality they paint. However, they each affect how sexuality is researched and written about, and how it is understood in the popular imagination. After discussing these paradigms, attention is focused on the contemporary challenges facing the third paradigm: critical sexuality studies. The contribution of sexology and sex research to these challenges is noted. Three key issues are discussed: the body; how we commonly understand sexuality; and the commodification of sexuality in late modernity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2014.959563DOI Listing
March 2016

The ethics of barebacking: Implications of gay men's concepts of right and wrong in the context of HIV.

Int J Sex Health 2013 ;25(3)

HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute/Columbia University, 1051 Riverside Drive, Unit 15, New York NY 10032.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/19317611.2013.764375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886189PMC
January 2013

Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer.

Urology 2013 Sep 14;82(3):565-71. Epub 2013 Jun 14.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia.

Objective: To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment.

Methods: Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries.

Results: There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04).

Conclusion: This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2013.04.022DOI Listing
September 2013

Falling through the cracks: the gap between evidence and policy in responding to depression in gay, lesbian and other homosexually active people in Australia.

Aust N Z J Public Health 2012 Feb;36(1):76-83

Australian Research Centre in Sex, Health and Society, Latrobe University, 215 Franklin St., Melbourne, Victoria.

Objective: To examine the evidence for a national policy response to depression among gay, lesbian and other homosexually active people in Australia.

Methods: A literature review using database searches on depression among non-heterosexual people then a web-based search of national policy investigating how mental health needs in this population are addressed in Australia.

Results: The literature review found that non-heterosexual people experience depression at higher rates, but the literature on interventions was sparse. The policy analysis found no mention of depression or the broader mental health needs of non-heterosexual people in key national mental health policy documents. These documents outline a policy approach for population groups with a higher prevalence of mental health problems, and stigma and discrimination are relevant associated factors, but only the National Suicide Strategy considers non-heterosexual people an 'at-risk group'.

Conclusions: The results suggest that the evidence on higher rates of depression in non-heterosexual people is strong, but that this is not recognised in current national policy.

Implications: Defining non-heterosexual people as an 'at-risk' group is appropriate, as is prioritising access to mental health services that are socially and culturally appropriate. Addressing homophobia as an associated factor would require a strategic policy approach across a range of sectors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1753-6405.2012.00828.xDOI Listing
February 2012

Falling through the cracks: the gap between evidence and policy in responding to depression in gay, lesbian and other homosexually active people in Australia.

Aust N Z J Public Health 2012 Feb;36(1):76-83

Australian Research Centre in Sex, Health and Society, Latrobe University, 215 Franklin St., Melbourne, Victoria.

Objective: To examine the evidence for a national policy response to depression among gay, lesbian and other homosexually active people in Australia.

Methods: A literature review using database searches on depression among non-heterosexual people then a web-based search of national policy investigating how mental health needs in this population are addressed in Australia.

Results: The literature review found that non-heterosexual people experience depression at higher rates, but the literature on interventions was sparse. The policy analysis found no mention of depression or the broader mental health needs of non-heterosexual people in key national mental health policy documents. These documents outline a policy approach for population groups with a higher prevalence of mental health problems, and stigma and discrimination are relevant associated factors, but only the National Suicide Strategy considers non-heterosexual people an 'at-risk group'.

Conclusions: The results suggest that the evidence on higher rates of depression in non-heterosexual people is strong, but that this is not recognised in current national policy.

Implications: Defining non-heterosexual people as an 'at-risk' group is appropriate, as is prioritising access to mental health services that are socially and culturally appropriate. Addressing homophobia as an associated factor would require a strategic policy approach across a range of sectors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1753-6405.2012.00828.xDOI Listing
February 2012

Sex, love, friendship, belonging and place: is there a role for 'Gay Community' in HIV prevention today?

Cult Health Sex 2008 May;10(4):329-44

New York State Psychiatric Institute and Columbia University, New York, USA.

The decade since highly active anti-retroviral therapy (HAART) arrived has been a time of change for gay men in the West. HIV incidence rates have been levelling off--and in some cities, increasing markedly--for the first time since the early years of the pandemic. New sexual subcultures have found expression, including Internet chat rooms, 'poz-only' sex parties, 'barebacking' and crystal methamphetamine use. These circumstances force a re-evaluation of HIV prevention targeting gay communities. We examine the antecedents of current HIV-prevention dilemmas in findings from a qualitative study of gay men who were personally and professionally engaged in HIV/AIDS in Sydney, Australia, in 1997-1998, immediately after the 'protease moment'. The men's lives were characterized by constant and difficult negotiation of gay subjectivities. They did not find a place of uniform belonging in the gay community; rather, ambivalence--toward the gay community and HIV prevention--and fragmentation emerged as themes. Our findings suggest that by the late 1990s, the ethos of safe sex developed in the early HIV/AIDS period was no longer a unifying cultural value. We explore the conditions that led to this shift and the implications for HIV prevention in the 21st century.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691050701843098DOI Listing
May 2008

Male circumcision and HIV prevention: is there really enough of the right kind of evidence?

Reprod Health Matters 2007 May;15(29):33-44

Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, Melbourne, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0968-8080(07)29302-4DOI Listing
May 2007

Cybercartography of popular internet sites used by New York City men who have sex with men interested in bareback sex.

AIDS Educ Prev 2006 Dec;18(6):475-89

HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York 10032, USA.

A systematic method was used to elicit the names of the six most popular free Internet sites used by gay men and other men who have sex with men in New York City, to meet partners for "bareback" sex. An analysis of the sites characteristics shows that men can use mainstream Internet sites, gay-specific sites, and sex-focused sites free of charge to search for bareback sex partners, selecting by location, physical attributes, sexual mode, HIV-serostatus, and other characteristics. Many individuals use these sites, producing the impression that bareback sex is not an oddity confined to just a few. The official language of the bareback sites associates bareback sex with masculinity and courage, prioritizing pleasure, freedom, choice, and intimacy over HIV-transmission prevention. The sites facilitate sexual experimentation and the expansion of bareback networks. Although some consider bareback sex to represent a failure of HIV prevention, this study suggests that harm reduction strategies may be viable within bareback networks.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1521/aeap.2006.18.6.475DOI Listing
December 2006

Some considerations on sexuality and gender in the context of AIDS.

Authors:
Gary W Dowsett

Reprod Health Matters 2003 Nov;11(22):21-9

Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.

Gender has become a major conceptual tool for understanding the evolving HIV pandemic globally. As such, it has provided a powerful way to see the structure of relations between men and women as central to various epidemics, and added weight to our understanding of HIV infection as not simply an individual experience of disease. Yet, as a concept, gender has its blind spots. This paper argues that there are four issues central to our understanding of how the HIV pandemic moves and develops that are not necessarily best understood through an analysis that uses gender alone, namely: women's vulnerability, men's culpability, young people's sexual interests and marginalized sexual cultures. The paper proposes using sexuality as a framework for analysing these issues and seeks to utilise developments in critical sexuality research to add to gender as a way to increase the capacity to respond to the HIV/AIDS crisis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0968-8080(03)02290-0DOI Listing
November 2003