Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys

Globally, gay, bisexual and other men who have sex with men (GBMSM) experience an increased burden of poor sexual, mental and physical health. Syndemics theory provides a framework to understand comorbidities and health among marginalised populations. Syndemics theory attempts to account for the social, environmental, and other structural contexts that are driving and/or sustaining simultaneous multiple negative health outcomes, but has been widely critiqued. In this paper, we conceptualise a new framework to counter syndemics by assessing the key theoretical mechanisms by which pathogenic social context variables relate to ill-health. Subsequently, we examine how salutogenic, assets-based approaches to health improvement could function among GBMSM across diverse national contexts. Comparative quantitative secondary analysis of data on syndemics and community assets are presented from two international, online, cross-sectional surveys of GBMSM (SMMASH2 in Scotland, Wales, Northern Ireland and the Republic of Ireland and Sex Now in Canada). Negative sexual, mental and physical health outcomes were clustered as hypothesised, providing evidence of the syndemic. We found that syndemic ill-health was associated with social isolation and the experience of stigma and discrimination, but this varied across national contexts. Moreover, while some of our measures of community assets appeared to have a protective effect on syndemic ill-health, others did not. These results present an important step forward in our understanding of syndemic ill-health and provide new insights into how to intervene to reduce it. They point to a theoretical mechanism through which salutogenic approaches to health improvement could function and provide new strategies for working with communities to understand the proposed processes of change that are required. To move forward, we suggest conceptualising syndemics within a complex adaptive systems model, which enables consideration of the development, sustainment and resilience to syndemics both within individuals and at the population-level

Les différences dans les tactiques de «grooming» entre les agresseurs sexuels d’enfants intrafamiliaux et extrafamiliaux

Rapport de stage présenté en vue de l’obtention du grade Maître ès sciences (M.Sc.) en criminologie option stage en intervention clinique.Objectif : L’agression sexuelle est un sujet très répandu dans la littérature. Celle-ci fait notamment ressortir deux différents types de délits sexuels, soit intrafamiliaux et extrafamiliaux. Outre ces différences, il existe bon nombre de distinctions quant aux délits sexuels, dont le processus de passage à l’acte que l’on peut aussi nommer grooming. L’objectif de cette étude était donc d’approfondir les différences qui peuvent exister entre les délits sexuels intrafamiliaux et extrafamiliaux quant au processus de grooming. Concrètement, ces distinctions permettront de cibler les besoins des délinquants en matière de traitement visant ainsi à diminuer le risque de récidive sexuelle. Méthode : Afin de permettre l’approfondissement de ces connaissances, des études de cas ont été menées dans le cadre d’un stage clinique réalisé au Service correctionnel du Canada. Des entrevues semi-structurées ont été réalisées auprès de quatre hommes ayant commis des agressions sexuelles sur des enfants et/ou adolescents. Résultats : Les résultats ont identifié un certain nombre de distinctions dans le processus de grooming, entre les délinquants sexuels intrafamiliaux et extrafamiliaux. Ces distinctions indiquent que le traitement devrait prendre en compte le processus de grooming spécifique à chaque délinquant afin de mieux personnaliser l’intervention visant à réduire le risque de récidive.Object : Sexual aggression is an issue that gathers much attention in the scientific literature. Within this context, it is well established sexual crimes against children include intrafamilial and extrafamilial offenses. Further distinctions can also be found within the process of grooming – a process designed to obtain victims. The object of this study was to investigate the differences that exist in the grooming process between intrafamilial and extrafamilial sexual offending. These distinctions will help improve interventions designed to reduce the likelihood of future sexual offending. Method : Case studies were conducted within the framework of a clinical internship in the Correctional Service Canada. Semi-structured interviews were conducted with four men who had committed sexual offenses against children or teenagers. Results: The findings identified a number of distinctions between intrafamilial and extrafamilial offenders in their process of grooming. These distinctions indicate that treatment should take in account the grooming process specific to the offender in order to better personalize intervention designed to reduce the risk of reoffending

Somatic Genomic Variations in Extra-Embryonic Tissues

In the mature chorion, one of the membranes that exist during pregnancy between the developing fetus and mother, human placental cells form highly specialized tissues composed of mesenchyme and floating or anchoring villi. Using fluorescence in situ hybridization, we found that human invasive cytotrophoblasts isolated from anchoring villi or the uterine wall had gained individual chromosomes; however, chromosome losses were detected infrequently. With chromosomes gained in what appeared to be a chromosome-specific manner, more than half of the invasive cytotrophoblasts in normal pregnancies were found to be hyperdiploid. Interestingly, the rates of hyperdiploid cells depended not only on gestational age, but were strongly associated with the extraembryonic compartment at the fetal-maternal interface from which they were isolated. Since hyperdiploid cells showed drastically reduced DNA replication as measured by bromodeoxyuridine incorporation, we conclude that aneuploidy is a part of the normal process of placentation potentially limiting the proliferative capabilities of invasive cytotrophoblasts. Thus, under the special circumstances of human reproduction, somatic genomic variations may exert a beneficial, anti-neoplastic effect on the organism

Virtual Cellphilming with GBTQ Pups: Towards Participant-Driven Research as Activism

In the present paper, we draw upon our research, entitled Puppy Philms, to guide researchers who are interested in queering cellphilming methodologies. In this context, “queering” refers to the process of challenging and disrupting heteronormative roles and perspectives within research practices. We argue that taking a queer poststructural approach to virtual cellphilming helped us shift this project away from typical academic relations of power, towards participant-driven research as activism. In emphasizing flexibility, reflexivity, a desire for partnership and community building, we found queer communication to be a mechanism through which we could shift power and drive levels of engagement. In considering the continued stigma associated with pup play, queer poststructuralism theories allow cellphilms to disrupt traditional norms, both societal and academic norms. We found that cellphilming is particularly suited for the study of queer eroticism because participants can control the narrative, deliver a more nuanced understanding of the experiences portrayed, and claim legitimacy through association with an arts-based participatory research project

Suicide Related Ideation and Behavior Among Canadian Gay and Bisexual Men: A Syndemic Analysis

Background While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization. Methods This study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n  = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior. Results Suicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47–8.70) times the odds of experiencing suicide ideation and 16.29 (9.82–27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems. Conclusions This investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men’s health problems holistically and the urgent need to reduce this population’s experience with marginalization and violence

Suicide Prevention From the Perspectives of Gay, Bisexual, and Two-Spirit Men

Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants’ perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM

Conception d'un revêtement bioactif pour implant cardiovasculaire par la méthode du layer-by-layer

La technique du layer-by-layer (LbL) constitue une approche intéressante pour modifier la surface des implants afin d’améliorer leur biocompatibilité et leur performance clinique. L’objectif global de ce projet consiste à concevoir un revêtement de type LbL permettant de favoriser l’adhésion, la prolifération et la migration des cellules musculaires lisses vasculaires (VSMC) sur et à proximité des endoprothèses couvertes, utilisées pour le traitement minimalement invasif des anévrismes de l’aorte abdominale (AAA). Dans le cadre de ce projet, plusieurs revêtements LbL ont été mis au point et étudiés. Certains contiennent du facteur de croissance des fibroblastes (bFGF) que l’on cherche à relarguer afin de stimuler les VSMC. Ainsi, des films formés à l’aide de chitosane (CHI), de sulfate de chondroïtine (CS), de collagène (COL) et de bFGF ont été développés sous la forme des revêtements suivants : a) [CS/CHI]; b)[CS/COL] et c) [CS/CHI]-[CS/bFGF]-[CS/COL]. Ceux-ci ont été caractérisés à l’aide de plusieurs techniques telles que la microbalance à cristal de quartz (QCM-D), l’angle de contact, l’ellipsométrie, la microscopie à force atomique (AFM), le titrage immunoenzymatique utilisant un antigène absorbé(ELISA) et enfin, la culture (adhésion, croissance et survie) des VSMC. La faisabilité de créer les revêtements LbL avec ces biomolécules a été démontrée, grâce aux résultats QCM-D qui montrent une addition de masse après chaque dépôt de polyélectrolyte indiquant une formation linéaire des films. Cette dernière a été confirmée par ellipsométrie. Les résultats d’angle de contact et d’AFM ont quant à eux montré que les films formés possédaient bien une structure LbL étant donné l’alternance des angles de contacts entre les différentes couches de même que les changements de morphologie de surface et de rugosité entre les dépôts des différents polyélectrolytes. Les films LbL [COL/CS] se sont avérés beaucoup plus efficaces que les films [CHI/CS] pour favoriser l’adhésion cellulaire. L’ELISA a démontré que le film [CS/CHI]-[CS/bFGF]-[CS/COL] permet d’accumuler et de relarguer du bFGF tandis que les essais de survie cellulaire des VSMC en présence de bFGF en solution ont révélé qu’une concentration de 10ng/ml était suffisante pour avoir un effet significatif sur la survie cellulaire. Il est toutefois à souligner que l’effet du film LbL sur la survie des VSMC est incertain étant donné que, dans les conditions testées, les quantités de facteurs de croissance relâchées sont substantiellement plus faibles que celles testées in vitro. En conclusion, bien que des essais complémentaires doivent être effectués, les films LbL constituent une approche prometteuse pour améliorer la guérison autour des endoprothèses couvertes, améliorer leur fixation au vaisseau sanguin et limiter la progression de l’anévrisme

Understanding stigma and suicidality among gay men living with HIV: A photovoice project

Gay men living with HIV (GMHIV) are at relatively high risk for suicide. To inform tailored suicide prevention interventions, we conducted a photovoice study with 22 GMHIV with a history of suicidality. Our study findings revealed three discrete but connected themes characterizing suicidality among GMHIV: first, HIV stigma featured prominently in participants' narratives who described accumulating experiences of prejudice that triggered their hopelessness. Second, many participants perceived their HIV as a personal failure and felt shamed and blamed, heightening men's suicidality. Third, to avoid disgrace, men withdrew from social interactions, resulting in isolation. However, the subsequent dearth of social interaction weighed heavily, as men admitted longing for social, sexual and romantic connections. All themes contributed in complex ways to participants' experiences of suicidality. The findings affirm the need for tailored suicide prevention efforts focused on promoting social connectedness and public health efforts to de-stigmatize HIV and mental illness

Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research

Good sexual health requires navigating intimate relationships within diverse power dynamics and sexual cultures, coupled with the complexities of increasing biomedicalisation of sexual health. Understanding this is important for the implementation of biomedical HIV prevention. We propose a socially nuanced conceptual framework for sexual health literacy developed through a consensus building workshop with experts in the field. We use rigorous qualitative data analysis to illustrate the functionality of the framework by reference to two complementary studies. The first collected data from five focus groups (FGs) in 2012 (n = 22), with gay, bisexual and other men who have sex with men aged 18–75 years and 20 in-depth interviews in 2013 with men aged 19–60 years. The second included 12 FGs in 2014/15 with 55 patients/service providers involved in the use/implementation of HIV self-testing or HIV prevention/care. Sexual health literacy goes well beyond individual health literacy and is enabled through complex community practices and multi-sectoral services. It is affected by emerging (and older) technologies and demands tailored approaches for specific groups and needs. The framework serves as a starting point for how sexual health literacy should be understood in the evaluation of sustainable and equitable implementation of biomedical sexual healthcare and prevention internationally