Ethnic minority gay men: Redefining community, restoring identity

This report presents the results of one of three studies investigating how social and cultural factors shape gay male identity and influence gay male social life in London today (see also Keogh, Dodds, Henderson 2004a; Keogh, Dodds, Henderson 2004b). These studies aim to problematise monolithic and (we believe) unhelpful concepts such as ‘gay community’ or ‘gay scene’ and show how the population of gay men in London is riven with cultural, political and social differences. It has often been said that ‘the gay community’ or the ‘gay scene’ is an essentially White, middle-class concept which excludes men from other classes or ethnic backgrounds. This research shows that this is not the case. Numerically, the population of gay men in London is disproportionately White and mainly British (as is the population of London), but it is also as multi-ethnic and multi-cultural as the broader London population. Although we regularly celebrate the multi-culturalism of the capital, we rarely, if ever describe the gay community in this way. This is unfortunate because the many facets of the gay community which should otherwise be acknowledged or represented in health or social policy for gay men are obscured. As a consequence, social and community services for gay men remain woefully impoverished. Moreover, by speaking the language of exclusion, we are condemned to always consider weakness as opposed to strength. There is an implicit assumption in nearly all research and policy work on gay men that to be within the charmed (White, middle-class) circle of the gay community is to be ‘included’ and therefore without need. It follows that, those outside of it are automatically ‘excluded’ and therefore, disadvantaged, weaker or more needy. These three reports will show that there is no paradigmatic gay experience or group. Rather, there are many ways of being gay, all of which are imbued with strengths as well as weaknesses. The three reports which emerge from this collection of studies can each stand alone, but are best read in relation to one other. One examines the relationship between being less well-educated, working class and having a gay identity. Another examines the experiences of gay adult migrants to London. This report investigates ethnic minority identity and gay identity specifically concentrating on the experience of British-born Black Carribean men and White Irish immigrants to London. Our aim in carrying out these studies is to change the way that health promoters and policy makers conceive of the gay male population. We want to replace the dominant ‘centre vs. periphery’ construction with a conception of the gay population of London as a composite of a range of different experiences; as fractured, antagonistic and constantly changing. Moreover, the factors which account for these differences amongst gay men are larger social and structural factors: ethnicity, religion, education, class, income etc. To put it simply, no gay man is simply gay, he also has a class background, an ethnicity, an employment history, a family and probably a religious affiliation. On a policy level, we hope to take gay men’s health and social concerns out of the policy ‘ghetto’ that is HIV. Gay and HIV community organisations should be broadening their policy objectives. We feel they should be seeking to transform the education of all boys as well as increasing the capacity of all families to live with and enjoy their gay children. We feel they should be challenging all services to meet the needs of their gay users and of all communities to capitalise on the presence of their gay members. In seeking to do this, we can all learn from the experiences of gay men from ethnic minorities, gay adult migrants and working class gay men

Providing sex and relationships education for looked-after children: a qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers

Objectives: To explore how personal and institutional factors promote or limit caregivers promoting sexual health and relationships (SHR) among looked-after children (LAC). In so doing, develop existing research dominated by atheoretical accounts of the facilitators and barriers of SHR promotion in care settings. Design: Qualitative semistructured interview study. Setting: UK social services, residential children’s homes and foster care. Participants: 22 caregivers of LAC, including 9 foster carers, 8 residential carers and 5 social workers; half of whom had received SHR training. Methods: In-depth interviews explored barriers/facilitators to SHR discussions, and how these shaped caregivers’ experiences of discussing SHR with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers’ understanding of their role. Results: SHR policies clarified role expectations and increased acceptability of discussing SHR. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted practice. Identified training gaps were how to: (1) Discuss SHR with LAC demonstrating problematic sexual behaviours. (2) Record the SHR discussions that had occurred in LAC’s health plans. Contrary to previous findings, caregivers regularly discussed SHR with LAC. Competing demands on time resulted in prioritisation of discussions for sexually active LAC and those ‘at risk’ of sexual exploitation/harm. Interagency working addressed gaps in SHR provision. SHR discussions placed emotional burdens on caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/ pastoral support and ‘safe care’ procedures minimised these harms. Conclusions: While acknowledging the existing level of SHR promotion for LAC there is scope to more firmly embed this into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing SHR policies and training, promoting interagency working and providing pastoral support are important steps towards achieving this

Working class gay men: Redefining community, restoring identity

This report presents the full results of one of a suite of three studies investigating how a range of pre-existing social and cultural factors mediate the development of gay male identity and shape the many forms of gay male social life in London today. These studies aim to problematise monolithic and (we believe) unhelpful social categories such as ‘gay community’ or ‘gay scene’ and show how the population of gay men in London is riven with cultural, political and social differences. It is common to talk simplistically about ‘gay men’ or ‘the gay community’. Commentators have unsuccessfully attempted to undermine such simplistic concepts by asserting that these identities and communities are restricted to White, middle class men. However, we believe that this position on its own is unhelpful because it fails to articulate the broader impact of such sweeping terminology. It serves to obscure the myriad ways of being gay that are not currently being described or represented in health or social policy or interventions for gay men. It implicitly robs anyone who is not White and middle class of a gay identity and sociality. It therefore uses the rhetoric of exclusion to ensure that so-called excluded groups are never considered in mainstream health and social policy for gay men because they are somehow not ‘properly’ gay. In addition, it is reductionist in relation to White middle class gay men. It is always well to be suspicious of any notion of the ‘default’ group which is considered powerful, wealthy etc. Such groups are usually one of two things: an aspirational ‘brand’ created by marketeers to sell us certain lifestyles (a quick review of the commercial gay media supports this suspicion) or a conceptual construction which everyone else uses as a benchmark to establish their own ‘individuality’ or ‘difference’. In short, we are asserting that, in policy terms, the White middle class ‘mainstream’ gay community is a useful political fallacy. In short, our representations of gay men and gay sociality remain woefully impoverished and simplistic. There is one additional over-arching effect of the White middle class fallacy. That is, by speaking the language of inclusion and exclusion, we are condemned to always consider weakness as opposed to strength. There is an implicit assumption in nearly all research and policy work on gay men that to be within the charmed circle of the White middle classes is to be without need. Thus, other experiences of being gay and other groups of gay men are described as automatically disadvantaged and weaker. These three reports will show that there is no paradigmatic gay experience or group. Rather, there are myriad ways of being gay, all of which are imbued with strengths and weaknesses. To this end, we have conducted a suite of qualitative studies into gay men resident in London. One of the others examines the relationship between ethnic minority identity and gay identity and the other investigates the lives of gay migrants in London. This report examines the experiences of blue collar or working class gay men. We aim, with all these studies to change the way that health promoters and policy makers conceive of the gay male population. We want to challenge the construction of the gay male population as having a centre which is privileged – White and middle class – and a periphery of excluded ethnic minorities, migrants, bisexuals and working class men etc. Instead, we present a conception of the gay population of London as a composite of a range of different experiences. As fractured, antagonistic and constantly changing. Moreover, the factors which fracture that population, which create the flux and antagonisms are larger social and structural factors such as ethnicity, religion, education, class, income etc. To put it simply, no gay man is simply gay, he probably also has a class background, an ethnicity, a job, a family, and a religious affiliation or history among other things. It is these differences that animate the gay population of London. Therefore, in all these reports we talk about things rarely considered in policy-oriented research on gay men. We talk of the importance of biological family and heterosexual forms of sociality for many gay men. We talk of the centrality of spirituality and organised religion. We talk about education and the passage from school to work. We talk about masculinity and health. We talk about nationalism. We talk very little about HIV and AIDS and sexual health. We have a transparent aim in doing so. We are hoping to take gay men’s health and social concerns out of the service and policy ‘ghetto’ that is HIV. We are reasserting a particularly sociological perspective that gay men’s health (sexual and otherwise) and the HIV epidemic are fundamentally influenced by broader social factors. In short, if we were to recommend one practice outcome as a result of these studies it would be to produce less community interventions telling gay men what to do (or how to be). Rather, we should be seeking to transform the education of all boys and to increase the capacity of all families to live with and enjoy their gay children; of all services to meet the needs of their gay users and of all communities to capitalise on the presence of their gay members. This is not as socially transformative an agenda as it sounds. We have much to learn from the experiences of working class gay men, gay men from ethnic minorities and gay migrants. Such interventions are, properly speaking, HIV health promotion

Morality, responsibility and risk: Gay men and proximity to HIV. London

Network analysis and network theory have emerged in various strands of research on HIV. Epidemiological research has used network analysis to map and predict the course of the HIV and STI epidemics among Gay men (Doherty et al. 2005; Piqueira et al. 2004). It constitutes an advance on cruder epidemiological models of random mixing (see Keeling & Eames 2005). Social network analysis and social attachment have been important concepts in informing more recent HIV prevention interventions (see Fernandez et al. 2003; Latkin and Knowlton 2005) and have had specific applications in the case of disadvantaged communities such as injecting drug users and sex workers (Latkin et al. 2003; Rhodes et al. 2005). Moreover, network analysis has been useful in understanding social support of disadvantaged groups living with HIV such as African migrants and ethnic minority women (Hough et al. 2005; Asander et al. 2004; Sivaram et al. 2005). Considering a Gay man as part of a social network involves engaging with the social and cultural factors that shape his experience. Rather than thinking of his relationships as essentially random, we characterise them as being profoundly influenced by his social environment; an environment made up by other individuals who share common understandings and social norms. This social network is generally self-perpetuating and limited. Individuals come into contact and hence derive friends and partners from this finite network. Network analysis is especially valuable when examining a population that is highly heterogeneous and made up of individuals who enter that population as autonomous adults. Gay men are such a population being made up of socially mobile individuals deriving from a range of social, ethnic and geographical backgrounds. Social networks are central to our understanding of the dynamics of HIV risk among Gay men. The nature and density of social networks have been found to be connected to sexual risk practices and susceptibility to HIV infection in Gay men (Smith et al. 2004). Moreover, networks influence Gay men’s perceptions and understandings of the HIV epidemic (Grierson 2005). In addition, social networks may have a role in influencing an individuals’ knowledge and understandings of, and access to new technologies such as PEP (see Dodds & Hammond 2006; Korner et al. 2005). Social norms have been found to be important in influencing Gay men’s attitudes towards safer sex and risk-taking especially among groups that have been traditionally disempowered or marginalised such as young Gay men (see Amirkhanian et al. 2005a) and Black/ethnic minority Gay men (see Wilson et al. 2002; Peterson et al. 2003; Zea et al. 2005). Finally social network analysis has been useful in describing social support for Gay men living with HIV and their carers (Shippy et al. 2003; White and Cant 2003; Cant 2004; Zea et al. 2005). A range of HIV prevention interventions have been based around social networks and innovation diffusion theory (see Amirkhanian et al. 2005a). Such interventions would seem to have most salience with disadvantaged groups of Gay and Bisexual men and have achieved some success (see Amirkhanian et al. 2005b). Other authors point out the limitations of network interventions in reaching men at relatively low risk or stress limitations in their efficacy over time (see Martin et al. 2003). Findings from the 2003 Gay Men’s Sex Survey (GMSS) highlight the importance of proximity to HIV. That is, men in certain social and cultural networks had limited experience of HIV in their social network and these men tended to have greater HIV prevention need (see Reid et al. 2004). GMSS 2003 established a range of indicators to measure personal and social proximity to the epidemic. These included: • Having tested for HIV. • Not having tested positive, but believing you are or could be infected. • Being in or having had a sero-discordant relationship. • Personally knowing someone with HIV. At the population level proximity to HIV was mediated by a range of demographic factors. • Area of residence: Men resident in London had greater proximity than men resident elsewhere, although men with low proximity to HIV were present in every city and town and in every area of the UK. • Age: Men in their 30's and 40's had greater proximity than either older or younger men. • Ethnicity: Black men and White men of ethnicities other than British had greater proximity than men in other ethnic groups. • Education: Better educated men had greater proximity (even though less well educated men were more likely to have HIV). • Income: Men in higher income brackets had greater proximity than men in lower income brackets. • Gender of sexual partners: Exclusively homosexually active men had greater proximity to HIV than men who were behaviourally bisexual. • Numbers of male partners: Men with greater numbers of partners had greater proximity than men with fewer partners. While these differences are important it is essential to note that they denote difference at the population level. In fact, there are men with low proximity to HIV in every city and town in the UK (including London); in every age group and ethnic group; with every level of formal education and at every income level; and with a range of sexual identities and sexual practices. These population differences in proximity to HIV present an interesting health promotion dilemma. Those men with greatest proximity have less unmet needs but are more likely to be involved in HIV exposure. Those with less proximity have the greatest unmet need and will therefore be vulnerable if they do come into contact with HIV (either knowingly or unknowingly) but they are probably less likely to do so. In response, the original research recommends “a diverse portfolio of interventions that are encountered by men with a wide variety of relationships to HIV” (Reid et al. 2004). The study presented in this report is in response to these findings. That is, a qualitative examination of social proximity to the epidemic among Gay men. However, we must start with a caveat. Neither GMSS nor this study measures actual proximity to HIV, that is the numbers of social and sexual contacts an individual has who are actually HIV positive, or the percentages of a social network who are actually positive. Rather, GMSS sets up a range of proxy markers to indicate proximity (such as testing history, beliefs about one’s own status and beliefs about the HIV status of social and sexual partners). Likewise, this study measures perceptions of proximity to the epidemic rather than actual proximity (to study actual proximity would require an ambitious network analysis where we recruited all the social and sexual contacts of respondents and asked them about their actual or known HIV status). Studying men’s perceptions of their proximity to the epidemic allows us to examine the ways in which men’s perceptions of their social surroundings influence how they experience and negotiate sexual risk. Moreover, an individual’s perception of the world around him influences the types of information and messages he is likely to notice. The purpose of this study is to inform the nature of interventions targeting men based on their perceived proximity to the epidemic. We will do so by exploring how their perceptions of proximity influence management of HIV-related sexual risk among men who assume or know themselves to be HIV negative

IGFBP-5 as a biomarker of de-differentiation in hepatocytes

Describes IGFBP-5 as a biomarker of de-differentiation in hepatocytes presented at the 47th Congress of the European-Societies-of-Toxicolog

Living with fragility : children in New Crossroads

Living with Fragility, traces the lives of sixteen African children between 1992 and 1995. It explores the intimate spaces of children's social relationships and charts discontinuities they experienced. The eight girls and eight boys, aged between and sixteen years, resided in New Crossroads, Cape Town, a suburb marked by poverty, inadequate schooling, and a history of violent intervention by the apartheid state and other power holders. The thesis shows that institutions of childhood are fragile, that children's social relationships are fragmented, as are their senses of self. Fragility is traced within and the social domains the children inhabited and created. The thesis argues that children's senses of self are subject to flux and interruption. Narrative ethnographies about the children demonstrate their individuality. Nuanced descriptions of children and the changes in their lives over time challenge bald categorisations of, for example, the African child, or, youth at risk. The descriptions demonstrate the agency, dexterity and responsibilities of children in fluid circumstances and lead to a critical appraisal of predominant notions of childhood. The work also outlines processes of social and relational reconstitution to which children and care-givers had recourse. Methods used in gathering data included a series of formal interviews conducted in Xhosa (the children's first language) in which economic descriptions of households, life histories, social networks, and ritual and religious affiliations of children and care-givers were sought. The formal interviews complemented by repeated visits to each child's home to record changes time. The sixteen children were brought together in workshops where discussion directed towards themes to do with mobility between care-givers, violence, sexuality and senses of self the data were enriched by use of dramatic improvisations and drawings. Improvisations yielded insight into children's bodily style and their critical appraisal of trends in social relationships in New Crossroads. The ethnography describes the social circumstances of children in urban South Africa. It is analysed through use of an eclectic set of theoretical fragments because they resonate with the study's ethnographic material. The eclecticism impelled by the data raises questions

The growing challenge: a strategic review of HIV social care, support and information services across the UK.

This report appears 10 years after the widespread introduction of anti-retroviral therapies. Availability of effective HIV treatment has transformed the UK epidemic, producing a dramatic reduction in mortality and, for many people living with HIV, an increase in health and well-being. Yet, in spite of medical advances, many services seem to continue to follow a historical pattern. Against this background we commissioned Sigma Research to review service commissioning in the HIV sector in order to inform members’ future grant making strategies. Results in the report indicate that commissioners and providers of services believe that people from ethnic minority backgrounds, migrants, children, carers and people from different age groups have unmet needs. Other findings in this research indicate that many more services have been commissioned recently for Africans, on the basis that Africans make up a significant part of the current UK epidemic. We believe this is a valid focus but are discouraged by the approach to these varied communities as one homogenous population. It seems timely to ask whether configuring services to follow broad epidemiological categories without any further refinement is sufficient. The report further suggests that commissioners and providers believe the needs of gay men are well met. This is a surprise and does not accord with the views and experiences of many gay men living with the virus. A significant minority of HIV positive people are neither gay men nor Africans. Even within these two groups the experience of living with HIV varies by age, geographical location and length of infection. HIV positive individuals may look at their needs from another starting point – for example, as a woman or an injecting drug user. The picture appears to be, increasingly, one of fragmentation and isolation. This poses the question: do we have the service models to meet the needs of HIV positive people in the third decade of the epidemic? The report further shows that many of the problems with access to services – including housing and welfare rights – are structural problems, present across health and social care, and are not unique to HIV. HIV support services are funded from budgets which must also contain the increasing costs of anti-retroviral drugs and other medical interventions, and which are therefore subject to continuous attrition and dissaggregation. Also highlighted is the lack of needs-based planning, the diminishing levels of knowledge and expertise among commissioners and the lack of a national strategic vision. In view of the fact that the Government has established a cross-departmental task force to address the epidemic in developing countries this lack of a national strategic vision is lamentable and has the effect of keeping the issue off the political agenda and almost invisible within local funding priorities. This is a concern both to us as funders and to agencies working within the HIV voluntary sector

Poly-substance use and sexual risk behaviours: a cross-sectional comparison of adolescents in mainstream and alternative education settings

Background: Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK evidence of health inequalities between AES and mainstream education school (MES) pupils, assessing whether observed inequalities are attributable to socioeconomic, familial, educational and peer factors. Methods: Cross-sectional, self-reported data on individual- and poly-substance use (PSU: combined tobacco, alcohol and cannabis use) and sexual risk-taking from 219 pupils in AES (mean age 15.9 years) were compared with data from 4024 pupils in MES (mean age 15.5 years). Data were collected from 2008 to 2009 as part of the quasi-experimental evaluation of Healthy Respect 2 (HR2). Results: AES pupils reported higher levels of substance use, including tobacco use, weekly drunkenness, using cannabis at least once a week and engaging in PSU at least once a week. AES pupils also reported higher levels of sexual health risk behaviours than their MES counterparts, including: earlier sexual activity; less protection against sexually transmitted infections (STIs); and having 3+ lifetime sexual partners. In multivariate analyses, inequalities in sexual risk-taking were fully explained after adjusting for higher deprivation, lower parental monitoring, lower parent-child connectedness, school disengagement and heightened intentions towards early parenthood among AES vs MES pupils. However, an increased risk (OR = 1.73, 95% CI 1.15, 2.60) of weekly PSU was found for AES vs MES pupils after adjusting for these factors and the influence of peer behaviours. Conclusion: AES pupils are more likely to engage in health risk behaviours, including PSU and sexual risk-taking, compared with MES pupils. AES pupils are a vulnerable group who may not be easily targeted by conventional population-level public health programmes. Health promotion interventions need to be tailored and contextualised for AES pupils, in particular for sexual health and PSU. These could be included within interventions designed to promote broader outcomes such as mental wellbeing, educational engagement, raise future aspirations and promote resilience

Oxidative stress via hydrogen peroxide and menadione does not induce the secretion of IGFBP-5 in primary rat hepatocytes

Conference abstract describing how oxidative stress via hydrogen peroxide and menadione does not induce the secretion of IGFBP-5 in primary rat hepatocytes. Presented at the 2010 annual congress of the british toxicology societ

Pathogens: the plight of plants

A report on the British Society for Plant Pathology Presidential meeting 'Plant pathogen genomics - from sequence to application', University of Nottingham, UK, 15-18 December 2003