What Does the Term 'Gay Community' Mean to You - Understandings Among Gay Men in Glasgow and North Lanarkshire

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Understandings of participation in behavioural research: a qualitative study of gay and bisexual men in Scotland

An array of empirical research has emerged related to public participation in health research. To date, few studies have explored the particular perspectives of gay and bisexual men taking part in behavioural surveillance research, which includes the donation of saliva swabs to investigate HIV prevalence and rates of undiagnosed HIV. Semi-structured interviews were conducted with twenty-nine gay and bisexual men in Scotland who had participated in a bar-based survey. Thematic analysis of men’s accounts of their motives for participation and their perceptions of not receiving individual feedback on HIV status suggested a shared understanding of participation in research as a means of contributing to ‘community’ efforts to prevent the spread of HIV. Most men expressed sophisticated understandings of the purpose of behavioural research and distinguished between this and individual diagnostic testing. Despite calls for feedback on HIV results broadly, for these men feedback on HIV status was not deemed crucial

024 PP: Meaningful and engaging, or tokenistic?:Reflections on collaborative engagement in the process of designing sexual health interventions

Working with non-academic partners and including participants, and other stakeholders, in the design and delivery of research is emerging as a critical element in the field of health research. As researchers based in an interdisciplinary team with a focus on the development of sexual health interventions, we have long recognised that engagement with individuals and communities is a critical part of the research process, and actively sought out opportunities to collaborate with non-academic partners with a view to ensuring that our work is relevant in the ‘real-world’. While the increasing call for ‘collaboration’, ‘patient and public involvement’ and ‘co-production’ is welcome, we recognise the possibility that without critical reflection on the part of the research team, such engagement can lack meaning for those being asked to participate, potentially reducing its value and risking it being perceived as tokenistic. In this paper we reflect on our experiences as qualitative researchers for whom a key role in interdisciplinary research teams has been undertaking a number of ‘patient public involvement’ projects with both young people and gay, bisexual and other men who have sex with men (MSM) to inform the development of sexual health interventions. We critically reflect on some of the challenges and opportunities involved in this form of ‘consultation’, and explore the ethical implications of engaging stakeholders in identifying issues they consider important as part of the design and delivery of future interventions, but which may not be considered either a priority or feasible

Personal communities and safer sex: a qualitative study of young gay and bisexual men in Scotland

Background: Successful HIV prevention efforts among gay men have been linked to strong ‘community’ responses to HIV and adherence to safer sex practices. Research has found that gay men are increasingly ambivalent about ‘gay communities’, leading some to suggest that using the lens of ‘personal communities’ (PCs) may offer a more useful way of exploring gay men’s personal and social relationships. This qualitative research study set out to explore young gay and bisexual men’s PCs, and the role people within them may play in shaping men’s understandings of, and approach to, ‘safer sex’. Methods: The findings of this qualitative study are based on data drawn from 30 semi-structured interviews with young (aged 18-29) gay and bisexual men living in Scotland. Spencer and Pahl’s (2006) method of exploring PCs using ‘affective maps’ was applied. Two interconnected phases of analysis were conducted: 1) analysis of the ‘maps’ developed by participants; and 2) thematic analysis of interview data using principles of the Framework approach. Findings: The findings suggest that men’s PCs are complex and diverse. Patterns were observed in terms of overall composition of the men’s PCs. Many of the men had ‘mixed’ friendship groups in terms of gender and sexual orientation. Although the men’s PCs were not wholly shaped by connection to ‘gay communities’, men nevertheless articulated the importance of support around safer sex from their gay male friends. Understandings of safer sex were based primarily on the need to protect against sexual infection. A novel finding was that some men framed safer sex as the need to protect against non-sexual risks. Men drew on a range of resources, from within their PCs, gay communities, and beyond, in developing understandings of safer sex. Social norms of condom use among the men’s PCs shaped men’s responses to risk in sex, specifically their approach to condom use. Consistent condom use with new and casual partners was framed as ‘normal’, however many of the young men reported a desire to discontinue condom use in the context of a relationship. Condomless sex in this context was not generally framed as ‘unsafe sex’. A novel finding was that many of the men articulated the need for HIV testing prior to ceasing condom use, not only as a response to risk of infection, but also as a way of building trust within a relationship. Conclusions: The findings suggest that future community-level interventions need to take into account changing patterns of sociality among young gay and bisexual men, and suggest that HIV prevention interventions could capitalise upon supportive relationships between men and other people within their PCs

The People vs the NHS:Biosexual citizenship and hope in stories of PrEP activism

This is the final version. Available on open access from Edinburgh University Press via the DOI in this recordDiscourses of pre-exposure prophylaxis (PrEP) revel in its radical potential as a global HIV prevention technology, offering a promise of change for the broader landscape of HIV prevention. In 2018, the British Broadcasting Corporation (BBC) aired The People vs The NHS: Who Gets the Drugs?, a documentary focussed on the ‘battle’ to make PrEP available in England. In this article we explore how the BBC documentary positions PrEP, PrEP biosexual citizen-activists, as well as the wider role of the NHS in HIV prevention and the wellbeing of communities affected by HIV in the UK. We consider how biosexual citizenship (Epstein 2018) is configured through future imaginaries of hope, and the spectral histories of AIDS activism. We describe how The People crafts a story of PrEP activism in the context of an imagined gay community whose past, present and hopeful future is entangled within the complexities and contractions of a state-funded health system. Here, PrEP functions as a ‘happiness pointer’ (Ahmed 2011), to orient imagined gay communities towards a hopeful future by demanding and accessing essential medicines and ensuring the absence of needless HIV transmissions. This biomedical success emerges from a shared traumatic past and firmly establishes the salvatory trajectory of PrEP and an imagined gay community who continues to be affected by HIV. However, campaigns about the individual’s right to access PrEP construct the availability and consumption of PrEP as an end goal to their activism, where access to PrEP is understood as an individual’s right as a pharmaceutical consumer

Learning from the implementation of Universal Free School Meals in Scotland using Normalisation Process Theory:Lessons for policymakers to engage multiple stakeholders

In 2014/15, Universal Free School Meals (UFSM) were introduced in Scotland and England for children in their first three years of primary school. This study examined the implementation of UFSM in Scotland using Noramlisation Process Theory (NPT), a middle-range theory of implementation, to identify areas of learning for policymakers wishing to introduce or extend similar policies. NPT is predominantly used to evaluate interventions or new technologies in healthcare settings. Qualitative data were collected across Scotland using a case study approach shortly after implementation (n = 29 school-level stakeholders) and in the following school year (n = 18 school-level stakeholders and n = 19 local authority-level stakeholders). Observations of lunchtime in each school were conducted at both timepoints. Data were analysed using a thematic framework approach using NPT constructs and sub-constructs. Results suggested education and catering stakeholders experiences of implementation diverged most around the NPT concepts of coherence, cognitive participation, and reflexive monitoring. Lack of coherence around the purpose and long-term benefits of UFSM appeared to reduce education stakeholders’ willingness to engage with the policy beyond operational issues. In contrast, catering stakeholders identified a direct benefit to their everyday work and described receiving additional resources to deliver the policy. Overall, participants described an absence of monitoring data around the areas of greatest salience for education stakeholders. This study successfully used NPT to identify policy learning around school meals. Policymakers must increase the salience of such intersectoral policies for all relevant stakeholders involved before policy implementation, and plan adequate monitoring to evaluate potential long-term benefits

Abortion patients’ perspectives on enhancing a telemedicine model of post-abortion contraception:a qualitative study

Background: Access to post-abortion contraception (PAC) is critical for reducing unintended pregnancies and supporting reproductive decision-making. Patients often face challenges in identifying, accessing, and initiating their preferred contraceptive methods post-abortion. This may be particularly so with telemedicine models of care with absence of in-person appointments, and reduced opportunities to provide some contraceptive methods. This qualitative service evaluation explored patients' perspectives on PAC consultations and decision-making to inform future PAC service models in the era of telemedicine.Methods: Qualitative interviews with 15 patients who had telemedicine medical abortion at home up to 12 weeks gestation. Data were analysed using reflexive thematic analysis.Results: Contraceptive discussions during pre-abortion consultations were valued for supporting informed choices about future contraceptive use. Decision-making was influenced by previous contraception experiences, emotional state at the time of abortion and concerns about contraceptive ‘failure.’ Some preferred non-hormonal methods due to past negative experiences with hormonal contraceptives. However, limited information about 'natural' contraceptive methods and concerns about discussing these with healthcare professionals were described. Barriers to accessing preferred methods, particularly long-acting reversible contraceptives (LARC), included reduced availability of appointments and caring responsibilities. Fast-tracked appointments for LARC fitting post-abortion were valued. The need for flexible PAC consultations and access after abortion, for example, remote consultations complemented by personalised interactions with sexual and reproductive health experts, was emphasised.Conclusion: The findings highlight the need for flexible and more accessible PAC service models in the era of telemedicine care to ensure timely access to preferred contraceptive methods.<br/

Mass media and communication interventions to increase HIV testing among gay and other men who have sex with Men:Social marketing and visual design component analysis

Mass media and communication interventions can play a role in increasing HIV testing among gay, bisexual and other men who have sex with men (GBMSM). Despite the key role of social marketing principles and visual design within intervention development of this type, evidence is limited regarding interventions’ social marketing mix or visual design. As part of a systematic review, intervention content was assessed using social marketing theory and social semiotics. Data were extracted on the nature of the intervention, mode of delivery, use of imagery, content and tone and the eight key characteristics of social marketing. Data were synthesised narratively. Across the 19 included studies, reference to social marketing principles was often superficial. Common design features were identified across the interventions, regardless of effectiveness, including: the use of actors inferred to be GBMSM; use of ‘naked’ and sexually explicit imagery; and the use of text framed as statements or instructions. Our results suggest that effective interventions tended to use multiple modes of delivery, indicating high social marketing complexity. However, this is only part of intervention development, and social marketing principles are key to driving the development process. We identified consistent aspects of intervention design, but were unable to determine whether this is based on evidence of effectiveness or a lack of originality in intervention design. An openness to novel ideas in design and delivery is key to ensuring that evidence-informed interventions are effective for target populations

Process evaluation of the implementation of Universal Free School Meals (UFSM) for P1 to P3: Research with Schools and Local Authorities

In January 2015, Scotland moved from a targeted system of Free School Meals (FSM) to a service providing universal free school meals (UFSM) for all children in Primaries 1 to 3 (P1-3). The targeted system remained for children in P4 and above. Since the launch of Hungry for Success in 2003, a series of policies and guidance has focused on school food reform and nutrient standards. The UFSM policy is set within this context alongside an increased policy focus on reducing health inequalities in Scotland. A theory of change was developed by NHS Health Scotland for UFSM provision. It was identified that key policy outcomes will be underpinned by a number of assumptions and that achievement of these outcomes will also be influenced by certain external factors. Further, it recognised that the implementation of UFSM may also generate positive and negative unintended consequences. NHS Health Scotland commissioned a research team from three universities to undertake a process evaluation of the implementation of the UFSM policy. The research was led by the Institute for Social Marketing at the University of Stirling, in collaboration with the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow, and the Centre for Public Health Nutrition Research at the University of Dundee. The process evaluation comprised three main strands: research with parents, schools and local authorities. This report focuses on the research with schools and local authorities. A detailed report on the research with parents was published in October 2015