478 research outputs found
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Testing public health intervention guidance on increasing the uptake of HIV testing among men who have sex with men. Final fieldwork report
This guidance is for NHS and other commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, increasing the uptake of HIV testing among men who have sex with men. This includes those working in local authorities and the wider public, private, voluntary and community sectors. It will also be of interest to members of the public, in particular men who have sex with men.
The focus of the guidance is on increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission.
The recommendations include advice on:
planning services, including assessing local need and developing a strategy
promoting HIV testing among men who have sex with men, including outreach schemes and providing rapid point-of-care tests
offering and recommending an HIV test in primary care, secondary care and specialist sexual health services
repeat testing
HIV referral pathways
Pharmaceutical HIV prevention technologies in the UK: six domains for social science research
The development of pharmaceutical HIV prevention technologies (PPTs) over the last five years has generated intense interest from a range of stakeholders. There are concerns that these clinical and pharmaceutical interventions are proceeding with insufficient input of the social sciences. Hence key questions around implementation and evaluation remain unexplored whilst biomedical HIV prevention remains insufficiently critiqued or theorised from sociological as well as other social science perspectives. This paper presents the results of an expert symposium held in the UK to explore and build consensus on the role of the social sciences in researching and evaluating PPTs in this context. The symposium brought together UK social scientists from a variety of backgrounds. A position paper was produced and distributed in advance of the symposium and revised in the light this consultation phase. These exchanges and the emerging structure of this paper formed the basis for symposium panel presentations and break-out sessions. Recordings of all sessions were used to further refine the document which was also redrafted in light of ongoing comments from symposium participants. Six domains of enquiry for the social sciences were identified and discussed: self, identity and personal narrative; intimacy, risk and sex; communities, resistance and activism; systems, structures and institutions; economic considerations and analyses; and evaluation and outcomes. These are discussed in depth alongside overarching consensus points for social science research in this area as it moves forward
Lambeth LGBT Matters: The needs and experiences of lesbians, gay men, bisexual and trans men and women in Lambeth.
This report presents the findings of a study of the experiences of Lesbians, Gay men, Bisexual and Trans (LGBT) men and women who live, work and socialise in Lambeth. It presents the results of part of a larger study which included analysis of Lambeth’s policies and procedures, stakeholder interviews and staff focus groups. The full report can be found at our website. Here, we present the results of a self-completion quantitative survey of LGBT people who live, work or socialise in Lambeth (Chapter 2) and qualitative focus groups/interviews with LGBT residents of Lambeth (Chapter 3). Chapter 4 contains some conclusions and recommendations arising from this research.
The study was commissioned by The London Borough of Lambeth (LBL) to provide the Council with information to improve services for these populations. LBL is the largest and possibly most diverse of inner London’s boroughs. Patterns of UK and international migration ensure that the LGBT population in London is far larger than elsewhere in the UK. Using Census (Office for National Statistics 2006) and other data (Mercer et al. 2004) we can estimate that Lambeth’s LGBT resident population is approximately 18-20,000 adults. This figure does not include people who come to Lambeth to work or socialise. Lambeth also hosts a substantial LGBT social and commercial scene with six Gay saunas / gyms, 12 LGBT social support agencies and at least 17 bars, clubs and cafes in the borough. Lambeth also contains several public areas where men meet for sex (parks, commons and public toilets)
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Wasted opportunities: Problematic alcohol and drug use among gay men and bisexual men
This report describes the findings from a qualitative and quantitative study of alcohol and drug use among gay and bisexual men and other men that have sex with men (MSM) in England. The qualitative element describes the experiences and understandings of men who identified themselves as being concerned about their alcohol or drug use. The quantitative element shows the broader picture of use and concern about use among MSM. So we go from a broad picture of the extent of alcohol and drug use and concern about it, to a narrower and more detailed focus on men experiencing concern and problems related to alcohol and drug use.
The aims of the study are to qualitatively explore the contexts and attendant needs of men who are concerned about their substance use, to locate that use within the broader MSM population and to suggest ways in which the drug-related needs of MSM might be better met. So we have specifically recruited men who were concerned about their substance use and investigated the way these men used drugs and alcohol, what drugs and alcohol mean to them and the harms caused by drugs and alcohol. Many men, perhaps the majority, use alcohol and other drugs without any mishap or unhappiness. However, the range of experiences described highlight the pervasive and often detrimental role that alcohol and other drugs play in the social and personal lives of many men.
Although there is some research which examines the effects of substance use treatments on sexual risk behaviour (that is, do drugs services reduce unsafe sex), there is little or no research which investigates the accessibility, acceptability or effectiveness of current substance use services for gay men and other MSM. So in the qualitative interviews we also sought information about the role services played in meeting drug-related needs, for example information, motivational and practical support
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Relative Safety 2: Risk and unprotected anal intercourse among gay men diagnosed with HIV
In 1999 Sigma Research published Relative safety: an investigation of risk and unprotected anal intercourse among gay men diagnosed with HIV (Keogh et al. 1999). This study explored the social, psychological and cultural meanings associated with unprotected anal intercourse (UAI) among men with diagnosed HIV. It highlighted both the complexity of sexual interaction for men with diagnosed HIV, and the many potential costs and benefits perceived by them. Now, with more than 24,000 homosexually active men diagnosed with HIV in the UK (Health Protection Agency 2008), a figure that is set to increase in years to come, it is vital that agencies involved in HIV prevention interrogate their own beliefs about UAI and ensure that their interventions meet the needs of men with diagnosed HIV.
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The following chapter explains how the study was undertaken, outlines the broad topic areas addressed during the interviews, and describes the sample of men who took part. Chapter 3 outlines the range of harms that men with HIV perceive when engaging in UAI. Chapters 4 and 5 explore the ways in which men responded to these perceived harms, firstly those relating to the risk of onward HIV infection, or superinfection, and latterly those concerning the potential for harms to their personal and social identities. Chapter 6 considers the implications of these findings for health promotion interventions targeting men with HIV, and with homosexually active men more broadly
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The Field Guide: Applying <i>Making it Count</i> to health promotion activity with homosexually active men
This Field Guide considers a range of methods used to carry out health promotion with homosexually active men. It is a companion document to Making it count: a collaborative planning framework to reduce the incidence of HIV infection during sex between men (Hickson et al., 2003). Like Making it count, this document will be reviewed every two to three years and accompanied by training opportunities. The authors welcome comments and suggestions on this document and its use. These can be sent to: [email protected] or [email protected]. "Briefing papers" that add to the content of this guide will be produced as part of the CHAPS sector development programme. These will be available periodically from www. chapsonline.org.uk.
Making it count describes a co-ordinated national framework to reduce HIV incidence occurring as a consequence of sex between men. It is intended for workers, managers, policy makers, legislators, health professionals or anyone with an investment in reducing HIV incidence among homosexually active men.
This Field Guide is written for gay men's HIV health promoters. It places the theory, goals and strategic aims contained in Making it count in the context of day-to-day health promotion activity. It was developed through a range of formal interviews and informal discussion with more than 40 managers and key workers with experience and expertise in specific areas of HIV health promotion for homosexually active men. It concentrates mainly on direct contact work (Chapters 3 to 7), but also considers other types of health promotion that benefit homosexually active men by influencing the structures they live within (Chapter 8).
Section one (Chapters 1 and 2) provides an overview of Making it count and the relationship between this document and that main framework. It outlines the key strategic aims of Making it count and contextualises what follows.
Section two concerns direct contact with homosexually active men. Chapters 3, 4, 5 and 6 deal with different methods of carrying out direct contact work with this population. Chapter 7 considers the different target groups within the entire population of homosexually active men. It examines how to prioritise target groups using epidemiological and needs data and how best to target different groups in various settings.
Section three (Chapter 8) addresses other types of health promotion interventions that are necessary including policy, community and service interventions. These are the interventions needed in order to facilitate direct contact interventions and attend to the broader determinants of sexual health for homosexually active men.
It is anticipated that some (NHS) commissioners would benefit from reading this document in order to further their understanding of the range of work that they could fund. However, this document is not an implementation plan for the NHS in relation to HIV incidence among homosexually active men. Rather, Terrence Higgins Trust are currently in discussion with the Department of Health concerning further work to support the use of Making it count as the basis for Primary Care Trusts' planning and purchasing of HIV prevention activity for homosexually active men
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
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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
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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
Embodied, clinical and pharmaceutical uncertainty: people with HIV anticipate the feasibility of HIV treatment as prevention (TasP)
Evidence of the efficacy of HIV treatment as prevention (TasP) precipitated a highly optimistic global response and a radical redesign of HIV policy. Sociologists and others have framed TasP within promissory or enterprising discourses which require HIV prevention planners and people with HIV to engage in anticipatory assessments of risk and uncertainty. In 2013, I conducted focus groups with people with HIV in London, UK, to explore their understandings and anticipations of TasP. An environment of economic constraint obliged participants to triage clinical need and presentation, and they expressed scepticism about the sustainability of pharmaceutical investment in treatment innovation. These perceptions were informed by an embodied knowledge of HIV which implies a construction of health as a form of capital that is finite and must be conserved. This is contrasted with a biomedical construction of health as a form of capital that can be exponentially generated through investment. The imperative of conservation entailed by people with HIV’s anticipations contrasts with the speculative economy of biomedical production entailed in planners’ anticipations of TasP. Rather than researching ‘TasP acceptability’ and considering whether people with HIV’s behaviours constitute an obstacle to TasP’s effectiveness, we should recognise that people with HIV are already involved in shaping what TasP is, what it will be and ultimately how it ‘works’
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