Suchergebnisse

Narrative therapy and expressive writing interventions have been found to improve health and wellbeing among vulnerable populations; however, few have been conducted with young lesbian, gay, bisexual, transgender, and queer people, and those of other diverse sexual orientations and gender identities (LGBTQ+). This study aimed to determine how young LGBTQ+ people in Australia might make meaning of themselves and their experiences through life writing and the implications for health and wellbeing. A study was conducted with 20 LGBTQ+-identifying participants, aged 16 to 20, in or around Melbourne, Australia. The participants attended one of two writing workshops held at a public library in Melbourne in October 2019 and February 2020, where they were taught creative nonfiction writing techniques. They were asked to submit pieces of life writing ("narratives") and reflections about participating in the study. Fifteen participants submitted one or more narratives in response to a prompt, and 10 participants provided reflections. Thematic analysis was used to code the data and identify themes that emerged. The participants' processes of meaning-making were analysed using a performativity lens. This article explores the theme "sex and relationships" that emerged and the related sub-themes. The participants' writing provided insights into sociocultural norms, discourses, and tropes, including those present in school-based sexuality education and in the media, that may impact the developing sexual subjectivities of young LGBTQ+ people in Australia. Engaging in life writing provided an outlet for developing self-knowledge, agency, and subjectivity. The findings can be used to promote the use of creative, youth-centred and queer-affirming practices and interventions for LGBTQ+ youth in school and community settings, including peer support and community health approaches. They indicate the need for de-pathologising the medicalised risk- and prevention-based interventions for LGBTQ+ youth in health and education research and policy, particularly around sexual and mental health.

AbstractIn recent years, men and masculinities in Southeast Asia has begun to receive more attention from scholars as the result of increasing attention to intersections of race, gender space, colonialism, and place in countries such as Vietnam. This article provides an overview of current research on men and masculinities in Vietnam. It finds research on Vietnamese masculinities is predominantly understood through (i) concepts of Confucianism, with a particular focus on traditional ideas about gender and gender relations in kinship structures; (ii) considerations of Vietnamese masculinities post Đổi Mới (Renovation) and the impact of women's engagement in the labor market; and (iii) a focus on men as "at risk" or vulnerable, including a focus on alcohol consumption and engagement in domestic violence. We highlight limited focus in areas of sexuality and sexual practices, reflexive engagements with concepts of masculinity, focus on men residing in urban centres, considerations of bodywork and body project practices, and an overall Western approach to the study of masculinity in Vietnam. We conclude with a call for further research on men and masculinities in Vietnam framed through postcolonial epistemologies and research methodologies.

AbstractIntroductionOral pre‐exposure prophylaxis (PrEP) forHIVprevention has been proven to significantly reduce newHIVinfections yet scale‐up has been slow. As contexts continue to adjust to make space for PrEP, it is crucial to understand the perspectives and experiences of potential end‐users. In order to inform PrEPand demand creation interventions, this paper examines personal perspectives on adopting and using PrEPamongHIVat‐risk populations in sub‐Saharan Africa.MethodsUsing the principles of a scoping review in July 2018, we explored the extent, range, and nature of published literature regarding PrEPuptake and use among; men who have sex with men,HIVserodiscordant couples, adolescent girls and young women, pregnant and breastfeeding women, women partners of migrant workers; and people who use drugs. Steps included: identification of the research question; identification of relevant studies; study selection; charting the data; and collation – summarizing and reporting results. PubMed and PsycInfo were searched for papers relating to PrEPuptake and use in sub‐Saharan Africa. Resulting papers were reviewed with data extracted and compiled in Excel for analysis. A broad content analysis was conducted and organized into high‐level themes.Results and discussionThirty‐five papers were included in this review. There was little opposition in general to oral PrEP; however, there were significant nuances in its broader acceptability, applicability, and usability. We identified five themes within which these are discussed. These relate to balancing complexities of personal empowerment and stigma; navigating complex risk environments; influences of relationships and partners; efficacy and side effects; and practicalities of use. This body of research suggests that while product attributes and the logistics of PrEPdelivery and use are important topics, it is vital to consider stigma, the interactions of PrEPuse with relationships, and the need for broader understanding ofARVs for prevention versus treatment.ConclusionsPlanning for, programming and promoting the adoption of oral PrEPnecessitates a deeper understanding of end‐user priorities in order to ensure successful interventions. This review illustrates the nuances facilitating or deterring PrEPuse that may affect the larger effort of PrEPscale‐up.

Abstract
Purpose
IPV constitutes a serious health concern for LGBTQ populations within Australia, yet inclusive service provision remains sparsely and unevenly accessible to victim-survivors. While poor availability and accessibility of inclusive services is widely recognized as an issue facing LGBTQ victim-survivors, few researchers have examined the structural or systemic basis of this problem. The current piece seeks to explore the structural conditions obstructing inclusive service provision to LGBTQ victim-survivors, from the perspective of service providers.

Method
N = 19 interviews were conducted with N = 21 key personnel with affiliations to a variety of: (i) general population service organizations, (ii) community-led service organizations and (ii) advisory or convening groups. Interviews explored the structural conditions of the IPV service sector, focusing on barriers and enablers to implementing inclusive service provision for LGBTQ populations.

Results
Three broad factors that obstructed or curtailed inclusive service implementation were identified. These were namely: (i) resistance from both internal and external sources around inclusive practice, (ii) accommodating keeping demands in resource constrained contexts, and (ii) political will and LGBTQ visibility within official policy. Responses to these challenges on the organizational level were sometimes sufficient to meaningfully – though only partially – ameliorate these factors, but seldom addressed the structural conditions that necessitate such responses.

Conclusion
Inclusive service provision is a crucial element of victim-survivor recovery. The sporadic accessibility of such services within Australia can be attributed to several core features of sector and policy landscapes, which demand a significant degree of inter-organizational collaboration and collective advocacy to overcome.

Abstract
Purpose
There are inadequate resources available to support lesbian, gay, bi + , trans and gender diverse, intersex and queer (LGBTIQ) people experiencing family violence in Australia. Government funding agencies and mainstream family violence service providers regularly state that there is insufficient evidence to justify investment in more inclusive services. This article explores practitioner perceptions of such claims.

Method
21 practitioners from mainstream and specialist LGBTIQ family violence services were interviewed about structural challenges associated with implementing LGBTIQ-inclusive family violence services. Participants' accounts highlight the political tensions and material repercussions of epistemic definitions of 'evidence' as they pertain to LGBTIQ individuals' experiences of violence within policy environments. Utilizing Carol Bacchi's feminist policy analysis framework, we ask 'what is the problem represented to be?', examining participant perceptions about how evidence is currently positioned in policy and resourcing decisions pertaining to LGBTIQ family violence, and discuss its implications.

Results
Participants overwhelmingly called for more investment in research and data gathering about family violence against LGBTIQ people and provision of effective supports. Even allowing for this, participants indicated that there is also already enough existing knowledge to justify urgent expansion of LGBTIQ-inclusive services.

Conclusions
Expanded provision of services and generating a more robust evidence base about LGBTIQ family violence service needs are critically important and intertwined issues. However, the way that they are currently sequenced in policy and broader sector conversations, where 'enough' evidence is required in order to justify increased services, is inhibiting progress on both.

AbstractPurposeThis study examined the experiences of LGBTQ victim-survivors who sought out support from domestic violence services in Australia. While the literature on intimate partner violence (IPV) is increasingly focused on improving LGBTQ inclusivity and cultural safety within both service and policy contexts, the experiences of LGBTQ victim-survivors themselves are often absent from these discussions. Consequently, little is understood about how LGBTQ victim-survivors navigate and negotiate service contexts that are frequently optimized for cisgender, heterosexual victim-survivors.MethodsStructured life history interviews were conducted with (N = 29) LGBTQ victim-survivors aged 19–79 years of age who had recent (< 2 years) or ongoing experiences of IPV.ResultsLGBTQ victim-survivors' help-seeking behaviors are undertaken against the backdrop of a highly variegated service landscape. Individual service organizations and service workers' attitudes towards LGBTQ clients can run the gamut from inclusive and culturally sensitive to heterosexist and exclusionary, with little outward distinction between such. While participants within our study demonstrated the ability to deftly navigate or minimize the incidence of such treatment, there were clear limits to the extent that deploying such strategies would successfully enable victim-survivors to access service support. The additional psychological costs of cautiously navigating service systems were also not insubstantial and contributed significantly to both service disengagement and poorer service outcomes.ConclusionsEfforts to expand service capabilities to improve service uptake and service outcomes for LGBTQ victim-survivors must be attentive to, and address the impact of anticipated and experienced discrimination on service provision.

AbstractIntroductionFemale sex workers (FSWs) are at high‐risk for HIV acquisition in South Africa, where the advent of new HIV prevention and treatment interventions represent the potential to significantly impact the epidemic. This paper focuses on aspects of PrEP acceptability as a new intervention within the context of a larger service delivery programme including the simultaneous rollout of early ART. This paper explores PrEP acceptability among the FGD participants as future potential users.MethodsFGDs were conducted in two clinic‐based sites in Johannesburg and Pretoria. They aimed to explore community‐level, multi‐dimensional acceptability of PrEP within the context of imminent implementation alongside early ART in the TAPS Demonstration Project. Sex worker peer educators recruited participants from varying sex work locales. Facilitation was in English with adaptation by facilitators into local languages as needed. Transcripts were translated and transcribed into English. Thematic analysis was used to analyse the data.ResultsFour FGDs were conducted in each site for a total of eight FDGs and 69 participants. Demographics were largely similar across the sites. Overall, there was strong acceptability of PrEP among participants and positive anticipation for the imminent delivery of PrEP in the local sex worker clinics. Themes arising from the discussions exploring aspects of PrEP acceptability included: awareness and understanding of PrEP; PrEP motivations including choice, control, and vulnerability, managing PrEP risks and worries; and, de‐stigmatizing and empowering PrEP delivery. Participant discussions and recommendations highlighted the importance of developing clear education and messaging to accurately convey the concept of PrEP, and intervention integration into supportive and tailored services.ConclusionsThrough the course of these FGDs, PrEP became a positive and highly anticipated prevention option among the FSWs participants who endorsed implementation in their communities. Effective integration of PrEP into existing services will include comprehensive health programming where ART is also available, appropriate messaging, and support.

Chapter 1. Introduction (Sarah Bernays, Adam Bourne, Susan Kippax, Peter Aggleton and Richard Parker) -- Part I: Efficacy and Effectiveness: Shaping Policy and Informing Interventions -- Chapter 2. 'PrEP is a Programme': What does this mean for policy (Hakan Seckinelgin) -- Chapter 3. Making the ideal real: Biomedical HIV prevention as social public health (Mark Davis) -- Chapter 4. PrEP, HIV, and the Importance of Health Communication (Josh Grimm and Joseph Schwartz) -- Chapter 5. Anticipating Policy, Orienting Services, Celebrating Provision: Reflecting on Scotland's PrEP Journey (Ingrid Young) -- Chapter 6. Fighting for PrEP: The politics of recognition and redistribution to access AIDS medicines in Brazil (Felipe de Carvalho Borges da Fonseca, Pedro Villardi and Veriano Terto Jr.) -- Part II: Pleasure, Agency and Desire -- Chapter 7. The Beatification of the Clinic: biomedical prevention 'from below' (Kane Race) -- Chapter 8. New potentials for old pleasures: The role of PrEP in facilitating sexual well-being among gay and bisexual men (Bryan A. Kutner, Adam Bourne and Will Nutland) -- Chapter 9. New hierarchies of desirability and old forms of deviance related to PrEP: Insights from the Canadian experience with an epilogue about the COVID-19 pandemic (Adrian Guta, Peter A. Newman and Ashley Lacombe-Duncan) -- Chapter 10. Agency, Pleasure & Justice: A Public Health Ethics Perspective on the Use of PrEP by Gay and Other Homosexually-Active Men (Julien Brisson, Vardit Ravitsky and Bryn Williams-Jones) -- Part III: Provision Politics and New Forms of Governmentality -- Chapter 11. The political life of PrEP in England: an ethnographic account (Sara Paparini) -- Chapter 12. PrEP trials and the politics of provision (Catherine Dodds) -- Chapter 13. The stigma struggles of biomedical progress: PrEP and the potential for community engagement (Andy Guise) -- Chapter 14. How the science of HIV treatment-as-prevention restructured PEPFAR's strategy: The case for scaling up ART in 'epidemic control' countries (Ryan Whitacre) -- Chapter 15. Getting real on U=U: Human rights and gender as critical frameworks for action (Laura Ferguson, William Jardell and Sofia Gruskin) -- Chapter 16. Falling short of 90-90-90: how missed targets govern disease elimination (Kari Lancaster and Tim Rhodes) -- Part IV: Anticipating and Understanding the Consequences of Biomedicine -- Chapter 17. Stigma and confidentiality indiscretions: Intersecting obstacles to the delivery of Pre-Exposure Prophylaxis to adolescent girls and young women in east Zimbabwe (Morten Skovdal, Phyllis Magoge-Mandizvidza, Rufurwokuda Maswera, Melinda Moyo, Constance Nyamukapa, Ranjeeta Thomas and Simon Gregson) -- Chapter 18. Imagined futures and unintended consequences in the making of PrEP: an evidence-making intervention perspective (Martin Holt) -- Chapter 19. The drive to take an HIV test in rural Uganda: a risk to prevention for young people? (Sarah Bernays, Allen Asiimwe, Edward Tumwesige and Janet Seeley) -- Chapter 20. Entangled bodies in a PrEP demonstration project (Lisa Lazarus, Robert Lorway and Sushena Reza-Paul) -- Chapter 21. An unfinished history: a story of ongoing events and mutating HIV problems (Marsha Rosengarten).

AbstractIntroductionSexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same‐sex relationships and drug‐using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy.MethodsWe systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta‐analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta‐analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates.Results and discussionOf the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta‐analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10–16%; I2 = 97.6) but higher when studies utilized self‐administered surveys (15%; 95% CI = 12–19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82–5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27–8.21).ConclusionsSDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between‐study comparisons. Responses to SDU‐related harms should consider local contexts, including specific drug types used and their relative risks.

Abstract
Background
Gender and sexual minority adults have significant unmet mental health care needs and are often faced with barriers to accessing appropriate services. In this context, LGBTQ individuals often turn to each other for mental health support.

Methods
In a sample of 326 LGBTQ adults (M age = 37.64) who were providing mental health support to their LGBTQ peers, we examined the nature of LGBTQ peer support, including who provides peer support, to whom, and for what issues. We also examined the experiences of those providing LGBTQ peer support, and the role of mental health training. Data were collected in 2020.

Results
Participants provided support to a range of individuals, including close friends, colleagues, and those who were previously strangers. The types of concerns they supported their peers with varied greatly, though depression, anxiety, suicidality, and coping with discrimination were common concerns. Participants were often managing multiple competing demands, and many appeared to be managing their own mental health concerns. Those who had received at least some mental health training appeared to fare better in their experiences of providing peer support compared to those without such training.

Policy Implications
Findings illustrate the importance of increasing access to LGBTQ-affirmative mental health services. We also highlight the importance of developing and disseminating initiatives designed to support those providing LGBTQ peer support, both to increase the effectiveness of peer support and to help manage the impact of providing LGBTQ peer support.

AbstractIntroductionChemsex, the use of psychotropic drugs before or during sexual intercourse, is associated with various HIV risk factors, including condomless sex and reduced adherence to pre‐exposure prophylaxis or antiretroviral therapy (ART). In the Philippines, there are still limited studies exploring the associations between chemsex, HIV status and ART adherence. This study aims to compare recent and lifetime chemsex engagement in association with self‐reported HIV status among Filipino men who have sex with men (MSM). We further explored the association between chemsex and ART adherence among people living with HIV engaged in chemsex.MethodsA cross‐sectional online survey of 479 Filipino MSM was conducted from 3 August to 1 December 2019. Demographic profiles, sexual behaviours, drug use, history of sexually transmitted infections (STIs), chemsex engagement and HIV status were collected and analysed. Bivariable and multivariable logistic regression were employed to assess the association between self‐reported HIV status and chemsex engagement.ResultsAmong the 479 respondents, Filipino MSM engaged in drug use and chemsex were generally older compared to those not engaged in drug use and chemsex (average age 31−33 vs. 29 years old; p<0.05). Methamphetamine was the most common drug for people who reported using drugs. An HIV‐positive status was associated with recent chemsex engagement (aOR = 5.18, p<0.05) and a history of STIs (aOR = 2.09, p<0.05). The subgroup analysis showed that 79% (166/200) of persons living with HIV were adherent to ART. There was no significant association found between chemsex and ART adherence in the logistic regression analyses.ConclusionsChemsex behaviour, particularly recent chemsex engagement, is significantly associated with self‐reported HIV status. The emerging data on MSM engaged in chemsex require integration of a more person‐centred, comprehensive and robust harm reduction programmes into the existing combination prevention strategies in the country. Health education for Filipino MSM engaged in chemsex should prioritize raising awareness about methamphetamine effects and overdose risks, alongside proper medical management.