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The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure. [ABSTRACT FROM AUTHOR]

Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study’s findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered ‘core-business’ by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people. [ABSTRACT FROM AUTHOR]

There are particular complexities faced by people attempting to tell their stories in the context of social stigma, such as the hostility which often surrounds injecting drug use. In this article, we identify some of the distinct advantages of taking a narrative approach to understanding these complexities by exploring a single case study, across two life-history interviews, with “Jimmy,” a young man with a history of social disadvantage, incarceration, and heroin dependence. Drawing on Miranda Fricker’s notion of “hermeneutical injustice,” we consider the effects of stigmatization on the sociocultural practice of storytelling. We note the way Jimmy appears both constrained and released by his story—how he conforms to but also resists the master narrative of the “drug user.” Narrative analysis, we conclude, honors the complex challenges of the accounting work evident in interviews such as Jimmy’s, providing a valuable counterpoint to other forms of qualitative inquiry in the addictions field. [ABSTRACT FROM AUTHOR]

Expansion of Needle and Syringe Programs (NSPs) to non-specialised sites requires an NSP workforce with skills in engaging stakeholders who may have different opinions of NSP. This study examined the strategies used by NSP workers to develop and maintain NSP services and the emotional labour involved in performing this work. Qualitative interviews were undertaken with 12 staff of a NSP network in metropolitan Sydney, Australia. Participants had undertaken a range of activities to expand NSP sites, often in unwelcoming environments in which NSP was viewed as a “cowboy” service. Participants’ strategies included building positive, ongoing inter-group contact, being visible in external services, and maintaining their professionalism to promote NSP as a legitimate service and themselves as legitimate health workers. Some participants employed strategies which were at odds with their personal and professional values. Participants relied on cohesion within the NSP team to support and encourage each other. Dealing with external services to establish and maintain NSPs was a source of significant emotional labour for NSP workers and was grounded in the stigma attached to injecting drug use. NSP policies and procedures should account for this additional work undertaken by NSP staff and leadership is required to address stigmatisation of NSPs. [ABSTRACT FROM PUBLISHER]

AimThis paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses’ clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine.BackgroundIn international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia.MethodsData for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce.FindingsViewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients’ exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV. [ABSTRACT FROM AUTHOR]