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The term "gay community" has been criticized for its inability to explain the pluralities in a specific cultural and political context. Based on in-depth interviews with 63 non-heterosexual males in Bulgaria, this study aims to revisit the theories of gay communities in a non-Western, post-communist context. The data from this study suggest that (1) the idea of a "gay community" is often rejected due to anti-communist notions and explicit engagement with individualism as anti-communitarianism; (2) belonging to a gay community is subjective, and initial verbal detachment from gay communities does not indicate a lack of factual belonging to such communities; (3) the concepts of "personal communities" and "family of choice" remain relatively irrelevant in the Bulgarian context; (4) the most significant factor for attachment to a gay community is the notion of "gay culture" and "gay scene"; (5) recent forms of "sexual attachments" have led to a certain political involvement; and (6) the "anti-gender campaigns" have revitalized the importance of gay communities and have brought an increasing number of respondents to certain involvement in gay communities and networks, challenging the theories of "post-gay" societies.

Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence; if they were younger; university educated; close contact of someone with COVID-19; or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM; had a higher proportion of friends willing to vaccinate against COVID-19; and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices., (© 2022. The Author(s).)

Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks., (© 2022. The Author(s).)

Negative stereotypes about pre-exposure prophylaxis (PrEP) hinder PrEP uptake among young men who have sex with men (YMSM). Prior research suggests community homophobia may be linked to negative PrEP attitudes. Conversely, individuals with high gay community attachments (GCA) may have more access to credible PrEP information/resources. Among 285 YMSM recruited online, we estimated structural equation models to test competing conceptual models that inform pathways from perceived stigmas, GCA, and negative PrEP stereotype endorsements to PrEP uptake. In Model A, perceived stigma was directly associated with PrEP uptake, partially mediated by stereotype endorsement (β =  - 0.05; 95% CI [- 0.09, - 0.01]) and GCA (β =  - 0.06; 95% CI [- 0.11, 0.02]). In Model B, perceived stigma was associated with PrEP uptake (β =  - 0.07; 95% CI [- 0.14, - 0.01]) through stereotype endorsement among high GCA YMSM. Complemented by anti-stigma initiatives, PrEP outreach for YMSM should utilize sex-positive messaging and disentangle negative PrEP stereotypes within gay-centric social spaces.

The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.

This qualitative study explores the social lives of older gay men. In-depth interviews were conducted with 10 gay men over the age of 65 to elicit details about their relationships with other people. Findings paint a complex picture of older gay social life that is compounded by significant events affecting gay men from a particular socio-historical period. Three overarching themes emerged that capture the social lives of the participants: (1) coming of age as a gay man in the 20th century; (2) dealing with the aging body; and (3) enduring loss and the consequent impact on social life. The participants reported that being in a gay environment and closing the gay generational divide helped them adjust to their changing social lives in later life. This study adds to the ongoing discussion about the experiences of older gay men and makes suggestions for future research and practice considerations.

Public stigma surrounding HIV is related to heightened emotional distress, poor psychological functioning, and reduced subjective well-being in people living with HIV. For men who have sex with men (MSM) living with HIV, they may also face stigmatizing attitudes within the gay community, which create an additional burden to their health. Grounded in the psychological mediation framework, the present study examined the underlying psychological processes through which HIV stigma from the public and within the gay community influences the mental and social health of MSM living with HIV. Findings from 206 Chinese MSM living with HIV in Hong Kong indicated that negative self-concept, maladaptive coping, and peer isolation mediated the effect of HIV stigma on mental and social health. The study revealed the cognitive, regulatory, and interpersonal processes underlying HIV stigma and health. Feeling intense HIV stigma from the public and within the gay community may render MSM living with HIV more vulnerable to negative self-concept, maladaptive coping, and peer isolation, which contribute to poor mental and social health. To combat prejudice and discrimination against people living HIV, stigma reduction initiatives should be implemented not only in the public, but also in the gay community. Cognitive-behavioral interventions can also be used to restructure negative self-beliefs and build adaptive emotion regulation skills, which can improve stigma-related health outcomes among MSM living with HIV.

Gay and bisexual men suffer from higher rates of mental health disorders than their heterosexual counterparts. Minority stress theory provides the framework for much research that seeks to explain this discrepancy. Recently, several studies have also examined the role of connection with the gay community with mixed results. Operationalizing gay community connectedness in terms of two separate constructs-community involvement and community identification-this study sought to examine and compare the role that each of these factors plays in affecting gay and bisexual men's mental health. We analyzed data from 371 gay and bisexual men in New York City, focusing on measures of minority stress factors, gay community connectedness, and mental health outcomes. As hypothesized, factor analysis showed that the community connectedness scale loaded onto two sub-factors corresponding to the theorized constructs of identification and involvement. Linear regression models adjusting for potential confounding factors showed that community involvement was significantly associated with better mental health outcomes. Community involvement also significantly moderated the impact of internalized homonegativity on mental health. This factor was not a significant moderator of the impact of sexual orientation discrimination on mental health, and community identification was not significantly associated with mental health outcomes. It also did not significantly moderate the effect of either minority stress factor. Future research would benefit from developing an updated and highly reliable measure of community involvement.

Young gay men in Beirut are at significantly elevated risk of HIV infection compared with the general Lebanese population. Despite nascent HIV prevention efforts in the region, there is a need for effective community-level HIV prevention interventions tailored for young gay men. This qualitative study examined internal dynamics within Beirut's gay community as a basis for developing community-level interventions. Peer ethnographers were trained to collect field notes on conversations between young gay men in public spaces in Beirut, and conducted follow-up focus groups with young gay men. Analyses revealed three major themes: (1) the need for safe spaces in which to socialise, (2) the importance of being able to locate and connect with other young gay men, and (3) ambivalence regarding a gay community that was supportive in some ways but also fragmented and often judgemental. Study findings also confirm the existence of external threats to community such as stigma, cultural and familial norms regarding heterosexuality and criminalisation of refugee status. Understanding such community dynamics and the environmental context is central to designing effective community-based HIV prevention programmes.

The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.

Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between methamphetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between methamphetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about methamphetamine use to take hold. We outline what appear to be two dominant interpretations of the methamphetamine/sexual practice relationship: the first proposes that methamphetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes; the second proposes that methamphetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they individualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand methamphetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use methamphetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Gay and bisexual men (GBM) who participate in gay community subcultures have different profiles, including differing risk behaviors. We examined men's participation in gay community subcultures, and its association with risk behavior. In a cross-sectional survey, 849 GBM provided information about men in their personal networks. We devised measures of their participation in five subcultural groupings and explored their associations with sexual behavior. We identified five subcultural groupings: sexually adventurous; bear tribes; alternative queer; party scene; and sexually conservative. Higher scores on the sexually adventurous measure was associated with being older, having more gay friends, being HIV-positive, and being more sexually active. It was also independently associated with unprotected anal intercourse with casual partners (AOR 1.82; 95 % CI 1.20-2.76; p = 0.005). HIV prevention strategies need to account for the different subcultural groupings in which GBM participate. Measures of engagement with gay subcultures are useful indicators of differential rates of risk behavior and modes of participation in gay community life. Men in more sexually adventurous subcultures are more likely to engage in sexual risk behavior.

Changes in gay and bisexual men's connectedness to the gay community are related to the declining public visibility of HIV/AIDS and greater acceptance for homosexuality and bisexuality in mainstream society. Little work, however, has focused on perceived acceptance for subgroups within the gay community or broader society. Using interviews (n = 20) and a survey (n = 202) of gay and bisexual men in a mid-sized Canadian city, we find perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and bisexual men in Canada.

Sense of belonging to the general and broader gay communities has been shown to be beneficial for gay men's mental health. This research investigated the interrelations between sense of belonging to three forms of gay community (the broader gay community, gay groups, and gay friends), sense of belonging to the general community, and depressive symptoms by examining a path model. A community sample of 177 gay men, aged 18 to 79 years, completed the Sense of Belonging Instrument-Psychological subscale, the Centre for Epidemiological Studies-Depression Scale, and the Sense of Belonging within Gay Communities Scale. The model provided excellent fit to the data in which sense of belonging to the general community mediated the relationships between a sense of belonging to gay groups and with gay friends and depressive symptoms. Results imply that enhancing gay men's sense of belonging to gay groups and with gay friends is likely to be associated with fewer depressive symptoms, by virtue of their enhanced sense of belonging to the general community.

Understanding how people in any given population think about and experience their sexuality is fundamental to developing and implementing good health policy, research, and practice. Yet despite several decades of focus on sexual identity and HIV risk within health research, gay men as a category are often treated in an uncomplicated way. This article reports on focus group discussions held with 45 gay and other men who have sex with men in New Zealand to identify how they talked about issues of gay identity and gay community/ies. The men negotiated and renegotiated their gay identity and being gay was reported as just one part of most men's lives. Many men did not like to be labeled as gay and downplayed aspects of their gay identity. Only a few men proclaimed being gay. Men reported very mixed experiences with the gay community/ies. Understanding how men experience being gay, provides information vital to enhancing policy, research and practice responses to gay men's health issues. A major challenge for health service provision to appropriately engage with men who have sex with other men but resist being labeled as gay was identified., (© The Author(s) 2014.)

This essay analyzes the writings from a gay male intergenerational project, wherein the process of generating creative prose, poetry, and fiction are used to explore differing understandings of age, aging, and future across gay male cohorts in Chicago. The project suggests one's age strongly informs one's perception of power dynamics and one's perceived access to power. Specifically, youthist logics and lingering cultural myths surrounding the aging gay male shape and constrain intergenerational relations. Furthermore, the study marks and theorizes an emergent generational divide in the conceptualization and articulation of "gay identity" as well as how this identity is understood in relation to "the gay community." The essay concludes by examining the implications and potential of this research to expand models and logics for meaningful gay male intergenerational exchange, or a queered form of generativity.