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This paper addresses some of the ways in which psychological constructs, which have been traditionally positioned as intra-psychic phenomena, may be more productively understood as local performances of intelligible 'healthy subject positions'. More specifically, it focuses on the cultural location of psychological epistemologies, and the assumptions of universality (based upon the normative subject position 'white middle-class heterosexual male') that shape them. Through an analysis of traditional locus of control research, it explores the ways in which individualistic notions of 'personality traits' enact a form of governmentality over subjects who are expected to inhabit specific, fixed subject positions. Thus, traditional research on locus of control can be seen as instantiating the very subject positions that it seeks to measure. To counter this, the paper draws upon experience as a methodological tool in order to examine some of the ways in which neo-liberal discourses of control work to homogenize the broad range of experiences that construct intelligible subject positions. In particular, the focus is on the potentialities and limitations of drawing on such discourses of control to understand non-heterosexual experiences, and it is suggested that we need to examine how such experiences may render individuals complicit with heterosexist 'practices of self'. [ABSTRACT FROM AUTHOR]

Studies of sexual risk behaviour in the context of HIV/AIDS often utilize theories of risk which are predicated on the idea of the rational actor making choices, and thus operate with a strong notion of the autonomous individual. The underlying assumption is that a well-informed individual would strive to reduce risk and therefore choose not to engage in risky behaviour in sexual encounters. Drawing on longitudinal fieldwork in Arusha town and the surrounding districts in northern Tanzania, this paper explores how people draw on a complexity of knowledge and experience when they try to reduce the likelihood of contracting HIV. It shows how the embeddedness of social relationships, and the constraints of culture restrict the possible range of options, particularly for women. The paper examines the paired concepts of risk and trust, arguing that trust in a sexual relationship is gendered in particular ways. Gender hierarchies often place women in a subordinate position to men as a result of which women have to make compromises which put their health at risk. [ABSTRACT FROM AUTHOR]

This paper presents data on the need for sexual health information and advice of 4353 students aged 13/14 years in 13 English secondary schools. Data were collected by peer educators as part of a sex education programme, and through a questionnaire survey administered by researchers. Data illustrate young people's need for concrete information and advice on issues related to physical development and puberty; transmission of sexually transmitted diseases; accessing and using condoms and other contraception; using sexual health services; managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality. Differences between the concerns and interests raised by young people and current UK guidance on sex and relationships education are examined, and the implications of these findings for designing future policy and effective school based sex education programmes are discussed. The paper highlights some of the wider social norms around sex and sexuality that influence young people's understanding and sexual behaviour, and the importance of addressing these within sex education is noted. Factors influencing the processes of expressing and assessing needs are explored. [ABSTRACT FROM AUTHOR]

Recent research indicates that risk perceptions are shaped by social and cultural factors, and therefore it is important to study the cultural aspects of sexual risk understandings. This paper reports on a pilot study using consensus analysis to study the content and distribution of knowledge of sexual risk among a small sample of college students at a private university in western New York. Twenty men and 20 women were surveyed. The results of the subsequent consensus analysis suggest that the men, the women, and all the respondents combined share a model of what constitutes risky sex. The women showed a greater level of consensus and average competence than men. There were important differences between men and women in some aspects of the content of knowledge. In particular, men perceived sexual desire as more likely to prevent the practice of safe sex, whereas women saw alcohol in that role. One issue raised in this paper is the problematic assumption that culture as knowledge determines behaviour. [ABSTRACT FROM AUTHOR]

This paper examines the gendered nature of desire in a North Balinese rural village adjacent to a tourist resort. It poses the theoretical question of what happens when a culture's dominant belief systems fail to accommodate desire. Observing that male promiscuity is indulged and naturalized in this community, the paper argues that women's desire is channelled narrowly into achieving and retaining a spouse. Women who admit of desire outside these cultural constraints may be subject to episodes of 'hysteria'. Hysterical illness is read herein as a displacement of desire onto the body such that the body becomes 'the place'—as a site of illness—where desire may reside. Although the resort to hysteria may provide temporary emotional release for women's frustrated affect, it does not fundamentally transform the gendered relations of desire. Curiously, neither does it appear to exacerbate the inequalities they sustain, implying that in North Bali (hysterical) illness may serve as a legitimate avenue for the expression of desires that are otherwise culturally-proscribed. [ABSTRACT FROM AUTHOR]

This paper describes findings from fieldwork conducted among Pitjantjatjara tribespeople of Central Australia between 1989 and 1997. The study examined the impact of a distinctive gender system and practices of masculinity, particularly sexual and ritual practices, on the risk of contracting sexually transmissible infections and other blood-borne diseases. The research was designed as an ethnography of masculinity, conducted via participant observation, life history interviews, ritual analysis, and critical reflection on the work of early ethnographers. The paper presents selected field data, examined in the light of early twentieth century anthropological description of Pitjantjatjara sexuality. It identifies a systematic deflection of male same-sex attraction away from possible resolution through sexual practices between men. Key components of this deflection are the ritual construction of a culturally distinctive masculinity, the inextricable linkage between masculinity rites and the system for arranging marriages, and the cultural coding of the penis during ritual. The paper concludes that although men may feel erotic attraction for each other, the gender and kinship systems of the Pitjantjatjara conspire to limit completely the possibilities for the physical, sexual expression of this attraction. The findings reported here add to our understanding of the cultural basis of heteronormativity. [ABSTRACT FROM AUTHOR]

This paper argues that the relationship between homophobia and HIV/AIDS is not as direct as is often assumed. This argument is pursued through an examination of the situation of gay men in Australia, a country where the HIV epidemic is largely confined to gay men, and Bangladesh, a country and culture where sex between men does not conform to categories of human sexuality privileged in Western theory. Both of these countries reveal something different about cultures of sex between men, which provides a counterpoint to the often compelling and usually pervasive accounts of HIV-related discrimination that are derived particularly from North America. The paper concludes with a plea that as efforts are geared up to fight the HIV pandemic in Asia and the Pacific, researchers, planners and practitioners become more critical of the conceptual tools they rely on in thinking about HIV/AIDS and human sexual activity, so that it is possible to mobilize (and do less damage to) local cultures of sexuality. [ABSTRACT FROM AUTHOR]

This paper brings into question conceptualizations of community, specifically those that have been termed 'communities of shared interest and circumstance'. To do this, it explores the ways that people with haemophilia and their families experience and constitute community. Drawing on empirical data from semi-structured interviews and participation in joint activities, this paper details and describes the nature of the Australian haemophilia community. In doing this it addresses the role that advances in medical technologies and blood borne viruses, such as HIV, play in the production and maintenance of this community. Findings suggest that the haemophilia community is one steeped in historical intrafamilial genealogies and a network of other families, interfamilial, that pre-existed HIV and other blood borne viruses. As such, it is a more complex community than the term 'communities of shared interest and circumstances' suggests and has the potential to provide much to public health partnerships, which respond to HIV and other blood borne viruses that infect and affect others. [ABSTRACT FROM AUTHOR]

Recent advances in treatment have improved the health of many people living with HIV/AIDS. The research described in this paper shows that the changing context of care is also impacting significantly on people who provide services. In this paper, we explore both perspectives by comparing recent service provider data with that derived from research involving people living with HIV/AIDS. We explore four themes: (1) hope and optimism; (2) changing context, roles and identities; (3) changing relationships; and (4) quality of life. Treatment advances and a new focus on living has altered the context of working with people living with HIV/AIDS and challenges health professionals to find new meanings and relationships within that context. Study findings have implications for the wider health care context and the changing roles and power balances within this arena. [ABSTRACT FROM AUTHOR]

Abortion decision making by rural villagers in Thailand must be understood within its broader economic, social and ideological context. Abortion laws are highly restrictive in Thailand, yet abortions remain common. This paper examines rural villagers' normative constructions of the act of abortion and the 'socially embedded morality' they bring to discussions about abortion. The paper is based upon seven focus group discussions with women and men and long-term ethnographic fieldwork in rural north-east Thailand. Vignettes based upon real stories of women stimulated detailed discussion in the focus groups of the circumstances under which abortion is acceptable. The paper first discusses the social construction of abortion in Thailand, definitions of abortion as Buddhist sin and ethnomedical categorizations of the foetus. Then it describes the major themes that emerged from focus group discussions and interviews on abortion decision making. The material conditions of women and men's lives, changing constructions of children and motherhood, and gender relations were all found to influence reproductive health decisions. Abortion is described through social idioms that allow villagers to reconcile the practice of abortion with acceptable social norms. [ABSTRACT FROM AUTHOR]

This paper describes the experiences of a hitherto invisible and possibly increasing population in England, namely young homeless lesbian, gay and bisexual people. It draws on preliminary findings from research into transitions for young lesbian, gay and bisexual people that took homelessness as one theoretically informed focus. The paper explores two main questions. Firstly, how far and in what ways does sexuality play a role in a housing crisis? Secondly, why have the experiences of young people who may be questioning their sexuality been neglected in service provision and in the mainstream literature on leaving home and homelessness? Qualitative and quantitative evidence is brought together to suggest that a sizeable proportion of young homeless people may be lesbian, gay and bisexual, and that issues of sexuality have had an important bearing on their circumstances. At a time when it may be easier than before for a person to come out at a younger age, the risks associated with constructing identity and lifestyles against the norm should not be underestimated. Accounts of sexuality that ignore wider material circumstances do so at their peril. [ABSTRACT FROM AUTHOR]

This paper presents an analysis of the 'meanings' of sexuality, reproduction and contraception among the men of a rural community in Central Mexico (Ocuituco). The study is based on 74 in-depth interviews conducted between 1988 and 1992 with women, men and key informants (physicians, midwives and teachers) of the community. Interview data was analysed from a qualitative and contextual perspective. Findings suggest that men from this community conceive of male sexuality as a natural force that is difficult to control. This belief makes them permanently suspicious about the fidelity of their wives and the paternity of their own children. It also accounts for the fact that contraceptive use is experienced with ambivalence, in as much as it holds the potential to relieve the economic burden of the family, which is deemed an advantage, but it also promotes the sexual freedom of the women, which is perceived as a risk. This paper concludes by showing the possibilities of generalizing research of this kind and its subsequent usefulness for the formulation of public policies on reproductive health. [ABSTRACT FROM AUTHOR]

Over the past four decades, two forms of lesbian community have come gradually into existence in Taiwan: the T-Po community which revolves around butch-femme distinctions, and the feminist lesbian community which advocates women's liberation through same-sex practises. This paper examines the ways in which each community has come into formation. It highlights how, via a process of 'domestic colonialism', the feminist lesbian community has appropriated many of the gender and sexual roles performed by the T-Po community so as to establish a global and progressive 'queer' identity. The paper end by exploring a number of issues that remain problematic in Taiwan's feminist lesbian discourse today. These include notions of social class and the relevance of concepts of globalization for an understanding of contemporary lesbian identities and practises. [ABSTRACT FROM AUTHOR]

This paper reflects on recent research on Thai discourses of gender and eroticism in order to problematize some of the universalist assumptions that have dominated discussion of the international proliferation of forms of erotic diversity. By mapping the proliferation of Thai gender/sex categories from the 1960s to the 1980s, the paper shows that Thai homoeroticisms are not converging towards Western models and points to the cultural limits of Foucauldian-modelled histories of sexuality. In particular, it demonstrates the inability of Foucauldian history of sexuality, and queer theoretical approaches drawing on Foucault, to account for shifts in Thai discourses in which gender and sexuality do not exist as distinct categories. Only when current feminist theories of gender and queer theories of sexuality are integrated so as to offer a unified account of the eroticization of gender, and the gendering of eroticism, will Western theoretical models be capable of mapping shifts in non-Western patterns of eroticism. [ABSTRACT FROM AUTHOR]

This paper offers a review of the ways in which the Thai print media presents images of transgendered and/or homosexual identities or what may be termed 'gendered/transgendered sexualities'. The author argues that the varied, and at times contradictory, images of gendered sexualities used by the print media can be understood as discursive devices in broader social debates within Thai society. The paper reviews three cases recently covered by the Thai print media: the emergence of lesbian/gay youth cultures (tom-dee, gay); the Rajaphat College ban on transgendered/gay students; and sex crime cases in which the defendant is labelled as 'Tuy' or a type of homosexual male. These three cases offered particular representations of gendered sexualities that can only properly be understood within the social-political context of modern day Thailand. In particular, they operate as a kind of Thai 'Orientalism', or cultural critique, which contrasts sharply with the ironic silence of the media towards high profile individuals who are well known to be transgender/homosexual. [ABSTRACT FROM AUTHOR]

Axel Mundigo has been a close working partner even though his intellectual trajectory is situated outside the feminist field. His paper, 'Reconceptualizing Men's Role in the post-Cairo Era', however, draws extensively on feminist conceptual tools. This is not a trivial observation. Studies on masculinity are not always inspired by feminist ideas. Consequently, for those of us working within feminism, Mundigo's endeavour is both flattering and engaging. The paper is like a mirror in which the winding road of contemporary feminist thinking is reflected, modified and, eventually, simplified. This mirror effect is what inspired my commentary. It has not been written as an exclusive dialogue with the author, but as a review and appraisal of our own (feminist) conceptualization. I will initially focus attention on the concepts and uses of 'patriarchy', 'gender', and 'power'. Later, I want to problematize notions of 'male responsibility' and 'male involvement'. [ABSTRACT FROM AUTHOR]

This paper focuses on the emergence of HIV seropositivity as a new identity, closely linked to male homosexuality, in Brazilian culture. Based on the author's personal experience as an AIDS activist, together with his ongoing research on homosexuality and HIV/AIDS, the article examines two distinct conceptions of seropositive identities that have emerged in the Brazilian HIV/AIDS movement. The first of these conceptions suggests that all people whose lives have been touched by HIV and AIDS can work together, based on principles of solidarity, in seeking to respond to the epidemic-whether or not they are themselves directly infected with HIV. The second, more specific conception, suggests that those infected by HIV share a number a range of common experiences that distinguish them from others, while at the same time recognizing the specificity of those who are homosexual men as opposed to heterosexual women or injecting drug users. The paper seeks to explore the ways in which these differing conceptions have taken shape as the basis for social action and activism around AIDS-related issues such as prevention, treatment and care. [ABSTRACT FROM AUTHOR]

This paper describes research into the meanings of virginity and sexual initiation in three contrasting areas in Mexico. Starting from an approach that considers sexuality as a 'historical invention', the paper begins by describing personal and theoretical context within which the study was designed and conducted. Data was collected by means of group and in-depth individual interviews. The material collected was analysed in three principal ways-in terms of narrative, metaphor and polyphony. Findings highlighted the existence of a range of sometimes contradictory social languages informing participants' perceptions and self understandings. These included those of the Church, of family planning and of local community knowledge. These languages and the discourses on which they drew, provide both meaning and a rationale for action. The degree of authority granted to these different and competing discourses varied according to participants' experience of urban culture, whether as residents or migrants, and with their formal education. Throughout the analysis, the researcher's gaze and its influence on the information elicited was analysed reflexively. The usefulness of this method for the study of sexual meanings is discussed, particularly in relation to the understanding of hybridity within contemporary sexual cultures 'A word is a bridge thrown between myself and another' Voloshinov (1929/1973). [ABSTRACT FROM AUTHOR]

This paper draws on ethnographic data collected from two low-income communities in Mumbai India to explore types of risk and intimacy associated with marital practices. A rapidly globalising India offers access to media, social networks and changing gender norms that create opportunities for young women. Concurrently, enduring patriarchal norms impact marriage and the development of intimacy. Young women whose parents decide on early arranged marriages face inequity and difficulties in establishing emotional and physical intimacy with their husbands. Some young women and their families delay an arranged marriage to ensure educational and/or career advancement, seeking a husband and family that will appreciate her independence. Young women in delayed arranged marriages are more prepared for marital relationships but may experience difficulties meeting family and career expectations and establishing intimacy. Young women who develop their own relationships that evolve into 'love' marriages can initially achieve high levels of intimacy, but the strains stemming from the loss of family support can later undermine the spousal relationship. Within and across these different marital types, there is also a great deal of fluidity and variation in young women's experiences as they adapt to globalised and patriarchal norms in urban India. [ABSTRACT FROM AUTHOR]

It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners' HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants' experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support. [ABSTRACT FROM AUTHOR]

Data from a six-year study of married women's sexual health in a low-income community in Mumbai indicated that almost half the sample of 1125 women reported that they had a negative view of sex with their husbands. Qualitative interviews and quantitative survey data identified several factors that contributed to this diminished interest including: a lack of foreplay, forced sex, the difficulty of achieving privacy in crowded dwellings, poor marital relationships and communication, a lack of facilities for post-sex ablution and a strong desire to avoid conception. Women's coping strategies to avoid husband's demands for sex included refusal based on poor health, the presence of family members in the home and non-verbal communication. Factors that contributed to a satisfactory or pleasurable sexual relationship included greater relational equity, willingness on the part of the husband to not have sex if it is not wanted, a more 'loving' (pyaar karna) approach, women able to initiate sex and greater communication about sexual and non-sexual issues. This paper examines the ecological, cultural, couple and individual dynamics of intimacy and sexual satisfaction as a basis for the development of effective interventions for risk reduction among married women. [ABSTRACT FROM AUTHOR]

This paper discusses motivations for the use of MDMA among young adults in intimate relationships living in resource poor environments, where structural constraints limit potential for economic mobility and impact upon interpersonal relations. Drawing from in-depth interviews with men and women in intimate relationships with one or more partners, we report the range of motivations for MDMA use and their association with indicators of relationship quality, specifically trust and romantic exclusivity. Findings demonstrate that both men and women use MDMA primarily for the purpose of sexual enjoyment. However, men report the use of MDMA for sexual enjoyment more often, while women more frequently report the use of MDMA to compensate for psychological or physical displeasure, particularly in relationships characterised by distrust. We discuss how these motivations to use MDMA are shaped by gender norms and larger contextual and socio-economic factors and conclude with a call for more relational and sexual counselling opportunities for urban young adults to avoid MDMA use for self-medication. [ABSTRACT FROM AUTHOR]

This paper explores the behaviours and meanings associated with intimacy and sexuality among older adults with diverse partners living in subsidised senior housing. It utilises survey and qualitative data from a mixed methods of ageing/HIV exposure to illustrate gendered views on sexual and intimate behaviours, and attitudes towards transactional/commercial sex. Data suggest that women were cautious about engaging in intimate relationships, while men sought them and the companionship they provided to address loneliness. Reasons for non-intimacy were age and health problems. Generally speaking, both men and women had positive attitudes towards sex. Men took risks by having multiple partners and using condoms irregularly; women believed they could avoid risks by taking time to get to know their partners, but never used condoms. Forty per cent of men who saw sex workers were not regular condom users. They traded risk of gossip, violence and infection for companionship with women seeking money and physical safety. Findings have implications for policies, counselling and interventions for older sexually active adults in institutional and residential settings. [ABSTRACT FROM AUTHOR]

Women are most exposed to sexual health risks within their marital relationships, primarily due to the sexually risky behaviours of their spouses. Studies show that expanding agency is critical for women to mitigate both physical and sexual health risks and is linked to increased psycho-social well-being and economic independence. Drawing on qualitative and quantitative primary data collected from a peri-urban community in Zambia, this paper explores how women exert agency in a community where few educational and economic opportunities and substantial food insecurity exacerbate women's risk for HIV within their marital relationships. It also examines how expressions of agency within marital unions can reduce HIV risk exposure and lead to socio-economic benefits. However, expressions of agency can also create physical, psycho-social and sexual health risks, particularly when spouses do not support independent decision-making and actions that women consider necessary to support the household and maintain intimacy. Findings highlight the importance of community involvement and addressing harmful socio-cultural norms to foster the realisation of women's agency. [ABSTRACT FROM AUTHOR]

The promise of egg freezing for women's fertility preservation entered feminist debate in connection with medical and commercial control over, and emancipation from, biological reproduction restrictions. In this paper we explore how women negotiate and make sense of the decision to freeze their eggs. Our analysis draws on semi-structured interviews with 16 women from the Midwest and East Coast regions of the USA who froze their eggs. Rather than freezing to balance career choices and 'have it all', the women in this cohort were largely 'freezing for love' and in the hope of having their 'own healthy baby'. This finding extends existing feminist scholarship and challenges bioethical concerns about egg freezing by drawing on the voices of women who freeze their eggs. By viewing egg freezing as neither exclusively liberation nor oppression or financial exploitation, this study casts egg freezing as an enactment of 'responsible' reproductive citizenship that 'anticipates coupledom' and reinforces the genetic relatedness of offspring. [ABSTRACT FROM AUTHOR]

This paper explores two key norms that underpin intimate partner violence in Rwanda: men’s roles as economic providers and decision-making authorities in the household. It describes the political, legal and socio-economic factors affecting these norms and how they create opportunities and barriers to ‘undoing’ restrictive gender norms. Findings are drawn from an evaluation of Inadshyikirwa, an intimate partner violence prevention programme operating in Rwanda. Across three intervention sectors, 24 focus groups were conducted with unmarried and married men and women residing in intervention communities. Thirty interviews with couples and nine interviews with opinion leaders were conducted before they completed programme training designed to shift gender norms underlying intimate partner violence. The data indicate a strong awareness of and accountability to Rwandan laws and policies supporting women’s economic empowerment and decision-making, alongside persisting traditional notions of men as household heads and primary breadwinners. Transgression of these norms could be accommodated in some circumstances, especially those involving economic necessity. The data also identified increasing recognition of the value of a more equitable partnership model. Findings highlight the importance of carefully assessing cracks in the existing gender order that can be exploited to support gender equality and non-violence. [ABSTRACT FROM AUTHOR]

This study explores the way in which some Chinese gay men negotiate dance performances in parks and other public spaces in an attempt to invent and experiment with 'possible selves'. In most circumstances, these same men conceal their sexual orientation for fear of stigma and discrimination, experiencing in the process something of a 'divided self'. Little attention has been given to understanding the way such individuals negotiate and construct same-sex experiences, especially through the negotiation of specific and restricted social interactions and performances. Based on participant observation with a group of dancers practising in a Chinese public park, this paper analyses how these men explore same-sex relations and lifestyles through the circumscribed performance of collective public dance. [ABSTRACT FROM AUTHOR]

When viewed over time, many gay men's relationships are not static, or firmly fixed to monogamy or non-monogamy. This paper uses in-depth interviews with 61 Australian gay men to explore how monogamy and non-monogamy are experienced over time, expectations of what constitutes the norms regarding gay men's relationships and how couples experience and practices change. Although some gay men may idealise monogamy, particularly at the beginning of a relationship, it is often experienced as temporary. Non-monogamy is often seen as a likely prospect for gay relationships owing to the social and cultural norms that operate in gay communities. These expected trajectories are reflected in practice - many relationships begin monogamously and then become non-monogamous over time. While the application of 'rules', experimentation and flexibility can facilitate change, couples may struggle to navigate new territory as their relationship structures shift. This is particularly the case when partners value monogamy and non-monogamy differently, or when one partner's values change. These findings shed light on how gay men approach change to the status of 'fidelity' within their relationships, and the tensions and opportunities that change can produce for couples. [ABSTRACT FROM AUTHOR]

There has been limited research on the experiences of men who have sex with men and transgender women in Timor-Leste. Previous research has suggested a phenomenon by which same-sex-attracted men and transgender women have sexual and intimate relationships with straight-identifying men or mane-forte. Transactional sex has also been reported to be common. This paper, which complements a larger national size estimation among key populations at risk of HIV, further investigates sexual and social identities and roles, including sexual practices, among men who have sex with men and transgender women in Timor-Leste. Fifteen interviews were conducted with a profile of participants from urban and rural settings. Using inductive thematic analysis, we found that gender identity played a significant role in sexual relationships, with mane-forte having power over their sexual partner(s). Transactional sex was also found to be customary. Some participants experienced stigma, discrimination, sexual coercion and violence, while others, such as mane-forte, did not. Our research suggests that gender identity and power are significant in sexual relationships between men who have sex with men and transgender women in Timor-Leste, have implications for HIV prevention efforts and may reflect gender norms within the broader community. [ABSTRACT FROM AUTHOR]

In most developed countries, competent patients have the legal right to refuse any medical treatment; Advance Care Planning mechanisms extend this right to non-competent patients. However, some groups, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people, risk their wishes not being respected if they lose capacity, more than others. Little is known about medical practitioners' knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. One scenario (the focus of this paper) asked which of four plausible substitute decision-makers, including a same-sex partner, had the legal authority to make such decisions. The overall response rate was 32% (867/2702). Less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. LGBTI people face multiple obstacles to having their end-of-life wishes respected. Where healthcare providers are also ignorant of the partner's legal right to make such decisions, the problem is compounded. Improved legal education for clinicians and promotion of educational resources for members of the LGBTI community is needed. [ABSTRACT FROM AUTHOR]

The birth control pill is one of the most popular forms of contraception in North America and has been a key player in women's rights activism for over 50 years. In this paper, I conduct a feminist deconstructive analysis of 12 biomedical texts on the birth control pill, published between 1965 and 2016. This study is situated amongst the feminist scholarship that challenges the representation of women's bodies in biomedicine. Findings suggest that clinical texts on the birth control pill continue to universalise women's lives and experiences, and essentialise them based on their reproductive capacities. One way the texts accomplish this is by making women absent or passive in the literature thereby losing concern for the diversity of their lives, interpretations and identities as more than reproductive beings. The consequence of such representations is that biomedical texts disseminate limited forms of knowledge, in particular concerning definitions of 'natural' and 'normal' behaviour, with important consequences for the embodied experiences of women. [ABSTRACT FROM AUTHOR]

The Cook Islands is one of several countries in the Pacific region that has high rates of teenage pregnancy and birth. While the social determinants of pregnancy and early motherhood are well established in the global context, little is known about how Cook Islands young women who become pregnant before age 20 make sense of their experiences. Drawing on individual interviews with a purposive sample of 10 young mothers, this paper examines the phenomenology of early pregnancy from their perspectives. Structural, cultural and individual factors emerged as salient themes in participants' accounts. Qualitative analysis revealed that nearly all the pregnancies were unplanned and every participant reacted negatively when she learned she was pregnant. While some participants wanted to terminate their pregnancies, lack of access to safe, legal and affordable abortion care limited their options. Ultimately, while nearly all participants wished they had been able to delay motherhood, they expressed happiness and pride about their new-found status as mothers. These findings allow for a fuller understanding of factors shaping young women's experiences of pregnancy in the Cook Islands, which have policy implications for reproductive health and rights. [ABSTRACT FROM AUTHOR]

Western discourses about young people and sexuality centre around the concept of risk. Anxieties have been fuelled by the increasing popularity of social media and practices such as 'sexting' and watching 'sexually explicit' materials online. Research has shown however that such risk discourses mainly serve to moralise about, pathologise and police particular behaviours and children. In order to counter such paternalism, researchers advocated a reconceptualisation of youth not as passive victims, but as active agents who actively negotiate sexual experiences and discourses. In this paper, which is based on ethnographic fieldwork among young people in The Netherlands, I argue that we need a reconceptualisation not only of youth, but also of their sexual practices, especially their online sexual practices. Mobilising an interdisciplinary interaction between critical socio-cultural studies of risk, feminist theory and adventure studies, I propose to reconceptualise these practices as 'adventures' rather than 'risky behaviour'. This opens up possibilities for a more reasoned analysis that acknowledges: (1) the distinction between risks and outcomes of an activity; (2) the constructive potential of risk; and (3) the subjective, dynamic character of risk and pleasure. [ABSTRACT FROM AUTHOR]

This paper draws on ethnographic, qualitative and survey data with transwomen in Puerto Rico to examine the social and political-economic context of lay injection with hormone and silicone - common practices within this community. We describe specific practices of hormone and silicone injection, the actors that govern them, the market for the sale and distribution of syringes and the networks of lay specialists who provide services to a population that is neglected by and largely excluded from biomedical settings. Our data derive from ethnographic observations, sociodemographic questionnaires, surveys and semi-structured interviews conducted with a diverse group of transwomen in metropolitan San Juan, Puerto Rico. Our analysis focuses on four overlapping social domains or processes that shape the practices of lay silicone and hormone injection among transwomen: (1) the circulation of gender transitioning technologies within local and global markets; (2) the tension between the social exclusion of transwomen and their resilient sub-cultural responses; (3) the cultural meanings that shape transwomen’s attitudes about injection; and (4) the perceived consequences of injection. We conclude with a discussion of the kinds of intervention and policy changes that would respond to the factors that most endanger transwomen’s health. [ABSTRACT FROM AUTHOR]

This paper details results of a study examining administrative case data from 2010-2015 from abortion funds serving the USA and the Republic of Ireland, Northern Ireland and the Isle of Man. Driven by the available data, the researchers compared organisational characteristics, patient characteristics, procedural costs, patient resources and the ratio between patient resources and procedural costs. Independent t-tests were conducted to assess whether differences in characteristics, costs or resources were significant. The number of patients serviced by abortion funds across the two datasets increased yearly from 2010-2015. While patients in the USA had more resources, on average, to contribute to their abortion procedure, Irish, Northern Irish and Manx patients had the resources to pay for a greater percentage of their costs, on average, which was mainly attributable to the differences in gestational age of those helped by the different abortion funds. Patients across all nations were similar in terms of their marital status, average age and number of existing children. Patients across these countries face expensive procedures and a lack of resources that are bridged in part by abortion fund assistance. [ABSTRACT FROM AUTHOR]

This paper explores barriers to consistent condom use among female sex workers in Jamaica in a qualitative study using grounded theory. Multiple perspectives were sought through 44 in-depth interviews conducted with female sex workers, clients, the partners of sex workers and facilitators of sex work. Poverty and lack of education or skills, severely limited support systems as well as childhood abuse served to push the majority of participants into sex work and created vulnerability to HIV and other STIs. Despite these constraints, women found ways to exercise agency, ensure condom use, adopt protective measures and gain economic advantage in various aspects of the Jamaican sex trade. Perceived relationship intimacy between sex workers and their clients and/or their main partners emerged as the main factor contributing to reduced risk perception and inconsistent condom use. Relationship intimacy, with associated trust and affirmation of self, is the most important factor influencing sexual decision-making with respect to lapse in condom use among female sex workers in Jamaica. Study findings provide important insights that can enhance individual psychosocial, interpersonal and community-based interventions as well as inform environmental, structural and policy interventions to reduce risk and vulnerability among female sex workers. [ABSTRACT FROM AUTHOR]

This paper investigates how masturbation, as one form of non-coital sexual practice, is interpreted and experienced by young married women in contemporary Vietnam. Data were collected through semi-structured interviews with 20 professional women aged 25-40 living in Hanoi. Thematic analysis suggests that by embracing the pursuit of pleasure and aspiring to achieve this goal, many women stake a claim for modernity by promoting the idea that they are no longer traditional in this particular domain of social life. However, wider social forces associated with traditional Vietnamese gender ideology and sexual values remain firmly rooted, impacting on their everyday lives as working wives and mothers, and stalling their pursuit of pleasure and thus 'wellbeing' in its fullest sense. Indeed, among participants in this study, sex was interpreted as being almost exclusively organised around penile-vaginal intercourse. Even when sex was conceptualised as involving more than penetration, penile-vaginal intercourse was still viewed as its most essential component, without which a sexual transaction could not be seen as complete. The normality of penetrative sex was sometimes coupled with the stigma and discrimination associated with other non-coital sexual practices, positioning women firmly within conventional discourses of naturalness and health in regard to sex. [ABSTRACT FROM AUTHOR]

There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the 'gay scene' on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic 'risk-environments' and 'littoral spaces' in which chemsex and risk behaviours are played out. [ABSTRACT FROM AUTHOR]

This paper provides longitudinal examination of women’s health and sexual risk trajectories in US exotic dance clubs, which represent an important commercial setting for the economic mainstreaming of sexual services and an important target for public health programmes. Between July 2014 and May 2015, two semi-structured interviews (at baseline and at three months) were conducted with 24 female exotic dancers who had recently started working in in Baltimore City, USA. Results from a constant comparative analysis point to the interrelationship between the structures of the club setting, including the social context, and women’s agentic practices concerning their sexual health. Study findings highlight the centrality of the interrelationship between individual- and structural-level experiences in influencing dancers’ risk behavior. Findings point to the need for interventions to empower women both individually and collectively so as to provide the foundation for longer-term structural change. [ABSTRACT FROM PUBLISHER]

Based on a multi-method study conducted with middle-class young people (aged 15–17) in three secondary schools in New Delhi, India, this paper focuses on heterosocial dynamics within school peer cultures as an important site of learning about gender and sexuality. Findings indicate that young people negotiate and adaptrakhi(brother-sister) relationships to form less strictly platonic heterosocial friendships, which leave open the possibility of romance. Students’ preferences for certain heterosocial relationships are considered within the context of wider cultural narratives. For example, students often rejectedrakhirelationships, tied to traditional, conservative values, in favour of heterosocial friendships associated with more modern and desirable social patterns. Moreover, students’ own definitions of acceptable heterosocial interactions within peer cultures suggest that they are adept at negotiating norms of gender segregation that are enforced in co-educational schools. In contrast to other formal and informal sources of sexual learning available to them, experiences and stories of romances circulating in schools seemed to offer students alternative, more positive ways of understanding teenage intimacy and sexuality. [ABSTRACT FROM PUBLISHER]

Each year large numbers of Western men travel to Thailand for sex tourism. Although many will use condoms during their sexual encounters, others will not, potentially exposing themselves to the risk of acquiring sexually transmitted infections, including HIV. Although sex tourism in Thailand has been well documented, the social drivers underpinning voluntary sexual risk-taking through the avoidance of condoms remain poorly understood. Engaging with R.W. Connell’s concept of hegemonic masculinity and drawing on data collected from 1237 online discussion board posts and 14 face-to-face interviews, this study considers the ways in which understandings and performances of masculinities may inform the sexual risk-taking behaviours of Western male sex tourists. It argues that for some of these men, unprotected sex is viewed not as a reckless behaviour but, instead, as a safe and appropriate masculine practice, supported by relationships that are often framed as romantic and within a setting where HIV is still largely considered a homosexual disease. With sex workers often disempowered to request safer sexual practices, and some men’s attitudes towards unprotected sex resistant to external health promotion advice, the paper concludes by considering what this might mean for policy and practice. [ABSTRACT FROM PUBLISHER]

Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme:ku ti hlayisa(to take care of yourself). For older adults, ‘taking care’ in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one’s HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings. [ABSTRACT FROM PUBLISHER]

Understandings of violence, and especially sexual violence against children, must be situated within the local context. The 2009 Violence against Children Survey in Zanzibar indicated that 6% of girls and 9% of boys reported having experienced sexual violence before the age of 18 years. This paper reports on an in-depth qualitative study conducted in Zanzibar to provide further insights to these findings by examining the circumstances for sexual and other violence against children in Zanzibar. Twenty-four in-depth interviews with young people and 18 focus-group discussions with young people and adults were conducted in rural and urban Zanzibar. A further 8 interviews were conducted with parents and key stakeholders in government and NGO offices that provide services for children. The findings revealed that religious and cultural practices, which form the foundation of Swahili culture in Zanzibar, provide a moral frame for childhood development, but structural factors make children vulnerable to sexual violence. Both boys and girls are vulnerable to sexual violence in the home, neighbourhood, at school and, in particular, atmadrasaor Qur’anic schools. As religion and culture are strong influences on childhood, preventing sexual violence atmadrasaschools would strengthen the positive aspects of religious teachings for ensuring a safe childhood. [ABSTRACT FROM PUBLISHER]

Hijra, the iconic figure of South Asian gender and sexual difference, comprise a publicly institutionalised subculture of male-bodied feminine-identified people. Although they have existed as a culturally recognised third gender for a very long time, it is only recently thathijrahave been legally recognised as a third gender in several South Asian countries. This paper focuses on the transformation of this long-running cultural category of third gender into a legal category of third gender in Bangladesh, showing that the process of legal recognition has necessitated a simultaneous mobilisation of a discourse of disability in the constitution ofhijraas citizens worthy of rights. While the international community views the recognition of a third gender as a progressive socio-legal advance in the obtaining of sexual rights in a Muslim majority Bangladesh, locally,hijraare understood as a special group of people born with ‘missing’ or ambiguous genitals delinked from desire. Furthermore, what was previously a trope of disfigurement based on putative genital status has now been transformed into a discourse of disability, a corollary to which several interest groups, namely the civil society, the state, international community andhijrathemselves, have all been party. [ABSTRACT FROM PUBLISHER]

This paper explores two key norms that underpin intimate partner violence in Rwanda: men's roles as economic providers and decision-making authorities in the household. It describes the political, legal and socio-economic factors affecting these norms and how they create opportunities and barriers to 'undoing' restrictive gender norms. Findings are drawn from an evaluation of Inadshyikirwa, an intimate partner violence prevention programme operating in Rwanda. Across three intervention sectors, 24 focus groups were conducted with unmarried and married men and women residing in intervention communities. Thirty interviews with couples and nine interviews with opinion leaders were conducted before they completed programme training designed to shift gender norms underlying intimate partner violence. The data indicate a strong awareness of and accountability to Rwandan laws and policies supporting women's economic empowerment and decision-making, alongside persisting traditional notions of men as household heads and primary breadwinners. Transgression of these norms could be accommodated in some circumstances, especially those involving economic necessity. The data also identified increasing recognition of the value of a more equitable partnership model. Findings highlight the importance of carefully assessing cracks in the existing gender order that can be exploited to support gender equality and non-violence. [ABSTRACT FROM AUTHOR]

Research has shown that the gender transition of one partner in a relationship can have a significant impact on the non-transitioning partner. This paper explores the experiences of former and current cisgender partners of people making a gender transition. Six participants were recruited via snowball sampling and took part in semi-structured interviews, which were transcribed and analysed using interpretative phenomenological analysis. Three superordinate themes were identified, namely: (1) the shared and ongoing process of learning about a partner’s transgender identity; (2) changes in relationships; and (3) impact on self and identity. Findings highlight the constructed nature of gender and sexual identities, and the fluidity with which partners experienced these aspects of their lives. Future research could usefully explore the support needs of partners of transitioning people and the best ways to access and distribute this support. [ABSTRACT FROM PUBLISHER]

The idea of community evokes a sense of belonging and connectedness with others. Community life can, however, be troublesome for those who are part of a community that rejects their sexual identity. This paper presents findings from a phenomenological study that involved in-depth interviews with 23 same-sex-attracted Mormon women. Themes emerged around community experience, including sub-themes related to influence of congregations and geographic location. In addition, themes of loss of community and the rebuilding of community were explored. Findings indicate the need to build safe community spaces in which women can safely integrate their religious and their sexual identities. [ABSTRACT FROM PUBLISHER]

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women’s experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women. [ABSTRACT FROM PUBLISHER]