Search

For a few weeks in 2009 it was not certain whether the world faced a lethal influenza pandemic. As it turned out, the H1N1 pandemic was less severe than anticipated, though the infection did affect groups not usually susceptible to influenza. The deep uncertainties of this pandemic moment were associated with immense practical, scientific and political challenges for public health agencies around the world. We examine these challenges by drawing on the sociology of uncertainty to analyse the accounts given by UK public health practitioners who managed local responses to the pandemic. We discuss the retrospective and mitigating discourse; ‘we had to do what we thought was right at the time’, used by interviewees to explain their experience of articulating plans for a severe pandemic influenza with one that turned out to be mild. We explore the importance of influenza's history and imagined future for pandemic management and, relatedly, how pandemic response and control plans disrupted the normal ways in which public health exercises its authority. We conclude by suggesting that difficulties in the management of pandemic influenza lie in its particular articulation of precautions, that is, securing a safe future against that which cannot be predicted.

Rates of HIV testing are increasing among men who have sex with men (MSM) in Scotland and the UK. However, it remains vital to encourage MSM to test for HIV. The aim of the current study was to determine which factors discriminated among three groups of MSM: those tested for HIV within the previous year, those who had tested over one year previously, and those who had never tested. Cross-sectional data were collected using self-report, anonymous questionnaires from MSM frequenting gay venues in Glasgow, Scotland, during July 2010 (N = 822, response rate 62.6%). Those who identified themselves as HIV positive (n = 38), did not normally reside in Scotland (n = 88), and did not provide information on HIV testing (n = 13), were excluded (139 excluded, leaving N = 683). Around 57% (n = 391) had tested for HIV within the previous year, 23% (n = 155) had tested over one year previously and 20% (n = 137) had never tested. Compared with those tested within the previous year, those tested over one year previously and those never tested had greater fear of a positive-HIV test result, a weaker norm for HIV testing, and were more likely to have had no anal sex partners at all within the previous year. Those tested over one year previously were significantly older than both other groups (who were more likely to be under 25 years of age). Unprotected anal intercourse (UAI) did not discriminate among the HIV testing groups. The results highlight the need to promote HIV testing in Scotland among those under 25 years and over 45 years, those with high fear of testing, and those whose sexual behaviour puts them at risk. Interventions to increase HIV testing should promote positive norms and challenge the fear of a positive result.

This study presents a qualitative investigation into the effects of enforced occupational change on a professional musical identity. Interpretative Phenomenological Analysis (IPA) is used to explore the meaning of redundancy for six professional opera choristers. The paper highlights aspects of career disruption that are unique to singers who make their living using a biologically embedded instrument. Findings show the ‘opera singer’ identity to be a professional identity which consists of several subjective sub-identities. Adaptation to change is dependent on the salience given to these subjective identities. It is suggested that if more attention is given to these subjective sub-identities during a professional career, musicians may be better prepared for unexpected disruption to an established career pattern.

Background Condom use problems are common amongst Scotland’s men who have sex with men (MSM). To date condom errors have been associated with the likelihood of sexually transmitted infections in heterosexual sexually transmitted infection (STI) clinic attendees but not in MSM and direct evidence of a link between condom problems and STI acquisition in MSM have been lacking. This study investigated the possibility of an independent association between condom proficiency, condom problems and STI acquisition in MSM in Scotland. Methods An exploratory observational design employed cross-sectional surveys in both STI clinic and community settings. Respondents completed self-report measures of socio-demographic variables, scales of condom proficiency and condom problems and numbers of different partners with whom men have had unprotected anal intercourse (UAI partners) in the preceding year. Self-report data was corroborated with clinical STI diagnosis where possible. Analysis included chi-squared and Mann–Whitney tests and multiple logistic regression. Results 792 respondents provided data with an overall response rate of 70% (n = 459 clinic sample, n = 333 community sample). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months (p Conclusions This exploratory study highlights the potential importance of targeted condom use skills interventions amongst MSM. It demands further research examining the utility of condom problem measures in wider populations, across prospective and experimental research designs, and a programme of research exploring their feasibility as a tool determining candidacy for brief interventions.

This study presents an interpretative phenomenological analysis of the experiential accounts of HIV-positive gay men. Participants took part in open-ended interviews. Three key-related recurrent themes are presented: ‘Disclosure, deliberation and the abject other’; ‘Disclosure, care and the valued other’ and ‘Disclosure and intimate citizenship’. These highlight the complex, situated and mindful ways in which disclosure occurs. They stand in contrast to the understandings of HIV status disclosure as a ‘health behaviour’ deracinated from its social, relational and emotional dimensions. We explore the findings in relation to contemporary HIV prevention (with its increasing biomedical slant) and in relation to a biopsychosocial framework.

Purpose of the research To explore the lived experience of multiple concurrent symptoms in people with advanced lung cancer to contribute to the understanding of the experience of symptom clusters. Methods and sample Purposive sampling recruited ten people with advanced lung cancer who were experiencing three or more concurrent symptoms, were at least 18 years of age and were able to provide written informed consent. The participants took part in two consecutive, in-depth interviews, 3–5 weeks apart. Interpretative Phenomenological Analysis was used to analyse the data. Findings Participants experienced 4–11 concurrent symptoms with fatigue, cough, pain and breathlessness featuring prominently in their interviews. The participants commonly identified associations between the symptoms that they experienced, with the occurrence of one symptom often used to explain the occurrence of another. Reductions in physical and social functioning were often associated with the experience of multiple concurrent symptoms, particularly at times of high symptom severity. The participants' highlighted breathlessness and cough as being of particular salience, due to the association of these symptoms with fear of death and visibility and embarrassment in public. Conclusions People with lung cancer experience multiple concurrent symptoms and perceive relationships between the symptoms experienced. Within the experience of multiple symptoms, people with lung cancer highlight individual symptoms that are of particular importance, based on their concomitant meanings. Such findings provide vital information for the future development of meaning-based symptom cluster interventions.

Objectives This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. Methods Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. Results Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = –8.46; P

This chapter presents a review of the current literature addressing the therapeutic use of music among those affected by: chronic illness, cancer, and cardiac disease. It includes a systematic analysis of each of these areas, highlighting music listening (both music therapy and other types of music listening) as the most prevalent type of music activity reported. Results suggest beneficial effects of music listening upon a range of physiological (e.g., blood pressure, heart rate, enzyme production, respiration) and psychological variables (e.g., anxiety, mood, relaxation, pain). Theoretical integration and synthesis is then explored, with three mechanisms presented as possible explanations for the positive effects of music listening: musical communication as a form of social support; emotional engagement with music; and increased levels of perceived control.

This article outlines the importance of conceptualizing ‘sexual health’ as a pluralistic and context-bound phenomenon. It explores gay men's sexual decision making in the particular context of public parks. Twenty gay men from Glasgow, Scotland, took part in semi-structured, in-depth interviews. Interpretative Phenomenological Analysis (IPA) was employed to analyse transcripts for recurrent themes—these represent shared understandings across participants. Risk reduction, danger and safety figured frequently in men's accounts of sex and sexual decision making. However, the risks men reported related more directly to the threat of attack or arrest rather than the avoidance of sexually transmitted infections. Indeed, danger itself was occasionally something to be sought and enjoyed. Given these findings, we discuss the appropriateness of traditional health psychological approaches to understanding sexual health. It is hoped that this approach can highlight some issues that a true psychology of sexual health must address in order to represent sexual decision making more accurately and to be useful with respect to both service provision and theoretical development.

Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses.This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews.Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews.Our analysis focuses upon the participants' struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation.In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.

Organisations are increasingly adopting Web2.0 technologies such as web-based communities, social networking sites, wikis and blogs to enable users to interact, share information and alter web-based content. In a business/ commercial context, the use of such technologies has been termed Enterprise2.0. This paper explores organisational actors’ experiences of this new technology and how the shift to Enterprise2.0 is shaping how people work and organise. We present an in-depth case study of a large multinational telecommunications company that is commonly regarded as one of the leading proponents of Enterprise2.0. Data were collected from three business units each exhibiting different characteristics in terms of the level of Enterprise2.0 experience and employee participation in decision-making. Our findings show that while Enterprise2.0 is claimed to be “social”, “open” and “participative” and has the potential to deliver significant business benefits, the experiences of organisational actors suggest that their expectations regarding Enterprise2.0 use were not met. Paradoxically, employee participation was limited and the monitoring and moderation of certain discussions, together with political use of the technology by leaders, meant that the use of Enterprise2.0 was often thought of as no more “social”, “open” or “participative” than more traditional methods of communication. These results are discussed within the framework of previous research on the management of the introduction of new technology and its use and exploitation within organisations.

International audience; HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland) Objective: To examine changes in the proportions of those reporting 2+ unprotected anal intercourse (UAI) partners in the previous 12 months among men who have sex with men (MSM) in Scotland between 1996 and 2008. Differences according to age group were also examined. Methods: Logistic regression was used, with data from eight cross-sectional anonymous, self-report surveys in commercial gay venues in Glasgow and Edinburgh (N=10,223). Data were stratified according to survey and age group (

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could 'invest' more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.

In the West the normalisation of HIV has crystallised a singular, dominant, medical construction of HIV infection. Of course medical constructions of HIV have always been present and central to understanding HIV, yet recently, in conjunction with the advent of antiretroviral therapy (ART), they have become far more salient. This chapter, with an exploration of the experiences of people living with HIV in the UK, seeks to refocus the reader upon a range of psychosocial issues which can sometimes be overlooked, or overshadowed, when faced with the brightness and clarity of the biomedical narrative of HIV. Through drawing on a range of positive people’s experiences the chapter tentatively explores how processes of HIV normalisation rely upon the medicalisation of HIV and a concomitant process of the minimisation of psychosocial issues. In the global context of difficulties accessing treatments and care, these psychosocial concerns may indeed appear minor, yet sometimes, and often in surprising ways, the biomedical depends upon the psychosocial to function.

Patient choice is nothing new (1) but it is a motif that is increasingly mobilised by politicians, policy-makers, and health service providers across much of the Western world. Despite its global resonance, we want to make the case for considering the complexity of the contexts in which patient choice is offered. In this paper, we consider research in relation to the domain of localised prostate cancer in the UK, specifically to choosing treatment after first diagnosis. Before making some recommendations for research, the UK context is elaborated through a consideration of health policy, which is then related to changes in a specific service (the Yorkshire Cancer Centre) and research on patients’ experiences of treatment.

Resurgent HIV and sexually transmitted infection incidence among men who have sex with men (MSM) requires an urgent re-examination of sexual transmission sites. To these ends, we systematically review qualitative literature concerning men's sexual behaviors within public sex environments (PSEs). Sex, therein, is negotiated by the highly codified, largely nonverbal practice of “cruising.” A generic, shared PSE sexual culture emerges from the literature—across locations, countries, and decades—because of the importance of concealment and common structural constraints on sexual encounters in PSEs. However, differences in local geography and facilities may transform key features of this, resulting in specific, local sexual cultures emerging for each locale. We argue that, although sexual cultures developed to minimize nonsexual cruising risks, they may be exploited to improve contemporary in situ outreach work.

This study aimed to investigate the effects of preferred music listening on anxiety and pain perception in patients undergoing haemodialysis. A two group experimental design was used. Sixty people diagnosed with end stage renal failure undergoing haemodialysis treatment participated in this study. Preferred music listening was applied as an intervention. Anxiety and pain were measured pre-test and post-test. The control group scored significantly higher in state anxiety than the experimental group and experienced significantly higher pain intensity in post-test phase. Findings provide experimental evidence to support the effectiveness of preferred music listening in medical settings.

Notifying patients of the results of syphilis testing by telephone can be cost-effective for clinic staff. This study compared the acceptability ratings among potential patients of three methods of learning of syphilis test results: with a call to a mobile phone; with a call to a home phone; and with the patient phoning in for results. A questionnaire was distributed to male clients of gay venues in Glasgow, Scotland, during 2005 ( n = 150). Phoning in for results was rated as significantly more acceptable than either learning of results with a call to a mobile phone, or receiving a phone call at home (both P < 0.001). Further, receiving a call on a mobile phone was rated as significantly more acceptable than receiving a call at home ( P < 0.001). It is recommended that patients be given the option of initiating the communication of test results.

Narratives of homophobia and the repathologization of gay men now emerge and coalesce in often unconsidered ways. Within this paper, we present a deconstructive analysis of a recent paper published within the British Journal of Social Psychology (Crossley, 2004) and highlight how a narrative of repathology emerges through the selective appropriation of particular textual sources. By employing pathological constructions of sexual conduct between men; focusing upon singular homogenized constructions of gay men and simplistic constructions of health promotion and through a process of reconstructing HIV as a gay plague and it is possible to embroider a moral tale which constitutes a further deviant ‘othering’ of gay men. We contend that by employing (functional) discourses of ‘unconscious motivation’, together with a constellation of disclaimers, caveats and tokenistic pluralization, it becomes possible for psychologists to engage in homophobic knowledge production whilst maintaining an identity as a (dis)interested professional. Our analysis raises issues pertinent to all social psychologists engaged in ‘suspicious’ research on ‘the other’. To this end, we expand our critique by employing ideas from Ricoeur's hermeneutic phenomenology to provide more general discussion of ethical and constructive ways of engaging in textual analyses of persons outside one's own tradition.

Introduction Health literacy is an important determinant of health yet has not been formally applied to sexual health. An expert event brought 38 researchers, community members, and service providers together to explore gay men’s sexual health literacy (SHL). Methods Using a World Cafe method, three rounds of discussion posed questions about SHL in relation to gay men, providers, and underlying systems. Documented notes were analysed thematically through two rounds of group synthesis and a subsequent review by one investigator. Results SHL was influenced by ways men access information, through peer networks, and coded communications with prospective partners. The Internet influences access to, delivery of and engagement with information, while new technologies and changing sexual norms complicate message consistency and risk assessment. Actionable risk assessment requires numeracy skills. Gay men were generally perceived to have high SHL with concern that SHL may be lower for some sub-populations (e.g., youth, immigrant men). Participants valued bottom-up/community-based over top-down/expert models of providing SHL. Health care provider attitudes, cultural competency, knowledge and communication skills were seen as key determinants of SHL and non-traditional health sectors also play key roles (e.g., education, pornography). Underlying determinants of SHL included stigma related to HIV or sexual orientation, access and organisation of health care services, systemic shifts to self-care models, political ideologies and funding. Syndemic, intersectional, and holistic health approaches to SHL were advocated. Participants recognised the strong history of activism and mobilisation within gay communities as integral to SHL. Conclusion Critical health literacy has been a core component of the gay men’s health movement to date. Innovations in biomedical technologies and access to online information are critically shaping experiences of SHL for gay men. The expanded theoretical framework emerging from these findings serves as a starting point to inform enhancing SHL and designing effective interventions. Disclosure of interest statement The authors have no conflict of interest to disclose.

Background Health literacy is a priority for health policy. However, there is limited research on how health literacy influences sexual health, particularly among men who have sex with men (MSM). Aim To review sexual health literacy research among MSM in high-resource countries (UK, Canada, USA, Australia). Methods We searched relevant databases (MEDLINE, Embase, Health and Psychosocial Instruments, Web of Science) to identify research which examined sexual health literacy and MSM explicitly and implicitly (using formal and informal articulations of health literacy) along with a set of sexual health and MSM terms. Relevant articles were identified, coded and assessed to illustrate the range of evidence available. Results We found no studies explicitly focusing on sexual health literacy, and three exploring health literacy. Findings highlight the need for tailored information, healthcare and promotion for different groups of MSM, variable health literacy levels, and the importance of social context. We found 611 articles that implicitly explored sexual health literacy. We analysed a sub-sample which focused on interactive health literacy (negotiating, applying knowledge and interaction). There was a strong focus on communication and negotiation (verbal, non-verbal and online) with sexual partners and health providers, and the varying contexts within which these interactions take place. Discussion We found no research on explicit sexual health literacy with MSM. Clinic-based interventions could use health literacy as a tool to improve sexual health. Findings suggest that tailored health information, communication skills, and the role of social context in shaping sexual health literacy skills could play a critical role.

Background/introduction While sexual activity, including partner change, is known to continue throughout the life course, there is a paucity of qualitative evidence on how adults over 45 years engage with risk for sexually transmitted infections (STIs), limiting the scope for effective health promotion among this age group. Aims/objectives The research aimed to explore older adults’ sexual risk-taking behaviour within the context of sexuality in later life. Methods A qualitative in-depth study involving 31 interviews with middle aged heterosexual men and women aged 45 to 65, recruited from sexual health clinic and community settings. Results Vulnerability to STI risk emerged around key life course transitions, including following divorce, separation and bereavement. Some spoke enthusiastically of embracing sexual freedom and pleasure within a perceived changed culture, resulting in frequent partner change; however, many found themselves ‘re-engaging’ with their sexual careers within an unfamiliar gendered landscape. Lacking an (ageing) body confidence led to the prioritisation of intimacy over STI risk; condoms were viewed as being for birth control and therefore mostly unnecessary, or linked with casual sex and lack of trust. STIs were commonly considered to be a young person’s concern. Discussion/conclusions Information provision alone will not be enough to counter the complexities of navigating the dramatically different sexual landscape these older adults find themselves within compared to their youth, particularly those who have emerged from long-term relationships. A separately focussed approach to STI prevention taking account of life course experience, ageing and cultural change is advocated.

Background: This paper explores the role of contact efficacy in evidence-based health promotion by evaluating a public sex environment (PSE) based sexual health outreach program. The service operated in situ from a dedicated mobile unit to promote sexual health among PSE users. Methods: A cross-sectional survey (response rate 56%) measured socio-demographics, sexual health behaviours and outreach-service use among men sampled within the PSE (n = 216). Results: Most participants were aware of the service and two-thirds had contacted them. Men who had not completed hepatitis A vaccination (odds ratio (OR) = 2.02), who had ever received money for sex (OR = 2.07) or who reported a diagnosed mental health disorder(s) (OR = 2.38) were significantly more likely to have contacted the service. Although 89% of service users perceived the intervention positively, only 26% felt it had contributed to sexual behaviour changes. Conclusions: The ‘mobile-unit’ outreach model contacted a large proportion of PSE users, specifically men who had greater health needs. We advocate the adoption of this outreach model over traditional PSE-based outreach approaches. Contact efficacy evaluation is useful to assess ongoing health interventions. However, caution must be exerted when interpreting certain contact efficacy results. Since causality may not always be inferred, triangulation with other evaluative methodologies is recommended.

Highly Active Anti-Retroviral Treatment (HAART) has reduced death and morbidity among people with HIV. However, HAART is not always effective, can produce serious side-effects and implies uncertainty for patients. To address HAART-related uncertainty, 20 qualitative interviews were conducted with gay men with HIV in Glasgow and London. The interviewees were purposively selected to reflect diversity in terms of year of diagnosis, experiences of illness and treatment-related side-effects. The interviews were analysed using the constant comparison method to derive themes. Among those using HAART, analysis identified themes of ‘good health’, ‘illness’ and ‘loss of confidence’. Uncertainty was managed through a discourse of ‘technological horizon’ that combined the ongoing innovations of HAART and biographical time. These themes are discussed in terms of the implications for HIV care. In particular, technological horizon provides a basis for the management of uncertainty in the prescribing relationship between patient and clinician

This paper describes sexual risk behaviours and HIV testing amongst men who cruise an urban public sex environment (PSE) in southern England. Data were collated using a cross-sectional survey (response rate = 56%; n=216), sampling men from directly within the PSE. As such, this represents the first peer-review study generalizable to the wider population of urban PSE users. The current sample reflect a highly sexually active population, almost one-third (31%) reported over 50 sex partners in the last year. However, just one-quarter (26%) reported unprotected anal intercourse (UAI) with at least one partner outside of a 'safer sexual strategy'. Almost 1 in 12 (7%) reported UAI within the PSE. Over two-thirds (71%) had had a named HIV test of whom 16% had tested HIV positive. Just one-third (34%) of negative/untested PSE users had tested within the previous two years. Positive men were significantly more likely to report unsafe sex within the PSE in the last year. PSE users report lower levels of UAI than men in the local gay community but higher HIV prevalence. PSE-based UAI remains an HIV (re)infection risk. In concert, these findings suggest the importance of in situ targeted health promotion to prevent PSE-based risks.

This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral combination therapies and associated tests from the perspective of their prescribers. The prescribers were interviewed during the later part of 2002 at three London HIV clinics. Their comments, considered in light of other recent studies in the field, suggest that current therapies are part of a transitional phase in the epidemic which informs the identification and negotiation of known risks and uncertainty. An undetermined but extended life expectancy, afforded by anti-retroviral therapies, is understood against risk of iatrogenic diseases and/or viral drug resistance. The tension arising in this situation of unwanted and even uncertain phenomena poses ethical dilemmas and affects doctor/patient relations. Indeed, it also contributes to a reconfiguring of the lived experience of managing HIV. While the new technologies have offered considerable advances in the medical management of HIV, they are altering the nature of HIV medicine both materially and socially. The scenario is further complicated by the uneven allocation of resources and different patient health and disease states. The heterogeneity of resources, disease states and technological effects points to the need for ongoing and extended evaluation as the relationship between these and the everyday practice of medicine continues to change.

Objective: To assess the impact of a peer education intervention, based in the "gay" bars of Glasgow, which sought to reduce sexual risk behaviours for HIV infection and increase use of a dedicated homosexual men's sexual health service, and in particular increase the uptake of hepatitis B vaccination. Design: Self completed questionnaires administered to men who have sex with men (MSM) in Glasgow's gay bars. Subjects: 1442 men completed questionnaires in January 1999, 7 months after the end of the 9 month sexual health intervention. Main outcome measures: Self reported contact with the peer education intervention, reported behaviour change, and reported sexual health service use. Results: The Gay Men's Task Force (GMTF) symbol was recognised by 42% of the men surveyed. Among men who reported speaking with peer educators 49% reported thinking about their sexual behaviour and 26% reported changing their sexual behaviour. Logistic regressions demonstrated higher levels of HIV testing, hepatitis B vaccination, and use of sexual health services among men who reported contact with the intervention. These men were more likely to have used the homosexual specific sexual health service. Peer education dose effects were suggested, with the likelihood of HIV testing, hepatitis B vaccination, and use of sexual health services being greater among men who reported talking to peer educators more than once. Conclusion: The intervention had a direct impact on Glasgow's homosexual men and reached men of all ages and social classes. Higher levels of sexual health service use and uptake of specific services among men who had contact with the intervention are suggestive of an intervention effect. Peer education, as a form of health outreach, appears to be an effective intervention tool in terms of the uptake of sexual health services, but is less effective in achieving actual sexual behaviour change among homosexual men. Key Words: homosexual men; peer education; sexual behaviour; sexual health service use

Background: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. Methods: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. Results: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. Conclusions: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant hearth promotion amongst homosexual men in the UK.

OBJECTIVE: To date, the epidemic of HIV infection in Scotland has been primarily associated with injecting drug use. However, the epidemiology of HIV in Scotland changed in the late 1980s, with homosexual men becoming the largest group at risk of HIV infection and AIDS. Our aim was to describe homosexual men's sexual risk behaviours for HIV infection in a sample of men in Scotland's two largest cities. DESIGN/SETTING: Trained sessional research staff administered a short self completed questionnaire, to homosexual men present in all of Glasgow's and Edinburgh's "gay bars," during a 1 month period. SUBJECTS: A total of 2276 homosexual men participated, with a response rate of 78.5%. Of these, 1245 were contacted in Glasgow and 1031 in Edinburgh. MAIN OUTCOME MEASURES: Sociodemographic data, recent (past year) sexual behaviour, information on last occasion of anal intercourse with and without condoms, and sexual health service use. RESULTS: Anal intercourse is a common behaviour; 75% of men have had anal intercourse in the past year. A third of our sample report anal intercourse with one partner in the past year, but 42% have had anal intercourse with multiple partners. Over two thirds of the total population have not had any unprotected anal intercourse (UAI) in the past year and a quarter of the sample have had UAI with one partner only. 8% report UAI with two or more partners. More men in Edinburgh (17% v 10%) reported unprotected sex with casual partners only, but more men in Glasgow (29% v 20%) reported UAI with both casual and regular partners (chi 2 = 12.183 p < 0.02). Multiple logistical regression found that odds of UAI are 30% lower for men with degree level education and 40% lower for men who claim to know their own HIV status, whereas they are 40% higher for those who have been tested for HIV and 48% higher for infrequent visitors to the "gay scene". Men who have had an STI in the past year are 2.4 times more likely to report UAI than those who have not. Men with a regular partner were significantly more likely to report UAI, as were those who had known their partner for longer, and who claimed to know their partner's antibody status. CONCLUSION: On the basis of current sexual risk taking, the epidemic of HIV among homosexual men in Scotland will continue in future years. The data reported here will prove useful both for surveillance of sexual risk taking, and the effectiveness of Scotland-wide and UK-wide HIV prevention efforts among homosexual men.

The UK and USA guidelines recommend at least annual HIV testing for men who have sex with men (MSM), with more frequent testing for those at risk. Although measures of risk and regularity of HIV testing are essential for evaluating interventions, these are not yet standardised across the UK.1 Risk criteria could include recent unprotected anal intercourse (UAI), a high number of partners, unknown partners and recent sexually transmitted infection (STI).2 From self-report data collected in Glasgow with a bar-based sample (excluding non-Scottish …

Background The effectiveness of condoms in preventing sexually transmitted infections (STI) including HIV depends on consistent and correct use. Aims To examine associations between demographics, STI risk, condom proficiency, condom problems and STI acquisition among MSM and to direct discussion and debate towards thinking about how and why it might be important to improve condom use skills. Methods Cross-sectional surveys of MSM were conducted in GUM clinics and commercial gay venues in Summer 2010. The self-completed, anonymous questionnaires recorded data on socio-demographic variables, numbers of unprotected anal intercourse (UAI) partners in the preceding year, STIs diagnosed over the previous year and self-reported condom problems and condom proficiency. Results 792 respondents provided data with an overall response rate of 70% (n=459 clinic sample, n=333 community). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months. Demographic characteristics were not associated with self-reported STI diagnosis. However, condom proficiency score was associated with self-reported STI acquisition in the previous 12 months. Condom problem score was also associated with self-reported STI diagnosis in the clinic but not community sample. Condom problem score remained associated with STI diagnosis after adjusting for number of UAI partners with logistic regression. Discussion This study identified a measure of condom use associated with likelihood of STI diagnosis when controlling for number of UAI partners. Targeting those who experience condom problems may improve overall frequency and consistency of condom use among MSM; in turn reducing likelihood of STI acquisition. This could involve developing condom problem scales into screening tools for STI risk. Accordingly we encourage further research to determine the value of condom use training as a potential intervention to improve sexual health among MSM.

This chapter discusses the physiological properties of amines and amides. In its association with life, nitrogen forms three classes of compounds: (1) the amino acids, and their condensation products, the proteins, (2) the amines or nitrogen bases, and (3) the amides. Cyclic structures such as the pyrimidines, purines, pteridines, and imidazoles can be regarded as cyclic amine or amide types. Complex amines and onium compounds include the plant alkaloids and betaines and bacterial products, many of which have powerful physiological effects. Because of the diversity of biological and pharmacological interests, a comprehensive classification of the amines and onium compounds is not yet achieved. Prominent among mixed responses are the pressor effects: (1) vascular constriction, with accompanying rise in blood pressure, (2) increased force of cardiac contraction, (3) inhibition of the peristaltic movements of the intestine, (4) dilation of the pupil of the eye, and (5) contraction of the uterus. These pressor effects provide a basis for classification because they resemble some of the effects obtained when sympathetic nerves are stimulated.

This paper explores HIV risk‐related behaviour in the context of men's entry into the gay community. It is an exploratory study which employed a qualitative approach to describe men's accounts of the process of acculturation. Twenty in‐depth interviews were conducted with working‐class gay men from Barnsley, UK. These were translated and analysed, using interpretative phenomenological analysis, for recurrent themes which reflect the way gay men thought about HIV risk‐related behaviour, ‘coming out’ and their sexual debut. As men began to socialize with other gay men in their local community they had much to learn with regard to local gay culture, e.g. a distinct new vocabulary and local sexual mores. By virtue of their lack of experience and the personal impact of first sexual experiences, some men reported feelings of disempowerment with their initial sexual partners. Theoretical accounts relating to gay men's sexual health would benefit from a consideration of the way gay men report the process of acculturation. Sexual debut and the particular vulnerabilities of entry into the gay community highlight a temporal context in which affective experiences are privileged above considerations of sexual health.

Objectives. To explore the theoretical utility of current health psychology in understanding the occurrence of unprotected anal sex amongst gay men in relationships. Design. Interpretative Phenomenological Analysis was employed to highlight the utility of incorporating the perspective of gay men in addressing a theoretical understanding of sexual decision making. Methods. Twenty in‐depth interviews were conducted with working‐class gay men from a small South Yorkshire town. These were transcribed and analysed for recurrent themes which reflect the way gay men thought about sex and relationships. Results. There were many differences between the way gay men thought about sexual activity and the way health psychology assumes men think about it. Within the context of romantic relationships men often privileged the expression of commitment, trust and love as more important than their own health. Conclusions. Psychological theory relating to sexual health would benefit from a consideration of the way gay men report thinking about sexual behaviour in the context of romantic relationships. Such an informed theory would direct sexual health promotion beyond the simple provision of condoms.

This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups ( n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from ‘death sentence’ to ‘life sentence’. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.

This chapter addresses expertise and health technology via two case studies: the online pro-ana movement and transitions in the treatment of HIV. In different ways, each case study sheds light on the construction of patient/consumer expertise. Before presenting the two case studies, we first outline the notion of the ‘expert patient’ as it is depicted in recent policy frameworks and consider several critiques of the idea of patient expertise. We then consider how patient expertise is taken into forms of innovative health technology, in particular, Internet-based health care and rapid developments in the diagnosis and treatment of chronic illness. The case studies of the pro-ana movement and HIV that follow help deepen the analysis and we conclude the chapter with a summary that draws out some of the general perspectives on expertise identified in the cases.

Health and social care workers (HSCWs) have an essential role in the uptake of the COVID-19 vaccine. Vaccination is an emotionally charged issue and perceptions of risk associated with COVID19 can contribute towards vaccine hesitancy (VH). The aim of this study was to explore the role of emotion and risk perception associated with HSCWs' uptake of the COVID-19 vaccine during the initial mass roll-out of the vaccine in Scotland. A cross-sectional online survey with a correlational design was used. An online survey was conducted with HSCWs (N = 1189) aged 18 to 67 years (M = 44.09 yrs, SD = 11.48) working in Scotland during the third lockdown period (December 26th – March 31st 2021) of the COVID-19 pandemic. The survey collected data relating to sociodemographic characteristics, vaccine uptake and VH, emotions associated with the COVID-19 vaccine, and risk perception. Open-ended free text data were also collected on HSCWs’ main reasons for VH. Most participants (83.96%) felt positively about the roll-out of the COVID-19 vaccine, stating it would be beneficial for themselves and others to receive it. Nonetheless, 16.04% of HSCWs expressed VH. Occupational group, age, gender and risk perceptions did not affect variance in VH, but positive emotions associated with the COVID-19 vaccine and years of experience did. We emphasise the importance of future interventions to increase COVID-19 vaccine uptake by enhancing positive emotions and reducing ambivalent emotions associated with the COVID-19 vaccine particularly among less experienced HSCWs.

Individual in-depth, semi-structured interviews with 30 HIV positive Black Africans were conducted in London, UK. The interviews focused upon experiential accounts of living with HIV. The interviews were transcribed and analysed for recurrent themes using interpretative phenomenological analysis. The social context of being a Black African living in the UK emerged as an important framework within which the experience of being HIV positive was positioned. In terms of people's accounts of their own experiences of living with HIV, diagnosis figured as an important moment in people's lives. The majority of participants were surprised and upset upon receiving their positive antibody test results. Many reported a period of depression and social isolation. Stigma and prejudice associated with HIV also emerged as a major force shaping the daily lives of the participants. We discuss the role of identity and social context in disrupting the medical meaning of diagnostic tests.