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Gay men's use of the internet for social and sexual purposes is now so common that some predict an end to gay bars. In New York City, where this study took place, the use of the internet by men to meet other men seeking sex without condoms, called bareback sex, has created concerns among public health and gay community HIV/AIDS workers. This study of six popular bareback internet sites seeks to understand the nature of this new online sexual culture, initially by investigating the sites themselves through the methodology of cyber-cartography. That investigation suggested that masculinity as an analytic in gender studies might offer some value in understanding what was happening on these sites. Issues of race and ethnicity also emerged to challenge any singular notion of masculinity. This paper suggests that masculinity itself might need some recalibration, and that we may also need to rethink these sites as evolving ethical sexual cultures. [ABSTRACT FROM AUTHOR]

If you want to understand educational work and workers in the HIV community sector, how do you access, model and theorize educational practice and those who do it, and how do you generate critical perspectives on this? Further, how do you determine the ways in which effective educational development and changes might be effected? How do you proceed through a set of practices that generate knowledge collaboratively with those whose practice is the focus of the research? Whose knowledge is generated and whose is described in the research process? In order to explore these questions, this paper addresses the principles and approach to a set of collaborative action research projects conducted within community-based HIV organizations throughout Australia. The Community Educational Workforce and Training project has attempted to describe and critique the educational work and workforce of this sector, approaching the research as an action-based collaborative endeavour. A central premise of the research has been that complex and expert systems of knowledge about educational practice reside with practitioners. As researchers our challenge is to find ways to extricate these knowledges and to interpret, link, structure and analyse the data with a view to developing the theory and practice of educational work. Principles of discourse analysis and theory generate a perspective on the differently positioned views and roles of the research partners, and allow the research enterprise to be seen as one that is as much embedded in interpersonal and relational interaction as it is in intellectual endeavour. The methods of data collection and analysis, embedded within critical discourse analysis, ethnography, models of action and collaborative research produced a critical, iterative and rigorous research process. Reflexivity as a research principle and practice demands a continuous, critical dialogue between researchers, participants and ideas. This occurred within individual moments of research and in an accumulating sense, over time as each project was undertaken. Our understanding of educational logics, problematics and meta-structures deepened during the research process. [ABSTRACT FROM AUTHOR]

This study examined lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients’ sexual well-being post-cancer, and the associations between sexual well-being and social support, physical concerns, distress, quality of life (QOL), and coping. We used a mixed-methods approach, including 430 surveys and 103 interviews, representing a range of tumor types, sexual and gender identities, age groups, and intersex status. The findings indicated that LGBTQI people with cancer experience declines in sexual well-being following cancer, which are associated with reduced QOL, greater physical concerns, and lower social support. The perceived helpfulness of coping mechanisms was associated with greater sexual well-being across genders, with cisgender men reporting the sharpest declines in sexual well-being and highest use of coping mechanisms. Across all groups, searching for information online was the most frequently used coping mechanism, with support groups and counseling the most under-utilized. Qualitative findings facilitated interpretation of these results, providing examples of ways in which cancer impacted sexual well-being and how physical changes influence sexual embodiment or desire to engage in sex. Concerns about reduced sexual desire and activity, associated with changes to breasts, vulva, vagina, penis, erectile dysfunction, incontinence, scarring, and stoma, reflect previous findings in the non-LGBTQI cancer population. Unique to this population are the impact of physical changes on LGBTQI embodiment, including disruption to sexual and gender identities, and feelings of disconnection from queer communities. Addressing LGBTQI sexual well-being within oncology healthcare is a matter of sexual and reproductive justice, for a population whose needs are often overlooked within cancer care. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PCa) is often diagnosed early with prolonged survival, which makes sexual quality of life (QoL) an increasingly important treatment consideration, but existing QoL questionnaires have limited applicability for men who-have-sex-with-men (MSM) beyond penile erections and penetrative sex., Aim: We aimed to create a validated survey instrument for assessing a variety of sexual activities beyond penile insertive sex for MSM after PCa treatment., Methods: Based on our previously published survey findings, we have generated a prototype questionnaire with 13 different domains, reviewed by both healthy MSM and pilot-tested by MSM treated for PCa., Outcomes: We report here on progress in developing the questionnaire and demonstrate the complexity of MSM sexual side effects resulting from PCa treatment(s)., Results: Statistical analysis of 204 responses from MSM treated for PCa showed that each domain performed well individually (Cronbach's alpha coefficients ranged from 0.80 to 0.95; item-total correlations ranged from 0.16 to 0.89), with many significant intercorrelations between the domains (ranged from -0.048 to 0.93)., Clinical Implications: The questionnaire can contribute to clinical diagnosis and treatment decisions that best fit the preferred sexual practices of individual MSM., Strengths & Limitations: The current questionnaire considers a much broader repertoire of MSM's sexual practices and preferences than other currently available questionnaires. The high intercorrelations between the many parameters demonstrate that problems in one domain can affect other domains. This preliminary analysis warrants further exploration with a larger sample size., Conclusions: Once validated our questionnaire should help develop tailored psychosocial supports for MSM experiencing sexual dysfunction after PCa treatment and help newly diagnosed MSM with PCa make treatment decisions informed by their preferred sexual practices. Wibowo E, Dowsett GW, Nelson CJ, et al. Development of a Sexual Quality of Life Questionnaire for Men-Who-Have-Sex-With-Men With Prostate Cancer. Sex Med 2022;10:100480., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Digital technologies play a significant role in people's sexual and intimate lives via smart phones, cameras, dating apps and social media. Although there is a large body of research on the potential risks posed by these technologies, research on benefits and pleasures is limited., Methods: This study explored digital sexual practices, including perceptions of risks and benefits among a sample of Australian adults (n =445). Data were collected in 2020 via an online survey. Descriptive and bivariate analyses were undertaken to identify significant relationships between demographic variables and the use of technologies in relation to perceived risks and benefits. The mean age of participants was 42 years, over half were women (58.5%) and identified as heterosexual (61.1%)., Results: Findings reveal that use of digital media was common in participants' sex lives and relationships; 60.3% of participants had viewed pornography online, 34.9% had used dating apps, and 33.9% had sent sexual or naked self-images to another person. Over one in three reported positive outcomes from this: 38.2% felt emotionally connected to their partners due to online communication; 38.0% agreed that digital technologies facilitated closer connections;however, the majority of participants were aware of potential risks associated with online sexual engagement, particularly non-consensual exposure of their sexual or naked images, with women expressing greater concern., Conclusions: Policy, legal and educational responses should be based on holistic understanding of digital sexual engagement, acknowledging the ways in which technologies can support sexual relationships while also building people's knowledge and capacity to manage risks.

This paper explores the perceptions of 35 key informants (KIs) in a range of relevant health and community sectors regarding the stigmatisation of GBM's crystal methamphetamine use and sexual practice with view to informing stigma reduction efforts. A modified social ecological model was used to guide analysis and interpretation. At the individual level, KI participants indicated that crystal methamphetamine was used by some GBM to reduce the effects of internalised stigma. At the network level, KIs thought that some drugs and types of use could attract more stigma and that this could erode support from GBM networks for men who use crystal. KIs felt that few "mainstream" organisations could provide appropriate services for GBM who use crystal and furthermore, that there was significant work to "undo" misperceptions of the harms of crystal use. At the policy level, mass media anti-drug campaigns were seen to be a significant generator of stigma with irrelevant and patronising messages that lacked useful information. Efforts to reduce stigma about crystal methamphetamine use amongst GBM must address individual, network, organisation and policy issues and be underpinned by understandings of social power in relation to sex, sexuality, drug use, infectious status and sexual minorities., Competing Interests: Declarations of Interest Carla Treloar has received speakers’ fees from Abbive and Gilead and research funding from Merck. Max Hopwood has received research funding from Merck., (Copyright © 2021. Published by Elsevier B.V.)

Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling "out of control", and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a "counterpublic health" underpinned by forms of "sex-based sociality", which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex., Competing Interests: Declarations of Interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In Australia, the crystalline form of methamphetamine ("crystal") is a commonly used illicit substance associated with sexual activity among gay and bisexual men. Attention to psychoactive substance use among this population is the subject of increasing global concern regarding the intentional and simultaneous combination of sex and drugs, often referred to as "chemsex". While not all gay and bisexual men who use psychoactive substances report problematic use, those who do often become representative of chemsex practices more generally, and the harms they experience become attributable to all men who use drugs for sex. The way in which these practices have been framed over the past few decades contributes to the rise of a narrow set of understandings of chemsex defined by the circumstances and behaviours presumed of drug-enhanced sexual activity. In effect, these understandings now align recognisable combinations of sexual and drug-using practices with assumed correlates of risk. The Crystal, Pleasures and Sex between Men study conducted 88 interviews with gay and bisexual men in four Australian cities between 2017 and 2018. Findings from the project revealed that men used crystal in a variety of settings and relations, which mediated their sexual practices and patterns of use. In looking at the wider context in which practices were associated with the combination of sex and drugs, we identified experiences that the contemporary discourse of chemsex-in its rhetorical proposition of at-risk behaviours and circumstances-may leave out of consideration. Our findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. Accordingly, we seek to destabilise the definition of chemsex that precludes consideration of the influence of experiences beyond pre-determined risk parameters., Competing Interests: Declaration of Competing Interest Declarations of interest: This research was supported under National Health and Medical Research Council Project grant (project number APP1124378) and by a grant from the Western Australia Health Department (project number RG171390). The Centre for Social Research in Health and the Australian Research Centre in Sex, Health and Society also receive funding from the Australian Government Department of Health and Ageing., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The use of assistive aids in sexual rehabilitation after prostate cancer (PCa) was examined in 124 gay, bisexual, and other men who have sex with men (GBM) and 225 heterosexual men. GBM were significantly more likely to use assistive aids (79% versus 56%), to try multiple assistive aids ( M  = 1.65 versus M  = 0.83) including medication, penile injection, penile implant, vacuum pump, and nonmedical sex aids, and to seek information about sexual rehabilitation on the Internet, through counseling, or in a support group. There were no differences between the groups in satisfaction with the use of assistive aids. However, use of aids was a significant negative predictor of sexual functioning for GBM and a significant positive predictor for heterosexual men. Interview accounts described satisfaction with assistive aids in terms of maintaining erectile functioning and relationships. The majority of men in the study also described hindrances, both physical and social, resulting in discontinuation of assistive aids, including perceived artificiality, loss of sexual spontaneity, side effects, failure to achieve erectile response, cost, and lack of access to information and support. It is concluded that the specific needs and concerns of GBM and heterosexual men regarding sexual rehabilitation after PCa need to be addressed by clinicians.

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

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an "invisible diversity" in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men's lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men's sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.

In coining the term 'post-AIDS' some 20 years ago, I was noting the dissolution of a singular and unified experience of HIV and AIDS for gay communities that had been the case until that time. Not only were HIV-positive and HIV-negative gay men having increasingly different experiences, but divergent trajectories were opening up. Since then, many other factors have come into play, for example age and generation; the ascendancy of the biomedical and the technosexual; and the supremacy of neoliberal politics (including sexual politics). Now, if gay men are to survive as such - and there is a question about this - are there larger issues than HIV and AIDS that ought to command our attention? Or do we need to rethink how we situate HIV and AIDS within the larger framework of gay men's health and wellbeing. This might be just a question of politics, or it could be a question of theory. Are we finally returning to the original gay liberation agenda of the eradication of difference, or simply being traduced (seduced?) by our success at intimate citizenship?

Same-sex marriage is a widely debated issue, including in Australia. This study used an online anonymous survey, with free-text responses, to investigate romantic and sexual relationships among Australian gay and bisexual men. We sought to identify what proportion of such men intended to marry their primary regular partner if marriage was made legally available to same-sex couples in Australia, as well as factors associated with intention or non-intention to marry. Most men in the sample did not intend to marry their primary regular partner. Even among men who considered themselves to be in a 'relationship' with their primary regular partner, less than half intended to marry him. However, many men who would not marry their current primary regular partner agreed that same-sex marriage should be available for gay and bisexual men in Australia. Reasons for intention to marry included a desire for social and legal equality, and ideas about marriage as a rite of passage, an expression of love and the most valued form of relationship in Australia. Those who did not intend to marry their primary regular partner offered a number of reasons, including that the nature of their relationship was incompatible with marriage, and reported a critical position towards marriage as a heteronormative institution.

Introduction: Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men., Aim: HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support., Method: One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments., Main Outcome Measure: Functional Assessment of Cancer Therapy-Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors., Results: GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R2Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R2Adj = .690)., Conclusion: These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this "hidden population" in PCa care., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: With earlier prostate cancer (PCa) diagnosis and an increased focus on survivorship, post-treatment sexual quality of life (QoL) has become increasingly important. Research and validated instruments for sexual QoL assessment based on heterosexual samples have limited applicability for men-who-have-sex-with-men (MSM)., Aim: We aimed to create a validated instrument for assessing sexual needs and concerns of MSM post-PCa treatment. Here we explore post-PCa treatment sexual concerns for a sample of MSM, as the first part of this multi-phase project., Methods: Individual semi-structured interviews were conducted with 16 MSM face-to-face or via Internet-based video conferencing. Participants were asked open-ended questions about their experiences of sexual QoL following PCa. Interviews were recorded, transcribed verbatim, uploaded to NVivo 8(TM) , and analyzed using qualitative methodology., Main Outcome Measure: We have conducted semi-structure qualitative interviews on 16 MSM who were treated for PCa. Focus was on post-treatment sexual concerns., Results: The following themes were inductively derived: (i) erectile, urinary, ejaculation, and orgasmic dysfunctions; (ii) challenges to intimate relationships; and (iii) lack of MSM-specific oncological and psychosocial support for PCa survivorship. Sexual practices pre-treatment ranked in order of frequency were masturbation, oral sex, and anal sex, an ordering that prevailed post-treatment. Sexual QoL decreased with erectile, urinary, and ejaculation dysfunctions. Post-treatment orgasms were compromised. Some single men and men in non-monogamous relationships reported a loss of confidence or difficulty meeting other men post-treatment. Limited access to targeted oncological and psychosocial supports posed difficulties in coping with PCa for MSM., Conclusions: The negative impact on sexual QoL can be severe for MSM and requires targeted attention. Penile-vaginal intercourse and erectile function have been the primary focus of sexual research and rehabilitation for men with PCa, and do not adequately reflect the sexual practices of MSM. Our findings suggest that future research dedicated to MSM with PCa is needed to incorporate their sexual practices and preferences specifically into treatment decisions, and that targeted oncological and psychosocial support services are also warranted., (© 2015 International Society for Sexual Medicine.)

In the 1976 sci-fi film Logan's Run, actor Michael York, relaxing in a fetching caftan after a day hunting 'Runners', logs-in to the 'Circuit', a de- and re-materialisation technology that allows those seeking sex to select partners. Logan's first candidate, a young man, is passed over with a smile. The second is co-star Jenny Agutter; she is accepted and we join a sexual ride in the future. Online dating sites such as Gaydar® and RSVP® would seem to have a long way to go to achieve that, and Microsoft™ needs some fast apps development to get us there. Against this background, this paper examines some starting points in our fascination with technosex, long before the Internet, in books and magazines, the creative arts and other media and cultural forms. It focuses upon gay men's contribution to this fascination, and looks at the queering of heterosexuality and the part technology has played in that process. Online technologies are examined, particularly in relation to the 'publicisation' of sexual life and to shifts in sexual identity and practice related to changing processes of sexual objectification, self-objectification and subjectification. Finally, the transformation of sex into health and healthy sex is discussed.

Research and scholarship on sexuality has grown exponentially over the last 60 years; but what is this 'sexuality' that so fascinates us. During those 60 years, three academic traditions or paradigms have emerged and evolved to provide that main ways we understand sexuality. These are: (1) sexology; (2) sex research; and (3) critical sexuality studies. These paradigms do not always agree; at times, they are incommensurable in the picture of sexuality they paint. However, they each affect how sexuality is researched and written about, and how it is understood in the popular imagination. After discussing these paradigms, attention is focused on the contemporary challenges facing the third paradigm: critical sexuality studies. The contribution of sexology and sex research to these challenges is noted. Three key issues are discussed: the body; how we commonly understand sexuality; and the commodification of sexuality in late modernity.

Introduction: Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse., Aim: The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED., Methods: An international online survey was conducted in 2010-2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment., Main Outcome Measures: The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment., Results: Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and "versatile"). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment., Conclusions: Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115-120.

Objectives: To design a method for assessing the strength of evidence on the effectiveness of different interventions to prevent the spread of HIV that will be the basis for the reviews in this series., Methods: The literature on the evaluation of public health interventions was reviewed, and a method was developed in consultation with colleagues involved in this series of reviews and others., Findings: The method involves the following steps. First, define the key types of intervention that policy-makers need to choose between in the population setting under consideration. Second, define the strength of evidence that would be needed to justify widespread implementation of the intervention. Third, develop explicit inclusion and exclusion criteria for the studies under review. Fourth, critically review all eligible studies and their findings, by intervention type. Fifth, summarize the strength of the evidence on the effectiveness of each type of intervention. Sixth, compare the strength of the evidence provided by the studies against the threshold of evidence that would be needed to recommend widespread implementation. Seventh, from this comparison, derive evidence-based recommendations related to the implementation of each type of intervention in the setting or population group., Conclusions: The method proposed here provides a systematic, rigorous and transparent approach to reviewing evidence on the effectiveness of interventions of different types and in different population settings in order to generate recommendations for policy-makers.

Gender has become a major conceptual tool for understanding the evolving HIV pandemic globally. As such, it has provided a powerful way to see the structure of relations between men and women as central to various epidemics, and added weight to our understanding of HIV infection as not simply an individual experience of disease. Yet, as a concept, gender has its blind spots. This paper argues that there are four issues central to our understanding of how the HIV pandemic moves and develops that are not necessarily best understood through an analysis that uses gender alone, namely: women's vulnerability, men's culpability, young people's sexual interests and marginalized sexual cultures. The paper proposes using sexuality as a framework for analysing these issues and seeks to utilise developments in critical sexuality research to add to gender as a way to increase the capacity to respond to the HIV/AIDS crisis.