Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis

Objectives: 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.

Design: 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.

Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews.

Results: 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.

Conclusions: 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.     

Paths and Pitfalls

SUMMARY

In up to two million couples ever married, one spouse has disclosed or may disclose being gay, lesbian, or bisexual. An increasing number of spouses are coming out, yet the phenomenon remains little known. Disclosing spouses generally find supporting organizations, while their heterosexual spouses find little support or understanding of their issues. Isolated, most cope alone. Dealing with sexual rejection, the challenge to the marriage, and, if they have children, spouse/parent conflicts is followed by handling questions about their own identity, integrity, and belief system. This piece describes issues that heterosexual spouses typically face and stages through which they move from survival to reconfiguring their lives whether or not they stay married. Peer support helps this process that lasts several years or more. Knowledge about spouse's concerns assists therapists working with spouses to help them resolve potentially paralyzing pain, anger, grief, or fear.     

Metanoia

SUMMARY

The author draws on her experience working with individual men who are violent to their partners to think about the problem of international violence. A parallel is drawn between a man's feeling of “entitlement” to forcefully keep his partner “in line” and feelings of national entitlement to engage in violence to force one group's agenda on another. The differences between morals and taboos are discussed underscoring the community value of that which becomes socially and ethically “unthinkable.”     

The Role of Rape Myth Acceptance and Psychopathy in Sexual Assault Perpetration

Perpetrators of sexual aggression consistently report higher scores on measures of psychopathy and acceptance of rape myths relative to nonperpetrators. However, less is known about psychopathy among nonincarcerated individuals and the relation between the two constructs has not been empirically examined among college perpetrators. To address this gap, both constructs were measured in a sample (N?=?308) of college men. Rape myth acceptance was positively correlated with psychopathy, and perpetrators scored higher on both constructs. Myths transferring responsibility to victims were related to Factor 1 psychopathy (i.e., callous and manipulative traits). The myth that “rape is trivial” was associated with Factor 1 and Factor 2 (i.e., impulsive and antisocial behavior), possibly suggesting that this myth is related to a larger tendency to excuse aggressive behavior. Although both constructs distinguished perpetrators when considered individually, rape myth acceptance did not explain unique variance in the presence of psychopathy.     

History and Analysis of Delayed Discovery Statutes of Limitations in Adult Survivor Litigation

Summary

In this chapter, attorney Mary R. Williams examines how while Childhood Sexual Abuse (CSA) cases share many of the types of facts for which delayed discovery, mental incapacity, equitable estoppel and other legal statutes of limitations doctrines were created, the combination of factors of CSA cases, including unusual social dynamics and long-term psychological effects, does not fit exactly with any of these legal doctrines. She explores the historical development of delayed discovery statutes of limitations, evaluates the different types of statutes and case law, and analyzes the problematic use of the concept of repression in legislation. This chapter interprets her ground-breaking state-by-state tabulations of delayed discovery statutes of limitations and reported appellate decisions on limitations in CSA actions, published in this volume as appendices A, B, and C.     

For Now We See Through In Vitro Darkly; But Then Face to Face: An Alternative Theological Perspective on In Vitro Fertilization

Abstract

This article uses the techniques of discourse analysis to highlight the ways in which official Church documents on IVF have eclipsed from view the desires, dilemmas and pastoral needs of women seeking treatment for infertility. Furthermore, this analysis reveals how an overriding concern for the embryo has also curtailed debate upon the wider social context in which the procedures of the biomedical community are located. It is argued that the insights generated through feminist debates concerning an ‘ethics of care’ can effectively challenge the androcentric ‘rights’ perspectives enshrined in the moral teaching of the churches. The attention to context generated within this feminist ethical framework would provide a more effective means of challenging the commercial activities of the biotechnology industry than is currently employed.     

“Never reflected anywhere”: Body image among ethnoracialized gay and bisexual men

A growing body of literature has highlighted the increased prevalence of body image concerns and associations with health outcomes among gay and bisexual men (GBM). Little research, however, has examined the link between body image and social oppression for ethnoracialized GBM. Using an intersectionality lens and qualitative inductive analysis, data were collected through focus groups and interviews with GBM (n = 61) who identify with one of four ethnoracial groups (Black, East/Southeast Asian, South Asian, Latino/Brazilian). Three main themes emerged: (1) body image idealization in gay/bisexual male culture, (2) negotiating a racialized body image, and (3) negotiating the impact of body image on relationship with self and others. The study results highlighted how multiple forms of oppression (e.g., racism, sexism) intersected with one another to impact the body image and overall well-being among ethnoracialized GBM.     

Psychotic dream-related aggression: A critical review and proposal

The relationship among parasomnias, sleep-related violence (SRV), and psychosis has neither been reported nor studied. The authors introduce the phenomenon of psychotic dream-related aggression (PDRA) and, through a review of the research on manifest dreams, the continuity of thinking across the sleep–wake cycle, and SRV, argue for its inclusion alongside the parasomnias of DSM-IV. Five cases are presented that illustrate this phenomenon, usually a male diagnosed with paranoid schizophrenia whose violent act toward another was closely associated with the manifest content of his nocturnal dreams and his inability to test reality. Differential diagnostic criteria are proposed to separate PDRA from other parasomnias that may be related to violence. Treatment and forensic implications are discussed.     

Can men talk about problems with weight? The therapeutic implications of a discourse analytic study

This paper discusses the implications for counsellors of a discourse analytic study examining men's talk about body weight. It is argued that research in the area of problems with body has neglected the growing pressures on men to manage body as a feature of self. This research perpetuates the dominant discursive construction of men's relationship to body as unproblematic — a construction that may present many barriers to men in seeking help for any distress encountered. An analysis of men's talk is discussed in terms of the expectation that body is not problematic and the observable downplaying of any concerns acknowledged. The accountability of body as a site of regulation also emerges within the extracts presented. It is argued that this property within the accounts resonates with work highlighting the growing pressures on men to exercise control over body. The contradictions between the two discourses identified are discussed in terms of their therapeutic implications. It is postulated that male distress emerging from the growing pressures to maintain body weight may be neglected within primary care and therapeutic domains if discourses formulating such difficulties as not relevant to men remain dominant.     

Gay men's experiences of therapy

Fourteen gay men were interviewed using a structured interview schedule to explore their experiences of being in therapy. Particular importance was given to their perceptions of how their sexual orientation impinged on the counselling process and how their assumptions about counsellor sexual orientation affected the therapeutic relationship. The limitations of using structured interviews in qualitative research are acknowledged. Some significant findings were made, which were not well documented in the literature, such as the impact on the therapeutic relationship of internalised homophobia within gay men themselves. These findings hold the potential to inform counselling practice with gay male clients. Recommendations are made in relation to both practice and further research.