tag:theconversation.com,2011:/au/topics/sexual-stigma-28478/articlesSexual stigma – The Conversation2024-02-07T12:32:53Ztag:theconversation.com,2011:article/2213732024-02-07T12:32:53Z2024-02-07T12:32:53ZSome women enjoy anal sex – it shouldn’t be a guilty pleasure<figure><img src="https://images.theconversation.com/files/572879/original/file-20240201-17-o5ikwl.jpeg?ixlib=rb-1.1.0&rect=3%2C0%2C2049%2C1671&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shaming women for enjoying anal sex is damaging to their health, wellbeing and sexual autonomy</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/woman-lying-on-bed-with-arms-raised-portrait-elevated-view-news-photo/82144239?adppopup=true">Archive Photos / Stringer</a></span></figcaption></figure><p>What first comes to mind when you think of anal sex? Do you think of pain, fear, coercion? Do you think that anal sex is obscene, hardcore, adventurous, taboo, and perhaps dirtier than other forms of sex? Do you think of sex between gay men? Or do you think of pleasure, romance, love, connection, intimacy, trust and joy? </p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/13691058.2022.2037020">Research suggests</a> that it is common to associate anal sex with stigma, shame, and suspicion, <a href="https://www.bmj.com/content/378/bmj.o2323">with negative perceptions</a> dominating understanding of anal sex behaviour. </p>
<p>Where anal sex is depicted as occurring between men and women, both <a href="https://www.bmj.com/content/378/bmj.o1975">medical research</a> and popular culture tend to see <a href="https://journals.sagepub.com/doi/10.1177/10778012211045716">men as the penetrators</a>, <a href="https://www.marieclaire.com/sex-love/a5489/rise-in-anal-sex-statistics/">women as the receivers</a>, anal sex as a <a href="https://www.theguardian.com/society/2022/aug/11/rise-in-popularity-of-anal-sex-has-led-to-health-problems-for-women">riskier sexual activity</a>, and as <a href="https://metro.co.uk/2017/07/18/teenage-girls-pressured-into-painful-and-coercive-anal-sex-because-of-porn-6788524/">having a coercive element</a>. </p>
<p>For example, in the <a href="https://www.etonline.com/tv/160691_sex_and_the_city_creator_darren_star_up_the_butt_scene">US series Sex and the City</a>, one of the lead characters Charlotte York was disturbed and distressed because her male partner wanted to have anal sex. “I don’t want to be the up-the-butt girl, because I mean … Men don’t marry up-the-butt girl. Whoever heard of Mrs. Up-The-Butt?” she laments to her friends.</p>
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<figcaption><span class="caption">Charlotte is troubled by her boyfriend’s request for anal sex in the first series of Sex and the City (Series 1, episode 4, 1998)</span></figcaption>
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<p>And of course, there’s the infamous Fleabag scene which depicts Phoebe Waller-Bridge’s character acquiescing to anal sex with “Arsehole Guy”, while stating to camera:</p>
<blockquote>
<p>After some pretty standard bouncing, you realise, he’s edging towards your arsehole, but you’re drunk, and he did make the effort to come all the way here, so you let him. He’s thrilled.</p>
</blockquote>
<p>As well as the episode of US comedy series <a href="https://www.newyorker.com/video/watch/the-new-yorker-festival-mindy-kaling-on-the-sexual-nature-of-the-mindy-project">The Mindy Project</a> dedicated to <a href="https://www.glamour.com/story/the-mindy-project-explores-acc">“accidental” anal sex</a>.</p>
<p>These depictions both <a href="https://www.mumsnet.com/talk/telly_addicts/3553942-Fleabag-Im-disappointed">shock viewers</a> and <a href="https://link.springer.com/article/10.1007/s12147-020-09250-7">put men’s pleasure</a> and desire above women’s. Women are rarely viewed as the active instigators or penetrators of anal sex, especially between female same-sex partners, and are almost never seen as <a href="https://www.vogue.com/article/is-anal-sex-no-longer-taboo-breathless-karley-sciortino">anal enthusiasts</a>.</p>
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<figcaption><span class="caption">Acclaimed TV series Fleabag opened with a scene about anal sex (Series 1, episode 1, 2016)</span></figcaption>
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<p>Our research team conducted a series of focus groups with 20 participants aged between 19 and 56 years of age. They included sexual health practitioners and those with a vested interest in sexual health, such as youth workers, and young people. The purpose of the study was to explore perceptions of anal sex, exploring questions such as: What is anal sex? Who is involved and for what reasons? </p>
<p>In our focus groups, anal sex was immediately assumed to be a male sexual preference before women’s pleasure was considered. <a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">Participants</a> expressed that women who desire anal sex are culturally perceived as adventurous, sexually experimental, or “out there” in some way.</p>
<p>Imagine meeting a woman who is open about how much she enjoys pegging her boyfriend (where she’s the giver rather than the receiver) every other night. Would she be seen as edgy? Wild? Kinky? Would she experience bias on the basis of her sexual preferences? Would she be judged? </p>
<p>Our research strongly suggests that she would. Perhaps these negative attitudes are unsurprising – after all, even <a href="https://www.bmj.com/content/378/bmj.o2323">some doctors are reluctant</a> to discuss anal sex with women, <a href="https://www.bmj.com/content/378/bmj.o1975">causing a potential risk to health</a>. </p>
<h2>Anal sex is commonplace – despite the stigma</h2>
<p><a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">Our research</a> highlights the concerns of some sexual health practitioners that women may be <a href="https://researchspace.auckland.ac.nz/bitstream/handle/2292/63866/Carvalho%20Pinto%20Faustino-2022-thesis.pdf?sequence=4">influenced by their male partner</a> to engage in anal sex or may make decisions to participate in anal sex without being fully informed. These concerns then raise questions about whether women are consenting to their own sexual desires and behaviour or men’s. </p>
<p>Most of our participants thought that <a href="https://www.bmj.com/company/newsroom/doctors-reluctance-to-discuss-anal-sex-is-letting-down-young-women/">anal sex was a neglected area</a> of relationships and sex education. And definitely <a href="https://www.glamour.com/story/anal-sex-guilt">not taught as something pleasurable</a>.</p>
<p>It is difficult to estimate how many people generally, and women specifically, are engaging in anal sex. Many people are not comfortable speaking openly about their sex lives due to geographic, contextual and intersectional factors such as race, religion, gender and sexuality. </p>
<p>There is also no clear consensus over what constitutes anal sex, whether it’s rimming, pegging, fingering, penile-anal intercourse, anal massage, or other activities. But <a href="https://www.sciencedirect.com/science/article/abs/pii/S1743609515341801?via%3Dihub">some estimates</a> show that just over <a href="https://journals.lww.com/stdjournal/fulltext/2023/11000/changes_in_oral_and_anal_sex_with_opposite_sex.3.aspx">one-third of US women</a> have had heterosexual penile-anal sex. </p>
<p>Other scholars have argued that more adults and adolescents are engaging in anal sex <a href="https://journals.lww.com/stdjournal/Fulltext/2018/12000/Anal_Sex_Is_More_Common_Than_Having_a_Twitter.2.aspx">than have an account with X</a> (formerly Twitter). </p>
<p>Contrary to immediate negative biases of – and concerns over – anal sex, these estimates suggest that it is a <a href="https://www.refinery29.com/en-us/2015/08/93122/anal-sex-statistics">relatively common practice for women</a> to engage in anal sex as part of their wider sexual repertoire. </p>
<p>How then, given the immediate negative biases and potentially overzealous concerns over male-led coercion of women and young girls, should anal sex be discussed appropriately?</p>
<h2>Foregrounding women’s safety and pleasure</h2>
<p>A focus on women’s sexual pleasure is strikingly lacking from conversations in sex and relationships education, and within sexual health clinical practice. In our research <a href="https://journalofpositivesexuality.org/wp-content/uploads/2023/07/10.51681.1.912_Perceptions-of-Young-Women-Who-Engage-in-Anal-Sex_Pickles-Hirst-Froggatt-Kenny.pdf">we argue</a> that anal sex must be included in sexual health education as part of a wider repertoire of sexual pleasure. </p>
<p>What should be concerning is not engagement with anal sex per se – <a href="https://www.glamourmagazine.co.uk/article/anal-sex-safety">women are having anal</a> whether we want to acknowledge it or not – but the <a href="https://bmjopen.bmj.com/content/4/8/e004996.short">lack of education around anal sex</a> that, if included in relationships and sex education, could increase the <a href="https://www.tandfonline.com/doi/full/10.1080/14681810802433929">sexual literacy of women and young girls</a>. </p>
<p>We are not encouraging anyone to engage in anal sex if they do not wish to, but our research does emphasise that if young women are to have anal sex, they are entitled to the self-knowledge that will allow this to occur safely, consensually, pleasurably and positively. </p>
<p>Our research has highlighted implicit assumptions that must be challenged and destigmatised These involve what anal sex actually is, who the primary instigator is, and whether women are active participants who want to engage in anal sex for their own pleasure. </p>
<p>Providing knowledge on anal sex that centres women’s pleasure allows for a higher degree of choice to engage in sexual practices that feel right for all women involved.</p><img src="https://counter.theconversation.com/content/221373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The stigma around anal sex is damaging for women – and diminishes their sexual autonomyJames Pickles, Senior Lecturer in Criminology, School of Humanities and Social Science, University of BrightonChloe Froggatt, Associate Lecturer in Sociology and Public Health, Sheffield Hallam UniversityJulia Hirst, Professor of Sexualities & Sexual Health, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2038292023-11-01T12:36:19Z2023-11-01T12:36:19ZEndometriosis afflicts millions of women, but few people feel comfortable talking about it<figure><img src="https://images.theconversation.com/files/555396/original/file-20231023-21-48765g.jpg?ixlib=rb-1.1.0&rect=38%2C0%2C5046%2C3369&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Endometriosis pain can be so severe that it impairs a person's ability to keep up with school, succeed at work or have a satisfying sex life.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stomach-pain-royalty-free-image/1463546435?phrase=pain&adppopup=true">Kinga Krzeminska/Moment via Getty Images</a></span></figcaption></figure><p><a href="https://www.who.int/news-room/fact-sheets/detail/endometriosis#">Endometriosis</a> causes physical, sexual and emotional pain. About <a href="https://www.ox.ac.uk/news/2023-03-14-global-study-shows-experience-endometriosis-rooted-genetics">190 million people around the globe</a> have endometriosis, <a href="https://gonzalez-colon.house.gov/media/press-releases/house-approves-push-finkenauer-and-endometriosis-caucus-double-research">including one in 10 American women</a>, but there has historically been <a href="https://doi.org/10.1007/s00404-023-07205-3">a deafening silence</a> about the disease and the pervasive impact it can have on a person’s life. </p>
<p>While endometriosis is a chronic gynecological illness that can affect anyone with a uterus – women, transgender men and nonbinary individuals – it often goes undiagnosed because its symptoms can be attributed to other physical or psychological concerns. Patients presenting with this pain are often told it is “all in your head.” </p>
<p>However, endometriosis is becoming a more visible illness, thanks in part to celebrities such as Lena Dunham, Chrissy Teigen, Amy Schumer, Whoopi Goldberg and others who have <a href="https://www.everydayhealth.com/endometriosis/living-with/celebrities-who-speak-endometriosis/">begun sharing their stories publicly</a>. After going undiagnosed for 23 years, Padma Lakshmi, a popular cookbook author, actress and host of the TV show “Top Chef,” founded <a href="https://www.endofound.org/">EndoFund, previously Endometriosis Foundation of America</a>, in 2009 so that others do not have to go through what she did.</p>
<p>I am a <a href="https://www.adler.edu/programs/kristina-s-brown/">couple and family therapy professor, clinician</a> and <a href="https://scholar.google.com/citations?user=ZeuvLPoAAAAJ&hl">researcher</a>. My own endometriosis diagnosis at the age of 19 has inspired my work exploring how this illness affects others beyond the physical symptoms.</p>
<p>To better understand the impact of endometriosis on relationships, I interviewed 10 couples about their experiences of diagnosis, treatment and living with this disease. Through their stories of how endometriosis-related pain can affect every aspect of daily life, including their intimate relationships, I provide some specific recommendations. The quotes I have included in this article <a href="https://surface.syr.edu/mft_etd/14/">are from my doctoral dissertation research</a>. </p>
<h2>The basics of endometriosis</h2>
<p>When a person has endometriosis, the endometrial cells that line their uterus “implant” in places outside the uterus, such as the ovaries, fallopian tubes and the lining of the abdomen — called the <a href="https://teachmeanatomy.info/abdomen/areas/peritoneum/">peritoneum</a>. At the end of each menstrual cycle, the uterus sheds its lining, which exits the body via the cervix and vagina. The “misplanted” endometrial cells also shed, but they have no place to go – resulting in internal bleeding, inflammation and pain. </p>
<p>An endometriosis diagnosis is described in stages related to the visual presence of the disease, from minimal, or Stage 1, to severe, or Stage 4. However, there is no connection between the stage and the experience of pain. </p>
<p>One symptom of endometriosis is <a href="https://doi.org/10.1080/10410236.2018.1440504">intense pain during the menstrual cycle</a>. Another is pain with sex. Because pain with menses or sex can be attributed to “normal” pain, a history of sexual abuse or psychiatric reasons such as a dislike of sex, some people with endometriosis wait an average of seven years for diagnosis, which can <a href="https://doi.org/10.1016/j.advms.2022.02.003">be visually confirmed only through</a> a procedure called <a href="https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laparoscopy">laparoscopy</a>. </p>
<p>In addition to these and other types of severe pain, endometriosis <a href="https://doi.org/10.1111/jocn.16145">can also cause infertility</a>, and patients who want to have children must often undergo <a href="https://doi.org/10.3389/fsurg.2022.1049119">medical or surgical interventions</a> to conceive.</p>
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<figcaption><span class="caption">Dr. Megan Wasson of the Mayo Clinic explains what endometriosis is and how it can be treated.</span></figcaption>
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<h2>Impacts on school, work and sex</h2>
<p>Physical pain from endometriosis can be debilitating. Adolescents with endometriosis <a href="https://theconversation.com/endometriosis-can-end-womens-careers-and-stall-their-education-thats-everyones-business-179846">may struggle to keep up</a> with their classes, friends, homework or extracurricular activities when the pain becomes too severe. They may <a href="https://doi.org/10.1016/j.jpag.2021.01.021">shift to home-schooling or virtual learning</a> <a href="https://www.yalemedicine.org/news/teens-endometriosis">to complete their studies</a>.</p>
<p>The pain can also deeply <a href="https://theconversation.com/endometriosis-can-end-womens-careers-and-stall-their-education-thats-everyones-business-179846">affect a career trajectory</a>. “I almost lost my job because of time off,” one interviewee told me. “In fact, when I had to get my hysterectomy, I walked in to tell my manager and he goes, ‘Well, I hope you’re not going to tell me that you have to have a hysterectomy and have to be out for six weeks!’ And I just broke down in tears.” </p>
<p>All of my participants shared experiences where doctors <a href="https://doi.org/10.3390/ijerph20043362">dismissed complaints</a> of sexual pain – called <a href="https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967">dyspareunia</a> – from endometriosis. This can delay diagnosis and treatment.</p>
<p>Sex and intimacy often become nonexistent, while some couples shared that they have come to accept that <a href="https://hdl.handle.net/2123/22345">pain is part of sex</a>. One woman shared with me: “I don’t want to be touched or have my naked body seen because I feel bloated and ugly and I’m in horrible pain!” </p>
<p>Partners can also be affected emotionally. “I just feel horrible,” one told me. “There are times when we are having sex that I actually feel guilty that I know that I am hurting her and I know she is going to be in pain and it makes me unhappy.”</p>
<p>These experiences of pain, of not being believed by doctors and professionals, of negative effects on education and career and of intimacy destroyed create a heavy emotional burden on individuals and relationships. </p>
<h2>Breaking the silence around endometriosis</h2>
<p>When I was diagnosed with endometriosis, it changed the course of my life. My partner and I learned to expand our definition of intimacy and to redistribute household responsibilities when I was incapacitated. As the risk of infertility only increases without intervention, we started conversations about having children earlier than anticipated. My diagnosis also led me to focus my professional identity as a medical family therapist to help others deal with endometriosis and chronic illnesses.</p>
<p>Based on this experience, here are some ways to break this silence:</p>
<ul>
<li><p>Learn about endometriosis. It directly helps when one’s support systems are educated.</p></li>
<li><p>Separate the person from the disease. When the pain you are experiencing from endometriosis is debilitating, help those around you who are also affected to understand that it is because of your endometriosis and it is not personal. </p></li>
<li><p>Speak from your own experience, saying, “I …” rather than “You …” When we do this, it decreases the other person’s defenses and opens up the communication, making space for connection.</p></li>
</ul>
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<figcaption><span class="caption">Social work researcher Brené Brown describes how to create a genuine empathetic connection with another person.</span></figcaption>
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<h2>Recommendations from people living it</h2>
<p>My research participants shared their own recommendations with me, especially the importance of <a href="https://doi.org/10.12968/bjon.2005.14.9.18073">believing that their pain is real</a>; accept that what they are sharing is their very real experience, and let them know that they are believed. </p>
<p>Bestselling author and social work researcher <a href="https://www.youtube.com/watch?v=KZBTYViDPlQ&ab_channel=DianaSimonPsihoterapeut">Brené Brown has said</a>, “Empathy fuels connection, sympathy drives disconnection.” Approaching someone with endometriosis from a position of empathy sends a message that you <a href="https://doi.org/10.5301/JE.2011.8906">want to work with them collaboratively</a>. </p>
<p>By practicing these important relationship skills, we can break the silence around endometriosis.</p><img src="https://counter.theconversation.com/content/203829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I continue to be grateful to the ten couples who shared their experiences of painful sex with endometriosis for my dissertation research.</span></em></p>Health care providers often dismiss endometriosis pain as ‘all in your head’ − which can delay a correct diagnosis and treatment for years.Kristina S. Brown, Professor and Chair of Couple and Family Therapy, Adler UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896192022-09-22T12:40:05Z2022-09-22T12:40:05Z‘Men who have sex with men’ originated during the HIV pandemic to focus on behavior rather than identity – but not everyone thinks the term helps<figure><img src="https://images.theconversation.com/files/485710/original/file-20220920-14360-lngmmg.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The monkeypox pandemic has seen an increase in the use of the term "men who have sex with men."</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-gay-couple-on-lookout-above-the-city-royalty-free-image/1195433903">Westend61/Getty Images</a></span></figcaption></figure><p>Since the <a href="https://www.npr.org/2022/08/05/1116036167/talking-about-monkeypox-effectively-without-stigmatizing-men-who-have-sex-with-m">global monkeypox outbreak</a> started to spread this past spring, more people are seeing the term “men who have sex with men,” or MSM, in the news and public health messages. You may have also heard this term in places like HIV prevention campaigns or at the doctor’s office.</p>
<p>I am a <a href="https://cph.osu.edu/people/jricks">behavioral scientist</a> who focuses on reducing health disparities and improving health equity for sexual and gender minority populations at highest risk for poor outcomes. At the most basic level, <a href="https://doi.org/10.1080/00224499009551551">men who have sex with men</a> is a term that was originally intended to describe the risk of HIV transmission associated with sex between two men. But in reality, MSM describes a diverse group of behaviors and identities, bringing with it a complex web of social, political and cultural considerations about how it’s used.</p>
<h2>Why use MSM?</h2>
<p>HIV researchers have used the term “men who have sex with men” <a href="https://doi.org/10.1007/BF01326525">since at least 1988</a> as a way to describe a particular type of sexual behavior that may affect health.</p>
<p>The acronym MSM, however, was <a href="https://doi.org/10.1902/jop.1994.65.5.393">introduced in 1994 as a new concept</a> by some researchers and community advocates in response to public health research and prevention efforts early in the HIV/AIDS pandemic. These efforts almost exclusively targeted men based on their sexual identity as gay. Community advocates <a href="https://prideindex.com/in-touch-with-cleo-manago/">criticized this approach</a> for excluding Black and Latino men who have sex with men who were affected by the pandemic but did not identify as gay, homosexual or bisexual. MSM was considered to be a more inclusive, less stigmatizing term that could be used to reach a broader range of people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Demonstrators holding signs protesting against AIDS discrimination" src="https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=839&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=839&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=839&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1055&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1055&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485707/original/file-20220920-11202-cf9dvv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1055&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During the AIDS epidemic, new terminology arose to focus research and public health interventions on behavior rather than identity.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AIDSDiscriminationProtest/96ceaffa64224626b88eae3bd88e7503">AP Photo/Rick Maiman</a></span>
</figcaption>
</figure>
<p>From a scientific perspective, using an identity-free term like MSM allows medical providers and public health practitioners to bypass the complexities of the social, cultural and political context of sexual orientation. Instead, they can then focus on the behavior that might put someone at risk for an infection such as HIV or monkeypox. This approach is <a href="https://pubmed.ncbi.nlm.nih.gov/16080458/">intended to help</a> increase the likelihood of screening, diagnosing and treating those at the greatest risk.</p>
<p>Prevention strategies that target people based on “what you do” rather than “who you are” reach more people who may be affected by a public health concern, including heterosexual men who have sex with men, rather than limiting outreach just to those who identify as gay or bisexual. They offer a larger number of men the opportunity to understand their risk and take the steps necessary for protection or treatment. They also help <a href="https://doi.org/10.2105/AJPH.2004.046714">decrease stigma</a> for those who identify as gay or bisexual.</p>
<h2>Limitations of MSM</h2>
<p>Despite its usefulness in some contexts, the term MSM has been hotly debated by scholars and community advocates since it was coined. <a href="https://doi.org/10.2105/AJPH.2004.046714">Disagreement</a> <a href="https://doi.org/10.2105/AJPH.2020.305870">on its use</a> is usually grounded in three arguments.</p>
<p>The first is that the term is ambiguous. Some researchers argue that distilling MSM down to “sex between two men” is too simplistic. For one, there are a number of nuances and factors that <a href="https://www.cdc.gov/hiv/group/msm/msm-content/prevention-challenges.html">influence the amount of risk</a> associated with sex between two men, such as how sex is performed and who and how many partners are in their sexual network. There is also confusion about how frequently or recently someone must have sex in order to be considered MSM. And there is <a href="https://doi.org/10.7448/IAS.19.3.20779">no consensus</a> about whether transgender men who have sex with men should be considered MSM. </p>
<p>The second critique is that the term <a href="https://doi.org/10.2105/AJPH.2004.046714">undermines the identities</a> of sexual minority group members, particularly people of color. Many public health researchers use MSM as a neutral term to push back against the idea that there is only one legitimate gay identity. However, some have criticized the term for erasing other sexual identities such as queer, two-spirited and same-gender loving by being the default term used in research, despite participants describing themselves as otherwise.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/JOSN1bKG3zQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">While HIV cases are largely decreasing across the U.S., high infection rates remain in Southern states.</span></figcaption>
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<p>Finally, the third argument is that the term conceals the social, political and cultural dimensions of health important for public health research and intervention. One of the greatest advantages of MSM is that it is grounded in tangible behaviors that researchers can target for health promotion and prevention efforts. But sexual health is influenced by a constellation of factors, and focusing on behavior alone is often not enough to completely protect against illness. </p>
<p>Beyond sexual behavior, <a href="https://doi.org/10.17226/25877">discrimination and social marginalization</a> put sexual minorities at significant risk of poor health outcomes. These can take the form of structural factors, such as anti-gay legislation, and community factors, such as discrimination and stigma. Interpersonal factors like relationship abuse and individual factors like internalized stigma also play a role. These factors <a href="https://doi.org/10.1016/j.mhp.2016.10.002">increase the risk of mental illness</a>, such as depression and suicidal thoughts, as well as risky health behaviors, such as sex without a condom or while under the influence of drugs.</p>
<p>Almost 30 years since it was introduced, the term MSM is becoming increasingly ubiquitous in both medical and public health spaces. But it does have limitations. Considering the sociopolitical context of whether MSM should be used, rather than using it by default, can help support the self-determination of those who belong to historically marginalized communities.</p><img src="https://counter.theconversation.com/content/189619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>JaNelle Ricks does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The term ‘MSM’ allows public health interventions to gloss over the social, political and cultural complexities of identity. But it’s not without its limitations.JaNelle Ricks, Assistant Professor of Health Behavior and Health Promotion, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1417462020-07-20T21:18:20Z2020-07-20T21:18:20ZSex workers are criminalized and left without government support during the coronavirus pandemic<figure><img src="https://images.theconversation.com/files/348475/original/file-20200720-31-1kyk4vy.jpg?ixlib=rb-1.1.0&rect=86%2C137%2C2317%2C1594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The red umbrella is a symbol used by sex worker activists to draw attention to the work conditions and human rights of people in the sexual service industry.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Paid sexual labour is a form of employment that most people generally don’t think about. From street workers to escorts to exotic masseuses, jobs in the sexual services industry have been disrupted during the coronavirus pandemic — that is, if they wish to keep themselves safe. </p>
<p>These workers have little in the way of job security. Most <a href="https://www.cbc.ca/news/canada/hamilton/swap-hamilton-1.5517795">are unable to receive</a> federal income relief and many have to <a href="https://canoe.com/news/national/sex-workers-say-theyve-been-left-out-of-canadas-covid-19-response">continue working</a> despite the risks. During the current pandemic, what happens to people whose job requires physical intimacy?</p>
<h2>Non-accessible COVID-19 relief</h2>
<p>Most sex workers do not qualify for <a href="https://www.canada.ca/en/revenue-agency/services/benefits/apply-for-cerb-with-cra.html">the Canada Emergency Response Benefit</a> (CERB) because they cannot prove they have <a href="https://www.huffingtonpost.ca/entry/sex-workers-coronavirus-cerb_ca_5e9cb5dcc5b60806d73fa781">earned at least $5,000</a> in the past year. Due to <a href="https://www.justice.gc.ca/eng/rp-pr/other-autre/c36faq/">federal criminal laws</a> around prostitution, even those who can provide such proof <a href="https://www.huffingtonpost.ca/entry/sex-workers-coronavirus-cerb_ca_5e9cb5dcc5b60806d73fa781">are afraid</a> to apply and draw the attention of the authorities via their <a href="https://www.theglobeandmail.com/investing/personal-finance/taxes/article-the-nuances-of-cerb-are-becoming-clearer-with-time/">CERB application</a> and/or the 2020 tax filing requirement.</p>
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Read more:
<a href="https://theconversation.com/coronavirus-contact-tracing-poses-serious-threats-to-our-privacy-137073">Coronavirus contact tracing poses serious threats to our privacy</a>
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<p>Since sex workers typically are either <a href="https://doi.org/10.1300/J056v17n01_09">self-employed or work as independent contractors</a>, they are also not able to benefit from the <a href="https://www.canada.ca/en/revenue-agency/campaigns/covid-19-update/support-employers-cra-covid-19.html">Canada Emergency Wage Subsidy</a> (CEWS). There is no “employee” classification legally available for workers because the employee-employer relationships for this industry violates the “Material Benefit Offence” (s. 286) of the Criminal Code. As a result, <a href="http://web2.uwindsor.ca/courses/sociology/maticka/star/pdfs/safety_and_security_report_final_version.pdf">workers do not qualify</a> for the rights and protections typically afforded to workers categorized as employees </p>
<p>The exclusions for COVID-19 assistance are an echo of the charter rights violations that the Supreme Court found in <a href="https://www.pivotlegal.org/canada_v_bedford_a_synopsis_of_the_supreme_court_of_canada_ruling">Canada vs. Bedford (2013)</a>.</p>
<h2>Regulating prostitution in Canada</h2>
<p>Before Dec. 6, 2014, the exchange of sexual services for money or other forms of compensation between two consenting adults was legal. The Criminal Code of Canada, however, made it <a href="https://doi.org/10.1111/j.1755-618X.2011.01249.x">very difficult</a> for workers to conduct business without running into conflict with the law. In 2013, the Supreme Court <a href="https://owjn.org/2015/10/sex-work-laws-unconstitutional-canada-attorney-general-v-bedford-supreme-court-of-canada-2013/">unanimously ruled</a> that three sections of the criminal code pertaining to prostitution violated <a href="https://www.pivotlegal.org/canada_v_bedford_a_synopsis_of_the_supreme_court_of_canada_ruling">the charter rights of workers</a>. </p>
<p>To address the Supreme Court ruling, in 2014 the Harper government introduced <a href="https://www.justice.gc.ca/eng/rp-pr/other-autre/c36faq/">Bill C-36</a>. The new legislation targeted customers, making it illegal to purchase sexual services for money. Although selling sexual services remains legal, workers cannot <a href="https://www.justice.gc.ca/eng/rp-pr/other-autre/c36fs_fi/">advertise their services</a> nor can they communicate with customers regarding their services in a public place.</p>
<figure class="align-center ">
<img alt="Two women, one in a bikini carrying a red umbrella, another in a red tank top, black skirt and red cowboy hat, carry a banner between them that says, 'Sex workers' rights are human rights.' There is a crowd a few meters behind them." src="https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/348445/original/file-20200720-92332-1aps99i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women carrying a banner about sex worker rights in the Capital Pride Parade on Aug. 26, 2012, in Ottawa, Ontario.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Impact of criminal laws on workers’ lives</h2>
<p>Instead of enhancing workers’ rights and safety, Bill C-36 effectively <a href="https://theconversation.com/canadas-laws-designed-to-deter-prostitution-not-keep-sex-workers-safe-107314">criminalizes prostitution</a>, frames all sex work as <a href="https://globalnews.ca/news/5970549/canada-sex-work-decriminalization/">exploitative</a> and all workers as victims of trafficking. In my research team’s <a href="https://books.google.ca/books?id=M6T7BwAAQBAJ&pg=PT221&dq=going+%27round+again:+the+persistence+of+prostitution-related+stigma&hl=en&sa=X&ved=2ahUKEwjeofa7ysDqAhV2mXIEHdR1AngQ6AEwAHoECAAQAg#v=onepage&q=going%20'round%20again%3A%20the%20persistence">earlier work</a>, we found that this framing enhances the stigma tied to the industry, making it harder for adult workers to have the legitimacy of their labour recognized. In addition, it <a href="https://globalnews.ca/news/5970549/canada-sex-work-decriminalization/">increases the dangers</a> workers may experience and makes it harder for them to protect themselves while on the job.</p>
<p>Criminal laws tied to the sex industry also affect the financial security of workers. Under most circumstances, there can be a <a href="http://web2.uwindsor.ca/courses/sociology/maticka/star/pdfs/money_matters_prnt.pdf">legitimating effect</a> resulting from government recognition of forms of labour, via filing taxes and holding <a href="https://doi.org/10.1080/00224490509552256">municipal licenses</a>, to name a few options. However, to avoid coming to the attention of authorities and the associated risks (for example, surveillance, arrest, fines, jail time, lawyer bills), sex workers are less like to <a href="https://www.cbc.ca/news/canada/british-columbia/even-sex-workers-need-to-file-a-tax-return-vancouver-group-offers-tips-as-deadline-nears-1.4576674">file taxes</a>, which means they cannot benefit from EI, CPP/QPP and now federal COVID-19 relief funds.</p>
<figure class="align-center ">
<img alt="A neon sign says 'massage' in red capital letters with a green border." src="https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/348447/original/file-20200720-133010-mfeule.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Like other workers in the sexual service industry, massage parlour workers are also ensnared by the limits of the CERB and other income support programs.</span>
<span class="attribution"><span class="source">(Shutterstock.)</span></span>
</figcaption>
</figure>
<h2>Impact of failed campaign promises</h2>
<p>Even before COVID-19, <a href="https://www.ubcpress.ca/red-light-labour">research showed</a> the harmful impact of sex work policies like Bill C-36 that criminalizes customers. <a href="https://doi.org/10.3138/cjccj.52.3.285">As I noted</a> elsewhere, “The way to judge the justness of a state and its policies is by looking at how the most marginalized members of society are treated.” Despite a campaign pledge to reform Bill C-36, the Trudeau government <a href="https://globalnews.ca/news/5970549/canada-sex-work-decriminalization/">has yet to act</a>. </p>
<p>As the economy begins reopening, the federal government is <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/measures-reduce-community.html">putting an emphasis on plans</a> that protect workers, customers and the greater community from the spread of the virus. But how this applies to sex industry workers is unclear. </p>
<p>Unlike the <a href="http://www.bccdc.ca/Health-Info-Site/Documents/COVID19_SexWorkersGuidance.pdf">B.C. government</a>, which provided COVID-19 work guidelines for sex workers in May 2020, there are no federal government work or return-to-work guidelines for this industry. Instead sex workers are left to fend for themselves or turn to <a href="https://www.maggiesto.org/covid19">local organizations</a> and advocacy groups for assistance. Once again, people working in the sex industry are at the end of the list of government priorities.</p>
<h2>Needed action</h2>
<p>In a country whose populace <a href="http://www.ekospolitics.com/articles/FG-2011-03-23.pdf">values science-based policy</a>, we need to engage in policy development that can better protect sex workers, combating <a href="https://theconversation.com/the-stigma-of-sex-work-comes-with-a-high-cost-79657">marginalization and stigmatization</a>, and improving the overall occupational health and safety of those working in the industry. Similar to <a href="http://espu-usa.com/espu-ca/wp-content/uploads/2008/02/nz-health-and-safety-handbook.pdf">New Zealand</a>, orienting sex work policy around <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1755-618X.2011.01249.x">harm reduction and labour rights</a> will enable us as a country to better address the needs and rights of workers.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1266065807710154752"}"></div></p>
<p>The short-sightenedness of Bill C-36 and a <a href="https://www.macleans.ca/news/canada/governments-have-failed-canadas-sex-workers-and-theyre-running-out-of-patience/">failure to enact promised change</a> by the Trudeau government is more apparent now than ever. By fulfilling their campaign promise to this labour sector, the federal Liberals could deliver protection for people working in the sex industry, broadening the forms of labour protected by federal law. In doing so, people working in the sex industry will have their labour rights protected and will be less likely to <a href="https://www.cbc.ca/news/canada/hamilton/swap-hamilton-1.5517795">fall through the cracks</a>, especially when government assistance is so urgently needed.</p><img src="https://counter.theconversation.com/content/141746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacqueline Lewis has received funding from Health Canada and the Social Science & Humanities Research Council (SSHRC). </span></em></p>Work in the sexual services industry has been disrupted by the coronavirus pandemic and workers have been left without access to government support.Jacqueline Lewis, Associate Professor, Sociology, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/796572017-08-09T19:41:48Z2017-08-09T19:41:48ZThe stigma of sex work comes with a high cost<figure><img src="https://images.theconversation.com/files/181610/original/file-20170810-3852-gska2d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jules Kim, Zahra Stardust and Cameron Cox at the Festival of Dangerous Ideas.</span> <span class="attribution"><span class="source">Zahra Stardust</span></span></figcaption></figure><p><em>Although sex workers around the world lobby for decriminalisation, sex work law remains controversial. This is the final article in a <a href="https://theconversation.com/au/topics/sex-work-series-41416">series</a> exploring sex work and regulatory reform.</em></p>
<hr>
<p>Stigma is a mark of disgrace, a social discrediting, <a href="https://www.thoughtco.com/stigma-notes-on-the-management-of-spoiled-identity-3026757">or a spoiled identity</a>. For sex workers, legal, cultural and social discourse is characterised by <a href="https://books.google.com.au/books/about/Stigma_and_the_Shaping_of_the_Pornograph.html?id=tpNhCQAAQBAJ&redir_esc=y">“prurience, titillation, outrage and disgust”</a>.</p>
<p>Narratives of sex work as undesirable and sex workers as disposable victims are heavily steeped in our cultural imagination. </p>
<p>We need only think of the differential media treatment of <a href="https://theconversation.com/dehumanising-sex-workers-whats-prostitute-got-to-do-with-it-16444">the murders of Jill Meagher and Tracy Connelly</a> to learn that sex workers’ lives are deemed less valuable. Or the <a href="https://www.theguardian.com/media/2014/oct/08/mayang-prasetyo-killing-disrespectful-courier-mail-coverage-sparks-inquiry">Courier Mail’s reporting</a> on the horrific murder and dismembering of Mayang Prasyeto (<a href="http://www.presscouncil.org.au/document-search/adj-1650/">ruled “offensive” and “gratuitous”</a> by the Press Council), and Mia Freedman’s <a href="http://www.news.com.au/lifestyle/relationships/former-sex-worker-tells-freedman-to-save-the-apology/news-story/78f1bdcbd3a84cc0556125740a0458d5">infamous comments on ABC’s Q&A</a> that:</p>
<blockquote>
<p>No little girl grows up wanting to be a sex worker, thank heavens. </p>
</blockquote>
<p>Examining the individual and institutional treatment of sex workers reveals how <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.462.7005&rep=rep1&type=pdf">sexuality is organised and stratified</a>, and how certain kinds of intimacies are rewarded or punished. It exposes the ways in which the state <a href="https://butlerphile.files.wordpress.com/2010/06/regulating-sex-the-politics-of-intimacy-and-identity.pdf">“has a sexual agenda”</a> and demands mechanisms for accountability and redress.</p>
<h2>Systemic discrimination</h2>
<p><a href="http://www.scarletalliance.org.au/library/unjust-counterproductive">Research</a> has uncovered discrimination against sex workers in access to goods and services, housing and accommodation, employment opportunities and justice. </p>
<p>Sex workers report having their <a href="https://broadly.vice.com/en_us/article/gvzzkx/why-its-perfectly-legal-for-airbnb-to-discriminate-against-sex-workers">Airbnb accounts suspended</a>, their <a href="https://www.engadget.com/2015/12/02/paypal-square-and-big-bankings-war-on-the-sex-industry/">PayPal accounts closed down</a>, and being <a href="http://www.dailytelegraph.com.au/news/national/aussie-sex-workers-miffed-after-mastercard-places-worldwide-ban-on-customers-placing-adult-ads-on-backpagecom/news-story/e01c5dd61197e62a5a11fcc0ea8e18c1">banned from advertising</a>. </p>
<p>Both the Salvation Army and Family Protection Society have <a href="http://www.abc.net.au/news/2009-05-22/salvos-apologise-to-sex-workers-over-ads/1691098">publicly apologised to sex workers</a> for further stigmatising sex work in their fundraising campaigns. </p>
<p>Stigma is compounded for sex workers who work for survival, use illicit drugs, are trans or gender-diverse, Aboriginal or Torres Strait Islander, migrants or culturally and linguistically diverse, are parents, or work on the street. These communities experience <a href="http://www.theage.com.au/victoria/police-switch-position-on-push-to-curb-st-kildas-sex-trade-20160504-gom9f5.html">disproportionate levels of policing</a>, <a href="https://independentaustralia.net/life/life-display/australian-border-force-raid-massage-parlours,8112">harassment</a> and criminalisation. </p>
<p>Sex workers living with HIV have been incarcerated, <a href="http://www.tandfonline.com/doi/full/10.1016/S0968-8080%2810%2935496-6">despite no evidence</a> they have transmitted HIV or engaged in unsafe practices. </p>
<p>Discrimination is not an isolated experience. A New Zealand teacher who posed for Australian Penthouse was <a href="http://www.smh.com.au/breaking-news-world/nz-teacher-deregistered-over-penthouse-pic-20110503-1e5k4.html">deregistered</a>. In the US, a woman was charged with conduct <a href="http://www.nydailynews.com/new-york/education/education-dept-charges-bronx-teacher-ex-sex-worker-melissa-petro-conduct-unbecoming-article-1.470861">“unbecoming a teacher”</a> for merely writing about her prior sex work experience.</p>
<p>Not only do anti-discrimination protections for sex workers remain inconsistent and inadequate, but in 2012, Queensland anti-discrimination legislation was amended to deliberately permit discrimination <a href="http://www.abc.net.au/news/2012-11-02/hoteliers-given-power-to-evict-sex-workers/4350560">against sex workers</a> in providing accommodation. </p>
<h2>Legally complicit</h2>
<p>Stigma manifests in policy and regulatory frameworks that <a href="https://www.afao.org.au/article/sex-work-legislation-stands-way-australias-commitments-decriminalisation-sex-workers-health-safety-rights/">criminalise or licence sex work</a>, require sex workers to have mandatory medical testing or permanent registration on police or government databases, prohibit sex work from being visible from churches and hospitals, and local council policies that <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1742580">treat brothels as “outlaws”</a>.</p>
<p>Stigma puts sex workers at risk. Criminal and licensing laws create opportunities for violence where sex workers have to choose between safety and legality. </p>
<p>Mere knowledge of someone’s sex work can be used against them by abusive partners, as blackmail or suggesting they are unfit parents in custody cases. </p>
<p>Stigma is socially isolating. It reduces the options for sex workers to turn to for support and is recognised as a <a href="http://www.tandfonline.com/doi/abs/10.1080/13691058.2011.628411">critical barrier to accessing health care</a>, human rights, and justice. </p>
<h2>Global support for destigmatising sex work</h2>
<p>Former UN secretary-general Ban Ki-moon says discrimination against sex workers <a href="http://www.unaids.org/sites/default/files/sub_landing/files/JC2306_UNAIDS-guidance-note-HIV-sex-work_en.pdf">“must change”</a>. And former Australian High Court judge Michael Kirby says human rights for sex workers are a matter of <a href="https://www.parliament.nsw.gov.au/committees/DBAssets/InquirySubmission/Summary/51415/Submission%2082%20-%20Inquiry%20into%20the%20Regulation%20of%20Brothel%20-%20Redacted%20Version.pdf">“public morality”</a>. The UN Program on HIV/AIDS and the UN Population Fund <a href="http://www.hivpolicy.org/Library/HPP001830.pdf">insist upon</a> universal rights and access to justice for sex workers. </p>
<p>Eliminating the negative impact of stigma and discrimination against sex workers remains an objective of <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/8E87E65EEF535B02CA257BF0001A4EB6/$File/HIV-Strategy2014-v3.pdf">Australia’s national strategies</a> tackling HIV, viral hepatitis, and sexually transmitted infections. Protecting sex workers from discrimination falls within <a href="http://www.scarletalliance.org.au/library/stardust_2014">Australia’s international human rights obligations</a>.</p>
<p>Despite this, there is no national system in place to assess and monitor experiences of stigma among sex workers in Australia. Without these mechanisms, we cannot effectively implement <a href="https://www.ncbi.nlm.nih.gov/pubmed/17130068">strategies to reduce stigma</a>.</p>
<h2>Stigma reduction</h2>
<p>Reducing stigma requires not only legal and policy change, but cultural change. </p>
<p>There are obvious first steps: <a href="http://www.scarletalliance.org.au/library/principles_2014">decriminalisation of sex work</a>, anti-discrimination protections, and funding for peer-driven rights-based sex worker organisations. But these steps alone are not enough. </p>
<p>Researching and monitoring the prevalence, manifestations and implications of stigma is crucial to developing strategies to reduce its impact. </p>
<p>UNSW’s <a href="https://csrh.arts.unsw.edu.au/research/projects/stigma-indicators/,">Centre for Social Research in Health</a> in partnership with <a href="http://www.scarletalliance.org.au/who/">Scarlet Alliance</a>, is currently conducting qualitative focus groups on sex work stigma in Australia. This pilot project will inform the future development of a national quantitative survey instrument that can be used annually to measure sex work stigma in Australia. </p>
<p>The development of national stigma indicators will allow for concrete targets to be set to reduce stigma. This data can be used as a foundation for stigma reduction interventions, such as media audit tools or regulatory guidelines. </p>
<h2>Emotional costs of stigma</h2>
<p>Sex workers continue to mobilise, engage and fight against stigma. The hashtags #rightsnotrescue and <a href="http://www.news.com.au/lifestyle/real-life/true-stories/australian-sex-workers-fight-back-against-industry-stigma/news-story/e0f2aabf1e261a074d1668afb0ae2fe9">#facesofprostitution</a> are examples of the diverse human faces behind sex work.</p>
<p>But one of the most insidious consequences of stigma is its ability to curtail the capacity of sex workers to fight for basic human rights. </p>
<p>Both external and internalised stigma <a href="https://link.springer.com/article/10.1007/s12119-011-9120-3">impacts the mental health and emotional resilience</a> of sex workers to engage in advocacy, organising and activism. Stigma feels heavy. Stigma is exhausting. Stigma is grieving the death of <a href="https://www.crikey.com.au/2015/10/21/to-hell-with-your-morality-decriminalising-sex-work-saves-lives/">another community member and friend</a>. </p>
<p>The sheer weight of stigma is an intergenerational burden passed on and held by sex workers. The greatest travesty is that stigma directs sex workers’ energies to the reactive work of responding to sensationalist headlines or political expediency and diverts it from peer education, community building and world-making – the very generative work that allows us to survive and thrive. </p>
<hr>
<p><em>Read the rest of the articles in this series <a href="https://theconversation.com/au/topics/sex-work-series-41416">here</a>.</em></p><img src="https://counter.theconversation.com/content/79657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zahra Zsuzsanna Stardust is a researcher on the Sex Work Stigma Indicators project conducted by the Centre for Social Research in Health in partnership with Scarlet Alliance. </span></em></p>Stigma continues to inform legal, social and cultural attitudes towards sex work and remains a barrier to health, human rights and justice. Developing stigma indicators is one step towards change.Zahra Zsuzsanna Stardust, PhD Candidate, Arts/Media & Law, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/785872017-06-30T00:04:01Z2017-06-30T00:04:01ZWhy do so many gay and bisexual men die from suicide?<figure><img src="https://images.theconversation.com/files/173670/original/file-20170613-30067-hp6q6t.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A photo entitled "Apprehension" is part of the Still Here project at the University of British Columbia's Men's Health Research Program. The project uses photos to engage gay and bisexual men who have previously struggled with suicide.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>Gay and bisexual men are <a href="http://dx.doi.org/10.2105/AJPH.2016.303088">four times more likely</a> to attempt suicide in their lifetime than heterosexual men. Researchers now estimate that <a href="http://dx.doi.org/10.1080/09581596.2014.946887">suicide kills more gay and bisexual men than AIDS</a>. Despite this well-documented inequity, there are no targeted suicide prevention programs in Canada. Gay and bisexual men are rarely mentioned in mental health policies.</p>
<p>Homophobia — within families, schools, communities and even in doctors and counsellors offices — is a key cause, according to the <a href="http://www.stillhereproject.ca">Still Here</a> project within the Men’s Health Research Program at the University of British Columbia.</p>
<p>As a postdoctoral research fellow in nursing at the University of British Columbia, I work on the Still Here project to engage gay and bisexual men who have previously struggled with suicide (or who have lost another gay or bisexual man to suicide) to tell their stories through photographs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174101/original/file-20170615-24962-o4z1xy.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A photo entitled <em>No answers – but occasional evidence of beauty in non-conformity</em>.</span>
<span class="attribution"><span class="source">(Still Here Project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Twenty-nine gay and bisexual men have participated in Still Here thus far, contributing more than 300 photographs. Each participant met with a research team member to describe his photographs and to share his story. Together, these photos and stories are helping us better understand the multiple factors that lead gay and bisexual men to consider suicide.</p>
<h2>Homophobia a common theme</h2>
<p>Each story is unique and we are finding that the reasons gay and bisexual research participants consider suicide are varied. Homophobia is, however, a common theme uniting all the stories and photos. </p>
<p>Most of the men in our study spoke of experiences of violence, bullying and family rejection because of their sexuality. Others learned to internalize society’s negative view of gay and bisexual people.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174102/original/file-20170615-24971-1wr13mm.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The photo <em>Washing the fear away</em>.</span>
<span class="attribution"><span class="source">(Still Here project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Many Still Here participants also described how they were confronted with homophobia and stigmatizing attitudes when they opened up to talk about their feelings to their doctor or counsellor.</p>
<p>Because of homophobia, men described feeling isolated, lonely and invisible. These feelings often led to depression, sentiments of helplessness and thoughts of suicide. </p>
<p>Homophobia is not the only reason these men contemplated suicide. It was often coupled with mental illness, financial problems or losing a job. For some, it was an abusive relationship, or the end of a relationship, that contributed to their thoughts of suicide.</p>
<h2>Breaking the silence</h2>
<p>We need to break the silence around suicide. There is a pervasive myth that talking about suicide encourages it. But not talking about it perpetuates shame and stigma. Many Still Here participants described how they felt very alone with their suicidal thoughts because it is not something that people openly talk about. This silence made it harder for them to ask for help.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174099/original/file-20170615-24971-2kvr0g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A photo called <em>I am locked in the closet and hope to free myself. But I am scared</em>.</span>
<span class="attribution"><span class="source">(Still Here project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>To spark a conversation on suicide, the Still Here participants worked with the research team to host several exhibits of their photographs. These exhibits have had a powerful impact on those who viewed them, and provided space and inspiration for people to share their own stories and discuss prevention.</p>
<p>To extend the reach of these photographs, the Still Here project launched an online gallery at <a href="http://www.stillhereproject.ca">www.stillhereproject.ca</a> that has now been visited by thousands of individuals worldwide.</p>
<h2>Prevention strategies</h2>
<p>The first prevention strategy is to improve mental health services for gay and bisexual men. Accessing mental health services is difficult. The barriers are numerous and include cost, long wait lists and the fact that many health professionals have difficulty discussing suicide. Also, men are often offered pills to deal with their depression when they would rather talk to someone.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174104/original/file-20170615-24962-17r1igb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A photo called <em>Left behind</em>.</span>
<span class="attribution"><span class="source">(Still Here project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Mental-health professionals and doctors also need better training to address the complex needs of gay and bisexual men, and to reduce homophobic and stigmatizing attitudes.</p>
<p>As a society we need to work harder to resist stigma. Legal progress has been made in Canada for sexual minorities but homophobia continues to impact the lives of many gay and bisexual men. A study published in 2015 found that <a href="http://dx.doi.org/10.1186/s12889-015-1961-5">half of gay and bisexual men have been harassed or bullied because of their sexuality</a>. One in 10 has been gay-bashed. </p>
<p>If we do not eliminate homophobia and if we fail to change perceptions of mental illness, gay and bisexual men will continue to endure high rates of suicide.</p>
<p><em>If you are feeling distressed or are concerned about a friend, family member or work colleague, visit <a href="http://www.suicideprevention.ca">www.suicideprevention.ca</a> to find a crisis centre near you.</em></p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174105/original/file-20170615-24943-26it92.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A photo entitled <em>Bad day</em></span>
<span class="attribution"><span class="source">(Still Here project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/174106/original/file-20170615-24971-18c1agw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A photo entitled <em>A way out</em>.</span>
<span class="attribution"><span class="source">(Still Here project)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/78587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Still Project was funded by the Movember Foundation. </span></em></p>Pride Month: It’s time to talk about the shockingly high rate of suicide among gay and bisexual men. Photos and stories in the Still Here project document the complex reasons.Olivier Ferlatte, Postdoctoral Research Fellow of Men's Health Research, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/607722016-07-25T03:23:09Z2016-07-25T03:23:09ZHooking up on campus: Sexual double standards may leave students feeling disempowered<p>Over the past few years, there has been a steady flow of articles in magazines, newspapers and online news outlets examining what hookup culture on college campuses means for sexual norms and behaviors among young adults, <a href="http://www.nytimes.com/2013/07/14/fashion/sex-on-campus-she-can-play-that-game-too.html?pagewanted=all">particularly young women</a>. </p>
<p>Some writers suggest women who participate in hookup culture often feel like outsiders struggling to navigate a territory where <a href="http://qz.com/685852/hookup-culture/">young men set the terms</a> of sexual activity. Still, with similar proportions of college men and women hooking up, others wonder if hookup culture might be <a href="http://www.theatlantic.com/magazine/archive/2012/09/boys-on-the-side/309062/">liberating for young women</a>. Perhaps it’s even a sign that the traditional sexual double standard is a thing of the past. </p>
<p>This isn’t an easy question to answer. On the one hand, college hookup culture allows women to explore their sexuality in ways that previous generations of women could not. On the other hand, it is a <a href="http://dx.doi.org/10.1080/08164649.2011.546333">deeply gendered</a> custom that can enhance a man’s reputation and damage a woman’s.</p>
<p>As a sociologist who studies gender and sexuality, I decided to explore the status of the traditional sexual double standard in college hookup culture. Do college students today support it, and if so, to what degree?</p>
<h2>Contemporary status of the traditional double standard</h2>
<p>In 1960 sociologist <a href="https://kiweb.webtest.iu.edu/collections/archival/ira-l-reiss-collection.php">Ira Reiss</a> published “<a href="https://books.google.com/books/about/Premarital_sexual_standards_in_America.html?id=LgQdAAAAYAAJ">Premarital Sexual Standards in America,”</a> inspiring decades of research on a traditional double standard that is used to judge women more harshly than men for engaging in similar sexual behaviors. </p>
<p>So, what does all this subsequent research say about the status of this double standard today? </p>
<p><a href="http://link.springer.com/article/10.1007%2Fs11199-008-9542-z">Some studies</a> indicate the traditional double standard is still relevant. <a href="http://dx.doi.org/10.1016/j.ssresearch.2013.04.006">Others</a> indicate it has been surpassed by an egalitarian standard where men and women are judged similarly for engaging in similar behaviors and that some college students even use a <em>reverse</em> sexual double standard to judge men more harshly than women. </p>
<p>Why are these findings so mixed? One <a href="http://dx.doi.org/10.1300/J056v13n02_05">explanation</a> is that contemporary college students tend to believe that the traditional double standard exists in society, but not in their own minds. In other words, they think they don’t judge women more harshly than men, but they believe others do.</p>
<p>In fact, findings from a number of studies indicate both men and women expect college women to be negatively judged (presumably by others) for “going too far” on a hookup. This can have real implications for power dynamics in sexual encounters.</p>
<p>In their interviews with college women, sociologists <a href="http://dx.doi.org/10.1177/0891243209345829">Laura Hamilton and Elizabeth A. Armstrong</a> found that some attributed their negative experiences with hookups to men’s endorsement of the traditional double standard. These women believed the traditional double standard gave men power in hookups and justified the disrespectful treatment of women.</p>
<p>This suggests that when <em>men</em> endorse the traditional double standard it has implications for women’s experiences with college hookups. So how common is it for men to endorse the traditional double standard? Do women tend to endorse a different standard? And what does judgment of sexual behavior mean for power dynamics in hookups?</p>
<p>I explored <a href="http://dx.doi.org/10.1080/00224499.2016.1145181">these questions</a> using data from a sample of over 11,000 students who responded to the <a href="http://www.nyu.edu/projects/england/ocsls/">Online College Social Life Survey</a>. </p>
<h2>Sexual double standards and power in college hookups</h2>
<p>Since college students often believe that double standards exist in society, but not in their own minds, I paid particular attention to respondents’ belief that a past hookup partner had lost respect for them after a hookup.</p>
<p>I found that most respondents judged men and women similarly for similar sexual behaviors. However, when I broke the results down by sex, an interesting pattern emerged. Approximately 45 percent of men endorsed the traditional double standard, while about 33 percent of women endorsed the reverse double standard. In other words, men’s judgments of women were generally harsher than women’s judgments of men.</p>
<p>Additionally, over half of women reported feeling that they had been disrespected for hooking up, compared to 22 percent of men. This suggests that the traditional double standard is still relevant, even if college students believe that it only exists outside of their own minds.</p>
<p>I also found that a respondent’s belief that he or she had been personally disrespected by a previous hookup partner was associated with power disadvantages in their most recent hookup. </p>
<p>The respondents who reported feeling disrespected were more likely to engage in sexual acts that they did not personally desire. This included performing sexual acts to please their partner and giving in to verbal pressure to have sex when they didn’t want to. Importantly, this was the case for both men and women in the study.</p>
<h2>Stigma about sex doesn’t help anybody</h2>
<p>It’s possible that popular discourse about hookup culture may benefit young people if it promotes neutral perspectives that do not portray <em>anyone</em> negatively for hooking up. </p>
<p>The fact is, as these findings show, there is a relationship between stigmatization of sexual behavior and sexual disempowerment for young people. When young adults feel judged for past sexual behavior, they may have trouble expressing their desires and setting limits with future partners.</p>
<p>Ultimately, judgment does nothing to promote the development of healthy sexuality among young people.</p><img src="https://counter.theconversation.com/content/60772/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Hensman Kettrey does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>College students often believe that double standards exist in society, but not in their own minds.Heather Hensman Kettrey, Research Associate, Peabody Research Institute, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/610012016-06-16T09:55:26Z2016-06-16T09:55:26ZWhere does anti-LGBT bias come from – and how does it translate into violence?<p>In the United States, public support of the lesbian, gay, bisexual and transgender (LGBT) community has <a href="http://dx.doi.org/10.1111/1468-2508.t01-1-00133">increased in recent years</a>. These changes are associated with increased visibility of openly gay characters on television, the repeal of “<a href="https://www.whitehouse.gov/the-press-office/2011/09/20/statement-president-repeal-dont-ask-dont-tell">don’t ask, don’t tell”</a> and the Supreme Court decision that <a href="http://www.supremecourt.gov/opinions/14pdf/14-556_3204.pdf">legalized same-sex marriage</a>.</p>
<p>Nevertheless, violence against sexual minorities remains a <a href="http://www.fbi.gov/about-us/cjis/ucr/hate-crime/2013/topic-pages/victims/victims_final.pdf">major public health problem in the U.S.</a> and <a href="http://fra.europa.eu/sites/default/files/memo-fra-s-eu-lgbt-survey_en.pdf">internationally</a>. A recent study concluded that approximately 50 percent of LGBT adults <a href="http://dx.doi.org/10.1177/0886260508316477">experience bias-motivated aggression</a> at some point.</p>
<p>For every highly publicized act of violence toward sexual minorities, such as the recent <a href="https://theconversation.com/us/topics/orlando-shooting-2016">mass shooting at a gay nightclub in Orlando</a>, there are many more physical and verbal assaults, attempted assaults, acts of property damage or intimidations which are <a href="http://www.avp.org/storage/documents/Reports/2014_HV_Report-Final.pdf">never reported to authorities</a>, let alone publicized by the media.</p>
<p>What spurs on these acts of violence? Can we do anything to prevent them? Fortunately, an extensive body of social science research exists that identifies perpetrators’ motivations and suggests ways we can reduce the likelihood of these acts of aggression toward sexual minorities.</p>
<h2>Reinforcing the roots of antigay bias</h2>
<p>Prejudice toward sexual minorities is rooted in what psychologists call sexual stigma. This is an attitude that reflects “the <a href="http://dx.doi.org/10.1111/j.1540-4560.2007.00544.x">negative regard, inferior status and relative powerlessness</a> that society collectively accords to any nonheterosexual behavior, identity, relationship or community.”</p>
<p>Sexual stigma exists and operates at both individual and society-wide levels.</p>
<p>At the societal level, sexual stigma is referred to as heterosexism. The conviction that heterosexuals and their behaviors and relationships are superior to those of sexual minorities is built into various social ideologies and institutions – including religion, language, laws and norms about gender roles. For example, religious views that homosexual behavior is immoral support heteronormative norms, which ultimately stigmatize sexual minorities.</p>
<p>On an individual level, heterosexuals can internalize sexual stigma as sexual prejudice. They buy into what they see around them in their culture that indicates sexual minorities are inferior. Consider the <a href="https://www.washingtonpost.com/politics/supreme-court/2013/06/26/f0039814-d9ab-11e2-a016-92547bf094cc_story.html">Defense of Marriage Act</a>. This legislation, which defined marriage as a union between one man and one woman, denied homosexuals the rights held by heterosexuals. Heterosexuals can incorporate that stigmatizing view into their own belief system. </p>
<p>Sexual minorities themselves can internalize sexual stigma, too – <a href="http://dx.doi.org/10.1111/j.1540-4560.2007.00544.x">a process called self-stigma</a>. Aligning their own self-concept with society’s negative regard for homosexuality results in myriad negative health outcomes.</p>
<p>The heterosexism of our society and the sexual prejudice of individuals are interrelated, reinforcing each other. When cultural ideologies and institutions espouse heterosexism, they provide the basis for individuals’ sexual prejudice – and perpetration of violence based on it. Conversely, researchers theorize that pro-gay attitudes reduce heterosexism that exists within these same institutions.</p>
<h2>Beyond prejudice: a masculinity problem</h2>
<p>Many people believe that antigay violence is caused by prejudice. To a certain extent, they’re correct. But when we back up and think about this aggression within the framework of sexual stigma, we can see that the causes of antigay violence run deeper and are more complex than a simple “prejudice” explanation.</p>
<p>Perpetrators of anti-LGBT aggression may or may not hold prejudiced attitudes, but they carry out their violence within a heterosexist society that implicitly sanctions it. It’s these society-level heterosexist attitudes that provide the foundation for three well-established <a href="http://dx.doi.org/10.1016/j.cpr.2008.02.001">motivations and risk factors</a> for <a href="http://dx.doi.org/10.1177/088626000015004001">aggression toward sexual minorities</a>.</p>
<p>Heterosexual masculinity is a fundamental factor that starts to explain anti-LGBT violence. To be masculine, one must be heterosexual, so the thinking goes. The logic continues that any man who’s not heterosexual is therefore feminine. In essence, a man’s aggression toward sexual minorities serves to enforce traditional gender norms and demonstrate his own heterosexual masculinity to other men. </p>
<p>Researchers have identified two major aspects of this <a href="http://dx.doi.org/10.1037/a0021581">masculinity-based motivation</a>.</p>
<p>The first is adherence to norms about status – the belief that men must gain the respect of others. The status norm reflects the view that men should sit atop the social hierarchy, be successful, and garner respect and admiration from others.</p>
<p>The second is a strong conviction in antifemininity – that is, believing men should <a href="http://dx.doi.org/10.1111/j.1467-6494.2009.00577.x">not engage in stereotypically feminine activities</a>. Men who endorse this norm would not engage in behaviors that are “traditionally” reserved for women – for instance, showing vulnerable emotions, wearing makeup or working in childcare.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/126855/original/image-20160616-19925-gjgqyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A narrow definition of what constitutes ‘masculinity’ is at the root of anti-LGBT violence.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic.mhtml?id=269291762&src=id">Tea party image via www.shutterstock.com.</a></span>
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</figure>
<p>Other norms can also lead to violence under certain circumstances. For instance, recent data indicate that <a href="http://dx.doi.org/10.1037/a0036427">alcohol intoxication may trigger</a> thoughts that men need to be tough and aggressive. Being drunk and having toughness in mind may influence men to act in line with this version of masculinity and attack gay men.</p>
<p>In the most common aggression scenario, an assailant is in a group when he becomes violent toward a member of a sexual minority. The attacker has the support of his group, which can act as a motivator. Indeed, the male peer group is the ideal context for proving one’s masculinity via aggression because other males are present to witness the macho display.</p>
<p>Studies also indicate that perpetrators of hate crimes, including violence toward sexual minorities, seek to alleviate boredom and have fun – termed thrill-seeking. It’s important to note that for thrill-seeking assailants, the selection of sexual minority targets is not random. Given that sexual stigma devalues homosexuality, it sanctions these perpetrators’ strategic choice of a socially devalued target.</p>
<h2>Translating motivations into violence</h2>
<p>How does a given perpetrator get to the point where he decides to attack a sexual minority? Research suggests it’s a long process.</p>
<p>Through personal experience and from social institutions, people learn that LGBT people are “threats” and heterosexuals are “normal.” For example, throughout adolescence, boys consistently have it drilled into them by peers that they need to be masculine and antifeminine. So when a young boy teases a gay person, verbally intimidates that person or hits him, he gets positive reinforcement from his peers.</p>
<p>As a result of these processes, we learn over time to almost automatically view sexual minorities with lower social regard and as a threatening group. </p>
<p>Recent research suggests two types of threats – <a href="https://books.google.com/books?id=Oo55AgAAQBAJ&lpg=PP1&ots=FaJMZWq4MD&dq=Intergroup%20threat%20theory.%20Handbook%20of%20prejudice%2C%20stereotyping%2C%20and%20discrimination&lr&pg=PA43#v=onepage&q=Intergroup%20threat%20theory.%20Handbook%20of%20prejudice,%20stereotyping,%20and%20discrimination&f=false">realistic and symbolic</a> – may lead to sexual prejudice and a heightened risk for anti-LGBT aggression. It doesn’t matter whether an actual threat exists – it’s one’s <em>perception</em> of threat that is critical.</p>
<p>A group experiences realistic threat when it perceives sexual minorities as threats to its existence, political and economic power or physical well-being. For example, heterosexuals may fear that pro-gay policies such as the legalization of same-sex marriage will make it harder to advance their own alternative political agendas. In this way, they should perceive a gay man as a direct threat to their own political power.</p>
<p>Symbolic threat reflects a heterosexual’s perception that sexual minorities’ beliefs, attitudes, morals, standards and values will lead to unwanted changes in his or her own worldview. For instance, a highly religious heterosexual may fear that a same-sex relationship or marriage <a href="http://dx.doi.org/10.1111/j.1540-4560.2005.00433.x">poses a threat to his or her own values and beliefs</a>.</p>
<h2>Can we prevent anti-LGBT violence?</h2>
<p>Sexual stigma may be reduced by targeting the processes that lead to sexual prejudice. For example, studies indicate that heterosexuals who have a close relationship with an LGBT individual <a href="http://dx.doi.org/10.1037/0022-3514.90.5.751">report lower levels of sexual prejudice</a>. That’s probably because positive feelings regarding the friend are generalized to all sexual minorities.</p>
<p>These kinds of experiences may help lessen heterosexism within various social contexts. But given the widespread nature of bias-motivated aggression and the ubiquity of heterosexism, these individual-level approaches are likely insufficient on their own. </p>
<p>If we’re serious about tackling the public health issue of anti-LGBT violence, we need to try to reduce heterosexism at the societal level. Succeeding at that should lead to corresponding reductions in sexual prejudice and antigay violence. </p>
<p>There are a few prongs to a societal level approach. Changing public policies – things like hate crime legislation, repealing “don’t ask, don’t tell,” legalizing same-sex marriage – can work to reduce heterosexism. Likewise, positive portrayals of sexual minorities in the media and popular culture can contribute to changing views. Social norms interventions that work to correct misperceptions of LGBT people can help, too.</p><img src="https://counter.theconversation.com/content/61001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominic Parrott receives funding from the National Institute on Alcohol Abuse and Alcoholism.</span></em></p>Aggression against sexual minorities is rooted in society-level stigmas that devalue LGBT individuals.Dominic Parrott, Professor of Psychology, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.