tag:theconversation.com,2011:/global/topics/gay-health-7633/articlesGay health – The Conversation2021-02-14T18:49:22Ztag:theconversation.com,2011:article/1531902021-02-14T18:49:22Z2021-02-14T18:49:22Z‘You never know if you will be treated properly and with respect’: voices of LGBTIQA+ people who lived through disasters<p>When disaster strikes, not everyone is affected the same way. A growing body of <a href="https://www.tandfonline.com/doi/abs/10.1080/0966369X.2013.802673">research</a> shows the experiences of sexually and gender diverse people are frequently very different to those of heterosexual people.</p>
<p>Our <a href="https://researchdirect.westernsydney.edu.au/islandora/object/uws:53735/">research</a> in Australia and New Zealand sought to explore and make visible the experiences of lesbian, gay, bisexual, trans and intersex people, among other sexual and gender identities.</p>
<p>People who are lesbian, gay, bisexual, transgender, intersex or queer can have quite different experiences but are often incorrectly lumped together as one “community”. In fact, there are multiple communities.</p>
<p>For our research, we wanted to know how disasters <a href="https://www.tandfonline.com/doi/abs/10.1080/14649365.2016.1153137">affected</a> these people and communities, about their experiences with government and other support agencies and what positive experiences they’d had of resilience, <a href="https://www.tandfonline.com/doi/abs/10.1080/0966369X.2015.1136806">coping</a> and adapting.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/you-cant-talk-about-disaster-risk-reduction-without-talking-about-inequality-153189">You can't talk about disaster risk reduction without talking about inequality</a>
</strong>
</em>
</p>
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<h2>‘You never know if you will be treated properly and with respect’</h2>
<p>It became clear LGBTIQA+ people are differently vulnerable in disasters and their aftermath. Fear, marginalisation, misunderstanding, exclusion and discrimination are all factors to contend with, on top of the other personally and financially devastating impacts of disaster.</p>
<p>Many LGBTIQA+ people do not openly reveal their sexual and gender identities. However, if your home is damaged or you need to evacuate to a public shelter shared with possibly hundreds of other people, your identity can become very obvious.</p>
<p>One <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2015.1136806">person</a> told us:</p>
<blockquote>
<p>I wasn’t fully out at this time so I already had to hide things.</p>
</blockquote>
<p>In many instances, becoming “visible” when disaster strikes resulted in verbal abuse or worse. One person <a href="https://ro.uow.edu.au/cgi/viewcontent.cgi?article=4684&context=sspapers&httpsredir=1&referer=">told us</a> that while videoing flooding, he was accused of being a paedophile.</p>
<p>Accessing support services can be stressful and problematic, with one person <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2017.1334632">telling</a> us:</p>
<blockquote>
<p>It is always a bit of a concern outing myself.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A same sex couple hug." src="https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383159/original/file-20210209-15-ldz51f.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>
<figcaption>
<span class="caption">In many instances, becoming ‘visible’ when disaster strikes resulted in verbal abuse or worse.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/@kernieflakes?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText%22>courtney%20coles</a>%20on%20<a%20href=%22https://unsplash.com/s/photos/lgbt-wildfire?utm_source=unsplash&amp;utm_medium=referral&amp;utm_content=creditCopyText">Photo by courtney coles on Unsplash.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Uncertainty can weigh heavily on some, as <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2015.1136806">one</a> person explained:</p>
<blockquote>
<p>Discrimination when accessing mainstream services is always an issue – you never know if you will be treated properly and with respect.</p>
</blockquote>
<p>Another <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2015.1136806">said</a>:</p>
<blockquote>
<p>I would have been concerned my relationship may not have been accepted in mainstream support services.</p>
</blockquote>
<p>One person <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2015.1136806">described</a> how</p>
<blockquote>
<p>I was concerned that if I needed direct contact assistance that I would have been either judged or misidentified concerning my gender.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young man looks serious while an older relative stands in the background." src="https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383163/original/file-20210209-23-1c1d79u.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>
<figcaption>
<span class="caption">If your home is damaged in a disaster or you lose work because of a pandemic, moving in with parents or other family isn’t always a simple solution.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>If your home is damaged, moving in with parents or other family isn’t always a simple solution, as stories from some people made clear:</p>
<blockquote>
<p>I went home and was stuck in the house all week with my family because I
can’t drive and there was no public transport […] My family were not aware at
the time that I was dating anyone – and it wasn’t something I was going to
disclose – so it wasn’t something I could talk about.</p>
<p>I stayed with my cousins, who were quite conservative […] I had to shut off
some part of my identity for a little while. </p>
</blockquote>
<p>We also found an <a href="https://www.tandfonline.com/doi/abs/10.1080/00918369.2016.1172901">absence of queer stories from most mainstream media coverage</a> contributed to a narrative that constructed disasters as experienced exclusively by heterosexual families.</p>
<h2>Unwelcoming spaces</h2>
<p>In evacuation shelters, bathrooms and toilets are usually divided in to “male” and “female” spaces. For some LGBTIQA+ people, being forced into a female/male bathroom space where their bodies become visible to others can be highly traumatic. That’s often due to previous experiences of discrimination, harassment and violence.</p>
<p>For transgender people — particularly those in a process of transitioning — single-sex, heteronormative public bathrooms can be utterly overwhelming. </p>
<p>Some people spoke of being blamed for disaster. One person <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2017.1334632">said</a>:</p>
<blockquote>
<p>There were religious nutters saying the queers had caused the quakes.</p>
</blockquote>
<p>In the wake of flooding, one person <a href="https://ro.uow.edu.au/cgi/viewcontent.cgi?article=4684&context=sspapers&httpsredir=1&referer=">said</a>:</p>
<blockquote>
<p>People were targeting groups of gay people in town as our ‘behaviour’ had
brought this upon the community as a whole. So I was told on many
occasions.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Floodwaters cut off a road." src="https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383170/original/file-20210209-13-vtrrz3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some spoke of being blamed for floods.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Emergency responses are sometimes <a href="https://www.sciencedirect.com/science/article/abs/pii/S2212420916300097">outsourced to third party, faith-based Christian institutions</a>. It is worth noting such organisations have not always been consistently welcoming for LGBTIQA+ people.</p>
<p>More research is needed on the experiences and needs of LGBTIQA+ people (including those of faith) and how faith-based institutions might support LGBTIQA+-inclusive response and recovery.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two older men look into the distance while wearing masks." src="https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383172/original/file-20210209-17-2kqqbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The current COVID-19 pandemic is an example of how pandemics can be experienced differently by many LGBTIQA+ people.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Pandemics are disasters too</h2>
<p>Climate change and environmental degradation has heightened <a href="https://theconversation.com/coronavirus-is-a-wake-up-call-our-war-with-the-environment-is-leading-to-pandemics-135023">the risk of pandemics</a>. The current COVID-19 pandemic is an example of how pandemics can be experienced differently by many <a href="https://theconversation.com/coronavirus-lockdown-lgbtq-people-face-hostility-and-loneliness-135974">LGBTIQA+ people</a> (especially those who are younger and in precarious work or housing). </p>
<p>The current pandemic forced some LGBTIQA+ people to move to the parental home after losing work. This can force people back into the closet as they try to fit into expectations of unwelcoming families — an incredibly stressful experience.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A same sex couple wake in the haze." src="https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383171/original/file-20210209-23-ogn8b5.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>
<figcaption>
<span class="caption">Across our research, we also encountered many examples of resilience, coping and adaptation.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Resilience and mutual support</h2>
<p>Across our research, we also encountered many examples of resilience, coping and adaptation. For example, online communities of support spontaneously emerged after some disasters, allowing people to advertise safe accommodation for others.</p>
<p>Some people spoke of relying on the LGBTIQA+ community for help:</p>
<blockquote>
<p>I wasn’t going to leave my place but my LGBT friends (that live 10 houses
away) woke me in the middle of the night to inform me both ends of our road
had flooded in. We ended up getting my car out, through back yard access
and knocking down a fence.</p>
</blockquote>
<p>The United Nations <a href="https://www.undrr.org/publication/sendai-framework-disaster-risk-reduction-2015-2030">states</a> disaster preparedness, response and recovery arrangements and services should be uniformly available to all, but sensitive to the unique needs different members of our community have. As our research makes clear, much work lies ahead if we are to achieve that goal.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/domestic-violence-soars-after-natural-disasters-preventing-it-needs-to-be-part-of-the-emergency-response-151838">Domestic violence soars after natural disasters. Preventing it needs to be part of the emergency response</a>
</strong>
</em>
</p>
<hr>
<p><em>This story is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay foundation. You can read the rest of the stories <a href="https://theconversation.com/au/topics/disaster-and-resilience-series-97537">here</a>.</em></p><img src="https://counter.theconversation.com/content/153190/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dale Dominey-Howes receives funding from the Australian Research Council, the Global Resilience Partnership and State and Federal disaster management sources. </span></em></p>When disaster strikes, not everyone is affected the same way. Research shows the experiences of sexually and gender diverse people are frequently very different to those of heterosexual people.Dale Dominey-Howes, Professor of Hazards and Disaster Risk Sciences, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/969042018-06-04T02:48:46Z2018-06-04T02:48:46ZHow stigma impacts LGB health and wellbeing in Australia<figure><img src="https://images.theconversation.com/files/221473/original/file-20180604-142086-cth8qc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">LGB people are overall happier and healthier in communities with fewer 'no' votes in last year's same-sex marriage referendum. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Research in <a href="https://www.humanrights.gov.au/sites/default/files/document/publication/SOGII%20Rights%20Report%202015_Web_Version.pdf">Australia</a> and <a href="http://www.oecd.org/els/soc/LGBTI-in-OECD-Countries-A-Review-Valfort-2017.pdf">internationally</a> has documented poor health and wellbeing among LGBTQI people compared to heterosexual people. What’s less understood are the reasons why. </p>
<p>A dominant theory, the <a href="http://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress.aspx">minority stress</a> model, suggests that the discrimination and stigmatisation experienced by LGBTQI people in their everyday lives are to blame. </p>
<p>While several studies have been conducted to back up these claims in the <a href="https://www.tandfonline.com/doi/full/10.1080/15374416.2016.1247360?src=recsys">US</a>, my recent research with student Abram Todd at The University of Queensland is the first to examine this issue in Australia.</p>
<h2>Mapping community levels of stigma</h2>
<p>Our <a href="https://www.sciencedirect.com/science/article/pii/S0277953618302508">study</a> is partially based on the results of the 2017 same-sex marriage postal survey, made <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1800.0Main+Features382017?OpenDocument">publicly available</a> by the Australian Bureau of Statistics.</p>
<p>We determined where stigmatisation of LGB communities might be highest by identifying those electoral divisions that recorded the highest shares of “no” voters - defined as the number of people voting “no” out of the total number of people in the electorate invited to vote. To determine areas with low stigmatisation, we tracked the electoral divisions with the lowest shares of “no” voters. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/homophobia-is-a-health-hazard-not-just-for-ian-thorpe-29148">Homophobia is a health hazard, not just for Ian Thorpe </a>
</strong>
</em>
</p>
<hr>
<p>We then linked these electorate data to a national social survey of Australians aged 15 and older, the <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia (HILDA) Survey</a>. The HILDA Survey contains information on the sexual identity, health and wellbeing of 15,986 respondents, of whom 554 identified as lesbian, gay or bisexual. (The survey did not ask respondents whether they identified as transgender, queer or intersex.) </p>
<p>We examined the health and wellbeing of the people who responded to the survey using three standard measures:</p>
<ul>
<li><p>a <a href="https://www.ncbi.nlm.nih.gov/pubmed/11939242">general health</a> scale,</p></li>
<li><p>a <a href="https://www.ncbi.nlm.nih.gov/pubmed/15469617">mental health</a> scale, and</p></li>
<li><p>an indicator of <a href="https://link.springer.com/article/10.1007/s11205-012-0228-0">life satisfaction</a>.</p></li>
</ul>
<p>For comparability, we scored all of these measures on a range from 0 (worst health or wellbeing) to 100 (best health or wellbeing).</p>
<h2>How stigma matters</h2>
<p>Consistent with previous research, LGB people in our study reported worse overall health, mental health and life satisfaction than straight people.</p>
<hr>
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<hr>
<p>The key question is: to what extent do these health and wellbeing scores vary according to where people live and the levels of stigmatisation in their communities? To answer this, we factored in our proxy measure of stigma – the percentage of “no” voters in each electorate in the same-sex marriage postal survey. </p>
<p>Our findings portrayed a strong link between the two. LGB people living in electorates with smaller shares of “no” voters reported significantly better general health, mental health and life satisfaction than LGB people living in electorates with larger shares of “no” voters.</p>
<hr>
<p><iframe id="tc-infographic-279" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/279/75a1934f6875b735a15e581a1c0a59fdf6872d3a/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<hr>
<p>When comparing LGB and straight people in low-stigma communities, we found little to no difference in their health and wellbeing. However, differences were much larger when comparing LGB and straight people in high-stigma communities.</p>
<p>It is worth stressing that our estimates come from statistical models adjusting for a host of individual characteristics (such as age, gender or education) and electorate factors (such as unemployment rates and median income) that could otherwise bias the results.</p>
<h2>Social support: A missing piece of the puzzle</h2>
<p>In our study, we also tested whether perceived social support (friendships, good social relations and strong networks) contributed to the observed link between stigma and LGB health and wellbeing.</p>
<p>As we anticipated, we found LGB people living in electorates with higher shares of “no” voters received less social support than LGB people living elsewhere.</p>
<hr>
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<p>Additional statistical models revealed that these deficits in social support were key to explaining why LGB people fared worse in high-stigma areas.</p>
<h2>What does it all mean?</h2>
<p>Our findings are consistent with the notion that the disadvantage experienced by LGB people in society stems from social environments that are hostile to them.</p>
<p>Even within a relatively <a href="https://theconversation.com/revealed-who-supports-marriage-equality-in-australia-and-who-doesnt-82988">progressive</a> country such as Australia, the lack of acceptance of LGB people and the dearth of social support that they receive are to a large extent responsible for their overall poor health and wellbeing.</p>
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Read more:
<a href="https://theconversation.com/attitudes-to-same-sex-marriage-have-many-psychological-roots-and-they-can-change-84563">Attitudes to same-sex marriage have many psychological roots, and they can change</a>
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<p>Inclusive policies, such as the <a href="https://theconversation.com/from-postal-survey-to-parliament-how-australia-legalised-same-sex-marriage-87594">same-sex marriage provision</a>, undoubtedly contribute to improving the visibility of LGB people and normalising their life experiences. </p>
<p>But more is needed to redress the social inequality experienced by the LGB community. As our research indicates, tackling cultural forms of stigma and providing commensurate social support to our LGB and heterosexual neighbours is part of the solution.</p><img src="https://counter.theconversation.com/content/96904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francisco Perales receives funding from the Australian Research Council as part of its Discovery Early Career Researcher Award scheme for a project titled 'Sexual Orientation and Life Chances in Contemporary Australia'.</span></em></p>New research shows that LGB people living in communities with low levels of stigma report better health and well-being.Francisco Perales, Senior Research Fellow (Institute for Social Science Research & Life Course Centre) and ARC DECRA Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/755762017-04-04T00:43:54Z2017-04-04T00:43:54ZThe federal government will stop collecting data on LGBT seniors. That’s bad news for their health<figure><img src="https://images.theconversation.com/files/163730/original/image-20170403-21966-mwbk2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">AIDS Memorial Quilt on display in Washington, D.C., 2012. HIV is a particular health concern for LGBT seniors. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Global-AIDS/20693c7cc05546cbb8cf6b0bf39f6881/15/0">AP Photo/Jacquelyn Martin</a></span></figcaption></figure><p>You’ve likely read the front-page news about <a href="https://theconversation.com/the-transgender-bathroom-controversy-four-essential-reads-72635">accessible gender-neutral bathrooms</a>. This has gained attention, not only as a human rights issue, but also a political one.</p>
<p>What we don’t usually read is that LGBT populations face stigma and discrimination in employment and health care, as well as significant health disparities. Recent moves by the Trump administration, though, mean that these health questions will be more difficult to discern. </p>
<p>Information on civil rights and LGBT issues <a href="http://www.politifact.com/punditfact/statements/2017/jan/23/george-takei/george-takei-says-white-house-removed-pages-about-/">has been removed</a> from the White House website. And, on March 20, the U.S. Department of Health and Human Services proposed to eliminate LGBT elders from <a href="https://sageusa.org/newsevents/release.cfm?ID=173">critical national surveys</a>, including the <a href="https://aoasurvey.org/default.asp">National Survey of Older Americans Act Participants (NSOAAP)</a>. LGBT people will continue to lose presence in data, as sexual orientation and gender identity will not be collected in the 2020 census. Data from both surveys are directly used in health policy decision-making. </p>
<p>The sharp move to remove collection of LGBT elder data from these surveys removes the group’s voice from federal funding input. But my main concern as a public health practitioner is the potentially devastating impact on their health. Without knowing how health services are rated by consumers and how effective they are, LGBT elders and other vulnerable populations may not be able to maintain their independence and receive the myriad benefits provided by Title III services. As a result, they could face additional health disparities. </p>
<h2>What we don’t know</h2>
<p>March 27 through 31 was <a href="https://www.poz.com/article/national-lgbt-health-awareness-week-2017">National LGBT Awareness Week</a>. LGBT stands for lesbian, gay, bisexual and transgender, but the LGBT umbrella includes many other sexual and gender minorities, such as queer, intersex and asexual. Each year, the <a href="http://healthlgbt.org/advocacy/87-2">National Coalition for LGBT Health</a> hosts activities nationwide to improve and increase awareness of LGBT health issues. </p>
<p>It’s ironic that this event would coincide with the decision not to collect data on these communities. The NSOAAP survey programs on aging are funded by Title III of the Older Americans Act. They report on how well programs funded by the federal government meet their legislative goals. These data are needed to provide performance outcomes for state and area agencies on aging and local service providers.</p>
<p>The U.S. population is aging, with baby boomers being <a href="http://www.prb.org/Publications/Media-Guides/2016/aging-unitedstates-fact-sheet.aspx">between ages 52 and 70</a>. By 2050, more than 40 percent of all people in the U.S. will be over age 45 and more than 25 percent <a href="https://aoa.acl.gov/Aging_Statistics/future_growth/future_growth.aspx#age">over age 60</a>.</p>
<p>Why should we worry about LGBT elders in particular? Data are lacking, but <a href="http://dx.doi.org/10.1093/geront/gnw212">recent research</a> shows LGBT older adults are both resilient and at-risk, with <a href="http://age-pride.org/">higher rates</a> of disability, cardiovascular disease, depression and social isolation than non-LGBT adults of similar ages. In addition, cardiovascular disease is seen mostly among older adults, but <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303630">few studies include LGBT adults</a>, further adding to the list of what we don’t know. Many studies also have age restrictions when measuring sexual orientation. This further limits the possibility to identify disease disparities among older LGBT adults.</p>
<p>HIV affects everyone – young and old, LGBT and non-LGBT. Yet, when one thinks about HIV, one does not immediately move to association with seniors. But <a href="https://www.nia.nih.gov/newsroom/features/aging-hiv-responding-emerging-challenge">half of all HIV-positive people</a> in the U.S. are older than 50, and HIV accelerates the aging process. Indeed, one group often overlooked in HIV testing outreach <a href="https://www.cdc.gov/hiv/group/age/olderamericans/index.html">is seniors</a>. While half of all deaths of HIV-positive individuals are due to AIDS, half are caused by other age-related conditions and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464862/pdf/AJPH.2012.300844.pdf">simultaneous illness, or comorbidities,</a> such as cardiovascular disease, lung disease and cancer. </p>
<p>Despite our knowledge of the relationship between HIV and aging, there is a scarcity of information on older adults, particularly <a href="https://www.ncbi.nlm.nih.gov/pubmed/15498845">older LGBT adults</a>. This dearth of data is why perhaps there is an interest in studies related to HIV/AIDS and Aging by <a href="https://grants.nih.gov/grants/guide/pa-files/PAR-15-280.html">the National Institutes of Health</a>. Sadly, the current administration has proposed <a href="http://www.opposingviews.com/i/health/trump-administration-proposes-big-cuts-aids-program">significant cuts</a> to NIH AIDS funding, which will hinder data collection and progress toward an AIDS-free generation.</p>
<p>Most people likely don’t think about seniors as being at risk for HIV infection, but seniors <a href="https://theconversation.com/think-youre-not-having-enough-sex-try-being-a-senior-in-assisted-living-72920">are sexually active</a>. People over 50 may have similar risk factors to those under 50, such as unprotected sex and multiple sex partners, but may be less aware of their risk. Health care professionals, too, may underestimate older patients’ risk for HIV, leading to <a href="https://www.cdc.gov/hiv/group/age/olderamericans/">missed opportunities for HIV prevention</a>. This means that people over 50 are more likely to be diagnosed with HIV later in the course of the disease, with <a href="https://ucrtoday.ucr.edu/40414">missed opportunities</a> to connect early to HIV care. Some older adults may actually be at an increased risk for getting HIV – for example, vaginal thinning and dryness in older women can make HIV transmission easier. This is in addition to generally lower immune response due to aging. </p>
<p>Few surveillance systems collect data on gender identity, sex anatomy or sexual behaviors, although the Centers for Disease Control and Prevention’s <a href="https://www.cdc.gov/brfss/">Behavioral Risk Factor Surveillance System</a> does ask about sexual behaviors related to HIV transmission. Sadly, only some states utilize it. </p>
<p>And HIV isn’t the only pressing health concern for LGBT elders. <a href="http://www.documentcloud.org/documents/3527720-TransgenderHealthSurvey.html?embed=true&responsive=false&sidebar=false">One survey of the transgender community</a>, released during this year’s LGBT Awareness Week, found that three-quarters of respondents contemplated suicide, over two-thirds had depression or anxiety disorder and many experience stigma, isolation and abuse. While this report focused on the transgender population, 20 percent were over age 50, and the T in the LGBT may be at highest risk. </p>
<p>These survey outcomes are particularly relevant to LGBT seniors, as they may have less access to care for depression and anxiety, more isolation due to deaths of partners and friends and, importantly, may face abuse in care if not measured by national surveys. </p>
<h2>More data needed</h2>
<p>For these reasons, we need to include data from LGBT elders <a href="https://actionnetwork.org/letters/trump-administration-erasing-lgbt-elders">in national surveys</a>. Like all elders, they deserve our time and respect, and we should make sure they receive adequate services from hospitals, community centers and caregivers. Without the data to illustrate service provision, we will not know if they are receiving services, if they are satisfied with the services or how effective the services are. </p>
<p>With these data, we can design interventions to reach LGBT elders with services, as well as alter services to provide the highest standard of care to LGBT elders.</p>
<p>We can start this process by letting people know that LGBT people exist and surveying them like we do all other people. Young LGBT people grow up to be older LGBT people, and that older LGBT people have some specific health needs that are distinct from those of non-LGBT people.</p><img src="https://counter.theconversation.com/content/75576/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon Brown 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>LGBT people face discrimination in health care, as well as significant health disparities. Recent moves by the Trump administration will make these topics more difficult to untangle.Brandon Brown, Assistant Professor of Medicine, University of California, RiversideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/611862016-06-23T10:05:52Z2016-06-23T10:05:52ZHate crimes against LGBTQ people are a public health issue<p>The terrible tragedy that occurred in Orlando was an attack driven by hatred toward the lesbian, gay, bisexual, transgender and queer (LGBTQ) community. Unfortunately, this is not an isolated instance. Hate against the LGBTQ community is more widespread than many choose to believe. </p>
<p>As public health professionals working in sexuality and sexual health, we feel it is our responsibility to educate the public about the consistent threats that LGBTQ individuals face and to make the case that this is a public health issue. Hate directed at one community ultimately affects us all.</p>
<h2>Twenty-one percent of hate crime victims are LGBTQ</h2>
<p>LGBTQ populations are significantly more likely to be the victims of “single-bias” hate crimes or hate crimes motivated by a single cause or issue. </p>
<p>According to the FBI, in 2014, of 6,216 reported single-bias hate crimes, <a href="https://www.fbi.gov/about-us/cjis/ucr/hate-crime/2014">21 percent resulted from sexual orientation bias</a> and were targeted because of that identity. However, most incidents aren’t reported to the police. </p>
<p>On June 13, the National Coalition of Anti-Violence Programs (NCAVP), an organization that, in their words, “works to end violence against and within LGBTQ, and HIV-affected communities,” released their <a href="http://avp.org/storage/documents/ncavp_hvreport_2015_final.pdf">2015 report</a> outlining hate-driven violence reported by 13 NVACP member programs in 11 states. </p>
<p>This report is significant because hate crimes are often underreported to the police. Many LGBTQ individuals <a href="http://www.bjs.gov/content/pub/pdf/hcrvp.pdf">fear being revictimized</a> by the criminal justice system, feel shame for being a victim or lack knowledge on victims’ rights and services. Because LGBTQ individuals may feel more comfortable reporting these crimes at NCAVP member organizations, the coalition can collect information that might not get reported to police.</p>
<h2>What is hate-driven violence?</h2>
<p>Incidents of violence against another person range from blackmail, eviction and talking to sexual violence and murder. Of the 1,253 incidents, detailed data was collected from 752 incidents. </p>
<p>Here are some of the key findings from the report:</p>
<ul>
<li>62 percent of survivors knew the people who committed the hate crime</li>
<li>there were 24 hate violence related homicides of LGBTQ and HIV-affected people in 2015 (a 20 percent increase from 2014)</li>
<li>47 percent of survivors identified as gay and 17 percent of survivors identified as lesbian</li>
<li>38 percent of survivors were youth and young adults</li>
<li>64 percent of survivors identified as people of color</li>
<li>the most common types of hate violence reported were verbal harassment (15 percent), discrimination (14 percent), physical violence (12 percent) and threats or intimidation (11 percent)</li>
<li>Only 41 percent of LGBTQ and HIV-affected survivors reported their experience of hate violence to police (compared to 54 percent in 2014).</li>
</ul>
<h2>Why hate is a public health problem</h2>
<p>These individual acts of hate are indicative of a wider pattern of discrimination against the LGBTQ community. It is <a href="http://health-equity.pitt.edu/622/">now recognized within public health</a> that this discrimination causes significant health problems <a href="https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health">for the LGBTQ community</a>. </p>
<p>For instance, hate and discrimination can become internalized and a source of <a href="http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx">chronic stress</a>, which in turn is a risk factor for depression. And in fact, LGBTQ populations do experience <a href="http://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf">higher rates of psychological distress</a> and <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887282/">depression</a>. In addition, chronic stress can disrupt normal biological functioning. This in turn can make people more <a href="http://www.apa.org/topics/health-disparities/fact-sheet-stress.aspx">susceptible to infection</a>. </p>
<p>Related to this, men in long term same-sex relationships were significantly more likely to die from suicide than men who were married to women or men who were never married. The lifetime rate of suicide attempts among the LGBT population is <a href="http://dx.doi.org/10.1080/00918369.2011.534038">four times higher</a> than the rate of suicide attempts for non-LGBT people. This is most likely related to long-term depression and the impacted stigma and oppression LGBT people face on a regular basis. </p>
<p>Hate and discrimination also affect rates <a href="http://www.ncbi.nlm.nih.gov/m/pubmed/10910783/">and progression</a> of sexually transmitted infections (STIs), including HIV. Stigma against HIV - for instance, the perception that it is a “gay man’s disease” - still exists in our society. There is a fear of being labeled as HIV positive, which causes <a href="http://dx.doi.org/10.1080/09540121.2011.613910">many people to avoid testing</a>. The result is that many people who are HIV positive do not know that they are and are therefore more likely to spread the disease. Although men who have sexual contact with other men represent about four percent of the male population, they accounted for 78 percent of new HIV infections among men in 2010, and <a href="https://www.cdc.gov/hiv/pdf/library/reports/ryan_white_fy_2014_no1-pdf02.pdf">63 percent of all new HIV infections</a>. </p>
<p>Additionally, this fear of being tested for HIV often extends to a fear of being tested for other STIs. <a href="https://www.cdc.gov/std/stats14/std-trends-508.pdf">Eighty-three percent of new syphilis cases</a> in 2014 affected men who have sexual contact with men. </p>
<p>Homelessness is more likely to affect LGBT youth – <a href="http://www.thetaskforce.org/static_html/downloads/reports/reports/HomelessYouth_ExecutiveSummary.pdf">20-40 percent of homeless youth identifying as LGBT</a>. Many LGBT youth experience violent physical assault when they come out and may actually feel safer living on the streets.</p>
<p>Homophobia and intolerance affect everyone. This includes peoples who consider themselves straight, or who may not have friends or relatives in the LBGTQ community. It limits <a href="http://onlinelibrary.wiley.com/doi/10.1002/j.2164-4918.1981.tb00282.x/abstract">self-expression</a>, prevents same-sex friends <a href="http://link.springer.com/article/10.1007/BF01462005#page-1">from showing affection</a> toward each other, prompts people to <a href="http://dx.doi.org/10.5172/hesr.2010.19.4.505">act aggressively toward LGBTQ</a> individuals to “prove” they are not part of the community and causes youth to <a href="http://www.xyonline.net/sites/default/files/policingmanhood.pdf">prove their sexuality</a> by having sex before they are ready. Homophobia and intolerance make it hard to appreciate anything that is outside the realm of what is considered “normal” in our society. </p>
<p>Public health includes organized measures to <a href="http://www.who.int/trade/glossary/story076/en/">prevent disease, promote health and prolong life among the population as a whole</a>. Researchers in the field of public health have long studied the effects of many kinds of discrimination on health; whether as a result of <a href="http://dx.doi.org/10.2105/AJPH.2012.300773">race</a>, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891652/">socioeconomic</a> <a href="http://www.publichealthreports.org/issueopen.cfm?articleID=3078">status</a> or <a href="http://dx.doi.org/10.2105/AJPH.2009.174169">sexual orientation</a>. </p>
<p>Although hate crime research is a relatively new area of public health, there is already a <a href="http://dx.doi.org/10.2105/AJPH.2013.301424">growing body</a> of <a href="http://www.ncbi.nlm.nih.gov/pubmed/19042905">powerful</a> <a href="http://dx.doi.org/10.1016/j.drugalcdep.2013.11.001">evidence</a> of <a href="http://www.ncbi.nlm.nih.gov/pubmed/26160063">its health consequences</a>. We know the impacts of hate and discrimination. We know what perpetuates hate and discrimination. The next step is change. </p>
<p>For our part, we’ve launched a campaign on <a href="https://twitter.com/">Twitter</a> and <a href="https://www.instagram.com/">Instagram</a> using the hashtag #wechallengehate to educate people on how we can each stand up to hate.</p><img src="https://counter.theconversation.com/content/61186/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 organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It is now recognized within public health that discrimination causes significant health problems for the LGBTQ community.Spring Chenoa Cooper, Associate Professor, City University of New YorkAndrew Porter, Assistant Professor of Clinical, University of MiamiAnthony J. Santella, Assistant Professor of Health Professions and Public Health, Hofstra UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/515862015-12-07T19:12:56Z2015-12-07T19:12:56ZChemsex review: gay sex and drug use demand more careful forms of attention<figure><img src="https://images.theconversation.com/files/104393/original/image-20151204-4710-16okshw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A gay subculture revolves around risky, drug-enhanced sex. The reasons why are complex and deserve attention. </span> <span class="attribution"><span class="source">Chemsex, Pecadillo Pictures.</span></span></figcaption></figure><p>Drugs scare us and fascinate us. Societies might fight “wars” against drugs – but we also drink, smoke, ingest and inject an awful lot of them.</p>
<p>The Ancient Greeks captured this instability with their concept of the <a href="https://flutuante.wordpress.com/2009/08/01/pharmakon-the-cure-or-the-poison/">pharmakon</a>, which they used to refer to those things that can function as both poison and cure: their identity is unstable. </p>
<p>The instability of drugs has been used again and again to condemn them. We’re
much more comfortable attributing stable identities to drugs and categorising
them as either good or evil. </p>
<p>But as Belgian philosopher <a href="http://www.goodreads.com/author/show/194560.Isabelle_Stengers">Isabelle Stengers</a> argued in <a href="http://meson.press/wp-content/uploads/2015/11/978-1-78542-010-8_In-Catastrophic-Times_Stengers.pdf">Catastrophic Times,</a> our desire to categorise drugs definitively,</p>
<blockquote>
<p>allows the question of the appropriate attention, the learning of doses and the manner of preparation, to be done away with.</p>
</blockquote>
<p>This is a problem, because the propensity for a drug to be good or dangerous depends precisely on these considerations.</p>
<h2>Chemsex, intimacy and paranoia</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104386/original/image-20151204-29720-138q79m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chemsex.</span>
<span class="attribution"><span class="source">Pecadillo Pictures</span></span>
</figcaption>
</figure>
<p>I was reminded of the fundamental ambivalence of drugs when I watched <a href="http://www.imdb.com/title/tt5073738/">Chemsex</a> (2015), a documentary from Pecadillo Pictures, that explores gay men’s use of drugs to enhance sex in London.</p>
<p>It’s the dangerous end of the drug use spectrum that the documentary Chemsex takes as its principal focus: the film sets out to investigate what it describes as a “hidden health care emergency” in London. </p>
<p>The name is a vernacular term, first referenced in a 2014 study from the <a href="https://www.lambeth.gov.uk/sites/default/files/ssh-chemsex-study-final-main-report.pdf">London School of Hygiene & Tropical Medicine</a>, which describes a rise in the prevalence of drug-enhanced group sex and resulting health issues. </p>
<p>We’re introduced to guys who slam (inject) the amount of <a href="http://www.medicalnewstoday.com/articles/23207.php">crystal methamphetamine</a> that would last most users several days in a single hit. </p>
<p>We see disturbing interviews of men in the midst of crystal meth psychoses, or in the throes of the intense euphoria having just injected <a href="https://theconversation.com/meow-hear-this-mephedrone-is-a-curious-khat-2164">mephedrone</a> (a drug rarely seen in Australia, unlike crystal meth). </p>
<p>While the film presents footage of a variety of different drug practices, it’s injecting (rather than the <a href="http://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(14)70007-4/abstract">much more common habit</a> of snorting, or smoking methamphetamine) that features most prominently in the film, and the eerie soundtrack by Daniel Marle trains the viewer to lump all these practices together as the same, disturbingly abject and sinister, phenomenon. </p>
<p>For those unfamiliar with gay fetish scenes, this effect would be compounded by the documentary’s graphic footage of gay BDSM activities and group sex. </p>
<p>For those not fazed by <a href="http://www.whereversexhappens.com/sexualadventurism.php">sexual adventurism</a>, the participants’ openness to allowing straight male documentarians to film them is probably the real source of astonishment. But then, when people are high on psychoactive drugs, they’re prepared to do a lot of things they’d normally be reticent about, as Chemsex amply demonstrates. </p>
<p>There’s a lot to be learnt from Chemsex about the complexities of gay sex in the wake of the HIV epidemic, which has ravaged this community for the past 30 years. </p>
<p>Despite the availability of effective treatment and much better therapeutic prospects for people living with HIV, gay men are still processing the <a href="http://newamericamedia.org/2014/04/trauma-of-aids-epidemic-impacts-aging-survivors.php">traumatic effects of the epidemic</a> and its <a href="https://mitpress.mit.edu/books/melancholia-and-moralism">cultural impacts</a> on sexual desires, fears and intimacy. </p>
<p>For at least some men, drugs seem to provide the most ready-to-hand
contemporary solution to the age-old question, <a href="http://blogs.poz.com/joseph/archives/2013/05/how_to_have_sex_in_a.html">“how to have sex in an epidemic”</a>. </p>
<p>Ultimately, this must be an indictment on the state of sex education today, which tends to be organised around (heterosexual) reproduction rather than the <a href="https://theconversation.com/australian-schools-must-promote-lgbt-inclusive-education-23260">practicalities of achieving sexual happiness</a>.</p>
<h2>Dangerous desires</h2>
<p>The topic has received a <a href="http://www.bmj.com/content/351/bmj.h5790">flurry of attention</a> and alarm in British public health circles recently, but the phenomenon itself is not new: it’s been a source of concern and excitement in urban gay centres in the West for <a href="http://www.ncbi.nlm.nih.gov/pubmed/11482426">over a decade</a>. </p>
<p>In the early 2000s drugs such as crystal methamphetamine and GHB <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.235.pdf">replaced ecstasy as drugs of choice</a> for a subset of gay men, while the internet replaced socialising as the <a href="http://www.sciencedirect.com/science/article/pii/S1755458610000046">most common way of looking for sexual partners</a>. In this context, it became possible to party at home and cruise for partners without going out in public. </p>
<p>Activities that once took place at saunas, dance parties and cruising grounds were gradually relocated to private homes and became much easier to organise and more accessible from these locations. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104391/original/image-20151204-4389-17lyrha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chemsex.</span>
<span class="attribution"><span class="source">Pecadillo Pictures</span></span>
</figcaption>
</figure>
<p><a href="http://www.australianhumanitiesreview.org/archive/Issue-October-2003/race.html">The communal pleasures of the dance-floor</a>gave way to the erotic intensities of sex on drugs, which – for many enthusiasts – seemed to help cut to the chase.</p>
<p>But many of us gays miss dancing, and <a href="http://www.independent.co.uk/voices/having-a-moral-panic-about-chemsex-here-s-why-it-s-not-as-bad-as-you-think-a6748136.html">the changing geography of gay partying</a> has also given rise to new dangers – indeed, sometimes very serious ones. It’s hard to know when to “call it a night” when there’s no risk of the DJ stopping playing, and drugs like crystal meth can keep you buzzing for days. </p>
<p>Not only is crystal easy to integrate into domestic practices and everyday routines, it seems designed for repeat administration (just ask <a href="http://www.theage.com.au/victoria/jump-in-number-of-truck-drivers-testing-positive-for-ice-concerns-police-20150407-1mfqgc.html">truck drivers</a> or <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/phd-npi-methamphetamine-report-feb09-l%7Eusers">computer workaholics</a>). In short, it’s frighteningly easy to become dependent on it for a range of different purposes. </p>
<p>Meanwhile, taking too much GBH can cause users to lose consciousness, become comatose and (in the worst-case scenario) die. Unlike some clubs and dance events, private homes are rarely equipped <a href="http://www.rightnow.acon.org.au/drug_rovers">the right care and emergency services</a> to prevent these occurrences. </p>
<p>In their own ways, then, each of these drugs demonstrate the critical significance of “the learning of doses and the manner of preparation”, to recall Stengers’ comments.</p>
<h2>Gay men and the drug subculture</h2>
<p>For some gay men growing up in this context, drugs facilitate a process of what
psychologists call “cognitive disengagement” from the many fears and stipulations associated with <a href="https://www.dukeupress.edu/pleasure-consuming-medicine/?viewby=title">having sex in the shadow of HIV/AIDS</a>. </p>
<p>Some experts attribute the higher rates of injecting among gay men in London to the availability of the drug mephedrone, which is much more painful to snort than most other uppers, but <a href="https://csrh.arts.unsw.edu.au/media/CSRHFile/CSRH_Report__GCPS_Sydney_2015.pdf">rarely a part of chemsex practices in Australia</a>.</p>
<p>For other gay men, these substances are simply valued for much the same reason that
many in the wider community value alcohol: They can make sex more fun, sensual, intense, uninhibited and/or easier to negotiate. </p>
<p>The film does an excellent job of conveying the difficulty of fostering intimate or effective relationships when the process of arranging sex is divorced from other social contexts, as it is on digital platforms – and the dangerous effects of the
isolation some men experience as a consequence. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104401/original/image-20151204-29733-1q5sq5o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">David Stuart.</span>
<span class="attribution"><span class="source">Twitter</span></span>
</figcaption>
</figure>
<p>We meet David Stuart, the founder of the pioneering program at <a href="http://www.chelwest.nhs.uk/services/hiv-sexual-health/clinics/56-dean-street/chemsex-support">56 Dean St</a>, a London sexual health clinic, that provides much-needed services to gay men who find themselves in trouble as a result their drug use for sexual purposes, combined with a sense of isolation. </p>
<p>As Stuart reports, <a href="https://www.fsmag.org.uk/fs139-sex-on-tapp-right-now-cum-n-get-it">hook-up apps and websites</a> have made chemsex much more visible and easier to access in the course of looking for gay friends or sexual partners in the city. </p>
<p>What the film neglects to mention, though, is that chemsex remains <a href="https://csrh.arts.unsw.edu.au/media/CSRHFile/CSRH_Report__GCPS_Sydney_2015.pdf">a minority practice within this population</a>, and that many app-users remain quite capable of exercising what they believe to be the best judgment.</p>
<p>Chemsex also provides us with multiple accounts of what people enjoy about sex on
drugs and the happiness and connections it has allows some men occasionally to
develop. Rarely, though, does it take these accounts at face value. More often
they seem to be framed as delusional. But this is it’s mistake. </p>
<p>These “good” experiences are precisely the reason that some men continue to use these drugs in full knowledge of their dangerous possibilities in some situations. </p>
<p>Against the idea that drug use is always the product of some state of reckless abandon, there is rare footage in the film of the careful lengths some men go to arrange group sexual encounters that are consensual, pleasurable and free of unwanted dangers. </p>
<p>One fellow organising a sex party at his home even goes to the trouble of drawing up a detailed timetable to schedule his guests’ G consumption as a way of ensuring their safety. </p>
<p>Indeed, the film could have said much more about the techniques and “manners of preparation” some gay men have devised to occasionally enjoy the pleasures of drugs, while keeping themselves and their partners relatively safe from harm. Indeed, <a href="http://theinstituteofmany.org/index.php/home/turning-tina/">these techniques</a> are much more interesting and important to their practitioners than the film seems prepared to give them credit for.</p>
<h2>Unconstructively moralising</h2>
<p>Unsurprisingly, normative morality about both sex and drug use is <a href="http://www.trevorhoppe.com/blog/archives/2010/07/queering_hiv_pr.html">centrally at play here</a>. Chemsex is framed in such a way that the many pleasures associated with illicit sex and drugs are only ever allowed to emerge as dangerous. </p>
<p>The spectacle of non-normative sex and illicit substance-use gives the film an ominous tone that works against a more constructive treatment of its subject matter. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=918&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=918&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=918&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1154&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1154&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104400/original/image-20151204-29720-1jd2exf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1154&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Marc Gélinas</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>If you want to get a sense of how moral fears about gay sex are being exploited to frame our emotional responses to Chemsex, imagine setting the film’s creepy music as the soundtrack for a documentary about the activities and excesses associated with popular mainstream events like <a href="https://www.vichealth.vic.gov.au/media-and-resources/media-releases/melbourne-cup-number-one-day-for-bingeing">Melbourne Cup</a>, or St Patrick’s Day, or Anzac Day. I guess it would make a good comedy. </p>
<p>But most garden-variety, casual drinkers just wouldn’t take it seriously. Nor should they.</p>
<p>By treating the drugs it deals with as inherently bad, and stabilising the pharmakon in this way, Chemsex ultimately fails to find an appropriate “register of attention” to deal with its subject matter. </p>
<p>For this reason, I worry that the film runs the risk of doing more harm than good, by further marginalising the vast majority of occasional users (not to mention casual sex enthusiasts). </p>
<p>This is a great shame really, because people’s emotional and social circumstances change, making them much more vulnerable to some of the situations the film deals with, which are undoubtedly concerning. </p>
<p>Despite the (presumably) good intentions of the directors, what Chemsex demonstrates most powerfully is that the complexities of gay sex and drug use demand much more careful, incisive and intimate forms of attention.</p>
<p><br>
<em>Chemsex was released in the UK by <a href="https://www.peccapics.com/product/chemsex/">Pecadillo Pictures</a>, in conjunction with Vice, on December 4.</em></p><img src="https://counter.theconversation.com/content/51586/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kane Race is Associate Professor in the Department of Gender and Cultural Studies at the University of Sydney. He has received funding from the Australian Research Council for a Discovery Project on Changing Spaces of HIV Prevention (DP120101990). He is affiliated with the Association for the Social Sciences and Humanities in HIV and an associate of the Unit of Play, Goldsmiths College, London. He is currently working on a book called Gay Science: Remaking Sex, Drugs and HIV in the Digital Context.</span></em></p>Drugs scare us and fascinate us. Societies might fight “wars” against drugs – but we also drink, smoke, ingest and inject an awful lot of them. The Ancient Greeks captured this instability with their concept…Kane Race, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/286722015-03-25T19:16:35Z2015-03-25T19:16:35ZGay conversion therapy: a short history of an ongoing problem<figure><img src="https://images.theconversation.com/files/75923/original/image-20150325-4160-m2zel1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The religious groups trying to bring back aversion therapy need to catch up.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/andreuccio1986/3890520690">Andrea/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Many jurisdictions around the world now allow gay and lesbian marriages, but “treating” homosexuality remains a politicised topic. Some groups, mainly in the United Kingdom, are visibly displeased by efforts to discredit attempts to change homosexuals.</p>
<p>Despite appearances that we increasingly live in a world where same-sex attraction is acceptable, it’s not been long since homosexuality was considered to be a mental illness. Many psychiatrists though it was curable with “therapies” designed to turn gay people off their same-sex desires. </p>
<p>Like mental health governing bodies in the United States and Australia, those in the United Kingdom, such as the <a href="http://www.ukcp.org.uk/reparativetherapy">UK Council for Psychotherapy</a>, have long rejected the idea of conversion therapies for homosexuality. </p>
<p>But the practice has still not been entirely eradicated from mental health care. A <a href="http://discovery.ucl.ac.uk/68888/">2009 UK survey</a> found that while only 4% of therapists reported they would attempt to change a client’s sexual orientation if one consulted asking for such therapy, 17% reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings. </p>
<p>Opposition to this sometimes National Health Service-supported therapy (in 40% of cases) was <a href="http://www.theguardian.com/society/2014/apr/06/gay-conversion-therapy-nhs-health-minister">raised in parliament</a> by the UK health minister in April 2014. Political pressure to ban conversion therapies is mounting, and not only because the discredited therapy is a waste of public money. Such therapies are homophobic in that they continue to suggest homosexuality is a mental illness and something that can be eradicated.</p>
<h2>A wilful misinterpretation</h2>
<p>Mental health care has historically held various positions on homosexuality, from trying to cure it, to defending it against the law, to promoting a more positive view of same-sex attraction. </p>
<p>In April 2014, the UK Royal College of Psychiatrists (RCP) <a href="http://www.rcpsych.ac.uk/pdf/PS02_2014.pdf">released a position statement</a> on sexual orientation. This reiterated that homosexuality was not a mental disorder. </p>
<p>This document was an important step in the history of psychiatric engagement with lesbian, gay and bisexualities; it was (rather belatedly) in line with the removal of homosexuality from the Diagnostic and Statistical Manual of the American Psychiatric Association in 1973, and the International Classification of Diseases of the World Health Organisation in 1992. </p>
<p>The College said it:</p>
<blockquote>
<p>considers that sexual orientation is determined by a combination of biological and postnatal environmental factors. There is no evidence to go beyond this and impute any kind of choice into the origins of sexual orientation.</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75924/original/image-20150325-4197-17hadwv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Homophobia causes more suffering than homosexuality.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-195382592/stock-photo-mask-rabbit-and-horse-mask-lesbian-couple-at-home.html?src=VdgRsORg4faBZ8g_KsJPuw-1-1">Eugenio Marongiu/Shutterstock</a></span>
</figcaption>
</figure>
<p>The statement proved to be controversial, with some religious groups misinterpreting “postnatal factors” (that homosexuality is not only inborn) as a justification for conversion therapies.</p>
<p>The main thrust of <a href="http://www.rcpsych.ac.uk/pdf/PS02_2014.pdf">the College’s position</a> – that lesbian, gay and bisexuality don’t need to be “treated” – is in keeping with other psychiatric and psychological governing bodies. But in June 2014, <a href="http://www.core-issues.org/index.php?mact=News,cntnt01,detail,0&cntnt01articleid=110&cntnt01returnid=15">Mike Davidson, director of the Core Issues Trust</a>, the same British registered charity that unsuccessfully attempted to advertise “cures” for homosexuality on London buses in 2013, said:</p>
<blockquote>
<p>The assumption that people are ‘born gay’ has become deeply rooted in our society and has driven huge political, social and cultural change. As this latest statement [from the College] reveals, that assumption is false and it is vital that professional bodies stand up against it rather than perpetuate it.</p>
</blockquote>
<p>This wilful misinterpretation of the College’s position has been echoed by a number of other religious groups hoping to reinstate “cures” for homosexuality. </p>
<h2>Push and pull</h2>
<p>The debate around whether homosexuality is inborn, acquired, or a vice chosen by the person, is almost as old as modern psychiatry. </p>
<p>While many jurisdictions traditionally made homosexual activity illegal, assuming that the person was choosing to engage in a criminal act, several important sexologists attempted to show that it was inborn. Havelock Ellis’s radical <a href="http://www.palgraveconnect.com/pc/doifinder/10.1057/9780230592261">1897 work Sexual Inversion</a>, for instance, argued homosexuality was innate, natural, found in various periods of history and many cultures, and therefore should not be illegal.</p>
<p>Ellis advocated legalising consensual homosexual sex between adults. But it was many decades before such a law offered lesbian, gay and bisexual people some vestige of legal protection and similar social rights. </p>
<p>It’s only when homosexuality is considered to be acquired that it is sometimes thought to be possible to “treat” it. But this conception requires a belief that it’s actually a mental illness, rather than one of many appropriate means of seeking sexual pleasure and forming emotional bonds. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75926/original/image-20150325-4205-1sgcdm4.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">
<figcaption>
<span class="caption">There’s no case for attempting to cure sexual desire for people of the same gender.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/quinnanya/8065672959">Quinn Dombrowski/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Psychoanalysts considered homosexuality to be an immature deviation of the sexual object choice, caused by postnatal influences, some of which could be overcome in analysis to turn the analysand to heterosexuality. But in a <a href="http://legacy.fordham.edu/halsall/pwh/freud1.asp">letter to an American mother of a homosexual man</a>, the father of the movement, Sigmund Freud, insisted:</p>
<blockquote>
<p>it is nothing to be ashamed of, no vice, no degradation, it cannot be classified as an illness; we consider it to be a variation of the sexual function produced by certain arrest of sexual development.</p>
</blockquote>
<p>He thought psychoanalysis would help people deal with the persecution their sexuality received in an unaccepting world. </p>
<h2>A better time</h2>
<p>After many years of intense persecution by police in efforts to regulate homosexuality, aversion therapies were developed to “cure” people of their prohibited sexual desires in the mid-20th century. Submitting to such therapies was a way of shortening prison sentences for those incarcerated for being gay. </p>
<p>In what effectively amounted to psychological torture, homosexuals were given emetics and shown gay pornography while being kept unwashed and sleep-deprived in rooms that stunk of their own vomit for days on end, to create an aversion to the objects of their desires. The idea was to forge an association between this horror and their sexual needs. </p>
<p>Ultimately, such therapies were unsuccessful. But they <a href="http://www.manchesteruniversitypress.co.uk/cgi-bin/indexer?product=9780719095887">did cause</a> intense trauma and suffering in the people on whom they were performed.</p>
<p>Eventually, after criticism from homosexual rights groups, and in the face of evidence that the “treatments” caused more harm while effecting no cure, homosexuality came to be considered a normal and acceptable expression of sexual desire. It was and still is the case that homophobia causes more suffering than homosexuality, which was decriminalised in many jurisdictions between the 1960s and 1990s. It remains illegal in 78 countries.</p>
<p>The UK Royal College of Psychiatrists’ position statement on sexual orientation is important because it underlies the idea that homosexuality should be acceptable, even if it’s not solely inborn. It should make no difference to people’s sexual rights if they are born that way, if they became homosexual because of some influence after their birth, or if they decide to engage in gay sex because they find it pleasurable. </p>
<p>There’s no case for attempting to cure sexual desire for people of the same gender. There is much to be said for banning treatments that have only added to the suffering and persecution of people for their sexual feelings. </p>
<p>The Royal College of Psychiatrists is to be commended for continuing to state that such “cures” are wrong. The religious groups trying to bring back aversion therapy need to catch up.</p><img src="https://counter.theconversation.com/content/28672/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivan Crozier receives funding from the Australian Research Council, and has previously received funding for his work on the history of sexology from the Wellcome Trust in the UK. He is affiliated (as a volunteer) with the AIDS Council of NSW (ACON).</span></em></p>Many places around the world now allow gay and lesbian marriages, but ‘treating’ homosexuality remains politicised.Ivan Crozier, ARC Future Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/291482014-07-14T03:11:38Z2014-07-14T03:11:38ZHomophobia is a health hazard, not just for Ian Thorpe<p>Ian Thorpe coming out as gay during an interview with Michael Parkinson last night was both the most ordinary of stories and the most extraordinary. It also showed how deeply homophobia is ingrained in Australian society. </p>
<p>It was ordinary because, over the last 20 years, my colleagues and I have documented stories just like it. And it was extraordinary because Thorpe felt he was unable to come out earlier despite his high profile.</p>
<p>There’s no question that homophobia is <a href="http://www.tandfonline.com/doi/abs/10.1080/10615806.2014.887071#.U8NMmqik2qQ">a health hazard</a> and one that we’ve been slow to address. The depression and despair so powerfully described by Thorpe prevents young people from reaching out for help, out of fear of losing their attachment to family and friends, which they feel may be conditional on ignorance about their sexuality.</p>
<h2>An ordinary story</h2>
<p>In <a href="http://www.glhv.org.au/files/PrivateLives2Report.pdf">two recent surveys</a>, high levels of depression and suicide ideation were found to be part of the history of gay people of all ages and very much related to their shared history of everyday abuse and violence. </p>
<p>Gay men, in particular, are exposed to violence and the messages that accompany it as part of a rigorous policing of masculinity that begins in schools and may continue throughout their lives. </p>
<p>Research shows <a href="http://www.glhv.org.au/files/wti3_web_sml.pdf">harsh and neglectful school environments</a>, where homophobic abuse flourishes and large numbers of same-sex attracted young people experience anxiety, depression and suicide ideation. In fact, suicide contemplation rises <a href="http://www.glhv.org.au/files/wti3_web_sml.pdf">in exact proportion</a> to the amount of abuse suffered. </p>
<p>Move all this into the hyper-masculine sporting arena and no wonder Ian Thorpe felt part of his essential self had to be hidden to ensure his safety, perhaps even annihilated to prevent public disgrace. </p>
<p>He would have been under no illusion that the constant media badgering for confirmation of his sexuality would not have been to celebrate it, but rather to create a scandal. </p>
<h2>An extraordinary story</h2>
<p>But this is also the most extraordinary of stories because Ian Thorpe offered the Australian public so much, in the highly revered area of sporting accomplishment. Surely, he, of all people, should have felt the Australian people would forgive him this one thing. </p>
<p>I use the word forgive deliberately because despite the somewhat ho-hum reaction to Thorpe’s revelation in the press and social media today, it’s still difficult to escape the prevailing notion in Australia that being gay is bad news, that it is evidence of being somehow lesser.</p>
<p>Consider the related story of football commentator Brian Taylor’s casual description of Harry Taylor as “a big poofter”, which is at least as big a story this morning as Thorpe’s coming out. </p>
<p>His rap on the knuckles (being sent home to watch the football rather than to call it) is a sign that these days we understand it’s not okay to publicly berate gay people. Still, it was only a little rap, because most Australians also assume he didn’t mean to hurt anyone.</p>
<p>But hurt he would have, as gay people everywhere would have seen it as confirmation of this society’s deeply-held belief that nobody wants to be gay. Thorpe can be forgiven for not reading such remarks any differently.</p>
<h2>Looking up</h2>
<p>Today, the landscape for same-sex attracted young people is not nearly as bleak as it was in Thorpe’s youth. Social media has thrown closeted young people a lifeline that puts them in touch anonymously with others having, and working through similar doubts and fears. </p>
<p>It creates a rich virtual world to counteract the loneliness and hostility of their physical communities and helps them feel safe until they’re old enough to risk exposure. </p>
<p><a href="http://www.glhv.org.au/files/wti3_web_sml.pdf">Government funded anti-homophobia programs</a> in schools are having a demonstrable impact on the mental health of young people who are not straight. But <a href="http://www.fya.org.au/initiatives/safe-schools-coalition-australia/">these initiatives</a> are fragile and under constant attack. </p>
<p>Ian Thorpe’s revelation will have an impact. Hundreds of young people will relate to his story and draw on it to shape their own destinies. It certainly matters that he has a high profile and that the world didn’t end when he spoke up. </p>
<p>Just as he has inspired a generation of young swimmers to go swifter, higher, stronger so will his openness inspire other young people to work towards an authentic self. </p>
<p>The challenge for us as a society is to move beyond the big-hearted, open-minded response of “it doesn’t matter to me if he’s gay, he’s still a great sportsman” to a response of genuine celebration. By coming out, Thorpe has given more of himself as a gift to the Australian public, and shown leadership he was afraid to embrace in the past. </p>
<p>Nothing will land in the trophy room to recognise this achievement, but lives will be saved. And it will be step towards Australia becoming a nation where that matters. </p>
<p><br>
<br>
<a href="https://theconversation.com/do-openly-gay-public-figures-like-ian-thorpe-matter-they-sure-do-29149">Do openly gay public figures like Ian Thorpe matter? They sure do</a></p><img src="https://counter.theconversation.com/content/29148/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Mitchell is the chair of the steering committee of the Safe Schools Coalition of Australia. She has a grant from beyondblue. </span></em></p>Ian Thorpe coming out as gay during an interview with Michael Parkinson last night was both the most ordinary of stories and the most extraordinary. It also showed how deeply homophobia is ingrained in…Anne Mitchell, Professor Emeritus, Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/232042014-03-04T14:53:23Z2014-03-04T14:53:23ZIn the age of Grindr, HIV support needs to get online<figure><img src="https://images.theconversation.com/files/42768/original/8m3g622h-1393606076.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If people are talking online, we need to be talking about HIV online too.</span> <span class="attribution"><a class="source" href="http://www.flickr.com/photos/aheram/4129059724/sizes/o/">Jayel Aheram</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Websites and apps such as Grindr and Scruff are booming as a new way for men to meet other men. But the people who seek to inform men about HIV and AIDS are finding they need to think on their feet to keep up with their migration online.</p>
<p>The people who could once be found in bars and clubs are now hidden behind online profiles and are proving difficult to reach. As part of a research project for the Terence Higgins Trust, a research team I’m part of at the University of Sussex followed one group of outreach workers over the course of the summer in 2013 as they ventured online to provide support, information and advice on HIV to men who have sex with men.</p>
<p>The way in which gay and bisexual men and men who have sex with men (MSM) meet one another has changed radically over the past century, at least in the UK. Legal reforms, equal rights legislation and a growing tolerance (perhaps even acceptance) of male homosexuality has meant the opportunities for meeting in different ways have grown.</p>
<p>In the past, cruising grounds were often the only way to find sexual partners but by the year 2000, more socially acceptable sites of queer congregation had emerged. Gay, bisexual and other men could meet to socialise, hook up and learn from each other in bars, cafes and clubs. </p>
<p>Meting online is the latest evolution, with sites like Grindr and Gaydar offering the chance to socialise in new ways. For the uninitiated, these websites and applications allow users to create a digital profile, upload images of themselves and then use that profile to connect with other users, often for free. Grindr also uses your smartphone’s GPS to identify how far you are away from other users. Gaydar’s website includes a radio station, chat rooms and a host of other features that allow men to communicate with one another. While these services might be considered hook-up sites, they also offer the opportunity to socialise and hang out with other men online. </p>
<p>The huge numbers of people signing up to these sites is an unmissable opportunity for communicating about sexual health. <a href="http://grindr.com/learn-more">Grindr</a> app, for instance, is downloaded around 10,000 times per day. Meanwhile Gaydar, one the UK’s longest running gay websites has <a href="http://www.outrightresearch.com/content/about_overview.aspx">5.2 million registered users</a> worldwide. But a different approach is needed. </p>
<p>The idea of meeting in a bar or club to learn may seem surprising but it has long been an important part of queer congregation. In 1983, the first AIDS deaths were recorded in Britain. At a time when governments across the world struggled to formulate an appropriate response, it was gay men (and their friends) who started to educate one another about HIV, safe sex and condom use. This education didn’t happen in school or at work. It happened on the street, in bars, around the “village” and at the cruising ground. Community outreach has been an <a href="http://www.cdcnpin.org/scripts/hiv/programs.asp">integral part</a> of the battle against HIV/AIDS and this work continues today but now needs to get online.</p>
<p>The outreach workers we monitored found that the sense of anonymity and distance created by the computer screen provided an environment in which men could talk honestly about their worries and concerns. This in turn allowed workers to offer the most relevant and appropriate advice to their clients and even refer them to services in their local area.</p>
<p>On the downside though, it seems to take longer to gain the confidence of the people they were talking to on the sites. Where once conversations could be struck up in person, they now have all sorts of hurdles to overcome. Users of online services and social networks said they found it less easy to trust others on the sites and were concerned about being watched.</p>
<p>And although they saw the Terrence Higgins Trust as a reliable source of information about HIV and AIDS, there was a need to go the extra mile to prove the reliability of the information being provided. Online life is filled with hoaxes and scams. Getting users to trust that it really was THT online, offering support, was a major challenge to the outreach team.</p>
<p>There is still very much a need to inform people about HIV and AIDS. There were only 390 deaths from AIDS in the UK last year but HIV transmission rates continue to soar. As of January 2013, an estimated <a href="http://www.nat.org.uk/HIV-Facts/Statistics/Latest-UK-Statistics.aspx">98,400</a> people were living with HIV in the UK, including around 22,000 people who did not know they were HIV positive. In 2012 alone, there were <a href="http://www.nat.org.uk/HIV-Facts/Statistics/Latest-UK-Statistics.aspx">6,360 new HIV diagnoses</a>.</p>
<p>And while outreach workers make sense of how their traditional ways of working can be translated into digital outreach, there may well be a role for apps and websites to play too. The design and architecture of the commercial online platforms that are being used to bring men together with other men could themselves be improved to help outreach.</p>
<p>Unlike a bar, where people can shout across the room or have an intimate tête-à-tête, the design of an app like Grindr or a website like Gaydar means that discussions and chat happen largely out of sight. There is little opportunity for group discussion and outreach teams find it hard to break through and be seen. Bringing in functionality like this might be an important step in making sure the outreach workers can keep up with the new ways in which people are meeting each other in the digital age.</p><img src="https://counter.theconversation.com/content/23204/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharif Mowlabocus is a Senior Lecturer in Digital Media at the University of Sussex. For this research he received funding from the EPSRC's Cultures and Communities Network and the Terrence Higgins Trust.</span></em></p>Websites and apps such as Grindr and Scruff are booming as a new way for men to meet other men. But the people who seek to inform men about HIV and AIDS are finding they need to think on their feet to…Sharif Mowlabocus, Senior Lecturer of Media Studies and Digital Media, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/195292013-10-25T05:27:07Z2013-10-25T05:27:07ZPolice attitude to sex saunas is wrong, bizarre and dangerous<figure><img src="https://images.theconversation.com/files/33710/original/wt54r33x-1382627492.jpg?ixlib=rb-1.1.0&rect=5%2C49%2C1274%2C892&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The writing was on the wall for some in city licensing review.</span> <span class="attribution"><span class="source">Andy Bell</span></span></figcaption></figure><p>Scottish police were forced to issue a statement that they did “not advocate the banning of condoms” after a BBC report, which ran under the headline “<a href="http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-24632997">Police ask for condom ban in Edinburgh saunas</a>”, said: “Police Scotland has written to the city council arguing that if it grants licences for five saunas it should be on condition that no items of a sexual nature are allowed on the premises.” similar headlines appeared across other media outlets, including the <a href="http://www.mirror.co.uk/news/uk-news/police-want-condoms-banned-edinburghs-2482297">Mirror</a>, and <a href="http://www.edinburghnews.scotsman.com/news/police-s-ban-on-sauna-condoms-will-risk-lives-1-3149911">The Scotsman</a>. </p>
<p>The story began as the council considered the license renewal of 13 “saunas”, which in this case were referred to a mix of places where women “entertain” as masseuses and gay saunas, where members can engage freely in sex with each other. </p>
<p>It appeared a bizarre and paradoxical moment for HIV prevention and social justice in Scotland. The angry response from those working to prevent HIV was palpable, blunt and to the point. Experts such as Robert McKay, the national director of Terrence Higgins Trust, called it “<a href="http://www.huffingtonpost.co.uk/2013/10/23/condom-ban-edinburgh-sex-saunas_n_4147482.html?utm_hp_ref=uk&ir=UK">draconian</a>”, while Nadine Stott, of the charity Scot-Pep, <a href="http://www.huffingtonpost.co.uk/2013/10/23/condom-ban-edinburgh-sex-saunas_n_4147482.html?utm_hp_ref=uk&ir=UK">said it went</a> “against all basic common sense”. </p>
<p>Police Scotland’s <a href="http://www.scotland.police.uk/whats-happening/news/2013/october/police-statement-edinburgh-licensing-sub-committee-report/">subsequent statement</a> said it had merely submitted a number of written recommendations for their consideration as part of the council’s review of licences and had at no point made reference to the banning of condoms. It said: </p>
<blockquote>
<p>The issue of prostitution is a complex one and we work with the City of Edinburgh Council and local health services to ensure the safety of those involved in the sex trade.</p>
</blockquote>
<p>The removal of “items of a sexual nature”, which must surely include condoms isn’t the best way to start ensuring safety in venues where sex takes place and <a href="http://sti.bmj.com/content/87/3/257.full.pdf">rates of unprotected sex</a> remain high.</p>
<h2>A better way to do things</h2>
<p>As the BBC article pointed out, NHS Lothian distributes hundreds of thousands of condoms to saunas each year. Along with charities, it also provide services for sex workers such as needle exchange, hepatitis immunisations and drug and alcohol support. In addition, safer sex and awareness of infections is something that is regularly communicated to sex workers such that there is a package of public health-focused initiatives, supported by government funding, that looks to be undermined by such irresponsible recommendations, subsequent moral panic and ensuing confusion.</p>
<p>Research at GCU has focused repeatedly on the <a href="http://www.jstor.org/stable/3986643">barriers to condom use</a> and other aspects of sexual health within a variety of populations. We consistently find that social and cultural factors shape sexual activity, condom use and resulting sexual health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33709/original/3bn7dtvw-1382626765.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ignoring contemporary sexual life disadvantages all.</span>
<span class="attribution"><span class="source">Fotolia XS</span></span>
</figcaption>
</figure>
<p>Stigma, silence and <a href="http://bit.ly/HdBvdx">a lack of engagement</a> with the reality of contemporary sexual life consistently disadvantage all and <a href="http://bit.ly/1hcxsMe">lead to negative</a> sexual health outcomes. These aspects of sexual health also critically disadvantage some more than others. </p>
<p>Throughout our research we find that fundamental health inequalities enable and constrain different groups of people to use condoms, seek HIV testing and access appropriate treatment and care. Saunas such as those in Edinburgh represent a perfect storm of vulnerability for HIV and sexual ill-health. They reflect many of the issues which drive sexual health inequalities.</p>
<h2>Takes two to tango</h2>
<p>Condom use is never an individual behaviour; it always takes two to tango and it is influenced by wider social and cultural norms and other structural level influences. And <a href="http://www.ncbi.nlm.nih.gov/pubmed/22021641">within saunas</a>, gender dynamics, economic factors and the concomitant interplay of power all systematically work against translating desire to use condoms into actual sexual practice. Protective sexual scripts which govern the rules and expectations concerning sex and condom use can be absent.</p>
<p>Against this backdrop, factors that facilitate condom use can be vital in helping to improve everyone’s sexual health. And the provision of condoms is a very basic step in enabling their use. Their obvious presence as a non-verbal cue serves as a behavioural prompt; “nudging” people into using them.</p>
<p>Now the council has made its licensing decisions - <a href="http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-24632997">seven out of 13</a> of Edinburgh’s saunas have had their licenses renewed, although it isn’t clear <a href="http://www.dailyrecord.co.uk/news/scottish-news/police-edinburgh-lose-war-sex-2486335">how much weight</a> the police recommendations had on any decision. But this whole issue looks like a new lack of pragmatism towards sex workers and the gay sex scene and, as writer <a href="http://www.theguardian.com/commentisfree/2013/oct/24/edinburgh-saunas-aids-sex-work-police-scotland-gay">Ally Fogg argues</a>, may tie into the transfer of the responsibility of law enforcement to a zero-tolerance of Strathclyde police under a new national police force.</p>
<p><a href="http://apps.who.int/iris/bitstream/10665/77745/1/9789241504744_eng.pdf">Recommendations published</a> by the World Health Organization (WHO) in partnership with UNFPA, UNAIDS, and the Global Network of Sex Work Projects, suggest that countries work towards the decriminalisation of sex work, improve sex workers’ access health services, empower sex workers to manage their sexual health and emphasise correct and consistent condom use. </p>
<p>At the forefront of the guidelines is the protection of sex workers from HIV and other sexually transmitted infections, given their vulnerability for various reasons. Any attempt to undermine health promotion efforts could have devastating effects on HIV and STIs in Scotland, which has real world consequences for the lives of individuals, not to mention the various lifetime costs involved in treating and caring for someone living with HIV. </p>
<p>We cannot afford for anyone to become complacent. It was right that organisations such as Scot-Pep and others spoke out so strongly and that the media covered this. It’s also important we continue the dialogue after the headlines have faded away.</p><img src="https://counter.theconversation.com/content/19529/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Flowers is a Trustee of the National AIDS Trust</span></em></p><p class="fine-print"><em><span>Karen Lorimer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scottish police were forced to issue a statement that they did “not advocate the banning of condoms” after a BBC report, which ran under the headline “Police ask for condom ban in Edinburgh saunas”, said…Paul Flowers, Professor of Sexual Health Psychology, Glasgow Caledonian UniversityKaren Lorimer, Research Fellow in Public Health, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.