Men, bodywork, health and the potentiality of performance and image-enhancing drugs.

In a qualitative study on masculinity, embodiment and sexuality, we interviewed men who were recreational gym-goers about their bodywork practices in Melbourne, Australia. We also asked whether the men had used performance and image-enhancing drugs (PIEDs) as an adjunct to their bodywork practices. While none had used PIEDs, all were considering, or had considered, using them. We found that participants held varying opinions on PIED use and those who used them. The literature on PIEDs noted men's concerns with body appearance and health and focused largely on individual problematic use, but non-users were not mentioned. A second issue in the literature focused on social influences on PIED use, but again with no mention of non-users. Discussion on risk reduction as a public health response did not mention non-users either. This paper, therefore, reports on non-users' thoughts on, regular exposure to, and considerations of PIEDs and other men who use them. We propose that PIEDs might more usefully be understood as an everyday, if contradictory, consideration within most men's bodywork and health practices. We argue that PIEDs constitute a discursive practice exposing a potentiality that engages non-users also and this requires new health promotion approaches.

The hammer and the nail: The triple lock of methods, realities and institutional contexts in Australian research on nightlife violence.

There is considerable public and policy debate in Australia about measures to reduce violence associated with alcohol and young people in the night-time economy. Though overrepresented in violence, the role of men and masculinities is rarely explicitly addressed in policy responses to such violence, which rest on a narrow range of mainly quantitative research and recommendations favouring blanket alcohol restrictions. Drawing on John Law and colleagues' account of the 'double social life of methods' (2011), we analyse interviews conducted with Australian quantitative researchers about the role of gender in such violence. According to Law et al., methods inhabit and reproduce particular ecologies and reflect the concerns of those who advocate them. From this 'triple lock' of methods, realities, and institutional advocacies and contexts emerges particular modes of knowing. Participants described a research ecology in which the authority of quantitative research methods emerged in relation to an imperative to respond in a 'timely' and 'pragmatic' fashion to public policy debates, and prevailing governmental and policy priorities and public framings of violence. Though participants frequently acknowledged the role of men in violence, these arrangements sustain taken-for-granted assumptions about the properties and effects of alcohol while displacing men and masculinities from policy attention. The political consequences of these arrangements demand the development of innovative policy responses and new modes of knowing that make visible the gendering of violence.

Noticed and then Forgotten: Gender in Alcohol Policy Stakeholder Responses to Alcohol and Violence.

In this article, we analyse interview data on how alcohol policy stakeholders in Australia, Canada and Sweden understand the relationship between men, masculinities, alcohol and violence. Using influential feminist scholarship on public policy and liberal political theory to analyse interviews with 42 alcohol policy stakeholders, we argue that while these stakeholders view men's violence as a key issue for intervention, masculinities are backgrounded in proposed responses and men positioned as unamenable to intervention. Instead, policy stakeholders prioritise generic interventions understood to protect all from the harms of men's drinking and violence without marking men for special attention. Shared across the data is a prioritisation of interventions that focus on harms recognised as relating to men's drinking but apply equally to all people and, as such, avoid naming men and masculinities as central to alcohol-related violence. We argue that this process works to background the role of masculinities in violence, leaving men unmarked and many possible targeted responses unthinkable.

Enacting alcohol realities: gendering practices in Australian studies on 'alcohol-related presentations' to emergency departments.

'Alcohol-fuelled violence' and its prevention has been the subject of recent intense policy debate in Australia, with the content of this debate informed by a surprisingly narrow range of research resources. In particular, given the well-established relationship between masculinities and violence, the meagre attention paid to the role of gender in alcohol research and policy recommendations stands out as a critical issue. In this article, which draws on recent work in feminist science studies and science and technology studies, we focus on the treatment of gender, alcohol and violence in Australian research on 'alcohol-related presentations' to emergency departments (EDs), analysing this type of research because of its prominence in policy debates. We focus on four types of 'gendering practice' through which research genders 'alcohol-related presentations' to EDs: omitting gender from consideration, ignoring clearly gendered data when making gender-neutral policy recommendations, methodologically designing out gender and addressing gender in terms of risk and vulnerability. We argue that ED research practices and their policy recommendations reproduce normative understandings of alcohol's effects and of the operations of gender in social arrangements, thereby contributing to the 'evidence base' supporting unfair policy responses.

Exploring Diversity in HIV Research in the Sexual Partnerships of Australian Gay and Bisexual Men.

Gay and bisexual men engage in a variety of sexual partnerships, but the most common distinction made in HIV research and behavioral surveillance is a binary between "regular" and "casual" partners. The "regular partner" category is often perceived as pertaining to ongoing coupled "boyfriend" relationships, with the literature to date rarely troubling what actually constitutes a "regular partner." Some emerging literature has identified "fuckbuddy" partnerships as a type of regular partnership requiring attention, but it is relatively new and not well understood. Currently, assumptions of the regular partner category do not capture how men perceive and conduct commitment in different sexual partnerships that could also be considered "regular," and the implications this has for HIV prevention. Drawing on in-depth interviews with a sample of 61 Australian gay-identified men, we explore a diversity of partnership types that represent unique ways of enacting commitment. We identify three sexual partnerships: "fuckbuddies," dating, and serial monogamy, each with specific issues for HIV risk and prevention. These partnerships suggest important differences in the way men conceive of and practice intimacy and sex.

Negotiating gay men's relationships: how are monogamy and non-monogamy experienced and practised over time?

When viewed over time, many gay men's relationships are not static, or firmly fixed to monogamy or non-monogamy. This paper uses in-depth interviews with 61 Australian gay men to explore how monogamy and non-monogamy are experienced over time, expectations of what constitutes the norms regarding gay men's relationships and how couples experience and practices change. Although some gay men may idealise monogamy, particularly at the beginning of a relationship, it is often experienced as temporary. Non-monogamy is often seen as a likely prospect for gay relationships owing to the social and cultural norms that operate in gay communities. These expected trajectories are reflected in practice - many relationships begin monogamously and then become non-monogamous over time. While the application of 'rules', experimentation and flexibility can facilitate change, couples may struggle to navigate new territory as their relationship structures shift. This is particularly the case when partners value monogamy and non-monogamy differently, or when one partner's values change. These findings shed light on how gay men approach change to the status of 'fidelity' within their relationships, and the tensions and opportunities that change can produce for couples.

Hepatitis B testing and diagnosis experiences of patients and primary care professionals in Australia.

OBJECTIVE: A significant proportion of Australians with chronic hepatitis B (CHB) remains undiagnosed and unaware of their risk of liver disease and cancer. This study explored the hepatitis B testing and diagnostic experiences of people with CHB, general practitioners (GPs) and primary care nurses. METHODS: Semi-structured interviews were conducted with people who have CHB (n = 19), GPs (n = 14) and nurses (n = 5). RESULTS: The majority of patient participants with CHB were not provided with information prior to being tested, and were shocked to receive a diagnosis. Neither GPs nor nurses noted Australia's National hepatitis B testing policy as guiding their practice, and hepatitis B con-tact tracing was poorly executed. DISCUSSION: Patient participants' diagnostic experiences did not correspond with national policy recommendations. GPs and nurses need resources to provide accurate information when testing and diagnosing hepatitis B, and clear guidance about their role in contact tracing.

How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men.

Background Regular sexual partnerships among gay and bisexual men (GBM) who practice condomless anal intercourse (CLAI) have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships, although commonly reported by gay men, have largely been ignored in research and HIV prevention. Among regular partners reporting CLAI with each other, we determined factors differentiating romantic or committed relationships from partnerships organised primarily around sex ('fuckbuddies') and estimated the proportion of CLAI presenting risk for HIV transmission. METHODS: An online, cross-sectional survey of Australian GBM was conducted. Univariate and multivariate generalised estimating equations were used to determine statistical associations. RESULTS: Men reported on 2250 regular sexual partnerships. Over half the partnerships were romantic or committed relationships. Over half the partnerships were HIV-negative seroconcordant (54.9%), 3.1% were HIV-positive seroconcordant, 5.2% were serodiscordant and 36.8% were of unknown seroconcordance. Potential risks presented by CLAI were sometimes mitigated by protective factors, such as having a clear spoken agreement about sex with outside partners, having fewer outside partners, openly discussing HIV risk and having an agreement to reduce risk from outside partners. These protective factors were more often found in romantic or committed relationships than among primarily sexual partnerships, and were less often found in partnerships of unknown seroconcordance. CONCLUSION: CLAI is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Unknown seroconcordance, particularly lack of communication about HIV status among primarily sexual partnerships, is a key risk factor that needs to be addressed by HIV education.

Partnership agreements less likely among young gay and bisexual men in Australia - data from a national online survey of gay and bisexual men's relationships.

BACKGROUND: How gay and bisexual men (GBM) establish partnership agreements may be affected by several factors, including age. The ability to communicate with a partner about sexual agreements has important sexual health implications for GBM. OBJECTIVE: To assess differences in partnership agreements among GBM. METHODS: We surveyed GBM about their partnerships using a national, anonymous online survey in 2013-14. We compared men who had monogamous partnerships with men who had non-monogamous partnerships, according to age and other factors. RESULTS: Regarding the nature of their partnership with their primary regular partner (PRP), younger men were less likely to have an agreement of any sort and were less likely to have discussed it. Younger men were more likely to report having a monogamous partnership, but they were also less likely to report condomless anal intercourse with their PRP. In multivariate analysis of partnership arrangements, having a non-monogamous partnership with their PRP was associated with being older (adjusted odds ratio=1.03; 95% confidence interval=1.02-1.04; P<0.001). Nearly two-thirds (62.9%) of men with monogamous partnerships had a clear spoken agreement with their PRP about whether they could have sex with other men, largely regardless of age. Although slightly fewer than half the men with self-described open partnerships (46.0%) actually described it as a 'relationship', younger men were particularly less likely to do so. CONCLUSIONS: Due to less communication with partners about sexual agreements, when young GBM engage in sexual risk behaviour they may be at an increased risk of HIV and other sexually transmissible infections.

Gay and bisexual men's interest in marriage: an Australian perspective.

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

The Meaning of 'Regular Partner' in HIV Research Among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey.

Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.

Online dating among Australian gay and bisexual men: romance or hooking up?

Increasingly, gay and bisexual men (GBM) meet casual sex partners online and this has been associated with sexual risk behavior. How do GBM meet regular partners? This online anonymous survey of 4215 GBM included 2562 men with a primary regular partner (PRP) who were included in these analyses. Mean age of the sample was 38.1 years. 60.3 % had met their PRP at least 2 years earlier. Meeting their PRP online increased from 14.0 % before 2001 to 79.9 % in 2013-2014. At all time points, men who met their PRP online were somewhat older than those who met their PRP offline. Regardless of how they met their PRP, most men met casual sex partners online. Among GBM, meeting sexual and romantic partners online has replaced other methods, for all age groups. The population of GBM who use the internet for this purpose is now equivalent to all sexually active GBM.

Trust, commitment, love and sex: HIV, monogamy, and gay men.

Research on gay men's relationships has neglected monogamy. Instead, it has tended to (a) emphasize HIV risk and relationship agreements between partners regarding sex and condom use with outside partners or (b) focus on nonmonogamous relationships as emblematic of relationship innovation. On the basis of qualitative interviews with 36 gay Australian men who favored a monogamous relationship as ideal, this article explores the meaning and practice of monogamy and its association with HIV risk. The authors present themes that include men's use of condoms in monogamous relationships, expectations of fidelity, and understandings of trust and security as the basis to meaningful and satisfying relationships.

Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment.

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

Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer.

OBJECTIVE: To determine if heterosexual and nonheterosexual men treated for prostate cancer differ in diagnostic and treatment outcomes and in various measures of physical health, sexual function, and well being, before and after the treatment. METHODS: Four hundred sixty self-identified heterosexual and 96 self-identified nonheterosexual men completed an anonymous online survey. The men in the 2 groups were then compared using logistic regressions that controlled for differences among countries. RESULTS: There were no significant differences in age at diagnosis for men in the 2 groups. However, Gleason scores at diagnosis were significantly lower for the nonheterosexual men (P = .02). There were no significant differences among men in the 2 groups in the proportion who receive different treatment modalities or in the incidence of urinary incontinence, who experience bone pain (as a marker of disease progression), who take antidepressants (as a proxy measure for mental health), or who experience erectile dysfunction after the treatment. However, nonheterosexual men rated the degree to which they were bothered by an inability to ejaculate significantly higher than did the heterosexual men (P = .04). CONCLUSION: This is the first set of findings from a survey that compares heterosexual and nonheterosexual men treated for prostate cancer. Although the groups were generally similar, nonheterosexual men might experience more intensive screening for disease, as indicated by lower Gleason scores at diagnosis. Nonheterosexual men appear more distressed by loss of ejaculation after prostatectomy.