Sex on screens: the language of sexting and amateur pornography.

Frequently referred to as 'sexting' or 'amateur pornography', digital sexual images and videos form an increasingly common part of adult sexual relationships. However, the vocabulary available to speak about these practices is limited, with 'sexting' often associated with young people in negative terms. This study is based on 23 interviews with adults in Australia who are 25 years and older. It explores the language adults employ to discuss and comprehend the creation and sharing of sexualised images and videos. Findings show that negative or positive connotations associated with the terms used to discuss sexual images and videos influenced the ways participants drew on, or rejected, terms to align digital practices with their sexual subjectivity. Reticence to engage in active communication about digital sexual practices, and participant's distancing of their own practices from the terms commonly understood to refer to such practices, made it difficult to engage in conversations about consent or desire in the context of digitally mediated sex. Findings provide insight into the ways that -digital sexual subjectivities are discursively framed and extend these implications for sexual health promotion with respect to how to frame messages of digital sexual safety in a sex-positive and open way.

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.

Traversing TechSex: benefits and risks in digitally mediated sex and relationships.

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

Development of a Sexual Quality of Life Questionnaire for Men-Who-Have-Sex-With-Men With Prostate Cancer.

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

Attitudes, knowledge and practice behaviours of oncology health care professionals towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study.

OBJECTIVE: There is growing recognition that health care professionals (HCPs) and policy makers are insufficiently equipped to provide culturally competent care to lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients and their families. We examined HCP attitudes, knowledge, and practices regarding LGBTQI cancer care using a mixed-methods research design. METHOD: Surveys were completed by 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%), and clinical leadership roles (11%); 48 of the surveyed HCPs were interviewed. RESULTS: Most HCPs reported being comfortable treating LGBTQI patients, but reported low levels of confidence and knowledge and systemic barriers to LGBTQI cancer care. Most wanted more education and training, particularly on trans and gender-diverse people (TGD) and those born with intersex variations. CONCLUSION: Education of HCPs and health system changes are required to overcome barriers to the provision of culturally competent cancer care for LGBTQI patients. PRACTICE IMPLICATIONS: These findings reinforce the need for inclusion of LGBTQI content in HCP education and professional training curricula, and institutional support for LGBTQI-inclusive practice behaviours. This includes administrative and visual cues to signal safety of LGBTQI patients within cancer care, facilitating inclusive environments, and the provision of tailored patient-centred care.

Stigma as understood by key informants: A social ecological approach to gay and bisexual men's use of crystal methamphetamine for sex.

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

Priorities and practices of risk reduction among gay and bisexual men in Australia who use crystal methamphetamine for sex.

Crystal methamphetamine (hereafter crystal) is associated with deleterious health outcomes, such as drug dependence and physical and mental health disorders. While some harms from crystal use can affect all users, there may be additional risks for people who combine the use of drug with sex. Compared with the broader population, gay and bisexual men in Australia report a higher prevalence of methamphetamine use, and crystal is the most commonly injected illicit drug among this population. The Crystal, Pleasures and Sex between Men research project was conducted between 2017 and 2019 and examined gay and bisexual men's crystal use in four capital cities in Australia, with the aim of identifying how to best support men who use crystal for sex. In this article, we examine how risk is understood and prioritised by gay and bisexual men who combine crystal use and sex and identify the range of risk reduction practices that they used. We classified these risks as those associated with the transmission of HIV, HCV and STIs, and those associated with dependence on either crystal or the sex it facilitated. Gay and bisexual men overwhelmingly prioritised the risk of dependence over any other risks associated with crystal-enhanced sex, and this prioritization was reflected in the risk reduction practices they employed. While some of the strategies that gay and bisexual men have adopted may contradict anticipated public health principles, they derive from a carefully considered and shared approaches to the generation of pleasure, the maintenance of a controlled form of feeling "out of control", and the negotiated reduction of risk. The consolidation of these strategies effectively constitutes a "counterpublic health" underpinned by forms of "sex-based sociality", which gives primacy to the priorities and practices of gay and bisexual men in Australia who combine crystal and sex.

The significance and expectations of HIV cure research among people living with HIV in Australia.

Most people living with HIV (PLHIV) with reliable access to antiretroviral treatment (ART) have a life expectancy similar to uninfected populations. Despite this, HIV can negatively affect their social and psychological wellbeing. This study aimed to enhance understanding of the expectations PLHIV hold for HIV cure research and the implications this has for HIV cure research trials. We interviewed 20 Australian PLHIV about their expectations for HIV cure research outcomes and the impact a potential cure for HIV may have on their everyday lives. Data were analysed thematically, using both inductive and deductive approaches. The significance of a cure for HIV was expressed by participants as something that would offer relief from their sense of vigilance or uncertainty about their health into the future. A cure was also defined in social terms, as alleviation from worry about potential for onward HIV transmission, concerns for friends and family, and the negative impact of HIV-related stigma. Participants did not consider sustained medication-free viral suppression (or remission) as a cure for HIV because this did not offer certainty in remaining virus free in a way that would alleviate these fears and concerns. A cure was seen as complete elimination of HIV from the body. There is an ethical need to consider the expectations of PLHIV in design of, and recruitment for, HIV cure-related research. The language used to describe HIV cure research should differentiate the long-term aspiration of achieving complete elimination of HIV from the body and possible shorter-term therapeutic advances, such as achieving medication free viral suppression.

Destabilising the 'problem' of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use.

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

'It's like getting an Uber for sex': social networking apps as spaces of risk and opportunity in the Philippines among men who have sex with men.

The HIV epidemic in the Philippines has been expanding rapidly, with most newly diagnosed cases occurring among 'men who have sex with men' (MSM). New social contexts of HIV are evident in the evolving phenomenon of more MSM seeking partners online via social networking applications ('apps'). This study examines findings from a virtual ethnography of app use among MSM, focus group discussions with community-based healthcare workers, and key informant interviews with healthcare workers, policymakers and researchers in Metro Manila. We argue that participants viewed the expanding epidemic and apps as intimately linked, regarding the apps as 'risky spaces' for 'risky behaviour'. However, such narratives neglected the agentive capabilities of the apps and how they have transformed sexual practice, creating new ways of being as sexual subjects, while perpetuating old imaginaries among healthcare workers of 'hard-to-reach' populations. Such narratives of 'risk' have led to new interventions by healthcare workers on the apps, viewing these technologies as opportunities to reach more MSM for health promotion. However, the interventions have created new complexities by reconfiguring boundaries with target populations. By conducting community-based outreach through encouraging behaviour change in one-to-one interactions with app users, the potential impact of these interventions is limited.

Perceptions of HIV cure research among people living with HIV in Australia.

Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV's assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context.

Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs.

Background This paper explores associations between use of party-and-play drugs, including crystal methamphetamine, and wellbeing among HIV positive gay and bisexual men (GBM) in Australia. This study considers whether use of drugs in a social or sex-based setting facilitates access to social and support networks, which may in turn support wellbeing. METHODS: A cross-sectional survey of Australian people living with HIV (PLHIV) was conducted. There were 714 participants (79.7%) who identified as GBM. Differences between party-and-play drug users and non-users were examined using bivariate and multinomial logistic regressions. Mediation analysis examined the indirect effect of drug use on wellbeing via social connectedness and support. RESULTS: One in three participants (29.7%) reported party-and-play drug use within the past 12 months. Only 5% reported regular use. There were no differences between users and non-users on self-reported measures of general health, wellbeing or general social support. Compared with non-users, party-and-play drug users reported higher levels of resilience and lower levels of perceived HIV-related stigma. This was associated with spending more time with other people living with HIV and friends in the gay and lesbian community. CONCLUSIONS: While party-and-play drug use poses risks to the health of GBM, the social contexts in which these drugs are used may provide wellbeing benefits, particularly for HIV-positive GBM who may be subject to HIV-related stigma in other settings. Further research is needed to determine whether drug-use facilitates access to social networks or if people with more active social ties are more likely to engage in drug use.

The rush to risk when interrogating the relationship between methamphetamine use and sexual practice among gay and bisexual men.

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

HIV cure research: print and online media reporting in Australia.

OBJECTIVES: While still in its early stages, recent scientific research towards a cure for HIV has generated widespread media interest. The aim of this paper was to explore the ways in which this research has been represented in Australian print and online media and discuss implications of this. METHODS: A search of databases from four selected media outlets was conducted to identify published articles that directly discussed HIV cure research. Content analysis was used to explore the discursive framing of HIV cure research and identify the presence or absence of people living with HIV in articles. RESULTS: In total, 95 articles were identified that had been published in print or online between 2007 and 2015. Media reports tended to focus on research breakthroughs or the future potential of HIV cure research, rather than more immediate implications of research findings. While not inaccurate, this focus often implied the field of HIV cure research was more advanced than was generally the case. There was a notable absence of commentary from people living with HIV or community advocates in media reporting. CONCLUSIONS: Media reporting may generate unrealistic expectations of HIV cure research. This raises ethical concerns that media reporting may inadvertently contribute to therapeutic or curative misconceptions among potential participants in HIV cure-related trials. To address this, scientists, HIV advocates and people living with HIV will need to work collaboratively to engage with reporters and media outlets to provide more consistent input and guidance into reporting about research towards a cure for HIV.

Association between sexually transmissible infection testing, numbers of partners and talking to partners and friends about sexual health: survey of young adults.

Background Young adults, aged 18-30 years, comprise the largest proportion of sexually transmissible infection (STI) notifications in Australia compared with other age groups. Understanding the influence of partner and friendship networks on their STI testing practices may enhance health promotion efforts to increase testing for this group. METHOD: Participants aged 21-30 years, living in Australia for ≥3 years, were recruited within nightlife precincts in Melbourne, Australia. They completed a survey on demographic items, sexual health attitudes, sexual health knowledge and STI testing experiences and perceptions. Responses to items related to talking to partners and friends about STI testing were allocated partner and friend communication scores. Analyses included χ2 tests of independence and independent sample t-tests. RESULTS: Overall, 36.5% (61/167) of participants had tested for STIs in the previous 12 months. Of those who had tested for STIs, most had significantly higher numbers of sexual partners in the same period (P<0.05), and were significantly more likely to have felt at risk of STI acquisition (P<0.05). Significantly greater mean partner and friend communication scores were associated with higher numbers of sexual partners, feeling at risk of STIs, and testing for STIs in the previous 12 months (all P<0.05). There were no significant differences when participants were stratified by gender or age. CONCLUSION: Talking to partners and friends about STI testing is associated with testing rates for young adults. Feeling at risk and increased numbers of sexual partners may be associated with the promotion of STI testing among friends and partners.

HIV Futures 8: Protocol for a Repeated Cross-sectional and Longitudinal Survey of People Living with HIV in Australia.

INTRODUCTION: More than 27,000 Australians currently live with HIV. Most of these people have access to quality clinical care and antiretroviral treatment (ART) and can expect good general health. However, HIV-related stigma is a problem and many people living with HIV experience poorer than average mental health. Issues of aging are also of increasing concern. This paper describes the methods and sample for the HIV Futures 8 study, a national survey of people living with HIV in Australia that aimed to identify factors that support health and well-being among this population. HIV Futures 8 forms part of a series of cross-sectional surveys (The "HIV Futures" studies) that have been repeated periodically since 1997. In the most recent survey, participants were able to opt into a prospective longitudinal study. MATERIALS AND EQUIPMENT: HIV Futures 8 was open to people aged over 17 who were living with HIV. Data were collected in 2015/2016 using a self-complete survey that contained approximately 250 items related to physical and mental health, use of ART, HIV exposure and testing, financial security, social connectedness, relationships, life satisfaction, resilience, stigma, use of health and support services, and health literacy. To enable comparison of cross-sectional data over time, questionnaire items were consistent with those used in previous HIV Futures surveys. In HIV Futures 8, participants were invited to volunteer coded information that will allow longitudinal follow-up when participants complete subsequent HIV Futures surveys. The survey was advertised through the networks of HIV organizations, on social media and through HIV clinics and services. HIV Futures 8 was completed by 895 participants. This represents approximately 3.8% of the total number of people living with diagnosed HIV in Australia in 2014. EXPECTED IMPACT OF THE STUDY ON PUBLIC HEALTH: Findings from HIV Futures 8 will contribute important insights into the complexity of factors that support physical and mental well-being among people living with HIV. The findings will also assist HIV services to align with broader public health goals related to increasing ART use and improving quality of life among people living with HIV.

Abjection. Objection. Subjection: rethinking the history of AIDS in Australian gay men's futures.

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

Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer.

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

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.

Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men with Heterosexual Men.

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