Tailoring tobacco smoking reduction and cessation interventions with gay men living with HIV

Kevan (name changed) participated in one of two participatory focus groups held in Victoria and Vancouver in the spring of 2013 to provide advice on helping create services for men living with HIV who smoke tobacco products. During the focus group he learned that smoking rates among gay men and persons living with HIV (PLWH) are 2 – 4 times higher than the general population. Smoking is a major modifiable determinant of health associated with significant comorbidities (e.g., cardiovascular, neuropsychiatric, pulmonary, renal diseases) and HIV disease progression. Among gay and bisexual men, heavier tobacco use is associated with more severe illness symptoms and higher smoking rates are associated with comorbid illness. Previous smoking reduction and cessation (SRC) interventions used generalized (one-size-fits-all) approaches that have limited success with gay men. Tailoring SRC interventions to the unique needs of gay PLWH may improve the success of SRC with these men. Working with gay men living with HIV who smoke, the BC Lung Association’s QuitNow Program, and researchers from the Schools of Nursing at the University of British Columbia and the University of Ottawa are exploring the use of personas and empathy mapping to develop a tailored SRC web-assisted tobacco intervention (WATI).

Kevan and his peers were invited to become researcher-participants in the development of personas representing the typical gay man living with HIV who smokes. Personas are used in marketing to develop “detailed descriptions of imaginary people constructed out of well-understood, highly specified data about real people.” Personas help people who do not belong to a target market understand the needs of people like Kevan and how their culture influences health promotion and smoking behaviors. During participatory design sessions, Kevan and his peers generated a name and demographic information for their ‘persona’ and ascribed unique thoughts, feelings, and behaviors to each persona.  Four personas emerged from the design sessions, Joe Average, Biff Barista, Riley Homo, and Joe Schmo.

Joe Average, for example, is an HIV positive gay man living with his partner in a mid-sized city. He works full time He is a pack-a-day smoker who often smokes with his partner, co-workers, or friends. He is strongly goal oriented and he strives to manage his HIV. He makes sure that he eats right and gets plenty of exercise. Often under deadlines for his job, he finds himself smoking to relieve stress. He smokes as part of his many routines, including taking medications and vitamins, activities of daily living (e.g., showering), socializing with co-workers, smoking marijuana with his partner, and he sometimes smokes cigarettes after getting high on marijuana. Although concerned with his health, he hasn’t been able to quit smoking.

The four personas created by Kevan and his peers were analyzed using ethnographic and thematic analysis techniques to understand the collective needs of HIV positive gay men who smoke and how culture influences their SRC efforts. The first theme that emerged was navigating life and HIV, followed by triple stigma (i.e. gay-related stigma, HIV-related stigma, smoking-related stigma), immunity to public health messages, complexity of managing HIV, complexity of managing identity, benefits of smoking, anxiety about life, and apathy about life. Our goals with Kevan and his peers are to engage with gay men living with HIV who smoke as researcher-participants. This approach affords gay men living with HIV who smoke the opportunity to collaborate with each other, policy makers, researchers, and clinicians in the development of a WATI that includes input and collaboration from all stakeholders.



J. Craig Phillips, PhD, LLM, RN, ARNP, PMHCNS-BC, ACRN, Associate Professor, School of Nursing, University of Ottawa

Jack Boomer

Jack Boomer, MPA, B.Ed., Director, QuitNow, BC Lung Association, Principal, Context Research

Leanne M. Currie, PhD, RN, Associate Professor, School of Nursing, University of British Columbia

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Navigating the Risks and Rewards of Group Sex

 Queer and Questioning Men as Pleasure-Seeking Harm-Reduction Experts

Moving forward, particularly in HIV/AIDS prevention, and gay men’s health overall, we must not reduce members of our community to problems that need to be solved and thus rush to establish prevention strategies without any genuine grasp of our desires and sexuality.  -Charles Stephens

Group sex events (GSE) have been a social, albeit mostly secretive, phenomenon throughout history. From ancient Dionysian mystery cults to today’s commercial sex clubs, intense communal sex-capades have attracted segments of the populace. GSE may involve anywhere from five to many lovers in a variety of private and public settings. According to early data drawn from the Vancouver’s 2014 Momentum Health Study, a Canadian Institute of Health Research and National Institute of Health funded longitudinal study of Vancouver gay men’s health, nearly a quarter of gay/bisexual/question (GBQ) men participate in GSE. Of these, 74 percent of participants used anywhere from one to a combination of 12 substances with the intention to disinhibit, prolong and/or enhance pleasure; while the same number of participants of the same study expressed interest in safer sex parties. How do queer and questioning men negotiate seemingly competing needs between sexual pleasure and health?

Few would deny the known risks to GBQ men associated with group sex. Nearly 60 percent of all new HIV diagnoses here in BC are from within this population. Do we know enough about the potential rewards of sexual exploration? More nuanced, culturally sensitive information is needed to provide a richer understanding of what constitutes both “risk and reward” in areas of queer and questioning men’s health.

Resiliency Theory advocates for strength-based HIV programs for men who lust for men. A new study of GSE out of Vancouver in partnership with community organizations including Health Initiative for Men suggests such programs should be internally navigated from within the specific contexts of GSE.  Momentum Health Study data indicates a subculture of intensive sex partying associated with GSE, and importantly reveals evidence of personal harm reduction practices (e.g. always being the top in anal intercourse to reduce HIV transmission). The Momentum study seeks to determine what other indigenous prevention tactics are associated within this subculture. The mixed-methods study will gather more information about who attends GSE, what motivates participant’s risk-taking/reward-making choices, and their harm-reducing and pleasure-amplifying practices. Between 20 and 30 participants, interviewed twice over a three-month period will inform researchers and community practitioners about the cultural characteristics and intrinsic values GSE offer participants. Project participants will ideally recommend potential customized event-level sexual health concepts for implementation.

Researchers also intend to meet with sex party hosts to better understand their needs and strategies for offering higher quality, safer and sounder sexual experiences to their guests. By engaging queer and questioning men in conversations about their chosen sexual practices and culturally explicit erotic spaces, future health strategies may more successfully evolve by both honouring men’s need for sexual adventurism while supporting their efforts for self and communal care. Your thoughts are most welcome.

robert birch

Robert Birch, MA is a doctoral student with the Social Dimensions of Health program at the University of Victoria, a new qualitative researcher with the B.C. Centre for Excellence Momentum Health Study for gay/bi men, and writes for the award winning national HIV/AIDS blog www.positivelite.com

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC