Sexuality Research and Social Policy

, Volume 15, Issue 3, pp 302–311 | Cite as

“So Much Is at Stake”: Professional Views on Engaging Heterosexually Identified Men who Have Sex with Men with Sexual Health Care in Australia

  • Christy E. NewmanEmail author
  • Asha Persson
  • Pene Manolas
  • Heather-Marie Ann Schmidt
  • Catriona Ooi
  • Alison Rutherford
  • John de Wit


Australian HIV prevention, testing, and treatment services are well-established for men who have sex with men (MSM) who identify as gay or bisexual. However, the sexual health needs of heterosexually identified MSM (hereafter called “straight MSM” as a shorthand) and opportunities to engage this sub-group with services and information are less clear. Semi-structured interviews were conducted in 2015–2016 with 30 professionals working in the sexual health sector in the state of New South Wales, Australia. Participants viewed straight MSM as comprising multiple, intersecting sub-groups, but sharing a common preference for services which promise “discretion” and “confidentiality”, and information which does not presume an alignment between gay identity and sex between men. Participants described these men as typically very concerned about keeping this aspect of their sexual lives secret and separate from their family, work, and community lives. Participants were keenly aware of both the benefits and the challenges of providing respectful and non-judgmental care. This exploratory study provides initial evidence of the complexities of engaging straight MSM with sexual health care and suggests a range of strategies for increasing cultural understanding of the diverse sexual practices that can be present in the lives of some heterosexually identified men.


Heterosexual identity Men who have sex with men Sexual health services Professional perspectives Australia Qualitative 



This project was conducted at the UNSW Sydney and supported by the BBV & STI Research, Intervention and Strategic Evaluation Program (BRISE). BRISE is funded by the NSW Ministry of Health and undertakes policy-relevant research to support NSW Health in reducing blood-borne viruses (BBV) and sexually transmissible infections (STI) in NSW, as well as improving the health outcomes of people living with these infections. We are very grateful to all those who donated their time and expertise in taking part in interviews and to the organizations who have supported the investigators to contribute to this study, namely the Heterosexual HIV Service (Pozhet), Western Sydney Sexual Health Centre, and South Western Sydney Sexual Health Centre.

Compliance with Ethical Standards

Ethical approval was granted by the Sydney Local Health District (Royal Prince Alfred Zone) [X15-0275 & HREC/15/RPAH/376].


  1. Albury, K. (2015). Identity plus? Bi-curiosity, sexual adventurism and the boundaries of “straight” sexual practices and identities. Sexualities, 18(5–6), 649–664. doi: 10.1177/1363460714561672.CrossRefGoogle Scholar
  2. ASHM. (2016). Annual report 2015–2016. Sydney: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine Scholar
  3. ASHM and NCHSR. (2011). Stigma and discrimination around HIV and HCV in healthcare settings: Research report. Sydney: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine Scholar
  4. Australian Institute of Health and Welfare. (2014). Australia’s health 2014. Canberra: Australian Institute of Health and Welfare Scholar
  5. Bacchi, C., & Bonham, J. (2016). Poststructural interview analysis: Politicizing “personhood”. In C. Bacchi & S. Goodwin (Eds.), Poststructural policy analysis: A guide to practice (pp. 113–121). New York: Palgrave Macmillan.CrossRefGoogle Scholar
  6. Benoit, E., Pass, M., Randolph, D., Murray, D., & Downing Jr., M. J. (2012). Reaching and engaging non-gay identified, non-disclosing Black men who have sex with both men and women. Cult Health sex, 14(9), 975–990. doi: 10.1080/13691058.2012.709640.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Braun, V., & Clarke, V. (2006). Using thematic analysis in qualitative psychology. Qual res Psychol, 3(2), 77–101. doi: 10.1191/1478088706qp063oa.CrossRefGoogle Scholar
  8. Cant, B. (2008). Gay men’s narratives and the pursuit of well-being in healthcare settings: A London study. Critical Public Health, 18(1), 41–50. doi: 10.1080/09581590701829606.CrossRefGoogle Scholar
  9. Carrillo, H., & Hoffman, A. (2016). From MSM to heteroflexibilities: Non-exclusive straight male identities and their implications for HIV prevention and health promotion. Global Public Health, 1–14. doi: 10.1080/17441692.2015.1134272.
  10. Carrillo, H., & Hoffman, A. (2017). “Straight with a pinch of bi”: The construction of heterosexuality as an elastic category among adult US men. Sexualities, Online first: 8 Feb. doi: 10.1177/1363460716678561.
  11. de Visser, R. O., Badcock, P. B., Simpson, J. M., Grulich, A. E., Smith, A. M., Richters, J., & Rissel, C. (2014). Attitudes toward sex and relationships: The second Australian study of health and relationships. Sex Health, 11(5), 397–405. doi: 10.1071/sh14099.CrossRefPubMedGoogle Scholar
  12. Diamond, L. (2009). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.Google Scholar
  13. Flood, M. G. (2008). Bent straights: Diversity and flux among heterosexual men. In E. H. Oleksy (Ed.), Intimate citizenships: Gender, subjectivity, politics. New York: Routledge.Google Scholar
  14. Glenn, C. L., & Spieldenner, A. R. (2013). An intersectional analysis of television narratives of African American women with African American men on “the down low”. Sexuality & Culture, 17(3), 401–416. doi: 10.1007/s12119-013-9189-y.CrossRefGoogle Scholar
  15. Hardon, A., & Posel, D. (2012). Secrecy as embodied practice: Beyond the confessional imperative. Cult Health sex, 14(Suppl 1), S1–13.CrossRefPubMedGoogle Scholar
  16. Icard, L. D. (2008). Reaching African-American men on the down low: Sampling hidden populations: Implications for HIV prevention. J Homosex, 55(3), 437–449. doi: 10.1080/00918360802345198.CrossRefPubMedGoogle Scholar
  17. Joseph, S. (1997). She’s my wife, he’s just sex: Australian Centre for Independent Journalism.Google Scholar
  18. Khan, A., Plummer, D., Hussain, R., & Minichiello, V. (2007). Sexual risk assessment in general practice: Evidence from a New South Wales survey. Sex Health, 4(1), 1–8.CrossRefPubMedGoogle Scholar
  19. Kippax, S., & Race, K. (2003). Sustaining safe practice: Twenty years on. Soc Sci med, 57(1), 1–12. doi: 10.1016/S0277-9536(02)00303-9.CrossRefPubMedGoogle Scholar
  20. Krause, J., Subklew-Sehume, F., Kenyon, C., & Colebunders, R. (2013). Acceptability of HIV self-testing: A systematic literature review. BMC Public Health, 13(1), 735. doi: 10.1186/1471-2458-13-735.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Martinez, J., & Hosek, S. G. (2005). An exploration of the down-low identity: Nongay-identified young African-American men who have sex with men. J Natl med Assoc, 97(8), 1103–1112.PubMedPubMedCentralGoogle Scholar
  22. McNair, R. (2012). A guide to sensitive care for lesbian, gay and bisexual people attending general practice. Melbourne, Australia: The University of Melbourne Scholar
  23. McNair, R. P., & Hegarty, K. (2010). Guidelines for the primary care of lesbian, gay, and bisexual people: A systematic review. Ann Fam med, 8(6), 533–541. doi: 10.1370/afm.1173.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Newman, C., Persson, A., Holt, M., Callander, D., Schmidt, H., Gordon, T., Manolas, P., Rutherford, A., & Ooi, C. (2016). Understanding expert views on defining and reaching heterosexually-identified men who have sex with men for health promotion and care. Sydney: Centre for Social Research in Health, UNSW Scholar
  25. Newman, C. E., de Wit, J. B. F., Kippax, S. C., Reynolds, R. H., Canavan, P. G., & Kidd, M. R. (2012). The role of the general practitioner in the Australian approach to HIV care: Interviews with ‘key informants’ from government, non-government and professional organisations. Sex Transm Infect, 88(2), 132–135. doi: 10.1136/sextrans-2011-050130.CrossRefPubMedGoogle Scholar
  26. Newman, C. E., Persson, A., Paquette, D. M., & Kidd, M. R. (2013). The new cultural politics of the waiting room: Straight men, gay-friendly clinics and ‘inclusive’ HIV care. Sexuality Research and Social Policy, 10(2), 87–96. doi: 10.1007/s13178-013-0111-z.CrossRefGoogle Scholar
  27. NSW Health. (2016a). NSW HIV strategy 2016–2020: Ending HIV. Sydney: New South Wales Department of Health Scholar
  28. NSW Health. (2016b). NSW HIV strategy 2016–2020: Quarter 1 2016 data report. Sydney: New South Wales Department of Health Scholar
  29. NSW STIPU. (2017). Becoming more gay friendly in your practice. Sydney: NSW Sexually Transmissible Infections Programs Unit Scholar
  30. Operario, D., Smith, C. D., & Kegeles, S. (2008). Social and psychological context for HIV risk in non-gay-identified African American men who have sex with men. AIDS Educ Prev, 20(4), 347–359. doi: 10.1521/aeap.2008.20.4.347.CrossRefPubMedGoogle Scholar
  31. Pallotta-Chiarolli, M. (2016). Women in relationships with bisexual men: Bi men by women. London: Lexington Books.Google Scholar
  32. Parker, R., Aggleton, P., & Perez-Brumer, A. G. (2016). The trouble with ‘categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion. Global Public Health, 11(7–8), 819–823. doi: 10.1080/17441692.2016.1185138.CrossRefPubMedGoogle Scholar
  33. Persson, A., Newman, C. E., Manolas, P., Callander, D., Gordon, T., Holt, M., & de Wit, J. B. F. (forthcoming). Challenging perceptions of “straight”: Heterosexual men who have sex with men and the cultural politics of sexual identity categories.Google Scholar
  34. Pettaway, L., Bryant, L., Keane, F., & Craig, S. (2014). Becoming down low: A review of the literature on Black men who have sex with men and women. Journal of Bisexuality, 14(2), 209–221. doi: 10.1080/15299716.2014.902346.CrossRefGoogle Scholar
  35. Plummer, K. (1995). Telling sexual stories. London, New York: Routledge.CrossRefGoogle Scholar
  36. Prestage, G., & Drielsma, P. (1996). Indicators of male bisexual activity in semimetropolitan New South Wales: Implications for HIV prevention strategies. Aust N Z J Public Health, 20(4), 386–392.CrossRefPubMedGoogle Scholar
  37. Reback, C. J., & Larkins, S. (2010). Maintaining a heterosexual identity: Sexual meanings among a sample of heterosexually identified men who have sex with men. Arch sex Behav, 39(3), 766–773. doi: 10.1007/s10508-008-9437-7.CrossRefPubMedGoogle Scholar
  38. Reynolds, C. (2015). “I am super straight and I prefer you be too”: Constructions of heterosexual masculinity in online personal ads for “straight” men seeking sex with men. J Commun Inq. doi: 10.1177/0196859915575736.
  39. Richters, J., Altman, D., Badcock, P. B., Smith, A. M. A., de Visser, R. O., Grulich, A. E., et al. (2014). Sexual identity, sexual attraction and sexual experience: The second Australian study of health and relationships. Sex Health, 11(5), 451–460. doi: 10.1071/SH14117.CrossRefPubMedGoogle Scholar
  40. Santella, A. J., Schlub, T. E., Ooi, C., Varma, R., Holt, M., Prestage, G., & Hillman, R. J. (2015). Sexual behaviour and HIV prevention needs of men attending a suburban sex on premises venue. Sex Health, 12(5), 383–389. doi: 10.1071/SH14227.CrossRefPubMedGoogle Scholar
  41. Savin-Williams, R. C. (2016). Sexual orientation: Categories or continuum? Commentary on Bailey et al. (2016). Psychol Sci Public Interest, 17(2), 37–44. doi: 10.1177/1529100616637618.CrossRefPubMedGoogle Scholar
  42. Schrimshaw, E. W., Downing Jr., M. J., Cohn, D. J., & Siegel, K. (2014). Conceptions of privacy and the non-disclosure of same-sex behaviour by behaviourally-bisexual men in heterosexual relationships. Cult Health sex, 16(4), 351–365. doi: 10.1080/13691058.2014.887779.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Schrimshaw, E. W., Downing Jr., M. J., & Siegel, K. (2013). Sexual venue selection and strategies for concealment of same-sex behavior among non-disclosing men who have sex with men and women. J Homosex, 60(1), 120–145. doi: 10.1080/00918369.2013.735945.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Twenge, J. M., Sherman, R. A., & Wells, B. E. (2016). Changes in American adults’ reported same-sex sexual experiences and attitudes, 1973–2014. Arch sex Behav, 45(7), 1713–1730. doi: 10.1007/s10508-016-0769-4.CrossRefPubMedGoogle Scholar
  45. Ward, J. (2015). Not gay: Sex between straight white men. New York: NYU Press.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Christy E. Newman
    • 1
    Email author
  • Asha Persson
    • 1
  • Pene Manolas
    • 2
  • Heather-Marie Ann Schmidt
    • 3
  • Catriona Ooi
    • 4
    • 5
  • Alison Rutherford
    • 6
    • 7
    • 8
  • John de Wit
    • 1
    • 9
  1. 1.Centre for Social Research in HealthUNSW SydneySydneyAustralia
  2. 2.Pozhet (Heterosexual HIV Service), NSW Health (Sydney Local Health District)SydneyAustralia
  3. 3.Centre for Population HealthNSW Ministry of HealthNorth SydneyAustralia
  4. 4.Western Sydney Sexual Health Centre, Western Sydney Local Health DistrictParramattaAustralia
  5. 5.Sydney Medical School—Westmead Clinical SchoolUniversity of SydneySydneyAustralia
  6. 6.Illawarra Sexual Health Services, NSW Health (Illawarra Shoalhaven Local Health District)WarrawongAustralia
  7. 7.School of Public Health and Community MedicineUNSW SydneySydneyAustralia
  8. 8.Graduate Medicine, University of WollongongWollongongAustralia
  9. 9.Department of Interdisciplinary Social ScienceUtrecht UniversityUtrechtNetherlands

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