“So Much Is at Stake”: Professional Views on Engaging Heterosexually Identified Men who Have Sex with Men with Sexual Health Care in Australia
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.
KeywordsHeterosexual 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].
- ASHM. (2016). Annual report 2015–2016. Sydney: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine http://www.ashm.org.au/Documents/ASHM%20Annual%20Report%202015-16_Spreads%20(Feb%202017).pdf.Google Scholar
- 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 http://www.ashm.org.au/Publications/Stigma_and_Discrimination.pdf.Google Scholar
- Australian Institute of Health and Welfare. (2014). Australia’s health 2014. Canberra: Australian Institute of Health and Welfare http://www.aihw.gov.au/publication-detail/?id=60129547205.Google Scholar
- 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.
- 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.
- Diamond, L. (2009). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.Google Scholar
- 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
- Joseph, S. (1997). She’s my wife, he’s just sex: Australian Centre for Independent Journalism.Google Scholar
- McNair, R. (2012). A guide to sensitive care for lesbian, gay and bisexual people attending general practice. Melbourne, Australia: The University of Melbourne http://www.glhv.org.au/sites/www.glhv.org.au/files/LGB_GP%20Guide_RACGP%20logo%20July%202012.pdf.Google Scholar
- 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 https://csrh.arts.unsw.edu.au/research/projects/straight-msm/.Google Scholar
- 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
- NSW Health. (2016a). NSW HIV strategy 2016–2020: Ending HIV. Sydney: New South Wales Department of Health http://www.health.nsw.gov.au/endinghiv/Publications/nsw-hiv-strategy-2016-2020.PDF.Google Scholar
- NSW Health. (2016b). NSW HIV strategy 2016–2020: Quarter 1 2016 data report. Sydney: New South Wales Department of Health http://www.health.nsw.gov.au/endinghiv/Documents/q1-2016-nsw-hiv-data-report.pdf.Google Scholar
- NSW STIPU. (2017). Becoming more gay friendly in your practice. Sydney: NSW Sexually Transmissible Infections Programs Unit http://stipu.nsw.gov.au/stigma/becoming-more-gay-friendly/.Google Scholar
- Pallotta-Chiarolli, M. (2016). Women in relationships with bisexual men: Bi men by women. London: Lexington Books.Google Scholar
- 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
- 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
- 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.
- 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
- 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