Reimagining risk :exploring understandings of risk in sexual health amongst gay and bisexual men in the North East of England

Abstract

This ESRC funded qualitative research was initiated in response to a re-emergence of syphilis and continuing increases in HIV rates amongst gay, bisexual and/or men who have sex with men (MSM) in the North East of England. The research was conducted in partnership with local sexual health services from three NHS Primary Care Trusts and a gay and bisexual men’s sexual health organisation, with findings intended to inform sexual health services and policy. The aim of this research was to situate understandings and meanings of risk in sexual practice within the everyday lives and experiences of MSM within this particular epidemiological and geographic context. The research asked what MSM understood as a risk in their sexual practice; how they responded to perceived risk in their sexual practice; and what influenced these understandings and responses to risk. In-depth interviews were conducted between March and August 2009 with twenty-three gay and bisexual men, aged 18 – 63, who lived, worked, socialised or accessed sexual health services in the North East of England. In contrast to public health concerns that MSM are not longer practising ‘safer sex’ in a ‘post-crisis’ era of HIV, participants described the ways in which they were engaged in a creative and reflexive sexual practice which considered and responded to risk of infection. Findings indicate how respondents drew directly on biomedical knowledge and technologies to inform their understandings and responses to risk. However, these responses were embedded in perceived community norms of sexual practice, which drew on memories of HIV and were based on a harm reduction strategy. Findings from this research are discussed in three chapters in this thesis. The thesis first explores how participants negotiated biomedical and embodied understandings of risk within a community practice that prioritised HIV prevention. The following chapter considers how particular sexual actors were constructed as risky and the implications this had for participants’ own understandings of risk and responsibility. The final analysis chapter details the ways in which place and space played an important role in understandings of risk and responsibility, and points to the ways in which regional and national boundaries, as well as changing community sexual practices, impact on the location and management of risk.