Gay men and health : a critical analysis

Abstract

Health disparities between gay and heterosexual men exist in many areas other than HIV/AIDS. Internationally, psychology and health policy and practice have increasingly addressed health concerns for gay men, and the health of gay men, but there has been little attention to these issues in New Zealand. This research addresses that gap. It is located in the emerging field(s) of lesbian, gay, bisexual, and transgender (LGBT) health psychology, and specifically takes a critical approach to health psychology. It is framed within a social determinants of health approach, and acknowledges the usefulness of sexuality as a determinant of health to explore ongoing health inequities for gay men. The thematic analysis of data obtained from 11 focus groups with 45 gay men presents a rich cultural description of identity and community for gay men, identifying hegemonic and alternative discourses around identity, community and health. A range of knowledge, fears and aspirations held by gay men are discussed. Political and official framings of gay men’s health are also explored through a review of 17 international policy documents, and analysis of interview data from 11 key informants - people involved in health policy or service provision to gay men. Through a detailed case-study analysis, the research identifies a new area of health concern - the public health implications of alcohol marketing directed at gay men. Gay men reported complex understandings of sexuality; with few claiming a positive gay social and political identity and most portraying the gay community negatively. Gay men’s health was framed as deficit-based, and policy and research focus tended to be confined to a few specific areas. Tensions between individual and social accounts of health were identified. The former was more likely to be articulated by gay men, whereas key informants reported a more social view of health. This tension suggests there are divergent views on how best to improve health for gay men. The data analysed in this thesis demonstrates that gay men’s health is marginalised in current New Zealand health policy, and mainstream health research in New Zealand retains a heterosexist presumption. Overall, this thesis presents a powerful challenge to individualised views of health, arguing they do not adequately account for the health of groups; a social framing of health would allow for the influence of sexuality on health to be taken into account. A community action initiative is recommended as an appropriate strategy to involve gay men in the pursuit of health equity.