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Try out PMC Labs and tell us what you think. Learn More. An academic-community partnership conducted nine focus groups with 88 MSM. Mean age was 27 range 18—60 years. Grounded theory was used. A community forum was held to develop recommendations and move these themes to action. Although gay communities in the United States US are credited with making major reductions in, and sustaining relatively low levels of, sexual behavior that put them at risk for HIV during the s and into the early s, HIV and sexually transmitted disease STD incidence has been increasing among men who have sex with men MSM in the US since the mids Nanin, et al.
Most of what is currently documented for MSM is based on early epicenters of the epidemic e. Thus, this study was deed by a community-based participatory research CBPR partnership to qualitatively explore sexual risk and identify potentially effective intervention approaches to reduce risk among MSM. CBPR was used because its authentic approach to research can increase the validity of findings and their interpretation, and thus, the meaningfulness and impact of subsequent interventions Cashman et al.
Partnership members are committed to the principles presented in Table 1. Focus groups were conducted because the methodology provides the opportunity to investigate participant responses and reactions to HIV risk and intervention more fully than methodologies that collect data from participants individually or have closed-ended questions with predefined response options. Focus groups may reveal key perspectives and nuances that researchers may not be able to foresee. In the fall ofnine focus groups were conducted, according to standard focus group research methodology. Convenience samples of participants were recruited by announcing the focus groups on geographically localized list serves, chat rooms used for social and sexual networking among MSM, and through purposive snowball approaches.
The focus groups were held in the conference rooms in the facilities of trusted community partners in 6 different cities throughout NC: Asheville, Greensboro, Raleigh, Siler City, Wilmington, and Winton-Salem. Each focus group was audio-recorded with participant permission.
Two male moderators who also are authors were present during each focus group, one moderated the focus groups and the other served as the note taker to document nonverbal reactions of the participants and tracking participant dialogue. Focus groups averaged 90 minutes. Development of the guide was an iterative process that included: literature review; brainstorm of potential domains and constructs; and development, review, and revision of questions and probes for clarification and prompts for detail. The guide, outlined in Table 2was crafted with careful consideration to wording, sequence, and content.
Written informed consent was obtained from each participant. The audio-recorded discussion was transcribed in full detail by a professional transcriptionist. A multistage inductive interpretative thematic process was used by partnership members separately reading and rereading the transcripts to identify potential codes, conveing to create a common coding system and data dictionary, and then separately asing agreed-upon codes to relevant text.
Nvivo QSR International, second editionan analytic software program, was used to code and retrieve text. This process was not deed quantify participant experiences. The approach to data analysis adhered to the principles of CBPR, whereby community members were involved in each phase of the research process, including data analysis and interpretation. The refinement and validation of findings by community members i.
Revised themes and their interpretation were presented during a community forum to validate findings and develop recommendations to move knowledge generated to action. The forum was held in Chapel Hill, NC, to allow easy access for attendees from across the state. The focus group process, data analysis procedures, and findings and their interpretation were presented to the attendees of the community forum.
Forum attendees then participated in a facilitated group discussion and brainstorming session. Five primary questions, presented in Table 3were used to lead the action-oriented discussion. These questions were developed by the CBPR partnership based on ly used and published empowerment education triggers Eng, et al.
The discussion was captured in bullet-point format on newsprint and displayed around the room. Community forum attendees used these discussion points to make recommendations that also were captured on newsprint. A total of 88 men participated in one of nine focus groups. Two groups were held in Greensboro, Raleigh, and Winston-Salem each. Participants reported currently living throughout NC, with 17 participants representing three counties in the western region, 61 representing 11 counties in the central region, and 10 representing one county in the coastal region.
Participants had a mean age of 27 range 18—60 years. For non-self-identifying men, this may be intensified as they try to overcome external and internal perceptions about their masculinity.
Condom use may be antithetical to sex as an expression of love, trust, and closeness between men. Participants noted a variety of health issues that they worry about, specifically diabetes and cardiovascular disease. They recognized the importance of exercise, eating healthfully, and reducing stress.
When probed to share their thoughts about sexual health, participants noted that they and other MSM do not worry about their sexual health or risks of HIV or STD infection. As a white participant reported. A Latino participant noted. We have very little information about these types of diseases.
Participants noted that these men often are missed in typical prevention efforts; they do not go to gay-oriented bars and clubs, do not read gay-oriented publications, and may not disclose risks to providers or sexual partners. I had a girl and I had men [as sexual partners]. I knew nothing. I may not have wanted to acknowledge the information that was available. I ignored what was available because I was afraid. It would mean I was gay or I was doing something risky. Or I was hurting someone else. Besides asserting that they lacked information about HIV and STDs, participants illustrated this lack of information during the focus groups.
For example, a Latino participant mentioned that he thought that HIV could be transmitted by sharing a glass with someone who is infected with HIV. All of the focus groups concluded that manhood is often perceived by men and women to be best affirmed through sex with women.
Their self-image and self-esteem might suffer, which may contribute to depression and subsequent risk behaviors. An African American participant reported. It hurts because society tells us, from when we are young: boys must be men, and men must have sex with women. Given the need for men threatened by dominant masculine ideology to preserve their manhood, MSM may not use condoms consistently.
A white participant noted.
Many participants reported a history of being ostracized, harassed, and physically victimized by others for identifying as gay or engaging in same-sex behavior. They reported that being victimized reinforced their negative self-image, which led to further risk behavior. As an African American participant noted. Men are supposed to make it work. Participants reported that MSM often feel lonely and isolated from others. Participants reported that Latino MSM may not receive social support from general Latino communities, because they engage in same-sex behavior and thus feel like they must hide and deny who they are to avoid rejection.
Finally, Latino MSM may be isolated from one another because of 1 the distances they may live from one another in rural communities, 2 a lack of physical spaces to congregate, and 3 their fear of discovery.
Participants reported that the churches that they had been raised in were not supportive of MSM. Many participants reported that they had two options: being dishonest about who they are or being rejected by their churches. An African American participant summed up saying.
It is, I guess, but it is more about my disappointment. The church I grew up in, the church that my family belongs to and have been committed to feeds the intolerance, feeds the bigotry to my own family about people like me. So where did I turn when I was trying to figure all of this out? I had no one at my church, and that made it even harder. Participants identified stereotyping as contributing to sexual risk. Even for a short time? Condoms may be contrary to the meanings that men give to sex. An African American participant asserted. There is too much emphasis on the sexual act.
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