Dalla Lana School of Public Health, University of Toronto, Canada.
School of Social Work, McGill University, Canada.
Sociol Health Illn. 2019 Jul;41(6):1056-1070. doi: 10.1111/1467-9566.12884. Epub 2019 Mar 5.
There is mounting urgency regarding the mental health of gay, bisexual and other men who have sex with men (GBM). We examined how GBM are understanding the relationship between HIV and their mental health given the increasing biomedicalisation of HIV prevention and care. Our Grounded Theory analysis derived from qualitative interviews with 24 GBM living in Toronto, Canada, including both HIV-negative and HIV-positive men. Participants understood biomedical advances, such as undetectable viral load and pre-exposure prophylaxis (PrEP), as providing some relief from HIV-related distress. However, they offered ambivalent perspectives on the biomedicalisation of HIV. Some considered non-HIV-specific stressors (e.g. unemployment, racial discrimination) more significant than HIV-related concerns. These men expressed HIV-related distress as being under control due to biomedical advances or as always negligible when compared to non-HIV-specific stressors. Others emphasised the ongoing mental health implications of HIV (e.g. enduring risk and stigma). We describe a tension between optimistic responses to biomedicine's ability to ease the psychosocial burdens associated with HIV and the inability for biomedicine to address the social and economic determinants driving the dual epidemics of HIV and mental distress amongst GBM. We argue for more socio-material analysis over further sexual behavioural analysis of GBM mental health disparities.
关于男同性恋、双性恋和其他与男性发生性关系的男性（GBM）的心理健康问题，人们越来越感到紧迫。我们研究了 GBM 如何理解 HIV 与他们的心理健康之间的关系，因为 HIV 的预防和护理越来越具有生物医学化。我们的扎根理论分析源自对 24 名居住在加拿大多伦多的 GBM 的定性访谈，其中包括 HIV 阴性和 HIV 阳性男性。参与者理解生物医学方面的进步，如不可检测的病毒载量和暴露前预防（PrEP），为缓解与 HIV 相关的痛苦提供了一些帮助。然而，他们对 HIV 的生物医学化持矛盾的观点。一些人认为非 HIV 特异性的压力源（如失业、种族歧视）比 HIV 相关问题更为重要。这些人表示，由于生物医学的进步，HIV 相关的痛苦得到了控制，或者与非 HIV 特异性压力源相比，HIV 相关的痛苦始终微不足道。其他人则强调 HIV 持续存在的心理影响（例如持续存在的风险和耻辱感）。我们描述了一种紧张关系，一方面是对生物医学缓解与 HIV 相关的心理社会负担的能力持乐观态度，另一方面是生物医学无法解决导致 HIV 和 GBM 心理困扰双重流行的社会经济决定因素。我们主张对 GBM 心理健康差异进行更多的社会物质分析，而不是进一步进行性行为分析。
