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Health and social care workers (HSCWs) have an essential role in the uptake of the COVID-19 vaccine. Vaccination is an emotionally charged issue and perceptions of risk associated with COVID19 can contribute towards vaccine hesitancy (VH). The aim of this study was to explore the role of emotion and risk perception associated with HSCWs' uptake of the COVID-19 vaccine during the initial mass roll-out of the vaccine in Scotland. A cross-sectional online survey with a correlational design was used. An online survey was conducted with HSCWs (N = 1189) aged 18 to 67 years (M = 44.09 yrs, SD = 11.48) working in Scotland during the third lockdown period (26 December – 31 March 2021) of the COVID-19 pandemic. The survey collected data relating to sociodemographic characteristics, vaccine uptake and VH, emotions associated with the COVID-19 vaccine, and risk perception. Open-ended free text data were also collected on HSCWs' main reasons for VH. Most participants (83.96%) felt positively about the roll-out of the COVID-19 vaccine, stating it would be beneficial for themselves and others to receive it. Nonetheless, 16.04% of HSCWs expressed VH. Occupational group, age, gender and risk perceptions did not affect variance in VH, but positive emotions associated with the COVID-19 vaccine and years of experience did. We emphasise the importance of future interventions to increase COVID-19 vaccine uptake by enhancing positive emotions and reducing ambivalent emotions associated with the COVID-19 vaccine particularly among less experienced HSCWs. [ABSTRACT FROM AUTHOR]

In recent decades, 'whole school' approaches to improving health have gained traction, based on settings-based health promotion understandings which view a setting, its actors and processes as an integrated 'whole' system with multiple intervention opportunities. Much less is known about 'whole institution' approaches to improving health in tertiary education settings. We conducted a scoping review to describe both empirical and non-empirical (e.g. websites) publications relating to 'whole settings', 'complex systems' and 'participatory'/'action' approaches to improving the health of students and staff within tertiary education settings. English-language publications were identified by searching five academic and four grey literature databases and via the reference lists of studies read for eligibility. We identified 101 publications with marked UK over-representation. Since the 1970s, publications have increased, spanning a gradual shift in focus from 'aspirational' to 'conceptual' to 'evaluative'. Terminology is geographically siloed (e.g., 'healthy university' (UK), 'healthy campus' (USA)). Publications tend to focus on 'health' generally rather than specific health dimensions (e.g. diet). Policies, arguably crucial for cascading systemic change, were not the most frequently implemented intervention elements. We conclude that, despite the field's evolution, key questions (e.g., insights into who needs to do what, with whom, where and when; or efficacy) remain unanswered. [ABSTRACT FROM AUTHOR]

Participatory Design (PD) is increasingly applied to tackle public health challenges, demanding new disciplinary collaborations and practices. In these contexts, any proposed intervention must be supported by evidence that demonstrates it is likely to have the desired effect, particularly if it relies on investment of public funds. An evidence base can include evidence and theory from prior research, evidence generated through primary research, and evaluation. PD research generates evidence through collaboration directly with people who may use or receive an intervention, understanding their experiences and aspirations in situated contexts, without using formal abstractions or assuming evidence generated elsewhere will be directly applicable. Drawing on a case study of a collaboration with public health experts to develop an intervention using PD, we argue there is value in using existing evidence and theory to engage, inform, and inspire intended users of an intervention to participate in the design process. This article aims to support PD researchers and practitioners to consider how evidence can be integrated and produced through PD, enabling collaboration with other disciplines to produce evidence-based and theory-informed interventions to address complex public health challenges. [ABSTRACT FROM AUTHOR]

COVID-19 restrictions drove rapid adaptations to service delivery and new ways of working within Scotland's mental health sector. This study explores mental health workers' (MHWs') experiences of delivering their services remotely. Twenty participants, who had worked in mental health professions in the National Health Service (NHS) in Scotland throughout the COVID-19 pandemic, took part in online semi-structured interviews. Data was transcribed then analysed using an inductive thematic analysis. Two major themes are reported: (1) 'Improved Flexibility for both MHWs and Service Users' and (2) 'Teletherapies Challenge Therapeutic Boundaries'. In relation to (1) virtual platforms were seen as vital in maintaining patient care throughout the COVID-19 pandemic and a valuable resource for service users (SUs) who had previously struggled with mobility or social anxieties when accessing face-to-face services. Some MHWs' also noted benefits for their productivity and comfort. Regarding (2) MHWs highlighted that whilst conducting teletherapies from home, work-life boundaries became blurred and, in some instances, typically comforting spaces became associated with the traumatic content discussed by SUs. These stressors seemed to be compounded by MHWs' isolation, as they were less able to draw upon their colleagues for support. Further, confidentiality could not be assured, as MHWs and SUs alike had to accommodate their family members. These findings highlight important insights from MHWs in adapting to rapid changes in mental health working practices, particularly in relation to the challenges of delivering quality, safe and equitable services and the increased use of teletherapies. Such insights are vital in informing service developments and supporting future pandemic preparedness across a range of healthcare contexts and countries seeking to adopt hybrid models of mental health service delivery. [ABSTRACT FROM AUTHOR]

To specify intervention content to enhance influenza vaccination uptake among adults with chronic respiratory conditions using the Behaviour Change Wheel (BCW). Cross-sectional, multi-modal data collection and theory-informed analysis and expert stakeholder engagement. Content analysis was used to identify barriers and enablers to influenza vaccination from nine focus groups (n = 38), individual interviews (n = 21) and open-ended survey responses (n = 101). The Theoretical Domains Framework (TDF) and the BCW were used to specify evidence-based and theoretically-informed recommendations. Expert stakeholders refined recommendations using the Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria to yield a range of potentially actionable ideas. TDF analysis identified perceptions of vaccine side effects (beliefs about consequences [BACons]) was the most common barrier to vaccination, followed by time constraints (environmental context and resources [ECR]) and fear of needles (Emotion). Enablers included protection from influenza (BACons), receiving reminders (ECR) and support from others (Social Influences). These factors mapped to seven BCW intervention functions and 22 behaviour change techniques. Factors affecting vaccine uptake are multifaceted and multileveled. The study suggested a suite of complementary multi-level intervention components to enhance vaccination uptake involving a range of diverse actors, intervention recipients and settings. [ABSTRACT FROM AUTHOR]

Background: Gay, bisexual and other men who have sex with men (GBMSM) are at far greater risk of experiencing poor mental health (MH) than wider society. This disparity was exacerbated by additional 'unique to sexual minority status' COVID-19 stressors. Objective: This sequential, mixed-methods study examined remote MH help-seeking among GBMSM in the U.K. and Ireland during the first COVID-19 lockdown. Methods and Results: Quantitative survey data (n = 1368), analysed with logistic regression, suggested GBMSM experiencing moderate-to-severe anxiety and those with a past MH diagnosis were most likely to seek MH support. Thematic analysis of qualitative interview (n = 18) data identified multiple barriers and enablers to GBMSM seeking remote MH help, with the help primarily sought from GBMSM-facing organisations and generic online resources. Finally, the behaviour change wheel was used to generate theoretically informed recommendations to promote MH help-seeking among GBMSM in Scotland. Implications: We discuss how applying these recommendations in the short, medium and long term will begin to address GBMSM's MH needs, post COVID-19. [ABSTRACT FROM AUTHOR]

Efforts have been made to adapt the delivery of mental health care and support services to the demands of COVID-19. Here we detail the perspectives and experiences of mental health workers (MHWs), in relation to what they found helpful when adapting mental health services during the COVID-19 pandemic and responding to its demands. Individual interviews were conducted with MHWs (n = 30) during the third COVID-19 lockdown. Interviews were audio-recorded, transcribed and managed using NVIVO. Qualitative data was analyzed using an inductive thematic approach. Three themes emphasized the importance of: (1) 'self-care and peer support (checking in with each other)', (2) 'team cohesion and collaboration' and (3) 'visible and supportive management and leadership (new ways of working)'. Our findings emphasize the importance of individual, team and systems-based support in helping MHWs maintain their own wellbeing, whilst adapting and responding to the challenges in providing mental health care and support during this pandemic. Guidance and direction from management, with adaptive leadership in providing sustained, efficient, and equitable delivery of mental healthcare, is essential. Our findings support future policy, research and mental health practice developments through sharing important salutogenic lessons learned and transferable insights which may help with preparedness for future pandemics. [ABSTRACT FROM AUTHOR]

Background: Psychological interventions have mixed effects on improving employee outcomes, partly due to significant variability across studies and a lack of focus on mechanisms of action. This scoping review reports on the parameters of these interventions and examines intervention content to bring clarity to this heterogeneous topic area and direct future systematic review work. Method: Six databases were searched (Cinahl, Cochrane, Embase, Medline, PsychINFO and Web of Science) from April 2010 to August 2020, and a grey literature search was undertaken. Screening was undertaken independently by two authors. The results summarised country, participant and employment characteristics, psychological interventions and work, health and wellbeing outcomes. 10% of the papers were analysed to determine the feasibility of coding intervention descriptions for theory and behaviour change technique (BCT) components. Results: Database searches yielded 9341 titles, of which 91 studies were included. Most studies were conducted in Europe (78%) and included males and females (95%) ranging in age from 31-56.6 years although other demographic, and employment information was lacking. Musculoskeletal pain was common (87%). Psychological interventions commonly included cognitive behavioural therapy (30%) and education (28%). Most studies employed a randomised control trial design (64%). Over half contained a control group (54%). Interventions were delivered in mostly healthcare settings (72%) by health professionals. Multiple outcomes were often reported, many of which involved measuring sickness absence and return-to-work (62%) and pain and general health (53%). Within the feasibility analysis, most papers met the minimum criteria of containing one paragraph of intervention description, but none explicitly mentioned theory or BCTs. Conclusion: Psychological interventions for employees with chronic pain vary in their nature and implementation. We have shown scoping reviews can be used to assess the feasibility of applying tools from health psychology to identify the content of these interventions in future systematic review work to improve intervention development. [ABSTRACT FROM AUTHOR]

Good sexual health requires navigating intimate relationships within diverse power dynamics and sexual cultures, coupled with the complexities of increasing biomedicalisation of sexual health. Understanding this is important for the implementation of biomedical HIV prevention. We propose a socially nuanced conceptual framework for sexual health literacy developed through a consensus building workshop with experts in the field. We use rigorous qualitative data analysis to illustrate the functionality of the framework by reference to two complementary studies. The first collected data from five focus groups (FGs) in 2012 (n = 22), with gay, bisexual and other men who have sex with men aged 18–75 years and 20 in-depth interviews in 2013 with men aged 19–60 years. The second included 12 FGs in 2014/15 with 55 patients/service providers involved in the use/implementation of HIV self-testing or HIV prevention/care. Sexual health literacy goes well beyond individual health literacy and is enabled through complex community practices and multi-sectoral services. It is affected by emerging (and older) technologies and demands tailored approaches for specific groups and needs. The framework serves as a starting point for how sexual health literacy should be understood in the evaluation of sustainable and equitable implementation of biomedical sexual healthcare and prevention internationally. [ABSTRACT FROM AUTHOR]

Attitudes towards sexual health and relationships are learned from a young age, and there is an ongoing need for innovative and comprehensive approaches to sex education that keep pace with rapidly changing contexts of people's lives. We used thematic analysis of data from two qualitative studies in Scotland to explore learning contexts from a multi-generational perspective, as well as the influence of different socio-cultural factors on provision, access to and experience of sex education. The importance, but inadequacy, of school as a source of learning, was a persistent theme over time. Participants' strategies to address perceived gaps in knowledge included experience, conversations, vicarious and online learning. Gender and age differences emerged, with younger participants more likely to go online for information, and prevailing gender norms shaping attitudes and behaviours across both study groups. Participants who identified as gay, lesbian or bisexual described feeling particularly unprepared for sex and relationships due to the narrow, heteronormative content received. Although schools continue to be a common source of information, it appears that they fail to equip young people for their post-school sexual life-course. We recommend the mandatory provision of comprehensive, positive, inclusive and skills-based learning to improve people's chances of forming and building healthy, positive relationships across the lifespan. [ABSTRACT FROM AUTHOR]

As antibiotics have become increasingly ineffective against bacteria, antibiotic stewardship has been introduced across a variety of settings world-wide. Members of the public have been entreated to use antibiotics strictly as prescribed. We interviewed ninety-nine participants who shared their understandings of antibiotics and reflections on antibiotic resistant bacteria. Some participants were eager consumers of antibiotics whilst others sought to avoid them. Overall, the participants expressed their desire to act in a responsible manner in relation to antibiotic usage. However, we also found considerable confusion regarding responsible action linked with risk management and trust in expert advice. Despite the encouragement of personal responsibility for health decisions, sick individuals are urged to enact a Parsonian-like sick role that abdicates personal decision-making powers and invests trust in the expertise of prescribers. We find this assumption of a responsible, knowledgeable patient and expert clinician is disrupted by 1) patients' contingencies when circumstances force them to seek and use antibiotics despite their misgivings, 2) patients' own embodied knowledge and assessment of their vulnerability and progression of infections and 3) doubts in the expert knowledge of clinicians, as considered in light of scientific debate. Accordingly, lay publics are left entangled in contrary expectations of responsibility and trust regarding the use of antibiotics with significant implications for antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Purpose: Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people's experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS. Methods: An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified. Results: Nine participants continued to use the device. Three relevant super-ordinate themes were identified; impact of functional electrical stimulation, sticking with functional electrical stimulation, and autonomy and control. Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual's ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed. Conclusions: This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term. People with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities. A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual's ability to adapt, influence an individual's decision to continue using functional electrical stimulation. Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term. [ABSTRACT FROM AUTHOR]

Researchers using interpretative phenomenological analysis (IPA) within applied research typically use homogenous samples exploring shared perspectives on a single phenomenon of interest. This article explores the challenges and opportunities involved with developing rigorous and epistemologically coherent research designs for capturing more complex and systemic experiential phenomena, through the use of multiple perspectives to explore the same phenomenon. We outline a series of multiple perspective designs and analytic procedures that can be adapted and used across many diverse settings and populations. Whilst building upon existing approaches within qualitative methods and IPA, these designs and procedures are intended to scaffold clear routes to practical application, psychological intervention, the design of behaviour change interventions, and other recommendations for policy and practice. We discuss a variety of conceptual antecedents which situate these designs within phenomenology, pluralistic idiography, qualitative psychology, and wider debates within psychology and other social and behavioural sciences. [ABSTRACT FROM AUTHOR]

The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP. [ABSTRACT FROM AUTHOR]

Aim: Our aim is to offer and illustrate a novel meta-methodology to enhance the rigour of method selection and understanding of results in pluralist qualitative research (PQR). Method: To do so, we make innovative use of articulation of four discrete dimensions characterising different forms of thematic analysis. We provide secondary analyses of an interview from the Social Media, Men who have Sex with Men and Sexual Health project using critical discursive psychology, dialogical analysis, interpretative phenomenological analysis and psychosocial narrative analysis. Results: All four methods identified aspects of three central foci: Compartmentalisation, Detachment and Jouissance. Conclusion: We discuss how our proposed meta-methodology provides a rationale for the selection of methods in a PQR, offer evidence that it can anticipate the relative similarity in focus of the methods employed, and argue that our meta-methodology reveals the possibility of identifying an 'axial' or 'hub' method of a PQR which might be particularly fruitful in exploring commonalities and differences in results. Finally, we examine the synergies and challenges of combining pairs of the methods we used. [ABSTRACT FROM AUTHOR]

Individual interviews were conducted with six self-identified Muslim gay men living in London focusing on their experience of health service use. Transcripts were analysed using interpretative phenomenological analysis. Analysis identified two major themes: the close(d) community and self-management with healthcare professionals, detailing participants' concerns regarding the risks of disclosing sexuality; and the authentic identity - 'you're either a Muslim or you're gay, you can't be both' - which delineated notions of incommensurate identity. Analysis highlights the need for health practitioners to have insight into the complexity of intersectional identities, identity disclosure dynamics and the negative consequences of assumptions made, be these heteronormative or faith-related. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) imperils health for people across the world. This enormous challenge is being met with the rationalisation of prescription, dispensing and consumption of antimicrobials in clinical settings and in the everyday lives of members of the general population. Individuals need to be reached outside clinical settings to prepare them for the necessary changes to the pharmaceutical management of infections; efforts that depend on media and communications and, therefore, how the AMR message is mediated, received and applied. In 2016, the UK Review on Antimicrobial Resistance called on governments to support intense, worldwide media activity to promote public awareness and to further efforts to rationalise the use of antimicrobial pharmaceuticals. In this article, we consider this communications challenge in light of contemporary currents of thought on media publics, including: the tendency of health communications to cast experts and lay individuals in opposition; the blaming of individuals who appear to ‘resist’ expert advice; the challenges presented by negative stories of AMR and their circulation in public life, and; the problems of public trust tied to the construction and mediation of expert knowledge on the effective management of AMR. [ABSTRACT FROM AUTHOR]

Associations of sexual identity with a range of sexual and sexual health behaviours were investigated amongst men who have sex with men (MSM). Data from 1816 MSM recruited from 4 Celtic nations (Scotland, Wales, Northern Ireland and the Republic of Ireland) were collected via a cross-sectional online survey advertised via social media. About 18.3% were non-gay identified MSM (NGI-MSM). In the last year, 30% of NGI-MSM reported high-risk unprotected anal intercourse and 45% reported never having had an sexually transmitted infection (STI) test. When compared to MSM who were gay identified (GI-MSM), NGI-MSM were more likely to be older, have a female partner, fewer sex partners, fewer anal sex partners, STI diagnoses and less likely to be HIV positive, more likely to never use the gay scene and be geographically further from a gay venue. NGI-MSM were also less likely to report STI and HIV testing behaviours. The findings highlight variations in risk by sexual identities, and unmet sexual health needs amongst NGI-MSM across Celtic nations. Innovative research is required regarding the utility of social media for reaching populations of MSM and developing interventions which target the heterogeneity of MSM and their specific sexual health needs. [ABSTRACT FROM AUTHOR]

Influenza viruses are radically uncertain, leading to scientific and procedural challenges for diagnosis and surveillance and lending influenza symptoms a high degree of indeterminacy. In time of pandemic influenza, however, members of the general public are asked to enact non-pharmaceutical infection control measures such as hygiene and social distancing. Drawing on the concepts of manufactured risk and ontological insecurity, we use data from interviews and focus groups we undertook in 2011 and 2012 in Melbourne, Sydney and Glasgow, to examine how members of the general public understood the ‘fuzzy’ nature of the influenza virus and reconciled this with infection control measures. We found that participants in our research acknowledged: the difficulty of avoiding infection from influenza; impediments to accurate diagnosis and that infection control measures proposed by public health messages were compromised by the ‘fuzzy’ nature of the virus. However, we found that participants valued prevention measures, not necessarily because they were seen to be effective, but because they supplied security in the face of influenza’s uncertainties and the wider proliferation of daily and biographical risks. [ABSTRACT FROM AUTHOR]

Objectives: Adult-to-adult living liver donation (LLD) is a controversial procedure due to the risk to the healthy donor. The decision to proceed with LLD is an important, yet under-researched area. This study aims to explore the decision-making process of the donor and recipient independently, and within the donor–recipient dyad. Design: A longitudinal, qualitative analysis of the LLD decision from the perspective of a LLD donor–recipient dyad. Methods: In-depth interviews were conducted with the donor and recipient separately on three occasions: pre LLD, six weeks post and six months post LLD. Transcripts were subject to interpretative phenomenological analysis. Results: During the pre-LLD interviews, a series of intra- and interpersonal negotiations were reported as both the donor and recipient grappled to make a decision about LLD. Following the decision, the focus then centred on the consequences of the decision and making sense of unanticipated outcomes. By six months post LLD, both were able to reflect on adapting to the changes their decision had ultimately caused. Conclusions: This case study offers a unique insight into the risk assessment and decision-making demands of LLD and the results can help support future LLD candidates. [ABSTRACT FROM AUTHOR]

Rates of HIV testing are increasing among men who have sex with men (MSM) in Scotland and the UK. However, it remains vital to encourage MSM to test for HIV. The aim of the current study was to determine which factors discriminated among three groups of MSM: those tested for HIV within the previous year, those who had tested over one year previously, and those who had never tested. Cross-sectional data were collected using self-report, anonymous questionnaires from MSM frequenting gay venues in Glasgow, Scotland, during July 2010 (N= 822, response rate 62.6%). Those who identified themselves as HIV positive (n= 38), did not normally reside in Scotland (n= 88), and did not provide information on HIV testing (n= 13), were excluded (139 excluded, leavingN= 683). Around 57% (n= 391) had tested for HIV within the previous year, 23% (n= 155) had tested over one year previously and 20% (n= 137) had never tested. Compared with those tested within the previous year, those tested over one year previously and those never tested had greater fear of a positive-HIV test result, a weaker norm for HIV testing, and were more likely to have had no anal sex partners at all within the previous year. Those tested over one year previously were significantly older than both other groups (who were more likely to be under 25 years of age). Unprotected anal intercourse (UAI) did not discriminate among the HIV testing groups. The results highlight the need to promote HIV testing in Scotland among those under 25 years and over 45 years, those with high fear of testing, and those whose sexual behaviour puts them at risk. Interventions to increase HIV testing should promote positive norms and challenge the fear of a positive result. [ABSTRACT FROM PUBLISHER]

This article explores the ways gay men living with HIV talk about their identities in relationship to ideas concerning essentialism in the broader context of biomedicalisation. Data were collected from 36 HIV-positive gay men between 2001 and 2005 from two studies. All interview material was initially collected and analysed using broadly speaking thematic analysis. Identity-oriented themes were then further explored with a critical lens examining resonances with essentialism. We detail three related themes: ‘the intersections of homosexuality, HIV and the biomedical’; ‘being HIV: ontological crisis and obstinate essentialism’; and ‘identity and treating HIV’. These outline the ways in which both HIV- and gay identities are often interwoven (utilising shared narratives and concepts), embraced and/or resisted. We discuss the concept of essentialism within the wider transformation, or the ‘normalisation’, of both male homosexuality and HIV and draw attention to the salience of biomedicalisation and concomitant biopower within accounts of gay men living with HIV. [ABSTRACT FROM AUTHOR]

Objectives: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses. Design: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews. Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews. Results: Our analysis focuses upon the participants’ struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation. Conclusions: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses. [ABSTRACT FROM PUBLISHER]

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could 'invest' more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity. [ABSTRACT FROM AUTHOR]

Despite emerging evidence of the efficacy and continued importance of sexual health outreach within public sex environments (PSE), current literature fails to examine how such interventions work. Accordingly, we present a qualitative process evaluation of an innovative PSE outreach service in England, UK. Through interviewing volunteers (n = 5), cruisers (n = 14), and all salaried staff (n = 5), we provide an insider's perspective highlighting both the challenges of PSE outreach provision and the unique solutions developed locally. Outreach success is achieved through respecting the local sexual culture within which cruising activities occur. Moreover, this illustrates the importance of local cultural sensitivity when delivering health promotion in challenging settings. [ABSTRACT FROM AUTHOR]

Individual in-depth interviews were conducted with 14 people with Chronic Fatigue Syndrome (CFS). The interviews centred on the experience of living with the condition from the participants' own perspectives. All interviews were transcribed verbatim and were analysed using Interpretative Phenomenological Analysis. Three inter-related themes were presented: 'Identity crisis: agency and embodiment'; 'Scepticism and the self' and 'Acceptance, adjustment and coping'. Participants reported an ongoing sense of personal loss characterised by diminishing personal control and agency. An inability to plan for the future and subsequent feelings of failure, worthlessness and insignificance ensued. Scepticism in the wider social environment only heightened the consequential identity crisis. The importance of acceptance for adjusting to a life with CFS was highlighted. The findings are discussed in relation to extant literature and issues for health psychology are raised. [ABSTRACT FROM AUTHOR]

Individual in-depth interviews with 14 people with chronic fatigue syndrome (CFS) were conducted, focusing on the experience of living with CFS. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Here we present two inter-related themes: "Negotiating a diagnosis" and "Negotiating CFS with loved ones". Participants reported delay, negotiation and debate over diagnosis: further, they perceived their GPs to be sceptical, disrespectful and to be lacking in knowledge and interpersonal skills. However, participants found delegitimising encounters with their partners more difficult to deal with. Participants viewed such delegitimation as a form of personal rejection; they were hurt by their loved ones' reactions and subsequently pondered the price of love, respect and friendship. The findings are discussed in relation to extant literature, and recommendations for future research are suggested. [ABSTRACT FROM AUTHOR]

This paper examines the sexual health of men who 'cruise' public sex environments (PSEs). A cross-sectional survey (response rate 56%) recruited 216 men from an urban-based PSE in the UK. Half of participants reported lifetime STI experience and 16% reported an STI in the last year. Half attended an STI clinic in the previous year, with similar proportions vaccinated against hepatitis A and B. Men who recently attended STI clinic (OR = 3.03) and those educated to A level or higher (OR = 3.12) were significantly more likely to report lifetime STI experience. Unlike commercial venues, PSEs do not represent centres of STI transmission. However, sub-optimal STI clinic attendance may mask undiagnosed infections. A public health imperative remains to encourage more PSE users to attend STI clinic on a prophylactic basis and increase hepatitis vaccination. Furthermore, the sexual health needs of PSE users with higher qualifications, in terms of STIs other than HIV, must be addressed. [ABSTRACT FROM AUTHOR]

Individual in-depth, semi-structured interviews with 30 HIV positive Black Africans were conducted in London, UK. The interviews focused upon experiential accounts of living with HIV. The interviews were transcribed and analysed for recurrent themes using interpretative phenomenological analysis. The social context of being a Black African living in the UK emerged as an important framework within which the experience of being HIV positive was positioned. In terms of people's accounts of their own experiences of living with HIV, diagnosis figured as an important moment in people's lives. The majority of participants were surprised and upset upon receiving their positive antibody test results. Many reported a period of depression and social isolation. Stigma and prejudice associated with HIV also emerged as a major force shaping the daily lives of the participants. We discuss the role of identity and social context in disrupting the medical meaning of diagnostic tests. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the contributions of a range of psychosocial, demographic and behavioural variables to gay men's intentions to take an HIV test. A cross-sectional self-report survey was undertaken. Researchers approached patrons of all known gay bars in Glasgow and Edinburgh during May 2000. Questionnaires were completed by 803 men (response rate of 78%). Those with a stronger intention to test had previously tested, and they were younger, with two or more recent unprotected anal sex partners. They perceived their HIV status to be unknown, had less fear of a positive test result, and perceived more benefits of testing. Intention to test in those with two or more recent unprotected anal sex partners was attenuated if accompanied by increased fear of a positive test result. Results are considered in the context of the theories of reasoned action and planned behaviour. Intention to test is far from a unitary phenomenon, and the existence of various sub-groups within the gay population demands a new approach to both research and health promotion. [ABSTRACT FROM AUTHOR]

This article describes the relationship between HIV testing and a range of psychosocial, sexual and socio-demographic variables. Trained research staff distributed a self-report questionnaire in the gay bars of Glasgow and Edinburgh, in May 2000. Questionnaires were completed by 803 men (a response rate of 78%). We present the results of both bivariate and multivariate analyses identifying key variables associated with never having had an HIV test. Thus we outline some psychosocial barriers to HIV testing. Multivariate analysis indicated that the most important factor associated with never having tested was fear of a positive result; this was particularly true for those men who reported higher levels of risky sexual conduct. We discuss the relevance of these findings in terms of presenting a psychosocial agenda which demands that stigma and the social exclusion of HIV positive people should be addressed before gay men are encouraged to seek HIV testing. [ABSTRACT FROM AUTHOR]

This paper reviews the literature regarding levels of HIV antibody testing amongst gay men and rationales both for and against testing. Whilst marked differences in levels of reported testing were identified (regionally, nationally and across time), some consensus was found regarding reasons both for and against HIV antibody testing. Reasons for testing included accessing medical treatments, planning for the future and hoping for peace of mind. Reasons against testing included the negative psychological and social consequences of positive test results. The findings of the review are discussed in terms of recent medical discourses, which provide a powerful rationale for the uptake of HIV antibody testing amongst all gay men where treatments are available. Critically, we illustrate the lack of current research that seeks to reappraise HIV testing in the light of new HIV treatments, and discuss the implications for both research and practice. [ABSTRACT FROM AUTHOR]

This paper explores the role of locale and location in understanding gay men's sexual behaviour. Twenty gay men from Glasgow, Scotland took part in semi-structured, in-depth interviews. Interpretative Phenomenological Analysis (IPA) was employed to analyse transcripts for recurrent themes. Shared understanding relating to the relationship between locale and sexual activity emerged as important. Findings suggest the existence of distinct sexual cultures associated with locales such as the commercial gay scene (the bars), public toilets (the bogs) and public parks (the bushes). Furthermore, sexual activity was directly affected by its specific location. Sexual behaviour is understood and patterned by the locale (i.e. sexual space) in which it occurs; it is also constrained by location (i.e. specific site). In the light of these findings the appropriateness of traditional psychological approaches to understanding sexual activity and the relevance of other perspectives which map the links between social context and sexual behaviour are discussed. [ABSTRACT FROM AUTHOR]

The results of a quantitative review of 36 studies of the adoption of safer sex among gay and bisexual men are interpreted in terms of the three stages of the AIDS Risk Reduction Model (ARRM). Variables associated with the process of labelling oneself as at risk and of committing oneself to practising safer sex were moderately associated with safer sexual behaviour. One variable we included in the enactment of safer sex - relationship status - was a highly reliable predictor of unsafe sex. Particular attention is paid to the theoretical advances embodied in Catania, Kegeles and Coates (1990) AIDS Risk Reduction Model, its focus on the process of behaviour change and its specification of an enactment stage in which the intention-behaviour gap is addressed. The implications of the results are discussed with respect to a pragmatic knowledge base and future investigations of sexual health. [ABSTRACT FROM PUBLISHER]

There has been a recent global increase in sexually transmitted infections (STIs) including HIV among adults aged over 45. Limited evidence exists regarding middle-aged adults’ knowledge of STIs other than HIV. This qualitative study sought to understand middle-aged adults’ knowledge of STIs within a socio-cultural context. Individual interviews, based on a life-course approach, were conducted with 31 recently sexually active heterosexual men and women. Participants were aged between 45 and 65 and of mixed relationship status (14 were single, 17 in a relationship). Thematic analysis identified four key findings, including: “engagement with STI-related knowledge”; “general knowledge of STIs”; “learning about STIs from children”; and “limited application of knowledge”. The findings allow insight into a neglected area, and indicate that socio-cultural factors influence middle-aged adults’ STI-related knowledge acquisition throughout the life course. These are important implications for the prevention of STIs, particularly in addressing the on-going stigmatisation of STIs in older age groups. [ABSTRACT FROM AUTHOR]