Influence of HIV Status on Sexual Behaviours among Gay Men - Research Proposal Example

A Narrative Analysis Exploring What It Means To Be HIV Positive for Gay Men: How HIV Status Influence Sexual Behaviours among Gay Men Introduction: background literature and critique Rationale: for the current study and questions/hypotheses Methods: epistemology, design and methods/protocol Participants & Professional/Ethical Issues: consideration of context for research Resources and Execution: project planning and timescales 1. Introduction Being HIV positive for any individual is not an easy burden to bear given the stereotype and stigmatization these people always receive from the community as well as the society as a whole. As such, they are ordinary human beings who deserve the right to sexual satisfaction since the condition does not affect their sexual lives, least to say; being HIV positive does not reduce a persons sexual urge (Shuper, Joharchi & Rehm, 2014). Despite the stigmatization, the infected individuals still indulge in sexual behaviours, whether safe or unsafe. The attempts to reduce further spread of HIV/AIDS have always focused on introducing programs that aim at encouraging people with infections to practice safe sex and safeguard the well-being of the uninfected individuals (Cohen, 2012). On the contrary, this over-emphasis on individuals with the disease is increasing the spread of the virus because it is the common belief that once a person is infected, he or she must protect others they indulge in sexual behaviours with. However, it is the case with the gay men who have been identified to be at higher risks of contracting the disease because their sexual partners practice unsafe sex as suggested by (Davies, Hickson, Weatherburn & Hunt, 2013). In fact, studies show that men having sex with men are at higher risks of risky sexual behaviours, and this explains the high prevalent of HIV/AIDS among the gay men. For instance, a study confirmed the increased rate of unprotected sex among the HIV negative and the HIV positive gay men during a cohort study (Takács, Kelly, PTóth, Mocsonaki & Amirkhanian, 2013). On the other hand, the literature confirms that men who have sex with men increase their levels of risky sexual behaviours after they realize that they are positive. Therefore, the aim of this study is to find out what it means to be HIV positive for the gay men by exploring the struggle with the change, what leads them to increased risky sexual behaviours. It will also explore the encountering of increased or decreased psychosocial support. Background research and literature review. Davies, Hickson, Weatherburn and Hunt (2013) pointed across that increased rate of HIV infections among the gay men is much attributed to the high-risk behaviours they develop after contracting the disease. As such, gay men will indulge more in unprotected sex since they perceive this as the only means through which they can cope with living with the condition, alias HIV-positive. According to Cohen (2012), gay men who are HIV-positive are prone to high-risk behaviours including increased stigma, over-indulgence in unprotected sex, self-blame, and substance abuse. There are numerous theories that have been proposed to explain why the gay men over-indulge in unprotected sex. One of the reasons is that the HIV-positive gay men are usually alienated from the HIV-negative men (Takács, Kelly, PTóth, Mocsonaki & Amirkhanian, 2013). On the other hand, the social alienation explains why disclosure level among the HIV-positive men having sex with HIV negative men is low. For instance, a survey carried out among 100 gays in the UK revealed that these men would not disclose their status despite the society’s shift towards non-disclosure (McDaid & Hart, 2012). On the other hand, the society is yet to accept the fact that the HIV-positive men having sex with men should seek any form of medical attention. In fact, the stigmatization is here to stay (Smit et al., 2012), because even the national governments barely provide for their health coverage and as such leading to more alienation thus the gay men see indulgence in unprotected sex as the only way to cope up with the situation despite this being a risky behaviour (Halkitis, Wolitski & Millett, 2013). On the other hand, there is the stigma among the gay men community that treatment can lead to some physical changes thus they delay seeking as well as initiating treatment despite posing serious health risks to their sexual partners who they cannot disclose their HIV status to (McDaid & Hart, 2012). Dececco, John Dececco and Scarce (2013) argue that the sexual behaviours among men having sex with men can also be attributed to their access to health care as well as adherence to HIV medication. The implication is that high stigmatization in the society prevents the gay men community from adhering to the HIV treatment besides being associated with poor access to the medication (Smit et al., 2012). For instance, a study revealed that disclosing HIV status increased the levels of social stigmatization (McDaid & Hart, 2012). Besides, a study confirmed that gay men who reported being discriminated from their sexual partners were more than willing to adhere to the medication while on the contrary; there was a strong relationship between the involuntary disclosure of the HIV status and non-adherence (Dececco, John Dececco & Scarce, 2013). Alcohol use and drug abuse can also explain the increased risky sexual behaviours among men having sex with fellow men (Allen Jr, Myers & Ray, 2015). Though some studies have not found the link between the HIV status and the drug abuse (Theodore, Durán & Antoni, 2014), a study reported that young men who were HIV positive were in danger of greater stigmatization thus would indulge in drugs and alcohol abuse and in return risk indulging in risky sexual behaviours with their partners and this increases the spread of the disease (Allen Jr, Myers & Ray, 2015). Being HIV positive for the gay men also means that their partners will reject them and as such they become stressful, depressed and unsafe or unprotected sex is the only way they can console themselves (Allen Jr, Myers & Ray, 2015). For instance, McDaid & Hart (2012) refers to a study among the HIV-positive men in the UK having male sexual partners revealed that they were more likely to be rejected upon disclosure of their HIV status and the study confirmed that almost all the participants reported of being rejected by their potential sexual partners after revealing their HIV status. In return, the rejection causes them serious harm, including self-confidence and self-esteem. On the other hand, a qualitative study between the HIV-positive and HIV-negative gay men in Toronto revealed that the HIV-positive men reported being rejected and showed no empathy from their HIV-negative partners or even friends (George et al., 2012). On the other hand, the disclosure of HIV status would attract rejection and even abuse, through violence; from partners and that the HIV-negative gay men are also not supportive of their colleagues (Poon, Pui-Hing Wong, Sutdhibhasilp, Ho & Wong, 2013). Therefore, the stigmatization is not only in the society but also the HIV-negative gay men who shun their fellows for being HIV positive. In return, the HIV-positive gay men would not disclose their health status thus indulge in more risky sexual behaviours, further spreading the infection (McDaid & Hart, 2012). Another possible explanation for the increased sexual risk behaviours among the gay men who have been diagnosed with HIV-positive is much attributed to the introduction of the HAART as well as the attitudes they have towards this treatment method (Nelsen et al,. 2013). In fact, research documents that since the HAART was introduced, there has been an increase in the levels of unprotected sex as well as other sexually transmitted diseases (McDaid & Hart, 2012). Though statistics shows that patients receiving HAART showed least risky sexual behaviours, the beliefs about these therapies may be the reason for promoting unprotected sex and the same stereotype has been translated to the gay men living with the virus (Nosyk & Montaner, 2012). Therefore, the increased risky sexual behaviour is also attributed to the treatment method. Living with HIV/AIDS has some serious implications for the gay men because such an individual is always exposed to psychological distress because treatment of the disease is associated with morphological changes exposes individuals to appearance concerns and anxiety. Matthew, Benjamin, William, Gregory Wells and James (2014) refer to the psychological stress experienced by the sexual minorities, the homosexuals, as sexual minority stress because they live in a heterosexually dominated world. The stress is attributed to attitudes that result in internalised stigma like homophobia, concealing one’s sexual identity besides the discriminatory events like rejection, bullying, and violence (Beaulieu, Adrien, Potvin & Dassa, 2014). As such, a HIV/AIDS infected individuals is prone to self-pity to due dejection from the society and sexual partners and this situation drives them to self-directed anger, frustrations with lifer, and feeling of worthlessness. Eventually, such individual becomes negative life in general, decreased self-confidence. In effect, the emotional problem leads the individual to indulge in risky behaviours like drug and substance abuse, unprotected sex and as such, endangers his or herself thus the insecurity that comes with being a HIV-positive MSN. 2. Research Objectives The aim of this study is to find out: 1) What it is to live in silence, not disclosing the virus. 2) Struggling with change 3) Encountering a lack of psychosocial support 4) Increasing psychosocial support 5) Stigma associated with being HIV-positive for gay men Rationale for the Study Throughout the research literature, the study on HIV prevention has always not recognized the need to research on sexuality and its implications for sexual behaviours among the HIV-infected people. However, there is a gradual shift in this recognition but a lot still needs to be done so as to bring into light how the sexuality of an individual determines his or her sexual behaviours. In fact, for the past few years, both quantitative and qualitative research have been conducted on the same most of the finding presents the gap on why individuals of a particular sexual orientation would indulge in safe or unsafe sex. Though studies have been keen to identify the dangerous or risky sexual behaviours among men having sex with men, there is no evidence that they actually do not indicate how the men having sex with men conceptualize some of the complex issues involved with the gay sexuality and as well as what drives their sexual decision making immediately they have been diagnosed with the HIV virus or being HIV positive for that matter. The research question/hypothesis Since this is a psychological research, it is imperative to develop a qualitative approach so as to find out what the MSM perceive to be the reason behind their increased sexual behaviours. As such, this study adopts some hypothetical questions to substantiate the reason as to why the HIV-positive men having sex with men indulge in unsafe sex. Therefore, the hypothetical questions driving this research include: 1. Stigma associated with being HIV-positive: Is societal stigma to be blame for the increased sexually risky behaviours among the HIV-positive MSM? 2. What it is to live in silence, not disclosing the virus: Is fear of disclosure of the HIV status the reason behind the high sexually risky behaviours among the gay men? 3. Encountering change: Do morphological changes after treatment expose the individuals to emotional distress? 4. Encountering a lack of psychological support: Does rejection among of the sexual partners drive the HIV-positive MSM (gay men) into risky behaviours such as alcohol and drug abuse, unprotected sex among other risky social behaviours? 5. Increasing psychological support: what role does the society and the gay community has in increasing the psychological support of HIV-positive MSN? 3. Epistemology and methods Epistemology as used in research contexts basically refers to the method used to acquire knowledge. In this case, epistemology concerns how people know including the nature of research concepts, concept construction, as well as the validity of the knowledge being sought (Babbie, 2015). Methodology As documented by research experts, there are two approaches to research namely the deductive and inductive dimensions (Babbie, 2015). A deductive approach, as such, involves theory or hypothesis testing and has been found to be suitable for the scientific studies and social studies. In this case, the approach entails using existing data to ascertain claims. On the contrary, the inductive approach involves using existing data to develop a theory. In this regard, the study applies a deductive approach as the discussion or the research on sexuality and risky sexual behaviours is built on the conceptual framework from the existing literature that explore what it means to be gay man living with HIV/AIDS virus and the personal narrative provide the reason as to why they indulge in dangerous or unsafe sex. Thus, the finding of the research will ascertain why the MSM would engage in dangerous or risky sexual behaviours, based on the journey of gay men after being diagnosed with HIV. Nonetheless, a research methodology encompasses the available techniques for collecting both qualitative and quantitative data as well as its analysis and interpretation (Kothari, 2011). As such, a quantitative approach is suitable for measuring numerical variables and not personal attributes as with the case of qualitative research approach. The research prefers a qualitative research, particularly a personal narrative, for quite a number of reasons. For one, the approach leads to an in-depth analysis of the phenomenon besides using subjective information (Kothari, 2011). On the other hand, it lauds the qualitative approach for making it possible to examine complex questions that otherwise would be impossible to address through quantitative methods. Moreover, the approach is the best to use when exploring new areas of research as in this case, the sexual behaviours of HIV-positive MSM. It is also important to mention that data collection entails looking for both primary and secondary data (Kothari, 2011). In this regard, the secondary data comes in the form of a literature search to lay the basis or the conceptual framework to guide the study. However, the study has already collected secondary data in the form of literature search to form the background information and as such include relevant journals, conference papers, books as well as dissertation papers that talk about how sexuality influence sexual behaviours especially after an individual has been diagnosed to be HIV-positive. However, the collection of primary data is the most important part of a research since findings are to be analyzed and interpreted and also used to address the research question besides testing the hypothesis. As with this case, the study uses a narrative analysis to find out views of the MSM who have been diagnosed with HIV/AIDS by presenting the narrations of close friends who are HIV-positive gay men. The use of narrative in psychological research is best understood after having fast hand information of what narratives or stories are. In this regard, a narrative presents discourses that have been presented in a clear sequential order and as such connects the occurring events in a rather meaningful way to a particular audience thus offering a clear insight about the world and people’s experiences in it (Elliot, 2005). For instance, the study, through a narrative analysis, seeks to find out what it means to be a gay man living with HIV/AIDS including what drives their sexual behaviours. A narrative analysis as a research methodology has some advantages that make it preferable for a psychological research. For one, focusing on the story of the research subject or the participant makes it possible to reveal useful information from the point of view of the participant (Elliot, 2005). On the other hand, the narrative analysis provides the cultural and social situation to which the participant is responsive besides bringing out the sequence of experiences as well as the situations that shape the respondents story or life experiences. In this case, for instance, the narrative analysis presents the real life situations and experiences of gay men living with HIV/AIDS virus. On the other hand, a narrative psychology enables the researcher to understand the personal views, attitudes, as well as feelings since the story presented is the respondents own account of life experience (Riessman, 2000). Although it is not necessary for the respondent to provide the exact account of personal experience (Riessman, 2000), a personal story is a reflection of the interpretations and meanings are constructed based on the values of the participant (Elliot, 2005). Moreover, questions always arise concerning the validity of the narrative accounts but the validity is best addressed by the questions guiding the research. In this regard, the study will make sure that the questions being asked will enable the research to receive the accurate accounts of personal experiences; from gay men living with HIV/AIDS. Moreover, the narrative psychology dwells on the cultural and social cultural world that the respondent lives (Elliot, 2005). In this case, the personal accounts or the narratives make will it possible to identify cultural and social factors that influence the respondent’s behaviour. In this case, a narrative analysis provides an insight on how the behaviour of an individual finds its origin from the socio-cultural setting rather than the individual’s pathology. Nonetheless, a narrative analysis presents the past life experience of an individual and these past events can be used to explain the reasons behind his or her behaviours. For instance, social factors are attributed to the challenges that HIV-positive MSN encounter and as such, the narratives with provide the research with a clear of the societal factors including rejection, societal stigma, among others. The data collection procedure The data collection tool to be used in this study is narrative analysis where the 6 gay men who have been diagnosed with the HIV/AIDS virus will be recruitment; all are friends and people that the researcher is well acquainted with. Each participant will be given one hour to narrate their life experience with the HIV/AIDS and the research will use the elements of narrative psychology to make sure that the data collection process is a success. In this case, the study chooses individuals that are friends or friends of friends to get the MSM because they are a secretive society. To avoid any suspicion, it will be imperative to select the participants carefully and also explain to them the rationale behind the research. For instance, the study will promise the participants that their stories or narrations are for the purpose of the research and that the findings will be used to create awareness on dangers of risky sexual behaviours and also raise awareness among the societies so as to accept the HIV-positive MSM because if the stigmatization stops, then the infected gay men can live fulfilling lives and avoid infected their sexual partners or even engage in further spread of the disease through risky sexual behaviours. Experimental Goal Data Analysis and Interpretation After collecting the necessary data, it will imperative to analyse the findings so as to arrive at a conclusive interpretation of the results. In this case, the data will be analysed based on the themes of the study as identified from the literature search and the hypothetical questions. One of the possible themes to analyse from the research is how the societal stigmatization leads to risky sexual behaviours among the HIV-positive individuals including the gay men themselves. In this case, it will be imperative to look at the responses and the emerging trends from the individual qualitative attributes that will form the rationale for concluding that indeed the stigmatization is leading to risky sexual behaviours as it makes the infected depressed, stressed leading to abuse of drugs and alcohol thus more indulgence in risk behaviours due to loss of self control. Another possible theme to analyze and interpret based on the findings is how fear of disclosure of the virus is attributed to the rejection from partners as well as stigma from the society. Possibly, the results from the interview will indicate that upon disclosing that one is HIV-positive, he risks losing his partner implying that there is more depression as well as alienation and the stress drives the individual to risky behaviours and the loss of self-control leads to more spread of the infection. Therefore, as the analysis trend is set to continue, the study is also keen to identify other emerging themes from personal narratives or from the narrative psychology. Ethical considerations Finally, a study must consider the possible ethical implications that may arise due the data collection process. As such, confidentiality of information must be upheld, as the narrative analyses will be carried out on the MSM as a society that prefers to preserve its secrecy. However, the research promises to uphold the data confidence and that the narration pyschology will treat the respondents as unanimous (May, 2011). Informed consent is another ethical consideration for any research (Ritchie, Lewis, Nicholls & Ormston, 2013) thus the research prepares a consent form that will be given to the respondents that states that they are taking part in the study voluntarily and that they are free discontinue their participation in the event they foresee potential danger or harm. Resources and Execution The resources required for this research include the monetary expense to reach out to the participants for their narration. On the other hand, the research will need some information collection materials including recording electronic materials and note books, and storage materials like flash disks and portable computer or the laptop. Conclusion In a nutshell, the research seeks to find out the problems gay men experiences and as such, those who have been infected with HIV/AIDS. In this case, the study revolves around what drives the HIV-positive MSM to indulge in risky sexual behaviours by posing dangers to their sexual partners and further spreading the disease. However, the literature search reveals that there are various factors that promote the risky sexual behaviours among the gay men living with HIV/AIDS; that they fear disclosing their status because of stigmatization, that the stigmatization drives them to risky behaviours like drug and alcohol abuse and that they fear rejection from their sex partners. In essence, the research adopts a qualitative approach by using a narrative psychology or analysis collect views of both HIV-positive MSM who are close friends and people well acquainted with. Eventually, a thematic analysis confirms the assumptions made by the hypothetical questions that social stigma, fear of disclosure, struggling with change and lack of psychological support as the reason as to why HIV-positive men having sex with men engage in risky sexual behaviour. References Beaulieu, M., Adrien, A., Potvin, L. & Dassa, C. (2014). Stigmatizing attitudes towards people living with HIV/AIDS: validation of a measurement scale. BMC Health, 14(1), 246. Elliot, J. (2005). Using Narrative in Social Research Narrative and new developments in the social sciences. London: Sage Publications Ltd. Matthew D. Skinta, Benjamin D. Brandrett, William C. Schenk, Gregory Wells & James W. Dilley, Psychology & Health (2014): Shame, self-acceptance and disclosure in the lives of gay men living with HIV: An interpretative phenomenological analysis approach, Psychology & Health, DOI: 10.1080/08870446.2013.871283 Riessman, C.K. (2000). Analysis of personal narratives: In Handbook of Interviewing, Gubrium, J,F and Holstein, J.A. Sage Publications, 2001. Read More