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"He's still with these girls": Definitions of exclusivity between gay and behaviorally bisexual men and gendered implications for HIV risk

Williams, Whitney Erica (2014)
Master's Thesis (67 pages)
Committee Chair / Thesis Adviser: Stephenson, Robert
Committee Members:
Research Fields: Health Sciences, Public Health
Partnering Agencies: Emory University schools, faculty or affiliated programs
Keywords: Behavioral bisexuality; Gender norms; HIV risk
Program: Rollins School of Public Health, Hubert Department of Global Health
Permanent url:


Introduction: Studies have identified men who have sex with men and women (MSMW) as a bridge population for HIV between men who have sex with men (MSM) and women. Limitations in research methods reveal a need for nuanced investigation of feelings, motivations and relationship dynamics that inform risk perception and sexual behavior of MSMW and their partners. Methods: We conducted a 10-week longitudinal qualitative study to understand how MSM negotiate feelings of love, intimacy and trust with sexual decision-making. Participants completed baseline in depth interviews (IDI) that examined past relationship histories by building a timeline. Participants then tracked sexual experiences in web-based quantitative personal relationship diaries (PRD). Data from PRD were extracted and discussed during debrief interviews. Verbatim transcripts were analyzed as life-stories and thematically coded. Results: The presence of women presented a distinct challenge in establishing and negotiating sexual agreements with MSMW partners. For some participants, concepts of masculinity drove attraction to MSMW, shaped the formation of and created power imbalances within partnerships. Gender norms also influenced perceptions of HIV risk. While some participants asserted that men and women pose equal HIV risk to their sexual partners, some participants perceived men with one female partner or men who recently ended a relationship with a woman as among their least risky partners. Participants didn't explicitly attribute the lower perceived HIV risk of an MSMW partner to the female gender of his partners. However, their explanations for why these partners are less risky illuminate underlying perceptions of gender, behaviour, and HIV risk. Discussion:Results suggest gender norms that create power imbalances between MSMW and their female partners may also extend to MSM involved with MSMW sex partners. A novel understanding of these gendered forces in MSM/MSMW partnerships has various implications for further research and interventions that address HIV risk and prevention. Conclusion: Results call for researchers to consider the bridge between the epidemics not as a set of risk behaviors, but as gendered forces that influence power dynamics with both male and female partners. Results also call for a gender informed approach to HIV programming for both men and women.

Table of Contents

CHAPTER 1: INTRODUCTION.. 1 -- HIV in women and MSM: Bridging Parallel Epidemics. 1 -- LoveLab. 8 -- Problem Statement 11 -- Purpose/ Research questions. 11 -- Project Significance. 11 -- CHAPTER 2: MANUSCRIPT.. 13 -- Abstract 16 -- Introduction. 17 -- Methods. 22 -- Results. 25 -- Discussion. 34 -- Conclusion. 37 -- Acknowledgements. 37 -- References. 37 -- CHAPTER 3: PUBLIC HEALTH IMPLICATIONS.. 45 -- Expanded view of the bisexual bridge. 45 -- Integrating gender analysis and gender-responsive action into the design of HIV service programs for both men and women. 46 -- Proposed Intervention Setting. 49 -- REFERENCES.. 51 -- -- -- -- --


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