The Resonance Project

What we heard from gay men and their service providers about: Their Dual Role 

What we heard from gay men and their service providers about:

Service providers working in HIV prevention and gay men’s health—many of them gay men themselves—have privileged access to emerging information about HIV prevention. We explored how these gay service providers grappled with this new biomedical HIV prevention information, while occupying a ‘dual role’ as service providers and as members of the very same community that they serve. The following themes emerged: the challenges of separating personal and professional lives; the impact of having access to new and emerging HIV prevention information on fear and risk-taking behaviours; how they conveyed this information differently to their clients vs. friends vs. sexual partners; and, how insider subjectivity and reflexivity influenced their work.

Separating professional and personal lives

Gay service providers described the challenges of trying to ‘disconnect’ from work, and to separate their personal and professional lives. They felt that they were, and should be, held to  a higher standard of HIV risk reduction, a standard that was not just an expectation from community members, but also from other service providers.

  • I had sex with this guy, and then you cannot just like, no I’m not going to give out any information. SP, 35-49, CBO, TO

[Q: So next thing you know you’re doing an intervention.]

  • Yes. It’s unintentional but I still do it anyway. I struggle with that for a few years of working in this field. SP, 35-49, CBO, TO

It’s a small world. I can’t go out in my own city without seeing one of my clients somewhere, turning on Grindr… In another city I can go crazy and be up on a stage twirling my shirt around and not give a fuck. I am and can be a professional but I can also be a gay man in his 20s living his life to the fullest. They cross lines a lot.  SP, <35, GMHO, MTL

People hold us to a certain standard. sometimes they forget that we too are just gay men that want to fuck. I mean I’m no saint. I’m not perfect when it comes to condom usage or 100% adherence… I can make mistakes. I can be under the influence. All the things that are factors for the people that I work with are factors for me as well… I hate being held up to this golden standard and then sometimes the disappointment people might have when this standard wasn’t upheld. SP, <35, GMHO, MTL

We had a frontline worker who stood up at a conference and said ‘I’m positive, I party and I bareback.’ A lot of people were applauding as opposed to confronting it at all. It was just the reaction that really freaked me out. This is somebody who was doing outreach work at an ASO. They were very, very cavalier about it... But then everybody is kind of silent for whatever reason to not say, ‘well let’s talk about that; what you just said might be OK for you but as a worker is it OK to give those messages?’ I mean what i do in my personal life is my personal life. But what I have to do in my professional life is my professional life. I have to be very careful. I’m accountable to a higher whatever right because of our position here. SP, 50+, CLIN, TO

Impact on fear and behaviours

For some gay service providers, stress and fear increased as they were initially exposed to more information. However, their growing understanding of HIV risk eventually eased that fear. Many of the gay service providers noticed that working in the HIV sector led to an increase in what they used to consider risk behaviours, but believed that these were now more ‘calculated’ risks, more grounded in facts than ‘paranoia’, and about which they felt more comfortable.

In the beginning I was more panicky. Getting notices from public health about a rise in... LGV [Lymphogranuloma Venereum] or things like that. It’s a lot of information to absorb and I was young in the community… Later on I think it had the opposite effect. There’s not much that impresses anymore. OK. It’s like that, what else?... it’s about finding balance between safety/health/ information and pleasure. SP, <35, GMHO, MTL

Knowledge is power. I just feel more safe because I know that I’m fully aware of most of the consequences of my actions. SP, <35, GMHO, VAN

I’m much more relaxed about the issue of risk... At the least I would say that I take more risks, but in reality it’s just that I calculate a bit more. SP, <35, GMHO, MTL

Some gay service providers described their sex lives as getting worse, and some as improving, as a result of their work.

I used to have a lot of fuck buddies and then when I started doing [HIV work] I lost them all… I think that was the anxiety and the fear of sex. I had no interest in sex and I viewed sex as lethal. Yeah, a deadly thing. SP, 35-49, CBO, TO

I like to think that my own personal and sexual life is enriched because of the work that I do. I can make a lot more informed decisions. SP, <35, GMHO, MTL

Before… I always had a belief that I probably prefer not to sleep with someone who is known HIV-positive… Since working in the field that belief has completely been squashed. I don’t choose my sexual partners based on their HIV status anymore. SP, <35, GMHO, VAN

Talking to clients versus friends versus sexual partners

Gay service providers generally found that the factual information they provided regarding HIV risk remained the same, regardless of whether they were talking to clients, friends or sexual partners. However, they were more likely to give more nuanced information and personal opinions to friends. Some participants lamented  that they treated everyone the same, saying they had difficulty disconnecting their professional and personal lives. Finally, some gay service providers felt a responsibility to use their privileged access to information and professional credibility to challenge stigmatizing attitudes and to help other gay men in their community to make healthy decisions.

How PrEP works, it’s the same regardless of whether you’re talking to someone that you’re working with or with a friend. SP, <35, GMHO, MTL

Unfortunately, I treat it the same way because I have trouble letting go…I’m equally as intense with sexual partners, my friends and the people I meet at the clinic.  SP, <35, CLIN, MTL

When it comes to clients, I will never tell them what to do. When it comes to my friends though… sometimes I will take that liberty of being like ‘listen you should do this’... When it comes to people I am working with… I make sure they have the information they need to know to come to their own proper decisions. SP, <35, GMHO, MTL

With a client there’s an ethical and legal element, so I tell myself i need to protect myself and not express my opinion too much. SP, <35, CLIN, MTL

To a client I might say something like ‘there are conflicting reports.’ To a friend or a partner I probably would be a bit more on the advocate side and say well the evidence is quite strong that treatment has a very strong effect on transmission.  SP, <35, PSY, VAN

Insider subjectivity

Gay service providers described bringing insider perspectives to their HIV prevention work, sometimes directly referring to a practice of reflexivity as they described the role that their own life experiences played in the kinds of judgments they made and advice they provided to their clients.

There’s been a few committees and stuff where I’m told ‘you need to be an objective gay man.’ I’m like well no, that’s not actually my job. My job is to be a subjective gay man doing this job. I think that’s definitely very important. SP, <35, PSY, VAN

We made promises to ourselves, ‘I’ll never do this again. If my test comes back negative I promise to whatever God, I will never bareback again.’ And then guess what. You go back into the same cycle. [laughter] We can laugh at it now because we’re slightly smarter maybe… But that’s a good learning process as well. it’s important to go through that stage. so that you don’t become complacent, that you just become separate from the work that you do. SP, 35-49, CBO, TO

Patten S, LeBlanc MA, Jackson E, Adam B (2016). The Resonance Project Community Report: Emerging biomedical discourses on HIV among gay men and their service providers.

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