Goldring, JE (2007) There is more to health than HIV: social capital and health in the gay community. Doctoral thesis (PhD), University of Salford. Downloaded from: https://e-space.mmu.ac.uk/621099/ Usage rights: Creative Commons: Attribution-Noncommercial-No Deriva- tive Works 4.0 Please cite the published version https://e-space.mmu.ac.uk THERE’S MORE TO HEALTH THAN HIV: SOCIAL CAPITAL & HEALTH IN THE GAY COMMUNITY JOHN E. GOLDRING INSTITUTE FOR SOCIAL, CULTURAL & POLICY RESEARCH ESPaCH THE UNIVERSITY OF SALFORD PH.D. THESIS 2007 SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS OF THE DEGREE OF DOCTOR OF PHILOSOPHY, FEBRUARY 2007 Contents Acknowledgments Abstract Prologue: Background to the Research – Loose Ends & Knotty Questions 1 A Note on the Researcher - Multiple Identities & Split Personalities 4 Overview of the Thesis 6 Part I. The Gay Experience - Setting the Scene & Exploring the Issues 1. Reviewing the Literature – Stating the Case 11 Introducing Reflexive Individualisation Thesis 15 The Social Capital Framework – As it Stands 19 The Social Determinants of Health Inequalities 35 The Complexities of Health 38 2. The Methodologies & Approach 44 Aim, Objectives & Research Questions 48 The Qualitative Approach 50 Sampling Decisions 54 Issues in the Field 56 Data – Collecting the Stories 74 Data Analysis – Story Time 80 Seeking Ethical Approval 82 Part II. Climate change – A Thawing of Relations 3. Shared Histories - Generation & Career 92 The Generational Context – Climate change 93 A Gay Career 99 4. Heterosexism, Homophobia, & the Nature of Trust 106 Coming Out Stories 108 A Narrative of Trust in the Authoritarian Society 129 The Where & When of Social Trust – Identifying Others 136 Taking Control - Cyber Space & Disembodied Participation 139 Part III. Social Embeddedness – Constructing Reflexive Communities 5. Happy Families - Origin & Procreation 149 Family of Origin 150 Family of Procreation – Few & Far Between 164 6. Friends & Lovers – Constructing Families of Choice 173 Coupling & the Changing Face of Intimacy 174 Friendship Patterns 190 7. The Changing Face of the Gay Community 203 Community Groups & Participation 203 The Rise & Fall of the Gay Community 222 Have We Lost the Will to Participate? 232 Part IV. The Spectrum of Gay Men’s Health 8. Locating the HIV Discourse 240 Life before AIDS 246 Generational Differences to the Experience of HIV & AIDS 264 9. Taking Risks – Averting Risks 269 The Good, the Bad & the Downright Belligerent 269 Engaging the Healthy Citizen – The Generational Context 271 With Such A Messy Picture – What can be concluded? 292 10. Structuring Health - Sexual Orientation & Masculine Construction 296 Ronald – A Case Study of Non-compliance 302 How Sexual Orientation Structures the Experience of Health 331 Part V. Pulling the Threads Together Social Capital in a Reflexive Age – Whatever happened to Baby Jane 337 Reflexive Individualisation – Event Horizon 338 Social Capital & the Social Entrepreneur 346 An Experience of Health 351 And so to Policy 357 Epilogue: Unknown Unknowns & Other Great Mysteries 360 On Reflection? 362 Appendices 1. Online survey 365 2. Gaydar Research Profile 371 3. Biographies of participants and organisations 372 4. Semi-structured interview schedule 376 5. Organisational semi-structured interview schedule 381 6. Information sheet 382 7. Consent form 383 8. Group information sheets 384 9. Debriefing sheet 387 10. Risk reduction strategies 388 11. Key events shaping the lives and experiences of gay men in the UK 389 References 393 Tables & figures Table 1: Names and ages of participants in the Criminal-Generation Table 2: Names and ages of participants in the Legal-21-Generation Table 3: Names and ages of participants in the Legal-18-Generation Table 4: Names and ages of participants in the Legal-16-Generation Table 5: Locating participants within the notion of a gay career Table 6: Generation and gay career Table 7: The different styles of family mapped onto the four generations Table 8: The continuum of attitudes and behaviours towards health Table 9: Mapping the modes of relating in the Legal-16-Generation Figure 1: Defining the field Figure 2: The range of approaches and outlooks to health Acknowledgements – short but sweet Many people have helped me while conducting this research, and I am grateful to them all. My deepest gratitude must firstly go to all those people who took part in the research for without whom, this thesis would not have been possible. Some are no longer with us and are missed - others are now good friends and are cherished. I would also like to thank Professor Paul Bellaby and Dr. Sara MacKian for their inspirational supervision throughout the lengthy process of doing this PhD. There are also my close friends and family members who supported me emotionally throughout. I cannot mention you all by name, as I’ll miss someone and then what will happen? And finally, I would like to thank John for his support and for encouraging me to go back into education in the first place. Abstract The legal climate for gay men in the UK has undergone enormous change since the decriminalisation of ‘homosexuality’ in 1967 with changes in the social climate following. Bringing together concepts of ‘social capital’ and ‘reflexive individualisation’, the research explores how the changes have helped shape the gay experience, especially in terms of health and well-being. In recent history, gay men’s health has been located within the HIV discourse, assuming a homogeneous gay identity and community. Yet gay men have various identities and a full spectrum of health needs, well beyond HIV and AIDS alone. The research pursues ethnography as method to provide ‘thick description’ of gay men’s lives in context. After immersion in the context, access was gained to 24 gay men whose ages ranged from 17 to 73 years old. There were also five non-gay participants and six representatives of gay themed organisations. Participant observation, field notes and Internet data complemented semi-structured and unstructured interviews. The data were analysed using the thematic and grounded theory approach. This identified generational variations within the experience of gay men characterised by how the law defined them. The findings indicated that the social capital framework does not account for the experiences this minority group or the variations within it. Gay men displayed different styles of embeddedness, and ways of developing trust in others. Self-censorship hindered the development of these important skills. It also seemed plausible that these same conditions promoted reflexivity through the need to manage multiple identities in various social settings. With respect to health, it was HIV that structured much of their accounts, although they did vary across generations. Generation also structured the experience and practice in other areas of health. The project demonstrates the importance of both sexual orientation and masculinity in the construction of all men’s health. PROLOGUE BACKGROUND TO THE RESEARCH – LOOSE ENDS & KNOTTY QUESTIONS Good health and how to maintain it has become an omnipresent aspect of our daily routines. Hardly a day goes by without there being a news story relating to various aspects of the nation’s health, be it smoking cessation, binge drinking or obesity to name but a few. Generally speaking the ‘state sanctioned health ideology’ (Davison, Frankel et al. 1992) is based on reducing activities known to be detrimental to health while increasing those things that are thought to promote good health. In the gay context the main emphasis relates to HIV prevention and safer sex and for good reason: gay men continue to be the biggest single group affected by the virus. Yet there is little recognition that gay men face the same health issues as all men, regardless of sexual orientation. Indeed, the needs of gay men are absent from the ‘men’s health’ discourse. HIV is not the only health concern to face gay men, yet little if any health promotion or research targets these other issues in the gay context. Is the assumption that gay men do not smoke or that they are not obese? Or is it assumed that their health needs are met under the umbrella of ‘men’s health’? Neither is a sustainable argument. Gay men live varied lives, have a range of social networking styles and have a variety of good and bad health habits, as have all sections of society. Quite simply their various identities, social locations and experience of health need addressing, not only their sexual health. It is increasingly acknowledged that there are many social determinants of health over and above bio-physiology of disease and injury. The notion of health is contestable and is as much a subjective experience as it is a biological fact (Blaxter 1990). Social factors such as our gendered construction, socio-economic status, degree of embeddedness and level of social standing are all proposed as key determinants of health inequalities. What is currently missing from our understanding is the effect sexual orientation has on the experience of 1 health. This thesis will locate these issues within the social capital framework. Social capital is premised on there being some intrinsic worth or value in our social relationships. Communities and individuals with high levels of social capital or social embeddedness are likely to have better health outcomes than those with lower levels. Through the bonding and bridging distinction social capital has been defined as the glue binding society together and the lubricant that permits the smooth running of society’s interactions, (Smith 1997). As might be expected, social capital is itself a contested concept and although it offers a useful framework by which to explore aspects of health and community, it has not been problematised from a gay perspective and is currently premised on heterosexist norms and values. What seems to be lacking from the social capital debate is a contemporary understanding of how individuals are embedded in a variety of different styles of social networks that bear little resemblance to notions of the ‘traditional’ nuclear family.