Blog: Under the Lens

Beyond the buzzword: Resilience in gay men’s health

Written by Sarah Chown

Resilience isn’t a new concept for gay men.  Over the years, gay men sought each other out to build relationships and communities in times of strict legal prohibition and punishment. In response to the HIV epidemic, gay men published  ‘How To Have Sex in an Epidemic’ (1) in 1983, in the absence of any prevention information from public health or other institutions. Gay men have fought, and continue to fight, for increased visibility, and along with it, legal protection and rights, including decriminalization of anal sex, ending persecution of gay people within the public service, and more recently marriage equality.

However, public health research has only taken up this concept in the context of gay men’s health work since the 2000s as a result of calls from gay men, situated within and outside academia. These advocates pushed for a new approach to research, one that moved away from pathologizing gay men and instead was oriented towards the recognition of gay men’s many strengths and successes:

…we want to transform the ways in which we think about and evaluate gay men, shifting away from a perspective which exoticizes, demonizes, and pathologizes our bodies and our lives and into a model which recognizes the tenacity, survival-skills, and overall resilience of our cultures and communities.  What would it mean to understand openly gay men as the resilient portion of our community, that portion which has suffered physical assault, religious abuse, and political violence yet emerged emotionally intact and spiritually strong?  What would it mean to understand our gender play, kinship networks, and sexual cultures not as pathetic products borne of a homophobic society, but as adaptive survival strategies which have served us well? – Eric Rofes, 1999. (2)

Not long after, Canadian gay men’s health policy documents echoed this call, describing the need for “gay men’s health [to] begin with recognizing, acknowledging and affirming the resilience, the reserves of strength, and the courage of gay men” (Ryan & Chervin, 2001, p. 32) (3).

But, what is resilience? Perhaps that is a trickier question. Academic notions of resilience first emerged in the 1970s within the realm of psychology: children who, despite maltreatment, did not present with significant clinical disorders or negative traits were said to be resilient. Over time, the concept has expanded to study experiences of positive adaptation and/or avoidance of negative outcomes in the context of short-term or ongoing adversity.

In practice, research teams determine a set of criteria that act as a threshold or indicator of resilience. Typically, these criteria fit into four categories: achievement of developmental milestones (e.g. school completion); validated scales (e.g. Centre for Epidemiologic Studies Depression Scale); pre/post measures of functioning (e.g. assessing functioning before and after a period of adversity), and least commonly, self-report. Most often, this research is based on quantitative measures, although some qualitative work does exist.

Contemporary gay men’s health research on resilience differentiates between those men categorized as resilient and those men who are not. For example, Herrick et al. (2013) (4) study differences in health outcomes between men who have and have not ‘resolved’ internalized homophobia (5). Another approach examines differences between YMSM who had experienced high childhood adversity (indicated by foster home placement) and those who had not on seven indicators: 1. formal employment, 2. stable housing, 3. school enrollment or high school completion, 4. no criminal justice system involvement, 5. no clinical depression, 6. social support and 7. less than three days of hard drug use in the past month (Gwadz et al., 2006) (6). One study conducted a qualitative analysis of syndemics theory (7), and observed simultaneous narratives of risk and resilience among its 54 HIV-positive gay and bisexual adolescents (Bruce et al, 2011) (8).

Of course, these academic concepts can seem so removed from the ways resilience happens in real life. There is also the possibility that resilience is an overly romanticized notion of community cohesiveness and solidarity. It is also tempting to jump wholeheartedly into resilience research with its focus on celebrating successes rather than documenting (for the hundredth, millionth time) the health disparities that gay men continue to experience or the pervasive nature of the many forms of oppression that shape these health disparities in the first place. That said, I worry that some current resilience research (9) is using measures that do not reflect gay men’s understandings or experiences of resilience, and are instead based on other people’s ideas of what resilience is. I also wonder to what extent resilience research is fulfilling the vision of those men who advocated for it in the first place.

That said, research and programming that has, as its grounding principle, the belief that gay men have strengths, is leaps and bounds ahead of work that believes gay men are abnormal or unhealthy. As resilience work continues, I want to see more opportunities for gay men to imagine, articulate, and build communities that are happy, healthy, and well – and inclusive of the many men who are part of the umbrella of gay men. I also want to see diverse gay men’s ideas about resilience to be at the forefront of this work, and ensure that we are not reproducing notions of resilience that worked for other groups of people.

Resilience is an important part of the picture of gay men’s health work today: it affirms gay men’s leadership and activism in supporting their communities; it celebrates the ways gay men care for each other; and it solidifies the role of gay men in doing this work. It is necessary that we engage gay men in the conversations about what resilience feels like and looks like – and how we, as researchers, frontline workers, and policy makers, can support and affirm resilience in the work we are doing alongside gay men. Resilience is not going away, so it is important we find authentic ways to include it in our work.

Further Reading and Viewing

(1) How To Have Sex in an Epidemic

http://richardberkowitz.com/category/4-how-to-have-sex-in-an-epidemic/

(2) Eric Rofes, opening plenary at the Boulder Gay Men’s Health Summit: http://www.ericrofes.com/speaking/Gay_Mens_Health_Summit.pdf

(3) Bill Ryan & Michael Chervin, Framing gay men's health in a population health discourse: A discussion paper

http://cbrc.net/sites/cbrc.net/files/FramingGayHealth.pdf

New Directions in Gay Men's Health and HIV Prevention in Canada: Pan-Canadian Deliberative Dialogue Report, 2010: http://orders.catie.ca/product_info.php?products_id=25760

(4) Herrick, A. L., Stall, R. D., Chmiel, J. S., & Guadamuz, T. E. (2013). It Gets Better: Resolution of Internalized Homophobia Over Time and Associations with Positive Health Outcomes Among MSM. AIDS and Behavior, 1423–1430. doi:10.1007/s10461-012-0392-x

(5) My blog on homophobia: http://cbrc.net/blog/11-2012/‘homophobia-killing-us’-heterosexism-and-gay-men’s-health

(6) Gwadz, M. V., Clatts, M. C., Yi, H., & Leonard, N. R. (2006). Resilience Among Young

Men Who Have Sex With Men in New York City. Sexuality Research and Social Policy, 3(1), 13–21.

(7) My blog on sydemics: http://cbrc.net/blog/01-2013/understanding-syndemics-and-gay-mens-health

(8) Bruce, D., Harper, G. W., & Interventions, A. M. T. N. F. H. A. (2011). Operating Without a Safety Net and Emerging Adults' Experiences of Marginalization and Migration, and Implications for Theory of Syndemic Production of Health Disparities. Health Education & Behavior, 38(4), 367–378.

(9) http://vimeo.com/73257638

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