Facilitating Social Networks Among Gay Men
by Bob Cant
London South Bank University
Sociological Research Online, Volume 9, Issue 4, <http://www.socresonline.org.uk/9/4/cant.html>.
Received: 30 Sep 2004 Accepted: 16 Nov 2004 Published: 30 Nov 2004
Abstract
Social networks are increasingly recognised as being beneficial to health and wellbeing. This paper, drawing from a qualitative study into health services targeted at gay men in London, explores the facilitation by service providers of social networks among gay men. Networks are dependent upon reciprocity among their participants and the study examines how shared narratives can generate a sense of the reciprocity that contributes to the development of networks. The networks discussed here promote instrumental support or communication or emotional well-being or a combination of those. The paper explores the diversity of narratives among the thirty eight gay male service users who were informants to this study. While narratives around experiencing same sex desire, encountering social isolation and making decisions about coming out were articulated by all these informants, there were other organising principles in their lives which also shaped their narratives and their decisions about whom they shared these narratives with. The paper focuses on the development of social networks among three groups of gay men: young South Asian men accessing HIV prevention services, men seeking to give up smoking in relation to their experiences in the commercial venues which constitute the gay scene and carers of gay men and lesbians suffering from a chronic disease. The paper seeks to generate opportunities for reflection about the means to promote health and well-being among members of this marginalised population group.
Keywords: Diversity; Facilitation; Gay Men; Narratives; Networks; Sexuality; Social Circumstances
Introduction
1.1 Social networks are recognised as a setting where social support can be experienced and exchanged. Networks are primarily relational and the benefit to participants emerges from the dynamic among them rather than adherence to any external factor. Barnes understood the social dimensions of networks as being 'a set of points some of which are joined by lines' (Barnes 1954: 43). Scott has argued that networks should be understood as 'the contacts, ties and connections, the group attachments and meetings, which relate one agent to another and so cannot be reduced to the properties of the individuals themselves' (Scott 2000: 3). The Acheson Report into Inequalities in Health (1998) argued that people with good social networks live longer and are at a reduced risk from both physical and mental illnesses than those with poor networks. This paper into the facilitation of social networks among gay men has emerged from my PhD research (Cant 2004).
1.2 The telling of lifestories by gay men, in the public domain, has proliferated since the 1980s. Gay men have, through their lifestories, attempted to give meaning to their lives and to understand the interaction which they, as individuals, have had with other individuals, with the dominant culture and with the groups and sub-groups of which they have become part. 'All lifestories are reconstructions, attempts to make sense of a complex reality, to provide a narrative structure for oneself as well as for others' (Porter and Weeks 1991: 2). Plummer has explored the whole process of story telling, including lifestories told by gay men, and argues that there is an inter-dependence between narrative and community. It can thus be argued, after Scott and Plummer, that there is an interdependence between gay men's stories and the social experiences found in the 'contacts, ties and connections' that constitute the framework of their lives. As a result of the use of a grounded theory approach, one element of this research study investigated the process of sharing narratives in relation to the facilitation of social networks among gay men.
1.3 I begin the paper with a discussion of literature into both the development of social networks and the various features which can be identified within such networks. I also discuss literature relating to story telling among gay men. Drawing upon data collected from semi-structured, qualitative interviews with thirty eight gay men and twelve managers of healthcare projects which targeted gay male clients, I explore the diversity of networks which may be found in the multicultural, multiracial city of London. I focus, in particular, upon the facilitation of networks among three sub-groups of gay men: young South Asian men participating in an HIV primary prevention initiative, men seeking to give up smoking in relation to their experiences in those commercial venues which constitute the gay scene, and carers of gay men and lesbians suffering from a chronic disease. While the narratives shared among the members of the three sub-groups provide some basis for the development of networks, the survival of the resulting networks depends upon the continuing participation of its members. While health policy planners and service providers can offer material support to assist a network, it is the sense of reciprocity among participants that shapes a network and permits its survival.
Social Networks
2.1 Social support and social networks, occurring at the level of informal inter-personal relations, are increasingly acknowledged as important indicators of health and well-being. There has been a plethora of studies to explore, if not explain, the links between health and social support since Durkheim identified a link between suicide and lack of social integration. Cobb (1976) described 'social support as information leading to one or more of three outcomes: feelings of being cared for; the belief that one is loved, esteemed and valued; the sense of belonging to a reciprocal network' (Sarason et al 1990: 10). Cassel (1976) recognised, in an epidemiological context, the benefits of strengthening individuals' social support as opposed to isolating them from potential stressors. Since then a number of studies have explored social support in relation to particular chronic illnesses, such as coronary heart disease (Woloshin et al 1997), depressive symptoms (Penninx et al 1998), diabetes (Ford et al 1998), Alzheimer's disease and Parkinson's disease (Monohan and Hooker 1997) and sickle cell syndromes (Levers et al 1998). Lin et al (1999) also suggest that certain social groups tend to have higher levels of well-being. While little is known about how or why social support affects illness or changes in health status, research has shown that a lack of social support has been associated with increased mortality risk, delay from recovery from disease, poor morale and poor mental health.
2.2 Social networks are recognised as a setting where social support can be experienced and exchanged. Networks represent the relations or linkages between a number of participants; while networks may be associated with particular agencies or particular settings, they do not constitute attributes of those agencies or settings. Barnes (1954) investigated patterns of social life that existed beyond structures based upon geographical territory or formal economic and political structures and identified that a strong role in the maintenance of communities was played by kinship, friendship and neighbourliness. Investigations into the role of networks have continued over the half century since then and Scott explains that networks should be understood as 'the contacts, ties and connections, the group attachments and meetings, which relate one agent to another and so cannot be reduced to the properties of the individuals themselves' (Scott 2000: 3). The relational aspects of networks indicate that any function that they provide will come from the dynamic among the participants rather than, say, adherence to some externally designed programme of health promotion. Some networks will give priority to communication, transfer of information, establishment of norms; other more instrumental networks will be concerned primarily with the transfer of goods and services between people (Mitchell 1969). Drawing upon Cobb's definition and the growing interest in emotional well-being (Pavis et al 1996), I shall extend Mitchell's definition of the possible functions of networks so as to address communication, instrumentality and emotional well-being.
2.3 Networks have been defined as comprising the web of identified social relationships surrounding an individual and the particular characteristics of the web (Seeman and Berkman 1988). Networks are an important way for individuals to influence their environment and study of networks can indicate how particular environments influence the everyday lives of individuals. Networks can be analysed on an ego-centred basis in relation to a particular individual or on a more 'global' basis in relation to a particular aspect of social activity such as kinship obligations, workplace relations or friendship patterns. Social network analysis of a support group for people with a chronic illness showed that the importance of networks lies in the extent to which they fulfil their members' needs (Dipple and Evans 1998). Networks function such that a set of personal contacts are developed through which the individual maintains his or her identity and also receives emotional support, material aid, information and new contacts. Networks can facilitate the interactive process whereby communicative, emotional and instrumental support is obtained. The characteristics of networks, drawing upon the work of Sarason et al (1990), are size of networks, frequency of contacts between members, density of inter-connectedness among members, number and quality of confidants, network composition and perceived support (White and Cant 2003). Granovetter (1973) identified the 'strength of weak ties;' an example of such 'weak ties' will be discussed below in 8.4 in relation to the behaviour of a group of neighbours. Particular qualities, such as size or perceived support, do not, in themselves, guarantee social support but network analysis can provide insight into the means through which particular networks may or may not benefit the health and well-being of their participants.
2.4 The increased normality of mobility in society gives greater opportunities for the development of partnerships based around identified shared interests rather than reliance upon long established traditions, such as stable family life, secure employment and land ownership. Giddens (1994), Sennett (1998) and Wittel (2001) have all reflected upon the development of modes of communication and attachment in societies that can be interpreted as being post-industrial and de-localised. While opportunities still remain to form ties and networks with neighbours and others in geographical communities, there are also opportunities to form networks around shared spheres of interest such as sexuality, ethnicity, parental status, faith, age, health status, leisure, political beliefs and voluntary activities. Contemporary patterns of population dispersal, on a voluntary or involuntary basis, and the increased prevalence of communities of interest, not necessarily attached to any geographical locality, would suggest that study of social networks can provide useful insights into means of promoting health and well-being within dispersed population groups. I go on to discuss the role narratives can play in the development of social networks among gay men.
Story Telling among Gay Male Population Groups
3.1 Story telling is common to so many cultures that culture itself has been defined as 'an ensemble of stories we tell about ourselves' (Geertz 1975: 448). People use the narrative form to shape the stories of their everyday lives. 'It is hard to take a step without narrating. Before we sleep each night we tell over to ourselves what we may also have told to others, the story of the past day' (Hardy 1975: 4). Story telling can also be a mechanism of resistance on the part of excluded or other oppressed groups. 'Oppressed people resist by identifying themselves as subjects, by defining their reality, shaping their new identity, naming their history, telling their story' (hooks 1989: 43). Involvement in a narrative process can enable the participant to 'concentrate on what can be said, why it is said now and not at other times, and the effects of telling a story in a particular way' (Weeks et al 2001: 26).
3.2 My particular interest is in the relational features of story telling as told by gay men to one another, to their confidantes and to their service providers. There are few archetypes of such stories but, as Plummer (1995), argues, many of the stories told by gay men are about coming out as gay and they follow traditional narrative structures of recounting suffering followed by a turning point or epiphany and then a transformation. The sharing of a narrative structure can provide space for gay men to tell stories of how they engaged with the dynamics of particular situations, to hear the stories of other men in similar situations and to develop a communicable consciousness about the circumstances through which they are living. The twenty years since the mid-1980s has seen a proliferation of publications containing lifestories of individual gay men and lesbians (Cant and Hemmings 1988; Hall Carpenter Archives 1989a; Hall Carpenter Archives 1989b; Porter and Weeks 1991; Cant 1993; O'Carroll and Collins 1995; Cant 1997; Nardi 1999).
3.3 Plummer has studied the story telling phenomenon and has postulated a theory about the symbiotic relationship between story tellers and the communities of which they are members. 'For narratives to flourish there must be a community to hear; that for communities to hear, there must be stories which weave together their history, their identity, their politics. The one - community - feeds upon and into the other - story. There is an ongoing dynamic or dialectic of communities, politics, identities and stories
... But there is nothing inevitable about this and nor can it be simply projected into the future: my view of change and history is contingent and piecemeal' (Plummer 1995: 87).There is, in Plummer's view, an inter-dependence between the narrative and the community; the vitality of one can enhance the vitality of the other. In his exploration of the role of the coming out story of gay men and lesbians, Plummer argues that 'the most momentous act in the life of any lesbian or gay person is when they proclaim their gayness to self, to other, to community' (Plummer 1995: 82). The coming out story is thus not so much an exchange of information as a re-definition of the relationship between the gay person and the person who hears the coming out story. The person who is telling the coming out story is sharing his consciousness of same sex desire, of sexual activity, of stigma and of his rationale for coming out and the listeners are re-shaping their consciousness of the life of the story teller. 'The impact of disclosure of homosexuality on an individual's relationship with others has relevance for the process of homosexual identity formation; individuals do not exist in a vacuum and are affected by both macro and micro influences' (Taylor 1999: 524). The privileged position of heterosexuality means that there are near-universal assumptions of heterosexuality about the identities of people who have not specifically come out as gay; the process of coming out problematises such assumptions.
3.4 The socio-historical constitution of identities has been widely mooted (McIntosh 1981; Foucault 1981; Gilroy 1993; Scott 1993; Weeks 2000). I share the concerns of other writers that an exclusive focus on sexuality can obscure the significance of other factors in gay men's lives. Berube is critical of the 'belief that homosexuality could and should stand alone as the organising principle of our lives'; he argues that homosexualities will be 'shaped significantly by our race, gender and class' (Berube 1996: 152). Smith and Bartos warn that while coming out can be seen, in the context of HIV peer education, as a 'manifestation of authenticity' (Smith and Bartos 1997: 223) it can also be a process that silences and excludes gay men who are already HIV positive. While coming out may prove to be 'momentous', the other organising principles in the lives of the person who is coming out also have an impact upon the evolving identity of that individual and the interaction with those who are listening to his story. As Scott has argued,
'Subjects are constituted discursively, but there are conflicts among discursive systems, contradictions within any one of them, multiple meanings possible for the concepts they deploy. .... They [subjects] are not unified, autonomous individuals exercising free will, but rather subjects whose agency is created through situations and statuses conferred on them' (Scott 1993: 409).The other organising principles do not pre-determine the results of the coming out process but they shape the context within which the person who is coming out makes decisions about the direction where he goes with his sexuality. There is, thus, a particular dynamic to be shared among gay men who share other experiences, such as national origin or class background or seropositive status, in addition to their sexuality. The telling of narratives among sub-groups and social networks of gay men helps them give meaning to their individual lives; it also enables them to identify shared experiences with other gay men from similar backgrounds to their own. The complexity of the lives and attachments of individuals in the multicultural, multiracial city of London suggests that coming out can successfully challenge assumptions of heterosexuality and also generate a variety of opportunities for those who have come out. Far from being the single organising principle in the lives of gay men in London, sexuality is likely to be one of a number of organising principles.
The Research
4.1 Semi-structured qualitative interviews, with thirty eight gay male service users of health services targeted at gay men and twelve managers of health service projects targeted at gay men, were carried out as part of my PhD research (Cant 2004). The sample of service users was selected purposively in an attempt to reflect the diversity of the gay male population of London. Service user informants were recruited through a variety of routes: advertisements in the gay press and the HIV positive press, circulation of a flyer through the mailing list of a voluntary organisation working with lesbians and gay men, interacting with potential informants at a GUM clinic targeted at gay men and snowballing. On the flyer and in preliminary discussions I explained that I was a gay man and that I was carrying out PhD research in a university setting. I also explained in preliminary discussions that I was committed to the kind of social change which might result in improvement in services for gay men and a number of informants indicated that they had agreed to participate because they thought that it would "help". The interaction that took place between me and the informants in this research was thus mediated by their knowledge about my sexuality and my commitment to social change as well as my academic status.
4.2 Purposive sampling of service user informants was used in an attempt to reflect the diversity of the gay male population of London. I took positive action measures to ensure that frequently under-represented groups were included in the sample. I engaged in dialogue about recruitment with a number of colleagues in the HIV sector and I encouraged snowballing on the part of individual informants from groups frequently under-represented on account of ethnicity or age. As result of this approach, eighteen of the twenty two informants from black and minority ethnic communities and three of the five men over 50 were recruited with the assistance of workers in the HIV sector or as a result of snowballing, rather than as a direct response to adverts in the press or to flyers. Fourteen young South Asian men participated in a focus group discussion; they were recruited as a result of their affiliation to a voluntary organisation which conducts HIV prevention work in minority ethnic communities.
4.3 Managers were recruited on the basis of the extent to which their services and/or organisations were visible within the population of gay men in London or to service user informants. They were, therefore, recruited if their services were advertised in the gay press and/or the HIV positive press, if they had responsibility for the production of resources which were widely available in gay meeting places and if reference to their particular service was made in interviews by service users. The organisations in which the managers were located were in the statutory health sector, the HIV voluntary sector, the lesbian/gay voluntary sector and the mainstream voluntary sector.
4.4 A grounded theory approach was used to ensure that my arguments and conclusions were grounded in the utterances of the informants. Charmaz explains the three-fold nature of grounded research: 'researchers attend closely to the data (which amounts to "discoveries" for them when they study new topics or arenas), their theoretical analyses build directly on their interpretations of processes within those data and they must ultimately compare their analyses with the extant literature and theory' (Charmaz 1990: 1165). A grounded theory approach is thus capable of respecting both the emergent data and the creativity of the researcher in engaging with those data and with other ongoing debates in the public domain. As part of my commitment to engaging with both the data and wider debates, I conducted an exhaustive process of recording and interpreting discoveries from the data through memo writing; this process helped to establish categories and identify the themes to be used in the analysis. 'Memo writing gives the researcher an analytic handle on the materials and a means of struggling with discovering and defining hidden or taken for granted processes and assumptions within the data' (Charmaz 1990: 1169). It was from the nuanced findings emerging from my reading of the memos that I was able to articulate my grounded theory in relation to the population group being studied.
Facilitation of Social Networks
5.1 The networks which I discuss here are facilitated by service providing organisations. Research (Annetts et al 1996; Gatter 1999; Kelley et al 1997; Keogh et al 1998) has suggested that networks on the gay scene can be used as a setting for HIV prevention health promotion activity. Evidence was found in this study of a number of self-generating networks in relation to the gay scene, cultural interests, sporting interests, dinner parties, circles of confidants and use of the internet but these are not the focus of this discussion. There was an interest among managers in facilitating networks or groups from which networks might emerge so that they eventually became self-supporting. One manager of a community centre which targeted lesbians, gay men and bisexual people explained the rationale for facilitating networks rather than establishing befriending services.
'What was happening was that they [clients] were developing friendships but only with their befriender. And actually the need was for them to start forming relationships with other people as well - so they could go out of their homes and access other services and form social networks. The idea was that we referred people from the befriending service to a closed group and the idea is that there'll be a social networking group which is user led'. ( M11)While there are different models for facilitating social networks, all the models discussed below aimed to support participants to develop a sense of reciprocity among themselves; such reciprocity can act as the basis for the development of social networks.
5.2 Each of the three models of facilitated network development discussed here relates to the social experience of a particular sub-group of gay men. The first of these emerged from an HIV prevention programme; the second of these has a loose connection with HIV prevention although that is not its primary purpose; the third of these is open to both gay men and lesbians and did not emerge from an HIV-related programme. The functions of each of these networks include, to differing degrees, elements of communication, instrumentality and emotional well-being.
South Asian Young Gay Men
6.1 HIV primary prevention has increasingly moved towards approaches that promote dialogue and community development. The content of the safer sex messages has not substantially changed. Reflection upon the ways in which these messages are communicated has led providers to provide opportunities for particular groups of gay men to gain access to safer sex resources, to meet together and to support one another as part of the primary prevention process. In the case of young gay men, this process has frequently been intermingled with general attempts to promote social and emotional well-being through the development of networks. I shall examine both the rationale behind the promotion of networks among young South Asian gay men and the experiences of men involved in this development.
6.2 The promotion of HIV prevention messages in minority ethnic communities needs, in the view of several informants, to engage with a whole number of narratives in addition to the safer sex message. A manager in a minority ethnic HIV service took the view that an individualistic approach to the promotion of safer sex would not be adequate to support young men in relation to the negative attitudes towards homosexuality which they might encounter in their communities of origin and the negative attitudes towards their ethnicity which they might encounter on the gay scene. Furthermore, he identified a key problem with mainstream HIV services as being about diversity.
'People often don't accept the view that different races or cultures express sexuality in different ways and you have to deal with those issues.' (M3)This manager was concerned that such non-engagement resulted in mainstream services producing health promotion materials which did not connect with the experiences of minority ethnic men who were gay, bisexual or questioning their own sexuality. Another manager regretted the lack of safe spaces for minority ethnic gay men to meet together.
'People don't get the opportunities to participate in all the issues around their lives, around their sexuality in a kind of safe environment where they can do that with other men of similar background and most of the spaces that there are have alcohol and drugs and so on.' (M6)A service user informant from a minority ethnic background questioned the ability of mainstream gay men's organisations, most of whose staff and clients were white, to communicate with men from backgrounds such as his.
'With regards to the Turkish and South Asian communities, I would say that they [the mainstream gay organisations] are not at all good at communication.' (R1)These three informants identified problems in relation to working with gay men from minority ethnic communities on issues of HIV prevention.
6.3 Many of the South Asian young men who participated in the youth group which was targeted at them described feeling a sense of belonging there that they did not experience elsewhere. Before joining the group, it had been the norm for many of them to keep their sexuality secret from other members of their communities of origin and to avoid discussion about the values of their particular South Asian community with other gay men whom they met. One informant explained that if he went into a gay bar alone he experienced no problems but if he went as part of a group of Asian men, there was 'a lot of staring' and he felt that other, mainly white, customers were 'apprehensive and confused and shocked' (R22). Group members had maintained a strict division between those parts of their lives that reflected two important parts of their identities. The group not only reduced their sense of isolation but it also provided a safe space where they could question the divisions in their lives and exchange narratives with their peers about ways of achieving meaningful lives for themselves. One participant described his experience of belonging to the group.
'We understand more about each other - where we're from and where the other person's from - why they think a certain way or act a certain way. So I think we've got more in common than just our sexuality - we've got this kind of cultural linkage between us - even though we're all from completely different backgrounds - the caste thing, the geography - some people from Pakistan, some people from South India, East India, North India - there's a helluva difference between the different parts. I'm Punjabi. Lots of Pakistani people speak Punjabi and there's one other Punjabi person here - the one I'm closest to - we speak the same language but I think we have lots of things in common - but at the same time we have different life experiences. There's the fact that we're all Asians in a very white society and that our parents all came to this country and we all have a different work ethic to the rest of the UK. We'll tell each other about our coming out stories and we do talk about what you could do and what your options are.' (R8)The group has provided space for young South Asian gay men to explore what they have in common as well as what separates them. It provides space where neither their sexuality nor their ethnicity is problematised; they do not have to justify themselves to others who may approach the concerns of South Asian gay men with a set of assumptions. The group space, by enabling them to explore and develop their identities in an integrated manner, gives them opportunities to enhance their emotional and social well-being. The group does not seek to assist its members to adjust to some pre-ordained norm; rather it provides opportunities for the sharing of narratives and the development of networks that meet the needs of their participants.
6.4 The potential to reflect upon both the minutiae and the meaning of their lives as South Asian gay men in a multiracial but primarily white society is exemplified in the following extract from the focus group discussion. It highlights the way in which they are able to tease out and debate the issues that concern them; they are illuminating some of the shared narratives that they have as South Asian men on the gay scene. The extract begins with a discussion about being the only Asian man in a gay bar and about meeting gay men there, most of whom are white.
FG/W: It doesn't stop me from going out on the scene - I walk into a gay bar lots of times on my own - it doesn't stop me from going there - I don't think it's negative - it's something you think about.This exchange touches upon a number of themes that were of concern to these four young men. There is the issue of being possibly the only minority ethnic person in a highly sexualised setting; there is the issue of making conversation and contact with other men there. As well as negotiating their way into or away from sexual contact, there is also the concern about how to negotiate their way out from under the weight of history which is one of the factors shaping the ways in which white and Asian people see each other. Each of these has its own challenges and together they represent a formidable challenge, particularly in a crowded noisy London bar. There was no political or ethical conclusion to the discussion about racism on the gay scene; there was a long silence at the end of this exchange as people reflected on the exchange and the meaning it had for their personal lives. Despite the presence of a white researcher, the group members had taken the opportunity to explore the implications of a particular aspect of their lives in the knowledge that there would be no intervention from some agency external to the group membership.
FG/Z: Colour's a factor - it's there - race is a factor - it's there -
FG/Y: Maybe I'm wrong but I think there's less racism in the gay community than there is in the straight community -
FG/W: No, I wouldn't call it racism -
FG/Y: You have a white boyfriend.
FG/W: No, I wouldn't call it racism.
FG/Y: Not racism - but not so much racism.
FG/W: It's a difference in culture which will always be there.
FG/Y: I chose the wrong word - it's not racism - it's just -
FG/J: Ignorance.
FG/Y: Ignorance, yeah.
FG/Z: I mean, if I do get talking to somebody first thing they'll ask me is how is it being Asian and coming out - things like that, you know - you know it's not that bad any more. Yeah, I'm Asian but I could come out if I wanted to and things will be OK - probably be the same as any white person coming out - yeah, maybe ignorance, lack of understanding.
6.5 Networks were in the process of being formed from within the group membership as a result of such dialogues. One significant feature of these networks was that while they drew upon two of the major narratives which shaped the lives of the young men - their extended family/community and the gay scene - they did not require them to choose between the two. Emerging networks were contingent upon some degree of attachment to both the family/community and the gay scene. These networks did not require their members to prioritise the narrative of one setting over the other. They gave support to the young men to face up to their dilemmas, to establish their own norms and to make decisions about how to live less fragmented lives. They provided space for their participants to enhance their own emotional well-being.
Smoking Cessation among Men accessing the Gay Scene
7.1 Research has shown that smoking levels are higher among gay men then their heterosexual counterparts (Stall et al 1999). An HIV prevention agency had acknowledged this and, as part of a commitment to promote the overall health and wellbeing of gay men, they established a self-funding course targeted at gay men who access the pubs, clubs and other commercial venues that constitute the London gay scene. The course comprised groupwork and the promotion of ongoing dialogue between pairs of men. One of the course aims was to illuminate the operation of particular networks and to generate understanding of the meanings of these networks.
'I came out four years ago - I basically [was] a non-smoker. But the drama of coming out - the impact of it, the enormity of it - made me go back to smoking again as a kind of crutch ... I think the reason I went to a gay men's Stop Smoking course is because most of the reasons that I have smoked over the past three years have been to do with being gay - mainly that I've been constantly meeting new people, socially and sexually - that is a very stressful experience - you are hanging about in unfamiliar, kind of vaguely embarrassing or threatening or self-conscious making environments that lead you to want to have something to rely on - lots of other gay male smokers and lacking confidence - it [looking for a light for a cigarette] is non-confrontational and you don't feel rejected if you have to back off.' (R2)The settings described by this informant are characteristic of the commercial venues of Central London where pursuit of casual sex partners is a norm. The stressful experiences that he indicates are related more to participating in that setting than the acceptance of his sexuality. The problems that he describes about making contacts, fearing rejection and avoiding harassment are very specific to that context. Scott (1995: 24) has argued that 'the "glue" that holds the gay community together' is sexual but while many men share some consciousness about how that 'glue' works there are limited opportunities to reflect verbally and collectively upon it. This smoking cessation group brought together men who shared similar experiences of these venues, encouraged them to share narratives of those experiences and assisted them to develop strategies to minimise their smoking patterns. Far from problematising their participation in the gay scene, the course encouraged them to examine and understand its social mechanisms better so that they could operate in a more health enhancing way there. It, in effect, generated an opportunity to share narratives and thus facilitated the establishment of networks, based upon both instrumentality and communication, among the course participants. The networks were not necessarily expected to survive the course but the lessons learned from the facilitated networks could be learned and re-used later in more informal networks. The facilitation of networks had made it possible for the participants in the future to make ties and connections with other people who were interested in promoting a particular aspect of their health.
7.2 The course was further appreciated by participants because they could learn about changing their smoking behaviour without having to engage with expressions of homophobia or other cultural insensitivity in the process.
'You want people to "get it" - so if you're needing to use a particular service you want to know that that person is going to get it - you're not going to have to explain things about being a gay man.' (R25)
'It [a gay men's course] would feel like a safer, more welcoming environment than doing it with any old Joe Bloggs. In a gay men's group, you've got more common experiences together - if I was in a general public group I might feel shy about talking about why I haven't got a wife and I wouldn't have to be dealing with their views about my sexuality and how I live my life.' (R12)The fact that men could relax in this group setting without any anxiety about being expected to explain the whole of their lifestory to people who did not share that narrative was welcomed by participants. The fact that they were free from having to engage with assumptions of heterosexuality was identified as a factor likely to enhance their attempts to improve their health. It made the learning experience less stressful and increased the likelihood that participants could contribute freely about the social patterns of their smoking.
7.3 The experience of one informant highlights the fact that the course was designed for those gay men who shared the social experience of accessing the gay scene rather than for anyone who identified as gay. The course engaged with the relational aspects of gay life in a particular social setting rather than some essentialised notion of gayness. This informant, who was over 40 years of age and comfortable with his sexuality, completed the course but he expressed criticisms of the limitations of the course in relation to his social experience as a gay man.
'I'm not normally one to want to look just for a gay targeted group. But I do look for similarities that I would have with people and people who live alone do have their own set of characteristics. The fact is that we were vastly different people and other than smoking and other than the gay thing there was very little in common - we went through the motions in terms of what we were supposed to talk about - but I would probably have been as happy in a group where other characteristics were shared.' (R3)His sense of detachment from the course highlights the complexity of the social dimension of such courses. The value of such a course is that it enables gay men to acknowledge that they share narratives or similar network experiences with others and to articulate the significance of those experiences in their everyday lives. This particular course freed the participants from the constraints associated with assumptions of heterosexuality but it went further in that it enabled men who accessed the gay scene to form networks with other men who shared similar narratives of the scene. Men who did not share such scene-related narratives were likely to be less able to access the networks generated by the course. These networks enabled them to communicate with one another about their smoking patterns on the scene and thus provided an opportunity for them to improve their health and well-being.
Carers of Gay Men and Lesbians with a Chronic Disease
8.1 One informant explained the background to his efforts to establish a national telephone based network for gay and lesbian carers of people suffering from a particular chronic disease. There may be as many as seventeen and a half million people in Great Britain living with chronic diseases (DoH 2001); the impact of such diseases is not only physical but is also likely to extend to psychological problems, socio-economic factors and general quality of life. Engagement with chronic disease requires, of necessity, engagement with the whole life of the sick person. This informant argued that services which are unable to accept or engage with the sexuality of their gay and lesbian clients are problematic for people who have lived openly gay or lesbian lives. The failure of some mainstream chronic disease management services to engage with the narratives of gay men and lesbians is one factor contributing to the facilitation of targeted networks to support them. A manager in a mainstream voluntary organisation described the behaviour of such organisations as exemplifying a kind of 'benign ignorance' (M9) towards the needs of gay men and lesbians.
8.2 Informant R18 experienced considerable difficulties, after his partner was diagnosed with a chronic illness, in persuading either medical staff or the national voluntary organisation for this chronic illness to treat him as a significant other, let alone the next of kin. Although he had enduring powers of attorney, his partner was moved from one hospital to another without him being either informed or consulted. When he tried to write of his experiences for the journal of the voluntary organisation, their response was to say that the topic of homosexuality had been covered once some years previously and did not, therefore, require further coverage.
8.3 Networks function effectively where there is regular contact and he explained how, while he was able to access formal membership of the local branch of the voluntary organisation, he did feel excluded from the 'contacts, ties and connections' that are inherent in the less formal social networks of the organisation.
'One of the things that I decided to do was get involved in my local group and they were willing to accept me - then they never asked me how my partner was when I used to go to committee meetings - whenever I went it was 'Hi, how are you?' - fine, good - but at no point did anyone say 'How's your partner?' It was almost a blanking out sort of acceptance - they were willing to accept my experience but they seem to transfer my experience away from it being a gay experience.' (R 18)While he was not physically excluded from the local group, the narrative of his experience with his partner was censored so that it was almost impossible for him to refer to the person who had been his partner for over thirty years. If he withdrew from the organisation, he was withdrawing from access to a whole range of resources and information. Whether the behaviour of the group members was motivated by ignorance or prejudice is not possible to say, but the impact of their behaviour was such that he felt excluded from the networks of support within the group. He was marginalized by their patterns of communication and he experienced no support in relation to his emotional well-being.
8.4The behaviour of another informal network of gay and lesbian neighbours was contrasted with the voluntary organisation. The neighbours' support was particularly important when his partner began to experience symptoms of dementia.
'The biggest problem that we had was in stopping [my partner] leaving the residential home, which he did about six or seven times during the day and night - he wandered around the area - it was very difficult to keep him in - we have fourteen [lesbian or gay] people in this road or the roads just going off it and we're all of an age [50+] - they used to pick him up and take him back. I used to find that the only way I could cope was by going away for no more than four days at a time and I used to go away knowing that he would get out of the home but I also knew that people would be around for him who would simply pick him up and take him back.' (R 18)The fourteen gay and lesbian neighbours were, in effect, operating as a network of support. In relation to R 18's partner, their support was primarily instrumental in that they escorted him to the warmth of his home; in relation to R18 himself it was more about communication and empathising with the experience of a gay men whose partner had become terminally ill. It is not possible to explain their motives but their behaviour suggests that they understood the narrative of the experience of the couple and they took steps to acknowledge it and to offer instrumental support. Such behaviour could be interpreted as exemplifying what Granovetter (1973) has identified as 'the strength of weak ties.' The 'weak ties' related to the way in which these neighbours had been in a position to offer support on account of their shared attachment to a geographical neighbourhood as well as their shared sexuality.
8.5 R18's appreciation of the dangers of social isolation among carers of the gay or lesbian person with a chronic disease led him, after the death of his partner, to establish through the channels of the appropriate national voluntary organisation a telephone based network for the carers of gay men and lesbians with this particular chronic disease.
'My experience is that the gay men who have phoned me have almost always started off by saying 'I'm glad to be able to talk to you because you are gay but more especially because I can say things to you that I wouldn't normally say to other people.' (R 18)The conversation may be about the guilt that callers can feel about not loving their terminally ill partner enough; it may be about sexual issues; it may be about camp humour. There are fewer female volunteers than male volunteers and fewer female callers than male callers but if a woman expresses a preference to talk to a woman volunteer that can be facilitated. The overall ethos of the phoneline values the sharing of narratives between caller and volunteer in addition to the shared narrative around illness. A telephone-based network cannot supplant the need for professional medical support or personal homecare but by virtue of the fact that it acknowledges the social, sexual and emotional dimensions of the identity of a gay man or a lesbian, it can assist the caller to feel like a whole person rather than just a sick patient or an over-stressed carer. The regular sharing of narratives between callers and volunteers indicates that this telephone network promotes the value of communication among gay and lesbian carers and supports the emotional well-being of its individual participants.
Discussion
9.1 Each of the three models discussed here facilitated a mixture of the functions characteristic of social networks. The network for young South Asian gay men enabled participants, instrumentally, to access safer sex resources but participants also expressed appreciation of the opportunities which the group and its networks provided for them to reduce their sense of isolation; they acknowledged the opportunities to enhance their own individual emotional well-being and to communicate with those who shared common narratives with them around the social dimensions of their sexuality and their ethnicity. The networks that emerged around smoking cessation facilitated communication among men who accessed the gay scene. While there were also opportunities to access resources and possibilities to enhance their emotional well-being, these networks focused on facilitating communication among men who felt some social isolation on the gay scene; the primary target of this initiative was related to the social experience of accessing the gay scene and did not engage with the social experiences of gay men who did not access the scene. The networks for carers of people with a chronic diseases generated opportunities for emotional well-being and communication among participants. Having emerged from a small self-help group with limited resources, they had less opportunity to provide material resources that might have, instrumentally, provided some form of support for participants.
9.2 The survival of each of the networks discussed was contingent upon the social circumstances of its participants. The narratives around shared social experiences were able to act as precursors of the development of networks but it was the fact that there had been attempts to facilitate networks that provided opportunities for participants to articulate and to share their narratives. All of the networks engaged with both the sexuality of their participants and some other social dimension in their lives. Both of the networks for South Asian men and around smoking cessation had some relationship with the highly sexualised gay scene and were, therefore, open only to male participants. The carers' network related more to domestic settings and was, therefore, open to both women and men. None of the networks discussed related to sexuality alone.
9.3 Networks' survival depends upon the continuing participation of their members and once there is a withdrawal of participation, the networks change their patterns of functioning or collapse. The efficacy of a particular network can only be understood by an analysis of the interaction among its participants. While health policy planners and service providers can offer material support to assist a network, if their intervention creates any conflict of accountability among network members they may have contributed to a weakening of the sense of reciprocity among network members and perhaps even to its collapse.
9.4 This research suggests that there is potential for the facilitation of networks among gay men or gay men and lesbians where there is evidence of shared narratives; there could, for example, be research into the facilitation of networks around chronic illness. There are also considerations and challenges for planners and providers within a culture of service provision who wish to facilitate the sharing of narratives and the development of health enhancing social networks among this population group. While this research has discussed the intellectual case for the facilitation of networks that promote well-being, the policy and resource implications for the support of such initiatives by health and social care providers have yet to be explored.
Footnote
Participants are identified by a code beginning with R, FG or M. R denotes that the participant was a gay male service user who took part in a semi-structured interview; the number attached indicates the sequence of participation. FG denotes that the participants took part in focus group discussion; the letter attached indicates the first name which they had chosen to use for the purposes of this interview. M denotes that the participant was a service manager who took part in a semi-structured interview; the number attached indicates the sequence of participation.References
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