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Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men a
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Alex Iantaffi PhD , J. Michael Wilkerson PhD , Jeremy A. Grey PhD & B. R. Simon Rosser PhD
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Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA b
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Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA c
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Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA Accepted author version posted online: 15 Jun 2015.Published online: 15 Jun 2015.
To cite this article: Alex Iantaffi PhD, J. Michael Wilkerson PhD, Jeremy A. Grey PhD & B. R. Simon Rosser PhD (2015): Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men, Journal of Homosexuality, DOI: 10.1080/00918369.2015.1060066 To link to this article: http://dx.doi.org/10.1080/00918369.2015.1060066
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Journal of Homosexuality, 00:1–14, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0091-8369 print/1540-3602 online DOI: 10.1080/00918369.2015.1060066
Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men ALEX IANTAFFI, PhD Downloaded by [Yale School of Medicine] at 12:51 22 July 2015
Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
J. MICHAEL WILKERSON, PhD Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
JEREMY A. GREY, PhD School of Public Health, Emory University, Atlanta, Georgia, USA
B. R. SIMON ROSSER, PhD Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
Sexually explicit media (SEM) have been used in HIV-prevention advertisements to engage men who have sex with men (MSM) and to communicate content. These advertisements exist within larger discourses, including a dominant heteronormative culture and a growing homonormative culture. Cognizant of these hegemonic cultures, this analysis examined the acceptable level of sexual explicitness in prevention advertisements. Seventy-nine MSM participated in 13 online focus groups, which were part of a larger study of SEM. Three macro themes—audience, location, and community representation—emerged from the analysis, as did the influence of homonormativity on the acceptability of SEM in HIV-prevention messages.
Address correspondence to Alex Iantaffi, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 180, Minneapolis, MN 55454, USA. E-mail: [email protected] 1
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KEYWORDS gay men, HIV prevention, pornography, sex education, sexually explicit media, social marketing, homonormativity
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INTRODUCTION HIV-prevention messages developed for men who have sex with men (MSM), while not targeting heterosexuals, are not immune to the predominance of heteronormative discourse within U.S. culture. Even the most basic prevention messages—for example, “wear a condom”; “get tested”; or “discuss your HIV status with potential partners”—are influenced by a range of complex psychological, economic, and sociocultural constructs, including individual and communal identities, psychological and socioeconomic factors (Rotheram-Borus et al., 2009), and mode of delivery (e.g., offline vs. online). Heteronormative mainstream culture considers gay/bisexual/queer identities, relationships, and behaviors to be outside the bounds of citizenship to some degree, as evidenced by the current debate about marriage equality (Herdt & Kertzner, 2006). Gay men have responded by creating a mainstream gay movement that can be differentiated from the sexual liberation and gay rights movements of the 1960s and 1970s. This phenomenon has been labeled by Duggan (2002) as “the new homonormativity” (p. 175) and by Bell and Binnie (2000) as the “good gay citizen” narrative (p. 30). This narrative rewards subscription to the same principles underlining heteronormativity, such as gender conformity, by privileging hegemonic masculinity, Whiteness, consumerism, monogamy, and HIV-negative status (Duggan, 2002; Nast, 2002; Puar, 2006). Though similar to the heteronormative script in many ways, the new homonormative script distinguishes itself by still allowing for freer sexual expression within certain contexts. One of the acceptable contexts for sexual expression appears to be the consumption of pornography, also described in the literature as sexually explicit media (SEM) (Rosser et al., 2012). However, both hetero- and homonormative discourse consider sex to be the realm of private rather than public discourse. Unlike Rubin’s (1984) and Califia’s (2002) analysis of sex in relation to power, rooted in feminist and queer liberation discourses, homonormative discourses seek to contain SEM within the realm of the apolitical, private sphere, in order to reinforce the “good gay citizen” narrative. Within this framework, SEM is seen as a private pursuit—that is, gay men might watch porn, but they do so in private, just as most heterosexual men do. This is further reinforced in the United States by a longstanding, puritanical, sex-phobic overculture, to which sexual minorities are not immune (Aurand & Wood, 2011). Nevertheless, SEM is ubiquitous in gay male culture (Morrison, Morrison, & Bradley, 2007), and producers of gay SEM claim its role in validating
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homosexuality—as an outlet for desire and exploration and for strengthening community (Lucas, 2006). Researchers have similarly found a role for SEM in young MSM’s sexual development. SEM provided younger MSM with information about same-gendered sexual behavior (Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010, 2011) and often confirmed sexual attraction and desire (Morrison, 2004). The prevalence of SEM within gay male culture creates opportunities for HIV prevention. Erotic and sexually explicit images and language have historically been used in HIV prevention to both engage the desired audience and to communicate content (Palmer, 2004). As discussed earlier, sexually explicit media (SEM) are ubiquitous in many gay spaces (Martin, 2006; Morrison et al., 2007), are widely accessed by the majority of MSM (Hald & Malamuth, 2008; Traeen, Nilsen, & Stigum, 2006; Traeen, Spitznogle, & Beverfjord, 2004), and are also highly acceptable (Hooper, Rosser, Horvath, Oakes, & Danilenko, 2008). Previous studies have already argued for attention to be paid to a range of psychological and sociocultural constructs, such as cultural scripts, in HIV prevention and interventions (Wilson & Miller, 2003). In this study (Wilson & Miller, 2003), culture was “defined as ‘the way of life’ among members of a group, including the values, beliefs, norms and traditions that might influence some people to put themselves at risk for HIV transmission” (p. 185). However, we do not have enough information about the influence of the homonormative gay movement on the use of SEM in HIVprevention advertisements, especially from the 1990s onward, nor do we have a good understanding of the contextual factors contributing to the perceived acceptability of SEM in prevention advertisements. Thus understanding how to use SEM effectively in HIV-prevention messages deserves further attention. As part of a wider qualitative study examining SEM use by U.S. MSM, we sought to identify what level of sexual explicitness in HIV-prevention messages might be acceptable to this population and the reasons for those preferences. The research questions that guided this analysis were 1. What level of sexual explicitness is acceptable to MSM in HIV-prevention messages? 2. Which sociocultural constructs influence MSM’s opinions of what level of sexual explicitness is acceptable in HIV-prevention messages?
METHODS The Sexually Explicit Media (SEM) study is an NIH-funded study exploring how the use of SEM by MSM might influence sexual behavior. For the purpose of this study, SEM was defined as any kind of material aimed at creating or enhancing sexual feeling or thoughts in the recipient and (1) containing
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explicit exposure or depictions of the genitals and (2) clear and explicit sexual acts (e.g., vaginal intercourse, anal intercourse, oral sex, masturbation, bondage) (Hald & Malamuth, 2008). For the formative portion of this study, 13 focus groups were carried out online. Participants were recruited over a 2-week period in January 2010 using banner advertisements on 148 gay Web sites affiliated with the Gay Ad Network (Quantcast Corporation, n.d.). Banner advertisements directed interested persons to a Web page hosted on a dedicated university server with appropriate encryption to ensure data security. The Web page included information about the study procedures and a link to the eligibility screener. A total of 448,472 banner impressions were displayed, with a click-through rate of 0.3% (N = 1410). Of these, 227 men met the eligibility criteria: being a male, age 18 years or older, having had sex with another man in the 90 days prior to study enrollment, living in the United States, and, on average, having viewed SEM at least weekly. To ensure we collected a diverse range of experience, focus groups were stratified according to SEM preference and use, as described below in the section on procedures. Based on availability and stratification, 139 MSM were invited to take part in the study, and 79 of those logged in at their scheduled time and participated in an online synchronous focus group. No one dropped out of a focus group after logging into the system. The 13 focus groups took place from mid-January to mid-March 2010. All study protocols and procedures were reviewed and approved by the Institutional Review Board (IRB) at the University of Minnesota.
Procedures This Internet-based study involved online synchronous focus groups, combined with an asynchronous, bulletin board follow-up. The synchronous focus groups were conducted using Adobe Connect and included viewing of visual materials and text-based discussions through a “chat” function. No audio or video functions were used in the synchronous focus groups to maximize participants’ confidentiality. After consenting to be in the study, participants were asked if they preferred watching SEM in which the models used condoms for anal sex (safer-sex SEM) or not (bareback SEM). To examine the self-perception of SEM use, we asked participants two questions aimed at determining if their SEM use was problematic to them: “Has your use of porn ever caused you to feel distress? (yes/no/unsure/refuse to answer)” and “Has your porn use ever gotten in the way of doing things socially, at work, or in another important area of your life? (yes/no/unsure/refuse to answer).” Participants were then assigned to one of four categories: nonproblematic bareback SEM consumers, problematic bareback SEM consumers, nonproblematic safer-sex SEM consumers, or problematic safer-sex SEM consumers.
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Each category had three online synchronous focus groups with the exception of the nonproblematic bareback category, which had four focus groups to compensate for low attendance in one of the previous groups. Each focus group lasted approximately 1.5 hours. In order to ensure anonymity within focus groups, participants were asked to create a handle for the study that was not associated with their usual online profiles on either social media or sex-seeking Web sites. Three members of the research team facilitated each synchronous focus group using a semistructured interview guide focused on SEM consumption, preferences, and viewing habits, as well as sexual behaviors. One member of the research team served as primary facilitator, posing questions and prompts. A second member of the research team was a cofacilitator, uploading questions, and a third member of the research team provided technical support, saving transcripts and tracking participant engagement. After each synchronous focus group, the research team reviewed the transcript and identified up to five follow-up questions, which were used to clarify comments made during the focus group and to generate discussion during the asynchronous focus group. Within 24 hours after the conclusion of the synchronous focus group, participants were invited to respond to follow-up questions about issues raised during their synchronous group discussion through an asynchronous message board. Participants had 48 hours to respond to questions and comments posted on the message board. Participants were compensated $50 for participating in the synchronous focus group and an additional $5 for participating in the asynchronous focus group.
Measures We asked participants which sexually explicit images used in HIV-prevention messages they found acceptable and why. Participants were shown five deidentified HIV-prevention poster advertisements and one HIV-prevention video advertisement. The images in the posters were selected to range from not explicit (one had three motorbike helmets and three condoms in semaphore colors; one poster had a black and white photograph of a naked man lying on his stomach), to semi-explicit (one poster was a comic-style graphic depicting a naked head and torso, with drops of semen on his stomach), to explicit (one poster included the photo of an erect penis wrapped in a condom, and one poster showed two leathermen having anal sex). The HIV-prevention advertisement shown addressed SEM directly and included images of men having sex. Participants were asked to comment on each image and the message in each advertisement, and to share whether they liked them or not, and why.
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Data Analysis Focus group transcripts were analyzed using NVivo 8 (QSR International, 2010). Using social constructivism as the epistemological lens for this analysis, two members of the research team conducted a content analysis. They engaged in an iterative coding process, moving from open codes to concepts and, ultimately, to macro-level themes. Later, one of the two researchers who carried out the content analysis and another member of the team, who had not previously analyzed the data, conducted axial coding. The stratification by SEM preference (bareback vs. condom use) and use (problematic vs. nonproblematic) did not identify any meaningful differences between the groups. Therefore, the 79 participants were treated as one class. The research team validated study findings by seeking alternative explanations and by conducting one peer debriefing with a team of international colleagues experienced in HIV prevention.
RESULTS To ensure anonymity, letters have been used as pseudonyms when quoting participants. Most of the participants could be described as white, gay, and HIV-negative men who were between the ages of 18 and 44 years old (Table 1). All participants’ quotations are reported verbatim. Participants’ preferences, both in relation to images and text used in the advertisements, were varied. Nevertheless, through axial coding, we identified three clear macro-level themes: audience, location, and community representation. We also observed a common thread across these comments, which seem to illustrate the influence of homonormativity (Duggan, 2002) on the opinions expressed by our sample. This thread is addressed in the discussion section.
Audience We grouped under the theme of audience those comments that addressed the impact of the images and messages on the perceived audience. Participants had a strong preference for language that was simple and direct, as illustrated by the following quotes: Directly to the point no bullshit (L.) Simple is good (R.)
In fact, when direct and simple language was coupled with direct and simple graphics, as in the case of the condoms/semaphore poster, the preference was even stronger. A participant wrote: “shows the condoms, and everyone
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SEM in HIV Prevention TABLE 1 Participant characteristics (N = 79)
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Variables Age 18–24 25–44 45+ Race Asian Black White Other Ethnicity Hispanic Non-Hispanic Sexual identity Gay Bisexual Queer Not sure HIV status HIV+ HIV– HIV unsure Refuse to answer
n
%
33 34 12
41.8% 43.0% 15.2%
7 6 59 7
8.9% 7.6% 74.7% 8.9%
9 70
11.4% 88.6%
65 8 3 3
82.3% 10.1% 3.8% 3.8%
9 55 14 1
11.4% 69.6% 17.7% 1.3%
knows traffic lights and helmets are trusted safety icons” (O.). This statement met everyone’s agreement, even though one participant added: “tho (sic), I think that hot nudeish guys wearing the helmets might make it stick a bit more, hahaha” (Y.). The preference for nudity expressed by this participant contrasted with another participant’s more popular opinion about the same advertisement: “simple without putting SEX in your face” (Z.). This tension, between participants who preferred sexually explicit images and those who did not, emerged in all 13 focus groups. Overall, most participants appeared to prefer the non–sexually explicit posters. There were several themes or explanations given why some participants found the more explicit posters problematic. First, several participants commented that the more explicit advertisements were making them think more about sex, and that the safer-sex message would be lost. This opinion seems evident in the following quotes: In the bar you would see sex, think sex, look for sex, ignore message. (T.) If you are promoting safe sex . . .might turn too many people on . . .they might not even remember the message and focus on the erection. (B.)
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To me it just makes me want to have random sex with this guy; safe or not, HIV prevention shouldn’t be trying to get us to hook up more than we already do. (D.)
The participants who expressed these views seem to be not only commenting on their own reaction but also thinking about the larger intended audience, as is well illustrated by the last quote in particular. Several participants’ comments focused on how the explicit nature of some of the advertisements might portray the community or, indeed, how it might reflect on them. One participant strongly felt that the images of the erect penis or two guys having sex were “playing to the lowest common denominator” (F.). Another reacted, “I would not want to be seen looking at this ad” (J.). They highlighted how the setting in which the poster is viewed is an important factor in assessing the acceptability of sexually explicit prevention messages.
Location There was wide agreement across all strata that acceptability of sexually explicit HIV prevention materials is location-specific. Most participants felt that a public context was inappropriate for sexually explicit materials. For example, “I’ll watch porn on my own time, I don’t want it thrown into my face with advertisements” (H.). This seemed to be congruent with the tension between wanting a message that was eye-catching but not necessarily sexually arousing, as one participant stated: “Getting someone horny will not make them wake up to the idea of wanting to be safe” (K.). However, other participants felt that in gay establishments, such as bars and bathhouses, the more explicit images would be appropriate, and would be potentially effective in engaging the audience, as shown in the following quotes: At the gay bar it would be very fine. (V.) The helmet ad is fine in any publication whereas the hard cock one would be acceptable in a gay bar. (I.) Good again for a bathhouse. (N.) Hot, but you couldn’t only put it in certain bars. (X.).
One participant opined that sexually explicit messages are needed to compete with an already sexually charged environment: “I think you need to be a lot more explicit in a bar, because most likely you’ll be fighting for attention with a stripper, or your next hook up, plus not to mention the alcohol” (C.). This dichotomy between gay and public spaces was widely discussed by participants in all focus groups. As one participant noted, “I would only want to see nudity within certain contexts” (P.). Other participants also stated how the more metaphorical image of the condoms/semaphore poster might be
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more appealing to the general public as well as more acceptable in a range of locations, as illustrated in the quotes below: Gets the point across and is able to be shown in a place where ppl (sic) can see in public. (O.)
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Can be placed anywhere. (S.)
The contrast between those images that were considered acceptable in mainstream public contexts and those deemed acceptable only in gay venues is visible in this participant’s comment on the poster depicting two guys having sex: “yea, thats a very gay specific add (sic)” (G.). The latter statement illustrates how the intersection between audience and location was also crucial to participants. That is, participants often had a preference for gay-specific advertisements and images in bars and bathhouses, whereas less explicit messages were deemed to be more suited to places more accessible by the general public.
Community Representation Although most participants agreed that the message, and not the sexual explicitness, was the most important consideration for HIV-prevention posters, a minority reported a strong preference for sexually explicit posters, such as the image of the erected penis wrapped in a condom. Others disagreed, stating they did not want to have “a dick in my face” (S.). Hence, we found diversity of reaction to sexual explicitness. The participants who commented positively on this particular poster advertisement stated: It is a sexy cock, and the condom is clear where that it remains sexy even wrapped. (U.) It’s nice to look at and it gets to the point! (M.)
In similar ways, different opinions were expressed around what was felt to be representative of the community, especially on a visual level. This illustrated the complexity of deciding what is acceptable in HIV prevention in relation to SEM, since a crucial issue seemed to be representation of the gay community. Several comments expressed the importance of visual representations. For example, when discussing the poster of the two leathermen having sex, some participants felt that was not appropriate, since it was perceived as applicable only to a specific group within the larger gay community, as illustrated in the following quotes: Much clearer. But does nothing for me. The guys aren’t that hot to me, and leather is not my scene. (A.)
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I think for the guys out there who are into leather and that scene this is a pretty good ad, for me I wouldn’t really look since it’s not the type of guys I’m into. (Q.)
Other participants, though, felt not only that this advertisement was not relevant but also that it portrayed gay sex as “deviant,” as illustrated in these quotes: Nice try but makes sex look bad/deviant in some ways to me; it makes gay men look like we are all pigs. (W.)
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This isn’t my community. (L.)
The issue of who can represent the community surfaced also in the comments about the video shown, in which participants commented on whether a drag queen was a suitable spokesperson for safer sex, as shown in the quotes below: Drag queens don’t do anything for me and I don’t need one yelling at me. (X.) No offense to drag queens, but are they a credible source? (F.) I kind of don’t like how the gay community and drag is always connected so I agree with you guys on that. The message is okay though. (C.) It is a very serious topic and seeing a guy dressed in drag—it’s very implausible to take that so seriously. (R.)
Again, a few participants had positive reactions, and one self-identified as a drag queen himself. Overall, most participants felt that the content would be more effective if delivered by a “hot guy,” despite the earlier statements that this would detract from the message in the posters shown. This popular opinion is summarized in this participant’s comment: “if it was a hot naked guy telling me that I would think different” (T.).
DISCUSSION Despite the diverse range of opinions expressed by the focus group participants, it seems clear that the themes of audience, location, and community representation are worth considering when identifying which level of sexual explicitness is acceptable to MSM in HIV prevention campaigns. Most participants thought that the more sexually explicit advertisements were appropriate for gay environments. In mainstream environments, those same advertisements appeared to be far less
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acceptable. Furthermore, in those contexts, participants expressed concerns about how those images might depict MSM as sex-obsessed. Participants wanted attention to be paid to who represents whom in the community. While many wanted images of men they find attractive, most had negative reactions to some of the images. This suggests that a one-image-fits-all is not possible, and that images and language need to be tailored to specific communities within the larger MSM community (e.g., leathermen, drag). The thread emerging from the majority of the participants’ comments seems consistent with the sociocultural construct of homonormativity. Participants seem to display, first of all, a strong sensitivity for public visibility. Consistent with Hooper et al.’s (2008) quantitative findings, SEM is deemed suitable and appropriate for personal use, or within gay-specific venues and sexually charged environments, but it is not deemed appropriate for public consumption. This seems in line with the current public discourse of the “good gay citizen” (Bell & Binnie, 2000), who cannot be seen as a public consumer of SEM. Normativity, whether heterosexual or homosexual, requires sex to be kept strictly within the confines of personal spaces and venues dedicated to this purpose (e.g., bathhouses for the gay community, strip clubs for the heterosexual community). Furthermore, many participants’ comments indicate they associated SEM in HIV prevention with promiscuity and kinky sex, behaviors that are seen as counter to homonormativity. Following this desire to be seen as viable citizens, many participants also displayed a discomfort with the association of drag, which is a nonconforming performance of gender, and the gay community. The language used by the vast majority of our participants seemed, therefore, to follow the current, dominant homonormative discourse within U.S. mainstream culture. Besides political and activist contexts, this can best be seen in popular cultural representation, such as the character of Max in ABC’s show Happy Endings and the characters of Cam and Mitchell in another ABC show, Modern Family. The former is a straight-appearing and straight-acting “dude” who just happens “to sleep with dudes,” and the latter are a monogamous, child-adopting couple who are never seen to be sexual, besides sharing a bed and an occasional, chaste kiss on the lips. All these characters also seem to be White, middle-class, and definitely not a threat to heteronormative values. In contrast, the poster and video advertisements presented to our participants included images and characters that used to be seen as belonging within gay culture, such as male nudity, leathermen, sexual openness, and drag queens. Within an increasingly homonormative gay culture, these seem to be ultimately less acceptable, credible, or even desirable representations of MSM communities.
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Limitations and Future Research Our findings must be read within the context of limitations inherent in our study. This study took place entirely online, with a relatively small, homogenous sample of White, younger, gay men living in the United States. It also took place via text-based synchronous and asynchronous discussions. This limited our data to written text and did not give us access to audio or visual participants’ reactions. The questions asked were placed within a broader focus group on SEM use, and the researchers had limited time to ask follow-up questions and to delve deeper into the participants’ sociocultural constructs. The poster advertisements and the video shown presented only some images and language commonly used in HIV-prevention messaging, and it was not exhaustive of all possible approaches. We did not collect enough information on the participants’ sexual practices to know whether they were the right audience to evaluate the HIV-prevention materials presented. Responses might have differed if the HIVprevention images were matched to the participants’ identities, sexual practices, and preferences, which are broad within the larger MSM population. The participants’ expressions of homonormativity could be a byproduct of the chosen research methodology of focus groups. It is possible that bringing together groups of MSM to discuss their views on SEM might enhance the potential for groupthink, especially around demand characteristics—that is, the desire to fit the perceived scope of the study. Since this was a study focused on HIV and SEM, it is reasonable to hypothesize that participants might have felt that they were expected to be critical of SEM, especially in a group setting, and to adhere to prevalent, normative thinking. In hindsight, we believe that individual interviews might have elicited more positive accounts of SEM, and we would recommend this method for future research on this topic. Further research could explore and identify the sociocultural and psychological constructs underlining the current beliefs held by MSM about sex, community, and HIV, including the potential impact of homonormative discourses on younger MSM. More research is needed on what is acceptable in online and offline environments frequented by both gay/ bisexual/queer and heterosexual audiences. Studies to explore the potential use of SEM in HIV prevention in gay/bisexual/queer exclusive spaces as well as in communal spaces would contribute to our current, limited knowledge on these issues.
CONCLUSIONS Sexually explicit messages have the potential to engage the audience in sexually charged offline and online environments, as well as having the advantage of visually depicting the desired safer sexual behaviors. Existing and emerging normative discourses about the identities and sexual scripts of MSM should be
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considered when using SEM to develop HIV-prevention messages. The landscape in which HIV-prevention messages emerge is not neutral or simple. Psychological and sociocultural constructs have shaped 30 years of HIV-prevention messages that have, in turn, shaped gay, bi, trans, and mainstream communities. HIV researchers and educators attending to the manifestation of homonormativity in audience, location, and community representation will produce more acceptable and effective HIV-prevention messages.
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FUNDING The Sexually Explicit Media (SEM) study was funded by the National Institute of Mental Health Center for Mental Health Research on AIDS, grant number R01MH087231. All research was carried out with the approval of the University of Minnesota Institutional Review Board, study number 0906S68801.
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Lucas, M. (2006). On gay porn. Yale Journal of Law and Feminism, 18, 299–302. Martin, J. I. (2006). Transcendence among gay men: Implications for HIV prevention. Sexualities, 9, 214–235. doi:10.1177/1363460706058398 Morrison, T. (2004). “He was treating me like trash, and I was loving it . . .”: Perspectives on gay male pornography. Journal of Homosexuality, 47(3–4), 167–183. doi:10.1300/J082v47n03_09 Morrison, T. G., Morrison, M., & Bradley, B. (2007). Correlates of gay men’s self-reported exposure to pornography. International Journal of Sexual Health, 19(2), 33–43. doi:10.1300/J514v19n02_03 Nast, H. J. (2002). Queer patriarchies, queer racisms, international. Antipode, 34, 874–909. doi:10.1111/1467-8330.00281 Palmer, N. B. (2004). “Let’s talk about sex, baby”: Community-based HIV Prevention work and the problem of sex. Archives of Sexual Behavior, 33, 271–275. doi:10.1023/B:ASEB.0000026626.88454.43 Puar, J. K. (2006). Mapping U.S. homonormativities. Gender, Place & Culture, 13, 67–88. doi:10.1080/09663690500531014 QSR International. (2010). NVivo (version 9). Cambridge, MA: Author. Quantcast Corporation. (n.d.). Gay Ad Network. Retrieved from http://www.quant cast.com Rosser, B. R. S., Grey, J. A., Wilkerson, J. M., Iantaffi, A., Brady, S. S., Smolenski, D. J., & Horvath, K. J. (2012). A commentary on the role of sexually explicit media (SEM) in the transmission and prevention of HIV among men who have sex with men (MSM). AIDS and Behavior, 16, 1373–1381. doi:10.1007/s10461-012-0135-z Rotheram-Borus, M. J., Swendeman, D., Flannery, D., Rice, E., Adamson, D. M., & Ingram, B. (2009). Common factors in effective HIV prevention programs. AIDS and Behavior, 13, 399–408. doi:10.1007/s10461-008-9464-3 Rubin, G. (1984). Thinking sex: Notes for a radical theory of the politics of sexuality. In C. S. Vance (Ed.), Pleasure and danger: Exploring female sexuality (pp. 267–319). Boston, MA: Routledge. Traeen, B., Nilsen, S., & Stigum, H. (2006). Use of pornography in traditional media and on the Internet in Norway. Journal of Sex Research, 43, 245–254. doi:10.1080/00224490609552323 Traeen, B., Spitznogle, K., & Beverfjord, A. (2004). Attitudes and use of pornography in the Norwegian population 2002. Journal of Sex Research, 41, 193–200. doi:10.1080/00224490409552227 Wilson, B. D. M., & Miller, R. L. (2003). Examining strategies for culturally grounded HIV prevention: A review. AIDS Education and Prevention, 15, 184–202. doi:10.1521/aeap.15.3.184.23838
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Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men a
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To cite this article: Alex Iantaffi PhD, J. Michael Wilkerson PhD, Jeremy A. Grey PhD & B. R. Simon Rosser PhD (2015): Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men, Journal of Homosexuality, DOI: 10.1080/00918369.2015.1060066 To link to this article: http://dx.doi.org/10.1080/00918369.2015.1060066
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Acceptability of Sexually Explicit Images in HIV Prevention Messages Targeting Men Who Have Sex With Men ALEX IANTAFFI, PhD Downloaded by [Yale School of Medicine] at 12:51 22 July 2015
Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
J. MICHAEL WILKERSON, PhD Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
JEREMY A. GREY, PhD School of Public Health, Emory University, Atlanta, Georgia, USA
B. R. SIMON ROSSER, PhD Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
Sexually explicit media (SEM) have been used in HIV-prevention advertisements to engage men who have sex with men (MSM) and to communicate content. These advertisements exist within larger discourses, including a dominant heteronormative culture and a growing homonormative culture. Cognizant of these hegemonic cultures, this analysis examined the acceptable level of sexual explicitness in prevention advertisements. Seventy-nine MSM participated in 13 online focus groups, which were part of a larger study of SEM. Three macro themes—audience, location, and community representation—emerged from the analysis, as did the influence of homonormativity on the acceptability of SEM in HIV-prevention messages.
Address correspondence to Alex Iantaffi, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 180, Minneapolis, MN 55454, USA. E-mail: [email protected] 1
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KEYWORDS gay men, HIV prevention, pornography, sex education, sexually explicit media, social marketing, homonormativity
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INTRODUCTION HIV-prevention messages developed for men who have sex with men (MSM), while not targeting heterosexuals, are not immune to the predominance of heteronormative discourse within U.S. culture. Even the most basic prevention messages—for example, “wear a condom”; “get tested”; or “discuss your HIV status with potential partners”—are influenced by a range of complex psychological, economic, and sociocultural constructs, including individual and communal identities, psychological and socioeconomic factors (Rotheram-Borus et al., 2009), and mode of delivery (e.g., offline vs. online). Heteronormative mainstream culture considers gay/bisexual/queer identities, relationships, and behaviors to be outside the bounds of citizenship to some degree, as evidenced by the current debate about marriage equality (Herdt & Kertzner, 2006). Gay men have responded by creating a mainstream gay movement that can be differentiated from the sexual liberation and gay rights movements of the 1960s and 1970s. This phenomenon has been labeled by Duggan (2002) as “the new homonormativity” (p. 175) and by Bell and Binnie (2000) as the “good gay citizen” narrative (p. 30). This narrative rewards subscription to the same principles underlining heteronormativity, such as gender conformity, by privileging hegemonic masculinity, Whiteness, consumerism, monogamy, and HIV-negative status (Duggan, 2002; Nast, 2002; Puar, 2006). Though similar to the heteronormative script in many ways, the new homonormative script distinguishes itself by still allowing for freer sexual expression within certain contexts. One of the acceptable contexts for sexual expression appears to be the consumption of pornography, also described in the literature as sexually explicit media (SEM) (Rosser et al., 2012). However, both hetero- and homonormative discourse consider sex to be the realm of private rather than public discourse. Unlike Rubin’s (1984) and Califia’s (2002) analysis of sex in relation to power, rooted in feminist and queer liberation discourses, homonormative discourses seek to contain SEM within the realm of the apolitical, private sphere, in order to reinforce the “good gay citizen” narrative. Within this framework, SEM is seen as a private pursuit—that is, gay men might watch porn, but they do so in private, just as most heterosexual men do. This is further reinforced in the United States by a longstanding, puritanical, sex-phobic overculture, to which sexual minorities are not immune (Aurand & Wood, 2011). Nevertheless, SEM is ubiquitous in gay male culture (Morrison, Morrison, & Bradley, 2007), and producers of gay SEM claim its role in validating
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homosexuality—as an outlet for desire and exploration and for strengthening community (Lucas, 2006). Researchers have similarly found a role for SEM in young MSM’s sexual development. SEM provided younger MSM with information about same-gendered sexual behavior (Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010, 2011) and often confirmed sexual attraction and desire (Morrison, 2004). The prevalence of SEM within gay male culture creates opportunities for HIV prevention. Erotic and sexually explicit images and language have historically been used in HIV prevention to both engage the desired audience and to communicate content (Palmer, 2004). As discussed earlier, sexually explicit media (SEM) are ubiquitous in many gay spaces (Martin, 2006; Morrison et al., 2007), are widely accessed by the majority of MSM (Hald & Malamuth, 2008; Traeen, Nilsen, & Stigum, 2006; Traeen, Spitznogle, & Beverfjord, 2004), and are also highly acceptable (Hooper, Rosser, Horvath, Oakes, & Danilenko, 2008). Previous studies have already argued for attention to be paid to a range of psychological and sociocultural constructs, such as cultural scripts, in HIV prevention and interventions (Wilson & Miller, 2003). In this study (Wilson & Miller, 2003), culture was “defined as ‘the way of life’ among members of a group, including the values, beliefs, norms and traditions that might influence some people to put themselves at risk for HIV transmission” (p. 185). However, we do not have enough information about the influence of the homonormative gay movement on the use of SEM in HIVprevention advertisements, especially from the 1990s onward, nor do we have a good understanding of the contextual factors contributing to the perceived acceptability of SEM in prevention advertisements. Thus understanding how to use SEM effectively in HIV-prevention messages deserves further attention. As part of a wider qualitative study examining SEM use by U.S. MSM, we sought to identify what level of sexual explicitness in HIV-prevention messages might be acceptable to this population and the reasons for those preferences. The research questions that guided this analysis were 1. What level of sexual explicitness is acceptable to MSM in HIV-prevention messages? 2. Which sociocultural constructs influence MSM’s opinions of what level of sexual explicitness is acceptable in HIV-prevention messages?
METHODS The Sexually Explicit Media (SEM) study is an NIH-funded study exploring how the use of SEM by MSM might influence sexual behavior. For the purpose of this study, SEM was defined as any kind of material aimed at creating or enhancing sexual feeling or thoughts in the recipient and (1) containing
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explicit exposure or depictions of the genitals and (2) clear and explicit sexual acts (e.g., vaginal intercourse, anal intercourse, oral sex, masturbation, bondage) (Hald & Malamuth, 2008). For the formative portion of this study, 13 focus groups were carried out online. Participants were recruited over a 2-week period in January 2010 using banner advertisements on 148 gay Web sites affiliated with the Gay Ad Network (Quantcast Corporation, n.d.). Banner advertisements directed interested persons to a Web page hosted on a dedicated university server with appropriate encryption to ensure data security. The Web page included information about the study procedures and a link to the eligibility screener. A total of 448,472 banner impressions were displayed, with a click-through rate of 0.3% (N = 1410). Of these, 227 men met the eligibility criteria: being a male, age 18 years or older, having had sex with another man in the 90 days prior to study enrollment, living in the United States, and, on average, having viewed SEM at least weekly. To ensure we collected a diverse range of experience, focus groups were stratified according to SEM preference and use, as described below in the section on procedures. Based on availability and stratification, 139 MSM were invited to take part in the study, and 79 of those logged in at their scheduled time and participated in an online synchronous focus group. No one dropped out of a focus group after logging into the system. The 13 focus groups took place from mid-January to mid-March 2010. All study protocols and procedures were reviewed and approved by the Institutional Review Board (IRB) at the University of Minnesota.
Procedures This Internet-based study involved online synchronous focus groups, combined with an asynchronous, bulletin board follow-up. The synchronous focus groups were conducted using Adobe Connect and included viewing of visual materials and text-based discussions through a “chat” function. No audio or video functions were used in the synchronous focus groups to maximize participants’ confidentiality. After consenting to be in the study, participants were asked if they preferred watching SEM in which the models used condoms for anal sex (safer-sex SEM) or not (bareback SEM). To examine the self-perception of SEM use, we asked participants two questions aimed at determining if their SEM use was problematic to them: “Has your use of porn ever caused you to feel distress? (yes/no/unsure/refuse to answer)” and “Has your porn use ever gotten in the way of doing things socially, at work, or in another important area of your life? (yes/no/unsure/refuse to answer).” Participants were then assigned to one of four categories: nonproblematic bareback SEM consumers, problematic bareback SEM consumers, nonproblematic safer-sex SEM consumers, or problematic safer-sex SEM consumers.
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Each category had three online synchronous focus groups with the exception of the nonproblematic bareback category, which had four focus groups to compensate for low attendance in one of the previous groups. Each focus group lasted approximately 1.5 hours. In order to ensure anonymity within focus groups, participants were asked to create a handle for the study that was not associated with their usual online profiles on either social media or sex-seeking Web sites. Three members of the research team facilitated each synchronous focus group using a semistructured interview guide focused on SEM consumption, preferences, and viewing habits, as well as sexual behaviors. One member of the research team served as primary facilitator, posing questions and prompts. A second member of the research team was a cofacilitator, uploading questions, and a third member of the research team provided technical support, saving transcripts and tracking participant engagement. After each synchronous focus group, the research team reviewed the transcript and identified up to five follow-up questions, which were used to clarify comments made during the focus group and to generate discussion during the asynchronous focus group. Within 24 hours after the conclusion of the synchronous focus group, participants were invited to respond to follow-up questions about issues raised during their synchronous group discussion through an asynchronous message board. Participants had 48 hours to respond to questions and comments posted on the message board. Participants were compensated $50 for participating in the synchronous focus group and an additional $5 for participating in the asynchronous focus group.
Measures We asked participants which sexually explicit images used in HIV-prevention messages they found acceptable and why. Participants were shown five deidentified HIV-prevention poster advertisements and one HIV-prevention video advertisement. The images in the posters were selected to range from not explicit (one had three motorbike helmets and three condoms in semaphore colors; one poster had a black and white photograph of a naked man lying on his stomach), to semi-explicit (one poster was a comic-style graphic depicting a naked head and torso, with drops of semen on his stomach), to explicit (one poster included the photo of an erect penis wrapped in a condom, and one poster showed two leathermen having anal sex). The HIV-prevention advertisement shown addressed SEM directly and included images of men having sex. Participants were asked to comment on each image and the message in each advertisement, and to share whether they liked them or not, and why.
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Data Analysis Focus group transcripts were analyzed using NVivo 8 (QSR International, 2010). Using social constructivism as the epistemological lens for this analysis, two members of the research team conducted a content analysis. They engaged in an iterative coding process, moving from open codes to concepts and, ultimately, to macro-level themes. Later, one of the two researchers who carried out the content analysis and another member of the team, who had not previously analyzed the data, conducted axial coding. The stratification by SEM preference (bareback vs. condom use) and use (problematic vs. nonproblematic) did not identify any meaningful differences between the groups. Therefore, the 79 participants were treated as one class. The research team validated study findings by seeking alternative explanations and by conducting one peer debriefing with a team of international colleagues experienced in HIV prevention.
RESULTS To ensure anonymity, letters have been used as pseudonyms when quoting participants. Most of the participants could be described as white, gay, and HIV-negative men who were between the ages of 18 and 44 years old (Table 1). All participants’ quotations are reported verbatim. Participants’ preferences, both in relation to images and text used in the advertisements, were varied. Nevertheless, through axial coding, we identified three clear macro-level themes: audience, location, and community representation. We also observed a common thread across these comments, which seem to illustrate the influence of homonormativity (Duggan, 2002) on the opinions expressed by our sample. This thread is addressed in the discussion section.
Audience We grouped under the theme of audience those comments that addressed the impact of the images and messages on the perceived audience. Participants had a strong preference for language that was simple and direct, as illustrated by the following quotes: Directly to the point no bullshit (L.) Simple is good (R.)
In fact, when direct and simple language was coupled with direct and simple graphics, as in the case of the condoms/semaphore poster, the preference was even stronger. A participant wrote: “shows the condoms, and everyone
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SEM in HIV Prevention TABLE 1 Participant characteristics (N = 79)
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Variables Age 18–24 25–44 45+ Race Asian Black White Other Ethnicity Hispanic Non-Hispanic Sexual identity Gay Bisexual Queer Not sure HIV status HIV+ HIV– HIV unsure Refuse to answer
n
%
33 34 12
41.8% 43.0% 15.2%
7 6 59 7
8.9% 7.6% 74.7% 8.9%
9 70
11.4% 88.6%
65 8 3 3
82.3% 10.1% 3.8% 3.8%
9 55 14 1
11.4% 69.6% 17.7% 1.3%
knows traffic lights and helmets are trusted safety icons” (O.). This statement met everyone’s agreement, even though one participant added: “tho (sic), I think that hot nudeish guys wearing the helmets might make it stick a bit more, hahaha” (Y.). The preference for nudity expressed by this participant contrasted with another participant’s more popular opinion about the same advertisement: “simple without putting SEX in your face” (Z.). This tension, between participants who preferred sexually explicit images and those who did not, emerged in all 13 focus groups. Overall, most participants appeared to prefer the non–sexually explicit posters. There were several themes or explanations given why some participants found the more explicit posters problematic. First, several participants commented that the more explicit advertisements were making them think more about sex, and that the safer-sex message would be lost. This opinion seems evident in the following quotes: In the bar you would see sex, think sex, look for sex, ignore message. (T.) If you are promoting safe sex . . .might turn too many people on . . .they might not even remember the message and focus on the erection. (B.)
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To me it just makes me want to have random sex with this guy; safe or not, HIV prevention shouldn’t be trying to get us to hook up more than we already do. (D.)
The participants who expressed these views seem to be not only commenting on their own reaction but also thinking about the larger intended audience, as is well illustrated by the last quote in particular. Several participants’ comments focused on how the explicit nature of some of the advertisements might portray the community or, indeed, how it might reflect on them. One participant strongly felt that the images of the erect penis or two guys having sex were “playing to the lowest common denominator” (F.). Another reacted, “I would not want to be seen looking at this ad” (J.). They highlighted how the setting in which the poster is viewed is an important factor in assessing the acceptability of sexually explicit prevention messages.
Location There was wide agreement across all strata that acceptability of sexually explicit HIV prevention materials is location-specific. Most participants felt that a public context was inappropriate for sexually explicit materials. For example, “I’ll watch porn on my own time, I don’t want it thrown into my face with advertisements” (H.). This seemed to be congruent with the tension between wanting a message that was eye-catching but not necessarily sexually arousing, as one participant stated: “Getting someone horny will not make them wake up to the idea of wanting to be safe” (K.). However, other participants felt that in gay establishments, such as bars and bathhouses, the more explicit images would be appropriate, and would be potentially effective in engaging the audience, as shown in the following quotes: At the gay bar it would be very fine. (V.) The helmet ad is fine in any publication whereas the hard cock one would be acceptable in a gay bar. (I.) Good again for a bathhouse. (N.) Hot, but you couldn’t only put it in certain bars. (X.).
One participant opined that sexually explicit messages are needed to compete with an already sexually charged environment: “I think you need to be a lot more explicit in a bar, because most likely you’ll be fighting for attention with a stripper, or your next hook up, plus not to mention the alcohol” (C.). This dichotomy between gay and public spaces was widely discussed by participants in all focus groups. As one participant noted, “I would only want to see nudity within certain contexts” (P.). Other participants also stated how the more metaphorical image of the condoms/semaphore poster might be
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more appealing to the general public as well as more acceptable in a range of locations, as illustrated in the quotes below: Gets the point across and is able to be shown in a place where ppl (sic) can see in public. (O.)
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Can be placed anywhere. (S.)
The contrast between those images that were considered acceptable in mainstream public contexts and those deemed acceptable only in gay venues is visible in this participant’s comment on the poster depicting two guys having sex: “yea, thats a very gay specific add (sic)” (G.). The latter statement illustrates how the intersection between audience and location was also crucial to participants. That is, participants often had a preference for gay-specific advertisements and images in bars and bathhouses, whereas less explicit messages were deemed to be more suited to places more accessible by the general public.
Community Representation Although most participants agreed that the message, and not the sexual explicitness, was the most important consideration for HIV-prevention posters, a minority reported a strong preference for sexually explicit posters, such as the image of the erected penis wrapped in a condom. Others disagreed, stating they did not want to have “a dick in my face” (S.). Hence, we found diversity of reaction to sexual explicitness. The participants who commented positively on this particular poster advertisement stated: It is a sexy cock, and the condom is clear where that it remains sexy even wrapped. (U.) It’s nice to look at and it gets to the point! (M.)
In similar ways, different opinions were expressed around what was felt to be representative of the community, especially on a visual level. This illustrated the complexity of deciding what is acceptable in HIV prevention in relation to SEM, since a crucial issue seemed to be representation of the gay community. Several comments expressed the importance of visual representations. For example, when discussing the poster of the two leathermen having sex, some participants felt that was not appropriate, since it was perceived as applicable only to a specific group within the larger gay community, as illustrated in the following quotes: Much clearer. But does nothing for me. The guys aren’t that hot to me, and leather is not my scene. (A.)
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I think for the guys out there who are into leather and that scene this is a pretty good ad, for me I wouldn’t really look since it’s not the type of guys I’m into. (Q.)
Other participants, though, felt not only that this advertisement was not relevant but also that it portrayed gay sex as “deviant,” as illustrated in these quotes: Nice try but makes sex look bad/deviant in some ways to me; it makes gay men look like we are all pigs. (W.)
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This isn’t my community. (L.)
The issue of who can represent the community surfaced also in the comments about the video shown, in which participants commented on whether a drag queen was a suitable spokesperson for safer sex, as shown in the quotes below: Drag queens don’t do anything for me and I don’t need one yelling at me. (X.) No offense to drag queens, but are they a credible source? (F.) I kind of don’t like how the gay community and drag is always connected so I agree with you guys on that. The message is okay though. (C.) It is a very serious topic and seeing a guy dressed in drag—it’s very implausible to take that so seriously. (R.)
Again, a few participants had positive reactions, and one self-identified as a drag queen himself. Overall, most participants felt that the content would be more effective if delivered by a “hot guy,” despite the earlier statements that this would detract from the message in the posters shown. This popular opinion is summarized in this participant’s comment: “if it was a hot naked guy telling me that I would think different” (T.).
DISCUSSION Despite the diverse range of opinions expressed by the focus group participants, it seems clear that the themes of audience, location, and community representation are worth considering when identifying which level of sexual explicitness is acceptable to MSM in HIV prevention campaigns. Most participants thought that the more sexually explicit advertisements were appropriate for gay environments. In mainstream environments, those same advertisements appeared to be far less
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acceptable. Furthermore, in those contexts, participants expressed concerns about how those images might depict MSM as sex-obsessed. Participants wanted attention to be paid to who represents whom in the community. While many wanted images of men they find attractive, most had negative reactions to some of the images. This suggests that a one-image-fits-all is not possible, and that images and language need to be tailored to specific communities within the larger MSM community (e.g., leathermen, drag). The thread emerging from the majority of the participants’ comments seems consistent with the sociocultural construct of homonormativity. Participants seem to display, first of all, a strong sensitivity for public visibility. Consistent with Hooper et al.’s (2008) quantitative findings, SEM is deemed suitable and appropriate for personal use, or within gay-specific venues and sexually charged environments, but it is not deemed appropriate for public consumption. This seems in line with the current public discourse of the “good gay citizen” (Bell & Binnie, 2000), who cannot be seen as a public consumer of SEM. Normativity, whether heterosexual or homosexual, requires sex to be kept strictly within the confines of personal spaces and venues dedicated to this purpose (e.g., bathhouses for the gay community, strip clubs for the heterosexual community). Furthermore, many participants’ comments indicate they associated SEM in HIV prevention with promiscuity and kinky sex, behaviors that are seen as counter to homonormativity. Following this desire to be seen as viable citizens, many participants also displayed a discomfort with the association of drag, which is a nonconforming performance of gender, and the gay community. The language used by the vast majority of our participants seemed, therefore, to follow the current, dominant homonormative discourse within U.S. mainstream culture. Besides political and activist contexts, this can best be seen in popular cultural representation, such as the character of Max in ABC’s show Happy Endings and the characters of Cam and Mitchell in another ABC show, Modern Family. The former is a straight-appearing and straight-acting “dude” who just happens “to sleep with dudes,” and the latter are a monogamous, child-adopting couple who are never seen to be sexual, besides sharing a bed and an occasional, chaste kiss on the lips. All these characters also seem to be White, middle-class, and definitely not a threat to heteronormative values. In contrast, the poster and video advertisements presented to our participants included images and characters that used to be seen as belonging within gay culture, such as male nudity, leathermen, sexual openness, and drag queens. Within an increasingly homonormative gay culture, these seem to be ultimately less acceptable, credible, or even desirable representations of MSM communities.
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Limitations and Future Research Our findings must be read within the context of limitations inherent in our study. This study took place entirely online, with a relatively small, homogenous sample of White, younger, gay men living in the United States. It also took place via text-based synchronous and asynchronous discussions. This limited our data to written text and did not give us access to audio or visual participants’ reactions. The questions asked were placed within a broader focus group on SEM use, and the researchers had limited time to ask follow-up questions and to delve deeper into the participants’ sociocultural constructs. The poster advertisements and the video shown presented only some images and language commonly used in HIV-prevention messaging, and it was not exhaustive of all possible approaches. We did not collect enough information on the participants’ sexual practices to know whether they were the right audience to evaluate the HIV-prevention materials presented. Responses might have differed if the HIVprevention images were matched to the participants’ identities, sexual practices, and preferences, which are broad within the larger MSM population. The participants’ expressions of homonormativity could be a byproduct of the chosen research methodology of focus groups. It is possible that bringing together groups of MSM to discuss their views on SEM might enhance the potential for groupthink, especially around demand characteristics—that is, the desire to fit the perceived scope of the study. Since this was a study focused on HIV and SEM, it is reasonable to hypothesize that participants might have felt that they were expected to be critical of SEM, especially in a group setting, and to adhere to prevalent, normative thinking. In hindsight, we believe that individual interviews might have elicited more positive accounts of SEM, and we would recommend this method for future research on this topic. Further research could explore and identify the sociocultural and psychological constructs underlining the current beliefs held by MSM about sex, community, and HIV, including the potential impact of homonormative discourses on younger MSM. More research is needed on what is acceptable in online and offline environments frequented by both gay/ bisexual/queer and heterosexual audiences. Studies to explore the potential use of SEM in HIV prevention in gay/bisexual/queer exclusive spaces as well as in communal spaces would contribute to our current, limited knowledge on these issues.
CONCLUSIONS Sexually explicit messages have the potential to engage the audience in sexually charged offline and online environments, as well as having the advantage of visually depicting the desired safer sexual behaviors. Existing and emerging normative discourses about the identities and sexual scripts of MSM should be
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considered when using SEM to develop HIV-prevention messages. The landscape in which HIV-prevention messages emerge is not neutral or simple. Psychological and sociocultural constructs have shaped 30 years of HIV-prevention messages that have, in turn, shaped gay, bi, trans, and mainstream communities. HIV researchers and educators attending to the manifestation of homonormativity in audience, location, and community representation will produce more acceptable and effective HIV-prevention messages.
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FUNDING The Sexually Explicit Media (SEM) study was funded by the National Institute of Mental Health Center for Mental Health Research on AIDS, grant number R01MH087231. All research was carried out with the approval of the University of Minnesota Institutional Review Board, study number 0906S68801.
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