561490 research-article2014

JMHXXX10.1177/1557988314561490American Journal of Men’s HealthVerduzco

Article

Barriers to Sexual Expression and Safe Sex Among Mexican Gay Men: A Qualitative Approach

American Journal of Men’s Health 1­–15 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314561490 ajmh.sagepub.com

Ignacio Lozano Verduzco, PhD1

Abstract Same-sex sexual practices among men in Mexico City are stigmatized. This article analyzes sexual practices and experiences of gay men in Mexico City and its implications on emotional and sexual health. The concept of sexual practices is used from a public health perspective, and the concept of sexual experiences from a psychological one, intending to understand both physical and emotional discomfort and pleasure in sexual contexts. The aim of this article is to analyze sexual practices and experiences of gay men in Mexico City and its implications on health, particularly emotions that can lead to depression, anxiety, substance abuse, and unsafe sex. Fifteen in-depth interviews were carried out with gay men of three generations who live in Mexico City. The data were analyzed using techniques from grounded theory to identify categories, and critical discourse analysis as an analytical approach to understand how social discourses affect subjectivity, emotions, and practices. Sexual practices and experiences are the result of homoerotic desire, which gender and heteronormative culture encourage to be kept hidden and clandestine. This leads men into risk contexts where practices are hardly negotiated, thus exposing themselves to sexually transmitted infections and abuse. These practices also produce a series of emotions such as guilt, shame, fear, and sadness that may develop into mental health issues such as depression and anxiety. Interventions at all levels must consider homophobic discrimination as part of gay men’s daily lives and should be oriented toward decreasing it, to diminish discomforting emotions and reduce the probability of unsafe sex practices. Keywords homophobia, safe sex, HIV prevention, masculinities, gay men

Introduction This article analyzes the different social and cultural barriers that gay men who live in Mexico City experience throughout their sexual lives and practices. Hegemonic masculinity and gender culture in the Mexican context are of fundamental importance to this because they establish norms and stereotypes around what it means to be a man regarding sexual activity (Connell, 1995; Díaz-Loving, Rocha, & Rivera, 2007; Núñez, 2000). The hegemonic model of masculinity refers to a culturally specific form of doing gender (West & Zimmerman, 1987) that legitimizes a patriarchic system in which women and femininity are relegated to a subordinate status (Connell, 1995). Connell (1995) also explores other forms of masculinity, such as subordinated masculinity, which refers particularly to homosexual men who are subordinated to hegemony because their erotic desire ruptures the reproductive objectives set by patriarchy. In Mexico, hegemonic masculinity discourages homoeroticism, thus discriminating against this desire (Castañeda, 2007; Connell, 1995; Kimmel, 2009) and

ostracizes its practices to clandestine spaces (List, 2005). Even though men may find freedom in these sexual spaces, they pose a risk to their emotional and physical well-being (Granados & Delgado, 2007). Gender norms and stereotypes regulate sexual expression (Cruz, 2002; Schwartz, 2007), including negotiations for sexual practices that include safe-sex practices, use of power, consent, and sexual abuse. Thus, gender norms and the hegemonic model of masculinity in Mexico can be understood as barriers to not only sexual expression but also to access to safe-sex contexts and practices. One of the biggest health concerns in this regard is HIV infection, because of the costs it implies on the state, and the fact that it remains a chronic disease that, while treatable, is still not curable. 1

Universidad Pedagogica Nacional, Mexico City, Mexico

Corresponding Author: Ignacio Lozano Verduzco, Universidad Pedagogica Nacional, Carretera al Ajusco No. 24 Col. Héroes de Padierna Del. Tlalpan, C.P. 14200, Mexico City, Mexico. Email: [email protected]

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

2

American Journal of Men’s Health

HIV in Mexican Men Who Have Sex With Men (MSM) According to the National Center for the Control and Prevention of HIV and AIDS (CENSIDA, 2011), the HIV epidemic in Mexico is a concentrated one. Even though less than 1% of the population carries the virus, it is mostly concentrated among certain minorities, such as MSM, sex workers, and injecting drug users. According to Bautista, Colchero, Rubí, Martínez, and Conde (2012), 16% of the MSM participants tested positive for HIV, but only 5.4% perceived themselves as HIV positive. According to the same authors and the CENSIDA, the main course of infection for MSM is through unprotected anal sex, and 26% of the participants reported not having used a condom in their last sexual encounter. The HIV and sexual minority status of MSM are elements of discrimination: MSM feel stigma and discrimination because of their HIV status mostly from schoolmates, the police, friends, and family members (Bautista et al., 2012). While most research regarding HIV in Mexico has focused on the risk behaviors such as unprotected anal sex and sharing needles, recent research on the subject of HIV among gay men has focused on the context rather than on the individual behaviors (Braine, van Sluytman, Acker, Friedman, & Des, 2011; Granados-Cosme, TorresCruz, & Delgado-Sánchez, 2009; Ortíz-Hernández & García-Torres, 2005). Three conditions are particularly relevant in these contexts: the knowledge of preventive measures against sexually transmitted infections (STIs), the material access to prevention (such as condoms and their correct use), and the capacity to negotiate sexual practices. HIV prevention is then more complex, where the understanding of both experience and practice is central. These contexts, and men’s sexual behavior, are in part affected by macrostructural elements (such as gender and heteronormativity) that specify social and sexual interaction among people.

Gender Culture and Heteronormativity Rubin (1992) argues that heteronormativity holds that human beings fall into distinct and complementary genders, understood as natural roles, and that heterosexuality is the only sexual orientation. Heteronormative societies encourage heterosexual sex that leads to reproduction, and thus reject and discriminate same-sex sexual encounters (Baile, 2008; Castañeda, 2006; Cruz, 2002). This homophobic discrimination is sustained because there is no homosexual discourse that allows the naming of behaviors, practices, and identities outside of the heterosexual norms (List, 2009). Thus, these

aspects of homoeroticism are cited to a place of femininity (Lozano, 2014). The use of a gender discourse to name homoerotic practices and experiences are also adopted by social institutions such as the family, the school, and other state institutions that can be translated into forms of violence against gay men (Lozano, 2014). For men to be cited into a feminine space means to be brought into subordination to hegemonic masculinity, and lose patriarchal privileges that affect emotions and health (Burin, 2000; Tena, 2007). This citation and naming is important because, as Butler (1992) argues, this temporary citation allows for the existence of a subject that can carry out daily performativities that (re)produce gender norms. Citation and performativity of femininity for a man is what results in homophobic discrimination (Castañeda, 1999; Cruz, 2002). Gayness has been understood as a middle-class, urban concept used by homoerotic men in Mexico (Gutiérrez, 2012; Laguarda, 2009) that helps them build a sense of identity and resignify their sense of masculinity. Men who recognize a homoerotic desire and are socialized in urban spaces where a limited gay discourse is available may understand their desire and consequent sexual practices as part of this identity. At first, this understanding is felt as a threat against their sense of masculinity; gayness implies a renegotiation of masculinity where gay men resignify masculinity and still understand themselves as men (List, 2005). This intersection of elements also may allow for the development of certain emotional discomfort, such as shame, guilt, and fear (Granados & Delgado, 2007) because men understand they are acting and feeling outside of a specific masculine social order (Ahmed, 2010; Butler, 2004). Most health research conducted regarding sexual minorities in Mexico focuses on MSM in general, and few studies focus on self-identified gay men. Even though this latter group may have privileges because of their socioeconomic class, mental and sexual health is still a concern (Granados & Delgado, 2007; Ortíz-Hernández, 2005); the link between the social discourses used to build their identity and health issues will be discussed in this article. The use of the concepts of experience and practice are useful because they reflect the ambiguity and apparent contradictions in the study of masculinity. Mexican masculinity researchers such as Amuchástegui (2006) and Salguero (2012), following the lines of discursive psychology for men’s studies (Wetherell & Edley, 2014), affirm that men’s experiences and practices are a result of said model but, regardless of it, does not neatly reflect on all of the model’s mandates, showing that what these men express verbally usually contradicts their actions (Fernández & Vargas, 2012).

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

3

Verduzco

Experience and Practice The concepts of experience and practices are used in this article to distinguish and unite two views around sexuality and masculinities. The concept of experience is used to refer to the lived phenomenological aspects of men’s narratives that relate to emotions. According to Pérez (n.d.), experience is a concept based on emotions that allows the production of knowledge for the person; the author bases her arguments on Dewey’s philosophy, which argues that experience is interaction with the environment; it is action and feeling that allows the construction of a sense of self, a self that is capable of knowing and of producing knowledge around its realities (Bach, 2010; de Lauretis, 2008; Scott, 1991). The concept of experience is also useful in understanding emotional discomfort and well-being that stem from patriarchy and gender culture. Latin American feminists have explored men’s emotional discomfort as a result of not complying with patriarchal pacts or losing patriarchal privileges and dividends (Burin, 2000; Connell, 1995; Tena, 2007). Focusing on sexual experiences allows for the analysis of felt emotions throughout men’s sexual encounters and how these emotions contributed to making sense of themselves, their realities, and their behaviors in contrast to the hegemonic model of masculinity. Gay men’s emotionality is relevant when feelings are considered basic aspects of certain mental health issues, such as anxiety, depression, and substance use, which have been reported to be common among lesbian, gay, and bisexual groups in Mexico (Granados & Delgado, 2007; Ortíz-Hernández, 2005) and other countries (Baile, 2008; Blashill & Vander Wal, 2010; Carrillo, 2005; Cochran & Mays, 2006; Cole, 2006; Span & Derby, 2009), and are related to gender nonconforming performances of the person (Ortíz-Hernández, 2005; Sandfort, Melendez, & Diaz, 2007). These mental health issues and emotions have also been identified in Mexican men who have lost patriarchal privileges such as losing a job or getting a divorce (Fleiz, Ito, Ramos, & Medina-Mora, 2008; Tena, 2007). In fact, mental health issues and emotions of gay men and other sexual minorities in Mexico have been understudied. Research has focused on HIV (and other STIs) among MSM without analyzing social and subjective conditions that may link these men’s exposure to these STIs (Bautista et al., 2012; Gutiérrez, 2012). Even though the role of emotions in the prevention and treatment of STIs has been present in some studies carried out elsewhere, little is known of the emotional experiences of gay men and their links to sexual practices, particularly in Mexico (Fortenberry et al., 2002; Granados & Delgado, 2007; Gutiérrez, 2012). Literature from the United States has revealed underlying aspects of internalized and cultural homophobia that affect daily lives of gay men,

particularly their partner relationships, emotions (expressed in mental health issues), and sexual practices (Frost, 2011; Frost & Meyer, 2009), thus establishing an important relationship between lived emotions and homophobia. In Mexico, research on these topics is limited (Cruz, 2004; Granados & Delgado, 2007). Public health in Mexico understands risky sexual behavior as one that potentially allows infected bodily fluids to come into contact with body parts through which the infection can penetrate (NOM-253-SSA1-2012). Recent critical studies on HIV and gay men in Mexico have comprehended that focusing on the individual sexual practices may “invisibilize” important aspects that affect the probability of acquiring STIs for this group (Granados-Cosme, Torres-Cruz, & Delgado-Sánchez, 2009; List, 2009). Sexual practices are much more than what people do with their genitals; who, where, and when they use them with; how they meet partners, and how and where the interaction takes place. These are aspects that will allow a more global comprehension of behaviors, feelings, and cognitions that take place before, during, and after sexual encounters. The use of the concept sexual practices may allow for the analysis not only of risky sexual behaviors but also the immersion of gay men into risky contexts that minimize the possibility of sexual negotiation, and thus of unsafe sexual behaviors—including condom use—with their sexual partner (Granados & Delgado, 2007). In this sense, it is important to comprehend risky sexual practices within certain contexts, and the immersion into risky sexual contexts depends on social structures, norms, and interactions that make certain sexual interactions possible rather than on the individual. Thus, gay men’s participation in risk contexts and risk practices are theoretically related to the limitations imposed by hegemonic masculinity, heteronormativity, and homophobia. Because these structures regulate sex between men, gay men seek clandestine spaces where they can engage in sexual activities (List, 2005; Núñez, 2009) with higher probabilities of risky sexual behavior. These sexual contexts are usually dark, hidden, public spaces, such as the subway, public parks, dark street corners, and restaurant restrooms where sexual activity and homosociability take place in secrecy; men know about them from word of mouth, which are also known as “cruising spots” (Castañeda, 2006; Cruz, 2011; List, 2005).

Sexual Practices and Experiences of Gay Men According to Granados and Delgado (2007), these cruising spots are used by MSM to engage in sexual activity, particularly anal sex. An abundance of literature exists around topics of insertive and receptive anal sex among MSM and the risks these roles imply for STIs, particularly HIV, from

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

4

American Journal of Men’s Health

a public health perspective (Bautista et al., 2012), and within the framework of models of hegemonic masculinity. These models promote a dichotomic view of anal sex among men, and only once men are able to question this model, can they access other forms of sexual expression (Gallego, 2010; Johns, Pingel, Eisenberg, Santana, & Bauermeister, 2012). Literature regarding sexual practices between men is limited and refers mostly to anal sex. However, some literature provides information on other sexual practices gay men engage in, such as mutual masturbation and oral sex, and that even for some gay men, the concept of “sex” includes more activities than what is done with their genitals (Gallego, 2010; List, 2005). Even though Mexico City’s legal status of homosexuality has changed in recent years, due to the fact that same-sex marriage and adoption is legal since 2010, a structural change that has had social effects for the visibilization of the lesbian gay bisexual transgender community, homophobia survives in the city and throughout the country (CONAPRED, 2010). Homophobia, particularly against men, is motivated by dichotomist view of sexuality where a gay man is understood as feminine, and thus denying a “given” source of power. This view is enhanced with men who are anally penetrated during sex by virtue of which they adopt a “woman’s role,” and are thus subordinated (Castañeda, 2006; Gallego, 2010). According to Diez (2010), these legal and social changes are mostly due to the National Anti-Homophobia Campaign put in action by the federal government in 2000, which was, in turn, based on a human rights discourse that helped the gay movement gain ground for the acquisition of civil rights. The demand for these rights relate directly to a sociopolitical organization of the gay activist community during and after the HIV epidemic. When the first cases of HIV appeared in Mexico, mass media and health institutions built a homophobic and discriminatory discourse around the virus which considerably slowed down the political and medical process of attending people who carried the virus. This view also further stigmatized gay men as “sick,” “perverse,” and “condemned,” because MSM were the most affected segment of the population (García, Andrade, Maldonado, & Morales, 2009). Activist groups with strong political organization pressured the government to produce public policy and laws to attend the epidemic, but were not able to provide infected men and their partners with legal support in case of their death. So during the 1980s, 1990s, and 2000s, a gay man whose life partner passed away had no legal rights to their properties or to medical decisions (García et al., 2009). With the legalization of same-sex marriage, this is now possible. Legal discussions of same-sex marriage was widely reported in the mass media during 2009 and divided public discourse among the general population: on one hand there were people who accepted the legal

change, and on the other, were more conservative sectors (such as the Catholic Church and the conservative political party PAN [Partido Acción Nacional]) which fought against it (Lozano, 2010). These contextual aspects are important to keep in mind in order to understand the sexual experiences of gay men in Mexico City, since they are impregnated in the social discourse that men are socialized in.

Research Design The results presented in this article stem from a broader project that aimed to analyze the process of building a gay identity and how it relates to emotional experiences. This led the author to discussing historical, political, and social aspects in Mexico City that provided rich information on the contexts in which gay men are situated and socialized in. This entailed the author to situate himself within his own contexts, and understand how they have affected him, also understand himself as part of the contexts of the participants, as well as using his experience and reflexivity throughout the fieldwork and analysis. The interviews are understood as a co-construction of a particular identity narrative, one that was only possible due to the researcher’s presence in relation to the participants’ life stories. As a result of this interpretative emphasis on discourse, discourse analysis was considered to be the best methodological approach. This analysis is described as a method that allows the comprehension of realities as understood by each individual according to their social conditions, thus centering attention on power relations expressed through discourse, how they affect subjectivity (Van Dijk, 2002, 2011), and allows the researcher to understand the fluidity of how masculinity mandates are put into practice in relation to other forms of identity within particular cultural contexts (Wetherell & Edley, 2014). Contexts were central to the data analysis, so great care was given to analyze men’s discourse and to contrast it with available historical literature. The experience of men from different generations is understood as firsthand and privileged information. The interview protocol covered topics such as homophobia, relationships (friendships, family, work, and partners), sexual practices, the body, and health care. This article presents the findings on one of these topics: sexual practices. The research protocol and its ethical guidelines were approved by a peerreview committee.

Aim The main objective in this article was to understand the social barriers to sexual expression and safe-sex practices

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

5

Verduzco Table 1.  Sociodemographic Characteristics of Participants. Participant

Generation: Year of coming out

Age (years)

Occupation

Ramón David ED Dante Alfonso Komadreja Jorge Juan Mario Javier Teo Fernando César Roberto Hernán

G1: 2012 G1: 2008 G1: 2006 G1: 2005 G1: 2011 G2: 2002 G2: 1991 G2: 1995 G2: 1989 G2: 1990 G3: 1971 G3: 1983 G3: 1970 G3: 1976 G3: 1978

20 22 24 24 19 25 51 37 46 40 68 46 60 52 58

Student Student/employee Employee Student Student Student/employee Employee Businessman NGO director Government employee Retired NGO director Teacher Businessman Musician

Studies BA BA BA BA BA BA BA BA MA PhD BA MA BA BA BA

Approximate monthly income (USD) None None 650 650 None 200 3,500 2,900 2,900 2,500 1,700 1,100 550 6,500 No information

Note. USD = United States dollars; NGO = nongovernment organization.

according to the experiences of Mexican gay men, and how these affect sexual and emotional aspects of their discourse.

Participants Interviewees were recruited through nongovernmental organizations in Mexico City that work with lesbian, gay, bisexual and transgender groups and through snowball sampling (Flick, 2004). The sampling was done conveniently with a maximum variability criterion, where the participants were chosen depending on how much they differed from each other in variables such as age, years of education, monthly income, and calendar year of “coming out,” so as to highlight both similarities and differences (Flick, 2004). Fifteen in-depth interviews (Kvale, 2007) were carried out with men who identified themselves as gay and lived in Mexico City. The sample was divided into three generations based on important milestones in the Mexican gay movement, to draw contextual aspects of sexuality into the analysis. The third generation considered men who came out of the closet before 1984—the year in which the first HIV case appeared in Mexico. The second generation considered men who came out between 1984 and 2004—the HIV epidemic generated great political movement in the 1980s, which receded in the mid-1990s and faded away after 2000 because a national antihomophobia campaign was put in action. And the first generation included men who have come out since 2004. (For further information on Mexican gay movement see de la Dehesa, 2010; Diez, 2010; and Laguarda, 2009.) Interviews were carried out

in two sessions per participant and lasted between 120 and 180 minutes each. Participants were guaranteed anonymity and confidentiality through informed consent and debriefing. Table 1 reports the participant’s sociodemographic characteristics.

Analysis All interviews were carried out, audiorecorded, and transcribed verbatim in Spanish; only the extracts presented here have been translated to English. The process of analysis was based on two different perspectives. First, the techniques of immersion and crystallization from Grounded Theory (Strauss & Corbin, 1994) were used, which consist of a coming and going between the qualitative data and the theory and objectives; this allowed the different codes and categories to emerge. Second, the analysis and its interpretation were based on discourse analysis to understand how power dynamics and relationships affect subjectivity (Ibáñez, 2003; Jäger, 2003; Stecher, 2010; Van Dijk, 2011). The categories that emerged from immersion and crystallization, in their intersection with each participant’s life story, helped introduce discourse analysis as a broad perspective, useful to understanding how hegemonic discourses around gender, sexuality, and masculinity interacted with each participant’s life story. A theoretical and interdisciplinary (Janesick, 1998) triangulation was adopted to guarantee validity; the initial interpretations were discussed with other health researchers from the disciplines of sociology, medical anthropology, and social psychology. These discussions enriched the data interpretations and helped continue the dialogue between contexts and subjectivity.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

6

American Journal of Men’s Health

Results The topics addressed throughout the interview allowed for conversations that provided rich narratives of men’s sexual lives, experiences, and their identity as a whole. The processes of immersion and crystallization led to five emerging thematic categories. One of these categories was named sexual practices and experiences. Participants made sense of their sexual practices and experiences based on gender and heterosexual norms and rules. The analysis identifies that these norms and rules are interiorized into subjectivity and become social and personal barriers to sexual expression, particularly to safe sex. In this article, safe sex is understood not only as those behaviors and practices that reduce the probability of the transmission or acquisition of STIs but also practices free of any form of violence, particularly unconsensual sexual practices. In this sense, the category explored here is related to lived experiences and feelings (Pérez, n.d.). The following results are organized in three transversal themes identified from the participant’s discourse: how each participant positioned himself within gender culture, masculinity and heteronormativity, and how this positioning affected his emotional and sexual health. Each theme unites the subject position of the participants with regard to sexual expression and safe sex. These themes gave way to the subcategories presented below.

Sexual Initiation, Sex, and Sexual Spaces Many of the men who were interviewed grew up feeling desire and sexual-affective attraction to other men without them fully understanding what this desire and attraction meant. Their sexual practices and behaviors, in many cases, were lived after the existence of fantasies and intrapsychic sexual scripts (Longmore, 1998; Whittier & Melendez, 2007). Fantasies and desires usually appeared before first sexual experience. I would feel so aroused (laughs). Because, I mean, I wanted to feel, to be with. . . . I don’t know, give a blowjob, touch a dick something like that. (Komadreja, 25 years old, Generation 2, Student) When I was eight years old, I felt I liked girls and boys. I felt a kind of . . . Certain affinity towards boys, I liked boys. . . . It felt nice. (ED, 24 years old, Generation 2, Employee)

However, it was difficult for men to turn those fantasies into actions and practices. Men found physical and affective closeness with other males through friendship. For example, some interviewees talked about sexual interactions with their best friends during middle school, experiences that were satisfying for them, and allowed them to make sense of their homoerotic desires as part of

their personal identity. Other participants referred their first sexual encounters on the street or other public spaces. The first sexual encounter was lived with a great amount of nervousness and anxiety, even though they deeply desired it (Gallego, 2010). The contexts where men lived their first same-sex sexual encounters allowed for two patterns of sexual initiation to emerge, what Carrillo and Fontdevila (2011) name “gender-role sexual initiation” and “homosocial sexual initiation.” The first pattern is where the interviewees, usually younger, were initiated by an older male and forced to adopt a receptive (and thus, “feminine”) role, such as being penetrated or forced to perform oral sex. The second pattern speaks of interaction among equals that, among the men interviewed, was motivated by external elements such as pornography. Or oral sex on the subway. I was the one who usually did it, right? Because, . . . most of them were older, and they made me work it. . . . I mean, the young boys, they get eaten alive by the older guys. . . . I’ve noticed that when they see a younger kid, they’re like piranhas. . . . I think they feel like “yeah, I’m going to work him.” The kid doesn’t even ask for a condom. (Komadreja, 25, Generation 2, Employee/ student) And my friend asked me “hey, have you ever seen a porn movie?” and I said “No.” “I have one.” It was the famous Deep Throat with Linda Lovelace, and he played it. It was the first time I saw naked men and women, and having sex. He said, “look, mine is just like his,” he pulled down his pants and showed it to me, and said “let me see yours, look they’re almost the same,” and we masturbated that time. I was so relieved and we became friends, I would practically do his homework for him. . . . We started to have sex, the fourth or fifth time, we had sex. . . . He penetrated me, then I penetrated him. (Javier, 40, Generation 2, Government employee)

The first pattern described by Komadreja describes that power is an important element, where the older and more experienced man may almost force the younger, unexperienced, curious teen into sexual activities that he does not fully understand. These practices have greater probability of taking place in a clandestine context where there is little verbal communication, and a fear of being caught that limits the possibility of negotiation. On the other hand, sexual practices carried out between youth of approximately the same age and sexual experience, in a safer context such as their bedroom, facilitates verbal communication and negotiation, regardless of the nervousness and anxiety either one of them may feel. I had never kissed a man before, but then later I felt weird. But. . . . I don’t know how to explain it, I felt weird kissing him. . . . It’s just that I felt insecure, right? So it was like

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

7

Verduzco kissing when you’re insecure, it’s weird. (Alfonso, 19, Generation 1, Student)

Alfonso’s testimony describes the confusion he felt for kissing a man for the first time, and how this confusion led to feeling insecure with himself and with the sexual practice he had engaged in. The men interviewed reported that they repressed their homoerotic desires because they perceived them to be socially inacceptable, which produced a strong sense of loneliness. When men were asked about how they “discovered” their sexuality, they always made references to femininity, and how they had either always felt closer to traditional masculinity or to how other (peers and family) would cite them from a place of femininity. This led these latter men to understand their sexuality in relation to femininity, and thus subordinated to traditional masculine behaviors. This subjective subordination fed feelings of homophobia, discrimination, fear, guilt, and isolation. Because of the repression they have experienced, there was a constant search to relate to others like them. This repression made meeting other gay men difficult, particularly in their years of youth. A sense of loneliness became part of their daily experience; the appropriation of symbolic spaces was difficult. Thus, the interviewees recurred to clandestine spaces for socialization, such as the subway, public restrooms and baths, dark corners, movie theaters, public parks, and the Internet, where they felt they could interact and socialize with other men like them. Well, it happens to a lot of us . . . we feel we’re the only ones, the only ones that go through this. . . . I felt lonely. . . . And I didn’t have any other homosexual references. . . . So I thought, “yes, this is very painful.” (Fernando, 45, Generation 2, NGO director) (Identifying with that feminine part, led me to) isolation. . . . So much repression, so much self-repression. I isolated myself from the group, the group of peers. (Teo, 68, Generation 3, Retired) I mean, really, I felt I was the only gay in the world. . . . So I felt alone. . . . I felt I was alone, I felt it was wrong. (Juan, 37, Generation 2, Businessman)

These extracts suggest that carrying out sexual practices in these spaces, the anxiety felt in the first encounters, the lack of knowledge on the topics of STIs and same-sex sex, as well as power relationships between men (Gallego, 2010) are barriers to the negotiation of safe sex. For example, Komadreja discovered that one of the subway lines of Mexico City is used by MSM to engage in sex and became an “avid user.” He met a great deal of men with whom he practiced unprotected oral and anal sex. Because of the clandestine nature of these

interactions, men learn to use their bodies and establish paralinguistic communications with each other to establish sexual encounters. Guys started taking me to the baths so that I would give them a blowjob . . . and well, I did it, right? . . . I remember I became addicted to the subway, I could spend up to 8 or 10 hours a day trying to find a guy. . . . I did it because it was the only thing I knew, it was like an escape, it was either that, or nothing. . . . I preferred that. . . . I would let myself go. . . . I think I was still very insecure, so I would think to myself, maybe if I say no, or ask them for a condom, they’re going to stop, and I want to keep going. . . . The subway was like a whole other life. It was like. . . . There I could fuck around. . . . It felt. . . . good. (Komadreja, 25, Generation 2, Student) Of course, I met a ton of people on the street; it was the way to meet people, to flirt on the street, in strategic places where you knew homosexuals gathered, right? On that corner you could find “chichifos,” now called “escorts,” or “vestidas” now called “transvestites” or “transgenders,” and there was prostitution too. It was all of that, and you could just walk around. (Hernán, 58, Generation 3, Musician)

Interviewees confirmed a sense of freedom in the sexual practices they carried out in public spaces through emotions such as “good” and “fun.” For men of the third generation, who grew up in the late 1970s and the 1980s, during a time where gay spaces such as bars and nightclubs were limited, attending “the magic corner,”1 where they met with other gay men, flirted and picked up guys, like Hernán tells in his testimony, was a liberating and fulfilling experience. On the other hand, for first generation men, attending very “sexual” spaces produced feelings of discomfort; they reported that they felt frustrated in attending gay spaces because they felt that too much attention was poured into sexual interaction and it was hard “to find a boyfriend.” Gay spaces, from the perspective of the participants, question heterosexual norms such as the connection between love and sex; gay men learn that these two are separate spheres that may connect at some point, but that in most cases are isolated from each other. According to the data, this separation is appealing for some men, especially older men, and disappointing for younger men. For some men, attending sexual spaces meant having a place in which to dissipate their emotions and find emotional companionship. Men built important and significant friendships and partner relationships. For example, Jorge kept a 10-year relationship with a man he met at a movie theater. Flirting and seduction in public spaces attend social and psychological functions that allow men to approach each other not only sexually but affectively as well.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

8

American Journal of Men’s Health It was a huge movie theater. And it was famous because there was a lot of gay movement. . . . There was a set of stairs, on the right side, another on the left side. . . . Because everybody cruised on those stairs. And I started going there; I discovered it, that’s where I met my friend. Well, I met him outside. He says to me, “Where are you going?” And I said, “I just came from the movies,” “I’m just going in,” he told me. And then I said, “Why don’t we go get some coffee, instead?” And he said, “OK, let’s get coffee,” and then he asked, “or, don’t you prefer to come to my place?” And I said, “OK, your place.” We never had that coffee. And we went to his place. The falling in love was so intense. . . . when we started. . . . I liked him so, so, so much back then. (Jorge, 51, Generation 2, Employee)

These spaces, however, are not exempt from violence and masculine power. They were very vigilant of their attendance, fearing to be found out by others. Komadreja’s case is exemplary; he attended the subway train for many years from the time he was 16 years old. Other men would seduce him and initiate him in sexual practices. According to him they would “make me work it,” referring to the way in which men pushed his head down so he would practice oral sex on them, or take him to public restrooms where they would anally penetrate him without telling him. Even though Komadreja did enjoy these practices at the time, he recognized a certain abuse; he felt that since he was not familiar with how sex happened between two men, because no one had ever talked to him about condoms or STIs, and that he was so curious to be with other men, that older men would take advantage of his condition solely for their pleasure. This resulted in abuse of power of one man over another, where there is no consent, an abuse that can easily be translated into sexual abuse. This means that there are structural elements that contribute to sexual abuse among MSM; lack of formal and informal sex education, no spaces for gay socialization from early ages (middle school and high school), the power attributed to men that are closer to the ideal model of masculinity, and generalized homophobia. The following testimony reports the difficulty and stigma in using condoms when HIV first appeared in Mexico: In the eighties (I started to use condoms), around that time, during the boom, because of mass media. They said they had discovered a new disease, and that you had to protect yourself from people of certain sexual preferences. And I had a few friends who were medics, and they told me, “Look, you ask for them here in the clinic.” But I was afraid, I worked there. They even gave them to you in a little box, very discreet. A box, wrapped in a plastic bag. And of course you didn’t give your name, or your data. . . . It was very discreet. (Teo, 68, Generation 3, Retired)

Men felt scared and nervous to ask or buy condoms because Mexican media associated HIV to sex between

men. Even though today homophobia is alive and well, its expressions have changed and even decreased; condom use is much more frequent among different groups. However, men who identify homoerotic desires and wish to carry them out still do not fully understand how, where, and with whom to carry out their desires, aspects that stand as barriers to safe sex.

Partners and Sex Sexual and affective partners and their dynamics are affected by sexual roles. For the interviewees, the passive/active2 dichotomy was very important, because it initially helped them make sense of sex between men. Initial studies among MSM in Mexico suggest that this sexual dichotomy socially divides men based on their sexual preferences; in other words, those men who preferred to be anally penetrated were more stigmatized than those who preferred to be insertive (Carrier, 2001). This dichotomy is a product of the gender binary, because each role is attributed a series of gender characteristics; according to Gallego (2010), it is a product of heteronormativity because vaginal penetration is endorsed among heterosexual partners and seen as the only way to achieve pleasure (Schwartz, 2007). Instances of such stigma are evident in these passages. The active part dominates the other person, like a way of . . . well, not necessarily having control but. . . . Oh! I don’t know what to say. . . . I don’t know. (Juan, 37, Generation 2, Businessman) I know couples . . . where one is like really macho and the other is kind of femmy, and the macho is the active and the femme is the passive. And both of them live up to it. (Komadreja, 25, Generation 2, Student)

Men used other men’s bodies and their character to determine how they would act in bed. Komadreja stated that he could not imagine bottoming for a taller and/or stronger man (Johns et al., 2012). Attributions such as these limit sexual expression to penetrative acts linked to personality traits, as if both sexual roles and traits were static and permanent. The sexual role preferred by the men could also have effects on emotionality. ED, for example, who prefers to be receptive in anal sex, was constantly bullied by his friends because his ex-boyfriend also preferred to bottom, which made the couple a target of insults by their social groups. But there was a time when being a bottom was, was devastating, it was like being the submissive one, the one who handed over his manhood because I was penetrated. . . . Not with him [my ex-boyfriend], but with our friends, they would call us “quesadillas,” or “tortilleras”3. . . . Just because

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

9

Verduzco I was a bottom, and I really disliked being called those things. (ED, 24, Generation 1, Employee)

Even though some men explained that sexual roles and traits were fluid and not static for them; in general, the views regarding anal penetration are affected by gender binaries, heterosexuality, and particularly hegemonic models of masculinity that build sex between men as analogous to heterosexual sex (Johns et al., 2012). For example, both Komadreja and Juan explained that tops were usually more manly than bottoms, but when they talked about their own sexual practices, they reported having no problem in being versatile in their sexual role, where they could either bottom or top depending on their “mood,” and did not link their preferred role to gender traits. Men also spoke of ways that they transgressed and questioned the heterosexual matrix. Some of them talked about their “open” relationships where they had a stable relationship with their affective partner, but were under the agreement that they could have sex with other men if they wished. Komadreja and Juan carried out this type of relationship, and referred that they did not always feel sexually satisfied with their main partner. Komadreja also reported enjoying having sex with his friends; he felt that sex with them was “like having a conversation.” He and Hernán had also had been in affective and sexual triads; they carried out their triad relationships like any other partner relationship.

HIV and Health Care Two of the men interviewed reported being HIV positive, and two others reported close experiences with the acquisition of the virus (one’s ex-partner was HIV positive, and the other lived in fear of being positive for around 4 months). Komadreja and Javier do not know exactly when they were infected with HIV, but believed it was during their late teens or early twenties, when they had a very active sexual life in clandestine spaces, such as the subway and public restrooms, where they engaged in anal sex with unknown men without the use of condoms. The interviews, in general, evidence little knowledge on the subject of STI transmission, prevention, and treatment. Their experiences describe how sex education is poor or lacking in formal and informal Mexican education, and how their access to condoms and treatment options is limited. I remember they taught us about, for example, HIV and AIDS, and some others. . . . but now there are more, more diseases. . . . Mmm, well, about HIV, gonorrhea . . . mmm . . . Syphilis, right? Those are the ones I remember. (Dante, 22, Generation 1, Student)

When asked about their knowledge of STIs and condom use when they started their sex lives, men were not fully aware of the risks involved in their sexual practices, or how to reduce such risks. Men of the third generation, who lived their youth during the HIV epidemic, stated that they were saved “by a miracle,” referring to how they engaged in sexual intercourse without the use of condoms, and were never diagnosed as HIV positive. A few of the men from this generation reported feeling extremely scared of HIV because of the discourse produced by Mexican mass media and health institutions, fear that led them to a “religious use of the condom.” I was very shocked to read about the “lilac cancer,” or the “pink cancer,” right? And when they started to identify that homosexuals were more infected with HIV, that we were the only ones who got it, during the first 4 or 5 years, more like the first 10 years (since the appearance of the first case of HIV), we were never able to get that stigma off our shoulder. (Fernando, 46, Generation 2, NGO director)

Younger men reported not using condom in their first same-sex sexual encounters and feeling scared of the possibility of becoming HIV positive. This fear was grounded on the little information they had on the subject and appeared when they identified certain symptoms such as fever and coughs. However, for this generation, their fear led them to become informed about what HIV is, find out how to protect themselves, and investigate where they could receive treatment. They looked for information on the Internet, and not in health centers, where they felt they could be questioned and stigmatized. However, information did not guarantee a constant and correct use of condoms; they did not know which practices were higher or lower risk, where to acquire free condoms, and where they could get tested. Besides, I didn’t know where to go in case of . . . and I think that’s a big problem, to this day, people with HIV don’t know where to start, even if you have health insurance. (Javier, 40, Generation 2, Government employee)

These facts speak of the stigmatization of not only same-sex sexuality but of STIs. An important example of this is Komadreja’s experience in Mexican public health services. In his early 20s, he detected “lumps” on his anus and did not know what they were until he attended a conference during a university health rally. There, he learned that they were condylomas. He attended the health clinic in his neighborhood to be diagnosed. However, the general practitioner only prescribed him an ointment for hemorrhoids. The condylomas did not go away, so Komadreja went back to the same clinic and asked the medic to undertake a visual revision, which the medic denied to perform and

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

10

American Journal of Men’s Health

prescribed another ointment. After around 4 months, the medic finally checked him and sent him to a proctologist, who asked for blood tests. Komadreja received his test results alone in a general public hospital where he learned that an ELISA test had been performed and that he was HIV positive. Mexican law states that all tests to detect HIV must be done with the patient’s consent and must be given to the patient by an HIV counselor. When Komadreja returned to the proctologist with his tests results, the medic exclaimed, “You’re going to die, that’s what happens to these people.” The medic performed the surgery to remove the condylomas and Komadreja started antiretroviral therapy. Currently, he is not under medication because his virus levels “are low” (even though he does not know exactly how low). Fieldwork for this project led to a specialized HIV clinic in Mexico City, which is known for being the only clinic in the country specializing in sexual diversity and HIV prevention and treatment. Every person who asks for an HIV screening test in this clinic must take a 40-minute workshop where a counselor explains that only patients with a CD4 count below 300 are administered free HIV treatment. According to Komadreja, his doctors tell him he does not need any medication because his levels are “good.” This experience speaks of institutional, legal, and interpersonal discrimination and stigma against HIV-positive patients. This type of stigma is closely related to feelings of shame (Fortenberry et al., 2002), and limits access to health care (Varas-Díaz, Neilands, Guilamo-Ramos, & Cintrón, 2008), thereby complicating patient’s recovery and increasing the probabilities of infection to others. When asking men about their condom use, it was interesting to identify an important difference regarding pleasure. Men of the second and third generation responded that they did not enjoy using condoms but “had” to use them to protect themselves. Men of the first generation made no comment about the increase or decrease of pleasure when using condoms. This difference can imply that younger men do not signify a change in pleasure whatsoever because of condoms, while for second and third generation men, this is something worth noting constantly. This difference could be the result of public policy and interventions during the 1990s and 2000s that had the objective of convincing gay men to incorporate the condom into their sex lives. Men of the second and third generations were not socialized under these policies, while first generation men were. Furthermore, third-generation men and a few younger men shared the idea that through skin-to-skin genital contact and of “receiving” bodily fluids such as semen, there could be a deeper connection to their partner; they therefore believed that the latex acted as a barrier to this interpersonal connection:

And if we receive semen without the intervention of latex well, then it’s a deeper contact, a more intimate one. But now, you receive it in latex, I don’t like that. . . . The feeling of a penis in the anus, right? And to receive it, right? . . . It’s something really intimate, right? Condoms get in the way. (Hernán, 58, Generation 3, Musician)

These beliefs may lead men into engaging in sex without using condoms, and thereby put themselves at a greater risk of acquiring HIV or another STI. Regardless of these beliefs, all of the interviewees reported using condoms in every sexual encounter, except two. These two men are HIV positive. Komadreja stated that he sometimes forgets to use them, even though he does get worried about getting infected with another STI and affecting his HIV status. His condom use is also dependent on his partner’s body, appearance, and identity. For example, he stated that he does not use condoms with “jackals,”4 because the condom is not part of their modus operandi. Javier, on the other hand, seeks sexual encounters with no condom and has found bareback groups online. His practices are motivated by a feeling of acceptance when he performs bareback sex, due to his stigmatized condition of being gay and HIV positive.

Discussion and Conclusions There are important elements in the data presented that require further discussion. Regarding sexual initiation, research in Mexico has reported that friendships between young men usually include sexual activities (López, 2007), results that were also reported in the interviews for this project. However, first sexual experiences are lived with nervousness, anxiety, fear, and confusion. According to List (2005), this confusion is fed by homophobia and a lack of homoerotic models with which to identify. List argues that gender systems “have not allowed the existence of spaces for gay encounters, where all types of interactions may take place, this has led to the clandestine appropriation of public spaces” (List, 2005, p. 149). According to Cruz (2011), the occupation of public spaces by sexual minorities calls into question the public/ private dichotomy because its occupation allows the visibilization of nonnormative bodies and practices. According to this author, public sex “provides alternatives of freedom and expression of sexuality” (p. 271). Differences between generations are important to highlight, particularly the distinction between sex and affection that discomforted first-generation men, but that provided older men with a sense of well-being. For the third-generation men, the political upheaval around the gay movement in the 1980s allowed them to live their body as a space within which to question heterosexual practices and norms not only around desire but around

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

11

Verduzco sex as well, and to question institutionalized forms of sexuality such as “vanilla” sex, monogamy, and heterosexual sexuality (Rubin, 1992), which become the socially and morally desirable sexual acts, and thus the normative ones. For younger men, the sociopolitical climate is less questioning because the gay movement has been institutionalized and reached political goals and a certain acceptance of diverse sexual identities among the broader society (Lozano & Rocha, 2014). These clandestine, albeit public, expressions of sexuality among gay men in Mexico City are still forms of questioning social norms around sexuality and gender, but are related to how accepting the contexts are, and to the tolerance each participant perceives of his contexts. Thanks to a wider acceptance of sexual diversity in recent years (Diez, 2010; Lagaurda, 2009), men of the first generation, socialized under these recent circumstances feel more social acceptance in comparison with men of the second and third generations, and thus, sexual expression in diverse settings are more tolerated. This acceptance appears to lead younger men into wanting to unite sex with affect, rather than keep them as separate spheres. Last, men from the first generation did not report anything in regard to pleasure when using condoms, while men from generation two and three reported less pleasure during sex because of condoms. However, these differences do not appear to affect men’s use of condoms during anal sex. In regard to the active/passive dichotomy, the data in this study are similar to the data presented by Johns et al. (2012), who identified that young, gay, U.S. men tried to critique stereotypical traits linked to tops and bottoms through their sexual practices that were not always consistent with the stereotypes they verbally expressed. In the same sense, the data from this Mexican study reported a similar ambivalence, where men expressed gender stereotypes but not always lived up to them in their sexual encounters, which reflect ambiguity and diversity in how masculinity is lived (Salgero, 2012; Wetherell & Edley, 2014). However, the social stereotypes still remain: sexual practices and identities are built on two sole options that not only describe the sexual actions but the unidimensional character and identity that carries it out. The active may keep his “masculine” trait because he penetrates, while the passive is subordinated to a “feminine” status, which for masculinity signifies a loss of patriarchal privileges that stem from hegemonic masculinity (Lozano, 2014; Tena, 2007). This cultural discourse not only reduces sexual practices to two options but the idea of moving freely between the two is also restricted. Finally, the “open” relationships and “triads” mentioned by the participants speak of types of affiliation that question heterosexual scripts and ways of relating sexually and affectively with others, as well as the limits

between forms and types of relationships (Rubin, 1992). These affiliations are based on desire rather than on gender norms such as monogamy and fidelity. In other words, some men are able to free themselves from hegemonic norms around gender and sexuality, and are freed to follow the path of their desire. These expressions of desire are important because, as Mamo (2007) states, it is through meaning that it is possible to queer social dynamics, in this case family, marriage, and partnerships. Experience with these men identified that it is not only meaning that allows the queering of these dynamics but acts as well. The results presented here must be considered within their limitations. Even though Critical Discourse Analysis is an analytical tool that allows the comprehension of socially constructed realities, the size of the sample is an important limitation. Particularly in this case, because even though careful attention was paid to have a heterogeneous group of participants, all of them were middleclass men. As has been previously discussed, the term gay presents itself more frequently among Mexico’s middle classes (Gutiérrez, 2012). Thus, these results may apply only to middle-class men who self-identify as gay. This also highlights the importance of researching the social barriers to sexual expression and safe sex among MSMs that identify themselves with any other term. Nonetheless, the data also describe important contributions. The sexual practices and particularly the sexual experiences of the participants represent fundamental aspects of their sexual selves that allow them to make sense of their homoerotic desire. Men are able to express their desire through practices and experiences that are molded by heteronormative and gender scripts and discourses related to hegemonic masculinity (Carrillo & Fontdevila, 2011; Halperin, 2004; Schwartz, 2007; Whittier & Melendez, 2007; Wittig, 2006). Thus, in interacting with these scripts and discourses, gay men incorporate their norms into their identity, following gender structures that discriminate against them. Their identity is constructed on the basis of socially repressed desires and practices, because the hegemonic model of masculinity is based on the idea of reproduction. This internalized and external repression leads men to seek sexual interactions with other men in spaces where they might feel free and will not be stigmatized (Cruz, 2011), but at the cost of making verbal and affective interaction difficult, thus hindering the possibility of consensual sexual practices, and of all types of negotiation, including pleasurable sexual practices and condom use. This leads to sexual abuse in some cases, as well as to the transmission of STIs, including HIV. Condom use and sexual practices among Mexican gay men is affected by a lack of scientific information, by traditional views on sexuality that promote anal penetration

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

12

American Journal of Men’s Health

as the only available sexual practice for gay men, by a generalized sense of homophobia and discrimination, and by cultural norms that establish that skin-to-skin contact implies a more intimate and stronger connection to the partner. In this sense, social policy and public health efforts have run short because they restrict their focus to the individual acts rather than on the context that allows those actions to take place. Furthermore, stigma in medical and health services are also present in the interviewees’ narratives that affect the way they understand their sexual behaviors, their infection, and their treatment. This evidence suggests that, in fact, all levels of context (interpersonal interactions, interactions with communities and institutions, and interaction with broader cultural discourses) reproduce some sort of stigma that allow for the continuation of risky behaviors, such as not using condoms and not complying with STI treatments. Interventions such as social and public policy, as well as community and therapeutic interventions must consider the greater context of stigma and homophobic discrimination (in schools, families, clinics and hospitals, the street, and in media) that stem from hegemonic models of gender and its reduction. But they must also consider the diverse forms of identification and expression among men. Effects of these types of intervention may allow men who experience homoerotic desires, including gay men, to live their desires and practices as socially accepted and thus feel free to express themselves in public spaces, and reduce emotions that lead them to mental and sexual health issues. Interventions must also consider the historical contexts men of different ages have lived through. This study only provides evidence for historical contexts, but does not mean that class and urban/rural differences do not affect sexual behaviors (Carrillo & Fontdevila, 2011). The data gathered are evidence that condom use campaigns carried out during the 1990s had important effects on the perception of condom use among gay men; younger men do not think of the pleasure it may give or take away, while older gay men always have these effects present. However, no differences emerge among the generations concerning sexual contexts and emotions. This means that stigma and discrimination of gay identity derivative of its apparent feminization is still present throughout the lives and spaces where gay men of all ages interact. They live their first sexual encounters as morally and socially wrong, so they hide them in clandestine contexts such as cheap motels, the city subway, parks, and public restrooms. Emotions such as fear, nervousness, anticipation, and guilt are very much present before, during, and after sexual encounters; emotions that are mixed with a sense of physical and emotional pleasure of having sex with another man. It is this stigma and discrimination, combined with pleasure and sexual satisfaction that

mostly affect gay men’s identities, desires, and sexual experiences. Acknowledgments The author wishes to thank Nevin Siders for the review, edition, and proofread of this text; Dr. Martha Romero for her critical review of this text; and the reviewers assigned by the editor of this journal. Their comments and revisions made a great positive impact on this article.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes 1. This was the name that the interviewees used to identify a certain street corner in Mexico City where a lot of gay socialization took place during the 1980s. 2. In Mexican culture “active” is used to designate the man who is insertive, and “passive” to refer to the man who is receptive in anal sex. 3. Quesadilla, a typical Mexican food, and tortillera, women who make tortillas by hand, refer to lesbian sexual practices, because the making of these involve manual movements similar to the ones that stimulate the vagina and clitoris. 4. Jackals are described by Monsiváis (2009) as low-income class men with indigenous features who have sex with other men and have incorporated certain fashion elements into their attire such as gold chains, baseball caps, and baggy jeans. They have limited access to cultural resources such as formal education and the Internet.

References Ahmed, S. (2010). The promise of happiness. London, England: Duke University Press. Amuchástegui, A. (2006). ¿Masculinidad(es)? los riesgos de una categoría en construcción. In. G. Careaga & S. Cruz (Eds.), Debates sobre masculinidades: Poder, desarrollo, políticas públicas y ciudadanía [Masculinity(ies)? The risks of a category in construction. In In. G. Careaga & S. Cruz (Eds.), Debates on masculinities: Power, development, public policy and citizenship] (pp. 159-184). Mexico City, Mexico: PUEG-UNAM. Bach, A. M. (2010). Las voces de la experiencia: El viraje de la filosofía feminista [The voices of experience. The turn in feminist philosophy]. Buenos Aires, Argentina: Biblos. Baile, A. J. I. (2008). Estudiando la homosexualidad: Teoría e Investigación [Studying homosexuality: Theory and Research]. Madrid, Spain: Ediciones Piramide.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

13

Verduzco Bautista, A. S., Colchero, A., Rubí, S. S. G., Martínez, R. M., & Conde, C. (2012). Resultados principales de la encuesta de sero-prevalencia en sitios de encuentro de hombres que tienen sexo con hombres [Main results of the serprevalance survey in men who have sex with men sex spot ]. Cuernavaca Morelos, Mexico: Instituto Nacional de Salud Pública, Centro de Investigación en Evaluación y Encuestas. Blashill, A. J., & Vander Wal, J. S. (2010). Gender role conflict as a mediator between social sensitivity and depression in a sample of gay men. International Journal of Men’s Health, 9, 26-39. Braine, N., van Sluytman, L., Acker, C., Friedman, S., & Des, D. C. (2011). Sexual contexts and the process of risk reduction. Culture, Health & Sexuality, 13, 797-814. Burin, M. (2000). Atendiendo el malestar de los varones. In M. Burin & I. Meler (Eds.), Varones, género y subjetividad masculina [Attending men’s discomfort. In M. Burin & I. Meler (Eds.), Men, gender and masculine subjectivity] (pp.339-364). Buenos Aires, Argentina: Paidós Ibérica. Butler, J. (1992). El género en disputa [Gender Trouble]. México. Paidós. Butler, J. (2004). Deshacer el género [Undoing gender]. Mexico City, Mexico: Paidós. Carrier, J. (2001). De los otros: Intimidad y comportamiento homosexual del hombre mexicano [Of the others: Intimacy and homosexual behavior in the Mexican male]. Madrid, Spain: TALASA Ediciones. Carrillo, H. (2005). La noche es joven [The night is young]. Mexico City, Mexico: Océano. Carrillo, H., & Fontdevila, J. (2011). Rethinking sexual initiation: Pathways to identity formation among gay and bisexual Mexican male youth. Archives of Sexual Behavior, 40, 1241-1254. Castañeda, M. (1999). La experiencia homosexual [The homosexual experience]. Mexico City, Mexico: Paidós. Castañeda, M. (2006). La nueva homosexualidad [The new homosexuality]. Mexico City, Mexico: Paidós. Castañeda, M. (2007). El machismo invisible regresa [Invisible machismo returns]. Mexico City, Mexico: Paidós. CENSIDA. (2011). El VIH/SIDA en México 2011: Numeralia Epidemiológica [HIV/AIDS in Mexico 2011: Epidemiological numbers]. Mexico City, Mexico. Cochran, S., & Mays, V. M. (2006). Prevalencia de trastornos mentales y abuso de sustancias entre lesbianas y gays. In A. Omoto & H. S. Kurtzman (Eds.), Orientación sexual y salud mental [Prevalance of mental disorders and substance abuse among lesbians and gays. In A. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health] (pp. 131-150). Mexico City, Mexico: Manual Moderno. Cole, S. (2006). Amenaza social, identidad personal y salud física de gays que no han salido del clóset. In A. Omoto & H. S. Kurtzman (Eds.), Orientación sexual y salud mental [Social threat, personal identity and phisical health of gays who have not come out of the closet. . In A. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health] (pp. 223-243) . Mexico City, Mexico: Manual Moderno. CONAPRED. (2010). Encuesta nacional sobre discriminación [National Survey on Discrimination]. México City, Mexico: Author.

Connell, R. (1995). Masculinities. Berkeley: University of California Press. Cruz, S. (2002). Masculinidad y homofobia [Masculinity and homophobia]. El Cotidiano, 18, 8-14. Cruz, S. (2004). La pareja gay masculina. In G. Careaga & S. Cruz, (Eds.), Sexualidades diversas: aproximaciones para su análisis [The masculine gay couple. In G. Careaga & S. Cruz, (Eds.), Diverse sexualities: approximations for its analysis] (pp. 217-236). Mexico City, Mexico: PUEGMiguel Ángel Porrúa. Cruz, S. (2011). El comercio sexual masculino de calle en el centro de Juárez: Repensando la intimidad y la masculinidad en el espacio público. In C. M. Fuentes Flores, L. E. Cervera, L. E. Gómez, J. E. Monárrez Fragoso, & S. Peña Medina (Eds.), Espacio Público y Género en Ciudad Juárez, Chihuahua: Accesiblidad, sociabilidad, participación y seguridad [Masculine street sexual commerce in the center of Juárez: Rethinking intimacy and masculinity in the public space. In C. M. Fuentes Flores, L. E. Cervera, L. E. Gómez, J. E. Monárrez Fragoso, & S. Peña Medina (Eds.), Public space and gender in Ciudad Juárez, Chihuahua: Accesability, sociability, participation and security] (pp.38-50). Chihuahua, Mexico: El Colegio de la Frontera Norte y Universidad Autónoma de Ciudad Juárez. de la Dehesa, R. (2010). Queering the public sphere in Mexico and Brazil: Sexual rights movements in emerging democracies. London, England: Duke University Press. de Lauretis, T. (2008). Gender identities and bad habits. Keynote Speech at the 4th Congreso Estatal Isonomía sobre Identidad de Género vs. Identidad Sexual. Castellón de la Plana, Spain: Universitat Jaume I. Díaz-Loving, R., Rocha. T.E., Rivera, S. (2007). La insrumentalidad y expresividad desde una perspectiva psicosocio-cultural. [Instrumentality and expressiveness from a psycho-socio-cultural perspective]. México, Miguel Àngel Porrúa y UNAM Diez, J. (2010). The importance of policy frames in contentious politics: Mexico’s national homophobia campaign. Latin American Research Review, 45(1), 33-54. Fernández, M., & Vargas, M. (2012). Hombres que compran cuerpos: aproximaciones al consumo asociado a la trata de mujeres con fines de explotación sexual. México. INDESOL-GENDES. Fleiz, B. C. F., Ito, S. M. E., Medina-Mora, I. M. E., & Ramos L. L. (2008). Los malestares masculinos: narraciones de un grupo de varones adultos de la Ciudad de México [Masculine discomforts: narrations of a group of adult men in Mexico City]. Salud Mental, 31, 381-390. Flick, U. (2004). Introducción a la investigación cualitativa [Introduction to qualitative research]. Madrid, Spain: Ediciones Morata. Fortenberry, J. D., MacFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D. M., . . . Stoner, B. P. (2002). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92, 378381. Frost, D. M. (2011). Stigma and intimacy in same-sex relationships: A narrative approach. Journal of Family Psychology, 25(1), 1-10.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

14

American Journal of Men’s Health

Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationships quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97-109. Gallego, G. (2010). Demografía de lo otro: Biografías sexuales y trayectorias de emparejamiento entre varones en la Ciudad de México [Demography of the other: Sexual biographies and partner trajectories among men of Mexico City]. Mexico City, Mexico: El Colegio de México. García, M. M., Andrade, M. B., Maldonado, R. A., & Morales, C. E. (2009). Memoria de la lucha contra el VIH en México: Los primeros años [Memory of the struggle against HIV in Mexico: the first years]. Mexico City, Mexico: Historiadores de las Ciencias y las Humanidades. Granados, J., & Delgado, G. (2007). Salud mental y riesgo de VIH-SIDA en jóvenes homosexuals: aproximación cualitativa a la experiencia de la homofobia [Mental health and risk of HIV-AIDS among homosexual youth: qualitative approach to the experience of homophobia]. Mexico City, Mexico: UAM División de Ciencias Biológicas y de la Salud. Granados-Cosme, J. A., Torres-Cruz, C., & Delgado-Sánchez, G. (2009). La vivencia del rechazo en homosexuales universitarios de la Ciudad de México y situaciones de riesgo para VIH/SIDA [The experience of rejection in university homosexuals of Mexico City and risks for HIV-AIDS]. Salud Pùblica de México, 51, 482-488. Gutiérrez, J. P. (2012). Profile of gay men in Mexico City: Results of a survey of meeting sites. Tropical Medicine & International Health, 17, 353-360. Halperin, D. (2004). San Foucault: Para una hagiografía gay [Saint Foucault: For a gay hagiography]. Córdoba, Spain: El cuenco de plata. Ibáñez, L. (2003). El análisis del discurso en las ciencias sociales: variedades, tradiciones y práctica. In L. Ibáñez Rueda (Ed.), Análisis del discurso: manual para las ciencias sociales [Discourse analysis in social sciences: varieties, traditions and practices. In L. Ibáñez Rueda (Ed.), Discourse Analysis: manual for social sciences] (pp. 83-123). Barcelona, Spain: Editorial UOC. Jäger, S. (2003). Discurso y conocimiento: aspectos teóricos y metodológicos de la crítica del discurso y del análisis de dispositivos. In R. Wodak & M. Meyer (Eds.), Métodos de Análisis Crìtico del Discurso [Discourse and knowledge: theoretical and methodological aspects of critical discourse and the analysis of technologies. In R. Wodak & M. Meyer (Eds.), Methdos of Critical Discourse Analysis] (pp. 61-100). Barcelona, Spain: Gedisa. Janesick, V. (1998). The dance of qualitative research design: Metaphor, methodolatry, and meaning. In N. Denzin & Y. Lincoln (Eds.), Strategies of qualitative inquiry (pp. 35-55). London, England: Sage. Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health, 6, 505-518. Kimmel, M. (2009). Guyland: The perilous world where boys become men. New York, NY: HarperCollins.

Kvale, S. (2007). Doing interviews. Thousand Oaks, CA: Sage. Laguarda, R. (2009). Ser gay en la ciudad de México: Lucha de representaciones y apropiación de una identidad, 19681982 [Being gay in Mexico City: Fight of representations and identity apropiation, 1968-1982.].Mexico City, Mexico: CIESAS-Instituto Mora. List, M. (2005). Jóvenes corazones gay de la Ciudad de México [Hearts of gay youth in Mexico City]. Puebla, Mexico: BUAP. List, M. (2009). Hablo por mi diferencia, de la identidad gay al reconocimiento de lo queer [I speak for my difference, from gay identity to the recognition of queerness].. Mexico City, Mexico: Eón. Longmore, M. A. (1998). Symbolic interactionism and the study of sexuality. Journal of Sex Research, 35, 44-57. López B. C. (2007). Amistad: Conceptuación y mantenimiento, una visión psicosociocultural [Friendship: Conceptualization and maintnace, a psychosocial vision]. (Unpublished doctoral thesis). UNAM: Mexico City, Mexico. Lozano, G. (2010, November). El movimiento gay en México [The gay movement in Mexico]. Conference at the Tercera Semana de la Diversidad Sexual. Instituto Tecnológico Autónomo de México, Mexico City, Mexico. Lozano, I. (2008). El amor que no osa decir su nombre: Un estudio exploratorio de la homofobia en el D.F [The love that dare not say its name: an exploratory study of homophobia in DF]. (Unpublished licenciate thesis). UNAM: Mexico City, Mexico. Lozano, I. (2014). Violencia institucional homofóbica y emociones de hombres gay de la Ciudad de México [Homophobic Institutional violence and emotions of gay men of Mexico City]. Revista Puertorriqueña de Psicología, 25(2). Lozano, I., & Rocha, T. E. (2014). Situated knowledges: A critical analysis of “gay identity”. Unpublished mansucript. Mamo, L. (2007). Queering reproduction: Achieving pregnancy in the age of technoscience. London, England: Duke University Press. Monsiváis, C. (2009). Apocalipstick. Mexico City, Mexico: Debate. NOM-253-SSA1-2012. (2012). Norma Oficial Mexican 253SSA1-2012, “Para la disposición de sangre humana y sus componentes con fines terapéuticos.”[ Official Mexican Norm “For the disposal of human blood and its components for therapeutic means.”] Mexico City, Mexico: Secretaría de Salud. Núñez, G. (2000). Sexo entre varones: poder y resistencia en el campo sexual [Sex among men: power and resistance in the sexual field]. México. Porrúa y PUEG. Núñez, G. (2009). Vida vulnerables: hombres indígenas, diversidad sexual y VIH-SIDA [Vulnerable lives: indigenous men, sexual diversity and HIV-AIDS]. México. Edamex/ CIAD Ortiz-Hernández, L. (2005). Influencia de la opresión internalizada sobre la salud mental de bisexuales, lesbianas y homosexuales de la ciudad de México [Influence of internalized oppression on mental health of bisexuales, lesbians and homosexuals of Mexico City]. Salud Mental, 28(4), 49-65.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

15

Verduzco Ortíz-Hernández, L., & García Torres, M. I. (2005). Opresión internalizada y prácticas sexuales de riesgo en varones homo- y bi-sexuales de México [Internalized oppression and risky sexual practices of homo and bi sexual men of Mexico]. Revista de Saúde Pública, 39, 956-965. Pérez, R. A. R. (n.d.). La dimension afectiva de la racionalidad [The affective dimension of rationality]. Retrieved from http://www.artemasciencia.com/textos/anarosapr.pdf Rubin, G. (1992). Thinking sex: Notes for a radical theory of the politics of sexuality. In C. S. Vance (Ed.), Pleasure and danger: Exploring female sexuality (pp. 267-293). London, England: Pandora. Salguero, A. (2012). Masculinidad como configuración dinámica de identidades [Masculinity as a dynamic configuration of identities]. In J. C. Ramírez & J. C. Cervantes (Eds.), Los hombres en México: Veredas recorridas y por recorrer. Una Mirada a los estudios de género de los hombres, las masculinidades (pp. 37-52). Guadalajara, Mexico: CUECEA-AMEGH. Sandfort, T. G. M., Melendez, R. M., & Díaz, R. M. (2007). Gender nonconformity, homophobia and mental distress in Latino gay and bisexual men. Journal of Sex Research, 44, 181-189. Schwartz, P. (2007). The social construction of heterosexuality. In M. Kimmel (Ed.), The sexual self, the construction of sexual scripts (pp. 80-92). Nashville, TN: Vanderbilt University Press. Scott, J. W. (1991). The evidence of experience. Critical Inquiry, 17, 773-797. Span, S. A., & Derby, P. L. (2009). Depressive symptoms moderate the relation between internalized homophobia and drinking habits. Journal of Gay & Lesbian Social Services, 21(1), 1-12. Stecher, A. (2010). El análisis crítico del discurso como herramienta de investigación psicosocial del mundo del trabajo: Discusiones desde América Latina [Critical Discourse Analysis as psychosocial research tool in the labor world: Discussions from Latin America]. Universitas Psychologica, 9(1), 93-107.

Strauss, A., & Corbin, J. (1994). Bases de la investigación cualitativa. Técnicas y procedimientos para desarrollar la teoría fundamentada [Bases for qualitative research. Tecniques and procedures to develop grounded theory]. Medellín, Columbia: Editorial Universidad de Antoquia. Tena, G. O. (2007). Problemas afectivos relacionados con la pérdida, disminución y riesgo de pérdida del empleo en varones [Affective problems related to loss, decrease and risk of losing a job among men]. In M. L. Jiménez Guzmán & O. Tena Guerrero (Eds.), Reflexiones sobre “masculinidad” y empleo (pp. 357-375). Mexico City, Mexico: CRIM-UNAM. Van Dijk, T. (2002). Critical Discourse Studies: A Sociocognitive Approach. In Wodak, R., & Meyer, M. (eds.). Methods of Critical Discourse Analysis (pp. 95-120). London. SAGE. Van Dijk, T. (2011). Sociedad y discurso [Society and discourse]. Barcelona, Spain: Gedisa. Varas-Díaz, N., Neilands, T. B., Guilamo-Ramos, V., & Cintrón Bou, F. N. (2008). Desarrollo de la escala sobre el estigma relacionado con el VIH/SIDA para profesionales de la Salud mediante el uso de métodos mixtos [Development of a scale of stigma related to HIV/AIDS for health proffessionals through mixed methods]. Revista Puertorriqueña de Psicología, 19, 183-215 West, C., & Zimmerman, D. (1987). Doing Gender. Gender & Society. 1, 125-151 Wetherell, M., & Edley, N. (2014). A discursive psychological framework for analyzing men and masculinities. Psychology of Men & Masculinity, 15(2), 1-10. Whittier, D. K., & Melendez, R. (2007). Sexual scripting and self-process: Intersubjectivity among gay men. In M. Kimmel (Ed.), The sexual self, the construction of sexual scripts (pp. 191-208). Nashville, TN: Vanderbilt University Press. Wittig, M. (2006). El pensamiento heterosexual y otros ensayos [Heterosexual thought and other essays]. Barcelona, Spain. Egales.

Downloaded from jmh.sagepub.com at The University of Hong Kong Libraries on October 10, 2015

Barriers to Sexual Expression and Safe Sex Among Mexican Gay Men: A Qualitative Approach.

Same-sex sexual practices among men in Mexico City are stigmatized. This article analyzes sexual practices and experiences of gay men in Mexico City a...
309KB Sizes 0 Downloads 9 Views