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The sexual behaviour and sexual health of heterosexual-identifying men who have sex with men: understanding an understudied population to inform public health policy and practice

Curtis, Tyrone Joel; (2022) The sexual behaviour and sexual health of heterosexual-identifying men who have sex with men: understanding an understudied population to inform public health policy and practice. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Introduction: Sexual behaviour and identity do not always align. A small but significant proportion of men who have sex with men identify as heterosexual (H-MSM). H-MSM are a challenging population to research, and while their sexual health needs may be complex, these are currently poorly understood. This has important potential consequences for these men, their sexual partners, and the wider population. In this thesis, I use complementary methods to investigate the sexual behaviour and sexual health of H-MSM in high-income countries and consider the implications for public health policy and practice. Methods: I systematically reviewed 43 quantitative and 21 qualitative studies of H-MSM published 2008-2018 to summarise previous research. I harmonised data for 196,426 MSM from cross-sectional surveys conducted 2010-2017 in Australia, Canada, New Zealand and 14 Western European countries, and performed individual participant data meta-analysis to produce robust statistical estimates and associations giving insight into sexual behaviours and sexual health outcomes related to STI/HIV transmission and testing. I conducted 15 semi-structured interviews with H-MSM resident in England, to explore H-MSM’s decision-making regarding STI/HIV prevention and accessing sexual healthcare. Results: H-MSM were less likely than gay-identifying MSM, and in some cases bisexual-identifying MSM, to report sexual behaviours associated with STI/HIV transmission, or to test for STI/HIV - even among H-MSM reporting greater testing need. Qualitative evidence suggested that H-MSM considered their own health and that of their female partners when making STI/HIV prevention and testing decisions, while lack of information and privacy concerns limited their access to sexual healthcare and STI/HIV prevention. Conclusions: H-MSM are vulnerable to poor sexual health and face specific challenges in accessing sexual healthcare. My work informs novel approaches that might improve engagement between this population and health services to provide effective and holistic healthcare that generates both individual and public health benefits.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The sexual behaviour and sexual health of heterosexual-identifying men who have sex with men: understanding an understudied population to inform public health policy and practice
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: epidemiology, public health, sexual health, sexual behaviour, sexual identity, sexuality, mixed methods, qualitative research, quantitative research
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10143978
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