Saturday, August 29, 2009


retreat. v. Seconds on dessert. I had a light supper, so I retreated myself with ice cream.

revenue. v. To move an event from its original location. The unexpected douwnpour caused us to revenue the wedding ceremony.

predate. n. The period of time before a date when you can think about nothing else.

distance. adj. Holding both sides of an argument simultaneously. The senator distanced himself on the Health Care debate, hoping that whichever way it went, he'd be able to declare a victory.

promote. adj. Supportive of the political aspirations of dust particles.

reveal. v. Milk feeding the calf of a cow that never left its own mother's teat.

prevent. adj. The hot clammy slap in the face you get coming home to an apartment that's been shut up on a hot muggy day.

represent. v. see retreat above.

propound. n. (Br.) see anti-euro.

Sunday, August 23, 2009

Research Worth Reading (3)

There's a myth out there that gay men are self-obsessed and narcissistic, and I for one don't buy it.
David Nimmons, in Chapter 3 of his book Soul Beneath the Skin claims that on the contrary, gay men are actually more likely to get involved in volunteerism and altruistic behaviors, in part basing that on the enormous outpouring of volunteer time and energy devoted to AIDS service organizations.

Well, this is the first quantitative random sample analysis that really tries to get to the issue of whether gay men (and lesbians) are more or less altruistic than straight people. And that goal is what makes it 'research worth reading', in my opinion.
This is one of the few analyses that examines assets, rather than risks; one of a very small number of quantitative analyses to do so. So regardless of the results, regardless of the methodologic challenges, this is an important read in terms of thinking about the health of sexual minority populations.
    Self-reported altruistic and reciprocal behavior among homosexually and heterosexually experienced adults: implications for HIV/AIDS service organizations.

    Susan D. Cochran, Vickie Mays, Heather Corliss, Tom W. Smith, Joseph Turner

    AIDS Care 21(6):675-682. June, 2009

The authors used data already collected as part of the General Social Survey (GSS), a random-dialed telephone survey of the US population conducted annully since the 1960's, a staple dataset for the social sciences.
They looked at four potential measures of altruism across groups of people defined by whether they reported ever having had sex with someone of the same sex, or whether they reported only mixed-sex sexual relationships. The sample size of the GSS is fairly large (they combined 2 years to get 2,031 people), but the number of men and women reporting same sex partners in their lifetimes was pretty small (68 men and 51 women), so they elected not to divide that group farther, but lumped together men who were homosexually active and bisexually active together, and the same for the women.

The GSS asked a 7-item scale intended to measure empathic concern (other-oriented feelings), a 4-item altruistic feelings scale (similar idea, as far as I can tell), a set of 11 altruistic behaviors (things that one does for others that have no self-serving interest, like giving directions to a stranger, even at some risk to one's self, such as donating blood), and 4 reciprocal behaviors (things that one does for another, but do have self-serving aspects as well, like helping someone you know find a job, or lending a friend a considerable amount of money).

They found that gay/bi men (at least in terms of reported sexual behavior) were very similar on all of these measures, in terms of the average. Of course, the average is just the average, it doesn't really say much about the distribution of individuals in the population, meaning there might be a bunch of gay/bi men who are much more altruistic (for example: helped 7 people find jobs, not just one) but that wouldn't be reflected in the average.

The lesbian/bi women were also very similar across all four measures of empathy and altruism.

So, the results are pretty vanilla. Looks like we're about as caring and other-centered as everyone else.

Blood donations
One interesting side note is that they found lots of people in GSS reporting having given blood recently, over 20% of exclusively hetero men, and almost as many of the gay/bi men. That's similar to what I saw in the same dataset and reported on here.
I suspect that there's something wrong with that variable, not because it shows lots of men with same sex sexual behavior giving blood, but because it shows many many more people of all stripes giving blood than actually do.
I don't know what the problem in GSS is about blood donation. Maybe a lot of people are interpreting it to mean gave blood ever in their lives, rather than just in the last year. Maybe a lot of people are interpreting having given a tube of blood for medical tests as having given blood. I don't know.
But at any rate, there are more credible results on blood donation in the National Health and Nutrition Examination Survey, which I reported on here.

Study limitations
The General Social Survey (GSS) is an amazing dataset. They ask tons of questions, and repeat a lot of them year after year. But, it is also very general, and not necessarily designed for whatever analysis you or I might have in mind, so when re-purposing it, it is important to hold in mind that the results may not be what they seem for a variety of reasons.
As is typical for epidemiologists, I'll break them down into three large categories: errors in assessing sexual orientation; errors in assessing altruism; and other factors that may be associated with both sexual orientation and altruism.

errors in assessing sexual orientation
The GSS is a telephone survey, and it is a really long survey. And not everyone pays close attention the whole time they are on the phone. As a result, some people inadvertently give answers that don't actually represent their reality, and in very rare cases, the interviewer records something other than what the respondent said.
All that would be well and good if a little bit of error here and there gets swapped from one group to another, but it gets problematic when one group is much smaller than the other (like sexual minorities). In this sample, 5% of the women and 6.6% of the men reported at least one sexual partner of the same sex in their lifetimes (since age 18). It's possible that maybe 4% of the women and 5% of the men really did have same sex partners, and the other 1-1.5% represent people who were inattentive or miscoded for some reason (this is purely hypothetical, there's no way to know what the error rate really is). So, if that were the case, then gay/bi men and lesbian/bi women would look more like straight people than they should, because a bunch of the people we think are gay/bi/lesbian really aren't (Scout's Law of Fake Queers).
The GSS actually has more opportunity than most datasets to check on this kind of error, because at different points they ask about sexual partners ever in one's lifetime, in the last five years, and in the last year. And there's always people who say they have had no sex in the last five years, but they have in the last year. No way to tell which of those is correct, but they can't both be true, so you can get a sense of the error rate that way. I haven't done that analysis myself, but it could be done.
Another way to check is to see whether the queers identified in this study look like queers identified in other studies. Most demographic studies have found that people who describe themselves as LBG, or who report same sex partners, tend to be slightly younger, more highly educated, and especially less likely to be married. In this study, they were somewhat younger (much younger for the women), but not more highly educated. The LGB people identified in this study were less likely to report being married, but still about 30% reported being married, which is pretty high.
For those reasons, I'm a bit skeptical that the GSS sample has really accurately described the LGB population, I suspect that there's a fair amount of 'slop' from the heteros mixed in with us.

errors in assessing altruism
Another potential source of error is if altruism is not measured accurately. This is an area I'm much less familiar with, in part because I just don't trust scales. The known inaccuracy of the blood donation question gives me some cause to interpret this study cautiously, but that could be a problem mainly with that one question for whatever reason, and not reflect systemically on the other measures in the study.

other factors associated with sexual orientation and altruism
I don't know enough about how altruism is distributed in the population. They separated the population by sex, and that's probably the biggie. There weren't enough people to do stratified analyses across any other variable (like age, educational attainment), but they did do a mathematically smoothed model to try to partially adjust for these factors simultaneously, and found no big difference from the overall results.

Full disclosure: Susan Cochran, the lead author on this study, was also the external reader for my dissertation. She and I have never discussed this paper, though. I don't think seeing her name on the paper made me especially more likely to choose it, I was hooked by the word 'altruism' before I saw that she was associated with it. I do think that knowing that she and Vickie write good research is why I asked her to be my external reader.

Thursday, August 20, 2009

Patricio gives a very moving account of his experiences at the Chicago LGBTI Health Summit here.

Wednesday, August 19, 2009

Social Network Theory in HIV Prevention, the Role of Metaphor and Scope

With the realization that social context plays a large role in HIV transmission in addition to personal behaviors, some people have turned to social network theory to help explain why HIV infection happens the ways it does, and to whom it does.
In turn, researchers, health promoters and activists have been struggling with (and arguing about) the implications for social network theory-based analyses on how to inform public health practice (for an example, check this out).
This post comes out mainly of a series of conversations with Michael Scarce & Peter Keogh, with my own special twist.

Wrong toolbox?
I'm going to argue that there is a profound disconnect between thinking about what social context means and how to design public health strategies that address social contextual factors, and social network theory as an approach for understanding the interpersonal dynamics of disease transmission.

Social network theory
From what I can gather, social network theory is about describing the linkages between people, and in the disease transmission context, using those linkages to help explain why a disease moves in the way that it does.

social network graph of friendships among 4th graders from Moreno, 1934, as cited by Linton C. Freeman. Visualizing Social Networks. Journal of Social Structure. networks are often invoked to explain why rates of HIV infection are different in different demographic identified groups, despite similar occurrences of personal behaviors across these groups. But usually the evidence for that interpretation is the observation that the groups have different rates of HIV infection, a circular logic. I'm not aware of anyone having done the kind of individual mapping necessary to show how (over the span of decades, with constantly changing linkages) these communities came to have different HIV infection rates.

The metaphor of a social network as a map of nodes and lines, in this case describing who is friends with whom in a 4th grade class in the 1930's, has a remarkable similarity to the 'web of causation' models elaborated in epidemiology, especially since WWII.

Epidemiology's 'web of causation'
Web of Causation for the Major Cardiovascular Diseases. R. A. Stallones (1966). Prospective epidemiologic studies of cerebrovascular disease. Public Health Monograph No. 76 metaphoric imagery of the web of causation is so vivid that a web to show linkages between causes and effects for any specific study is rarely actually drawn out. Usually, someone trained in public health sees one in their textbook at some point, then that's it. For illustrative purposes, here's an example from a 1966 US Government report. If you can reduce hyperlipidemia by reducing fat in a population's diet, or increasing physical exercise, this will reduce atherosclerosis, which in turn will reduce the clinical manifestations of heart attacks and strokes. The power of the 'web' among public health folks is that interrupting any of the pathways between causes, intermediaries, and finally disease outcomes can have a large impact on public health.

The similarity of these metaphorical representations I think is partly at fault for the way interventions based on the invocation of social network theory sound so strange.

When someone from Public Health sees a network of nodes connected by lines, our gut reaction is to start thinking about how to break them, so in this case, that translates into breaking social networks apart in order to limit disease transmission.

In the specific case of HIV prevention, this could mean, for instance, trying to interrupt HIV transmission by limiting the sexual vectors between younger and older men, since older men are more likely to have HIV.

But in a social network, the lines represent the substance, the sociality, of social networks. They are the sources of information, of resources, of resilience, not just vector lines across which bits of infectious protoplasm are transmitted.

So, any program designed to tear these networks apart, or prevent them from forming, seems counter-productive. Ripping the heart out of the communication of ideas and resources, the means men have to get support from one another, just to interrupt sexual connections between younger and older men is an exchange that even Faust would have been hesitant to make.

A kinder, gentler form of social engineering designed to limit social network growth has been proposed, the idea being to present young men with neutral and unbiased information about higher HIV infection rates among older men than younger men, the implication being that they should choose to associate only with other younger men.
The impact is the same, even if the intent is somewhat more benevolent. No matter how you dress it up in neutral language, the message that "older guys represent a sexual danger to you, young man, so avoid them" comes through loud and clear.

So, the invocation of social network theory, and it's strong metaphorical resemblance to the 'web of causation' probably has played a role in the development of such bizarre and counter-productive ideas for addressing the social contextual factors that influence HIV transmission.

Lace, Macrame, or Felt?
Perhaps we need a new metaphor to describe social networks. At the Chicago LGBTI Health Summit, Marshall (Feldman?) described the network of social relations in San Francisco as 'lace', its fragility due to the high turnover of people in this transitory town. This metaphor may be more useful for us public health types - why would you cut lace? If anything, wouldn't it be better to bolster the lace with new connections, tougher and stronger connections.

Perhaps the goal of health promotion would be to turn lace into macrame, the knitting craze that filled American houses with hanging plants in the 1970's. But there's something too vertical and hierarchical about macrame for my taste as a metaphorical substitution.
Someone suggested that felt, made by mashing fibers together, rather than weaving or knitting them, might be a good metaphor, it invokes the idea of the strands having multiple points of contact with one another, not fixed into a pre-arranged shape, and the tighter the felt, the more points of connection between the fibers, the more difficult it is to rip apart.

At any rate, using fabric as a metaphor pushes one to think about strengthening ties, not rending them apart.

Social networks as units of analysis
Another way to think about using social network theory is to design studies and interventions around the idea that social networks are discrete entities. This may be plausible when describing the strictly sexual links that have been used to trace STD transmission among heterosexuals, whose sexual networks tend to be dyadic, or only slightly more extensive than that. But the idea of discrete, separable social networks quickly falls apart when thinking about social ties other than strictly sexual ones, or even "purely" sexual networks in the vibrant sexual culture that gay men have fought so hard to create.
Despite this practical limitation, one could theoretically think about how to design a study using an individual's perceptions of their social network as the unit of analysis, and ask which types of social networks are more successful than others at help that individual avoid HIV, or avoid exposing others in the context of secondary prevention.
Doing this sort of research would imply that interventions should be designed to intervene in social networks that are identified as being dysfunctional. How to do that without simultaneously stigamtizing the very groups one is trying to assist seems difficult to me. In simpler terms, "Hi, we're here becuase we think your friends might let you down, so we want to help you make new friends" could be taken as very offensive to people who have a lot invested in their social networks, no matter how dysfunsctional social science research deems that style of network to be.

Broadening scope
So, perhaps the main problem isn't one of metaphor, but of scope. Rather than focus on the ties that bind individuals together within discrete social networks, a more fruitful way to think about the role of intentionally altering social contexts might be to go a bit broader, and engage the structural forces of gender hierarchy, material deprivation, and racial ideologies that work a broad social level. These forces certainly get reflected within social networks of friends and family, but their source, and the means for addressing them require a broader focus; on laws, policy, and public opinion. It requires engaging the total population, not just the relatively small population that is 'at risk' for whatever reasons.
With this broader focus, lobbying, grassroots organizing, school-based anti-bullying campaigns, and social marketing campaigns designed to address stigma become practical, efficient ways to think about intervening in the realm of social context to reduce HIV infection rates.

Throw out the tools if they aren't working
Don't get fooled by the work 'social' in social network theory. Social network theory may be a good way for infectious disease epidemiologists to understand disease spread through a time- and space-limited population (such as measles through the Faroe islands), but it's probably not a good guide when thinking about how to address the social contextual factors that influence HIV infection spread.

Get some new tools instead.

Hurricane Bill: Why I Touched You in Chicago

OK, so nobody asked me why I was going around giving shoulder massages in Chicago. At least I don't remember anyone asking why.
And that's part of the beauty of it. It's not about talking.

But in case you're curious, and want to waste valuable head space with an answer, here's why.

I need it.
I've got a bad back, and sitting in a chair all day just kills me. So I've gotta get up and walk around. Touching your shoulders gave me something to do.

I want it.
I enjoy touching people. I'm a bit of a touch top, to be honest. If you get anything out of it, hooray for you, but that's not what it's really about for me.

I need it.
For me, it's easy to feel misunderstood, and it's easy to be critical. I've got a lifetime of training in feeling misunderstood, and an education that stressed critical thinking to the nth degree.
So even in the midst of a bunch of passionate queers getting together, for the purpose of critiquing our own and others work in promoting health, being critical and feeling misunderstood (or un-heard) came quickly and easily to me.
That's not how I wanted to spend my time with y'all though, so in discussions with a few other critical and easily misunderstood people, I decided to take some responsibility for feeling that way, both to get myself out of the mire, and also to subtly shift dynamics that I was afraid might lead others into a similar state.

I decided to concentrate on touch.
Intimate touch.
Public touch.
Touch that is not spoken about, just experienced.
Touch that is not sexual, but could be flirtatious, and could have sexual overtones.
Touch that has no pretense of healing, but may nonetheless be healing.

In short, touch that is designed to get us out of our heads a bit, and into each others lives.

Being together without touch is isolating
Chairs in a room, aligned in rows, with talking heads at the front reading words off of Power Point slides is about the most isolating and alienating sort of group experience I can imagine, and yet, somehow that has become the norm for academic and professional meetings, even how classes are taught, and it takes a great deal of resistance for us to create other forums and formats for the sort of group experiences we want and need to share ideas and inspiration from one another.

My intention
So to break though that isolation, I hoped that by touching you, in public, it would create some sort of intimate experience. Not only between you and I, but between me and the room, and between you and the room. Most of all, I hoped it would liberate you to touch other people in the rooms, hallways, and other Summit spaces, public and private, and everywhere in between. And as I said above, a main motivation was to move me from a critical space to a communal space.

I did not ask if you wanted it. I intentionally asked only "May I?" if I asked at all. For many of you, "May I?" and a nod of assent were the first and only words we exchanged during the entire weekend. That's kind of wild, thinking back on it.
I understand and expect that for some people, my touch may have been somewhat less than welcome; perhaps because intimate touch of any sort implies sexual expectations; perhaps because intimate touch triggers a bit of a traumatic response; perhaps because inter-racial touch and inter-generational touch have incredibly complex sets of meanings, especially when done in public. And what the heck does it mean for a gay man to touch a lesbian intimately in public?
I accept that my method of seeking consent may have left some people feeling less than comfortable, and am happy to take responsibility for that. It was, after all, an intentional approach I took. And I took the risks of having a somewhat ambiguous (if intentional) approach to consent to serve what I felt a greater goal, to create a common experience that wasn't in our heads, that was in our bodies.
What would it have meant to do a more complex ritual around consent? Having been a victim of hate crime myself, I have struggled long and hard with what it means to continue to perceive myself as a victim. And I have concluded that it is really unhealthy for me to live with that status, that identity. If my consent procedure had encouraged a victimhood status in someone else, that would be contrary to my goals in creating a communal experience.
Had I touched only the people I knew, that would have been contrary to that goal. Had I sought a special level of consent from people of a different racial background from mine, from people considerably older or younger than me, that would in a sense have reinforced a bunch of stereotypes about racial and age related sexual objectification. Did I as a middle-aged White guy have a position in the room that 'allowed' me to act in a way that seemed to ignore these racial and age dynamics that another person in the room may not have been able to 'get away with'? You bet, and it pains me that that's the case. I sure don't have a fix for that one. But I hope you'll understand what my intention was, and why I tried to address chiefly the issue of intimate public touch as a matter of breaking down barriers and creating more of a communal environment where we were invested in one another.

So, how was it for you?

Chicago LGBTI Health Summit

So many things to possibly blog about. Any suggestions?


Lace, crochet, ribbons, and cross-stitching to describe social networks: mixing fabrics is banned in Leviticus, but is mixing metaphors allowed?

Social network interventions: Why inquiry into what makes a social network fuctional or not is a counter-productive question.

Observations on Scout's Law of Fake Queers, and how we've already gotten in trouble because of it.

Why Identifying 'Research Worth Reading' is So D
ang Difficult.

Hurricane Bill: Why I Was Touching Your Shoulders at the Summit.