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A central message of this afterword is that HIV is not over and that the lives of people living with HIV are not over. Yet they continue to live with the stigma associated with HIV, as though their lives should be over. The critical gaze of caregivers, policymakers and researchers must be focused not on people living with HIV, but on people, policies and providers who stigmatise and marginalise. That is the central theme of all the stories we have heard, from all over the world, in this book. A goal of this book has been to encourage caregivers and policymakers not to participate in HIV stigma by assuming that the emotional, sexual and relational lives of people living with HIV in later life are over. Part of what living with HIV has done is to encourage people to reclaim all of their lives, including sex and sexuality, free from judgements and assumptions of otherness. The chapter concludes by drawing parallels between HIV and COVID-19.
As HIV treatment and prevention have advanced, the HIV response has become increasingly biomedicalised. However, biomedical solutions are insufficient to address the social, psychological and relational impacts of HIV. Drawing on a participatory qualitative study, this chapter discusses the views and experiences of older women living with HIV in the United Kingdom to explore the barriers HIV can pose for intimacy. Women living with HIV do not live single-issue lives, and different intersecting factors influence their experiences and views of sex and intimacy. These factors include ageism, sexism, anti-trans discrimination and past experiences of sexual and gender-based violence. Partners’ attitudes, wider society and diverse life experiences all influence sex and sexual behaviours in women ageing with HIV, indicating the limitations of an increasingly biomedicalised HIV response.
In recent years, chemsex has become the object of intense public scrutiny, mainly based on pathologising and panic-raising narratives. Building on critical contributions across the social sciences and cultural studies, the chapter focuses on an underexplored dimension within the literature on chemsex: ageing with HIV. Centred around the narratives of self-identified gay men living with HIV, aged over 45 and who practise chemsex, in England and Italy, the chapter analyses the relationship between their life courses and their engagement with chemsex. Data analysis reveals how research participants frame their engagement with chemsex as driven by the quest for sociality combined with a rediscovery of sexual pleasure and an improved sense of comfort with their bodies resulting from the emergence of the paradigm of undetectability. However, through the adoption of an intergenerational and intersectional perspective, the chapter reveals also ambivalences and tensions within participants’ engagement with chemsex.
Women living with HIV who do not belong to epidemiological target groups (referred to as ‘key populations’) represent an invisible group of people who are often ignored in public and medical debates about HIV/AIDS. Additionally, sexuality related to ‘older’ people is often considered taboo, and sexual issues for ‘older’ women are mainly addressed from a clinical perspective. Considering that gender and sexual orientations have shaped the medical and social representations of the AIDS pandemic, the chapter discusses how ageing with HIV affects specifically women’s sexuality and love lives. This is based on the narratives and experiences of 30 women living and ageing with HIV in the French-speaking part of Switzerland.
Current HIV prevention programmes in Ukraine are focused on sexual education of young people and prevention of vertical transmission, and on drug users. This chapter considers the experiences of Ukrainian older women who have HIV. Based on 12 interviews with HIV-positive women and representatives of HIV community services, the study identifies specific social and psychological problems of this group, reveals their attitudes towards their sexual lives and exposes their strengths and vulnerabilities. Notable findings of the research include: the self-blame and moral suffering of older women living with HIV; their scorned intimacies, which tend to be hidden; and the need to adjust national approaches to epidemic control in order to integrate the needs of older people into HIV policy. The chapter provides recommendations for prevention interventions for women ageing with HIV.
This piece is written as an autoethnographic memoir and study of how it has been and is to live as an HIV-positive gay man from Aotearoa New Zealand across a time of great cultural change. It is a reflection through a sociological and historical lens of how the personal side of my life as a gay man intersects with wider cultural, political and health-related themes. Generational trauma impacted how gay men coming of age during the AIDS crisis engaged in sexual practices. The biomedical methods of HIV prevention, like pre-exposure prophylaxis (PrEP), have the potential to transform community practices, with profound psychological consequences. In this chapter, I present an account of Allan, a gay man in his sixties who lives in Aotearoa New Zealand and uses PrEP. During the AIDS crisis, Allan’s perception of physical closeness with other men became contaminated with fear of HIV transmission and feelings of mistrust, guilt and shame. With PrEP, these feelings disappeared as Allan recovered important functions of his sexual experience: transcending the boundaries of individuality and resisting heteronormative norms through subversive practices. The effects of PrEP can be viewed from a generational perspective to reveal the undoing of the psychological effects of the AIDS crisis trauma and the recovering of the pleasure of sexual connection by older gay men.
This volume, third in a series of five on sexuality in later life, brings together the experiences of women, gay men, trans women and hijra from around the world as they describe what it means to live with HIV and navigate the often fraught areas of sex, sexuality, intimacy and relationships in later life. New drug treatments have transformed the lives and expectations of people living with HIV. In this book we hear from people living in Aotearoa New Zealand, Bangladesh, India, Kenya, Switzerland, Ukraine and the United Kingdom who are not only living with HIV but also facing stigma imposed on them by others. Too often they have learned to stigmatise themselves. Since no single approach or way of writing can capture the richly diverse experiences of people in later life living with HIV, the book includes a variety of empirical research as well as personal accounts, poetry and other forms of writing from an array of perspectives and academic disciplines. As always with HIV, we find that poverty challenges our notions about the length, expectations and quality of life.
This chapter explores the lived experiences of older Chinese gay/bisexual men living with HIV in Hong Kong. Their stories cover their emerging sexuality during their earlier formative years and living with HIV in later life. Four major themes have emerged from this study, including ‘filiality’, ‘heterosexist harassment’, ‘hidden lives’ and ‘living with ageing’, which indicate how cultural values and sexuality affected their ageing experiences. Their narratives illustrate how their unseen stories can shed light on this intersectional area of sexuality, HIV and ageing. The chapter concludes that older Chinese gay/bisexual men with HIV remain mostly invisible and closeted, affected by the barriers caused by heterosexism, HIV stigma and ageism that inhibit the process of successful ageing both within and outside the gay community.
Following the development of anti-retroviral therapies (ARVs), many people affected by HIV in the 1980s and 1990s have now been living with the condition for decades.
Drawing on perspectives from leading scholars in Bangladesh, Canada, Hong Kong, New Zealand, Switzerland, Ukraine, the UK and the US, as well as research from India and Kenya, this book explores the experiences of sex and sexuality in individuals and groups living with HIV in later life (50+). Contributions consider the impacts of stigma, barriers to intimacy, physiological sequelae, long-term care, undetectability, pleasure and biomedical prevention (TasP and PrEP).
With increasing global availability of ARVs and ageing populations, this book offers essential future directions, practical applications and implications for both policy and research.
This piece is written as an autoethnographic memoir and study of how it has been and is to live as an HIV-positive gay man from Aotearoa New Zealand across a time of great cultural change. It is a reflection through a sociological and historical lens of how the personal side of my life as a gay man intersects with wider cultural, political and health-related themes.