The research project
Introduction
Despite improvements in available therapies and investments in prevention campaigns, HIV-rates continue to rise across European cities. Gay men are over-represented amongst people with HIV, thus experiencing the combined effects of homophobia and HIV-related stigma. Recently, PrEP (Pre-Exposure Prophylaxis, which is advocated by clinicians and HIV service providers as a means to both reduce HIV infections and fight HIV-related stigma) has been introduced in Italy; while in the UK there is an on-going political and legal debate about whether the National Health Service (NHS) has a responsibility to make PrEP available. Several studies have found a correlation between becoming HIV-positive and gay men’s decision to migrate. To date, most of these rely on quantitative methodologies and concern the US and Canada. In a European context, there is very limited knowledge about the reasons why HIV-positive gay men choose to migrate to, and remain in, specific urban areas across the continent. This research project aims at addressing this gap in knowledge by investigating different migration paths of HIV-positive gay men with a focus on four urban areas, Bologna and Milan in Italy, Leicester and Manchester in England.
State-of-the-art and overview of the action
Early work published after the diffusion of HIV-AIDS emphasized two main trajectories for the migration of HIV-positive people: i) the return to their hometown; and, ii) migration towards major metropolitan areas where more specialist services are available. However the availability and efficacy of therapies have significantly improved since then, although stigma remains persistent. Health geographers have therefore called for the need for more qualitative research exploring the complexity of factors driving the decision to migrate for HIV-positive gay men. In fact HIV-related stigma intersects with homophobia, producing what has been defined as “the second closet” (Berg and Ross, 2014), i.e. hiding HIV-positivity in order to avoid negative social condemnation. However this is a painful process since “being closeted required substantial effort, in particular continuous management of stigmatizing information, and appeared to be psychologically taxing” (ibid, p. 196). N. Lewis (2014; 2015; 2016) has recently engaged with such a qualitative approach, although in relation to pre-exposure migration; however, the geographies of migrations after HIV-seroconversion remain unexplored.
Previous research I conducted in Barcelona has showed how HIV-seroconversion (i.e. becoming HIV-positive) is a key-element in the decision to migrate and the open, non-stigmatizing character of the large gay community in the city plays a central role in HIV+ men’s decisions to remain there (even in a situation of financial constraints). Building on this work, the research project addresses the gap in knowledge about the complexity of factors shaping the migration process for gay men after HIV-seroconversion. For this scope, three distinct sets of factors (material, cultural/lifestyle, and relational) are considered. The role of cultural/lifestyle and relational factors has already been widely emphasized in the literature on gay migration, although not in relation to HIV-positivity. On the contrary the role of material factors (beyond available HIV-services) has been completely overlooked in the literature (Di Feliciantonio & Gadelha, 2016).To account for material factors, the project focuses on the configuration of the welfare regime. In line with the milestone work of Esping-Andersen (1989), the conceptualization of welfare regimes in the project refers to the different level of de-commodified services available in a specific country/city and how access to services is made possible. An important factor to take into account here is whether service provision is oriented towards families or individuals. In this respect, the project focuses also on discourses and representations produced by welfare institutions, since they are expected to have a direct impact on the perception of stigma and inclusion/exclusion, pushing HIV-positive gay men to relocate.
To best highlight the complexity of factors and the special role of the welfare regime in shaping HIV-positive gay migration, the project adopts a comparative perspective in time and space. Specifically, the project investigates different migration paths of HIV-positive gay men towards Leicester (UK), Manchester (UK), Milan (Italy) and Bologna (Italy) in three different historical moments:
Objectives
By building a comparative analysis in time and space, the main aim of the project is to analyse the complexity of factors shaping the decision to migrate for HIV-positive gay men through the focus on different migratory paths and the use of qualitative methodologies. To best achieve this scope, the project focuses on three sets of factors (material, cultural/lifestyle and relational), each one individuated by a specific research (sub)question:
The need to explore the specific role of the welfare regime amongst the complexity of factors becomes particularly relevant to understanding the persistent differences in the perception of stigma by HIV-positive people across different places, even when the welfare regimes make available the same services, as highlighted by the opposite results of two recent research works about the persistence of HIV-related stigma
Main Research Question: What makes HIV-positive gay men decide to move to (and remain in) a specific city?
Configuration of the welfare regime (material factors)
Sub-question: How does the configuration of the welfare regime (in both the place of origin and destination) influence the choice to migrate to (and remain in) a specific city for HIV-positive gay men?
Cultural/lifestyle factors
Sub-question: What makes HIV-positive gay men decide to move to (and remain in) a given city? How important is the imagery and the perception of the city, its sexual life and tolerance in this residential choice?
Relational factors
Sub-question: Do social and migratory networks and relational capital influence the choice of the destination, or does the need to escape stigma erase their role?
Research methodology and approach
The research relies mostly on an online survey (open to both HIV-positive and HIV-negative men), and semi-structured interviews with HIV-positive gay migrants and relevant stakeholders. This choice will offer the possibility to analyse the process from different perspectives, accounting for the complexity of factors shaping the migration process for (HIV-positive) gay men.
The use of the survey is aimed at giving a general picture of the process, while accounting for the influence of welfare and social institutions on the decision to migrate. The compilation of the survey (available both in English and Italian) is online and guarantees full anonymity of the participants.
Semi-structured interviews to collect biographical life narratives represent the most used research method when researching gay migration in geography.The minimum goal is to do at least 48 in-depth interviews with HIV-positive gay men in the four cities (12 per city. To analyse interviews data I will deploy a narrative analysis around the life histories of the research participants in order to emphasize the contextual and breaking-points within their self-narratives.
Beyond migrants, semi-structured interviews are realized also with relevant policy-makers and stakeholders (e.g. service providers, representatives of gay associations) in order to analyse which strategies are envisaged in order to improve the social inclusion of HIV-positive gay men. The minimum goal is to undertake at least 12 interviews (3 in each city).
Despite improvements in available therapies and investments in prevention campaigns, HIV-rates continue to rise across European cities. Gay men are over-represented amongst people with HIV, thus experiencing the combined effects of homophobia and HIV-related stigma. Recently, PrEP (Pre-Exposure Prophylaxis, which is advocated by clinicians and HIV service providers as a means to both reduce HIV infections and fight HIV-related stigma) has been introduced in Italy; while in the UK there is an on-going political and legal debate about whether the National Health Service (NHS) has a responsibility to make PrEP available. Several studies have found a correlation between becoming HIV-positive and gay men’s decision to migrate. To date, most of these rely on quantitative methodologies and concern the US and Canada. In a European context, there is very limited knowledge about the reasons why HIV-positive gay men choose to migrate to, and remain in, specific urban areas across the continent. This research project aims at addressing this gap in knowledge by investigating different migration paths of HIV-positive gay men with a focus on four urban areas, Bologna and Milan in Italy, Leicester and Manchester in England.
State-of-the-art and overview of the action
Early work published after the diffusion of HIV-AIDS emphasized two main trajectories for the migration of HIV-positive people: i) the return to their hometown; and, ii) migration towards major metropolitan areas where more specialist services are available. However the availability and efficacy of therapies have significantly improved since then, although stigma remains persistent. Health geographers have therefore called for the need for more qualitative research exploring the complexity of factors driving the decision to migrate for HIV-positive gay men. In fact HIV-related stigma intersects with homophobia, producing what has been defined as “the second closet” (Berg and Ross, 2014), i.e. hiding HIV-positivity in order to avoid negative social condemnation. However this is a painful process since “being closeted required substantial effort, in particular continuous management of stigmatizing information, and appeared to be psychologically taxing” (ibid, p. 196). N. Lewis (2014; 2015; 2016) has recently engaged with such a qualitative approach, although in relation to pre-exposure migration; however, the geographies of migrations after HIV-seroconversion remain unexplored.
Previous research I conducted in Barcelona has showed how HIV-seroconversion (i.e. becoming HIV-positive) is a key-element in the decision to migrate and the open, non-stigmatizing character of the large gay community in the city plays a central role in HIV+ men’s decisions to remain there (even in a situation of financial constraints). Building on this work, the research project addresses the gap in knowledge about the complexity of factors shaping the migration process for gay men after HIV-seroconversion. For this scope, three distinct sets of factors (material, cultural/lifestyle, and relational) are considered. The role of cultural/lifestyle and relational factors has already been widely emphasized in the literature on gay migration, although not in relation to HIV-positivity. On the contrary the role of material factors (beyond available HIV-services) has been completely overlooked in the literature (Di Feliciantonio & Gadelha, 2016).To account for material factors, the project focuses on the configuration of the welfare regime. In line with the milestone work of Esping-Andersen (1989), the conceptualization of welfare regimes in the project refers to the different level of de-commodified services available in a specific country/city and how access to services is made possible. An important factor to take into account here is whether service provision is oriented towards families or individuals. In this respect, the project focuses also on discourses and representations produced by welfare institutions, since they are expected to have a direct impact on the perception of stigma and inclusion/exclusion, pushing HIV-positive gay men to relocate.
To best highlight the complexity of factors and the special role of the welfare regime in shaping HIV-positive gay migration, the project adopts a comparative perspective in time and space. Specifically, the project investigates different migration paths of HIV-positive gay men towards Leicester (UK), Manchester (UK), Milan (Italy) and Bologna (Italy) in three different historical moments:
- the mid ‘80s/early ‘90s when there was a rapid diffusion of the epidemic and a deeply stigmatizing public discourse;
- the mid ‘90s/early 2000s with a new focus on prevention and personal responsibility from health institutions and the introduction of effective therapies;
- the last decade with the introduction of a single pill-therapy, the strong improvement of life conditions for HIV-positive people and, more recently, the introduction of PrEP.
Objectives
By building a comparative analysis in time and space, the main aim of the project is to analyse the complexity of factors shaping the decision to migrate for HIV-positive gay men through the focus on different migratory paths and the use of qualitative methodologies. To best achieve this scope, the project focuses on three sets of factors (material, cultural/lifestyle and relational), each one individuated by a specific research (sub)question:
The need to explore the specific role of the welfare regime amongst the complexity of factors becomes particularly relevant to understanding the persistent differences in the perception of stigma by HIV-positive people across different places, even when the welfare regimes make available the same services, as highlighted by the opposite results of two recent research works about the persistence of HIV-related stigma
Main Research Question: What makes HIV-positive gay men decide to move to (and remain in) a specific city?
Configuration of the welfare regime (material factors)
Sub-question: How does the configuration of the welfare regime (in both the place of origin and destination) influence the choice to migrate to (and remain in) a specific city for HIV-positive gay men?
Cultural/lifestyle factors
Sub-question: What makes HIV-positive gay men decide to move to (and remain in) a given city? How important is the imagery and the perception of the city, its sexual life and tolerance in this residential choice?
Relational factors
Sub-question: Do social and migratory networks and relational capital influence the choice of the destination, or does the need to escape stigma erase their role?
Research methodology and approach
The research relies mostly on an online survey (open to both HIV-positive and HIV-negative men), and semi-structured interviews with HIV-positive gay migrants and relevant stakeholders. This choice will offer the possibility to analyse the process from different perspectives, accounting for the complexity of factors shaping the migration process for (HIV-positive) gay men.
The use of the survey is aimed at giving a general picture of the process, while accounting for the influence of welfare and social institutions on the decision to migrate. The compilation of the survey (available both in English and Italian) is online and guarantees full anonymity of the participants.
Semi-structured interviews to collect biographical life narratives represent the most used research method when researching gay migration in geography.The minimum goal is to do at least 48 in-depth interviews with HIV-positive gay men in the four cities (12 per city. To analyse interviews data I will deploy a narrative analysis around the life histories of the research participants in order to emphasize the contextual and breaking-points within their self-narratives.
Beyond migrants, semi-structured interviews are realized also with relevant policy-makers and stakeholders (e.g. service providers, representatives of gay associations) in order to analyse which strategies are envisaged in order to improve the social inclusion of HIV-positive gay men. The minimum goal is to undertake at least 12 interviews (3 in each city).