'It's grim up north' : a comparative study of the subjectivities of gay HIV positive men in an urban and rural area
This comparative study of the experiences of gay HIV positive men living in urban and rural areas explores the dynamic interrelationship between lived experience and service provision. The literature in this field has drawn on a familiar stereotype - the urban, sexually active, gay man. This man - and his community - does not exist in a rural environment in the way it is assumed nor does it necessarily fit the experience of gay men in London. By creating a link between the questions of subjectivity and the question of how we improve services, I argue that a mechanistic construction of need may follow an assumed urban model which may not hold for all men in an urban setting, nor for men in rural areas. Gay HIV positive men are faced with new psycho-social dilemmas in relation to the virus, including unpredictability of outcome, as well as the complexity and burden of the current treatment. They engage in a constant process of renegotiating their sense of themselves in space, time and relationships. Through the use of narrative methodology, my research builds a new perspective on the experience of these individuals which can help to shape the services and policies of the future. The stories of 21 gay HIV positive men were gathered and analysed in relation to five areas of focus: community/space, relationships, identity, health and services. Rural participants were less able to build and maintain a politically strong identity and rural services need to create strategies to enable gay men to draw on the strength of a collective voice. 'Doing for' services, prevalent in rural areas, may be appropriate for the very ill but can perpetuate a culture of helplessness. The healthist discourse adopted by London services promotes individualism and responsibility. Services for HIV positive men in all areas need to hold the dynamic between 'doing for' services for the sick and dying and a healthist discourse for those who can look to their future.