Gay and bisexual men's experiences of bathhouse culture and sex: 'looking for love in all the wrong places'.

The aim of this study was to describe gay and bisexual men's experiences of bathhouses and their perceptions of HIV risk associated with sex in this context. Face-to-face, semi-structured interviews were conducted with a purposive sample of gay and bisexual men-14 HIV-positive and 9 HIV-negative-who reported ever frequenting a bathhouse. The sample was selected from the Polaris HIV Seroconversion Study, a longitudinal open cohort study of documented recent seroconverters and HIV-negative controls in Ontario, Canada. Interview transcripts were analysed using a narrative approach. Four major themes were identified concerning views of gay bathhouse culture and environments; moral conceptions of self and others at a bathhouse; identity management at a bathhouse; and psychosocial functions of gay bathhouses. HIV transmission is a salient component of bathhouse culture; therefore, bathhouses are critical environments for the promotion of safer sex activities among gay and bisexual men.

Genetic susceptibility to cancer. Family physicians' experience.

OBJECTIVE: To explore family physicians' experiences in dealing with genetic susceptibility to cancer. DESIGN: Qualitative study using focus groups. SETTING: Four Ontario sites: northern, rural, urban, and inner city. PARTICIPANTS: Forty rural and urban FPs participated in four focus groups: 28 were male; average age was 41. METHOD: Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used. Key words and concepts were identified. Data were sorted using NUD*IST software. MAIN FINDINGS: Participants realized the escalating expectations for genetic testing and its effect on family practice. They explored an expanded role for themselves in genetic testing. Possible activities included risk assessment, gatekeeping, and ordering genetic tests. They were concerned about the complexity of genetic testing, the lack of evidence regarding management, and the implications for families. CONCLUSION: We must help FPs struggling to integrate genetics into their practices, by addressing their concerns, enhancing the way they communicate information on genetics, and developing appropriate educational tools.

What influences family physicians' cancer screening decisions when practice guidelines are unclear or conflicting?

OBJECTIVES: To determine (a) the respondents' perceptions of 4 unclear or conflicting cancer screening guidelines: prostate-specific antigen (PSA) for men over 50, mammography for women 40-49, colorectal screening by fecal occult blood testing (FOBT), and colonoscopy for patients over 40; and (b) the influence of various factors on the decision to order these tests. STUDY DESIGN: National Canadian mail survey of randomly selected family physicians. POPULATION: Family physicians in active practice (n=565) selected from rural and urban family medicine sites in 5 provinces representing the main regions in Canada. OUTCOME MEASURED: Agreement with guideline statements, and decision to order screening test in 6 clinical vignettes. RESULTS: Of 565 surveys mailed, 351 (62.1%) were returned. Most respondents agreed with the Canadian Task Force recommendations, and most believed that various guidelines for 3 of the 4 screens were conflicting (PSA 86.6%; mammography 67.5%; FOBT 62.4%). Patient anxiety about cancer, patient expectations of being tested, and a positive family history of cancer increased the odds that the 4 tests would be ordered. A good quality patient-MD relationship decreased the odds of ordering a mammogram. Screening decisions were also significantly influenced by the respondents' beliefs about whether screening was recommended and whether screening could cause more harm than good. A physician's sensitivity to his or her colleagues' practice influenced screening decisions regarding PSA and mammography. CONCLUSIONS: These results suggest a conceptual framework for understanding the determinants of screening behavior when guidelines are unclear or conflicting.