VIGNETTE

Carlos, a Latino Colombian gay man, came to the first session of Chicos Net, an HIV prevention behavioural intervention. He has lived in Canada for the past four years. During the process, he told the group that he had unprotected sex the week before. His reasoning was based on how much he was attracted to the guy he had sex with, and that he was so ‘into’ the moment that he ‘let things happen’. He was worried about the event. The group provided support and feedback. A discussion about similar situations in which other participants had been involved made Carlos feel a little bit better. “We have all been there,” a participant said. Then the group moved the focus of the night's discussion to sexual desires, pleasures and passions.

Introduction

In order to understand HIV infection and its relation to social determinants of health, it is relevant to touch on the conditions in which sexualities and gender relations are socially enacted and constructed. Logie (2012, p 1243) invites us to think about gender and sexual orientation as an intervening factor that affects an individual's wellbeing: ‘sexual minorities experience significant and pervasive health disparities’.

Different disciplines in social science have centred their attention on the social environments in which the HIV epidemic has evolved, particularly among homosexual communities. Moreover, scholars have long promoted the understanding and analysis of the role of social work in the field of sexualities and HIV prevention when working with gay populations.

According to Hicks (2008, p 66), social work is a discipline that should examine various forms of thinking of what sexuality is, and disentangle it from ‘dominant versions of “sexuality”’. This analysis is relevant because dominant forms of understanding sexuality have historically marginalised certain practices or individuals according to the particular historical moment and geographic locations. In consequence, those individuals practising ‘that’ kind of sex are often repressed, and forced to hide or live in fear. The social inequality comes from the idea that some forms of sexual expression or sexual practices are more acceptable than others, and in some extreme cases, some forms are banned or even illegal.

Health inequalities

Krieger (2001) invites us to think about ‘social epidemiology’ and how many health constructs that have been considered and analysed from a biological perspective are truly socially constructed.