Papers by Matthew Thomann
American Journal of Public Health, 2022
Objectives. To elucidate a structurally oriented theoretical framework that considers legacies of... more Objectives. To elucidate a structurally oriented theoretical framework that considers legacies of racism, trauma, and social exclusion and to interrogate the “unmet obligations” of the institutionalization of the
harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland.
Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n 5 72) and stakeholders (n 5 85) in 5 Maryland counties. We assessed PWUD’s experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs.
Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization.
Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates
a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched.
BMC Public Health, 2022
Background: HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less... more Background: HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations.
Methods: We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was “unreached” by the program, who then each identifed three respondents, resulting with data on 290 individuals.
Results: Findings illustrate the interconnectedness of community-based organization (CBO) members and nonmembers. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST.
Conclusion: Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.
Medical Anthropology, 2022
The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value o... more The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby “freed,” through technology, from the social conditions that might inhibit health services utilization. Following a community-centered collaborative approach, community researchers interviewed their peers who examined and reacted to the technology. Participants reframed the technosubject as intertwined with the social world and the testing kit itself as an object that exerts agency and possesses affective potential. Attending to these socio-material relationalities offers insights into program planning.
Male Same-Sex Sexuality and HIV in Africa
Critical Public Health, 2020
Medicine, Anthropology, Theory, 2019
How does an epidemiological category such as 'MSM' circulate across global health contexts? In wh... more How does an epidemiological category such as 'MSM' circulate across global health contexts? In what ways is this label implicated in and productive of global health knowledgemaking practices? The papers in this special section take up these questions by showing how the MSM category, across an array of social, cultural, and political backdrops, comes into existence as a 'category, thing, technology' (see Biruk, this issue), and especially as a vital or doing thing (see Boyce and Cataldo, this issue; Lorway, this issue). Rather than reiterate the already well-documented and important scholarly work detailing the (mis)uses of this category in global public health1a critique that stresses the erasure of lived realities that should be recognized to better understand people and promote sexual healththe contributions to this special section focus on the more 'ontological' materiality of 'MSM' and the work it does as it travels. That is to say, what comes of 'MSM' being in the world; and how does 'MSM' in turn call for new kinds of becomings? In short, our starting point for this special section extends beyond what MSM does not do, and instead emphasizes what it has done and can do. These contributions, then, examine the ontology of the term 'MSM': what it does and what it becomes in the concrete world of health and development interventions.
Global Public Health, 2018
Global Public Health, 2018
In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn... more In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an 'epidemic out of control', we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and 'costeffective' interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler's [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an 'epidemic of signification' to develop a review of 'End of AIDS' discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where 'Ending AIDS' has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic.
Archives of Sexual Behavior, 2018
Research on the use of pre-exposure prophylaxis (PrEP) among adolescents at high risk for HIV is ... more Research on the use of pre-exposure prophylaxis (PrEP) among adolescents at high risk for HIV is urgently needed, and parents’ perspectives on these studies are essential for guiding the responsible conduct of adolescent PrEP research. We conducted interviews with 30 parents of adolescent boys (50% known/presumed heterosexual; 50% sexual minority) to understand their views of research risks and benefits and parental permission regarding their sons’ involvement in a hypothetical PrEP adherence trial. Parents identified several health and educational benefits of the study, and expressed that waiving parental permission would overcome barriers to accessing PrEP, particularly for youth who may benefit most. Among their concerns were medication nonadherence and risk compensation. Parents provided suggestions to facilitate informed, rational, and voluntary participation decisions and protect youth’s safety if parental permission was waived. These findings can inform ways to increase parental trust in PrEP research and create adequate protections for adolescent participants.
AIDS Patient Care and STIs, 2018
Culture, Health, & Sexuality , 2017
Critical African Studies, 2017
Among sexual and gender minorities in Côte d'Ivoire, travestis are defined as individuals born an... more Among sexual and gender minorities in Côte d'Ivoire, travestis are defined as individuals born anatomically male who live as women on a full-or part-time basis. Travestis encounter harsher stigmatization and violence than sexual minorities whose gender normativity allows them to avoid unwanted attention. Moreover, they have traditionally been underserved by Ivoirian sexual minority rights groups, who have worked to distance themselves from travestis, framing them as recklessly indiscreet. In this paper, we examine the extent to which travestis' isolation has lessened in the wake of the post-election violence that followed Côte d'Ivoire's 2010 presidential election. We trace how Ivoirian travestis became increasingly vulnerable following the installation of a new national army that proved more hostile to them. And we show how, as a result of anti-travesti abuses committed by the army, nontravesti sexual minority activists became increasingly aware of the plight of travestis, and took steps to include them in their programming. These activists may have also been motivated by an increasing interest in transgender issues on the part of international donors. Finally, we explore the extent to which emerging human rights and HIV/AIDS programming has resulted in newly embodied positions for travestis as they confront identifications reflecting Western trans-spectrum identities.
Global Public Health , 2016
In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed... more In the fight against concentrated HIV epidemics, men who have sex with men (MSM) are often framed as a homogeneous population, with little attention paid to sexual and gender diversity and its impact on HIV vulnerability. This article draws on ethnographic research conducted in Abidjan, Côte d’Ivoire among les branchés – a local term encompassing several categories of same-sex desire and practice. In the context of increased HIV prevention programming targeting Ivoirian sexual and gender minorities, such diversity is effectively erased. This obfuscation of difference has particularly negative impacts for travestis, who may be at higher risk for HIV infection, though research and prevention efforts in which they are grouped with “MSM” render them underrepresented and make their vulnerability difficult to quantify. Branchés whose class and/or ethnic backgrounds compound their stigmatized status as sexual and gender minorities also bear the burden of this exclusion. Furthermore, some branchés deploy “MSM” as a form of self-identification, further complicating who such categories represent. By highlighting the ways in which constructions of gender and sexuality within HIV/AIDS programming obscure complex social realities, I aim to reorient thinking around the development of purposeful HIV programming that engages the complexity of sexual and gender minority experience.
Journal of Homosexuality, 2016
In Abidjan, Côte d’Ivoire, 18% of men who have sex with men (MSM) are HIV positive. This article ... more In Abidjan, Côte d’Ivoire, 18% of men who have sex with men (MSM) are HIV positive. This article is based on ethnographic research conducted among HIV peer educators and activists in Abidjan and examines their narratives and hand-drawn maps of city space. I draw on a methodological process of map-making to examine research participants’ evaluations of neighborhoods and link these evaluations to debates over national and cultural belonging in Côte d’Ivoire. I suggest a moral geography emerges from the maps and narratives and ask what the bioethical implications of moral geography are in the context of service delivery and activism among sexual minorities.
Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV preventi... more Introduction: Free or low-cost HIV testing, condoms, and lubricants are foundational HIV prevention strategies, yet are often inaccessible for men who have sex with men (MSM). In the global context of stigma and poor healthcare access, transgender (trans) MSM may face additional barriers to HIV prevention services. Drawing on data from a global survey of MSM, we aimed to describe perceived access to prevention services among trans MSM, examine associations between stigma and access, and compare access between trans MSM and cisgender (non-transgender) MSM. Methods: The 2014 Global Men's Health and Rights online survey was open to MSM (inclusive of trans MSM) from any country and available in seven languages. Baseline data (n 03857) were collected from July to October 2014. Among trans MSM, correlations were calculated between perceived service accessibility and anti-transgender violence, healthcare provider stigma, and discrimination. Using a nested matched-pair study design, trans MSM were matched 4:1 to cisgender MSM on age group, region, and HIV status, and conditional logistic regression models compared perceived access to prevention services by transgender status. Results: About 3.4% of respondents were trans men, of whom 69 were included in the present analysis. The average trans MSM participant was 26 to 35 years old (56.5%); lived in western Europe, North America, or Oceania (75.4%); and reported being HIV-negative (98.6%). HIV testing, condoms, and lubricants were accessible for 43.5, 53.6, and 26.1% of trans MSM, respectively. Ever having been arrested or convicted due to being trans and higher exposure to healthcare provider stigma in the past six months were associated with less access to some prevention services. Compared to matched cisgender controls, trans MSM reported significantly lower odds of perceived access to HIV testing (OR 00.57, 95% CI 00.33, 0.98) and condom-compatible lubricants (OR 00.54, 95% CI00.30, 0.98). Conclusions: This first look at access to HIV prevention services for trans MSM globally found that most reported inadequate access to basic prevention services and that they were less likely than cisgender MSM to have access to HIV testing and lubricants. Results indicate the need to enhance access to basic HIV prevention services for trans MSM, including MSM-specific services.
The chapter shows how studying African gender and sexual diversity movements allows scholars to r... more The chapter shows how studying African gender and sexual diversity movements allows scholars to reorient “northern” social movement theorizing in three ways. First, these movements challenge the distinction between “politics” and “culture.” Second, African gender and sexual diversity movements face complicated dilemmas related to the transnational patronage and funding. Third, African gender and sexual diversity movements disrupt the notion that queer movements are “identity movements,” an argument that overlooks gender and sexual diversity organizations’ survival efforts. This chapter constitutes one of the first essays synthesizing the lessons from African gender and sexual diversity movements for social movement theorizing.
The health and prevention benefits of antiretroviral therapies (ART), delivered as part of compre... more The health and prevention benefits of antiretroviral therapies (ART), delivered as part of comprehensive HIV care programs remain unrealized for men who have sex with men (MSM). This multilevel study explores the correlates of drop-off from the HIV care continuum in an international study of MSM, taking into account individual and regional differences in access to and utilization of care.
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Papers by Matthew Thomann
harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland.
Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n 5 72) and stakeholders (n 5 85) in 5 Maryland counties. We assessed PWUD’s experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs.
Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization.
Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates
a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched.
Methods: We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was “unreached” by the program, who then each identifed three respondents, resulting with data on 290 individuals.
Results: Findings illustrate the interconnectedness of community-based organization (CBO) members and nonmembers. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST.
Conclusion: Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.
harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs (PWUD) in Maryland.
Methods. In 2019, we conducted a rapid ethnographic assessment of and qualitative interviews with PWUD (n 5 72) and stakeholders (n 5 85) in 5 Maryland counties. We assessed PWUD’s experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs.
Results. The unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization.
Conclusions. The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates
a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched.
Methods: We undertook a socio-sexual network study to characterize and identify patterns of connection among MSM and inform an HIVST intervention in three sites in Kenya. Community researchers in each site selected eight seeds to complete a demographic form and network surveys for 15 each of their sexual and social network members. Seeds recruited three respondents, including two regular service users and one MSM who was “unreached” by the program, who then each identifed three respondents, resulting with data on 290 individuals.
Results: Findings illustrate the interconnectedness of community-based organization (CBO) members and nonmembers. In networks where a majority of members had a CBO membership, members had better contacts with programs and were more likely to have accessed health services. Larger networks had more HIV testing and seeds with frequent testing had a positive influence on their network members also being tested frequently. HIVST was tried in very few networks. Almost all network members were willing to use HIVST.
Conclusion: Willingness to use HIVST was nearly universal and points to the importance of networks for reaching individuals not enrolled in programs. Network analysis can help in understanding which type of networks had higher testing and how network-based approaches can be useful to promote HIVST in certain contexts.