Sexuality Research and Social Policy

, Volume 16, Issue 1, pp 121–133 | Cite as

Across Serostatus: a Study of Subjugation and Resistance in Older Gay Men’s Experiences Navigating Health Care

  • Hannah KiaEmail author
  • Daniel Grace
  • Carol Strike
  • Lori E. Ross


Despite the recognition of older gay men’s unique health needs, the health care experiences of this group have seldom been explored empirically. Accordingly, in this qualitative study, we utilize a poststructuralist approach to grounded theory known as situational analysis to examine older gay men’s experiences with health care. Specifically, we draw on interviews with 27 gay men ages 50 and over, 16 of whom disclosed being HIV-positive at the time of recruitment, to consider this group’s interactions with formal health systems. We analyze how processes of subjugation and resistance are reflected in older gay men’s narrative accounts of navigating health care, and in this process, highlight the role of the HIV/AIDS epidemic in constructing health care as a site of subjugation and resistance for these men. We inductively examine discourses, interpretations of medical practices, and constructions of aging gay bodies that together reflect the historical and contemporary role of HIV/AIDS in shaping present day systems of heath care for older gay men. We conclude the paper with implications for research and policy in the area of gay aging, including the need for specialized psychosocial services targeting the needs of older gay men in health systems.


Aging Older adults Gay men Health care Situational analysis Foucauldian governmentality 



Hannah Kia received funding from Canadian Institutes of Health Research (#336906) to conduct the research on which the current manuscript is based.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the University of Toronto’s HIV Research Ethics Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Of note, the study underwent review and approval by the University of Toronto’s HIV Research Ethics Board (#33523) prior to the start of participant recruitment.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Addis, S., Davies, M., Greene, G., MacBride-Stewart, S., & Shepherd, M. (2009). The health social care and housing needs of lesbian, gay, bisexual and transgender older people: A review of the literature. Health and Social Care in the Community, 17, 647–658.CrossRefGoogle Scholar
  2. Berard, T. J. (1999). Michel Foucault, The History of Sexuality, and the reformulation of social theory. Journal for the Theory of Social Behaviour, 29, 203–227.CrossRefGoogle Scholar
  3. Brier, J. (2009). Infectious ideas: US political responses to the AIDS crisis. Chapel Hill, NC: University of North Carolina Press.Google Scholar
  4. Chambré, S. M. (2006). Fighting for our lives: New York’s AIDS community and the politics of disease. Piscataway, NJ: Rutgers University Press.Google Scholar
  5. Clarke, A. E. (2003). Situational analyses: Grounded theory mapping after the postmodern turn. Symbolic Interaction, 26, 553–576.CrossRefGoogle Scholar
  6. Clarke, A. E., Friese, C., & Washburn, R. S. (2015). Situational analysis: grounded theory after the interpretive turn. Los Angeles, CA: Sage.Google Scholar
  7. Clover, D. (2006). Overcoming barriers for older gay men in the use of health services: A qualitative of study of growing older, sexuality and health. Health Education Journal, 65, 41–52.CrossRefGoogle Scholar
  8. Cole, C. (1996). Containing AIDS: Magic Johnson and post [Reagan] America. In S. Seidman (Ed.), Queer theory/sociology (pp. 280–310). Cambridge, UK: Blackwell.Google Scholar
  9. Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.Google Scholar
  10. Cronin, A., & King, A. (2014). Only connect? Older lesbian, gay and bisexual (LGB) adults and social capital. Ageing and Society, 34, 258–279.CrossRefGoogle Scholar
  11. Elliot, M. N., Kanouse, D. E., Burkhart, Q., Abel, G. A., Lyratzopoulos, G., Beckett, M. K., Schuster, M. A., & Roland, M. (2014). Sexual minorities in England have poorer health and worse health care experiences: A national survey. Journal of General Internal Medicine, 30, 9–16.CrossRefGoogle Scholar
  12. Emlet, C. A. (2006). “You’re awfully old to have this disease”: Experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. The Gerontologist, 46, 781–790.CrossRefGoogle Scholar
  13. Emlet, C. A., Fredriksen-Goldsen, K. I., Kim, H.-J., & Hoy-Ellis, C. (2017). The relationship between sexual minority stigma and sexual health risk behaviors among HIV-positive older gay and bisexual men. Journal of Applied Gerontology, 36, 931–952.CrossRefGoogle Scholar
  14. Emlet, C. A., Shiu, C., Kim, H.-J., & Fredriksen-Goldsen, K. I. (2017). Bouncing back: Resilience and mastery among HIV-positive older gay and bisexual men. Gerontologist, 57, S40–S49.CrossRefGoogle Scholar
  15. Epstein, S. (1989). Impure science: AIDS, activism, and the politics of knowledge. Berkeley, CA: University of California Press.Google Scholar
  16. Fenkl, E. A. (2012). Aging gay men: A review of the literature. Journal of LGBT Issues in Counselling, 6, 162–182.CrossRefGoogle Scholar
  17. Foucault, M. (2000). The subject and power. In W. J. Faubion (Ed.), Power (pp. 326–348). New York: New Press.Google Scholar
  18. Foucault, M. (2008). The birth of biopolitics: lectures at the Collège de France 1978–1979. New York: Palgrave Macmillan.Google Scholar
  19. Fredriksen-Goldsen, K. I., Hoy-Ellis, C. P., Goldsen, J., Emlet, C. A., & Hooyman, N. R. (2014). Creating a vision for the future: Key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender older adults in the health and human services. Journal of Gerontological Social Work, 57, 80–107.CrossRefGoogle Scholar
  20. Fredriksen-Goldsen, K. I., & Muraco, A. (2010). Aging and sexual orientation: A 25-year review of the literature. Research on Aging, 32, 372–413.CrossRefGoogle Scholar
  21. Fredriksen-Goldsen, K. I., Kim, H.-J., Muraco, A., & Mincer, S. (2009). Chronically ill midlife and older lesbians, gay men, bisexuals and their informal caregivers: The impact of the social context. Sexuality Research & Social Policy, 6, 52–64.CrossRefGoogle Scholar
  22. Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., Goldsen, J., & Petry, H. (2011). The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health.Google Scholar
  23. Gane, N. (2010). The governmentalities of neoliberalism: Panopticism, post-panopticism and beyond. The Sociological Review, 60, 611–634.Google Scholar
  24. Gardner, A. T., de Vries, B., & Mockus, D. S. (2014). Aging out in the desert: Disclosure, acceptance, and service use among midlife and older lesbians and gay men. Journal of Homosexuality, 61, 129–144.CrossRefGoogle Scholar
  25. Grace, D., Jollimore, J., MacPherson, P., Strang, M. J., & Tan, D. H. (2018). The pre-exposure prophylaxis-stigma paradox: Learning from Canada’s first wave of PrEP users. AIDS Patient Care and STDs, 32(1), 24–30.CrossRefGoogle Scholar
  26. Institute of Medicine. (2011) Later adulthood. In Institute of Medicine (Ed.), The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding (pp. 251–292). Washington, DC: National Academies Press.Google Scholar
  27. King, N. (1995). HIV and the gay male community: one clinician's reflections over the years. In G. M. Herek & B. Greene (Eds.), AIDS, identity and community: The HIV epidemic and lesbians and gay men (pp. 1–18). Thousand Oaks, CA: Sage.Google Scholar
  28. King, A. (2016). Older lesbian, gay and bisexual adults: Identities, intersections and institutions. New York: Routledge.CrossRefGoogle Scholar
  29. Lyons, A., Pitts, M., & Grierson, J. (2012). Growing old as a gay man: Psychosocial well-being of a sexual minority. Research on Aging, 35, 275–295.CrossRefGoogle Scholar
  30. Lyons, A., Pitts, M., Grierson, J., Thorpe, R., & Power, J. (2010). Ageing with HIV: Health and psychosocial well-being of older gay men. AIDS Care, 22, 1236–1244.CrossRefGoogle Scholar
  31. Masten, J. (2015). “A shrinking kind of life”: Gay men’s experience of aging with HIV. Journal of Gerontological Social Work, 58, 319–337.CrossRefGoogle Scholar
  32. McIlvenny, P., Klausen, J. Z., & Lindegaard, L. B. (2016). New perspectives on discourse and governmentality. In P. McIlvenny, J. Z., Klausen L. B., Lindegaard (Eds.), Studies of discourse and governmentality: New perspectives and methods (pp. 1–70). Philadelphia, PA: John Benjamins.Google Scholar
  33. McNutt, B., & Yakushko, O. (2013). Disenfranchised grief among lesbian and gay bereaved individuals. Journal of LGBT Issues in Counselling, 7, 87–116.CrossRefGoogle Scholar
  34. Owen, G., & Catalan, J. (2012). “We never expected this to happen”: Narratives of ageing with HIV among gay men living in London, UK. Culture, Healthy & Sexuality, 14(1), 59–72.CrossRefGoogle Scholar
  35. Parker, R., Aggleton, P., & Perez-Brumer, A. G. (2016). The trouble with ‘categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion. Global Public Health, 11, 819–823.CrossRefGoogle Scholar
  36. Rosenfeld, D., Bartlam, B., & Smith, R. D. (2012). Out of the closet and into the trenches: Gay male baby boomers, aging, and HIV/AIDS. The Gerontologist, 52, 255–264. Scholar
  37. Walters, W. (2012). Foucault, power and governmentality. In W. Walters (Ed.), Governmentality: critical encounters (pp. 9–43). New York: Routledge.CrossRefGoogle Scholar
  38. Wight, R. G., Leblanc, A. J., de Vries, B., & Detels, R. (2012). Stress and mental health among midlife and older gay-identified men. American Journal of Public Health, 102, 503–510.CrossRefGoogle Scholar
  39. Yuval-Davis, N. (2006). Intersectionality and feminist politics. European Journal of Women’s Studies, 13(3), 193–209.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of TorontoTorontoCanada

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