Contemporary societal shifts are disrupting established professional divisions of labour in healthcare. Some have argued that professionalism itself is being transformed, with professions characterised less by claims to exclusive jurisdiction and more by connectivity and complementarity. This article puts these arguments to the test in a domain traditionally characterised as one of professional conflict: patient safety. Informed by the sociology of expertise, we consider the case of a new role-the patient safety specialist-constructed by some as a profession in the making. Drawing on three qualitative datasets comprising interview and focus group contributions from 71 participants, we find that patient safety specialists struggled to establish the legitimacy of their expertise in organisational environments that were often hostile. By forging alignments with the interests of clinical professionals, however, some advanced their roles in ways that served mutual interests, in line with recent theses on the changing nature of professionalism and the need for expertise that connects increasingly interdependent jurisdictions. The extent to which this advancement offered a solid and durable foundation for a claim to professional status, however, seemed more questionable.

Previous research suggests integrating pleasure into HIV prevention programming improves health outcomes. There are no existing reviews on how exactly pleasure is used within HIV public communications campaigns (PCCs). This manuscript investigates: (1) how HIV PCCs operationalise pleasure; and (2) the efficacy of pleasure-based HIV PCCs. EMBASE, Web of Science Core Collection and PsycINFO were searched for articles that present pleasure-based HIV PCCs on 13/12/2023 (PROSPERO ID: CRD42023487275) with no language restrictions. A narrative synthesis on pleasure operationalisation centred around three inductively coded categories: Enjoyment, Emotional Connection and Empowerment. Another narrative synthesis summarised efficacy data around six categories of HIV-related outcomes. 19,238 articles were retrieved, with 47 articles included in analysis, describing 29 campaigns. 65.5% of interventions operationalised Empowerment, 48.3% Enjoyment, and 31.0% Emotional Connection, with narrative synthesis highlighting the diverse ways this was achieved across target communities. An analysis of efficacy identified heterogeneous outcome reporting with inconsistent results across studies, but important outcomes, such as stigma reduction and condom use, were positively associated with intervention exposure across all relevant interventions. We highlight a range of mechanisms through which pleasure can be operationalised, which should inform future intervention development, even if the extant literature weakly supports the efficacy of such interventions.

Previous research has documented the various challenges people living with HIV face as they navigate intimate relationships, including what is often referred to as disclosure. In studies of gay, bisexual and other men who have sex with men, the issue of telling or not telling others about an HIV-positive status has been examined primarily in relation to communication with sexual partners, with few studies focusing on other aspects of intimacy. Drawing on interviews with gay men living with HIV, conducted in four clinics in London, this article explores the narratives of men who have been asked by female friends about the possibility of being a sperm donor. The narratives highlight layers of complexity which have received little attention, not only in research on HIV but also in studies of sperm donation and co-parenting. The article advances dialogue between these two largely separate bodies of work. Our data suggest that reluctance to share an HIV-positive status with others can be an important factor in deciding how to answer the 'sperm donor question'. Examining reproductive relationships of a specific kind - those based on friendships between women and gay men - the article develops the understanding of how secrecy about HIV shapes intimate lives.

BACKGROUND:Despite the availability of guidance for the provision of good end-of-life care, there are significant variations across the UK in its delivery. This study sought to identify the influences on end-of-life treatment and care planning across several areas where deficiencies in evidence-based practice have been identified, and to develop consensus among healthcare providers and users for recommendations on how to address these deficits. METHODS:An online survey (106 responses), qualitative interviews (55 participants) and a consensus-building exercise (475 participants in the initial round) were undertaken. Participants included people approaching the end of life, people important to them, and health and care practitioners who help people plan for the end of life or provide end-of-life care. Recruitment was via online methods, including social media and online newsletters of relevant charities and professional organisations. Thematic analysis using the framework method was used to analyse qualitative data. Synthesis of qualitative and quantitative data led to the development of statements regarding recommendations for advancing implementation of good practice. A two-stage consensus-building exercise asked respondents first to rate these statements and then to rate and rank further sub-recommendations in three areas. RESULTS:Results from the consensus building exercise confirmed that end-of-life care planning conversations are to be welcomed and encouraged, and that the priority should be to have the conversation (which could be initiated by a range of professionals, or people planning end-of-life care themselves), rather than to wait for an ideal time to have it. Further rounds identified specific components of a standardised record of end-of-life treatment and care preferences that should be prioritised, specific health and care staff that should be empowered through training in advanced communication, and aspects of communication most important to include in training for healthcare professionals. CONCLUSIONS:Our study has identified opportunities for action to improve end-of-life treatment and care by combining multiple stakeholder perspectives and building consensus among them: the resulting recommendations have sufficient granularity to be implemented and evaluated. They are of relevance to policy makers, those who train healthcare professionals, and those looking after patients approaching the end of life.

Objectives: While safety-dedicated professional roles are common in other high-risk industries, in health care they have tended to have a relatively narrow, technical focus. We present initial findings from a mixed-methods evaluation of a novel, senior role with responsibility for leadership of safety in English National Health Service organisations: the patient safety specialist. Methods: We conducted interviews with those responsible for designing, developing and overseeing the introduction of the role. We also carried out a national survey of current patient safety specialists. Data collection and analysis focused on the rationale for the role, its theory of change, and experiences of putting the theory into practice. Results: Interview participants articulated a clear theory of change for the role, highlighting ways in which the focus of the role, the seniority, responsibility and influence of role holders, and the expertise they brought might result in better safety management and speedier implementation of initiatives to manage risk and improve safety. Survey respondents had mixed experiences of the role to date, particularly in terms of material and symbolic support from their organisations. Together, findings from the two datasets indicated the need for a careful balance between strategic and operational activities to secure impact for patient safety specialists while ensuring they were embedded in the realities of clinical work as done—a balance that not all role holders found easy to achieve. Conclusions: The vision for the patient safety specialist role is clear, and supported by a plausible account of how the work of role holders might result in the intended objectives. The degree to which specialists are supported and resourced to deliver on these ambitions, however, varies markedly across organisations.

Since obstetrics and gynecology emerged as one of the first medical specialties in the late nineteenth century, the female reproductive body has been a key focus of scientific knowledge production. Understandings of how women’s health impacts the health of future children have expanded beyond science and medicine into the general public, reinforcing common associations of reproductive risk and responsibility with women’s bodies. It was not until relatively recently that questions about how men’s health affects reproductive outcomes received serious attention. In her second book, sociologist Rene Almeling asks why it took so long for these questions to be taken more seriously. Following the insightful Sex Cells: The Medical Market for Eggs and Sperm (2011), GUYnecology continues an exploration of how gender shapes medicine by looking at reproductive health more broadly while focusing on men in particular. In the book, using a variety of sources, Almeling examines biomedical knowledge about men’s reproductive health, from its production to its circulation and reception. But the main subject of analysis is not the knowledge itself but rather its relative lack or absence. Almeling is especially attentive to why a specific kind of knowledge is not produced in the first place and what happens when it is not widely shared.

Background Research on HIV and reproduction has focused largely on women and heterosexual men. This article examines whether it is relevant to address parenthood in HIV care with gay men and what ways of doing so are most appropriate. Methods Qualitative interviews were conducted at four London clinics with 25 men living with HIV, aged 20-45, who did not have children, and 16 HIV clinicians. A thematic analysis identified potential reasons why parenthood was rarely discussed with gay men in HIV care. Results Two sets of ideas contributed to a lack of conversations about parenthood: clinicians' ideas about what matters to gay men and men's ideas about what it means to be HIV-positive. Both sets of ideas largely excluded having children, with patients and practitioners similarly unlikely to raise the topic of parenthood in the clinic. Contrary to what clinician commonly assumed, many men expressed interest in receiving more information, highlighting the importance of reassuring people upon diagnosis that it is possible to become parents while living with HIV. Conclusions Parenting desires and intentions were rarely discussed with men in HIV care. Our findings illuminate the potentially beneficial effects of emphasising that having children is a possibility at diagnosis, regardless of patients' gender or sexuality. Conveying this information seems meaningful, not only to men who want to become parents in the future but also to others, as it appears to alleviate fears about mortality and ill health.

In the context of growing visibility, recognition and acceptance of lesbian motherhood and gay fatherhood in countries such as Britain, it is important to ask how younger generations of sexual minorities approach the possibility of becoming a parent. Drawing on interviews with lesbians and gay men who do not have children but may have them in the future, I explore how people become aware that having children is an option. By attending to how this consciousness manifests in conversations and how conversations shape the consciousness, I illuminate specific dynamics that raising the topic of parenthood creates in intimate interactions. My data show that it is often unclear to men and women who form same-sex relationships whether they are socially expected to have children. I argue that this ambiguity requires a kind of ‘coming out’ through which feelings about parenthood are made explicit. Using the concept of coming out, I ask: What if we were to think of people in terms of their ‘reproductive orientations’ rather than sexual identities? I suggest that, similar to expressing sexual identities, articulating reproductive orientations involves aligning with particular life trajectories based on binary logic. However, with ambiguous expectations about parenthood, neither having children nor remaining childfree is explicitly normative. As such, unlike coming out as lesbian or gay, which transgresses norms surrounding sexuality, coming out as wanting or not wanting to have children challenges normativity itself. I reflect on how this ‘normative challenge’ makes it possible to imagine parenthood and ‘childfreedom’ as intimacies of equal value.

It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that 'being undetectable' changes how HIV-positive gay men experience their sex lives. But how does it affect gay men's reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV-positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people's understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.

Medical Anthropology QuarterlyVolume 34, Issue 2 p. e21-e22 BOOK REVIEW Being a Sperm Donor: Masculinity, Sexuality and Biosociality in Denmark. Sebastian Mohr. New York: Berghahn Books, 2018, 198 pp. Robert Pralat, Robert Pralat University of CambridgeSearch for more papers by this author Robert Pralat, Robert Pralat University of CambridgeSearch for more papers by this author First published: 28 January 2020 https://doi.org/10.1111/maq.12568AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume34, Issue2June 2020Pages e21-e22 RelatedInformation

What does it mean to have a child 'by accident'? And why is parenthood so often described as happening 'accidentally', even when it is likely to involve at least some degree of intention? Drawing on interviews conducted in England and Wales with lesbians and gay men who do not have children but may have them in the future, this article explores the meanings of the notion that, as a same-sex couple, 'you can't have a child by accident' - a comment that interviewees frequently made unprompted when they were asked about the possibility of becoming parents. My data show that referring to 'accidental parenthood' is a common way of distinguishing one's experience of early adulthood from that of heterosexual people, especially among white, middle-class lesbians. As a closer reading of the data also suggests, parenthood that arguably happens by accident is often neither unforeseen nor unfortunate, and its currency as a point of reference reveals a powerful cultural narrative. When a wide range of reproductive behaviours are often deemed irresponsible because of their broadly defined timing, describing a pregnancy as an accident obscures responsibility. I argue that, to a certain extent, the discourse of accidental parenthood can serve to prevent moral judgements about reproductive decisions. Consequently, however, the 'inability' to have a child by accident makes the prospect of creating a family not only more complicated but also subject to greater scrutiny.

Heterosexual reproduction is often seen as normal and natural, with the two descriptors commonly understood as mutually reinforcing. I argue that, despite their apparent similarity, the meanings of “normal” and “natural” are distinct in important ways—a distinction that questions the positioning of lesbian motherhood and gay fatherhood as inferior. Through an analysis of lesbian, gay, and bisexual people’s ethical judgments about different ways of creating families, I show that pathways to parenthood that make a family appear “more normal” rely on means of reproduction that seem, in fact, “less natural.” Conversely, reproductive possibilities seen as “more organic” create families that depart more substantially from the cultural norm of the nuclear family. As a result of this tension, different pathways to parenthood can be justified as being “in children’s best interests.” However, while this children-centered justification can be flexibly applied, it also has contradictory meanings.

This article presents information about the social, legal and medical issues that medical and non-medical practitioners in the UKi should consider in order to signpost options for people living with HIV (PLWH) who are not in a heterosexual relationship and want to become parents. Despite significant medical advances, increased medical awareness among HIV practitioners and the ability to live a full life with HIV, stigma still exists around PLWH wanting to have children. There is a lack of awareness among the general public and the non-specialist medical community about the realities of living with HIV, and the options available to become a parent.Vertical transmission rates in the UK are very low (<0.5%).1 Despite this, even among PLWH it is evident that stigma surrounding parenting with HIV is real, with almost 50% of HIV-positive respondents in a European study saying that having HIV would be a barrier to them deciding to have a family.2 Irrespective of their sexual orientation, HIV-positive parents and prospective parents may bear the brunt of a historical HIV stigma, and the negative discourses that surround lesbian, gay, bisexual or transgendered/gender diverse (LGBT) parenting, despite the legal advances over the past decade.First steps to breaking down this stigma are to increase public awareness around the realities of living with HIV, and awareness among PLWH that being a parent is an option for them. In 2016 in London, the UNAIDS 90-90-90 target was achieved for the first time. England came close to meeting that target, with 88% of those living with HIV being diagnosed, 96% of those on HIV treatment and 97% of them having an undetectable viral load.3 Most PLWH taking antiretroviral medication therefore have undetectable levels of HIV in blood, meaning they cannot transmit HIV via sexual fluids.4 Despite this, …

My mum made a comment one day about, you know, being gay and having children.I went, 'Oh, you'll be a grandmother soon, don't worry!'And she's like, 'Oh, I didn't realize!'And that was fine.She's like, 'Oh, okay, whatever', you know … It wasn't an issue, basically.You know, she was neither supportive nor unsupportive, but just like, 'Alright, okay, it's fine.

In the scientific literature on fertility and assisted reproduction, and in the corresponding area of clinical practice, increasing attention has been paid to two groups: people living with the human immunodeficiency virus (HIV) and gay men. However, research on fertility in the context of HIV focuses almost exclusively on heterosexual couples, whereas studies on non-heterosexual reproduction rarely mention HIV, despite the fact that, in many western countries, HIV prevalence among men who have sex with men is higher than ever before and men who have sex with men are the only group in which new HIV infections are on the rise. This review identifies links between reproduction, HIV and homosexuality, showing that, historically, they are closely intertwined, which has important implications for current issues facing HIV care and fertility services. Considering sex and parenthood as two different but related kinds of intimacy and kinship, the dual role semen plays in sexually transmitted infection and in assisted reproduction is discussed. The review reflects on the future of sperm donation and HIV prevention, asking whether two challenges that potentially face healthcare and medicine today – the shortage of ‘high-quality’ sperm and the ‘surplus’ of infected semen – could be addressed by a greater exchange of knowledge.