Pascoe, Edwin (2022) Australian Gay Men and Type 2 Diabetes. PhD thesis, Victoria University.

Abstract

This study sought to understand the role sexual orientation has on gay males’ health journey with type 2 diabetes in the Australian context, and the extent to which it informs diabetes management and education. A diagnosis of type 2 diabetes increases the amount of health care related tasks a person must perform to maintain their health. The literature identified some unique issues that may affect a gay man’s journey with diabetes, including homophobia in sports, amyl usage, increased smoking, and increased stress. Further issues explored were binge eating disorders related to rejection by family, work, church, and the gay community. There is also an increase in erectile dysfunction and decreased engagement with the diabetes teams leading to increase complications and blood glucose levels. Gay men living alone exacerbated the feeling of a lack of support when facing the increased demands of living with type 2 diabetes. This was a mixed methods study consisting of two phases of data collection. The first phase was the collection of quantitative data consisting of social media posts and an online survey. The study was advertised using social media posts, where people were invited to comment or ask questions. The survey focused on 83 gay men with type 2 diabetes with no HIV; however, 82 gay men without type 2 diabetes and 13 gay men with both type 2 diabetes and HIV were included using separate questions to act as a possible benchmark. From the first phase, 12 gay men with type 2 diabetes volunteered to participate in interviews, and the qualitative data collected became the second phase of data collection, which also included two diabetes educators. The interviews were taped, transcribed, and analysed using reflexive thematic analysis. Three main themes were identified that affected a gay man’s journey with type 2 diabetes. The first theme was the consultation which was influenced by seven areas that included the sexualisation of gay men, the decision to come out, not knowing who has a negative attitude, disregard for the psychosocial, centrality versus we are all the same, the power of language, and culturally appropriate information. These seven areas can disengage recipients of diabetes education, blunting its potential effect in areas such as increased blood glucose monitoring, reducing complications, and escalation of insulin when required. The second theme included being uniquely gay, which described the effect of rejection experienced in areas such as the gay community, work, church, and family on eating (binge eating disorder) and exercise. The third theme centred around support, identifying areas where support can be different or challenged, such as the shift from a biological family to friends, living alone, marriage, barriers to discussing support, and children. The distillation of the findings was informed by Antonovsky’s Salutogenic model (1979) and the Bio-Medical Model and led to the development of Pascoe’s Journey of Life model. It contains five areas of departure or clarification from the Salutogenic model (1979) and brings into focus the quality of life and psychosocial issues for gay men with type 2 diabetes. As such, the Pascoe Journey of Life model will enable diabetes educators to tailor diabetes management that is personcentred focussed for the gay man and promote better health outcomes and associated quality of life.

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