We're Here: Subjugation and Resistance in Older HIV-Positive Gay Men’s Experiences of Seeking and Receiving Care across Health Settings

Despite the prominent role of systemic discrimination in impeding equitable access to health care among older HIV-positive gay men, this population’s subjective accounts of subjugation in health systems remain limited in the literature on gay aging. Accordingly, this qualitative study sought to investigate experiences of subjugation among older HIV-positive gay men in health settings, and to examine this population’s accounts of resistance to such mechanisms of marginality. To this end, 16 Toronto-based HIV-positive gay men over age 49 underwent semi-structured interviews in which they were asked to reflect on their cumulative experiences of seeking and receiving care in health settings. Drawing on poststructuralist traditions of grounded theory to inform data analysis, these accounts were then used as a basis from which to infer discursive processes of subjugation and resistance that may be most salient for older HIV-positive gay men in care contexts. The accounts of participants revealed, among other findings, (1) complex intersections of gay identity, HIV history, and aging experience as potential targets of subjugation and sources of resistance across health settings, and (2) the role of informal and formal HIV care networks in both reinforcing historical conditions of subjugation and catalyzing opportunities for change. Unique configurations of identity and life history, among other factors, often constituted grounds for variable experiences of subjugation in health settings among older HIV-positive gay men with diverse social locations. HIV care networks, though often entangled with the legacy of HIV stigma, appeared to potentiate resistance among those in this population. The study’s findings promise to inform the development of health care policies that more closely address the intersectionality of subjugation among older gay men living with HIV, along with practice initiatives that capitalize on the emancipatory potential of HIV care networks.