Papers by Nathaniel M Lewis
Research on sexual orientation and gender identities, such as lesbian, gay, bisexual, transgender... more Research on sexual orientation and gender identities, such as lesbian, gay, bisexual, transgender, and queer (LGBTQ), has been limited in health geography compared with other sub‐fields of the discipline. The reasons for this gap include both the logistical limitations of data on sexual orientation and the historical dominance of visible, measurable infectious, and chronic disease outcomes in medical geography research. While medical geographers were among the first to research HIV/AIDS diffusion among gay men, there is now something of a divide between qualitative geographers studying experience and embodiment and health science researchers examining the socio‐spatial determinants of LGBTQ health outcomes. In the following article, we review the LGBTQ health inequalities research, emerging geographies of mental health and substance use among those identified as LGBTQ, and potential avenues for health geographers to re‐engage with this field of study.
Background: An established body of research documents that sexual minority (i.e., lesbian, gay, a... more Background: An established body of research documents that sexual minority (i.e., lesbian, gay, and bisexual) populations are at higher risk for several adverse health behaviors and outcomes compared to their heterosexual counterparts. Smoking is one behavior where the gap is especially large, particularly among youth. Researchers have increasingly drawn attention to contextual determinants of health behaviors affecting sexual minority youth. Purpose: Although these factors have evolved over time, few scholars have examined time as a contextual factor that affects sexual minority health behaviors or the level of inequality with heterosexual populations. We aimed to fill this gap. Procedures: We used eight years of data from the Massachusetts Youth Risk Behavior Survey (MYRBS), pooled into four waves, to determine whether gaps between sexual minority and heterosexual youth have widened or narrowed for three different indicators of smoking: having ever smoked, early onset smoking, and daily cigarette smoking in the past 30 days. Results: We find that, though rates of smoking for all youth in Massachusetts have declined since the late 1990s, significant disparities remain between sexual minority and heterosexual youth. Conclusions: Findings may suggest that targeted tobacco control programs in Massachusetts are needed; perhaps shifts in social attitudes toward smoking have affected smoking behaviors in diverse segments of society.
The potential for queer perspectives to influence understanding social reproduction has been rais... more The potential for queer perspectives to influence understanding social reproduction has been raised in human geography subfields as diverse as migration studies (Silvey, 2004), population geography (Bailey, 2009) and economic geography (Pollard et al. 2009). The dynamics of social reproduction practices within broader queer (e.g., lesbian, gay, and other sexually non-normative) communities is still relatively under-explored in geography (but see Gieseking, 2013; Gorman-Murray, 2012). Most of my own work during the past decade explores the formation of urban queer communities in North America, population movements into and out of these communities, and patterns of health and wellbeing within them. While I had never set out to examine social reproduction until very recently (Lewis and Mills, 2016), the various queer life events that comprise my research (e.g., coming out, finding work, making friends, and dealing with illness) are also inherently reliant on social reproductive practices. Activism, organizing, and belonging are not just political tools enabling the advancement of legal equalities for queer people, but also everyday practices that allow queer families, neighborhoods, and communities to sustain themselves. In this sense, social reproduction is not just something that can be queered but also something that for a portion of the population has always been inherently queer.
Life course scholars have theorised the relationship between individual life trajectories and geo... more Life course scholars have theorised the relationship between individual life trajectories and geographic phenomena such as migration, partnering, reproduction and locational choice. They have engaged less frequently with the politics of fieldwork or the interrelationship of the life course and the field. Feminist geographers, in contrast, have made significant interventions into the social dynamics of fieldwork (e.g. relationships between researchers and participants), but less so on the life trajectories that precede and follow the fieldwork encounter. This special section thus contributes to both life course geographies and ongoing feminist interventions into the fieldwork process. In understanding fieldwork experiences through a life course approach, the contributors to this special section simultaneously deepen and systematise much of feminist geographic research on fieldwork. Their work highlights how life events and turning points, including those before, during and beyond fieldwork, can profoundly change – or be changed by – research experiences and outcomes. They also reveal how the trajectories of researchers, participants and the field itself become interconnected within specific historical times and contexts.
This article discusses the ways in which fieldwork transforms, and is transformed by, the life tr... more This article discusses the ways in which fieldwork transforms, and is transformed by, the life trajectories of researchers, participants and the field itself. I suggest that fieldwork interweaves the past training and ongoing development of the researcher, the personal and professional life courses of his/ her research participants, and the cultural and institutional histories of both academic fields and the physical sites in which fieldwork is conducted. Each of these life course strands involves geographically contingent subjectivities and perspectives that coalesce in fieldwork and lead to productive exchanges as well as conflicts. Early career researchers in particular may face extensive challenges negotiating these conflicts in the context of competitive and neo-liberal academic environments.
HIV surveillance systems show that gay, bisexual, and other men who have sex with men (MSM) bear ... more HIV surveillance systems show that gay, bisexual, and other men who have sex with men (MSM) bear a disproportionate burden of HIV in North American and European countries. Within the MSM category, HIV prevalence is often elevated among ethnic minority (i.e., Latino, Asian, and Black) MSM, many of whom are also foreign-born immigrants. Little research has focused specifically on foreign-born populations , though studies that provide data on the nativity of their samples offer an opportunity to investigate the potential role of transnational migration in informing HIV risk among ethnic minority MSM. This systematic review of ethnic minority MSM studies where the nativity of the sample is known provides a robust alternative to single studies measuring individual-level predictors of HIV risk behaviour. In this review, HIV prevalence, unprotected sex, drug use, and HIV testing are analysed in relation to the ethnicity, nativity, and location of the samples included. The results, which include high rates of HIV, unprotected sex, and stimulant use in foreign-born Latino samples and high rates of alcohol and club drug use in majority foreign-born Asian Pacific Islander (API) samples, provide baseline evidence for the theory of migration and HIV risk as syndemics within ethnic minority populations in North American and European countries. The findings also suggest that further research on the contextual factors influencing HIV risk among ethnic minority MSM groups and especially immigrants within these groups is needed. These factors include ethnic networks, individual post-migration transitions, and the gay communities and substance use cultures in specific destination cities. Further comparative work may also reveal how risk pathways differ across ethnic groups.
Gay men have been implicated in neoliberal urban development strategies (e.g. the creative city) ... more Gay men have been implicated in neoliberal urban development strategies (e.g. the creative city) as a 'canary' population that forecasts growth. Paradoxically, both neoliberal redevelopment of North American inner-cities and the ways in which gay men become neoliberalised as individuals contribute to the dissolution of urban gay communities. In contrast to discourses of homonorma-tivity, which suggest that gay men's declining attachments to gay communities stem from new equalities and consequent desires to assimilate into the mainstream, this article argues that gay men in DC have internalised neoliberal discourses that call for career development, home ownership and social hypermobilities. The narratives of 24 gay-identified men living in DC indicate that the social and spatial dissolution of the gay community is linked with individual aspirations that are increasingly difficult to achieve. These aspirations include career advancement in a transient local economy, property ownership in an out-of-reach market, and the attainment of social status based on an ability to move through multiple neighbourhoods and venues with ease. As might be expected, African American and working class men are often left beyond the fray of these new neoliberal ideals.
Previous research has understood the migrations of gay men and other queer people through a lens ... more Previous research has understood the migrations of gay men and other queer people through a lens of identity development, whereby relocation is driven by processes of coming out and consuming particular urban amenities. Meanwhile, labour geographers have largely overlooked sexuality, seeking to understand work-related migration in relation to gender, race, citizenship and the collective organization of workers. Drawing on the migration narratives of gay-identified men living in Ottawa, Canada, and Washington, DC, USA, we argue that the norms governing gender and sexuality within various workplaces, economic sectors and locales continuously influence migration related to work and inextricably linked processes of social reproduction. In particular, we explain how the affective needs of gay workers both deflect them from and attract them to particular locales and workplaces. In their migration destinations, gay workers tend to also transform the norms of social reproduction within workplaces and sectors. While gay workers may use migration to successfully negotiate the uneven landscapes of inclusion and visibility in North America, their agency is also constrained by the ongoing of regulation of sexuality in both workplaces and social and community environments.
Gay men’s health researchers in North America have recently attended to sexual and mental health ... more Gay men’s health researchers in North America have recently attended to sexual and mental health issues affecting ethnic minority men, many of whom are also immigrants. Most of this work is grounded in epidemiological models that focus on relationships between individual HIV risk and sexual behaviors. Consequently, they the frame the sexual health of gay and bisexual immigrants as the product of cultural issues (for example, family and religious homophobia, lack of health education) or gay community issues (prevalence of drug use and casual sex) that lead to self-devaluation, depression, and unprotected sex with multiple partners. Few studies, however, examine these phenomena through the lens of migration and resettlement. Using the narratives from twelve in-depth interviews with settlement and AIDS Service Organization (ASO) workers in Toronto, Ottawa, and London, Ontario, Canada, this article examines four types of post-migration urban encounters that influence sexual health: negotiations of resettlement-related stress, encounters with the urban gay community, encounters with the online gay community, and encounters with sexual health promotion itself. The findings suggest that these encounters are important intervening events that mediate the relationship between the attributes of the immigrant and his sexual health behaviors and outcomes. Keywords: gay,
immigrants, racism, HIV/AIDS, mental health, sexual health, Canada.
Researchers interested in sexual minority health are beginning to
examine contextual and environm... more Researchers interested in sexual minority health are beginning to
examine contextual and environmental determinants of health such as neighbourhoods, health services, and social policies. Efforts to catalogue and systematise policies relating to the health of lesbian, gay, and bisexual (LGB) individuals are therefore central in uncovering more comprehensive determinants of LGB health.This commentary identifies the links between social policy and LGB health, some methodological concerns of spatial analyses in this research area, and some future research directions. In particular, there is a need to integrate both migration and life course into understandings of the relationships between LGB health and jurisdictional policies.
Changes in gay and bisexual men’s connectedness to the gay community are related to the declining... more Changes in gay and bisexual men’s connectedness to the gay community are related to the declining public visibility of HIV/AIDS and greater acceptance for homosexuality and bisexuality in mainstream society. Little work, however, has focused on perceived acceptance for subgroups within the gay community or broader society. Using interviews (n = 20) and a survey (n = 202) of gay and bisexual men in a mid-sized Canadian city, we find perceived hierarchies of acceptance for the various subgroups as well as an age effect wherein middle-aged men perceive the least acceptance for all groups. These differences are linked with the uneven impact of social, political, and institutional changes relevant to gay and
bisexual men in Canada.
Research on HIV/AIDS among gay men in North America has departed from pure disease diffusion mode... more Research on HIV/AIDS among gay men in North America has departed from pure disease diffusion models to consider the social and environmental contexts where transmission may take place. Most of this work, however, focuses on large metropolitan areas and operationalizes the concept of place with only some degree of nuance. Large cities—and the bars, bathhouses, and gay villages within them—are often treated as
containers of attributes that contribute to and concretize HIV risk. This article therefore seeks to apply a critical, ecological conception of place to understanding HIV risk, education, and prevention among gay men in the small city-region of Halifax, Nova Scotia. Using in-depth interviews with HIV/AIDS-related service providers and self-identified gay men, the study highlights four dynamics of HIV risk potentially affecting gay
men in smaller cities and rural areas: (1) institutional ambivalence toward HIV education and messaging, (2)
narrow conceptions of risk, (3) migrations into unfamiliar social and sexual environments, and (4) social and structural barriers to health service utilization.
Research in the field of sexuality and space has begun to explore the relationships between gay a... more Research in the field of sexuality and space has begun to explore the relationships between gay and queer sexual
subjectivities and migration. Much of this research examines the regulation and policing of queer international migrants or identity formation processes among younger queer people migrating within countries. This study, although located partially within the second category, broadens and deepens existing accounts of gay men’s migrations within countries by focusing on life circumstances and events beyond an initial coming-out process and considering the migration experiences of gay men at multiple points in the life course. This study uses life course theory to contextualize the migration narratives of 48 self-identified gay men in Ottawa, Ontario, Canada,
and Washington, DC. The findings lend credence to recent claims that migration is central in the lives of gay men and other queer people but extends the concept of gay migration to include more than just the disclosure or initial development of a gay identity. They reframe migration as a tool used to negotiate a variety of life circumstances and transitions (e.g., establishing careers, creating meaningful community identities) rendered challenging by variegated landscapes of stigma and inclusion in North America.
An established body of research in psychology, psychiatry and epidemiology links social stigma an... more An established body of research in psychology, psychiatry and epidemiology links social stigma and stress with poor mental and sexual health outcomes among gay-identified men. Less work considers how these linkages are mediated by place and almost none considers the role of movement across places. This qualitative study, based on the migration narratives of 48 gay-identified men living in Ottawa, Ontario, Canada, and Washington, D.C., U.S.A. gives more careful consideration to the ways in which mental and emotional health issues (e.g., anxiety, depression, substance use) in this population both precipitate migration and stem from migration. The narratives show that decisions to migrate often emerge from men's experiences of place-based minority stress and associated health outcomes. At the same time, moving to urban gay communities, when coupled with other life circumstances, can create or reinforce physical and emotional insecurities that lead to low self-esteem, substance use and sexual risk-taking.
ACME: An International E-Journal for Critical Geographies, Aug 21, 2013
""This article contributes to the growing body of literature linking migration to coming out amon... more ""This article contributes to the growing body of literature linking migration to coming out among gay, lesbian, and other queer individuals. Much of the extant literature frames or imagines these migrations as journeys between sets of oppositional spaces. The common metaphorical trope of moving from inside to outside of “the closet” is frequently equated with moving from a conservative country to a more liberal one or from the homophobic countryside to an accepting metropolis. This discourse abstracts the role of place in coming-out migrations and flattens the complexity of the challenges and concerns that drive them. This analysis of migration narratives among 24 self-identified gay men living in Ottawa, Ontario, Canada, frames coming-out migrations as emerging from the complex interplay of individuals’ needs and desires and the networks and institutions they occupy in places (i.e., the social dynamics of places) and not just a flat “mismatch” between one’s sexuality and a place’s containerized attributes or characteristics. The discussion elaborates on motivators for coming-out migration influenced by the social dynamics of the places that respondents were both situated in and seeking out. These include moving to advance gay life courses perceived to be stunted, moving to seek anonymity during the coming-out process, and moving to lessen the imagined social and familial burdens associated with coming out.""
Gay villages, usually defined as spatially concentrated configurations of bars, entertainment ven... more Gay villages, usually defined as spatially concentrated configurations of bars, entertainment venues, community spaces, and homes associated with a gay-identified population, have received considerable attention from urban geographers studying gentrification. Frequently, gay villages have been critiqued as commodified spaces that serve mostly upper- and middle-class patrons. Yet they are also culturally and historically significant sites of mobilization, community building, and identity formation. During the last decade, media outlets in some North American cities have begun to dismiss gay villages as ‘declining’ or ‘dead.’ In models of ‘gay village evolution,’ decline is often positioned as a natural end precipitated by the commercialization and normalization of gay community spaces, the emergence of alternative venues in out-of-centre neighborhoods, and recent advancements in gay rights that render ‘safe’ spaces unnecessary. Using the case study of Ottawa, Canada’s Le/The Village, a gay village designated by the municipal government in November 2011, this paper argues that gay village decline, more a discursive trend than a foregone conclusion, is contingent upon both the historical and cultural particularities of cities and the intersecting subjectivities of those who encounter the village. The Ottawa case runs counter to discourse that dismisses gay villages as normalizing, over-commercialized, exclusionary, or simply passé. Using the narratives of 24 gay-identified men living in Ottawa, this article suggests that the absence of a village, as much as the creation and concretization of one, can perpetuate extant class and locational privilege within gay communities and that ‘new’ gay villages in smaller cities—perhaps more symbolic and psychic than capitalistic—may work to challenge the perpetuation of privilege.
Health & Place, 2009
This meta-analysis featuring 12 national adult studies and 16 state/regional youth studies of sex... more This meta-analysis featuring 12 national adult studies and 16 state/regional youth studies of sexuality and mental health finds that sexual minorities—as a likely consequence of place-contingent minority stress—experience mental health outcomes such as depression, anxiety, and suicide ideation much more frequently than their heterosexual counterparts. By interrogating the geographic variations in the findings, such as high rates of poor mental health outcomes in the United Kingdom, large gay-heterosexual disparities in the Netherlands, and lower and improving rates of both outcomes and risk factors in Vermont and British Columbia, this study asserts that policy regimes, health programming, and the ways in which sexual minorities are constructed in places all contribute to their mental health.
Sexual Health
Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates... more Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada’s major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments.
Social & Cultural Geography, 2012
Drawing on recent work that examines the contingent, personal nature of queer migration, this pap... more Drawing on recent work that examines the contingent, personal nature of queer migration, this paper provides empirical support for recent claims that coming-out journeys are more complex than the linear, often rural-to-urban typologies that have framed them during the past two decades. Since coming-out journeys are rarely elaborated beyond a conceptual level, overly teleological understandings involving homophobic, rural places, inclusive urban homelands, and one-time, linear ‘flights’ and ‘escapes’ persist. Employing the migration narratives of 48 self-identified gay men who settled in Ottawa, Ontario, Canada, and Washington, DC, USA, this paper challenges the linearity and finality of coming-out migration by highlighting particular segments of the journey. These include short-term trips to scout the gay life potentials of places, migrations that result in a degree of re-entry into ‘the closet,’ relocations that allow men to test or try on different places and identities, and moves (or imminent moves) that ‘trigger’—rather than stem from—a coming-out process. Taken together, these segments suggest that coming-out journeys are ongoing, relational, and often discontinuous journeys influenced by both queer individuals' intersectional subjectivities (e.g., age, race, and class) and the social contexts of the places they encounter.
Gender, Place & Culture
This case study examines Ottawa, Canada, a ‘government town’, as both a destination for mobile ga... more This case study examines Ottawa, Canada, a ‘government town’, as both a destination for mobile gay men and a place where their conduct historically has been regulated by the government and military institutions located there. By placing the findings of 24 in-depth qualitative interviews with self-identified gay men in a Foucauldian governmentality framework, I argue that the government town is a powerful attractor for gay men in terms of economic opportunity and official prescriptions of nondiscrimination and acceptance, but is also a site where gay men and gay communities are regulated into certain modes of conduct. In particular, this article finds that Ottawa, as both a historic center of antigay activity and a more recent center of an LGBT (lesbian, gay, bisexual, transgendered) rights-seeking agenda in Canada, encourages practices that are based on discretion, gender normalization, and maintenance of the status quo. The article argues that these practices – with some notable exceptions – have led to a fragmented gay community characterized by economic and professional stratification, out-of-town consumption of gay culture, and a lack of recognizable social, political, and geographic focal points for gay men. It also posits that the mechanisms through which governmentality is leveraged are particularly central to the experiences of sexual minorities in places like Ottawa, where government institutions are especially dense or thick.
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Papers by Nathaniel M Lewis
immigrants, racism, HIV/AIDS, mental health, sexual health, Canada.
examine contextual and environmental determinants of health such as neighbourhoods, health services, and social policies. Efforts to catalogue and systematise policies relating to the health of lesbian, gay, and bisexual (LGB) individuals are therefore central in uncovering more comprehensive determinants of LGB health.This commentary identifies the links between social policy and LGB health, some methodological concerns of spatial analyses in this research area, and some future research directions. In particular, there is a need to integrate both migration and life course into understandings of the relationships between LGB health and jurisdictional policies.
bisexual men in Canada.
containers of attributes that contribute to and concretize HIV risk. This article therefore seeks to apply a critical, ecological conception of place to understanding HIV risk, education, and prevention among gay men in the small city-region of Halifax, Nova Scotia. Using in-depth interviews with HIV/AIDS-related service providers and self-identified gay men, the study highlights four dynamics of HIV risk potentially affecting gay
men in smaller cities and rural areas: (1) institutional ambivalence toward HIV education and messaging, (2)
narrow conceptions of risk, (3) migrations into unfamiliar social and sexual environments, and (4) social and structural barriers to health service utilization.
subjectivities and migration. Much of this research examines the regulation and policing of queer international migrants or identity formation processes among younger queer people migrating within countries. This study, although located partially within the second category, broadens and deepens existing accounts of gay men’s migrations within countries by focusing on life circumstances and events beyond an initial coming-out process and considering the migration experiences of gay men at multiple points in the life course. This study uses life course theory to contextualize the migration narratives of 48 self-identified gay men in Ottawa, Ontario, Canada,
and Washington, DC. The findings lend credence to recent claims that migration is central in the lives of gay men and other queer people but extends the concept of gay migration to include more than just the disclosure or initial development of a gay identity. They reframe migration as a tool used to negotiate a variety of life circumstances and transitions (e.g., establishing careers, creating meaningful community identities) rendered challenging by variegated landscapes of stigma and inclusion in North America.
immigrants, racism, HIV/AIDS, mental health, sexual health, Canada.
examine contextual and environmental determinants of health such as neighbourhoods, health services, and social policies. Efforts to catalogue and systematise policies relating to the health of lesbian, gay, and bisexual (LGB) individuals are therefore central in uncovering more comprehensive determinants of LGB health.This commentary identifies the links between social policy and LGB health, some methodological concerns of spatial analyses in this research area, and some future research directions. In particular, there is a need to integrate both migration and life course into understandings of the relationships between LGB health and jurisdictional policies.
bisexual men in Canada.
containers of attributes that contribute to and concretize HIV risk. This article therefore seeks to apply a critical, ecological conception of place to understanding HIV risk, education, and prevention among gay men in the small city-region of Halifax, Nova Scotia. Using in-depth interviews with HIV/AIDS-related service providers and self-identified gay men, the study highlights four dynamics of HIV risk potentially affecting gay
men in smaller cities and rural areas: (1) institutional ambivalence toward HIV education and messaging, (2)
narrow conceptions of risk, (3) migrations into unfamiliar social and sexual environments, and (4) social and structural barriers to health service utilization.
subjectivities and migration. Much of this research examines the regulation and policing of queer international migrants or identity formation processes among younger queer people migrating within countries. This study, although located partially within the second category, broadens and deepens existing accounts of gay men’s migrations within countries by focusing on life circumstances and events beyond an initial coming-out process and considering the migration experiences of gay men at multiple points in the life course. This study uses life course theory to contextualize the migration narratives of 48 self-identified gay men in Ottawa, Ontario, Canada,
and Washington, DC. The findings lend credence to recent claims that migration is central in the lives of gay men and other queer people but extends the concept of gay migration to include more than just the disclosure or initial development of a gay identity. They reframe migration as a tool used to negotiate a variety of life circumstances and transitions (e.g., establishing careers, creating meaningful community identities) rendered challenging by variegated landscapes of stigma and inclusion in North America.