Background: Research has shown that clinicians are not comfortable managing sexual dysfunction (SD), and there are gaps in the SD-specific training of medical students in the US and the UK. However, there is little research into the extent of SD-specific training needs and learning experiences of Australian medical students. This study aims to explore the extent of students' learning experiences and training gaps in the postgraduate medical curriculum at one Australian university.
Methods: The study was completed as part of the Doctor of Medicine program requirement, and due ethics approval was obtained. An anonymous 10-item online questionnaire, including one open-ended question was created and distributed to all final-year medical students at the University of Sydney. Data were analysed using descriptive and analytical statistical measures, and a thematic analysis was used for the open-ended question.
Results: There are 252 final-year medical students at the University of Sydney, of which 31 students completed the questionnaire, giving a 12% response rate. Of the 31 respondents, the majority of students reported that they never (n =7; 23%) or rarely (n =16; 52%) had opportunities to interact with patients presenting with SD throughout their training. Erectile dysfunction was the topic that all students had some training, whereas female orgasmic disorder was the topic that students had the least training. Of all the students who reported receiving training in the medication/substance-induced SD (n =26), one in two (n =14, 54%) reported feeling unprepared. Only 55% of students (n =17) felt comfortable to initiate discussions around SD with patients, whereas 84% of students (n =26) felt comfortable to discuss SD when the patient initiated the conversation. Students expressed a need for training on how to address these sensitive topics with patients, with more emphasis on the management of SD.
Conclusion: The data suggests that the current medical curriculum at the University of Sydney does offer some training in SD, but it is not adequate enough to confidently and comfortably manage SD. Considerations should be made to the curriculum to facilitate a broader recognition and understanding of SD and to prepare future clinicians to adequately address and manage SD.
{"title":"Sexual dysfunction: a study on learning experience of Australian medical students.","authors":"Vijayasarathi Ramanathan, Maya Sawaqed","doi":"10.1071/SH23172","DOIUrl":"10.1071/SH23172","url":null,"abstract":"<p><strong>Background: </strong>Research has shown that clinicians are not comfortable managing sexual dysfunction (SD), and there are gaps in the SD-specific training of medical students in the US and the UK. However, there is little research into the extent of SD-specific training needs and learning experiences of Australian medical students. This study aims to explore the extent of students' learning experiences and training gaps in the postgraduate medical curriculum at one Australian university.</p><p><strong>Methods: </strong>The study was completed as part of the Doctor of Medicine program requirement, and due ethics approval was obtained. An anonymous 10-item online questionnaire, including one open-ended question was created and distributed to all final-year medical students at the University of Sydney. Data were analysed using descriptive and analytical statistical measures, and a thematic analysis was used for the open-ended question.</p><p><strong>Results: </strong>There are 252 final-year medical students at the University of Sydney, of which 31 students completed the questionnaire, giving a 12% response rate. Of the 31 respondents, the majority of students reported that they never (n =7; 23%) or rarely (n =16; 52%) had opportunities to interact with patients presenting with SD throughout their training. Erectile dysfunction was the topic that all students had some training, whereas female orgasmic disorder was the topic that students had the least training. Of all the students who reported receiving training in the medication/substance-induced SD (n =26), one in two (n =14, 54%) reported feeling unprepared. Only 55% of students (n =17) felt comfortable to initiate discussions around SD with patients, whereas 84% of students (n =26) felt comfortable to discuss SD when the patient initiated the conversation. Students expressed a need for training on how to address these sensitive topics with patients, with more emphasis on the management of SD.</p><p><strong>Conclusion: </strong>The data suggests that the current medical curriculum at the University of Sydney does offer some training in SD, but it is not adequate enough to confidently and comfortably manage SD. Considerations should be made to the curriculum to facilitate a broader recognition and understanding of SD and to prepare future clinicians to adequately address and manage SD.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Warzywoda, James A Fowler, Joe Debattista, Deborah J Mills, Luis Furuya-Kanamori, Jo Durham, Colleen L Lau, Amy B Mullens, Satrio Nindyo Istiko, Carlos Santaolaya, Juhi Malhotra, Judith A Dean
Background: International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice.
Methods: A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference.
Results: Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH.
Conclusion: Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.
{"title":"The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians.","authors":"Sarah Warzywoda, James A Fowler, Joe Debattista, Deborah J Mills, Luis Furuya-Kanamori, Jo Durham, Colleen L Lau, Amy B Mullens, Satrio Nindyo Istiko, Carlos Santaolaya, Juhi Malhotra, Judith A Dean","doi":"10.1071/SH23098","DOIUrl":"10.1071/SH23098","url":null,"abstract":"<p><strong>Background: </strong>International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice.</p><p><strong>Methods: </strong>A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference.</p><p><strong>Results: </strong>Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH.</p><p><strong>Conclusion: </strong>Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rena Janamnuaysook, Yan Guo, Yeon Jung Yu, Nittaya Phanuphak, Surinda Kawichai, Karen MacDonell, Thidarat Jupimai, Chokechai Rongkavilit, Bo Wang
Background: Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation.
Methods: We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis.
Results: Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk.
Conclusions: The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.
{"title":"Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study.","authors":"Rena Janamnuaysook, Yan Guo, Yeon Jung Yu, Nittaya Phanuphak, Surinda Kawichai, Karen MacDonell, Thidarat Jupimai, Chokechai Rongkavilit, Bo Wang","doi":"10.1071/SH23102","DOIUrl":"10.1071/SH23102","url":null,"abstract":"<p><strong>Background: </strong>Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation.</p><p><strong>Methods: </strong>We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis.</p><p><strong>Results: </strong>Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk.</p><p><strong>Conclusions: </strong>The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lydia Jacenta Nakiganda, Benjamin R Bavinton, Isobel Mary Poynten, David Serwadda, Jeremiah Mulamba Bazaale, Andrew E Grulich
Background: Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda.
Methods: In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP.
Results: Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR=1.19, 95% CI=1.07-1.32, P =0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) and being On PrEP for the past 1-2years (aPR=1.18, 95% CI=1.00-1.38, P =0.032) was significantly associated with HIV-related worry (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) Conclusions : We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.
背景:在乌干达,女性性工作者(FSWs)在 HIV 传播中的比例过高,而接触前预防疗法(PrEP)可有效预防同性女性感染 HIV。心理因素对 PrEP 的采用非常重要,但很少有研究对乌干达因使用 PrEP 而产生的社会心理变化进行研究:2021 年,我们在乌干达西南部的三个泛非公路城镇和四个渔业社区招募了 524 名女性同性恋者。我们在六个医疗单位对参加 PrEP 常规随访的女性进行了结构化访谈。我们使用稳健协方差矩阵估计器进行了二变量和多变量修正回归,以确定与因 PrEP 而增加性快感和减少对 HIV 的担忧相关的因素:总体而言,80.9%的参与者表示由于服用了 PrEP,性生活更加愉悦。有统计趋势表明,在服用 PrEP 或与临时付费伴侣进行无套性行为时,性生活会更加愉悦(aPR=1.19,95% CI=1.07-1.32,P=0.001)。近四分之三的参与者(76.3%)因为服用了 PrEP 而减少了对感染 HIV 的担忧。与临时付费伴侣发生的无保险套性行为(aPR=1.17,95% CI=1.05-1.31,P=0.032,P=0.003)和在过去 1-2 年中接受过 PrEP 治疗(aPR=1.18,95% CI=1.00-1.38,P=0.032)与艾滋病相关担忧显著相关(aPR=1.17,95% CI=1.05-1.31,P=0.032,P=0.003)。结论:我们发现,PrEP 对乌干达的 FSWs 在两个关键的社会心理方面产生了积极的影响:(1)性生活更加愉悦;(2)对感染 HIV 的担忧减少。旨在提高 PrEP 使用率的干预措施可能会发现关注社会心理层面是有益的。
{"title":"Sexual pleasure and HIV-related worry in female sex workers on oral pre-exposure prophylaxis in south-western Uganda.","authors":"Lydia Jacenta Nakiganda, Benjamin R Bavinton, Isobel Mary Poynten, David Serwadda, Jeremiah Mulamba Bazaale, Andrew E Grulich","doi":"10.1071/SH23056","DOIUrl":"10.1071/SH23056","url":null,"abstract":"<p><strong>Background: </strong>Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda.</p><p><strong>Methods: </strong>In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP.</p><p><strong>Results: </strong>Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR=1.19, 95% CI=1.07-1.32, P =0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) and being On PrEP for the past 1-2years (aPR=1.18, 95% CI=1.00-1.38, P =0.032) was significantly associated with HIV-related worry (aPR=1.17, 95% CI=1.05-1.31, P =0.032, P =0.003) Conclusions : We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhuoheng Yin, Rayner Kay Jin Tan, Joseph D Tucker, Quanmin Li, Renslow Sherer, Linghua Li, Weiming Tang
Background: Emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) fixed-dose combination (FTC/TDF) is generally well-tolerated, although treatment-related adverse events have been reported.
Methods: We report two cases of persons using FTC/TDF PrEP who had acute neuralgia in a Chinese PrEP demonstration trial.
Results: Neurological symptoms subsided upon treatment discontinuation. Symptoms were reported as similar to one case's previous experiences with dolutegravir (DTG)+FTC+tenofovir alafenamide (TAF) (for PEP), leading to permanent discontinuation of PrEP.
Conclusion: Acute facial neuralgia appears to be a rare idiosyncratic adverse event to FTC/TDF.
{"title":"Acute facial neuralgia related to initiation of emtricitabine/tenofovir for HIV PrEP: a report of two cases in a PrEP demonstration trial.","authors":"Zhuoheng Yin, Rayner Kay Jin Tan, Joseph D Tucker, Quanmin Li, Renslow Sherer, Linghua Li, Weiming Tang","doi":"10.1071/SH23129","DOIUrl":"10.1071/SH23129","url":null,"abstract":"<p><strong>Background: </strong>Emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) fixed-dose combination (FTC/TDF) is generally well-tolerated, although treatment-related adverse events have been reported.</p><p><strong>Methods: </strong>We report two cases of persons using FTC/TDF PrEP who had acute neuralgia in a Chinese PrEP demonstration trial.</p><p><strong>Results: </strong>Neurological symptoms subsided upon treatment discontinuation. Symptoms were reported as similar to one case's previous experiences with dolutegravir (DTG)+FTC+tenofovir alafenamide (TAF) (for PEP), leading to permanent discontinuation of PrEP.</p><p><strong>Conclusion: </strong>Acute facial neuralgia appears to be a rare idiosyncratic adverse event to FTC/TDF.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Avallone, Kim Engler, Joseph Cox, Ford Hickson, David Lessard, Jeanne Bourdon, Réjean Thomas, Bertrand Lebouché
Background: Gay, bisexual, and other men (GBM) who have sex with men living with HIV in serodifferent couples (one partner living with HIV, the other HIV-negative) may encounter unique sexual health challenges. This study aimed to explore their definition of sexual health that could improve service provision.
Methods: We interviewed 10 gay-identified men living with HIV from 2017 to 2019 as part of CTNPT013, a study on the sexual health of HIV serodifferent GBM couples conducted at two HIV-specialised clinics in Montreal, Canada. Participants partook in semi-structured interviews on the meaning of sexual health. We performed a content analysis of interview transcripts, coding them according to the 10 dimensions of Robinson's Sexual Health Model.
Results: Mean age of interviewees was 35.4years (s.d.,10.2; range, 20-53). Every dimension of Robinson's model was spontaneously evoked, except for body image and spirituality. All men indicated intimacy/relationships (e.g. sexual agreements) and sexual health care/safer sex (e.g. HIV management, risk behaviours) as relevant aspects of sexual health. Other dimensions included: positive sexuality (n =7), such as pleasure and enjoyment during sex; talking about sex (n =5), which mainly concerned HIV disclosure; sexual functioning (n =4); challenges to sexual health (n =3), including substance abuse; and culture/sexual identity (n =3). Two participants (n =2) cited masturbation/fantasy.
Conclusions: This study emphasises the multi-faceted nature of sexual health for gay men with HIV in serodifferent couples and the pivotal roles of relationships, HIV, risk management (e.g. via health care, knowledge), and positive sexual experiences. These dimensions could be considered in sexual health promotion interventions targeting this population.
背景:在血清不同的伴侣(一方感染 HIV,另一方 HIV 阴性)中与感染 HIV 的男性发生性行为的男同性恋、双性恋和其他男性(GBM)可能会遇到独特的性健康挑战。本研究旨在探讨他们对性健康的定义,从而改进服务的提供:作为 CTNPT013 的一部分,我们在 2017 年至 2019 年期间采访了 10 名感染 HIV 的男同性恋者,该研究是在加拿大蒙特利尔的两家 HIV 专科诊所进行的一项关于 HIV 血清不同的 GBM 夫妇性健康的研究。参与者参加了关于性健康意义的半结构化访谈。我们对访谈记录进行了内容分析,并根据罗宾逊性健康模型的 10 个维度对访谈记录进行了编码:受访者的平均年龄为 35.4 岁(标准差为 10.2;范围为 20-53 岁)。除身体形象和灵性外,罗宾逊性健康模型的每个维度都能被自发唤起。所有男性都表示亲密关系(如性协议)和性保健/安全性行为(如 HIV 管理、危险行为)是性健康的相关方面。其他方面包括:积极的性行为(7 人),如性生活中的快感和享受;谈论性(5 人),主要涉及艾滋病毒的披露;性功能(4 人);性健康面临的挑战(3 人),包括药物滥用;以及文化/性身份(3 人)。两名参与者(人数=2)提到了手淫/性幻想:本研究强调了不同血清配偶中感染 HIV 的男同性恋者性健康的多面性,以及人际关系、HIV、风险管理(如通过医疗保健、知识)和积极的性经历的关键作用。针对这一人群的性健康促进干预措施可以考虑这些方面。
{"title":"Conceptions of sexual health by gay men living with HIV in serodifferent couples in Montreal, Canada: results from a qualitative analysis.","authors":"Francesco Avallone, Kim Engler, Joseph Cox, Ford Hickson, David Lessard, Jeanne Bourdon, Réjean Thomas, Bertrand Lebouché","doi":"10.1071/SH23164","DOIUrl":"10.1071/SH23164","url":null,"abstract":"<p><strong>Background: </strong>Gay, bisexual, and other men (GBM) who have sex with men living with HIV in serodifferent couples (one partner living with HIV, the other HIV-negative) may encounter unique sexual health challenges. This study aimed to explore their definition of sexual health that could improve service provision.</p><p><strong>Methods: </strong>We interviewed 10 gay-identified men living with HIV from 2017 to 2019 as part of CTNPT013, a study on the sexual health of HIV serodifferent GBM couples conducted at two HIV-specialised clinics in Montreal, Canada. Participants partook in semi-structured interviews on the meaning of sexual health. We performed a content analysis of interview transcripts, coding them according to the 10 dimensions of Robinson's Sexual Health Model.</p><p><strong>Results: </strong>Mean age of interviewees was 35.4years (s.d.,10.2; range, 20-53). Every dimension of Robinson's model was spontaneously evoked, except for body image and spirituality. All men indicated intimacy/relationships (e.g. sexual agreements) and sexual health care/safer sex (e.g. HIV management, risk behaviours) as relevant aspects of sexual health. Other dimensions included: positive sexuality (n =7), such as pleasure and enjoyment during sex; talking about sex (n =5), which mainly concerned HIV disclosure; sexual functioning (n =4); challenges to sexual health (n =3), including substance abuse; and culture/sexual identity (n =3). Two participants (n =2) cited masturbation/fantasy.</p><p><strong>Conclusions: </strong>This study emphasises the multi-faceted nature of sexual health for gay men with HIV in serodifferent couples and the pivotal roles of relationships, HIV, risk management (e.g. via health care, knowledge), and positive sexual experiences. These dimensions could be considered in sexual health promotion interventions targeting this population.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The timely provision of test results to facilitate early access to treatment is an essential component of sexually transmissible infection (STI) control and contributes to a significant proportion of the workload at sexual health services. We aimed to estimate the time to deliver client results and treatment as well as the health system costs of the nurse-led urgent results management model at the Sydney Sexual Health Centre (SSHC) compared to an alternative ‘ordering clinician’ model.
Methods
We conducted a retrospective analysis of urgent results managed by the results nurse over 2 weeks in 2019 and an observational study over 2 weeks in 2021, where 10 clinicians managed five of their own urgent results. Additional activity data were gathered to determine the annual health system costs for both models.
Results
In the nurse-led model 211 of 280 clients required notification; 156 (73.9%) were notified on the day their results became available, and the median time to treatment (n = 137) was 1 day. The annual health system cost for the nurse-led model was A$3 922 143. In the ordering clinician model, 17 (42.5%) clients were notified on the same day, and of the 27 clients treated at SSHC, the median time to treatment increased to 4 days. The annual health system cost for the ordering clinician model was A$4 043 667.28 compared with the nurse-led model, and an additional 33.3 h per week of clinician time was required for the same level of service provision.
Conclusions
This study highlights the strengths of the nurse-led results model at SSHC, demonstrating improved client outcomes for STI notification and treatment times and health systems savings.
{"title":"A nurse-led approach to urgent results management at Sydney Sexual Health Centre demonstrates benefits to client outcomes and cost savings: a time efficiency and health system cost analysis","authors":"E. Scally, C. G. Watts, C. Nugent, R. Houghton","doi":"10.1071/sh22200","DOIUrl":"https://doi.org/10.1071/sh22200","url":null,"abstract":"<strong> Background</strong><p>The timely provision of test results to facilitate early access to treatment is an essential component of sexually transmissible infection (STI) control and contributes to a significant proportion of the workload at sexual health services. We aimed to estimate the time to deliver client results and treatment as well as the health system costs of the nurse-led urgent results management model at the Sydney Sexual Health Centre (SSHC) compared to an alternative ‘ordering clinician’ model.</p><strong> Methods</strong><p>We conducted a retrospective analysis of urgent results managed by the results nurse over 2 weeks in 2019 and an observational study over 2 weeks in 2021, where 10 clinicians managed five of their own urgent results. Additional activity data were gathered to determine the annual health system costs for both models.</p><strong> Results</strong><p>In the nurse-led model 211 of 280 clients required notification; 156 (73.9%) were notified on the day their results became available, and the median time to treatment (<i>n</i> = 137) was 1 day. The annual health system cost for the nurse-led model was A$3 922 143. In the ordering clinician model, 17 (42.5%) clients were notified on the same day, and of the 27 clients treated at SSHC, the median time to treatment increased to 4 days. The annual health system cost for the ordering clinician model was A$4 043 667.28 compared with the nurse-led model, and an additional 33.3 h per week of clinician time was required for the same level of service provision.</p><strong> Conclusions</strong><p>This study highlights the strengths of the nurse-led results model at SSHC, demonstrating improved client outcomes for STI notification and treatment times and health systems savings.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Bourchier, Meredith Temple-Smith, Jane Hocking, Helen Bittleston, Sue Malta
Background
Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+ years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar ‘Sex, Age and Me’ study from 2015.
Methods
We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook.
Results
The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60–92 years (median 69 years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means.
Conclusions
Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.
{"title":"Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample","authors":"Louise Bourchier, Meredith Temple-Smith, Jane Hocking, Helen Bittleston, Sue Malta","doi":"10.1071/sh23116","DOIUrl":"https://doi.org/10.1071/sh23116","url":null,"abstract":"<strong> Background</strong><p>Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+ years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar ‘Sex, Age and Me’ study from 2015.</p><strong> Methods</strong><p>We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook.</p><strong> Results</strong><p>The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60–92 years (median 69 years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means.</p><strong> Conclusions</strong><p>Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138686224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Curtis Chan, Limin Mao, Benjamin R Bavinton, Martin Holt, Sujith Kumar Prankumar, Kevin Dong, Timothy Wark, Timothy Chen, Hendri Yulius Wijaya, Horas T H Wong
Background: Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM.
Methods: Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6months.
Results: Among 509 participants who had casual partners in the last 6months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL.
Conclusions: CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.
{"title":"The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia.","authors":"Curtis Chan, Limin Mao, Benjamin R Bavinton, Martin Holt, Sujith Kumar Prankumar, Kevin Dong, Timothy Wark, Timothy Chen, Hendri Yulius Wijaya, Horas T H Wong","doi":"10.1071/SH23036","DOIUrl":"10.1071/SH23036","url":null,"abstract":"<p><strong>Background: </strong>Asian gay, bisexual, and other men who have sex with men (GBMSM) are overrepresented in new HIV diagnoses in Australia. Social engagement with other GBMSM has been associated with HIV testing and pre-exposure prophylaxis (PrEP) uptake. Asian GBMSM may be socially disconnected from LGBTQ+ people, which may increase their HIV risk. This analysis assessed the contribution of social connection on HIV risk among Asian GBMSM.</p><p><strong>Methods: </strong>Using an online cross-sectional survey of Asian GBMSM in Australia, we measured condomless anal intercourse (CLAI) in the last 6months without PrEP or an undetectable viral load (UVL), i.e. CLAI with a risk of HIV transmission. Bivariable and multivariable logistic regression models were performed to compare demographic characteristics and social engagement of participants who had CLAI without PrEP or UVL to those who had not. Analyses were restricted to participants who reported sex with casual partners in the last 6months.</p><p><strong>Results: </strong>Among 509 participants who had casual partners in the last 6months, 151 (29.7%) reported CLAI without PrEP or UVL. CLAI without PrEP or UVL was negatively associated with full-time employment, and recently being tested for HIV and was positively associated with experiencing discrimination based on sexual orientation. Social engagement with LGBTQ+ people was not associated with CLAI without PrEP or UVL.</p><p><strong>Conclusions: </strong>CLAI without PrEP or UVL was not related to social connections with LGBTQ+ people but was more likely among Asian men who had experienced sexuality-related discrimination, suggesting that mitigating homophobia and biphobia may assist in improving HIV prevention among Asian GBMSM who live in Australia.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Concerns regarding antimicrobial resistance and the appropriate use of antibiotics have resulted in many sexual health clinics moving away from the epidemiological treatment of contacts of gonorrhoea. The aim of this study was to inform decision-making regarding patients who are contacts who should be given epidemiological treatment.
Methods: This is a retrospective study of positivity rates of symptomatic and asymptomatic contacts of gonorrhoea who attended the Adelaide Sexual Health Centre from 1 January 2018 to 31 December 2019. Relevant demographic and behavioural characteristics were examined. Non-parametric continuous data were examined as medians and interquartile ranges, and categorical variables were examined as proportions and percentages. Chi-squared tests were used to determine any statistically significant differences in the proportions of participants testing positive to gonorrhoea based on the categorical variables.
Results: A total of 402 clients were identified as contacts, of which 124 (30.8%) tested positive for gonorrhoea. Women were statistically more likely to test positive than men (27/56 (48.2%) of women vs 96/345 (27.8%) of men (P =0.002), 0/1 transgender female). From a total of 76 heterosexual men, 14 (18.4%) tested positive as contacts, compared to 82/269 (30.5%) of bisexual/MSM (P =0.038). Of the 214 asymptomatic bisexual/MSM, 55 (25.7%) were positive, 2/56 (3.6%) asymptomatic heterosexual men were positive and 10/29 (34.5%) asymptomatic females were positive for gonorrhoea.
Conclusion: This study identifies some demographic and behavioural characteristics that may be associated with a higher rate of gonorrhoea positivity as a contact, particularly females and MSM. Careful consideration may be required as to who should be given epidemiological treatment to ensure appropriate and judicious use of antibiotics.
{"title":"<i>Neisseria gonorrhoeae</i> positivity in contacts presenting to a sexual health centre.","authors":"T Bromley, D Sundran, C Khaw, M Ratnayake","doi":"10.1071/SH22160","DOIUrl":"10.1071/SH22160","url":null,"abstract":"<p><strong>Background: </strong>Concerns regarding antimicrobial resistance and the appropriate use of antibiotics have resulted in many sexual health clinics moving away from the epidemiological treatment of contacts of gonorrhoea. The aim of this study was to inform decision-making regarding patients who are contacts who should be given epidemiological treatment.</p><p><strong>Methods: </strong>This is a retrospective study of positivity rates of symptomatic and asymptomatic contacts of gonorrhoea who attended the Adelaide Sexual Health Centre from 1 January 2018 to 31 December 2019. Relevant demographic and behavioural characteristics were examined. Non-parametric continuous data were examined as medians and interquartile ranges, and categorical variables were examined as proportions and percentages. Chi-squared tests were used to determine any statistically significant differences in the proportions of participants testing positive to gonorrhoea based on the categorical variables.</p><p><strong>Results: </strong>A total of 402 clients were identified as contacts, of which 124 (30.8%) tested positive for gonorrhoea. Women were statistically more likely to test positive than men (27/56 (48.2%) of women vs 96/345 (27.8%) of men (P =0.002), 0/1 transgender female). From a total of 76 heterosexual men, 14 (18.4%) tested positive as contacts, compared to 82/269 (30.5%) of bisexual/MSM (P =0.038). Of the 214 asymptomatic bisexual/MSM, 55 (25.7%) were positive, 2/56 (3.6%) asymptomatic heterosexual men were positive and 10/29 (34.5%) asymptomatic females were positive for gonorrhoea.</p><p><strong>Conclusion: </strong>This study identifies some demographic and behavioural characteristics that may be associated with a higher rate of gonorrhoea positivity as a contact, particularly females and MSM. Careful consideration may be required as to who should be given epidemiological treatment to ensure appropriate and judicious use of antibiotics.</p>","PeriodicalId":22165,"journal":{"name":"Sexual health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}