ORCID Profile
0000-0003-0995-5789
Current Organisations
New Zealand Institute for Plant and Food Research Ltd
,
UNSW Australia
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Health Policy | Demography | Migration |
Behaviour and Health | Ethnicity, Multiculturalism and Migrant Development and Welfare | Disease Distribution and Transmission (incl. Surveillance and Response)
Publisher: Public Library of Science (PLoS)
Date: 17-12-2021
DOI: 10.1371/JOURNAL.PONE.0261074
Abstract: Migrants are underrepresented in population health surveys. Offering translated survey instruments has been shown to increase migrant representation. While ‘team translation’ represents current best practice, there are relatively few published ex les describing how it has been implemented. The purpose of this paper is to document the process, results and lessons from a project to translate an English-language sexual health and blood-borne virus survey into Khmer, Karen, Vietnamese and Traditional Chinese. The approach to translation was based on the TRAPD (Translation, Review, Adjudication, Pretesting, and Documentation) model. The English-language survey was sent to two accredited, independent translators. At least one bilingual person was chosen to review and compare the translations and preferred translations were selected through consensus. Agreed translations were pretested with small s les of in iduals fluent in the survey language and further revisions made. Of the 51 survey questions, only nine resulted in identical independent translations in at least one language. Material differences between the translations related to: (1) the translation of technical terms and medical terminology (e.g. HIV) (2) variations in dialect and (3) differences in cultural understandings of survey concepts (e.g. committed relationships). Survey translation is time-consuming and costly and, as a result, deviations from TRAPD ‘best practice’ occurred. It is not possible to determine whether closer adherence to TRAPD ‘best practice’ would have improved the quality of the resulting translations. However, our study does demonstrate that even adaptations of the TRAPD method can identify issues that may not have been apparent had non-team-based or single-round translation approaches been adopted. Given the dearth of clear empirical evidence about the most accurate and feasible method of undertaking translations, we encourage future researchers to follow our ex le of making translation data publicly available to enhance transparency and enable critical appraisal.
Publisher: BMJ
Date: 14-11-2013
Publisher: Oxford University Press (OUP)
Date: 24-11-2008
Abstract: In contrast to the broad literature on depression in the general population, little is known about the management of depression affecting gay men and HIV-positive men attending general practice clinics. This paper explores qualitative descriptions of how depression in gay men and HIV-positive men is managed by GPs. As part of the qualitative component of a mixed method study on HIV and depression, semi-structured interviews were conducted with 16 GPs in three geographical settings in Australia: Sydney, Adelaide and a rural coastal town. GPs identified a range of features in their experience of managing depression in gay men and in HIV-positive men. Some were common to the care of other groups with depression, but this paper reports on features unique to this patient group. These include capitalizing on the high frequency of contact with this patient group, taking advantage of the specialist multidisciplinary teams who provide support, building upon the unusual willingness of this patient group to take medication, appreciating the central importance to many gay men of sexual functioning, and recreational drug use, responding to social isolation in this patient group and coping with increasing challenges for the HIV general practice workforce. Despite the identification of several key strengths in working with this patient group, the ability of GPs to develop their capacity to manage depression in gay men and men with HIV is uncertain in the context of a growing range of challenges for GPs in both mental health and HIV care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2009
Publisher: SAGE Publications
Date: 04-2005
Abstract: This study aimed to determine and describe HIV-negative gay men's willingness to participate in HIV vaccine trials. Data were from participants who completed face-to-face interviews during the first 18 months (to the end of 2002) of recruitment into the Health in Men cohort of HIV-negative gay men in Sydney. A key outcome measure was a scale of Willingness to Participate in HIV Vaccine Trials, with scores ranging from 1 (unwilling) to 4 (willing). The 903 participants ranged in age from 18 to 75years (median=36). Mean of Willingness to Participate in HIV Vaccine Trials was 2.53 (standard deviation=0.54), with approximately 51% of the men having a score greater than the midpoint of 2.50. A reduced linear regression model yielded four significant independent associations with Willingness to Participate in HIV Vaccine Trials: lack of tertiary education ( P .001),having engaged 'in the previous six months' in any unprotected anal intercourse with casual or non-concordant regular partners ( P .001), higher self-rated likelihood of HIV infection ( P .01), and higher mean scores on a scale of Comfort with Participation in HIV VaccineTrials ( P .001). The willingness of HIV-negative gay men at potentially higher risk for HIV to participate in HIV vaccine trials augurs well for enrolment in HIV vaccine efficacy trials. Recruitment into trials is likely to be enhanced by addressing salient concerns such as confidentiality and vaccine-induced antibody positivity. Also, it will be important to ensure that gay men are educated and fully informed about HIV vaccines and trial processes.
Publisher: Springer Science and Business Media LLC
Date: 27-07-2022
DOI: 10.1007/S10461-022-03788-1
Abstract: COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the s le, the participants’ HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017–June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller s le sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020–June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.DRUGPO.2016.01.003
Abstract: Gay and bisexual men typically report high rates of illicit drug use, including meth hetamine use. This paper aimed to analyse trends in crystal meth hetamine ('crystal') and powder meth hetamine ('speed') use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use. The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005-14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007-14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data. Speed use declined from 25.0% to 10.2% during 2005-14 (p-trend <.001), while regular speed use declined from 7.0% to 2.3% during 2007-14 (p-trend <.001). Any crystal use declined from 15.6% to 11.4% during 2005-14 (p-trend <.001) and increased during 2010-14 (from 9.6% in 2010 p-trend <.001). Regular crystal use declined from 6.1% to 4.0% during 2007-14 (p-trend <.001) and remained stable during 2010-14 (3.9% in 2010 p-trend=.64). Participants who reported regular crystal use were more likely than men who used crystal less frequently to have used gamma-hydroxybutyrate, used party drugs for sex, and to have injected drugs in the previous 6 months. High rates of crystal use and injecting were reported among HIV-positive participants. Rates of both crystal and speed use, despite fluctuations, were consistently high throughout the study period. The high rates of crystal use and associations with potentially risky sexual practices indicate that gay and bisexual men should be a particular focus for targeted harm reduction and combined harm reduction and sexual health services.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-049010
Abstract: More research and policy action are needed to improve migrant health in areas such as sexual health and blood-borne viruses (SHBBV). While Knowledge, Attitudes and Practice Surveys (KAPS) can inform planning, there are no SHBBV KAPS suitable for use across culturally and linguistically erse contexts. This study pretests one instrument among people born in Sub-Saharan Africa, South-East and North-East Asia living in Australia. Employees of multicultural organisations were trained to collect data over three rounds using a hybrid qualitative pretesting method. Two researchers independently coded data. Researchers made revisions to survey items after each round. Responses to feedback questions in the final survey were analysed. Sixty-two participants pretested the survey. Issues were identified in all three rounds of pretesting. Of the 77 final survey respondents who responded to a survey experience question, 21% agreed and 3% strongly agreed with the statement ‘I found it hard to understand some questions/words’. It is essential to pretest SHBBV surveys in migrant contexts. We offer the following pretesting guidance: (1) large s les are needed in heterogeneous populations (2) intersectionality must be considered (3) it may be necessary to pretest English language surveys in the participants’ first language (4) bilingual/bicultural workers must be adequately trained to collect data (5) results need to be interpreted in the context of other factors, including ethics and research aims and (6) pretesting should occur over multiple rounds.
Publisher: Springer Science and Business Media LLC
Date: 27-09-2023
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 28-04-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-05-2022
DOI: 10.1097/OLQ.0000000000001649
Abstract: The rollout of preexposure prophylaxis (PrEP) for HIV prevention among gay and bisexual men (GBM) is associated with increases in condomless anal intercourse, potentially increasing the incidence of other sexually transmissible infections (STIs). We developed an in idual-based mathematical model to simulate the transmission of Neisseria gonorrhoeae among GBM in Sydney, accounting for changes in sexual practices, STI testing, and PrEP use. We calibrated and validated the model using reported incidence rates for HIV-positive and HIV-negative GBM from 2010 to 2019. Scenarios were run with varying PrEP uptake, PrEP-related STI testing, and PrEP-related sexual behavior and testing intervals up to 2030 to assess the impact of PrEP use on gonorrhea incidence. Preexposure prophylaxis uptake and associated 3-monthly STI testing from 2015 onward resulted in a predicted increase from 20 to 37 N. gonorrhoeae infections per 100 person-years among HIV-negative GBM by the end of 2020. This is lower than the counterfactual predictions of 45 per 100 person-years if PrEP were not scaled up and 48 per 100 person-years with nonadherence to 3-monthly STI testing. Increasing the time between STI tests for PrEP users by 1 month from 2018 results in the incidence rate among HIV-negative GBM increasing by 8% by 2030. If PrEP coverage doubles from 24% to 53%, incidence among HIV-negative GBM declines by ~25% by 2030. Behavior change due to widespread PrEP use may lead to significant increases in gonorrhea incidence in GBM, but the recommended quarterly STI testing recommended for PrEP users should reduce incidence by 18% by 2030.
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
DOI: 10.1007/S13365-022-01104-0
Abstract: Although increasing research is focusing on age-related comorbidities (ARC) among people living with HIV (PLHIV), no studies have concomitantly assessed non-HIV age-related neurological disorders (e.g., Alzheimer’s dementia). A total of 254 PLHIV and 69 HIV-negative controls completed baseline medical history and cognitive testing. ARC data were collected from medical records over the subsequent 9-10 years and included all types of strokes, all types of dementia, mild cognitive impairment, Parkinson's disease, motor neuron disease (grouped into a non-HIV age-related neurological category), cardiovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease, non-AIDS cancers, osteoporosis, and diabetes. Kaplan–Meier curves assessed differences in the incident rates (per 1000 person year) of groups of ARC as defined above and combined ARC (i.e., development of any of the ARC) among younger (baseline age 50) and older (baseline age ≥ 50) PLHIV and younger and older controls. Cox-proportional hazard models assessed the in idual and interaction effects of HIV status and chronological age, in addition to a range of demographic and clinical variables including historical and baseline HIV brain involvement on the risk of developing combined ARC. Older PLHIV had a higher incidence of cardiovascular disease, osteoporosis, and combined ARC compared to other groups ( p 0.05). Incident rate of non-HIV age-related neurological disorders was 2.3 [0.93, 4.79] per 1000 person year. While this incident rate was higher in older PLHIV (5.37 [1.97, 11.92]) than older HIV-negative participants (3.58 [0.18-17.67]), this was not significant. In multivariate analyses, HIV status and chronological age, but not their interaction, and smoking were associated with higher risk of combined ARC ( p 0.05). In analyses focusing on PLHIV, older age and taking abacavir/efavirenz/atazanavir/darunavir containing antiretroviral treatments at the time of diagnosis were associated with greater ARC ( p 0.05). Non-HIV age-related neurological disorders are uncommon in older PLHIV, where the majority were 70 years of age at the end of follow-up. However, the greater burden of ARC among older PLHIV, most of which are established dementia risk factors, warrants the establishment of commensurate prevention strategies and greater attention to neurocognitive screening.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2009
DOI: 10.1007/S10461-009-9527-0
Abstract: Using two cohort studies (Health in men-HIM and positive health-PH) and repeated large cross-sectional surveys (Gay Community Periodic Survey-GCPS) of gay men in Sydney, Australia, we examined the association between viral load and unprotected anal intercourse (UAI) between HIV sero-discordant regular partners. Between 2001 and 2007, we conducted 243 interviews with 102 HIV-negative gay men in HIM and 148 interviews with 99 HIV-positive gay men in PH who were in regular relationships with HIV sero-discordant partners. During the same time period, 437 HIV positive men with HIV sero-discordant regular partners completed questionnaires for the GCPS. All completed interviews or questionnaires during that time period were used for these analyses. Amongst the HIV-negative respondents, sero-discordant UAI was more likely to be reported when the men believed their HIV-positive regular partner had an undetectable rather than a detectable viral load (P = 0.002). Amongst the HIV-positive respondents, sero-discordant UAI was as likely to be reported when they themselves reported having an undetectable or a detectable viral load. Use of viral load in negotiating condom use between sero-discordant gay couples may be understood very differently by the HIV-negative and HIV-positive men within those partnerships.
Publisher: Informa UK Limited
Date: 23-12-2021
DOI: 10.1080/13691058.2021.2016975
Abstract: Translated questionnaires are increasingly used in population health research. Nevertheless, translation is often not conducted with the same rigour as the process of survey development in the original language. This has serious limitations and may introduce bias in question relevance and meaning. This article describes and reflects on the process of translating a large and complex sexual and reproductive health survey from English into Simplified Chinese. We interrogated assumptions embedded in taken-for-granted translation practice to locate the sociocultural origins of these assumptions. We discuss how terminology and expression related to sexual and reproductive health may lose their conceptual or linguistic significance during translation in three different ways. Firstly, meanings can be lost in the negotiation of meanings associated with linguacultural and geographical variations of terminology. Secondly, meanings can be lost in the clash between everyday and professional sexual and reproductive health discourses. Thirdly, meanings can be lost due to the design of the source questionnaire and the intended mode of survey administration. We discuss ways to help overcome the unavoidable translation challenges that arise in the process of translating English sexual and reproductive health surveys for migrants from non-English speaking backgrounds.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1111/J.1467-842X.2005.TB00245.X
Abstract: To report changes in sexual behaviour among gay men in Sydney from 1986 to 2003. Baseline data from four studies of gay men in Sydney were used: the Social Aspects of the Prevention of AIDS study (1986/87: 91 HIV-positive and 444 HIV-negative men) the Sydney Men and Sexual Health cohort (1993-95: 237 HIV-positive and 910 HIV-negative men) the Health in Men cohort of HIV-negative gay men (2001-03: 1,148 men) the Positive Health cohort of HIV-positive gay men (2001/02: 237 men). Each s le was recruited and interviewed using similar methods. Fewer HIV-positive men had sex with casual partners over time (76.9% in 1986/87 to 63.7% in 2001/02 p = 0.001), but more HIV-negative men had sex with 10 or more casual partners in the previous six months (27.7% in 1986/87 to 37.7% in 2001-03 p = 0.012). The proportions engaging in particular sex practices with casual partners changed over time: anal intercourse without condoms that included ejaculation in the rectum fell from 29.4% among HIV-positive men and 32.4% among other men in 1986/87 to 17.8% and 10.0% respectively in 1993-95 (p = 0.034 and p < 0.001 respectively), but increased to 37.7% and 18.4% respectively in 2001-03 (p-values < 0.001) rimming one's partner increased from 36.8% among HIV-positive men and 17.6% among other men in 1986/87 to 63.6% and 52.3% respectively in 2001-03 (p = 0.001 and p < 0.001 respectively). Gay men's sexual behaviour with casual partners has changed over time, perhaps partly in response to HIV and partly as a general expansion of sexual repertoires. These changes have implications for gay men's health.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
Publisher: Springer Science and Business Media LLC
Date: 29-11-2015
DOI: 10.1007/S10461-014-0959-9
Abstract: The use of antiretroviral therapy to prevent HIV transmission is now advocated in many settings, yet little research has documented the views of people with HIV. Semi-structured interviews were conducted in Australia between 2012 and 2014 with 27 HIV-positive people not using treatment at the time of interview. Thematic analysis of views on treatment-as-prevention found that while many participants recognised potential prevention benefits, only a minority was in support of initiating treatment solely to achieve those benefits. A range of uncertain or critical views were expressed regarding who would benefit, risk reduction, and changing treatment norms. Participants resisted responsibility narratives that implied treatment should be used for the public good, in favour of making considered decisions about their preferred approach to managing HIV. Engaging communities in dialogue and debate regarding the risks and benefits of treatment will be critical if this new prevention strategy is to engender public trust.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14009
Abstract: Background: To date, limited research has been conducted to identify the personal and contextual factors that contribute to women’s entry into the sex industry in China. Methods: The reasons for and factors associated with voluntary entry into the sex industry were explored through in-depth interviews conducted with 38 Chinese women who were held in detention centres for selling sex. Results: Women’s personal accounts reveal that entry into sex work is influenced by life aspirations, family responsibilities and social connections, which facilitate mobility to a new urban environment in which they encounter opportunities and challenges. Findings highlight the complex interactions between in idual and contextual factors in relation to women’s entry into sex work. Conclusions: In a rapidly developing country such as China, entry into sex work may appeal to women of low socioeconomic status, particularly young women who have recently migrated to urban areas. For members of this mobile and relatively disadvantaged population, comprehensive social services and support are urgently needed.
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: UNSWorks, UNSW
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 19-12-2016
DOI: 10.1007/S10461-016-1649-6
Abstract: An online survey was conducted among people living with HIV (PLHIV) in Australia to discern key factors associated with distinctive ART use patterns. The s le (N = 358), was further ided into three groups: those on ART continuously since initiation (n = 208, 58.1%) those on ART intermittently (n = 117, 32.7%) and those not on ART at the time of survey (n = 33, 9.2%). ART non-users were the most likely to hold serious concerns about ART that outweighed perceived necessities (benefits) from ART (AOR = 0.13 95% CI 0.06-0.29 p < 0.001). They were also the least self-efficacious in HIV disease management (AOR = 0.29 95% CI 0.09-0.87 p = 0.028). Intermittent ART users were more likely to receive their HIV diagnosis prior to 2003 (AOR = 0.38 95% CI 0.28-0.53 p < 0.001) and perceive lower HIV management self-efficacy (AOR = 0.50, 95% CI 0.28-0.87 p = 0.015) than continuous users. ART-related beliefs and perceived self-efficacy in HIV self-management play an important role in achieving universal treatment uptake and sustained high levels of adherence.
Publisher: Mary Ann Liebert Inc
Date: 05-2015
Publisher: Informa UK Limited
Date: 02-2006
DOI: 10.1080/09540120500358951
Abstract: This paper reports on the breaking of agreements between regular partners among HIV-negative gay men in Sydney. Data were from the 1333 men completing face-to-face interviews through December 2003 for the Health in Men (HIM) open cohort of HIV-negative gay men in Sydney.822 men had a primary regular partner during the six month period before their 2003 interview. Most of these men had entered into agreements with their partners about sex either with each other or with other partners (87.2%). They most commonly agreed not to use condoms with each other (50.6%). Regarding casual sex, they most commonly agreed to always use condoms (34.2%) or to have no sex with men outside their relationships (28.6%). 48.8% reported some discomfort discussing with their partner their sex outside the relationship. Among those with agreements with their partners, 27.7% reported ever breaking those agreements. Those who found it more difficult to discuss issues of HIV serostatus and sexuality were more likely to report having broken their agreements (p<.001 p=.021 at one-year follow-up) and were more likely to have engaged in unprotected anal intercourse with casual partners (p<.001). A third of those men who broke their agreements did not inform their partner. A substantial proportion of gay men with agreements with their regular partners report some discomfort discussing sexuality and HIV serostatus with their partners. Difficulty discussing these issues may place these men at increased risk of breaking their agreements and may place both themselves and their partners at increased risk of infection.
Publisher: Guilford Publications
Date: 02-2004
DOI: 10.1521/AEAP.16.1.55.27720
Abstract: A theoretical framework, which included perspectives of in idualism-collectivism and self-efficacy, was used to investigate factors associated with sexual risk practice among gay Asian and Caucasian men. "Risk" was defined as unprotected anal intercourse with any casual partner or with a regular partner whose HIV status was not concordant with the participant's. Altogether, 201 Caucasian and 199 Asian gay men, largely recruited from gay social venues in inner Sydney, completed an anonymous questionnaire. Most participants were gay self-identified and gay community attached, and more than half of the Asian men had been living in Sydney for at least 3 years. Overall, the Asian men were more collectivist oriented and the Caucasian men more in idualist oriented. Data analyses revealed that higher self-efficacy in avoiding casual risk encounters and smaller proportion of gay friends were associated with less risk. The inclusion of in idualism-collectivism and social cognitive variables in the examination of sexual risk practices among gay men from different cultural backgrounds holds promise.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2006
DOI: 10.1007/S10461-005-9057-3
Abstract: In recent years, increases in both risk behavior and in seroconversion among homosexually active men have been noted in a number of parts of the world. Data were available from 903 HIV negative homosexual men regarding number of acts of unprotected anal intercourse (UAI), separated into receptive and insertive UAI, with and without ejaculation, with steady and with casual partners. Partners were classified according to serostatus as reported by respondents. Men (N = 325) reported 13,692 UAI acts, most of which were with steady partners, of whom most were reported to be HIV-negative. With HIV-positive partners, both steady and casual, and with casual partners of unknown serostatus, receptive UAI with ejaculation was relatively rare. Insertive UAI without ejaculation was relatively common with casual partners of unknown serostatus. Patterns of UAI suggest that risk of transmission may be greater with steady partners. Men appear to modify practice according to both the nature of the relationship (steady or casual) and (assumed) serostatus of partner.
Publisher: CSIRO Publishing
Date: 16-11-2021
DOI: 10.1071/SH21101
Abstract: Background The ‘Down to Test (DTT)’ c aign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience. Methods Data was collected through three annual rounds of online surveys post c aign exposure, targeting young people (aged 15–29 years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening. Results Of the 10 044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age = 22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening (‘definitely yes’ in the next 12 months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR] = 2.02 95%CI 1.76–2.32 P 0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR = 1.14 95% CI 1.01–1.30 P 0.05). Conclusions The NSW state-wide DTT c aign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2023
DOI: 10.1007/S10461-023-04124-X
Abstract: HIV self-testing allows people to collect s les and test themselves at home, addressing known barriers to facility-based testing. We aimed to measure the uptake of home HIV testing among Australian gay and bisexual men (GBM). Using national cross-sectional data from the Australian Gay Community Periodic Surveys, we assessed trends in home HIV testing among non-HIV positive GBM between 2018 and 2020. Overall, the use of home HIV testing was low, but slightly increased during 2018–2020 (from 0.3 to 0.8%, RR = 1.54, 95%CI = 1.23–1.92, p-trend 0.001). Testing at home was more likely among non-HIV-positive GBM who were born overseas and recently arrived in Australia, at higher risk of HIV, and infrequent HIV testers. Given the greater use of home testing by men at higher risk of HIV, recent migrants and infrequent testers, all priority groups in Australia’s HIV epidemic, we recommend increasing access to HIV self-testing to enhance uptake in these and other groups of GBM.
Publisher: Routledge
Date: 24-03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-12-2015
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: New Zealand Plant Protection Society
Date: 26-07-2019
DOI: 10.30843/NZPP.2019.72.268
Abstract: Neofabraea actinidiae (syn. Cryptosporiopsis actinidiae) is a member of a suite of fungi associated with ‘ripe rots’ of kiwifruit. Although it has been recorded regularly from kiwifruit in New Zealand over the past 30-40 years, initially as ‘Cryptosporiopsis sp.’, there is a general lack of knowledge of this fungus. This paper provides a review of the current records and available literature on the taxonomy and biology of the organism, and assesses the knowledge gaps in the disease cycle and epidemiology of N. actinidiae in kiwifruit orchards. The conidia of the fungus are likely to be water borne, infect fruit during or near to flowering and remain latent until harvest and subsequent ripening. The source of inoculum remains unknown. This review may stimulate new research into this pathogen and give insights into potential control strategies.
Publisher: Frontiers Media SA
Date: 13-03-2023
DOI: 10.3389/FPUBH.2023.1018983
Abstract: The HIV epidemic in Australia is changing with higher risk for HIV among newly-arrived Asian-born men who have sex with men (MSM) compared to Australian-born MSM. We evaluated the preferences for HIV prevention strategies among 286 Asian-born MSM living in Australia for & years. A latent class analysis uncovered three classes of respondents who were defined by their preferences: “PrEP” (52%), “Consistent condoms” (31%), and “No strategy” (17%). Compared to the “No strategy” class, men in the “PrEP” class were less likely to be a student or ask their partner for their HIV status. Men in the “Consistent condoms” class were more likely to get information about HIV from online, and less likely to ask their partner for their HIV status. Overall, PrEP was the preferred HIV prevention strategy for newly arrived migrants. Removing structural barriers to access PrEP can accelerate progress toward ending HIV transmission.
Publisher: Informa UK Limited
Date: 08-2007
DOI: 10.1080/09540120701203386
Abstract: Gay men who engage in sex work may be at increased risk through risk behaviour outside the context of sex work. Among participants in the Health in Men (HIM) cohort of HIV-seronegative gay men in Sydney, 19.7% had ever engaged in sex work. Five percent reported being paid for sex in a six-month period during the study (2001-2006) a minority (18.3%) of these current sex workers reported unprotected anal intercourse (UAI) with clients and 62.0% reported UAI with any casual partners. The practice of sex work itself may not represent increased risk for HIV transmission but sex workers in this study were, nonetheless, at markedly increased risk in other aspects of their lives.
Publisher: Informa UK Limited
Date: 23-06-2015
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH13042
Abstract: Background: In recent years there has been an increase in the incidence of acute hepatitis C virus (HCV) in men who have sex with men (MSM). The aim of the present study was to examine the prevalence of HIV/HCV co-infection among MSM in Sydney, and to compare sexual and drug use risk practices of HIV/HCV co-infected MSM with HIV and HCV mono-infected MSM. Methods: Data were collected from gay and other homosexually active men as part of the ongoing Gay Community Periodic Surveys (GCPS). The analysis herein presents findings from the Sydney GCPS in August 2011, which collected data on HCV for the first time. The survey was completed by 2009 respondents. Results: Three per cent of respondents self-reported being HCV positive (representing 9.0% of HIV-positive men and 1.9% of HIV-negative men). Overall, 1.2% of respondents reported being HIV/HCV co-infected. HIV/HCV co-infected men were more likely than HCV or HIV mono-infected men to report several sexual and drug use practices that may increase the risk of blood-borne virus transmission. Conclusions: Consistent with other research, we found a higher prevalence of HCV among HIV-positive than HIV-negative men. Several risk practices were more commonly reported among HIV/HCV co-infected men. These findings, and the increasing incidence of HCV in MSM, reinforce the need for routine HCV screening in this population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-12-2021
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/SHV4N4AB64
Abstract: The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understood, in particular because any potential effect could be obscured by sexual practice as a mediating or confounding factor. Using data from the Health in Men (HIM) cohort of 1426 HIV-negative homosexually active men in Sydney, we compared the sexual practices and sexual experiences of circumcised and uncircumcised men. Overall 66% of men (n�=�939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no difference between circumcised and uncircumcised men in anal sexual practices, difficulty using condoms, or sexual difficulties (e.g. loss of libido). Among the circumcised men, we compared those circumcised at infancy (n�=�854) with those circumcised after infancy (n�=�81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity, men circumcised after infancy were more likely to practise receptive anal sex (88% vs 75%, p� �0.05) and to experience erection difficulties (52% vs 47%, p� �0.05) but less likely to practise insertive anal sex (79% vs 87%, p� �0.05) and to experience premature ejaculation (15% vs 23%, p� �0.05) than those circumcised at infancy. Our data suggest that overall circumcision status does not affect HIV-negative gay men's anal sexual practices, experience of condom use or likelihood of sexual difficulties. However, there is some suggestion of differences between circumcised men depending on the age at circumcision.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH18216
Abstract: Background Gay and other men who have sex with men of Asian background (GAM) have been identified as a key population in efforts to eradicate HIV in New South Wales. The aims of the present study were to evaluate current levels of engagement with HIV and sexually transmissible infection (STI) testing services, assess knowledge of pre- and post-exposure prophylaxis and to identify factors associated with service engagement in this group. Methods: A survey of 604 GAM residing in Sydney and Melbourne was undertaken. Results: The data identified that a significant proportion of non-HIV-positive men (i.e. HIV-negative men and men whose HIV status was unknown) surveyed (n = 567 93.9%) had engaged in frequent HIV testing and comprehensive STI testing in the 12 months prior to the survey (n = 180 31.7%). There were significant differences (P & 0.05) in sexual practices at the bivariate level between those who reported frequent and comprehensive HIV/STI testing and those who did not. Those who tested regularly were substantially more sexually active, were more likely to have multiple partners (P = 0.001) and were more likely to engage in condomless anal intercourse with both casual (P & 0.001) and regular (P = 0.002) partners. Those who engaged with testing initiatives were more likely to discuss HIV status with both regular (P = 0.008) and casual (P & 0.001) partners, and identified more reasons to test than their counterparts (P & 0.001). The data also highlighted key service venues, with gay men most likely to have used public sexual health clinics (46.9%) as their most recent testing venue. Conclusions: The data demonstrate an association between high levels of male-to-male sexual activity and engagement in frequent and comprehensive HIV and STI testing. This likely derives from both self-perceived notions of risk and current reliance on established gay community organisations to convey information around testing. Increasing engagement with testing initiatives beyond GAM who self-identify as being at high HIV and STI risk will require the use of novel routes by which to disseminate this information.
Publisher: Wiley
Date: 03-05-0100
DOI: 10.1111/HIV.12980
Publisher: BMJ Publishing Group Ltd
Date: 07-2019
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2018
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/FTWC-SB56
Publisher: SAGE Publications
Date: 03-2014
DOI: 10.1177/009145091404100103
Abstract: The aim of this study was to calculate the cost of a range of needle and syringe program (NSP) models to contribute to planning for effective NSP delivery. Existing health service data was used to estimate the cost per needle distributed across four modes of service delivery (Primary NSP, including one model of Primary NSP providing primary health care Secondary NSP Vending Machine and Outreach) over three years. Costs were primarily affected by the ratio of the volume of equipment distributed to staff costs. The average cost per unit for Primary, Secondary and Outreach modes was approximately $1.00. The cost for Vending Machine provision (accounting for income from service users) was the cheapest option at $0.30–0.40 per unit. When income from services users are not included in calculations, other considerations may be more important than cost when making decisions about providing access to NSP services to a marginalized client group with erse needs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-01-2018
Publisher: BMJ
Date: 19-04-2016
DOI: 10.1136/SEXTRANS-2015-052325
Abstract: Mobile phone apps are now the most popular method that Australian gay men use to find sex partners. Partner-seeking mobile phone apps use location functions to identify like-minded men and display their proximity. This study examines whether meeting partners via mobile apps is associated with a greater risk of HIV and sexually transmitted infections (STIs) than with other ways of meeting partners. Data were analysed from the Gay Community Periodic Surveys, community-based, cross-sectional surveys conducted in Australian state capital cities between 2010 and 2014. χ Data were analysed from 36 428 men who participated in the Gay Community Periodic Surveys between 2010 and 2014. In 2014, 4116 men reported meeting sex partners with the use of mobile apps, increasing from 23.9% in 2011 to 42.5% in 2014. Men who used a combination of online and offline methods reported a greater number of sex partners and were more likely to report a recent STI than men who used online methods only or offline methods only. There has been a steep increase in the use of mobile phone apps by gay men in Australia to meet male partners. However, men who use a combination of mobile phone apps, internet websites and offline places to meet partners appear to be at increased risk of STIs or HIV compared with men who use a narrower range of online and offline methods.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17099
Abstract: Background Routine HIV clinical monitoring is vital for people living with HIV (PLHIV) after treatment initiation. The relationship between clinical visits during the first 6 months after initial antiretroviral therapy (ART) and long-term, HIV-related mortality and service retention was investigated. Methods: A retrospective ART observational research database was established based on de-identified data extracted from 6959 records of adult HIV-positive registrants held by Hunan CDC (Center for Disease Control and Prevention) between 2003 and 2013. Results: During the first 6 months of initiation into ART, 2364 (34.0%) of PLHIV had completed four scheduled visits, meeting the Chinese ART clinical monitoring standards. From 6 months onwards (up to 36 months), this group had the lowest HIV-related mortality (4.4%) compared with those who had more or less than four kept visits in the first 6 months [one visit only: adjusted hazards ratio (AHR) = 3.15, 95% CI 2.24–3.88 two visits: AHR = 2.24, 95% CI 1.80–3.01 three visits: AHR = 1.86, 95% CI 1.69–2.05 and visits: AHR = 1.37, 95% CI 1.11–1.72]. Those with less than three kept visits were also at increased risk of cohort loss to follow up (ART discontinuation, prolonged service disengagement or death). A myriad of personal, clinical and social factors are identified to be associated with increased HIV-related mortality and clinical retention. Conclusions: Enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.
Publisher: Wiley
Date: 07-08-2013
DOI: 10.1111/J.1465-3362.2012.00494.X
Abstract: The findings of Australian drug surveys are typically not stratified by sexual orientation, despite the higher prevalence of drug use generally reported among gay and bisexual men. This paper aims to examine trends in drug use among gay and bisexual men in eastern Australia between 2004 and 2011. Data from the cross-sectional, ongoing Gay Community Periodic Surveys (GCPS) were used to analyse drug trends among gay and bisexual men in Sydney, Melbourne and Queensland. Between 2004 and 2011, 45,273 eligible questionnaires were completed. There was a downward trend in recent drug use (previous 6 months) between 2004 and 2011 from 62.2% to 57.5%. However, this trend was not found among men in Queensland, bisexual men, men aged over 40 years or HIV-positive men. Club drug use peaked in 2006 (45.1%), before steadily declining to 32.4% in 2011. There were significant reductions in use of ecstasy, meth hetamine, ketamine and cannabis, increased use of cocaine, gamma hydroxybutyrate, erectile dysfunction medications, amyl nitrite and lysergic acid diethylamide, and no change in heroin use. Recent injecting drug use fluctuated over time but experienced an overall downward trend from 5.5% in 2004 to 4.0% in 2011. Drug use trends among gay and bisexual men in Australia are broadly consistent with downward and upward drug trends reported in other Australian drug surveys. The risks associated with drug use in this population and high rates of use supports the ongoing role of the GCPS in monitoring drug trends among homosexually active men.
Publisher: Elsevier BV
Date: 08-2018
Publisher: UNSWorks, UNSW
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2006
Publisher: Wiley
Date: 28-11-2018
DOI: 10.1002/JMV.24988
Abstract: Co-infection with hepatitis B (HBV) and C (HCV) is common among people living with HIV (PLHIV). This study investigates the impacts of hepatitis co-infection on antiretroviral therapy (ART) outcomes and hepatotoxicity in PLHIV. The cohort study included 1984 PLHIV. Hepatotoxicity was defined by elevated alanine aminotransferase (ALT) levels. ART outcomes were measured by CD4 cell counts, viral load, and mortality rate in patients. Among 1984 PLHIV, 184 (9.3%) were co-infected with HBV and 198 (10.0%) with HCV and 54 (2.7%) were co-infected with HBV and HCV. Of these patients, 156 (7.9%) had ALT elevation ≥ grade 1 at baseline. During the course of ART, the mortality rate and its adjusted hazard ratio (AHR) in PLHIV who were co-infected with HCV (2.6/100 person-years [py], AHR = 2.3, 95%CI 1.1-4.7) was higher than for patients with mono-infected HIV, as it was for those with an elevated ALT (4.4/100 py, AHR = 3.8, [1.7-8.2]) at baseline compared to those with normal ALT. After 6-12 months of ART, the incidence of hepatotoxicity among all the patients was 3.7/100 py. The risk of hepatotoxicity was higher in HCV co-infected (18.6/100 py, adjusted odds ratio [AOR] = 12.4, [8.1-18.2]) than HIV mono-infected patients, and for all regimens (nevirapine: 30.0/100 py, 34.2, 7.3-47.9 zidovudine/stavudine: 24.7/100 py, 22.1, 7.1-25.5 efavirenz: 14.5/100 py, 9.4, 3.5-19.2 lopinavir/ritonavir: 40.1/100 py, 52.2, 9.5-88.2) except tenofovir (4.3/100 py, 4.9, 0.8-9.5). Patients with HBV/HCV co-infected had high hepatotoxicity (10.0/100 py, 6.3, 1.2-23.3) over the same period. Patients with HCV co-infection and HBV/HCV co-infection demonstrated higher hepatotoxicity rate compared with HIV mono-infected patients in China.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2016
Publisher: Elsevier BV
Date: 11-2014
Publisher: Wiley
Date: 29-12-2015
DOI: 10.1111/DAR.12234
Abstract: International research has shown that gay, bisexual and other homosexually active men (hereafter 'gay men') report disproportionately higher rates of risky alcohol use and associated problems compared with heterosexual men. However, little is known about alcohol use among this population in Australia. This study aimed to examine rates of risky alcohol use among a community-based s le of gay men in Sydney and characteristics of men reporting high-risk alcohol use and adverse consequences. A cross-sectional survey of gay men was conducted in Sydney in August 2013 as part of the ongoing Gay Community Periodic Surveys (n = 1546 eligible respondents). The Alcohol Use Disorders Identification Test-Consumption questions were used to assess alcohol use in the previous 12 months. Nine percent of respondents were categorised as abstinent from alcohol, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers. In separate multivariate logistic regression analyses, high-risk drinking and reporting ≥4 adverse alcohol consequences were associated with younger age, being Australian-born, recruitment from licensed premises and having met men for sex at gay bars and dance parties. Fifty-eight percent of high-risk drinkers reported a desire to reduce their alcohol use. In this community-based s le of gay men, we found high levels of moderate- to high-risk alcohol use. The results suggest that gay men should be a priority population for health promotion c aigns and treatment services.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-12-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-10-2023
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 19-11-2020
DOI: 10.1007/S10461-019-02737-9
Abstract: Using repeated, cross-sectional behavioural surveillance data from Australia, we assessed trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013-2018. We conducted three analyses: (i) trends in relationship agreements and casual sex over time (ii) bivariate comparisons of PrEP users and non-PrEP-users to identify factors associated with PrEP use and (iii) multivariate logistic regression to identify factors independently associated with PrEP use. The analysis of trends over time included 21,593 men, from which a sub-s le (n = 3764) was used to compare PrEP users and non-PrEP-users. We found a large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships (nearly 40% of whom had such an agreement). A further 34% of PrEP users reported having casual condomless sex without an agreement that permitted that behaviour, while 13% of non-PrEP-users also reported condomless sex with casual partners without an agreement. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. Our findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners.
Publisher: Springer Science and Business Media LLC
Date: 20-01-2016
Publisher: Wiley
Date: 19-04-2021
DOI: 10.1111/HIV.13102
Abstract: To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia. We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. Six indicators were measured: (1) state‐wide total HIV laboratory tests (2) number of GBM attending publicly‐funded clinics (3) 12‐monthly testing uptake (4) annual testing frequency (5) HIV testing with a STI diagnosis and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas‐born. Overall, 43,560 GBM attended participating clinics (22,662 Australian‐born, 20,834 overseas‐born) from 2010‐2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p .001 for all) in testing uptake (83.9% to 95.1%) testing with a STI diagnosis (68.7% to 94.0%) annual HIV testing frequency (1.4 to 2.7) and a decreasing trend (p .01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian‐born and overseas‐born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian‐born GBM (7.1% to 2.8%), but an increasing trend in overseas‐born GBM (15.3% to 16.9%) (p .001 for all).
Publisher: Centre for Social Research in Health, Sydney
Date: 2022
DOI: 10.26190/XGPT-QF42
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/2648923
Abstract: Background. Criteria for antiretroviral treatment (ART) were adjusted to enable early HIV treatment for people living HIV/AIDS (PLHIV) in China in recent years. This study aims to determine how pretreatment waiting time after HIV confirmation affects subsequent adherence and outcomes over the course of treatment. Methods. A retrospective observational cohort study was conducted using treatment data from PLHIV in Yuxi, China, between January 2004 and December 2015. Results. Of 1,663 participants, 348 were delayed testers and mostly initiated treatment within 28 days. In comparison, 1,315 were nondelayed testers and the median pretreatment waiting time was 599 days, but it significantly declined over the study period. Pretreatment CD4 T-cell count drop (every 100 cells/mm 3 ) contributed slowly in CD4 recovery after treatment initiation (8% less, P 0.01 ) and increased the risk of poor treatment adherence by 15% (ARR = 1.15, 1.08–1.25). Every 100 days of extensive pretreatment waiting time increased rates of loss to follow-up by 20% (ARR = 1.20, 1.07–1.29) and mortality rate by 11% (ARR = 1.11, 1.06–1.21), based on multivariable Cox regression. Conclusion. Long pretreatment waiting time in PLHIV can lead to higher risk of poor treatment adherence and HIV-related mortality. Current treatment guidelines should be updated to provide ART promptly.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/F57Q-0E06
Publisher: Hindawi Limited
Date: 19-10-2022
DOI: 10.1111/HSC.14066
Abstract: Ageing with a chronic hepatitis B (HBV) or hepatitis C (HCV) infection is an emerging public health priority. For people living with chronic viral hepatitis, their disease progression into old age is both underpinned by their existing blood borne virus and the potential emergence of other infectious and non-infectious conditions. These twinned pathways bring additional challenges to the care and support for people as they near end of life. This scoping review sought to examine what is known about the experiences of the end-of-life phase of an increasing population ageing with HBV and HCV in studies conducted in high-income settings and published in peer reviewed literature (2010-2021). In interpreting this literature, we found that challenges in determining the end-of life phase for people with lived experience of HBV or HCV are exacerbated by the conflation of aetiologies into a singular diagnosis of end-stage liver disease. Studies overwhelmingly reported the clinical aspects of end-of-life care (i.e. prognosis assessment and symptom management) with less attention paid to educative aspects (i.e. advance care directives and surrogate decision makers, discussion of treatment options and determining goals of care). Psychosocial interventions (i.e. quality of life beyond symptom management, including emotional/spiritual support and family and bereavement support) received limited attention in the literature, though there was some recognition that psychosocial interventions should be part of end-of-life care provision. Given the focus on the prominent disease presentation of liver cirrhosis and/or end-stage liver disease, the social and cultural dimensions of these infections have received less attention in the literature on end-of-life in the context of chronic viral hepatitis.
Publisher: Informa UK Limited
Date: 29-05-2013
DOI: 10.1080/09540121.2012.686598
Abstract: To assess the changing health promotion needs of human immunodeficiency virus (HIV)-positive gay men in Australia, we analysed the social and behavioural characteristics of HIV-positive men in the Australian Gay Community Periodic Surveys. We looked at change over time in the characteristics of HIV-positive men (from 2000-2001 to 2008-2009) and compared HIV-positive men with their HIV-negative peers within each time period. Multivariate logistic regression analysis was used to assess independent changes over time within each HIV status group. A total of 21,620 responses were included in the analyses 10,537 in 2000-2001 and 11,083 in 2008-2009. Between the two time periods, HIV-positive and HIV-negative men became more similar in the following areas: paid employment, sexual identity, number of male sex partners, the likelihood of having a regular male partner and having a seroconcordant regular male partner. The two groups erged in these areas: age, ethnicity, educational level, social engagement with gay men, types of relationship with regular male partners, likelihood of unprotected anal intercourse with casual male partners and likelihood of HIV disclosure to casual male partners. Workforce participation and educational attainment have improved among HIV-positive gay men since 2000, but they still lag behind their HIV-negative peers in these areas. Because HIV-positive men are an ageing cohort, support services will need to increasingly address issues of HIV, sexuality and ageing with HIV-positive men. The increase in unprotected anal intercourse and HIV disclosure with casual partners means that education and support services will increasingly need to address effective HIV disclosure and non-condom-based risk reduction strategies with both HIV-positive and HIV-negative gay men.
Publisher: Wiley
Date: 03-2015
DOI: 10.5694/MJA14.00443
Abstract: To examine whether there have been recent changes in Australian antiretroviral treatment (ART) prescribers' perceptions and practices relating to early ART initiation, which was defined as commencing ART when a patient's CD4+ T-cell count approaches 500 cells/mm3 or immediately after a patient is diagnosed with HIV. Self-completed, anonymous, cross-sectional surveys, targeting all ART prescribers in Australia, were conducted online in 2012 and 2013. The surveys included questions on prescriber factors, CD4+ T-cell count at which prescribers would most strongly recommend ART initiation, and perceived patient characteristics that could change prescribers' practices of early initiation of ART. Proportions of ART prescribers recommending early ART initiation. We analysed responses from 108 participants in 2012 and 82 participants in 2013. In both years, more male than female prescribers participated. The median age of participants was 49 years in 2012 and 50 years in 2013. In both rounds, over 60% had more than 10 years' experience in treating HIV-positive patients. More prescribers in 2013 stated that they would most strongly recommend early ART initiation compared with those in 2012 (50.0% [95% CI, 38.7%-61.3%] v 26.9% [95% CI, 18.8%-36.2%] P=0.001). The prescribers' primary concern was more about in idual patient than public health benefit. Out of 824 patients for whom ART was initiated, as reported by prescribers in 2013, only 108 (13.1% [95% CI, 10.9%-15.6%]) were given ART primarily to prevent onward HIV transmission. The number of patients for whom ART was initiated was significantly associated with prescribers' HIV caseload even after adjusting for prescriber type (adjusted odds ratio, 1.73 [95% CI, 1.47-2.03] P<0.001) of the 37 who had initiated ART for 10 or more patients, 29 had a high HIV caseload. In 2013, 60 prescribers (73.2% [95% CI, 62.2%-82.4%]) reported that they routinely recommended ART to treatment-naive, asymptomatic patients with a CD4+ T-cell count of 350-500 cells/mm3. Our findings show increasing acceptance of and support for early ART initiation primarily as treatment and not as prevention.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.DRUGPO.2019.06.002
Abstract: Direct-Acting Antiviral (DAA) treatments for hepatitis C have been widely promoted by health promotion professionals and medical clinicians as being 'side-effect free'. In this paper, we draw on data that troubles this approach. We used a mixed method design to collect data from people who inject drugs, and who were DAA treatment naïve, in New South Wales, Australia. We describe knowledge about and perceptions of DAA treatment. We found that concerns about side effects were commonplace - for ex le, one-third (37%) of participants who had not taken up treatment worried "a lot" about 'side effects' - and that these concerns were underpinned by a general distrust and suspicion of medical institutions and their technologies, including widespread negative associations linked to interferon treatment. In trying to make sense of this, we draw on the concept of counterpublic health and its recognition that the everyday health needs, knowledges and aspirations of subordinated citizens frequently contradict the normative frameworks governing public health interventions. We suggest that failing to engage with concerns about 'side effects' could hinder elimination efforts. Our analysis suggests that addressing the issue of 'side effects' within the 'public' discourse of DAAs will not d en or damage elimination efforts, as some might fear, but rather it will legitimate the concerns of people who inject, decrease their suspicion of medical interventions, and better support the uptake of DAA treatments.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.DRUGPO.2015.08.018
Abstract: Interest in health-care related trust is growing with the recognition that trust is essential for effective therapeutic encounters. While most trust-related research has been conducted with general patient groups, the experiences of people who inject drugs cannot be understood without acknowledging the critical role social stigma plays in shaping (mis)trust, both generally and in regards to health services specifically. This study examined the experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one area of Sydney, Australia. In-depth interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was informed by a five component model of trust, with particular emphasis on the notion of "global trust" as encompassing experiences of stigma and other negative social processes related to injecting drug use. Participant experiences of trust in NSPs were compared with those within other drug-related health services. Particular attention was paid to understanding the relationship between 'identity' (as a drug user) and 'legitimacy' (as a service user) and the centrality of this relationship to the experience of global trust for PWID. Notions of identity and legitimacy were inextricably bound up with the stigmatisation of drug use, shaping participants' experiences and accounts of trust in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs, especially when compared with drug treatment services, describing being treated like "any other person" even when negotiating 'sensitive' issues. NSP staff participants described the establishment of trust as not only underpinning their work with clients but as something that required ongoing renewal and demonstration. "Global trust" assists us to better understand the complex experiences shaping PWID decisions to engage with and trust health services. The high levels of trust reported between client and NSP need to be recognised as a valuable resource for the delivery of effective health care for people who inject drugs, including encouraging behaviours to support the prevention of blood-borne viruses.
Publisher: Wiley
Date: 2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-04-2022
Publisher: CSIRO Publishing
Date: 22-07-2022
DOI: 10.1071/SH22052
Abstract: Background Early uptake of HIV treatment among those newly diagnosed with HIV can improve in idual health and prevent onward transmission. Patient-centred care is considered an important aspect in health care, the management of HIV, and can improve uptake of and adherence to HIV treatments. Methods Semi-structured interviews were conducted with sexual health clinicians (n, 10) and HIV support workers (n, 4) to understand how they approached HIV diagnosis delivery and care immediately thereafter. Results Our thematic analysis identified three themes: (1) centring patient needs at diagnosis (2) assessing patients’ readiness to begin treatment and (3) referrals to psychosocial support services. Our findings highlight centring patients was an important aspect of how participants delivered HIV diagnoses. By taking this approach, clinicians were best able to consider patient readiness to initiate treatment and referrals to social support services. Conclusions Given HIV diagnoses are increasingly occurring in generalist health services, our findings offer an important opportunity to learn from the experiences of specialist sexual health clinicians and HIV support workers.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2017
DOI: 10.1007/S10461-017-1752-3
Abstract: The landscape of HIV testing has changed significantly in recent years following the rise in importance of the 'treatment as prevention' strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2008
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1007/S10508-018-1308-2
Abstract: We investigated the racial or ethnic partner preferences among Australian gay and bisexual men (GBM) as part of a large study of sexual preferences among GBM, to identify whether racial bias was a factor in how GBM expressed their partner preferences. We surveyed 1853 Australian GBM about their partner preferences and preferred sex practices. We used logistic regression to identify whether factors such as age, gay social engagement, or men's own ethnicity or race were associated with ethnic and racial partner preferences. Mean age was 34.8 years. Ethnic or racial background included: white or "Caucasian" (86.6%), Australian Aboriginal (2.7%), and Asian (6.6%). Mean attraction scores were highest for "Caucasian" men, and lowest for Aboriginal and Asian men. Under half (41.6%) were attracted to all racial or ethnic types 7.7% were only attracted to "Caucasian" men. Being older and lower homonegativity scores were independently associated with finding all ethnic and racial types attractive. Being attracted only to "Caucasian" men was associated with younger age. Mental health was not associated with ethnic or racial partner preferences. Although men more commonly found most racial or ethnic types attractive, racial biases in partner selection were more evident among younger men, and among those who were less comfortable with their own sexuality. Addressing anti-gay stigma and broader exposure to gay community subcultures may be as important in countering racial bias.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2019
DOI: 10.1007/S10461-019-02435-6
Abstract: In Australia, HIV testing services have become increasingly available in non-traditional settings such as peer-led, community-based services to expand access and increase uptake of HIV testing among gay and bisexual men (GBM). This study aimed to compare the socio-demographic and behavioural characteristics of GBM whose last HIV test was conducted at a community-based service to GBM whose last test was at a traditional clinical setting. We analysed behavioural surveillance data collected from 5988 participants in seven states and territories in the period 2016-2017. We found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings, particularly in terms of sexual practice and risk of HIV. However, non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study points to the successful establishment of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV.
Publisher: Oxford University Press (OUP)
Date: 05-2009
DOI: 10.1111/J.1743-6109.2008.01160.X
Abstract: Sexual expression affects physical, mental and social well-being. There is a lack of understanding of male sexual dysfunction in homosexually active men. Aim. We investigated gay men's self-report of a number of sexual problems. The survey data were from a s le of 542 self-identified gay men, 40% of whom were HIV positive, recruited from six high HIV-caseload general practices in Australia. The reporting of experiencing three or more sexual problems over a period of at least 1 month in the 12 months prior to a survey was defined here as having "multiple" sexual problems. We explored a number of factors, including HIV status, depression, alcohol and other drug use, and sexual risk-taking with casual male partners, in association with multiple sexual problems. Rates of a range of self-reported sexual problems were high, with erectile dysfunction and lack of sexual desire being the most commonly reported. These high rates were consistent with the limited data from previous Australian studies. Men who had multiple sexual problems were likely to suffer from major depression (P < 0.001). A higher proportion of the HIV-positive gay men (48.4%) reported multiple sexual problems than the HIV-negative men (35.1%, P = 0.002). Factors independently associated with multiple sexual problems among the HIV-negative gay men were poorer general health and interpersonal isolation, whereas for the HIV-positive gay men, they were adoption of avoidant strategies to cope with daily life stress, sexual risk-taking in casual encounters, and the use of antidepressants. Our findings underscore the complex interactions between depression, sexual dysfunction, sexual risk taking, HIV infection, and general well-being among homosexually active men.
Publisher: Springer Science and Business Media LLC
Date: 31-05-2016
Publisher: New Zealand Plant Protection Society
Date: 17-12-2021
DOI: 10.30843/NZPP.2021.74.11747
Abstract: Neonectria ditissima causes a debilitating apple tree canker disease. We determined the efficacy of polymerase chain reaction primers, originally designed for European strains, by sequencing New Zealand strains. The concatenated ribosomal inter-transcribed spacer and β-tubulin gene regions of 17 New Zealand isolates were compared with those of two European strains by phylogenetic analysis. New Zealand and European isolates of N. ditissima were in the same clade, suggesting that there has been little change in these gene regions following introduction to New Zealand. There was 100% homology with Bt-FW135 and Bt-RW284 primers. Based on sequencing 17 New Zealand isolates from several locations, these polymerase chain reaction primers can be relied upon to lify New Zealand isolates of N. ditissima.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12097
Abstract: Background Although half of the HIV notifications among Aboriginal and Torres Strait Islander people (‘Indigenous Australians’) are attributed to homosexual transmission, there has been little research examining sexual and drug use risk practices among Indigenous Australian men who have sex with men (MSM). Methods: Respondents were Indigenous Australian (n = 1278) and Anglo-Australian men (n = 24 002) participating in the routine cross-sectional Gay Community Periodic Surveys conducted in Australia from 2007 to 2011. Sociodemographic characteristics, sexual risk practices, drug use, HIV testing and HIV status of Indigenous and Anglo-Australian men were compared and evaluated to discover whether Indigenous status was independently associated with HIV risk practices. Results: Although an equivalent proportion of Indigenous and Anglo-Australian men reported being HIV-positive (9.6%), Indigenous MSM were more likely to report unprotected anal intercourse with casual partners in the previous 6 months (27.9% v. 21.5% Adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.11–1.49). Indigenous men were more likely than Anglo-Australian men to report use of several specific drugs and twice as likely to report injecting drug use in the previous 6 months (8.8% v. 4.5% AOR = 1.43, 95% CI: 1.11–1.86). Conclusions: Despite a higher proportion of Indigenous men reporting sexual and drug use practices that increase the risk of HIV transmission, there were no differences in the HIV status of Indigenous and Anglo-Australian men. However, the elevated rates of risk practices suggest that Indigenous MSM should remain a focus for HIV prevention, care and support.
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/S8DV-S822
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2011
Publisher: BMJ
Date: 15-07-2011
DOI: 10.1136/SEXTRANS-2011-050041
Abstract: Three decades into the HIV epidemic and with the advancement of HIV treatments, condom and non-condom-based anal intercourse among gay men in resource-rich countries needs to be re-assessed. The proportions of men engaging in a range of anal intercourse practices were estimated from the ongoing cross-sectional Gay Community Periodic Surveys in six states in Australia from 2007 to 2009. Comparisons were made between HIV-negative men, HIV-positive men with an undetectable viral load and those with a detectable viral load. Condoms play a key role in gay men's anal intercourse practices: 33.8% of HIV-negative men, 25.1% of HIV-positive men with an undetectable viral load and 22.5% of those with a detectable viral load reported consistent condom use with all male partners in the 6&emsp14 months before the survey. Among HIV-negative men, the second largest group were men who had unprotected anal intercourse (UAI) only in the context of HIV-negative seroconcordant regular relationships. Among HIV-positive men, the second largest group was men who had UAI in casual encounters preceded by HIV status disclosure to some, but not all, casual partners. A minority, yet sizeable proportion, of men consistently engaged in a number of UAI practices in specific contexts, suggesting they have adopted deliberate HIV risk-reduction strategies. While it is important that HIV behavioural prevention continues to reinforce condom use, it needs to address both the challenges and opportunities of the substantial uptake of non-condom-based risk-reduction strategies.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/5PM2-RG76
Publisher: BMJ
Date: 18-03-2020
DOI: 10.1136/SEXTRANS-2019-054360
Abstract: The rapid expansion of the recreational drug market becomes a global health concern. It is worrying that the bacterial and viral infection epidemics linking to drug use may worsen accordingly. This study aimed to estimate the impacts of changing trend and behaviours of using heroin only, synthetic drug (SD) only and polydrug (using SD and heroin concurrently) on HIV, hepatitis C virus (HCV) and syphilis epidemics among people who use drugs in China by 2035. We constructed a compartmental model to estimate HIV, HCV and syphilis epidemics in the dynamic drug-use trend by three scenarios: SD-only use, heroin-only use and polydrug use based on Monte Carlo simulations. The parameters for the model were collected from a comprehensive literature search. Our model estimated that polydrug use led to the highest HIV and HCV prevalence among three drug-use patterns. The prevalences were projected to increase from 10.9% (95% CI 10.2% to 11.5%) and 61.7% (95% CI 59.4% to 62.5%) in 2005 to 19.0% (95% CI 17.3% to 20.7%) and 69.1% (95% CI 67.3% to 69.5%), respectively, in 2035 among people using polydrug. Similarly, HIV and HCV prevalence in the SD-only group were projected to increase from 0.4% (95% CI 0.3% to 0.4%) and 19.5% (95% CI 19.4% to 21.7%) to 1.8% (95% CI 1.4 to 2.1%) and 33.7% (95% CI 33.2% to 34.9%) in 2005–2035. Conversely, HIV prevalence in the heroin-only group was projected to decrease from 8.0% (95% CI 7.6% to 8.1%) to 2.2% (95% CI 2.0% to 2.3%) in 2005–2035. Syphilis prevalence was estimated to remain unchanged in all population groups within this time frame. It was projected that the proportion of HIV transmitted by sexual transmission will increase compared with unsafe injection transmission in all people who use drugs from 2005 to 2035. Our modelling suggests that polydrug use is projected to lead to the highest HIV and HCV disease burden by 2035, and the proportion of HIV transmitted by sexual transmission will increase. Current HIV intervention among people using heroin seems effective according to our estimation.
Publisher: Hindawi Limited
Date: 19-06-2022
DOI: 10.1111/HSC.13886
Publisher: Oxford University Press (OUP)
Date: 22-12-2020
DOI: 10.1093/BJSW/BCAA232
Abstract: Risk management and empowerment have become key features of social work practice. Despite their increasing salience, relatively little is known about the perspectives of mental health social workers regarding how they navigate competing risk management approaches in modern practice that supports empowerment. The socio-cultural influences on risk management have also received insufficient attention in social work research. Focusing on these issues, this paper explored the perspectives of social workers in two geographically and culturally distinctive settings (i.e., Hong Kong and Sydney). Data were collected through semi-structured interviews with frontline social workers and were analysed using thematic analysis. Similar views were expressed by participants in both settings regarding assessment of clients’ readiness for risk-taking. Differences were identified in their practices of negotiating the perspectives of other key stakeholders and can be attributed to the influences of distinctive cultural and socio-political contexts. These insights may contribute to the development of more systematic, localised and practice-based risk assessment guidelines for mental health practitioners working towards the empowerment of clients.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/1FHH-AB12
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2018
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/SH23036
Publisher: MDPI AG
Date: 28-02-2023
Abstract: Australian HIV notification rates are higher for people born in Northeast Asia, Southeast Asia and sub-Saharan Africa compared to Australian-born people. The Migrant Blood-Borne Virus and Sexual Health Survey represents the first attempt to build the national evidence base regarding HIV knowledge, risk behaviors and testing among migrants in Australia. To inform survey development, preliminary qualitative research was conducted with a convenience s le of n = 23 migrants. A survey was developed with reference to the qualitative data and existing survey instruments. Non-probability s ling of adults born in Northeast Asia, Southeast Asia and sub-Saharan Africa was undertaken (n = 1489), and descriptive and bivariate analyses of data were conducted. Knowledge of pre-exposure prophylaxis was low (15.59%), and condom use at last sexual encounter was reported by 56.63% of respondents engaging in casual sex, and 51.80% of respondents reported multiple sexual partners. Less than one-third (31.33%) of respondents reported testing for any sexually transmitted infection or blood-borne virus in the previous two years and, of these, less than half (45.95%) tested for HIV. Confusion surrounding HIV testing practices was reported. These findings identify policy interventions and service improvements critically needed to reduce widening disparities regarding HIV in Australia.
Publisher: SAGE Publications
Date: 28-04-2022
DOI: 10.1177/14680173211009714
Abstract: Interprofessional practice has been broadly endorsed as a strategy which supports the delivery of high-quality health services. Few studies have addressed the dynamics inherent to interprofessional mental health practice in an era in which client empowerment is prioritised and valued. Social work perspectives are also underexplored in the studies which have been published on interprofessional health care, despite the increasingly important role of this discipline in community mental health contexts. Through a thematic analysis of 26 semi-structured interviews, this study explored the perspectives of mental health social workers located in two geographically and culturally distinctive sites (Hong Kong and Sydney), and identified a strong theme encompassing their concerns about the facilitation of client empowerment in interprofessional settings. Participant accounts direct attention to the strategies required to co-constitute the shared territories of the different mental health professions. Findings also highlight the frustration with recent mental health reforms which aim to challenge power differentials in interprofessional decision-making. Strategies were proposed for supporting the construction of shared language among different professions, revealing the creativity and insight of practitioners in managing the conflicts arising from interactions between different professional knowledge systems. The comparison of Hong Kong and Sydney accounts highlights the importance of structural, political and cultural influences in supporting not only interprofessional collaboration but also the independence and effectiveness of distinct professional roles. This article provides unique insights which aim to strengthen the contribution of social work to interprofessional practice in the promotion of empowerment-oriented interprofessional practice and education.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/00002030-200501280-00010
Abstract: To determine whether reporting that the HIV-positive partner's viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples. A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partner's viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P = 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94 95% confidence interval (CI), 0.87-1.00 P = 0.05], greater HIV optimism (OR, 4.98 95% CI, 1.25-19.8 P = 0.02) and reported undetectable viral load (OR, 2.88 95% CI, 1.13-7.37 P = 0.03). Most serodiscordant gay couples do not engage in any UAI. UAI within such relationships is significantly more likely to occur where the HIV-positive partner is reported to have undetectable viral load. UAI in HIV serodiscordant relationships is problematic even if viral load is undetectable because of unknown risk parameters, viral load variability and the possibility of drug-resistant strains of HIV.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2013
DOI: 10.1007/S10461-012-0350-7
Abstract: Increasing partner age may be an important risk factor for HIV infection in homosexual men. About 20 % of 1,427 participants in the Health in Men study in Sydney, Australia, reported that half or more of their partners were much older. Having more partners who were much older was associated with an increased risk of HIV seroconversion (p trend = 0.002), and this remained significant after adjustment for participants' age, number of regular and casual partners, and sexual risk behaviour (p trend = 0.027). Men who reported much older partners were at increased risk of HIV infection, independent of unprotected anal intercourse with sero-nonconcordant partners.
Publisher: Wiley
Date: 15-02-2016
DOI: 10.1111/MAQ.12274
Abstract: With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine's promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine-citizenship nexus in less-developed, resource-poor contexts. But how do we understand this relationship in resource-rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of in idual and community health. Drawing on Ecks's concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV "treatment revolution" have the capacity to both demarginalize and marginalize people with HIV.
Publisher: Elsevier BV
Date: 04-2015
Abstract: To examine the validity and impact of record linkage using name code compared to full name records. A registry of 45,419 opioid substitution clients (1985-2007) was linked with national population-based death and cancer registries using registrant's name, date of birth, sex, state, postcode and date of death. Records were linked using full name and then using the first two letters of the given and surname (2×2 name code). Sensitivity and specificity were computed and regression analysis used to identify factors related to linkage accuracy. Standardised mortality ratios (SMR) and standardised cancer incidence ratios (SIR) were estimated. The sensitivity and specificity of name code compared to full name linkage were 65.31% and 99.91% for death records and 76.81% and 99.89% for cancer records. Registrants' age and sex and accuracy of the registries were associated with risk of false linkages. Death and cancer risks (SMR 6.98, 95%CI 6.77-7.19 SIR 1.16, 95%CI 1.08-1.24) were significantly under-estimated using name code linkage (SMR 4.39, 95%CI 4.23-4.56 SIR 0.92, 95%CI 0.85-0.99). Record linkage using 2×2 name code has low sensitivity but high specificity, resulting in conservative estimates of death and cancer risk. This may translate to meaningful differences in outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2023
DOI: 10.1097/QAI.0000000000003224
Abstract: To assess changes in personal and relationship characteristics among HIV-positive Australian gay and bisexual men (GBM) as rates of antiretroviral therapy and knowledge and confidence regarding the effectiveness of viral suppression in preventing HIV transmission have increased. Repeated behavioral surveillance of GBM recruited from venues, events, and online in 7 Australian states and territories. HIV-positive participants were included. Trends in demographics, HIV treatment, and relationship characteristics were assessed with binary and multivariable logistic regression. A total of 3643 survey responses (2016–2020) were included. Over time, HIV-positive GBM became less likely to identify as gay or report an Anglo-Australian ethnicity. The average length of time since HIV diagnosis increased and the frequency of attending HIV-related clinical appointments decreased. There were no changes in the reported number of recent sex partners or proportion reporting regular male partners over time. Among HIV-positive GBM in relationships, the proportion reporting HIV-positive partners decreased and the proportion reporting HIV-negative partners increased. Levels of condomless sex with regular partners increased over time however, this was concentrated among HIV-positive GBM in serodiscordant relationships. Findings suggest that increased accessibility and trust in biomedical prevention strategies have contributed to broader relationship and sexual opportunities for HIV-positive GBM in Australia. Our findings suggest that future health promotion activities could highlight the social and relationship benefits of treatment as prevention to further increase trust in it as an HIV prevention strategy among GBM.
Publisher: Wiley
Date: 06-09-2016
DOI: 10.1111/HIV.12312
Publisher: Oxford University Press (OUP)
Date: 11-2008
DOI: 10.1111/J.1743-6109.2008.00845.X
Abstract: The relevance of circumcision in preventing male-to-male sexual transmission of HIV is poorly understood, in particular because any potential beneficial effect could be diminished by the impact of circumcision on sexual behavior. We examined the impact of circumcision on sexual experience. Univariate and multivariate logistic regressions were performed on data from 1,426 HIV-negative homosexually active men. We compared the sexual behaviors and preferences of circumcised with uncircumcised men, and men who were circumcised at infancy with those who were circumcised after infancy. Overall, 66% of men (N = 939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no differences between circumcised and uncircumcised men in any insertive or receptive anal intercourse, difficulty using condoms, or sexual difficulties (e.g., loss of libido). Among the circumcised men, we compared those circumcised at infancy (N = 854) with those circumcised after infancy (N = 81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity, the men circumcised after infancy were more likely to practice any receptive anal sex (88% vs. 75%, P < 0.05) and to experience erection difficulties (52% vs. 47%, P < 0.05), but less likely to practice any insertive anal sex (79% vs. 87%, P < 0.05) and to experience premature ejaculation (15% vs. 23%, P < 0.05) than those circumcised at infancy. Our data suggest that overall circumcision status does not affect the HIV-negative gay men's anal sexual behaviors, experience of condom use, or likelihood of sexual difficulties. However, there is some suggestion of differences in sexual practices and preferences among circumcised gay men depending on the age at circumcision. In particular, gay men circumcised later are more likely to engage in and prefer receptive anal intercourse.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/TBQA-M183
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2006
Publisher: BMJ
Date: 06-2018
Publisher: Public Library of Science (PLoS)
Date: 14-02-2019
Publisher: Research Square Platform LLC
Date: 17-10-2023
Publisher: Informa UK Limited
Date: 29-01-2015
DOI: 10.1080/09540121.2015.1005004
Abstract: Female sex workers are a priority population for HIV prevention and health promotion in China. This paper examines the patterns of and factors associated with the utilisation of HIV-related and general health services by establishment-based sex workers in Hongkou District, Shanghai. Participants were recruited through a three-stage s ling strategy and invited to self-complete a brief survey in 2012. The median age of the 400 participants included in the analyses was 33 years (range = 18-52 years old), with over three-quarters being married at the time of the survey. Participants were mostly internal migrants, more than half had lived in Shanghai for six months or longer and nearly two-thirds were working in an establishment with a total of less than five female sex workers. Routine physical examination and HIV testing were the most commonly accessed health services in the previous 12 months. Altogether, 347 women (86.8%) had actively sought, including 157 women had obtained, free health services mainly from local Community Health Service Centres (CHSCs) in the previous 12 months. The active seeking of free, largely CHSC-provided health services was associated with a longer duration of residence in Shanghai (adjusted odds ratio [AOR] = 2.55, 95% CI = 1.32-4.93 p < 0.01) and having tested for HIV in the previous 12 months (AOR = 3.68, 95% CI = 1.84-7.38 p < 0.001). Conversely, a higher annual income (AOR = 0.41, 95% CI = 0.21-0.80 p < 0.01), working in a larger establishment (AOR = 0.40, 95% CI = 0.20-0.79 p < 0.01) and knowing that HIV can be transmitted through blood transfusion with unscreened blood (AOR = 0.21, 95% CI = 0.05-0.91 p < 0.05) were associated with not actively seeking such services. Free, community-based health services are highly demanded by establishment-based female sex workers in Shanghai. Scaling-up of free and integrated health services provided by community-based health service providers in metropolitan areas in China and beyond holds promise for promoting health and well-being of female sex workers.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.DRUGALCDEP.2015.03.026
Abstract: Blood-borne viruses (BBV) are prevalent among people with opioid dependence but their association with cause-specific mortality has not been examined at the population-level. We formed a population-based cohort of 29,571 opioid substitution therapy (OST) registrants in New South Wales, Australia, 1993-2007. We ascertained notifications of infection and death by record linkage between the Pharmaceutical Drugs of Addiction System (OST data), registers of hepatitis C (HCV), hepatitis B (HBV) and human immunodeficiency virus (HIV) diagnoses, and the National Death Index. We used competing risks regression to quantify associations between notification for BBV infection and causes of death. BBV status, age, year, OST status, and OST episodes were modelled as time-dependent covariates sex was a fixed covariate. OST registrants notified with HCV infection were more likely to die from accidental overdose (subdistribution hazard ratio, 95% Confidence Interval: 1.7, 1.5-2.0), cancer (2.0, 1.3-3.2) and unintentional injury (1.4, 1.0-2.0). HBV notification was associated with a higher hazard of mortality due to unintentional injury (2.1, 1.1-3.9), cancer (2.8, 1.5-5.5), and liver disease (2.1, 1.0-4.3). Liver-related mortality was higher among those notified with HIV only (11, 2.5-50), HCV only (5.9, 3.2-11) and both HIV and HCV (15, 3.2-66). Registrants with an HIV notification had a higher hazard of cardiovascular-related mortality (4.0, 1.6-9.9). Among OST registrants, BBVs are a direct cause of death and also a marker of behaviours that can result in unintended death. Ongoing and enhanced BBV prevention strategies and treatment, together with targeted education strategies to reduce risk, are justified.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.ADDBEH.2019.01.022
Abstract: The use of synthetic drugs has exceeded heroin to become a major public health concern in China. We aimed to estimate the trend of heroin-only, synthetic drug-only and poly-drug (heroin and synthetic drug) use during 2000-2030 period in China using existing data. We used data from the Annual Report on Drug Control in China and peer-reviewed publications. We constructed a mathematical model to estimate the drug use trend based on Monte Carlo simulations. The best calibrated model estimated that the number of drug users would increase from 0.86 million to 3,120,059 (95% CI 2,669,214-3,570,904) during 2000-2030 period. The proportion of heroin-only users among the total drug users will decrease from 96.8% (95% CI, 96.6-97.1%) in 2000 to 36.9% (30.1-40.8%) in 2030, while the proportion of synthetic drug-only users will increase from 1.1% (0.9-1.3%) in 2000 to 57.7% (51.7-65.6%) in 2030. In contrast, the proportion of poly-drug users shared an increasing trend during 2000-2016 (from 2.1% (1.5-2.8%) to 15.1 (13.8-17.1%)) but declined to 5.5% (3.4-7.2%) in 2030. Estimated 46,370 (41,634-51,106) heroin-only users and 3767 (3481-4053) synthetic drug only users initiated poly-drug use in 2000. We observed a cross-over in 2012 where more synthetic drug-only users were initiating heroin use than heroin-only users initiating synthetic drug use. There will be estimated 2,094,052 (1,819,830-2,368,274) synthetic drug-only users and poly-drug users 211,407 (177,150-245,664) in 2030. Synthetic drug use will become dominant in drug users in China, but poly-drug use of both heroin and synthetic drugs will remain substantial.
Publisher: SAGE Publications
Date: 15-12-2010
Abstract: This article reports on in-depth interviews with gay men about their experiences and understanding of depression. It is a key outcome of the collaboration between social researchers, general practitioners and community partners to investigate the management of depression in gay men in primary care settings. As part of the qualitative arm of the project in-depth interviews were conducted with 40 gay men in Sydney and Adelaide (Australia). The approach to discourse analysis is informed by Hallidayan systemic functional linguistics. Six constructions of depression were identified: (1) depression as a constellation of symptoms (2) symptoms constructed as experience (3) depression as agent (4) depression as mental processes (5) not meeting social expectations and (6) engaging with psychiatric discourse: constructing alternative positions. Gay men draw on the biomedical model of depression as low mood and loss of pleasure as well as on constructions of depression in terms of social experience. The biomedical model of depression is, however, not positioned as unproblematic. Rather, gay men align or disalign with this discourse according to their own experience, thereby enacting erse masculinities. Gay men’s discourses of depression are inextricably linked to the community activism of gay men and their community organizations in the context of the HIV epidemic, as well as a synergy between gay men and their doctors.
Publisher: Hindawi Limited
Date: 15-01-2018
DOI: 10.1111/HSC.12544
Abstract: SMS reminders sent to personal mobiles are increasingly used by clinical services to promote patient engagement, including adherence to antiretroviral treatment (ART) for HIV. From August to September 2015, a 6-week, randomised SMS reminder for ART adherence intervention was implemented among 98 HIV-positive clients of Australian's largest HIV charitable organisation located in Sydney. This was followed by a mixed-method evaluation, comprising a self-completed online survey and a one-to-one interview. Of the 62 survey participants, all being men, the majority were gay (85.5%) and living long-term with HIV (median year of HIV diagnosis = 1998). While everyone was on ART, a substantial proportion (n = 27, 43.5%) had interrupted treatment in the past. At the end of the intervention, based on the standard SMAQ measure, 82% had consistently adhered to ART in the previous week. While there was no statistically significant intervention effect, perceiving less stigma were independently associated with better ART adherence (adjusted odds ratio = 0.37 95% CI 0.16-0.89 P = .026). Of the 11 interviewees, despite limited add-on effects on in idual ART adherence, the c aign was well-received as a unique community support service. This study underscores the essential role of empowerment through enhancing disease self-management, increasing social support and reducing stigma, particularly for long-term HIV survivors. SMS messaging, part of mHealth, delivered by community services could have broader impacts on reducing health and social inequity.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16072
Abstract: Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect in iduals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia’s primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000–15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P 0.001) in annual HIV testing (56.1–64.8%), condomless sex with casual partners (26.8—38.8%) and the proportion of HIV-positive men on HIV treatment (72.5–88.4%) and with an undetectable viral load (73.7–94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Publisher: Hindawi Limited
Date: 20-08-2015
DOI: 10.1111/HSC.12266
Abstract: Street-based female sex workers (SSWs) are subjected to a relatively high risk of HIV transmission, even higher than establishment-based female sex workers in China. However, very few HIV intervention programmes have targeted this particular group to date. Based in Southwest China, this study aims to identify perceived barriers, demands and suggestions on HIV prevention from the perspectives of SSWs, clients and healthcare providers in Chongqing. Face-to-face, in-depth interviews were conducted in July 2008 with 23 participants. They were recruited by purposive, convenience s ling and included 12 SSWs, 5 male clients, 4 government healthcare providers and 2 outreach workers from a community-based non-governmental organisation. Thematic analysis was used. SSWs were largely rural-to-urban migrants with a low socioeconomic status. Most of their clients shared a similar background. Both SSWs and their clients demonstrated a low awareness of HIV infection and a lack of understanding of effective preventive strategies. Financial hardships, lack of family support, fear of police arrest and stigma in relation to sex work were identified as SSWs' major barriers for accessing healthcare services. Both SSWs and their clients indicated an urgent demand for accessing adequate HIV prevention and care programmes. On the other hand, government organisations trying to provide services to this group have also encountered obstacles, specifically their limited ability to establish mutual trust. Programmes provided by community-based non-governmental organisation, however, were perceived to be more attractive. In conclusion, there remains a substantial gap between the need of adequate HIV prevention services for SSWs and their clients and what is currently available. Strengthening inter-sectoral collaboration, providing specifically tailored health services, actively involving SSW peers and their clients, and reducing stigma in the society are keys to meet this urgent demand by SSWs in China.
Publisher: Informa UK Limited
Date: 28-04-2016
Publisher: American Society of Hematology
Date: 26-08-2010
DOI: 10.1182/BLOOD-2010-03-272351
Abstract: Analysis of cancer risk in primary immune deficiency (PID) offers insight into the relationship between immune function and cancer. Data on Australian patients (n = 1132) notified voluntarily to the Australasian Society of Clinical Immunology and Allergy PID Registry (1990-2008) were linked with national death and cancer registries. Person-years of follow-up commenced from up to 15 years before registration on the PID Registry or January 1982, the inception of national cancer registration. Site-specific, 5-year age-, sex-, calendar year–, and state-standardized incidence ratios (SIRs) with 95% confidence intervals (95% CIs) were calculated for all cancers except nonmelanocytic skin cancer. During an average of 16 person-years follow-up, a 1.6-fold excess relative risk of cancer was observed (n = 58 SIR 1.60, 95% CI 1.22-2.07) for all PID combined. Relative risk was increased for non-Hodgkin lymphoma (n = 16 SIR 8.82, 95% CI 5.04-14.30), leukemia (n = 4 SIR 5.36, 95% CI 1.46-13.73), and stomach cancer (n = 3 SIR 6.10, 95% CI 1.26-17.84). Excess cancer risk was observed for predominantly antibody deficiencies and other well-defined immunodeficiency syndromes. Results suggest that predominantly antibody deficiencies may be associated with a narrower range of solid cancers than immunodeficiency characterized by predominantly T-cell deficiency, such as iatrogenic and HIV-related immunodeficiency, although this requires confirmation in larger cohorts.
Publisher: Cold Spring Harbor Laboratory
Date: 27-09-2022
DOI: 10.1101/2022.09.26.22280388
Abstract: Gay, bisexual and other men who have sex with men (GBMSM) and trans and gender erse (TGD) people are disproportionately affected by poorer sexual health outcomes compared to heterosexual populations. We aimed to explore the preferences of GBMSM and TGD for using eHealth for sexual health (eSexualHealth). We distributed an anonymous online survey among the lesbian, gay, bisexual, transgender, intersex, queer and other people of erse sexuality or gender (LGBTIQA+) community in Australia. The survey collected data on sociodemographic characteristics and sexual behaviours, their preferences for app/website functions and preferred HIV and sexually transmitted infection (STI) testing reminders. We used descriptive statistics to summarise the characteristics of the study population. Free-text responses were thematically analysed. Of 466 participants included, most identified as cisgender males (92.7%). The median age was 48 (interquartile range [IQR]: 37-56). For accessing sexual health-related information, 160 (34.6%) would use either a website or an app, 165 (32.7%) would prefer a website, 119 (25.8%) would prefer an app, and 33 (7.1%) would not use either platform. There was no significant difference between GBMSM and TGD people. Participants were most interested in information about STI clinics, HIV/STI hotspots, and sexual health education. Participants stressed the need for privacy and anonymity when using eHealth. Regarding reminders to test for HIV/STIs, receiving regular SMS was most popular (112/293, 38.2%), followed by regular emails (55/293 18.8%) and a reminder function on their phone (48/293, 16.4%). Our study suggests a promising future for eHealth among GBMSM and TGD people. Sexual health is still a stigmatised area, and eHealth may circumvent barriers this population faces. Gay, bisexual, and other men who have sex with men (GBMSM) and trans- and gender erse people (TGD) have poorer sexual health outcomes compared to heterosexuals eHealth (or digital interventions) to improve sexual health is a growing area Our survey among Australian GBMSM and TGD in iduals document their preferences for using eHealth to optimize their sexual health Being aware of preferences for eHealth can inform resource allocation and future development of features wanted by target populations
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/DTWE-JH83
Publisher: Elsevier BV
Date: 10-2023
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 07-06-2022
DOI: 10.1007/S10508-022-02310-X
Abstract: Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 ( N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 ( p 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 ( p 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
Publisher: CSIRO Publishing
Date: 2006
DOI: 10.1071/SH06009
Abstract: Male circumcision may reduce the risk of HIV acquisition in heterosexual men. In observational studies, confounding by demographic factors could produce spurious associations between circumcision and HIV risk. To assess this possibility, cross-sectional data on self-reported circumcision status and demographic factors were collected at baseline as part of the Health in Men study. Two-thirds of 1426 subjects were circumcised, mostly in the neonatal period. In multivariate analyses, age, ethnicity and country of birth were independently associated with circumcision status. Confounding by these demographic factors must be considered in future epidemiological studies addressing circumcision and HIV acquisition.
Publisher: Public Library of Science (PLoS)
Date: 03-04-2017
Publisher: SAGE Publications
Date: 31-03-2011
Abstract: The data for this article are from a primary health care project on HIV and depression, in which the prevalence, nature, clinical management, and self-management of depression among homosexually active men attending high-HIV-caseload general practice clinics were investigated. One of the qualitative arms consisted of in-depth interviews with general practitioners (GPs) with high caseloads of gay men. The approach to discourse analysis was informed by Halliday’s systemic functional linguistics. GPs constructed three discourses of depression: engaging with psychiatric discourse, engaging with the patient’s world, and engaging with social structures. When GPs drew on the discourse of psychiatry, this discourse was positioned as only one possible construction of depression. This discourse was also contextualized in the social lives of gay men, and it was explicitly challenged and rejected. Engaging with their patients’ social world was considered vital for recognizing depression in gay men. Finally, the GPs’ construction of depression was inextricably linked to social disadvantage and marginalization. Depression is highly heterogeneous and constructed in terms of social relationships rather than as an independent entity that resides in the in idual. There is a synergy between GPs’ constructions of depression and men’s experiences of depression, which differs from conventional medical views, and which enables GPs to be highly effective in dealing with the mental health issues of their gay patients.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Elsevier BV
Date: 02-2023
Publisher: SAGE Publications
Date: 12-10-2021
DOI: 10.1177/10497323211043823
Abstract: Videoconferencing focus groups have emerged as a popular method for collecting qualitative data. However, its use in sexual and reproductive health research is still very much in its infancy. Based on participants’ feedback and researchers’ reflections on using videoconferencing focus groups to collect sexual and reproductive health data with 39 heterosexual and non-heterosexual Chinese im/migrants in Australia, we discuss some of the key lessons learned, and considerations involved in shifting from face-to-face to online focus groups. Overall, videoconferencing focus groups appeared to be a highly feasible and acceptable way to discuss “sensitive” topics with Chinese im/migrants. Importantly, researchers need to be both creative and reflexive during the research process and must not forget that the success of a study lies not only in troubleshooting technical issues but also in cultivating and maintaining a trusting relationship with research participants.
Publisher: Springer Science and Business Media LLC
Date: 27-04-2012
DOI: 10.1007/S10461-012-0184-3
Abstract: Using data from Australian Gay Community Periodic Surveys 1998-2010, we assessed the prevalence, trends and characteristics of gay men not tested for HIV. In 2010, one in eight Australian gay socially-engaged men were never tested for HIV, most of them sexually active and 56.5 % reporting unprotected anal intercourse. The proportion of not tested men was significantly higher in men younger than 30, of non-European origin and living outside of gay metropolitan areas. Although frequency of testing was associated with sexual practices, significant proportions of men with multiple sex partners and reporting unprotected anal intercourse were not tested as recommended. There were issues with using gay-friendly testing services in gay metropolitan areas. Despite Australia's success in HIV testing, improvement is needed for early detection of HIV infections. Interventions should encourage regular testing, engage with young gay men, improve access and convenience of testing, train service providers and expand testing options.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18138
Abstract: Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. Methods: Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. Results: Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load & copies mL–1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3–7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0–9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5–9.7, P = 0.004). Conclusions: Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Springer Science and Business Media LLC
Date: 06-10-2020
DOI: 10.1007/S10461-020-03053-3
Abstract: Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV−) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study methods and choice of neurocognitive measurement methods and outcomes were heterogeneous imposing a narrative synthesis. In studies with an HIV- control s le, premature neurocognitive aging was found in 45% of the cross-sectional analyses (9/20), while accelerated neurocognitive aging was found in 75% of the longitudinal analyses (3/4). There was no evidence for accentuated aging, but this was tested only in two studies. In studies without an HIV- control s le, the age effect was always present but wide (NCI OR = 1.18–4.8). While large s le size ( 500) was associated with abnormal patterns of cognitive aging, most of the studies were under powered. Other study characteristics such as longitudinal study design and higher proportion of older participants were also associated with the findings of abnormal cognitive aging. There is some support for premature and accelerated cognitive aging among PLHIV in the existing literature especially among large and longitudinal studies and those with higher proportion of older s les. Future HIV and cognitive aging studies need to harmonize neuropsychological measurement methods and outcomes and use a large s le from collaborative multi-sites to generate more robust evidences.
Publisher: Centre for Social Research in Health, UNSW, Sydney: UNSW Centre for Social Research in Health
Date: 2022
DOI: 10.26190/Y2R6-2P17
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/P2GH-N362
Publisher: Frontiers Media SA
Date: 12-01-2023
DOI: 10.3389/FPUBH.2022.1064408
Abstract: Gay, bisexual and other men who have sex with men (GBMSM) and trans and gender erse (TGD) people are disproportionately affected by poorer sexual health outcomes compared to heterosexual populations. We aimed to explore the preferences of GBMSM and TGD for using eHealth for sexual health (eSexualHealth). We distributed an anonymous online survey from April to August 2021among the lesbian, gay, bisexual, transgender, intersex, queer and other people of erse sexuality or gender (LGBTIQA+) community in Australia. The survey collected data on sociodemographic characteristics and sexual behaviors, their preferences for app/website functions and preferred HIV and sexually transmitted infection (STI) testing reminders. We used descriptive statistics to summarize the characteristics of the study population. Free-text responses were thematically analyzed. Of 466 participants included, most identified as cisgender males (92.7%). The median age was 48 [interquartile range (IQR): 37–56]. For accessing sexual health-related information, 160 (34.6%) would use either a website or an app, 165 (32.7%) would prefer a website, 119 (25.8%) would prefer an app, and 33 (7.1%) would not use either platform. There was no significant difference between GBMSM and TGD people. Participants were most interested in information about STI clinics, HIV/STI hotspots, and sexual health education. Participants stressed the need for privacy and anonymity when using eHealth. Regarding reminders to test for HIV/STIs, receiving regular SMS was most popular (112/293, 38.2%), followed by regular emails (55/293 18.8%) and a reminder function on their phone (48/293, 16.4%). Our study suggests a promising future for eHealth among GBMSM and TGD people. Sexual health is still a stigmatized area, and eHealth may circumvent barriers this population faces.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/M99Y-SH21
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Frontiers Media SA
Date: 27-02-2015
Publisher: Springer Science and Business Media LLC
Date: 09-2015
DOI: 10.1007/S10461-015-1167-Y
Abstract: In this study we sought to identify the social and behavioural characteristics of Australian gay and bisexual men who had and had not tested for HIV during their current relationship. The results were based on 2012 and 2013 data collected from ongoing cross-sectional and community-based surveys held in six Australian states and territories. One thousand five hundred and sixty-one non-HIV-positive men reported that they were in a primary relationship. The majority of gay and bisexual men in primary relationships had tested for HIV during the relationship (73.4 %). Among men who had not tested during the relationship, almost half of these men had never tested for HIV. As untested men within relationships are potentially at risk of acquiring and transmitting HIV to their partners unknowingly, it is important to promote HIV testing to these men.
Publisher: UNSWorks, UNSW
Date: 2022
DOI: 10.26190/DY2G-Q958
Publisher: Springer Science and Business Media LLC
Date: 23-01-2020
DOI: 10.1007/S10461-020-02797-2
Abstract: Data from repeated, national behavioural HIV surveillance was used to identify similarities and differences between young gay and bisexual men (YGBM) aged 16-24 (n = 1608) and older GBM aged 25-49 (n = 6266), in order to quantify risks and identify gaps in HIV prevention. Trend analyses from 2014 to 2018 are also reported. While there were similar rates of condomless anal intercourse with casual partners in both age groups, YGBM had lower rates of HIV testing and PrEP use but also fewer male partners. Our results suggest most YGBM have lower HIV risk than older GBM but a minority merit enhanced testing and prevention efforts.
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1111/J.1753-6405.2009.00344.X
Abstract: Social factors associated with Major Depressive Disorder (MDD) were identified among gay men attending high HIV caseload general practices in Sydney and Adelaide. Men who visited four participating practices were invited to self-complete a survey. A self-screening tool (PHQ-9), based on the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV), was used to measure depressive disorders. The rate of MDD (PHQ-9 score 10 or above) among the 195 HIV-positive gay men was significantly higher than that among the 314 non-HIV-positive gay men (31.8% vs 20.1%, p=0.002). Current MDD was independently associated with younger age, lower income, recent major adverse life events, adopting denial and isolation as coping strategies, less social support, less gay community involvement and recent sexual problems. HIV-status, however, was not independently associated with MDD. Socio-economic hardship, interpersonal isolation and personal withdrawal were significantly and independently associated with major depression in this population of gay men. The study provides further evidence of health inequity affecting gay men in Australia. Structural health promotion approaches focused on homophobia and discrimination, as well as community-engaged primary health care responses are called for to mitigate this inequity.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.SOCSCIMED.2010.02.006
Abstract: The introduction of highly active antiretroviral therapy (HAART) is typically represented as a turning point in the social and medical history of HIV/AIDS, leading to a conceptual ision into pre- and post-HAART eras. This paper explores how generational discourse is produced in interviews with general practitioners (GPs) and their HIV positive gay male patients in making sense of this moment and related changes in the Australian HIV epidemic. A theme of 'HIV generations' was identified in in-depth interviews with GPs who have HIV medication prescribing rights (based in Sydney, Adelaide and rural-coastal New South Wales) and the HIV positive gay men who attend their practices. In a closer analysis, generational discourse was identified across the interviews with GPs, characterising pre- and post-HAART HIV generations through three main features: treatment histories, socioeconomic status, and modes of survivorship. While generational discourse was less common in the accounts of HIV positive gay men, many of their ex les wove together two narrative forms - 'a different time' and 'difference today' - suggesting that concepts of time and inequity are deeply embedded in these men's understandings of the HIV experience. Our analysis indicates that generational concepts play a significant role in shaping both professional and 'lay' understandings of changes and patterns in the HIV epidemic.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2012
Publisher: Informa UK Limited
Date: 11-2006
DOI: 10.1080/09540120500343144
Abstract: Past research on unprotected anal intercourse with casual partners (UAIC) contrasts those who report no UAIC with any UAIC. This paper examines differences among three groups of men who had any UAIC on the basis of the number of UAIC acts reported in a six-month period, namely no UAIC (n = 507), occasional UAIC (1-5 acts, n = 251) and frequent UAIC (more than 5 acts, n = 148). The occasional UAIC group had values lying between those of the no- and the frequent-UAIC group. As compared with the frequent-UAIC group, men in the occasional-UAIC group were less likely to have a steady partner, held less favorable attitudes toward condoms and higher levels of HIV treatments optimism and were more likely to report some disclosure of serostatus to or by casual partners and a range of esoteric sexual practice. On the other hand, men in the no-UAIC group had lower levels of 'feeling bad' (distress) and were less likely to use drugs to enhance sexual pleasure in casual encounters. Disclosure of serostatus had a strong association with frequent UAIC and this finding calls for both more research and more community exploration of issues surrounding sexual decision-making.
Publisher: Springer Science and Business Media LLC
Date: 28-10-2023
DOI: 10.1007/S13178-022-00769-W
Abstract: Stigma is a significant contributor to the HIV diagnosis disparities experienced among migrants who are gay and bisexual men (GBM) living in high-income countries. We conducted interviews with 24 migrant GBM in Australia diagnosed with HIV from 2017 onwards, who since their diagnosis had become well-connected to sexual health services and participation in research. Interviews were conducted between October 2018 and December 2019. We aimed to identify how HIV and sexual identity stigmas were barriers to accessing HIV testing and prevention. These stigmas were deeply embedded into social, cultural, and institutional settings in participants’ countries of origin, resulting in poor HIV literacy, reluctance to access HIV-related services, including HIV testing, and fears of being identified as gay/bisexual publicly. Underpinned by internalised stigma, these fears and poor outcomes often persisted after moving to Australia. Other barriers to accessing HIV-related services in Australia included apprehension about a potential HIV-positive result and the possibility of visa cancellation, concerns about confidentiality, and a lack of confidence and support in navigating the healthcare system, including how to access pre-exposure prophylaxis. Addressing these multifaceted HIV testing and prevention barriers requires policies, systems, and interventions that increase health literacy about HIV testing, prevention, and treatment build trust and confidence when navigating Australian health services and reduce the impacts of HIV and sexual identity stigmas in migrants’ countries of origin on their experiences in Australia.
Publisher: BMJ
Date: 27-09-2007
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15037
Abstract: Gay and other men who have sex with men (GMSM) are disproportionally affected by the HIV epidemic in Australia. The study objective is to combine a clinical-based cohort with a community-based surveillance system to present a broader representation of the GMSM community to determine estimates of proportions receiving antiretroviral therapy (ART) and/or with an undetectable viral load. Between 2010 and 2012, small increases were shown in ART uptake (to 70.2%) and proportions with undetectable viral load (to 62.4%). The study findings highlight the potential for significantly increasing ART uptake among HIV-positive GMSM to reduce the HIV epidemic in Australia.
Publisher: BMJ
Date: 2012
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 17-02-2018
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 22-05-2020
Publisher: Elsevier BV
Date: 02-2023
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/JVDK-BG23
Publisher: Elsevier BV
Date: 02-2023
Publisher: Informa UK Limited
Date: 2005
DOI: 10.1080/09540120412331305106
Abstract: The objective of the paper was to compare encounters involving unprotected anal intercourse (UAI) and protected anal intercourse (PAI) among HIV-negative gay men in Sydney. Data were from those completing baseline face-to-face interviews to end June 2003 for the Health in Men open cohort of HIV-negative gay men in Sydney. The 1,148 participants ranged in age from 18 to 75 years (median = 36). Three hundred and fifty-two (30.7%) reported an occasion of UAI with a casual partner in the previous 6 months and 531 (46.3%) reported an occasion of UAI with a regular partner in that same time. The men's most recent sexual contact with a casual partner involving UAI was distinguished from those involving PAI by a greater likelihood for both partners to disclose HIV serostatus (p = 0.006) and by respondents being more inclined to restrict themselves to the insertive position or to practise withdrawal during occasions involving any UAI than when a condom was used (p = 0.003 and p = 0.001 respectively). Neither location nor recreational drug use differentiated men's most recent sexual contacts involving UAI from those involving PAI. The decision by HIV-negative gay men to use condoms during sexual encounters with either regular or casual partners is guided more by HIV serostatus and risk reduction strategies than by other factors.
Publisher: Public Library of Science (PLoS)
Date: 18-05-2023
DOI: 10.1371/JOURNAL.PONE.0286025
Abstract: Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people’s participation examine changes in substance use and wellbeing over 90 days and assess which young people are most positively impacted Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an ‘engagement’ program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL) Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes. Aligning engagement program with therapeutic intervention can provide comprehensive support to disadvantaged young people, producing substantial improvements in AOD use, distress and wellbeing.
Publisher: Informa UK Limited
Date: 2002
Publisher: Springer Science and Business Media LLC
Date: 16-01-2013
DOI: 10.1007/S10461-013-0409-0
Abstract: Injecting drug use is commonly reported among gay and bisexual men in Australia. We examined the prevalence and covariates of injecting drug use among men participating in the Sydney Gay Community Periodic Survey between 2004-06 and 2011. In 2004-06, data was collected about which drugs were injected, while in 2011, data was collected about hepatitis C (HCV) and esoteric sexual practices. In 2004-06, 5.6 % of men reported injecting drugs in the previous 6 months 3.4 % reported meth hetamine injection and 0.4 % heroin injection. In 2011, men who injected drugs were less likely to be employed full-time, and more likely to be HCV-positive, HIV-positive, to have used party drugs for sex, and to have engaged in esoteric sexual practices. The strong associations between injecting drug use, sexual risk practices and blood-borne virus infection suggests the need for combined sexual health and harm reduction services for gay and bisexual men who inject drugs.
Publisher: Elsevier BV
Date: 2022
DOI: 10.2139/SSRN.4166357
Publisher: BMJ
Date: 06-2008
Abstract: Misreporting of circumcision status may affect observed relationships between circumcision status and HIV or other sexually transmissible infections. As no data exist on the validity of self-reported circumcision status among homosexual men, we investigated the agreement between self-report and examination findings in a subgroup of participants in the Health in Men (HIM) study in Sydney, Australia. A subgroup of 240 participants in the community based HIM cohort study attending annual interview agreed to a brief genital examination by a trained study nurse who was unaware of their previous self-reported circumcision status. Five participants reported being uncircumcised at baseline but were classified as circumcised on examination. All participants who self-reported being circumcised were found on examination to be circumcised. Three cases in which the examining study nurse was unsure of participants' circumcision status were excluded. Of the remaining 237 participants, 155 (65.4%) were classified as circumcised on examination, including five men who self identified as uncircumcised. Compared with examination, self-reported circumcision status resulted in a sensitivity of 96.8%, specificity of 100%, positive predictive value of 100% and negative predictive value of 94.3%. The overall agreement between circumcision status on examination and self-report was 97.9% (kappa score, 0.95 p<0.001) Self-report was a valid measure of circumcision status in this group of predominantly Anglo gay-community-attached men. We believe our findings can be generalised to similarly aged gay-community-attached men in other developed countries.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2018
DOI: 10.1038/S41598-018-25038-Y
Abstract: The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodeficiency virus (HIV) and syphilis among SD-only users, heroin-only users and poly-drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users ( p 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug effects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4] 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9] 3.9, [1.8–5.4]). Elevated risk of both HIV and syphilis infection have been established among poly-drug users.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2013
DOI: 10.1007/S10461-012-0406-8
Abstract: HIV-related risk perceptions and risk practices among gay men have changed over time. We revisited perceived HIV risk and engagement in anal intercourse with casual partners among HIV-negative gay men who participated in one of the Sydney Gay Community Periodic Surveys (GCPS). Perceived HIV risk was assessed by a range of anal intercourse practices combined with pre-specified casual partners' HIV status and viral load levels. Perceived HIV risk forms a potential hierarchy, broadly reflecting differences in the probability of HIV transmission through various anal intercourse practices. To a lesser extent, it also varies by casual partners' HIV status and viral load. Men who had unprotected anal intercourse with casual partners (UAIC) perceived lower HIV risk than those who used condoms consistently in the 6 months prior to survey. Recognising the complex associations between risk perceptions and risk practices helps to better address challenges arising from the 'Treatment as Prevention' (TasP).
Publisher: MDPI AG
Date: 26-09-2022
Abstract: In this article, we describe the approaches taken to recruit adult migrants living in Australia for a sexual health and blood-borne virus survey (paper and online) and present data detailing the outcomes of these approaches. The purpose was to offer guidance to redress the under-representation of migrants in public health research. Methods of recruitment included directly contacting people in in idual/organizational networks, social media posts/advertising, promotion on websites, and face-to-face recruitment at public events/venues. Search query strings were used to provide information about an online referral source, and project officers kept records of activities and outcomes. Descriptive statistical analyses were used to determine respondent demographic characteristics, proportions recruited to complete the paper and online surveys, and sources of referral. Logistic regression analyses were run to predict online participation according to demographic characteristics. The total s le comprised 1454 African and Asian migrants, with 59% identifying as female. Most respondents (72%) were recruited to complete the paper version of the survey. Face-to-face invitations resulted in the highest number of completions. Facebook advertising did not recruit large numbers of respondents. Same-sex attraction and age (40–49 years) were statistically significant predictors of online completion. We encourage more researchers to build the evidence base on ways to produce research that reflects the needs and perspectives of minority populations who often bear the greatest burden of disease.
Publisher: Wiley
Date: 02-06-2015
DOI: 10.1111/HIV.12169
Abstract: With the increasing momentum to maximize the benefits of antiretroviral therapy (ART), better understanding of opportunities and challenges in increasing ART coverage and promoting early ART initiation is urgently needed. Key sociodemographic, clinical and behavioural factors associated with Australian HIV-positive gay men's current nonuse of ART were systematically examined. Data were based on 1911 responses from HIV-positive men who had participated in the Australian Gay Community Periodic Surveys (GCPS) between 2010 and 2012. Stratified univariate analysis and multivariate logistic regression were used. A majority of the participants were recruited from gay community venues and events and self-identified as gay or homosexual. On average, they were 44 years old and had been living with HIV for at least 10 years. Close to 80% (n=1555) were taking ART, with >90% further reporting an undetectable viral load at the time of the survey. From 2010 to 2012, there had been a moderate increase in ART uptake [adjusted odds ratio (AOR) 1.40 95% confidence interval (CI) 1.20-1.65]. In addition, younger age (AOR 1.66 95% CI 1.45-1.92), recent HIV diagnosis (AOR 1.78 95% CI 1.59-1.98), not receiving any social welfare payments (AOR 2.20 95% CI 1.05-2.54) and no annual screening for sexually transmissible infections (AOR 1.55 95% CI 1.03-2.34) were independently associated with ART nonuse. Current ART coverage among HIV-positive gay men in Australia is reasonably high. To further increase ART coverage and promote early ART initiation in this population, better clinical care and sustained structural support are needed for HIV management throughout their life course.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/F13R-7P71
Publisher: Elsevier BV
Date: 09-2015
Publisher: Springer Science and Business Media LLC
Date: 11-03-2020
Publisher: Elsevier BV
Date: 08-2023
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.1080/09540121.2013.766304
Abstract: This study explores Australian prescribers' attitudes towards Treatment as Prevention (TasP) and their practices around initiating combination antiretroviral treatment (cART) for HIV. A brief online survey was conducted nationally amongst antiretroviral treatment (ART) prescribers in Australia. The s le broadly represented ART prescribers in Australia (N = 108), with 40.7% general practitioners (GPs), 25.9% sexual health clinic-based physicians and 21.3% hospital-based infectious diseases physicians. About 60% of respondents had been treating HIV-positive patients for more than 10 years. Respondents estimated that about 70-80% of all their HIV-positive patients were receiving ART. Over half of the prescribers agreed very strongly that their primary concern in recommending cART initiation was clinical benefit to in idual patients rather than any population benefit. A majority of the prescribers (68.5%) strongly endorsed cART initiation before CD4+ T-cell count drops below 350 cells/mm(3), and a further 22.2% strongly endorsed cART initiation before CD4+ T-cell count drops below 500 cells/mm(3). Regarding the optimal timing of cART initiation, this study shows that prescribers in Australia in 2012 focus primarily on the benefits for their in idual patients. Prescribers may need more convincing evidence of in idual health benefits or increased knowledge about the population health benefits for a TasP approach to be effective in Australia.
Publisher: UNSW Centre for Social Research in Health, Sydney
Date: 2021
DOI: 10.26190/NR8P-AT84
Publisher: Guilford Publications
Date: 02-2004
DOI: 10.1521/AEAP.16.1.1.27726
Abstract: Against a background of increasing unprotected anal intercourse (UAI) in the Sydney gay community (and internationally), complementary cross-sectional surveys of sexual practice were conducted among gay men of Asian background in 1999 (N = 319) and 2002 (N = 457). Self-complete questionnaires were used with recruitment at gay bars, gay social functions, and gay sex-on-premises venues. In 2002, self-report HIV status was 73.7% HIV-negative, 3.6% HIV-positive, and 22.8% unknown status (no significant change from 1999). Over time, the proportion of gay Asian men who reported any UAI with regular partners (in the previous 6 months) did not change significantly: 27.9% in 1999 24.3% in 2002. Similarly, rates of any UAI with casual partners remained steady: 16.3% in 1999 14.4% in 2002. Only one factor, more extensive engagement in esoteric practices (fisting, sadomasochism, group sex, rimming), was independently associated with sexual risk practice. This suggests that risk in this population of gay men, as in others, has more to do with the sexual cultures in which men are embedded rather than in idual-level differences.
Publisher: Hindawi Limited
Date: 15-09-2022
DOI: 10.1111/HSC.14011
Publisher: Centre for Social Research in Health, UNSW Sydney, Sydney
Date: 2019
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.HEALTHPOL.2021.07.002
Abstract: In 2015, New South Wales (Australia) removed patient co-payments for ART of HIV. We hypothesized the policy change would reduce overall out-of-pocket (OOP) healthcare expenditure, improve ART adherence, and better maintain HIV suppression. Using data from a national, 2-year prospective study of adults with HIV on ART (n=364) (2013-2017), we compared OOP healthcare expenditure, ART adherence, and virological failure (VF) in participants subject to the co-payment policy change with participants from other jurisdictions who never paid, and who always paid, co-payments. We used fixed effects regression models to compare outcomes, and incidence rates for VF. Although ART co-payments declined, there was no significant change in total OOP healthcare expenditure in participants ceasing co-payments compared to those who continued (adjusted coefficient 0.09, 95% CI -0.31 to 0.48). Co-payment removal did not significantly reduce suboptimal ART adherence (from 17.5% to 16.3%) or VF (from 5.0 to 3.7 episodes per-100-person-years). Participants in the lowest income group but not receiving concessional government benefits incurred a non-significant increase in total OOP healthcare expenses while concessional participants experienced a significant increase in non-ART HIV healthcare costs after the policy changed. In this population, ART co-payments represented a small proportion of OOP healthcare expenditure. Its removal did not materially impact ART adherence or VF, although the study was not powered to detect these.
Publisher: MDPI AG
Date: 08-03-2016
Publisher: Oxford University Press (OUP)
Date: 02-07-2019
DOI: 10.1093/BJSW/BCY057
Abstract: This study explored how social workers located in Sydney and Hong Kong conceptualised client empowerment. Further, it investigated these professionals’ perceived facilitators and barriers to their empowerment practices, based on an ecological framework. A cross-sectional online survey was used, where the original Empowerment Scale for clients with mental health issues was adapted to measure conceptualisation of client empowerment from social workers’ perspectives. Eighty-three social workers serving people with mental health issues (MHIs) in Sydney and eighty in Hong Kong responded. A two-factor model was generated suggesting that practitioners tend to conceptualise client empowerment into two aspects: a relation-based dimension and a resource-oriented one. Compared with their Sydney counterparts, the Hong Kong practitioners considered resource-oriented empowerment as more integral to client empowerment (t(161) = 4.17, p & 0.001). Several key factors were found to be independently associated with endorsement of the two-factor client-empowerment model by practitioners: perceived less support from medical specialists but more support from teams serving the same client, perceived benefits of social work training and, finally, beliefs in the importance of social workers’ role in client empowerment. The study highlights the multiple dimensions of client empowerment and a wide range of inter-professional and sociostructural factors enabling social workers’ practices that support empowerment. Our paper highlights the role of professional empowerment as a stepping stone to enable their client-empowerment practices through policy support and inter-professional collaboration.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Location: New Zealand
Start Date: 2018
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2018
End Date: 2021
Funder: Australian Research Council
View Funded ActivityStart Date: 08-2018
End Date: 12-2022
Amount: $317,000.00
Funder: Australian Research Council
View Funded Activity