ORCID Profile
0000-0002-5482-2822
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Research Topics
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.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Sociology | Sociology of health | Social and Cultural Anthropology | Public Health and Health Services | Social Policy | Health Policy | Sociology of family and relationships | Social policy | Sociology | Sociology and social studies of science and technology | Sociology not elsewhere classified | Aboriginal and Torres Strait Islander Health | Digital health |
ANZSRC Socio-Economic Objective (SEO)
Social Structure and Health | Expanding Knowledge through Studies of Human Society | Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) |
Related Links
Publications
Young people from culturally diverse backgrounds and their use of services for sexual and reproductive health needs: a structured scoping review
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15090
Abstract: Sexual and reproductive health needs are global health, development and human rights priorities, essential to the wellbeing of in iduals, couples and families. Despite widespread recognition of this, young people, including those from culturally erse backgrounds in wealthy nations such as Australia, remain largely hidden to, and underserved by, sexual and reproductive healthcare services. A scoping review was undertaken to describe the range of research on sexual and reproductive health among culturally erse young people in Australia, in order to identify gaps in the literature. This comprised a systematic literature search and key informant consultations, followed by descriptive thematic analysis of the included literature. One hundred and twenty papers were deemed eligible for inclusion, and findings are presented as three separate analyses. The first provides an overview of four dimensions identified in the literature: (i) cultural ersity (ii) the resettlement experiences of migrant communities (iii) the sexual and reproductive health needs of these communities and (iv) the practices of health services in this field. The second explores what is known from the literature about culturally erse young people’s needs for, use of, and engagement with services for sexual and reproductive health, while the third identifies two knowledge gaps: (1) the perspectives of culturally erse young people regarding sexual and reproductive health and health care and (2) the engagement of culturally erse young people with sexual and reproductive health services. New directions for a research agenda on sexual and reproductive health care for culturally erse young people in Australia are proposed, based on the identified knowledge gaps.
Features of the management of depression in gay men and men with HIV from the perspective of Australian GPs
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.
On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the “Treatment Revolution” Era
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.
Health literacy in relation to cancer: addressing the silence about and absence of cancer discussion among Aboriginal people, communities and health services
Publisher: Hindawi Limited
Date: 05-2013
DOI: 10.1111/HSC.12054
Abstract: Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non-Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined in idual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non-Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi-layered programme of work involving grass-roots community education, workers and Board members of Aboriginal community-controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community-based primary care and tertiary level cancer services.
‘Everything is okay’: The influence of neoliberal discourse on the reported experiences of Aboriginal people in Western Australia who are HIV‐positive
Publisher: Informa UK Limited
Date: 11-2007
DOI: 10.1080/13691050701496913
Abstract: While Australian Aboriginal conceptions of health have been described as holistic and collective, contemporary approaches to health services and health research are often premised on the rational, reflexive subject of neoliberal discourse. This paper considers how neoliberal conceptions of health and subjectivity arose and were negotiated in the context of a qualitative research project on Aboriginal experiences of HIV in Western Australia. Questions about 'coping', 'future' and 'life changes' stood out in the interview transcripts as ex les of neoliberal discourse. This paper explores the reflexive, contextual and deflective responses to these questions and suggests they demonstrate how neoliberal discourse can produce the impression that 'everything is okay' despite the difficult social and economic conditions of everyday life experienced by many Aboriginal people. Aboriginal people with a chronic and serious infectious disease such as HIV may utilise the language of self-management and responsibility when talking about HIV with a non-Aboriginal researcher for pragmatic and utilitarian reasons. In this way, the responses of the Aboriginal participants in this study provide a valuable opportunity for exploring new approaches to both research methodology and health service delivery.
Sustaining sexual and reproductive health through COVID-19 pandemic restrictions: qualitative interviews with Australian clinicians
Publisher: CSIRO Publishing
Date: 30-08-2022
DOI: 10.1071/SH22109
Abstract: Background The sexual and reproductive health care of people with HIV and those at risk of HIV has largely been delivered face-to-face in Australia. These services adapted to the coronavirus disease 2019 (COVID-19) pandemic with a commitment to continued care despite major impacts on existing models and processes. Limited attention has been paid to understanding the perspectives of the sexual and reproductive health care workforce in the research on COVID-19 adaptations. Methods Semi-structured interviews were conducted between June and September 2021 with 15 key informants representing a erse range of service settings and professional roles in the Australian sexual and reproductive health sector. Inductive themes were generated through a process of reflexive thematic analysis, informed by our deductive interest in clinical adaptations. Results The major adaptations were: triage (rapidly adapting service models to protect the most essential forms of care) teamwork (working together to overcome ongoing threats to service quality and staff wellbeing), and the intwined themes of telehealth and trust (remaining connected to marginalised communities through remote care). Despite impacts on care models and client relationships, there were sustained benefits from the scaleup of remote care, and attention to service safety, teamwork and communication. Conclusions Attending to the experiences of those who worked at the frontline of the COVID-19 response provides essential insights to inform sustained, meaningful system reform over time. The coming years will provide important evidence of longer-term impacts of COVID-19 interruptions on both the users and providers of sexual and reproductive health services.
Engaging Migrant and Refugee Young People with Sexual Health Care: Does Generation Matter More Than Culture?
Publisher: Springer Science and Business Media LLC
Date: 15-02-2018
Engaging Stigmatised Communities in Australia with Digital Health Systems: Towards Data Justice in Public Health
Publisher: Springer Science and Business Media LLC
Date: 06-02-2023
DOI: 10.1007/S13178-023-00791-6
Abstract: In 2018, following government policy changes to Australia’s national electronic health record system, ‘My Health Record’, consumer advocates—including organisations representing people living with HIV, people who use drugs and sex workers—raised concerns about privacy and data security. Responding to these controversies, this study explores the practical, ethical and political complexities of engaging stigmatised communities with digital health systems. We conducted 16 qualitative semi-structured interviews in 2020 with key informants representing communities who experience stigma, discrimination and marginalisation in Australia. These communities included people living with HIV, sex workers, people who inject drugs, gay and bisexual men and transgender and gender erse people. We conducted a reflexive thematic analysis. Key informants were sceptical of proposed benefits of electronic health records for their communities, and concerned about privacy risks and the potential for discrimination. Meaningful consultation, consent mechanisms and tackling structural stigma were raised as solutions for engaging communities. Although communities could benefit from being included in digital health systems, significant cultural, legal and social reforms from government were believed to be necessary to build trust in digital health systems. We argue that these forms of data justice are necessary for effective future systems. Engaging stigmatised communities—including in relation to gender, sexuality, sex work, drug use, HIV—requires a commitment to data justice. The design and implementation of digital health systems requires investment in ongoing and meaningful consultation with communities and representative organisations.
Expert perspectives on the contribution of HIV general practice nursing to the ‘extraordinary story’ of HIV medicine in Australia
Publisher: Cambridge University Press (CUP)
Date: 14-03-2013
What moves a family doctor to specialise in HIV? Interviews with Australian policy key informants
Publisher: Informa UK Limited
Date: 11-2011
DOI: 10.1080/13691058.2011.607904
Abstract: The population of people living with HIV in Australia is increasing, requiring an expert primary care workforce to provide HIV clinical care into the future. Yet the numbers of family doctors or general practitioners (GPs) training as community-based HIV medication prescribers may be insufficient to replace those retiring, reducing hours or changing roles. We conducted semi-structured interviews between February and April, 2010, with 24 key informants holding senior roles in organisations that shape HIV-care policy to explore their perceptions of contemporary issues facing the HIV general practice workforce in Australia. Informed by interpretive description, our analysis explores how these key informants characterised GPs as being 'moved' by the clinical, professional and political dimensions of the role of the HIV general practice doctor. Each of these dimensions was represented as essential to the engagement of GPs in HIV as an area of special interest, although the political dimensions were often described as the most distinctive compared to other areas of general practice medicine. Our analysis explores how each of these dimensions contributes to shaping the contemporary culture of HIV medicine and suggests that such an approach could be useful for understanding how health professionals become engaged in other under-served areas of medical work.
Is sex lost in translation? Linguistic and conceptual issues in the translation of sexual and reproductive health surveys.
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.
“So Much Is at Stake”: Professional Views on Engaging Heterosexually Identified Men who Have Sex with Men with Sexual Health Care in Australia
Publisher: Springer Science and Business Media LLC
Date: 20-06-2017
Understanding Concerns About Treatment-as-Prevention Among People with HIV who are not Using Antiretroviral Therapy.
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.
‘The black dog just came and sat on my face and built a kennel’: Gay men making sense of ‘depression’
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.
Promoting ‘Equitable Access’ to PrEP in Australia: Taking Account of Stakeholder Perspectives
Publisher: Springer Science and Business Media LLC
Date: 10-10-2018
DOI: 10.1007/S10461-018-2311-2
Abstract: As evidence of the safety and effectiveness of HIV pre-exposure prophylaxis (PrEP) has grown, so has attention to the views of prospective users and providers. However, far less attention has been paid to understanding the perspectives of other stakeholders in the rollout of PrEP access programs. We conducted 21 semi-structured qualitative interviews in 2017 with key stakeholders working across the policy, advocacy, research and/or clinical dimensions of the Australian HIV response, before federal support for a subsidised access scheme was achieved. Our analysis explored three areas of shared concern: who is a suitable candidate for PrEP why are disparities in PrEP access important and how can disparities be addressed? In examining how this erse group of professionals grappled with the challenges of promoting 'equitable access' to PrEP in an increasingly resource rationed health system, we can see how the principles believed to underpin the Australian response to HIV were both reaffirmed and challenged through this period of significant change.
Qualitative Interviewing
Publisher: Springer Singapore
Date: 2018
'Not Until I'm Absolutely Half-Dead and Have To:' Accounting for Non-Use of Antiretroviral Therapy in Semi-Structured Interviews with People Living with HIV in Australia
Publisher: Mary Ann Liebert Inc
Date: 05-2015
Aboriginal young people’s perspectives and experiences of accessing sexual health services and sex education in Australia: A qualitative study
Publisher: Informa UK Limited
Date: 02-01-2023
Beyond Compliance Checking: A Situated Approach to Visual Research Ethics
Publisher: Springer Science and Business Media LLC
Date: 19-03-2018
DOI: 10.1007/S11673-018-9850-0
Abstract: Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of in idual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous.
A ‘scoping review' of qualitative literature about engagement with HIV care in Indonesia
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17163
Abstract: Background The Indonesian response to HIV has been informed largely by quantitative evidence. This review examines what is known about the Indonesian HIV care cascade from published qualitative research. Methods: A ‘scoping review’ method was used to synthesise and interpret the findings of 17 eligible peer-reviewed publications. Results: Qualitative findings are reported in relation to two themes. Factors influencing successful engagement include a lack of HIV-related knowledge among clients, fear of stigma or lack of privacy/confidentiality at services, limited accessibility and affordability, and poor linkages between services. Factors affecting the broader response include a failure to adapt programs to specific socio-cultural settings, political issues in the distribution of donor funding, distrust and poor communication between service users and providers, the need for cultural privacy in particular community settings, and systemic experiences of gendered stigmatisation. Conclusions: Enhancing understanding of the Indonesian context would benefit from future qualitative research on HIV care in urban settings, describing the experiences of the most at-risk populations, and examining the role of clinics and providers in delivering HIV care in an increasingly decentralised health system.
Just a preference: Racialised language in the sex-seeking profiles of gay and bisexual men
Publisher: Informa UK Limited
Date: 04-09-2012
DOI: 10.1080/13691058.2012.714799
Abstract: Racialised language is a salient and contested aspect of contemporary sexual cultures, particularly in the online domain. This paper explores the ways in which gay men in Australia employ race-related language when using online sex/dating websites. Using inductive content analysis, descriptive categories were developed to identify recurrent patterns in the racialised language employed by website users. A coding framework was then constructed to identify the 'subject' (self, other or concept) of each piece of race-related content, its 'purpose' (marketing, negative or positive discrimination, commentary) and the 'position' adopted (defensive, normalised or critical). Descriptive and comparative analyses revealed differences in the ways in which members of racial groups employed racialised language online. These differences are reviewed in relation to broader discourses on Whiteness and race in Australia, as well as recent community-produced anti-racism c aigns.
How do self‐advocates use community development to change attitudes to disability?
Publisher: Wiley
Date: 04-09-2023
DOI: 10.1111/BLD.12549
Understanding the health care needs of transgender and gender diverse people engaging with rural Australian sexual health centres: a qualitative interview study
Publisher: CSIRO Publishing
Date: 05-06-2023
DOI: 10.1071/SH22159
Abstract: Background Although there is a presumption that LGBTQ+ people living in rural Australia will have poorer health outcomes than those living in metropolitan areas, minimal research has focused specifically on the perspectives of transgender and gender erse (henceforth referred to as ‘trans’) people living in these regions. The purpose of this study was to understand what health and wellbeing means to trans people in a regional or rural community and identify their health needs and experiences. Methods A total of 21 trans people were recruited through two regional sexual health centres (SHC) and interviewed between April and August 2021. Data were analysed via reflexive thematic analysis. This paper focuses on participants’ accounts of health and wellbeing regarding gender affirmation, the experience of rural living, respectful holistic care, safety in rural communities, isolation, loneliness, and employment. Results The experience of living rurally can have both positive and negative impacts on the experiences of trans people. Participants reported experiences of stigma and discrimination, reduced employment opportunities and limited social interactions, which led to feelings of isolation and loneliness however, they also reported high quality of care, particularly with the specific SHCs which supported this research. Conclusion Living rurally can impact both positively and negatively on the health and wellbeing of trans peoples, and the experiences of living in this environment are erse. Our findings challenge the perception that rural trans people experience only poor health outcomes and shows the difference that key health services such as SHCs can make in supporting trans health.
Challenging Perceptions of “Straight”: Heterosexual Men Who Have Sex with Men and the Cultural Politics of Sexual Identity Categories
Publisher: SAGE Publications
Date: 17-07-2017
Abstract: Research shows that some heterosexually identified men engage in sex with men however, they remain largely hidden and little understood. Despite long-standing scholarly recognition that sexual identity and orientation do not always neatly coincide, the culturally normative heterosexual/homosexual binary tends to shape mainstream perceptions of such men as well as render them invisible in sexual health systems reliant on stable sexual identity categories. This invisibility, in turn, perpetuates the fiction of the binary. We explore perspectives on heterosexually identified men who have sex with men, drawing on recent research literature and on qualitative interviews with “key informants” in the Australian sexual health field who have frontline knowledge of these men. We consider the limitations of inventing a label to “encapsulate” these erse men but also the significance of finding a language that meaningfully acknowledges their sexual realities and highlights heterosexuality as more varied and fluid than social attitudes and traditional sexual identity categories permit.
Engaging nonHIV specialist general practitioners with new priorities in HIV prevention and treatment: qualitative insights from those working in the field
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12157
Abstract: Background The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage nonHIV specialist Australian general practitioners (GPs) with these new priorities. Methods: Content related to the engagement of nonHIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n = 24) and general practice clinicians (n = 47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of ‘issues’ described by participants. Results: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more ‘routine’ in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response. Conclusions: To successfully engage nonHIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed.
Challenges of providing HIV care in general practice
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PY13119
Abstract: As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care.
Is sexual racism really racism? Distinguishing attitudes toward sexual racism and generic racism among gay and bisexual men.
Publisher: Springer Science and Business Media LLC
Date: 07-07-2015
DOI: 10.1007/S10508-015-0487-3
Abstract: Sexual racism is a specific form of racial prejudice enacted in the context of sex or romance. Online, people use sex and dating profiles to describe racialized attraction through language such as "Not attracted to Asians." Among gay and bisexual men, sexual racism is a highly contentious issue. Although some characterize discrimination among partners on the basis of race as a form of racism, others present it as a matter of preference. In May 2011, 2177 gay and bisexual men in Australia participated in an online survey that assessed how acceptably they viewed online sexual racism. Although the men s led displayed erse attitudes, many were remarkably tolerant of sexual racism. We conducted two multiple linear regression analyses to compare factors related to men's attitudes toward sexual racism online and their racist attitudes more broadly. Almost every identified factor associated with men's racist attitudes was also related to their attitudes toward sexual racism. The only differences were between men who identified as Asian or Indian. Sexual racism, therefore, is closely associated with generic racist attitudes, which challenges the idea of racial attraction as solely a matter of personal preference.
Discourses of Depression of Australian General Practitioners Working With Gay Men
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.
Clinician imaginaries of HIV PrEP users in and beyond the gay community in Australia
Publisher: Informa UK Limited
Date: 10-09-2021
DOI: 10.1080/13691058.2021.1957152
Abstract: Through the development and implementation of HIV pre-exposure prophylaxis (PrEP), the characteristics of PrEP users have been configured in a range of ways. Drawing on the concept of 'imaginaries', we consider how clinicians imagine PrEP users and related communities. We conducted 28 semi-structured interviews in 2019-2020 with PrEP-providing clinicians based in New South Wales and Western Australia. Participants included general practitioners, sexual health nurses and sexual health doctors. We inductively developed three themes through a reflexive thematic analysis: 'PrEP users as 99% gay men/MSM', 'The informed and connected PrEP user', and 'Condom users in the PrEP era'. Participants imagined PrEP users primarily as gay men, and so we focused on how gay community was imagined in relation to PrEP users. Users were imagined as supporting one another to use PrEP effectively, but some were imagined as threatening norms of condom use amongst gay community. Analysing clinician imaginaries of PrEP users reveals insight into how clinicians speculate about and engage with changing community norms related to condom use and accessing PrEP. These imaginaries reveal ongoing tensions about who is believed to be best suited to PrEP, and PrEP's impact on norms of conduct in imagined biosocial communities like gay men.
Does drug and alcohol use undermine concordance between doctors' assessments of major depression and patients' scores on a screening tool for depression among gay men attending general practice?
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/PY11011
Abstract: General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients’ scores on the Patient Health Questionnaire-9 screening tool, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria, and GPs’ ratings of the likelihood of depression for each participant. We observed high concordance between GPs’ assessments of major depression and patients’ scores on the PHQ-9 (79% agreement), although our analysis also suggested that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients’ AOD use, with the exception of frequent use of crystal meth hetamine. Here, men who reported frequent use of meth hetamine were significantly less likely to have concordant assessments (adjusted odds ratio 0.3, 95% CI 0.1–0.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal meth hetamine use, other AOD use may have less impact on the diagnosis of depression.
Human rights and universal access for men who have sex with men and people who inject drugs: A qualitative analysis of the 2010 UNGASS narrative country progress reports
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.SOCSCIMED.2011.05.047
Abstract: All UN member states have endorsed a commitment to protect human rights in the global fight against HIV and to ensure universal access to HIV prevention, treatment, care, and support. To assess progress towards fulfilling this commitment, countries submit reports to UNAIDS biennially, known as UNGASS reports. Our quantitative analyses show that core indicators relating to most-at-risk populations, particularly men who have sex with men (MSM) and people who inject drugs (PWID) are limited or absent from many UNGASS reports, particularly those submitted by countries in developing regions. We conducted a qualitative thematic analysis of the narrative part of the 2010 UNGASS country progress reports, an important yet under-explored part of the reporting process, to consider how signatory countries in developing regions address the issue of MSM and PWID in a written form. Our analysis identified a repertoire of narrative approaches to MSM and PWID which revealed fault lines between countries' endorsement of the Declaration of Commitment on HIV/AIDS and programmatic responses to MSM and PWID. Our findings raise questions about the relationship between "universal" human rights and "local" cultures, and about the UNGASS reporting process itself. Through critical engagement with these questions, our article aims to contribute to international dialogues on how to better recognise and respond to shortcomings in the global commitment to human rights and universal access for people vulnerable to HIV.
Men and masculinities in qualitative research on vasectomy: perpetuation or progress?
Publisher: Informa UK Limited
Date: 13-07-2020
DOI: 10.1080/14461242.2020.1789486
Abstract: Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men's perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men's contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of
No Ordinary Mainstream Illness
Publisher: SAGE Publications
Date: 20-11-2013
Abstract: Research has shown that social representations of HIV can constitute barriers to health workers’ willingness to provide HIV care. Considering a growing shortage in the HIV primary workforce in Western countries, we examine how HIV is perceived today by doctors involved in its care. In 1989 Sontag predicted that once the virus became better understood and treatable, the dehumanizing meanings that defined the early epidemic would vanish and HIV would turn into an ordinary illness. However, research shows that HIV still carries stigma, including in the health care sector. Drawing on qualitative interviews, we found that HIV doctors in Australia perceived HIV as a far-from-ordinary chronic illness because of its extraordinary history and its capacity to extend in multiple clinical and social directions. These rarely explored perspectives can contribute to the social reframing of HIV and to strategies to build a dedicated HIV workforce in Australia and elsewhere.
One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people
Publisher: Informa UK Limited
Date: 08-2013
DOI: 10.1080/13557858.2012.754408
Abstract: Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. Our team--which includes both Aboriginal and non-Aboriginal researchers--conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of 'discursive framing' in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what 'cultural difference' means for the design and delivery of cancer care services to Aboriginal people. Despite geographical, organisational, disciplinary and cultural ersity, these interview participants consistently drew upon six discursive frames, which we have interpreted as either eliding a discussion of difference ('everyone is the same' and 'everyone is different') or facilitating that discussion ('different priorities,' 'different practices' and 'making difference safe'). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the 'taken for granted' assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer.
Families Living with Blood-Borne Viruses: The Case for Extending the Concept of “Serodiscordance”
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/4352783
Abstract: The concept of “serodiscordance” (mixed infection status) is primarily associated with epidemiological concerns about HIV transmission risk in couples. We make the case for extending this concept to include families with mixed HIV and viral hepatitis status. Social research on couples with mixed HIV and hepatitis C status has laid an important foundation for illuminating how experiences of serodiscordance within intimate partnerships are much broader than concerns about risk. This body of work attests to serodiscordance holding promise as a valuable concept for understanding viral infections as socially situated and intensely relational phenomena. However, serodiscordance is still limited as a concept because of its near universal focus on couples. It is rarely applied to wider relationships, including family networks beyond the couple. Despite evidence in the literature that families are affected by blood-borne viruses in multiple social, emotional, financial, and generational ways, the concept of serodiscordance does not capture these broader dynamics. Making serodiscordance more inclusive is an important step in recognising the erse ways families’ everyday lives, relationships, and futures can be entangled with HIV, hepatitis C, and hepatitis B, and for understanding how today’s era of effective treatment options might shape the “family life” of viral infections.
'Not everyone’s gonna like me': Accounting for race and racism in sex and dating web services for gay and bisexual men
Publisher: SAGE Publications
Date: 16-04-2016
Abstract: Sexual racism can be thought of as a specific form of racial prejudice enacted in the context of sex and dating. It is a contentious issue among gay and bisexual men looking for partners online. This study draws upon 14 in-depth interviews conducted between August and October 2012 with gay and bisexual men of colour in Australia. Data were thematically analysed to identify interpretations and experiences of, and reactions to sexual racism online. Understandings of online sexual racism were erse, ranging from clear ideas about racist and non-racist practices to more ambiguous and contextual interpretations. Nevertheless, all participants described experiences of sexual racism while seeking partners online, which were, in some cases, largely indistinguishable from generic forms of racism. Most described experiences of subtle racism, but there were also cases of blatant and aggressive racial prejudice. Finally, men reacted in a range of ways when confronted with online sexual racism, with strategies ranging from disconnection to adaptation through to confrontation. Our findings highlight that sexual racism – as an expression of racism generally – is an ongoing issue for men who seek out other men online, and that men engage in a range of strategies for mitigating the negative effects of racial prejudice in this domain.
“I can’t do this, it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers
Publisher: Springer Science and Business Media LLC
Date: 21-04-2013
DOI: 10.1007/S00038-013-0466-1
Abstract: Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.
Drawing them in: professional perspectives on the complexities of engaging ‘culturally diverse’ young people with sexual and reproductive health promotion and care in Sydney, Australia
Publisher: Informa UK Limited
Date: 26-09-2016
DOI: 10.1080/13691058.2016.1233354
Abstract: Young people from minority ethnic, migrant and refugee backgrounds are widely recognised as being under-served by mainstream sexual and reproductive healthcare in developed economy nations. This paper documents the views of professionals in Australia on the complexities of, and best practice approaches to, engaging members of this group with sexual and reproductive health promotion and care. Semi-structured interviews were conducted with 23 purposively selected key informants (health service providers, policymakers, academics and community advocates). Interviews were transcribed verbatim and coded in NVivo10 using interpretive thematic analysis. Principles of 'cultural competence' were employed to structure the interpretation of findings. Five key themes reveal pivotal aspects of how professionals work in, and make sense of, this complex field. These may be summarised as: (1) appreciating the complexities of cultural ersity (2) recognising structural barriers and disincentives to engagement (3) normalising sexual health (4) balancing 'youth-friendly' and 'culturally-competent' priorities and (5) going beyond simple translation. As migration to Australia continues to ersify the population, an integrated, national approach to the design and delivery of sexual and reproductive health promotion and care would be of value, along with training and support for those involved. Implications may have resonance for other countries similarly engaged in facilitating the successful settlement of migrants and refugees.
‘Who’s coming up next to do this work?’ Generational tensions in accounts of providing HIV care in the community
Publisher: SAGE Publications
Date: 06-05-2015
Abstract: Generational change is believed to be transforming the educational and employment preferences of medical trainees. In this article, we examine generational tensions in interviews with policy leaders and clinicians on workforce issues within one subset of the Australian medical profession: general practitioners who provide care to people with HIV in community settings. Integrating the accounts of policy leaders (n = 24) and clinicians representing the ‘first generation’ (n = 21) and ‘next generation’ (n = 23) of clinicians to do this work, shared and ergent perspectives on the role of generational change in shaping professional engagement were revealed. While those engaged in the early response to HIV believed younger clinicians to be less interested in the scientific and political dimensions of HIV care and more concerned about financial security and life balance, the next generation both countered and integrated these beliefs into new ways of conceptualising the value and appeal of this field of medicine. Critical appraisal of the assumptions that underpin generational discourse is essential in appreciating the changing views of providers over time, particularly in fields of medicine which have featured significant historical turning points.
Social factors associated with Major Depressive Disorder in homosexually active, gay men attending general practices in urban Australia
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.
Patterns of Alcohol and Other Drug Use Associated with Major Depression Among Gay Men Attending General Practices in Australia
Publisher: Springer Science and Business Media LLC
Date: 05-05-2012
HIV generations? Generational discourse in interviews with Australian general practitioners and their HIV positive gay male patients
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.
Marriage Equality: Two Generations of Gender and Sexually Diverse Australians
Publisher: Informa UK Limited
Date: 02-01-2020
Using digital storytelling to promote the sexual health and well-being of migrant and refugee young people: A scoping review
Publisher: SAGE Publications
Date: 13-12-2017
Abstract: Digital storytelling and other methods of self-expression and autobiography have become an increasingly important tool for those working with young people, including those from migrant, refugee or other ‘culturally erse’ backgrounds. A structured scoping review was undertaken to better understand the potential value and challenges of using digital stories to promote the health and well-being of these erse groups of young people and to identify key knowledge gaps. The review process comprised a systematic search of the literature and strategic consultations with professionals working with young people in the area of sexual and reproductive health promotion and care. A descriptive-analytic method was used to collate and synthesise the literature and apply narrative and thematic analyses. In total, 28 papers were deemed eligible for inclusion. Findings are presented as two analyses: what is known from the literature and key knowledge gaps. Identified themes included the use of digital stories as social activism and as research intervention, recognition of digital stories as complex terrain and recommendations for good practice. Three key gaps of particular relevance to our research aims were identified. These were (1) the lack of digital stories on sexual health and relationships by ‘culturally erse’ young people in Australia, (2) the need for discussion of the ethical considerations of using digital storytelling and related methods in sexual health fields and (3) the value of exploring opportunities to employ digital methods as self-representation and autobiography to generate new knowledge and build organisational capacity. As confirmed in discussions with professionals working in the youth, migrant and sexual health sectors, the literature highlighted the many potential applications of digital storytelling to promoting the sexual health and well-being of young people from erse backgrounds. Additional research is required to understand the particular ethical and contextual issues shaping, and at times constraining, this engagement in specific cultural contexts.
Cancer and Aboriginal people in Australia: A review of the literature
Publisher: Informa UK Limited
Date: 03-2008
The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations
Publisher: BMJ
Date: 16-02-2012
DOI: 10.1136/SEXTRANS-2011-050130
Abstract: HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of 'key informants' described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs.
Troubling the non-specialist prescription of HIV pre-exposure prophylaxis (PrEP): the views of Australian HIV experts
Publisher: Informa UK Limited
Date: 23-12-2019
“I Had a Little Bit of a Bloke Meltdown…But the Next Day, I Was Up”
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine
Publisher: Springer Science and Business Media LLC
Date: 21-03-2013
Experiences in managing problematic crystal methamphetamine use and associated depression in gay men and HIV positive men: in-depth interviews with general practitioners in Sydney, Australia
Publisher: Springer Science and Business Media LLC
Date: 15-08-2008
Learning about sex and relationships among migrant and refugee young people in Sydney, Australia: ‘I never got the talk about the birds and the bees’
Publisher: Informa UK Limited
Date: 30-04-2018
Comparing ‘doctor’ and ‘patient’ beliefs about the role of illicit drug use in gay men’s depression
Publisher: Hindawi Limited
Date: 28-11-2011
DOI: 10.1111/J.1365-2524.2011.01044.X
Abstract: High rates of both illicit drug use and depression are consistently reported among gay men. However, little is known about how beliefs about drug use shape clinical encounters between gay men and health professionals, and that in turn affect clinical communication and care, particularly in relation to depression. We compared 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's depression. Semi-structured interviews were conducted during August-December 2006 with 16 general medical practitioners working in seven 'gay-friendly' practices in Sydney, Adelaide and a rural-coastal city in New South Wales, and during February-May 2008 with 40 gay men with depression recruited through four Sydney and Adelaide practices. A thematic analysis of these two sets of interviews found that doctors expressed the beliefs that: illicit drug use is related to depression in gay men illicit drug use impedes effective diagnosis and treatment of depression in gay men and illicit drug use increases the level of complexity involved in caring for gay men with depression. Gay men expressed the beliefs that: illicit drug use is closely related to depression illicit drug use can be helpful in dealing with difficult experiences and illicit drug use is just what you do as a gay man living in a big city. Both groups believed drug use and depression were related, but doctors emphasised the negative outcomes of drug use and interpreted these in relation to health. Gay men believed that drugs could have both negative and positive uses and differentiated between health and social outcomes. While the doctors articulated a pragmatic position on drug use, which is consistent with harm reduction principles, communication with gay male patients could be enhanced if both groups acknowledged their ergent views of illicit drugs and their potential role in mental health.
ORIGINAL RESEARCH–MEN'S SEXUAL HEALTH: Self-Reported Sexual Difficulties and Their Association with Depression and Other Factors among Gay Men Attending High HIV-Caseload General Practices in Australi
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.
Bridging Worlds, Breaking Rules: Clinician Perspectives on Transitioning Young People with Perinatally Acquired HIV Into Adult Care in a Low Prevalence Setting
Publisher: Mary Ann Liebert Inc
Date: 07-2014
Abstract: The first generation of young people with perinatally acquired HIV is moving into adulthood, precipitating a transition from pediatric to adult care. As the first research appraisal of Australian clinician perspectives on this process, this article makes a unique contribution by examining the particular challenges associated with transitioning this population into adult care in regions of low HIV prevalence among young people. Qualitative interviews were conducted with twelve pediatric and adult care clinicians and analyzed for dominant and erging themes. Clinicians anticipated significant client vulnerabilities during transition and worked beyond the boundaries of their roles and service parameters to keep clients engaged as they moved between pediatric and adult care. Strategies to strengthen the transition process focused on communication and teamwork, informed by and responsive to the needs of in idual young people and their families. Clinicians working in settings with very small numbers of young people with HIV must advocate for a hidden minority with little potential for gaining large scale recognition or system changes. New conversations are needed to design a stronger and more sustainable transition process for both young people living with HIV, and their clinicians who care for them, in low prevalence settings.
Understanding Client Empowerment: An Online Survey of Social Workers Serving People with Mental Health Issues
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.
“We get by with a little help from our friends”: Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.DRUGPO.2016.04.005
Abstract: In Australia, sterile needles and syringes are distributed to people who inject drugs (PWID) through formal services for the purposes of preventing blood borne viruses (BBV). Peer distribution involves people acquiring needles from formal services and redistributing them to others. This paper investigates the dynamics of the distribution of sterile injecting equipment among networks of people who inject drugs in four sites in New South Wales (NSW), Australia. Qualitative data exploring the practice of peer distribution were collected through in-depth, semi-structured interviews and participatory social network mapping. These interviews explored injecting equipment demand, access to services, relationship pathways through which peer distribution occurred, an estimate of the size of the different peer distribution roles and participants' understanding of the illegality of peer distribution in NSW. Data were collected from 32 participants, and 31 (98%) reported participating in peer distribution in the months prior to interview. Of those 31 participants, five reported large-scale formal distribution, with an estimated volume of 34,970 needles and syringes annually. Twenty-two participated in reciprocal exchange, where equipment was distributed and received on an informal basis that appeared dependent on context and circumstance and four participants reported recipient peer distribution as their only access to sterile injecting equipment. Most (n=27) were unaware that it was illegal to distribute injecting equipment to their peers. Peer distribution was almost ubiquitous amongst the PWID participating in the study, and although five participants reported taking part in the highly organised, large-scale distribution of injecting equipment for altruistic reasons, peer distribution was more commonly reported to take place in small networks of friends and/or partners for reasons of convenience. The law regarding the illegality of peer distribution needs to change so that NSPs can capitalise on peer distribution to increase the options available to PWID and to acknowledge PWID as essential harm reduction agents in the prevention of BBVs.
The epidemiology of HIV in South African workplaces
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
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Discovery Projects - Grant ID: DP230100245
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End Date: 07-2026
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Amount: $480,315.00
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Amount: $307,550.00
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End Date: 10-2022
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