ORCID Profile
0000-0003-3013-7721
Current Organisations
Alfred Health
,
University of Melbourne
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Publisher: Informa UK Limited
Date: 22-02-2021
Publisher: BMJ
Date: 16-11-2016
DOI: 10.1136/SEXTRANS-2015-052243
Abstract: The aim of this study was to characterise the clinical features of adenovirus urethritis in men and to compare the frequency of these between heterosexual men and men who have sex with men (MSM). This was a review of the clinical and laboratory information from men diagnosed with PCR-confirmed adenovirus urethritis at the Melbourne Sexual Health Centre between January 2006 and April 2014. 102 adenovirus urethritis cases were reported, among which 61 were heterosexual men and 41 MSM. Eighty-nine per cent (n=91) had signs of meatitis or conjunctivitis: 51% had meatitis only 32% meatitis together with conjunctivitis and 6% with conjunctivitis only. The distribution of symptoms and signs was similar among heterosexual men and MSM (p values >0.1). Adenovirus was the sole pathogen found in 93% of cases, excluding gonorrhoea, chlamydia, Mycoplasma genitalium and herpes simplex virus. Only 37% had ≥5 polymorphs per high-power field from a urethral smear. Where s les were still available for adenoviral sequencing (n=20), all were subgroup D. The clinical features of adenovirus urethritis in men can be distinctive and aid diagnosis, distinguishing it from other treatable causes of male urethritis.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19045
Abstract: Background Dual condom and long-acting reversible contraceptive (LARC) or non-LARC hormonal contraceptive use is the most effective way to protect against unwanted pregnancy and sexually transmissible infections (STIs). This study aimed to determine whether condom use varied between users of LARC and non-LARC hormonal contraceptives and explore their motivations for condom use. Methods: Women aged 16–24 years attending a sexual and reproductive health centre in Melbourne, Australia, completed a survey about contraceptives and sexual practices. The proportion of LARC and non-LARC hormonal contraceptive users using condoms was calculated and logistic regression compared condom use between the two groups. Condom use was based on frequency of use and coded as a binary variable ‘never, not usually or sometimes’ versus ‘usually or always’. Results: In all, 294 (97%) women participated in the study 23.8% (95% confidence interval (CI) 19.0–29.1%) used LARC and 41.7% (95% CI 36.0–47.6%) used non-LARC hormonal contraceptives. Condom use was reported by 26.1% (95% CI 16.3–38.1%) of LARC users and by 27.8% (95% CI 19.9–37.0%) of non-LARC hormonal contraceptive users. There was no difference in condom use between groups (odds ratio (OR) 0.9 95% CI 0.4–1.9). Condom use reduced with increasing relationship length (≥6 months vs no relationship: OR 0.2 95% CI 0.1–0.6). Non-LARC hormonal contraceptive users were more motivated to use condoms if worried about pregnancy than LARC users (62.8% vs 47.8% P = 0.04). Conclusion: Condom use was low and similar between users of LARC and non-LARC hormonal contraceptives, and was associated with the length of the relationship. These results highlight the need to promote condom use when prescribing LARCs and non-LARC hormonal contraceptives to reduce the risk of STIs.
Publisher: Oxford University Press (OUP)
Date: 03-11-2017
Abstract: In Australia, high uptake of the quadrivalent human papillomavirus (4vHPV) vaccine has led to reductions in the prevalence of human papillomavirus (HPV) genotypes 6, 11, 16, and 18 in women and girls aged ≤25 years. We evaluated the impact of the program impact on HPV prevalence in unvaccinated male subjects. Sexually active heterosexual male subjects aged 16-35 years were recruited in 2014-2016. Participants provided a self-collected penile swab s le for HPV genotyping (Roche Linear Array) and completed a demographic and risk factor questionnaire. The prevalence of 4vHPV genotypes among 511 unvaccinated male subjects was significantly lower in those aged ≤25 than in those aged >25 years: 3.1% (95% confidence interval, 1.5%-5.7%) versus 13.7% (8.9%-20.1%), respectively (P < .001) adjusted prevalence ratio, 0.22 (.09-.51 P 25 years (P = .76) adjusted prevalence ratio, 0.98, (.57-1.37 P = .58). A 78% lower prevalence of 4vHPV genotypes was observed among younger male subjects. These data suggest that unvaccinated men may have benefited from herd protection as much as women from a female-only HPV vaccination program with high coverage.
Publisher: BMJ
Date: 12-2008
Abstract: The clinical diagnosis of pelvic inflammatory disease (PID) is subjective. Our aim was to determine if the pattern of diagnosis of PID among experienced clinicians varied compared with the diagnosis of genital warts. We conducted a retrospective study of 325 PID diagnoses made by experienced clinicians at Melbourne Sexual Health Centre, Australia (2002-2006), where doctors saw 21 785 unselected female patients in a walk-in service. We compared the proportion of female patients diagnosed as having PID and genital warts between doctors and then compared doctors above (high diagnosing) and below (low diagnosing) the mean rate of PID diagnosis. There were significant and clinically important differences in the proportion of women diagnosed with having PID (0-5.7%) across 23 doctors investigated. Estimated standard deviation in the frequency of PID diagnosis (logit scale) was 1.26 (95% CI 0.81 to 1.95)--approximately four times greater than for warts. Patients seen by high (n = 4673) and low (n = 16 787) diagnosing doctors had similar epidemiological risk profiles suggesting true distribution of PID cases across doctors was similar (p>0.13). Women diagnosed with having PID by high diagnosing doctors compared with low diagnosing doctors were younger (odds ratio 1.7 95% CI 1.1 to 2.8, p = 0.013) but otherwise had similar epidemiological and clinical features. Differences in diagnostic rates for PID between doctors are substantial and may be because of PID cases being missed by some doctors.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
Publisher: BMJ
Date: 17-11-2020
DOI: 10.1136/SEXTRANS-2020-054688
Abstract: Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7% diff=6.4% 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8% diff=−3.3% 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8% 95% CI −26.9 to -19.8). Solo sex activities increased 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3% diff= −14.8% 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5% diff=4.7% 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2% diff=14.6% 95% CI 10.1 to 19.2) increased during lockdown. Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.
Publisher: BMJ
Date: 02-2003
DOI: 10.1136/STI.79.1.31
Abstract: To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing. A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine s les were tested for C. trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C. trachomatis infection. Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C. trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)), and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C. trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic. The high prevalence of C. trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C. trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C. trachomatis are not transferable between populations, even in the same city.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/SH09088
Abstract: Background: The legislation in Victoria requires HIV-positive results to be given in person by an accredited health professional. Many sexual health clinics require all men to receive HIV results in person. Our aim was to determine the proportion of low-risk heterosexual men at a sexual health centre who tested HIV-positive. Methods: The electronic data on all HIV tests performed between 2002 and 2008 on heterosexual men at the Melbourne Sexual Health Centre (MSHC) was reviewed. The in idual client files of all heterosexual men who tested HIV-positive were reviewed to determine their risks for HIV at the time that the HIV test was ordered. Results: Over the 6 years there were 33 681 HIV tests performed on men, of which 17 958 tests were for heterosexual men. From these heterosexual men, nine tested positive for the first time at MSHC (0.05%, 95% confidence interval (CI): 0.01%, 0.09%). These nine cases included six men who had had sex with a female partner from the following countries: Thailand, Cambodia, China, East Timor, Botswana and South Africa. Two men had injected drugs and one had a HIV-positive female partner. Of the 17 958 test results for heterosexual males, 14 902 (83% 95% CI: 84%, 86%) test results were for men who did not have a history of intravenous drug use or had sexual contact overseas. Of these 14 902 low-risk men, none tested positive (0%, 95% CI: 0, 0.00025). Conclusion: Asking the 83% of heterosexual men who have an extremely low risk of HIV to return in person for their results is expensive for sexual health clinics and inconvenient for clients. We have changed our policy to permit heterosexual men without risk factors to obtain their HIV-negative results by phone.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12114
Abstract: Objectives To assess the proportion of female sex workers (FSWs) from low-prevalence (‘other’) and high-prevalence countries (HPCs) for sexually transmissible infections (STIs) in Melbourne. Methods: Retrospective data analysis from the Melbourne Sexual Health Centre database for February 2002–May 2011. Results: Some 1702 HPC FSWs, 2594 other FSWs and 13 644 nonFSW women were included, with 12 891 and 21 611 consultations, respectively, for HPC FSWs and other FSWs. Proportions of HPC FSWs with chlamydia (Chlamydia trachomatis) (4.2% v. 3.3%, P = 0.14), gonorrhoea (Neisseria gonorrhoeae) (0.24% v. 0.31%, P = 0.66) or trichomonas (0.65 v. 0.46, P = 0.42) at first visit were similar to those of other FSWs, but nonFSWs had a higher prevalence of chlamydia and gonorrhoea (P 0.01). On return visits, chlamydia (1.2% v. 0.92%, P 0.05) and gonorrhoea (0.29% v. 0.10%, P = .05) were more common in HPC FSWs than other FSWs. The presence of any of these STIs among FSWs was predicted by having private nonpaying partners in the last year (adjusted odds ratio (AOR): 1.99 (95% confidence interval (CI): 1.52–2.61)), having private partners from overseas (AOR: 1.69 (95% CI: 1.33–2.16)) and being a HPC FSW (AOR: 1.38 (95% CI: 1.12–1.72)). Injecting drug use was less common in HPC FSWs than in other FSWs (0.82% v. 16.54%, P 0.0001). Conclusions: STI prevalence was low among FSWs from countries with high and low background STI. Among FSWs having private sex partners and private partners from overseas were the primary predictors for STIs.
Publisher: SAGE Publications
Date: 03-2009
Abstract: The aim of this study was to determine the experience and views of female patients when they were offered a chaperone by a male sexual health practitioner for a genital examination. Between November 2007 and January 2008, an anonymous survey was administered to female patients seen by male practitioners at Melbourne Sexual Health Centre. None of the 79 (95% CI 0–5%) patients who were offered a chaperone and declined one reported that they were uncomfortable declining the offer. The qualitative analysis showed that some participants appreciated being offered the option of a chaperone even if they did not want one and that the professional attributes of the practitioner influenced their decision not to have a chaperone. Only 8% (95%CI 4–15%) felt uncomfortable when asked if they would like a chaperone. The results reassure that when a female patient declines the offer of a chaperone within a sexual health clinic, the male practitioner can feel confident that this is the expression of the patient's wish.
Publisher: SAGE Publications
Date: 02-2007
DOI: 10.1258/095646207779949565
Abstract: Access to sexual health services, by those at highest risk of sexually transmitted infections (STI) is critical to effective STI control. Access to services is determined by the systems that clinics use to prioritize clients. However, despite there being thousands of sexual health services world wide, only three published studies in the last 25 years have specifically assessed changes in the process of access to STI clinics in which a control period was used. These studies indicate that appointments booked in advance provide the least access for higher risk clients, whereas both triage systems and systems with a significant proportion of same day appointments improve access. It is likely, however, that many services have changed their practices and evaluation of these changes could provide valuable data to improve the efficiency and hence improve STI control.
Publisher: Informa UK Limited
Date: 27-08-2022
DOI: 10.1080/13691058.2022.2112084
Abstract: Compared to their non-Chinese peers in Australia, Chinese international students have very low rates of effective contraceptive use and this combined with other factors impacts unintended pregnancy rates. There is limited research exploring Chinese international students in Australia's decision-making with respect to contraceptive choices. In early 2020, 26 in idual semi-structured interviews were conducted with 18-25-year-old Chinese international students to explore factors influencing their contraceptive choices. Using both deductive and inductive analysis, seven primary themes were identified. Of note was the identification of the strongly expressed cultural value of (
Publisher: BMJ
Date: 20-09-2011
DOI: 10.1136/SEXTRANS-2011-050002
Abstract: Rapid HIV testing is not permitted in Australia at the point of care. The authors evaluate the expected net effect of rapid HIV testing compared with standard serology diagnostic tests in terms of onward HIV transmission. The authors used data for 174 men who had sex with men testing HIV-positive at the Melbourne Sexual Health Centre, Australia, in an agent-based mathematical model. Time of diagnosis is simulated according to conventional enzyme immunoassays or rapid HIV tests, with different window periods. The authors calculated the expected number of additional/averted transmissions due to missed or earlier diagnoses. Fourth generation rapid tests were simulated to miss ∼2-3% of diagnoses compared with conventional fourth generation enzyme immunoassay tests. However, in the remaining 97-98% of cases the rapid test would result in earlier detection of HIV. Overall, the rapid test would reduce time to patients receiving results by a median of ∼12 days. Assuming no changes in testing rates, the introduction of rapid testing diagnostic technologies would prevent one in every 2000-5000 HIV transmissions compared with the conventional diagnostic test. Rapid tests would have a marginal benefit in reducing HIV transmission between men compared with conventional tests under assumptions of no changes in testing frequencies.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15143
Abstract: Background Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP. Methods: Semi-structured interviews were used to understand participants’ views on the use of PrEP. Interviews were conducted face-to-face or by telephone and transcribed verbatim for thematic analysis. Results: In total, 13 HIV-negative partners were interviewed six men and seven women. Participants demonstrated a high interest in the use of PrEP for conception. PrEP was also considered an option for general HIV prevention, although men saw more benefits for this use than women. Participants’ main concerns around PrEP usage were about cost, efficacy, daily adherence and side-effects. HIV-positive partner support is likely to play a central role for PrEP uptake and adherence. Conclusions: This study is one of the first studies to explore the views of HIV-negative heterosexual partners in serodiscordant relationships around the use of PrEP while trying to conceive, as well as for general HIV prevention. These study results provide new insights for the further development of guidelines governing the use of PrEP for serodiscordant couples.
Publisher: JMIR Publications Inc.
Date: 08-11-2016
DOI: 10.2196/MHEALTH.5760
Publisher: SAGE Publications
Date: 11-2010
Abstract: The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22–2.93]), three cases of genital herpes (0.28% [95% CI 0.055–0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061–0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77–6.42]). As chlamydia is effectively diagnosed and managed from self-collected s les, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/SH13204
Abstract: Background Australia’s philanthropic sector is growing and could support efforts to improve sexual and reproductive health (SRH). However, philanthropy is often misunderstood in Australia and there is limited evidence of philanthropic support for SRH initiatives. Methods: We aimed to understand the barriers and facilitators to philanthropic funding of SRH initiatives in Australia. A qualitative approach was used and involved 13 in-depth interviews with professionals from the philanthropic sector, and from organisations and services involved in SRH. Results: Barriers to organisations in seeking philanthropic funding for SRH activities included insufficient resources for writing grant applications and the small financial value of philanthropic grants. Facilitators to seeking philanthropic funding for SRH included a perception that government funding is shrinking and that philanthropic research grants are less competitive than government grants. Philanthropic participants identified that barriers to funding SRH include the sensitive nature of SRH and the perceived conservative nature of philanthropy. Facilitators identified by these participants in supporting SRH initiatives included networking and relationships between grant-makers and grant-seekers. All participants agreed that philanthropy does and could have a role in funding SRH in Australia. Conclusions: The findings of this research suggest that barriers to philanthropic funding for SRH in Australia exist for organisations attempting to access philanthropic funding. Philanthropic organisations could provide more financial support to Australian SRH service providers, as happens in countries such as the United States and United Kingdom. Addressing these barriers and promoting the facilitators could lead to increased awareness of SRH by Australia’s philanthropic sector.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Hennie Williams.