A Smith

Smoking and erectile dysfunction: findings from a representative sample of Australian men

Objectives: To examine whether there is an association between smoking and erectile dysfunction in a representative sample of Australian men. Design: Secondary analysis of cross-sectional survey data from the Australian Study of Health and Relationships. Participants: 8367 Australian men aged 16–59 years. Main outcome measures: Erectile dysfunction was identified in men who reported having had trouble keeping an erection when they wanted to, a problem which persisted for at least one month over the previous year. Variables examined in multivariate logistic regression analyses included age, education, presence of cardiovascular disease and diabetes, and current alcohol and tobacco consumption. Results: Almost one in 10 of the respondents (9.1%) reported erectile dysfunction that lasted for at least one month over the previous year. More than a quarter (27.2%) of respondents were current smokers, with 20.9% smoking ⩽ 20 cigarettes per day, and 6.3% smoking > 20 cigarettes per day. Compared with non-smokers, the adjusted odds ratios for erectile dysfunction were 1.24 (95% confidence interval (CI) 1.01 to 1.52, p u200a=u200a 0.04) for those smoking ⩽ 20 cigarettes per day and 1.39 (95% CI 1.05 to 1.83, p u200a=u200a 0.02) for those smoking > 20 cigarettes per day, after adjusting for other confounding factors. Older age, low level of education, and taking medications for cardiovascular disease were also independently and positively associated with erectile dysfunction. In contrast, moderate alcohol consumption (1–4 drinks per day) significantly reduced the likelihood of having erectile dysfunction. Conclusions: Erectile dysfunction is a significant health concern affecting around one in 10 Australian men aged 16–59 years. Current smoking is significantly associated with erectile dysfunction in Australian males. This association was strengthened as the number of cigarettes smoked increased. Health promotion programmes could use the link between smoking and erectile dysfunction to help reduce smoking levels among men.

When always isn't enough: Implications of the late application of condoms for the validity and reliability of self-reported condom use.

Condoms are most effective when they are applied before intercourse. This study assessed the prevalence of condom cheats--instances of condom use in which the condom is put on after initial penetration. As part of a prospective study of safer sexual behaviour, 103 heterosexual tertiary students completed a condom use diary over a period of up to 6 months. Of the 464 condoms used by study participants, 13% were put on after initial penetration. Thirty-eight percent of condom users reported at least one instance of late application of a condom. Late application of condoms is common and places individuals at risk of infection with HIV and many other STDs. The widespread practice of this behaviour casts doubt on the validity of self-reports of condom use. Assessments of risk based on self-reported condom use may lead to underestimates of the risk entailed in heterosexual young adults condom use behaviour, and may also lead to underestimates of condom efficacy.

Predictors of heterosexual condom use: Characteristics of the situation are more important than characteristics of the individual

An event-specific analysis was conducted in order to assess the relative importance of a number of predictors of condom use. Surveys were completed by 271 heterosexual tertiary students: 60% used a condom in their most recent sexual encounter. Condom use was more closely related to state-like characteristics of the sexual encounter (e.g. having an agreement to use a condom, use of other forms of contraception) than trait-like characteristics of the individual (e.g. attitudes toward condom use, perceived risk of infection with HIV or other STDs). In addition, condom use was more strongly influenced by concerns about pregnancy prevention than concerns about disease prevention. The results of this study show that if we are to understand why heterosexual young adults do not consistently use condoms then we cannot only examine trait-like characteristics of the individual. We must also examine the context of specific sexual encounters.

Inconsistent users of condoms: A challenge to traditional models of health behaviour

People who sometimes use condoms present a challenge to the utility of traditional models of health-protective behaviour in safe sex research. This study used a prospective condom use diary to identify predictors of condom use among heterosexual young adults who use condoms inconsistently. Rather than being influenced by the trait-like attitudes and beliefs central to traditional models of health behaviour, condom use was predicted by characteristics of the sexual encounter, particularly negotiation of condom use. The results of this study highlight the limitations of attempts to explain condom use solely on the basis of trait-like characteristics of individuals. The results also show that if we wish to increase rates of condom use among people who use condoms inconsistently, then we must instil in them skills for negotiating condom use, and confidence in their ability to use these skills.

Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships: a population-based study.

Background/Aims:u2002 The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties.

Individual characteristics are less important than event characteristics in predicting protected and unprotected anal intercourse among homosexual and bisexual men in Melbourne, Australia

Objective: To describe individual, social network and encounter specific factors associated with protected anal intercourse (PAI) and unprotected anal intercourse (UAI). Methods: This was a cross sectional survey conducted between April and November 2002. A total of 733 sexual encounters were reported by 202 men recruited from the gay community in Melbourne, Australia. Predictors of self reported PAI and UAI were examined. Results: Of the 733 sexual events most (56.3%) did not involve anal intercourse, and more involved PAI than UAI (30.6% versus 13.1%). PAI was more likely than no anal intercourse (NAI) if the participant’s social network was mostly homosexual, the partner was an occasional or casual partner, or was HIV positive. PAI was less likely if sex took place at a “beat” but more likely if it took place at a sauna. PAI was more likely if the partner was affected by drugs or alcohol. UAI was more likely than NAI if the participant had injected drugs in the year before interview. It was less likely if the partner was occasional or casual or was HIV positive but more likely if the partner’s HIV status was unknown. UAI was much more likely than NAI if the encounter took place at a “sex on premises” venue. Conclusions: In this analysis it is the characteristics of the sexual encounter that predict whether PAI or UAI rather than NAI takes place.

Knowledge of sexually transmissible infections: a comparison of prisoners and the general population:

The World Health Organization (WHO) has identified a failure to provide education for vulnerable populations such as prisoners as a contributing factor to the epidemic of sexually transmissible infections (STIs). Despite this recognition, little is known about prisoners level of knowledge of STIs compared with the general population. Using computer-assisted telephone interviews, we compared a representative sample of 2289 Australian prisoners, aged 18–59 years from New South Wales and Queensland prisons with a representative community sample of 3536 participants from these two states. Prisoners had significantly better knowledge than the general community of chlamydia-related questions, while knowledge of herpes (genital and oral) was slightly better in the community sample. Prisoners who were aged over 25 years, not married, female, self-identified as either homosexual or bisexual and reported a history of STIs tended to have better STI knowledge levels. Despite their more disadvantaged backgrounds, prisoners demonstrated relatively good health literacy in relation to STIs. Ongoing education about the transmission risks of STIs for prisoners and the general community is needed.

PHARMACY ACCESS TO THE EMERGENCY CONTRACEPTIVE PILL (ECP) IN AUSTRALIA: POLICY IMPLICATIONS OF THE FINDINGS FROM TWO NATIONAL STUDIES

Aim: To understand if a sexual behaviour in a child is a sign of sexual abuse or neglect we need to investigate sexual behaviours among chil-dren. In the present study we investigated Swedish child ...Sexual dysfunction is a known complication of diabetes mellitus in both men and women. nThe aims of this study: 1. to determine the prevalence of sexual dysfunction 2. to identify the types of sexual dysfunction experienced by Muslim women with type 2 diabetes mellitus in Malaysia. n nMethods: This sequential mix-method study was conducted on nmarried Muslim women with type 2 diabetes mellitus, who received treatment from three community clinics in Selangor, Malaysia. Female sexual function was assessed using Malay version of Female Sexual Function Index. Later, a few women were selected and interviewed using semi structured questions to obtain their opinion regarding their nsexual function. n nResults: Eighty-one women participated in this study which found that sexual dysfunction was present among 27.2% women. Sexual dissatisfaction was the commonest symptom among these women and was observed in 48.1% of women followed by poor libido (45.7%). Sexual arousal disorder was observed in 25.9%, 23.5% complained of lack of nlubrication, and 21.0% had vaginal discomfort. Orgasmic dysfunction was found in only 12.3% of these women. Semi structured interview revealed that women seek religious guidance, reading materials in magazines and traditional medicine to cope with sexual problems. All women expressed the importance of sexual health as they consider it as a religious obligation. n nConclusion: Sexual problems are frequently experience by Muslim women with diabetes mellitus. Further investigation is necessary to determine the associated factors including sociocultural and religious influences.Proceedings from the 20th World Congress of Sexual Health, Glasgow, June 2011; World Association for Sexual Health (WAS). http://www2.kenes.com/was2011/info/Documents/jsm_v8_supp3.pdf

P2-S7.07 Adherence and difficulties with antiretroviral medication in an Australian sample of people living with HIV

Background While combination antiretroviral therapy (cART) has revolutionised the course of HIV infection, a high level of adherence to cART is required to achieve the full mortality benefit. While a number of studies have investigated factors associated with non-adherence to cART, there has been considerable variability in the findings. In this study we set out to determine which personal, socioeconomic, treatment-related and disease-related factors are independently associated with adherence to ARV in an Australian sample of PLWH. Methods Using data from the HIV futures six survey, an anonymous cross-sectional survey of PLWH conducted in 2009, we conducted bivariate and multivariate analyses to assess the association of factors with self-reported difficulty taking ARV. Chi-square and t tests were used for bivariate analysis. A two-step logistic regression modelling procedure based on backwards stepwise regression was used for multivariate analysis. Factors that demonstrated a significant association at α=0.2 in bivariate analysis were included in multivariate analysis. Results We identified 75 variables within our data that were likely to be associated with difficulty taking ARV. 45 met multivariate analysis inclusion criteria. Factors found to be independently associated at a=0.05: younger age, alcohol and party drug use, diagnosis of mental health condition, poor or fair self-reported health, living in a regional centre, taking more than 1 ARV dose/day, experiencing adverse physical events in the last 12u2005months, health service discrimination in the last 2u2005years, using a nucleotide analogue reverse transcriptase inhibitor or protease inhibitor and specific attitudes: not believing in the benefits of ARV, concern about medication efficacy in the future and thinking that ARV tablets were an unwanted reminder of having HIV. Conclusion The multitude of factors found to be independently associated with difficulty taking ARV reaffirms the dynamic nature of adherence behaviour and the ongoing importance of addressing adherence behaviour in the clinical management of PLWH.

P2-S6.12 Sexual debut and sexual health: Is early age of first anal intercourse associated with heightened HIV vulnerability among gay men?

Background To explore the long-term sexual health implications for gay men having first anal intercourse (FAI) at an early age. Methods A nationwide online survey was conducted among 854 Australian gay men born between 1944 and 1993 (16–65u2005years). Results Age at FAI dropped sharply from a median of 35u2005years among men born 1944–1953 to 18u2005years among men born 1984–1993. At their most recent sexual encounter, men who reported FAI at age 16u2005years or younger were more than twice as likely to have had receptive anal intercourse or reciprocal anal intercourse (both insertive and receptive in the same sexual encounter), and were almost twice as likely to report having more than 10 sexual partners in the past year. These men were also nearly twice as likely to have become HIV-positive since their sexual debut and were several times as likely to report having had a hepatitis A or C diagnosis. Additional features of the sexual health and behaviour of gay men who report early FAI will be presented that further demonstrate a need to pay close attention to age at FAI. Conclusions Gay men who report early FAI are at higher risk of HIV than those who report later FAI, and are more likely to have recently engaged in risky sexual behaviour. Discussion will focus on explaining these patterns and why health service providers need to pay attention to age at FAI.