Andrea S. Fogarty

Undetectable viral load is associated with sexual risk taking in HIV serodiscordant gay couples in Sydney.

Objective:To determine whether reporting that the HIV-positive partners viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples. Method:A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. Results:Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partners viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P = 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.87–1.00; P = 0.05], greater HIV optimism (OR, 4.98; 95% CI, 1.25–19.8; P = 0.02) and reported undetectable viral load (OR, 2.88; 95% CI, 1.13–7.37; P = 0.03). Conclusions:Most serodiscordant gay couples do not engage in any UAI. UAI within such relationships is significantly more likely to occur where the HIV-positive partner is reported to have undetectable viral load. UAI in HIV serodiscordant relationships is problematic even if viral load is undetectable because of unknown risk parameters, viral load variability and the possibility of drug-resistant strains of HIV.

How has the sexual behaviour of gay men changed since the onset of AIDS: 1986–2003

Objective: To report changes in sexual behaviour among gay men in Sydney from 1986 to 2003.

Marijuana as therapy for people living with HIV/AIDS: social and health aspects.

Abstract Therapeutic use of marijuana has emerged as an important issue for people living with cancer, HIV/AIDS and multiple sclerosis. This paper examines therapeutic use of marijuana in the Positive Health cohort study, a longitudinal cohort study of men and women living with HIV/AIDS in NSW and Victoria, Australia. Factors that distinguish therapeutic use of marijuana from recreational use were assessed by comparisons on a range of social and health-related variables. The results show that among 408 participants, 59.8% reported some use of marijuana in the past six months. Of those participants (n=244), 55.7% reported recreational use only of marijuana and 44.3% report mixed use of marijuana for therapeutic and recreational purposes. Multivariate logistic regression analysis showed that participants who used marijuana for therapeutic purposes were significantly more likely than recreational-only users to have used other complementary or alternative therapies, experienced HIV/AIDS-related illness or other illnesses in the past 12 months, had higher CD4/T-cell counts, had lower incomes, be younger in age and less likely to have had a casual partner in the six months prior to interview. These results show that a substantial proportion of people living with HIV/AIDS (PLWHA) use marijuana for therapeutic purposes, despite considerable legal barriers, suggesting marijuana represents another option in their health management. Rather than solely using marijuana in response to illness, the experience of illness may influence a persons understanding of their marijuana use, so that they come to understand it as therapeutic. Further research might consider possible interactions between cannabinoids and antiretroviral treatments, potential use of oral THC and the difficulties faced by clinicians and PLWHA in discussing marijuana in the current legal context.

Differences between HIV-positive gay men who ‘frequently’, ‘sometimes’ or ‘never’ engage in unprotected anal intercourse with serononconcordant casual partners: Positive Health cohort, Australia

Abstract By measuring the actual number of risk acts engaged in by HIV-positive men participating in the Positive Health (PH) cohort study, this paper sets out to document the distribution of risk acts, to report on the proportion of acts of unprotected anal intercourse with casual (UAIC) partners that occurred between HIV-positive men (i.e. seroconcordant positive) and to examine the factors that differentiated men who ‘frequently’ compared with ‘sometimes’ or ‘never’ engaged in unsafe UAIC (i.e. UAIC with serononconcordant partners: partners who have not tested positive for HIV). The findings show that 42.6% of all UAIC acts occurred between seroconcordant HIV-positive partners, posing no risk of HIV infection to an HIV-negative person. A minority of participants (10%) accounted for the majority (70.7%) of the unsafe acts of UAIC. The HIV-positive men who ‘sometimes’ engaged in unsafe UAIC had higher treatment optimism scores and were more likely to use Viagra in comparison with those who did not engage in such risk. Those who reported ‘frequent’ engagement in unsafe UAIC were more likely to engage in a range of esoteric sexual practices, be slightly less well educated and be taking antiretroviral therapy compared with HIV-positive men who ‘sometimes’ engaged in unsafe UAIC. As such, taking ART but not viral load, predicted frequent unsafe UAIC. When considered alongside earlier studies, these results suggest that HIV-negative men who engage in esoteric sexual practices may be at increased risk of HIV transmission, not necessarily because they engage in esoteric sex practices but because of the sub-cultural milieu in which esoteric sex is occurring. The findings from this study also endorse the measurement of UAIC acts as a useful gauge of risk.

Factors distiguishing employed from unemployed people in the Positive Health Study

Objective:To identify predictors of unemployment among Australian people living with HIV/AIDS. Design:A longitudinal cohort of Australian men living with HIV/AIDS. Methods:Participants were separated into two groups, currently working versus currently unemployed. The two groups were compared on a range of factors related to physical health, mental health and sociodemographic variables. Each family of variables was reduced to a set of best predictors, and multivariate log binomial regression was used to identify the predictors of unemployment. Results:Unemployment was more likely among those who experienced HIV/AIDS-related illness, scored higher on the Kessler scale of psychological distress and were older. There was a lower likelihood of unemployment among those who had better self-rated health, had been living with HIV/AIDS for a shorter period and who had a tertiary education. Conclusion:These findings indicate that unemployment among people living with HIV/AIDS is best understood within a combined social and medical context. Interventions that acknowledge the differences in age and education that contribute to unemployment would improve employment prospects among people living with HIV/AIDS.

What Interrupts Suicide Attempts in Men: A Qualitative Study

Despite higher rates of suicide in men, there is a dearth of research examining the perspectives and experiences of males at risk of suicide, particularly in terms of understanding how interventions can be tailored to men’s specific needs. The current study aimed to examine factors assisting, complicating or inhibiting interventions for men at risk, as well as outlining the roles of family, friends and others in male suicide prevention. Thirty-five male suicide survivors completed one-to-one interviews, and forty-seven family and friends of male suicide survivors participated in eight focus groups. Thematic analysis revealed five major themes: (1) development of suicidal behaviours tends to follow a common path associated with specific types of risk factors (disrupted mood, unhelpful stoic beliefs and values, avoidant coping strategies, stressors), (2) men at risk of suicide tend to systematically misinterpret changes in their behaviour and thinking, (3) understanding mood and behavioural changes in men enables identification of opportunities to interrupt suicide progression, (4) distraction, provision of practical and emotional supports, along with professional intervention may effectively interrupt acute risk of harm, and (5) suicidal ideation may be reduced through provision of practical help to manage crises, and helping men to focus on obligations and their role within families. Findings suggest that interventions for men at risk of suicidal behaviours need to be tailored to specific risk indicators, developmental factors, care needs and individuals’ preferences. To our knowledge this is the first qualitative study to explore the experiences of both suicidal men and their family/friends after a suicide attempt, with the view to improve understanding of the processes which are effective in interrupting suicide and better inform interventions for men at risk.

Advocates, interest groups and Australian news coverage of alcohol advertising restrictions: content and framing analysis.

BackgroundLegislating restrictions on alcohol advertising is a cost-effective measure to reduce consumption of alcohol. Yet Australia relies upon industry self-regulation through voluntary codes of practice regarding the content, timing and placement of alcohol advertising. Ending industry self-regulation was recommended by the National Preventative Health Taskforce; a suggestion contested by the drinks industry. Debates about emerging alcohol-control policies regularly play out in the news media, with various groups seeking to influence the discussion. This paper examines news coverage of recommendations to restrict alcohol advertising to see how supporters and opponents frame the debate, with a view to providing some suggestions for policy advocates to advance the discussion.MethodsWe used content and framing analyses to examine 329 Australian newspaper items mentioning alcohol advertising restrictions over 24 months. All items were coded for mentions of specific types of advertising and types of advertising restrictions, the presence of news frames that opposed or endorsed advertising restrictions, statements made within each frame and the news-actors who appeared.ResultsRestrictions were the main focus in only 36% of 329 items. Alcohol advertising was conceived of as television (47%) and sport-related (56%). Restrictions were mentioned in non-specific terms (45%), or specified as restrictions on timing and placement (49%), or content (22%). Public health professionals (47%) appeared more frequently than drinks industry representatives (18%). Five supportive news frames suggested the policy is a sensible public health response, essential to protect children, needed to combat the drinks industry, required to stop pervasive branding, or as only an issue in sport. Four unsupportive frames positioned restrictions as unnecessary for a responsible industry, an attack on legitimate commercial activities, ineffective and ‘nannyist’, or inessential to government policy. Support varied among news-actors, with public health professionals (94%) more supportive than the public (68%), community-based organisations (76%), the government (72%), and the sports (16%), drinks (3%), or advertising (4%) industries.ConclusionRestrictions on alcohol advertising currently have low newsworthiness as a standalone issue. Future advocacy might better define the exact nature of required restrictions, anticipate vocal opposition and address forms of advertising beyond televised sport if exposure to advertising, especially among children, is to be reduced.

Risk, expert uncertainty, and Australian news media: public and private faces of expert opinion during the 2009 swine flu pandemic

During the outbreak of emerging infectious diseases scientists and public health officials play a key role in informing communities about what is happening, why and what they can do about it, and the news media are critical to how expert knowledge is presented to the public. Therefore, it is crucial to examine the media-oriented practices of experts and to gauge their perceptions of risk communication during public health emergencies. This study investigates the experiences of scientists and public health officials who were sources for the Australian news media during the 2009 pH1N1 (swine flu) pandemic. The paper discusses the perception among some participants that their colleagues were ‘toeing the party’ line as distinct from offering individual ‘expert opinion’, and identifies the different meanings they associated with responsible expert risk communication. In their encounters with the media some indicated frustration with news media constraints, while others demonstrated an internalization of the kind of skills required to play the ‘media game’. The paper discusses the ways in which scientific experts balanced their roles and responsibilities in the context of institutional pressures to be an active media performer. The study affirms the importance of looking beyond media texts and to the activities and perceptions of media sources in order to fully appreciate framing contests, especially when there is a suggestion that dissenting views on disease risk are restricted from entering public debate.

Australian television news coverage of alcohol, health and related policies, 2005 to 2010: implications for alcohol policy advocates

Objective: To describe television news coverage between 2005 and 2010 of alcohol, health and relevant alcohol‐control policies, with a view to informing policy advocacy.

What should be done about policy on alcohol pricing and promotions? Australian experts’ views of policy priorities: a qualitative interview study

BackgroundAlcohol policy priorities in Australia have been set by the National Preventative Health Task Force, yet significant reform has not occurred. News media coverage of these priorities has not reported public health experts as in agreement and Government has not acted upon the legislative recommendations made. We investigate policy experts’ views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates.MethodsWe conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants’ thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement.ResultsTwenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that “something should be done” about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the preferred form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks.ConclusionsDespite existing policy collaborations, a clear ‘cut through’ message is yet to be endorsed by all alcohol control advocates. There is a need to articulate and promote in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media.