Danielle Newton

The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis.

BackgroundChlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations.MethodsElectronic databases and conference websites were searched from 1997–2011 using the terms ‘Chlamydia trachomatis’ OR ‘chlamydia’ AND ‘prevalence’ OR ‘epidemiology’ AND ‘Australia’. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category.ResultsSeventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis.ConclusionsChlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.

Effects of Sexually Transmitted Infection Status, Relationship Status, and Disclosure Status on Sexual Self-Concept

Research has indicated that having a sexually transmitted infection (STI) such as genital herpes and genital human papilloma virus (HPV) can have a negative impact on an individuals sexuality. The current study was designed to evaluate the effect of STI status, relationship status, and disclosure status on various dimensions of sexual self-concept. A questionnaire that evaluated the above variables was completed by 117 individuals with genital herpes, 82 individuals with HPV, and 75 individuals with no STI. The results demonstrated that having herpes or HPV had a significant negative impact on aspects of sexual self-concept. It does not appear that an individuals relationship status is a factor associated with the impact of having an STI on the sexual self-concept. Respondents who had disclosed their STI to their partners, however, had significantly more positive feelings about aspects of their sexual self-concept than those who had not disclosed their STI to their partners. The implications of these research findings for health practitioners are discussed.

A theoretical discussion of the impact of stigma on psychological adjustment to having a sexually transmissible infection.

This paper provides a discussion of the utility of stigma theory as a conceptual framework for the interpretation and analysis of the psychological impact of contracting a sexually transmissible infection (STI). Most particularly, it focuses on those viral infections that cannot be medically cured, such as genital herpes and genital human papilloma virus. Recent research in the area of STIs suggests that the stigma associated with these conditions can hinder psychosocial and sexual adjustment post-diagnosis, and provides support for the use of stigma theory as a conceptual framework with which to analyse these experiences. This paper defines the concept of stigma and presents a theoretical overview of the process of stigmatisation. Three dimensions of stigma relevant to the experience of having a STI are then presented: the degree of concealability of the condition including the social consequences of concealing a condition; the origin of the condition; and the degree of peril presented by the condition. An overview of the way in which the presence of a stigmatising condition such as a STI may affect a persons feelings of self and his/her intimate relationships is then presented. Finally, the implications of stigma theory as a conceptual framework for guiding future research in the area of personal and interpersonal reactions to STIs is discussed.

The differing views of male and female patients toward chaperones for genital examinations in a sexual health setting.

Objectives: To determine the attitudes of male and female patients to the use of chaperones during genital examination within a sexually transmitted diseases clinic. Study Design: An anonymous, self-completed questionnaire was administered to patients attending the Melbourne Sexual Health Centre, Australia, between September and October 2006. Results: The participation rate among male and female patients was 60% (166 of 276) and 73% (153 of 210), respectively. Among male patients, only 7.3% and 6.0% expressed a desire for a chaperone when being examined by a male and female practitioner, respectively. Among female patients, 26.8% desired a chaperone if they were going to be examined by a male practitioner when compared with 5.5% for a female practitioner (P <0.001). Around one-third of male and female patients indicated they would feel uncomfortable having a chaperone present and this did not vary by the sex of the practitioner (P >0.48). For female patients being examined by a male practitioner, the desire for a chaperone was associated with having had a previous cervical smear (odds ratio, OR = 0.35, 95% CI: 0.12–0.98, P = 0.04) and feeling comfortable about the presence of a chaperone present (OR = 28.9; 95% CI: 11.1–75.0; P <0.001), but not age (P = 0.16) or previous genital examination (OR = 0.55, 95% CI: 0.21–1.45, P = 0.2). Conclusions: In a sexual health setting, female patients undergoing genital examination by a male clinician should be asked whether they would like a chaperone to be present.

Australian sexual health practitioners' use of chaperones for genital examinations: a survey of attitudes and practice.

OBJECTIVES To examine the current practice and attitudes of Australian sexual health practitioners towards the use of chaperones for genital examinations. METHODS In July 2006, an anonymous, self-completed questionnaire was mailed to members of the Australasian Chapter of Sexual Health Medicine. RESULTS Of the 166 questionnaires sent to practitioners, 110 (66%) were returned completed. Of the 110 respondents, only 9% and 19% reported that their clinic routinely provided chaperones for all male and female genital examinations, respectively. Among practitioners whose services did not offer chaperones routinely, chaperones were offered with a mean frequency of 19% for female examinations and 8% for male examinations (P = 0.01). Compared to female practitioners, significantly more male practitioners thought a chaperone was important for medico-legal purposes when examining females (72% v. 53%, P < 0.05). Compared to male practitioners, significantly more female practitioners thought a chaperone was sometimes important for patient support when examining male patients (52% v. 26%, P < 0.001). Only 39% (n = 18) of male practitioners and 36% (n = 23) of female practitioners felt that resources spent on chaperones were justified by the benefits they provided. CONCLUSIONS Despite only a minority of practitioners offering chaperones to patients or using them during examinations, many feel they are important for medico-legal reasons and as support for the patient. Best practice may be for services to routinely offer a chaperone and record instances where an offer is declined. This provides patients with choice and practitioners with some level of protection.

The impact of stigma on couples managing a sexually transmitted infection

Recent research has indicated that the stigma surrounding sexually transmitted infections (STIs) creates a psychological and emotional burden for individuals with these conditions. It would be expected that the stigma of having a STI would also alter the dynamics of an intimate relationship. This paper reviews the literature on the impact of STIs on intimate relationships, and considers the relevance of this research to both clinicians and researchers. In particular, the types of relationships in which the presence of a STI may have a varying degree of impact are examined. Since disclosure of a STI would also be expected to impact on a relationship, an overview of the factors involved in the disclosure of a STI to a partner is also considered. Finally, the implications of this research for both clinicians and researchers are discussed.

Sex workers working within a legalised industry: their side of the story

Objectives: To examine the characteristics and work attitudes of female sex workers working in licensed brothels in Victoria, Australia. Methods: This was a cross-sectional study of sex workers working at 38 of the 92 licensed brothels operating in Victoria during 2006. Results: Of the 108 women approached, 97 (90%) completed the questionnaire. Women working in the legal sex industry in Victoria were generally aged between 23 and 35 years (51%), had completed high school (26%) and had worked in the industry for more than 5 years (43%). Half had dependent children and one third were in a relationship. Women’s primary motivation for working in the sex industry was financial, whether this was the reason for their starting (56%), or the barrier to their leaving (61%). Although women valued the higher income and flexibility of this work, many were concerned about sexually transmitted infections (STI) (55%), community attitudes towards the industry (47%), their physical safety (38%) and maintaining their anonymity (37%). Over half of the women would like to leave the industry. The majority (95%) supported the monthly STI checks that are part of the Victorian regulations, with only one fifth reporting that the cost of these tests was prohibitive. Conclusions: The findings of this study indicate that women working in licensed Victorian brothels come from a diverse range of backgrounds and circumstances and hold varying attitudes towards working in the sex industry. It is hoped that these findings go some way to redressing the assumptions commonly made about women working in the sex industry and reducing the stigma associated with this occupation.

Managing Depression Among Ethnic Communities: A Qualitative Study

PURPOSE Clinical care for depression in primary care negotiates a path between contrasting views of depression as a universal natural phenomenon and as a socially constructed category. This study explores the complexities of this work through a study of how family physicians experience working with different ethnic minority communities in recognizing, understanding, and caring for patients with depression. METHODS We undertook an analysis of in-depth interviews with 8 family physicians who had extensive experience in depression care in 3 refugee patient groups in metropolitan Victoria and Tasmania, Australia. RESULTS Although different cultural beliefs about depression were acknowledged, the physicians saw these beliefs as deeply rooted in the recent historical and social context of patients from these communities. Traumatic refugee experiences, dislocation, and isolation affected the whole of communities, as well as individuals. Physicians nevertheless often offered medication simply because of the impossibility of addressing structural issues. Interpreters were critical to the work of depression care, but their involvement highlighted that much of this clinical work lies beyond words. CONCLUSIONS The family physicians perceived working across cultural differences, working with biomedical and social models of depression, and working at both community and individual levels, not as a barrier to providing high-quality depression care, but rather as a central element of that care. Negotiating the phenomenon rather than diagnosing depression may be an important way that family physicians continue to work with multiple, contested views of emotional distress. Future observational research could more clearly characterize and measure the process of negotiation and explore its effect on outcomes.

The impact of vocational education and training programs on recidivism : a systematic review of current experimental evidence

Although the association between unemployment and offending is well established, relatively little is known about the impact of vocational education and training programs on re-offending, with much of the previous work in this area failing to control for, or correct, selection bias. This article reports the findings of a systematic review, which considers the findings of only those studies that have used experimental or quasi-experimental designs to evaluate vocational training and employment program outcomes for adult offenders. The analysis identifies key features, based on these studies, of those programs associated with the best outcomes and recommends selection criteria for those who are most likely to benefit from prison vocational education and training.

Key informant perceptions of youth-focussed sexual health promotion programs in Australia

BACKGROUND This paper explores key informant (KI) perceptions of the barriers to effective sexual health promotion programs in Australia and suggests strategies to overcome these barriers. Three types of sexual health promotion programs were explored in this study: those targeting all young people (under 30), Aboriginal young people, and young people from culturally and linguistically diverse (CALD) backgrounds. METHODS The study utilised a qualitative approach and involved 33 semistructured interviews with sexual health professionals involved in funding or delivering Australian sexual health promotion programs or working clinically with individuals diagnosed with sexually transmissible infections. RESULTS Fourteen barriers to effective sexual health promotion programs were identified. Barriers included: difficulties associated with program evaluation, lack of involvement of the target community, the short-term nature of programs, problems with program resources and concerns about the content of programs. Additional barriers to programs targeting Aboriginal and CALD young people were also identified and included: a lack of cultural sensitivity; a failure to acknowledge differences in literacy, knowledge, and language skills; stigma and shame associated with sexual health; and the continued use of programs that lack inclusivity. KIs suggested strategies to overcome these barriers. CONCLUSION Sexual health promotion in Australia suffers from several barriers that are likely to impede the effectiveness of programs. In particular, poor or nonexistent program evaluation and lack of community involvement are among the key areas of concern. It is hoped that the findings of this study will be useful in informing and shaping future Australian sexual health promotions.