Heather Worth

Somewhere over the rainbow: Love, trust and monogamy in gay relationships.

Anthony Giddens argues that late modernity is characterized by a democratization of intimate relationships and that gay men and lesbian women appear to be an expression of that movement. This paper is based on interviews with 20 New Zealand men – representing 11 gay couples – who discussed issues of monogamy, trust and sexual behaviour negotiations in their relationships. Overall, they had conventional notions of relationships, romantic love and monogamy that prompted decisions to discard condoms for anal sex as proof of their love for each other. They simultaneously believed that monogamy was not sustainable. Generally, the relationships were marked by ‘infidelity’ anxieties and a reluctance to disclose sexual encounters outside the relationship and to discuss or negotiate their possibility. These experiences serve as reminders to not assume that gay relationships are necessarily as democratic and open as Giddens suggests – pertinent when regarding the development of programmes aimed at reducing HIV transmission within relationships.

Predictors of HIV Disclosure Among Untested, HIV-Negative and HIV-Positive Australian Men Who had Anal Intercourse with Their Most Recent Casual Male Sex Partner

We analysed HIV disclosure between Australian men who have sex with men (MSM) who reported anal intercourse with their last casual male partner. Of 804 MSM included in the analysis, 413 reported HIV disclosure and 391 reported no disclosure. After identifying bivariate associations with HIV disclosure, we developed three models of HIV disclosure (one for untested, one for HIV-negative and one for HIV-positive MSM). A range of factors was found to be associated with HIV disclosure. Having previously had sex with the last casual male partner and expecting HIV-negative and HIV-positive men to disclose before sex were predictors of HIV disclosure shared by more than one serostatus group. As unprotected anal intercourse was more common among MSM who disclosed (across all serostatus groups), we suggest caution should be exercised before encouraging HIV disclosure as a prevention strategy. Nondisclosure remains more strongly associated with safe sex among Australian MSM.

The Myth of the Bisexual Infector

Abstract Bisexual men are objects of fear and blame in an era of AIDS. They are not only considered secretive and promiscuous fence sitters, they are also condemned as risking womens lives because they have sex with both men and women. The percentage of women being newly diagnosed with HIV in ‘developed’ countries is increasing. Focusing on possible present HIV risk, this paper will examine the empirical evidence of widespread HIV transmission or risk to women from bisexual men. In order to examine whether the ‘bisexual infector’ is a reality, the paper will examine behavioural, epidemiological and virological evidence.

The impact of socio-cultural context on young people's condom use: evidence from two Pacific Island countries

Young people are a key group for HIV prevention in the Pacific region where levels of STIs are high and condom use is low. During 2008, 62 in-depth interviews were conducted with people aged between 18 and 25 years in Tonga and Vanuatu. The research was aimed at understanding factors impacting on young peoples’ condom use in two Pacific Island nations. The data show a marked disjuncture between attitudes and practice with regard to condoms. This paper discusses factors underpinning that inconsistency and directs attention to the effect of social and cultural influences on young peoples condom use. The authors conclude that individual-level approaches to improving rates of condom use will be inadequate unless they are informed by an understanding of the role of identity, culture and tradition in young peoples’ decisions around condom use. The findings also underline the need for country-specific approaches to condom promotion efforts in the Pacific.

Use of health services for sexually transmitted and blood-borne viral infections by young Aboriginal people in New South Wales.

The objective of the present study was to describe use of health services for sexually transmitted infections (STI), blood borne viral infections (BBV) and drug and alcohol issues by young Aboriginal people in New South Wales (NSW). A cross-sectional survey was conducted at two Aboriginal sports and cultural events in NSW, in 2007 and 2008, among Aboriginal people aged 16-30 years to ascertain their knowledge of STI, BBV, associated risk behaviours and health service access in NSW. A total of 293 young Aboriginal people completed the survey; 58% were female, the mean age was 20 years, and almost 70% were single. Just over one-third (34%) of participants had been tested for an STI in the past 12 months, and over half (58%) reported that they had ever had an STI test (including HIV). Of respondents who had had an STI test in the past 12 months, 54.0% had done so at an Aboriginal Community Controlled Health Service (ACCHS) and 29% by a GP. Just over one-third (36%) of participants had ever had a test for hepatitis C, 45% of whom had received their test at an ACCHS. Participants were also asked about the types of services they had used for advice about STI and BBV. Of the 69% who had sought STI advice, ACCHS was the most common clinical location for doing so (36% for STI and 26% for hepatitis C). This study highlights the important role that ACCHS play in the provision of STI and BBV testing care and management for a cohort of young Aboriginal people in NSW.

Discourses of disease: Representations of tuberculosis within New Zealand newspapers 2002–2004

Abstract This paper critically examines the ways that tuberculosis (TB) has been represented in the print media in New Zealand over recent years (2002–2004). Our broad contention is that, notwithstanding its biomedical reality, TB is socially constructed by, and through, human experience. Further, public health practitioners depend, to a large extent, on the media to alert the public to threats of disease and opportunities for protection. However, the messages conveyed are sometimes neither helpful nor accurate. In our analysis of TB coverage in three major daily newspapers in New Zealand, we enumerate and classify references to the disease, as well as undertake a discursive analysis of the revealed themes. Of the 366 texts we retrieved in the database search, we selected 120 for in-depth analysis. Our examination indicated the importance of bovine TB within the national consciousness, the stigmatised character of TB and the association between TB and immigrants. We observe that newspaper ‘stories’ in general, and commentaries by public health officials in particular, are invariably offered on a ‘case by case’ basis. We conclude that this specificity in time and place avoids more challenging discourses linking TB with deeply embedded determinants of health such as the strong link between TB and poverty.

Safer sex and condom use: a convenience sample of Aboriginal young people in New South Wales

BACKGROUND This paper examines condom use in a sample of Aboriginal young people in New South Wales (NSW) aged 16-30 years. METHODS Cross-sectional data were collected using hand-held computer devices from 293 Aboriginal people attending two Aboriginal events in NSW. RESULTS Almost two-thirds of respondents reported having had a casual sex partner in the previous 6 months. Of these, 39.2% reported always using a condom with casual partners. Having always used a condom with casual partners varied among respondents, and was more likely among younger respondents (adjusted odds ratio (AOR): 2.7, 95% confidence interval (CI): 1.2-6.1) and less likely among those who used illicit drugs (AOR: 0.2, 95% CI: 0.1-0.7). CONCLUSIONS In comparison to published studies of other Australians, casual sex appears to be more common among this sample of Aboriginal young people; however, the proportion who report having always used condoms with casual partners is very similar. This suggests that although casual sex is more common, Aboriginal young people do not engage in risky behaviour any more often than other young Australians. Further work should be conducted with those who do not always use condoms, such as those who are older and who use illicit drugs, particularly with regards to how abstinence from drug use supports protective behaviours such as condom use among this population of Aboriginal young people.

Living serodiscordantly in Papua New Guinea: sexual practices of HIV-positive people on ART by serostatus of regular heterosexual partner

Abstract This paper examines condom use in intimate relationships amongst Papua New Guineans on antiretroviral therapy (ART). These findings are from a mixed-method study in six provinces throughout Papua New Guinea (PNG). A total of 374 HIV-positive adult Papua New Guineans, over the age of 16 and on ART for more than two weeks were recruited using a non-probability, convenience sampling methodology. Participants were recruited through ART prescribing sites, People Living with HIV/AIDS (PLWHA) drop-in clinics and support groups. A small number (36) also participated in in-depth interviews. Of the sample 226 (60.4%) were women and 148 (39.6%) were men. The majority of the sample was aged below 40 years, with a median age of 30 years. Of the sample who were in a regular relationship 64.7% identified themselves as being in a relationship where both they and their partner were HIV-positive (seroconcordant). Smaller proportions (21.0%) reported being in a relationship with a HIV-negative partner (serodiscordant), or in a relationship where they were not aware of their partners HIV status (14.3%). The majority of participants who reported having a regular partner also reported having disclosed their HIV serostatus to their partner (91.8%). A significantly greater proportion of participants who reported being in relationships where they did not know the status of their partner, also reported living in the Southern Region of PNG (52.9%), while the majority of those in seroconcordant relationships lived in the Highlands Region (71.2%). There did not appear to be any differences in sexual practice of using condoms between the three groups. Knowledge of serostatus is important for “positive prevention”.

Enhancing HIV prevention requires addressing the complex relationship between prevention and treatment

Abstract Globally each year, HIV continues to infect millions of people, and the number of people living with HIV and AIDS grows. While there has been an increase in funding for HIV and AIDS, there is a growing gap between the funds available and the funds needed for both prevention and treatment. Yet, one of the means of closing that gap – preventing new infections – has slipped down the agenda. In arguing for a significant intensification of the HIV prevention response, and the relevance of a strong social stance within this response, this paper addresses the need to manage finding a balance between prevention and treatment and care. Not only is there not enough being spent on HIV prevention, but also in some instances, the prevention agenda has been hijacked by those who favour morally conservative, but ineffective, HIV prevention strategies. We argue that effective prevention needs to be firmly located within the everyday realities affecting communities and societies, and needs to focus on what is known to work. In particular, we need to move beyond a public health underpinned by neo-liberal notions of agency and individual responsibility to a public health that recognises the collective nature of epidemics, and works with communities and networks to transform social relations. This latter, more ‘social’ public health, is concerned with the social, political and economic factors that produce HIV risk and responses to it. Contrary to what some might suggest, HIV prevention has not failed, rather, governments and donors have failed HIV prevention.

AIDS is a tear in the social fabric of Papua New Guinea: HIV and its impact, 2005-2025

Abstract Using epidemiological data, this paper discusses the social impact of HIV in Papua New Guinea over the next two decades. It shows that the country will be facing an adult prevalence rate of nearly 11% by 2025, and that over 300,000 adults will die of AIDS related illness. HIV will impact particularly at the family and community levels, and women may bear a disproportionate burden of that impact. Immense pressure will be placed on families to cope with illness and death – both in terms of caring work and coping financially. This, in turn, will place pressure on village systems. These systems will be undermined by the loss of social capital that comes with widespread illness and the negative impact of the epidemic on the agriculture, education and health sectors. The major governance and security impacts will also be felt at village level – how to sustain viable local governance systems in the face of HIV.