Jason Ferris

Use of Silk Road, the online drug marketplace, in the United Kingdom, Australia and the United States

AIMS To investigate the prevalence of awareness of the online illicit drug marketplace Silk Road (SR), consumption of drugs purchased from SR and reasons for use and non-use of SR. DESIGN AND SETTING Global Drug Survey: purposive sample collected in late 2012. PARTICIPANTS The base sample (n = 9470) reported recent drug purchase and resided in the United Kingdom (n = 4315, median age 24, 76% male), Australia (n = 2761, median age 32, 76% male) or the United States (n = 2394, median age 21, 80% male). MEASUREMENTS Online questionnaire. FINDINGS A total of 65% of US, 53% of Australian and 40% of UK respondents had heard of SR; 18% of US, 10% of UK and 7% of Australian respondents had consumed drugs purchased through SR. Across the three countries, 3,4-methylenedioxy-N-methylamphetamine (MDMA) was the most commonly purchased drug (53-60%), followed by cannabis (34-51%), lysergic acid diethylamide (LSD) (29-45%) and the 2C family (16%-27%). The most common reasons for purchasing from SR were wider range (75-89%), better quality (72-77%), greater convenience (67-69%) and the use of vendor rating systems (60-65%). The most common reasons for avoiding SR purchase were adequate drug access (63-68%) and fear of being caught (41-53%). Logistic regressions found that, compared with people from the UK, Australians [odds ratio (OR) = 3.37; 95% confidence interval (CI) = 2.29, 4.97) and Americans (OR = 1.46; 95% CI = 1.10, 1.94) were more likely to use SR due to lower prices; and to avoid SR purchase due to fear of being caught (Australia: OR = 1.65; 95% CI = 1.39, 1.96; USA: OR = 1.62; 95% CI = 1.37, 1.92). CONCLUSIONS While reasons for Silk Road use accord with broader online commerce trends (range, quality, convenience, ratings), its appeal to drug purchasers is moderated by country-specific deterrents and market characteristics.

Homosexual men in Australia: population, distribution and HIV prevalence.

OBJECTIVES To assess the size, distribution and changes in the population of homosexual and bisexual men in Australia, and the capacity of available measures to make this estimation. METHODS We used data from five sources: the Australian Study of Health and Relationships, the Gay Community Periodic Surveys, HIV Futures, the Health in Men cohort study, the Australian National HIV and AIDS Registries and the Australian Household Census. RESULTS We estimated that in 2001 there were approximately 74 000 homosexual and bisexual men in New South Wales (NSW), approximately 42 000 in Victoria and approximately 37 000 in Queensland. There was, however, some discrepancy between datasets in the estimates of the overall proportions and distribution of homosexual and bisexual men across states. We also estimated HIV prevalence rates among homosexual and bisexual men in 2001 at approximately 8% in NSW, 5% in Victoria and 4% in Queensland. There were insufficient data to estimate whether the state-specific populations of homosexual men were changing with time. CONCLUSION There are ~75% more homosexual and bisexual men in NSW than in Victoria and about twice as many as in Queensland. There are about two-thirds as many HIV-positive men in NSW as in Victoria and Queensland combined. Improved collection of population-based data on homosexuality are required.

Sexual and Relationship Satisfaction Among Heterosexual Men and Women: The Importance of Desired Frequency of Sex

Little is known of the extent to which heterosexual couples are satisfied with their current frequency of sex and the degree to which this predicts overall sexual and relationship satisfaction. A population-based survey of 4,290 men and 4,366 women was conducted among Australians aged 16 to 64 years from a range of sociodemographic backgrounds, of whom 3,240 men and 3,304 women were in regular heterosexual relationships. Only 46% of men and 58% of women were satisfied with their current frequency of sex. Dissatisfied men were overwhelmingly likely to desire sex more frequently; among dissatisfied women, only two thirds wanted sex more frequently. Age was a significant factor but only for men, with those aged 35–44 years tending to be least satisfied. Men and women who were dissatisfied with their frequency of sex were also more likely to express overall lower sexual and relationship satisfaction. The authors’ findings not only highlight desired frequency of sex as a major factor in satisfaction, but also reveal important gender and other sociodemographic differences that need to be taken into account by researchers and therapists seeking to understand and improve sexual and relationship satisfaction among heterosexual couples. Other issues such as length of time spent having sex and practices engaged in may also be relevant, particularly for women.

Cannabis Use and Sexual Health

INTRODUCTION Cannabis is the most commonly used illicit substance worldwide. Despite this, its impact on sexual health is largely unknown. AIM The aim of this article is to examine the association between cannabis use and a range of sexual health outcomes. MAIN OUTCOME MEASURES The main outcome measures include the number of sexual partners in the past year, condom use at most recent vaginal or anal intercourse, diagnosis with a sexually transmissible infection in the previous year, and the occurrence of sexual problems. METHODS Method used in this article includes a computer-assisted telephone survey of 8,656 Australians aged 16-64 years resident in Australian households with a fixed telephone line. RESULTS Of the 8,650 who answered the questions about cannabis use, 754 (8.7%) reported cannabis use in the previous year with 126 (1.5%) reporting daily use, 126 reported (1.5%) weekly use, and 502 (5.8%) reported use less often than weekly. After adjusting for demographic factors, daily cannabis use compared with no use was associated with an increased likelihood of reporting two or more sexual partners in the previous year in both men (adjusted odds ratio 2.08, 95% confidence interval 1.11-3.89; P = 0.02) and women (2.58, 1.08-6.18; P = 0.03). Daily cannabis use was associated with reporting a diagnosis of a sexually transmissible infection in women but not men (7.19, 1.28-40.31; P = 0.02 and 1.45, 0.17-12.42; P = 0.74, respectively). Frequency of cannabis use was unrelated to sexual problems in women but daily use vs. no use was associated with increased reporting among men of an inability to reach orgasm (3.94, 1.71-9.07; P < 0.01), reaching orgasm too quickly (2.68, 1.41-5.08; P < 0.01), and too slowly (2.05, 1.02-4.12; P = 0.04). CONCLUSIONS Frequent cannabis use is associated with higher numbers of sexual partners for both men and women, and difficulties in mens ability to orgasm as desired.

The Australian longitudinal study of health and relationships

BackgroundEnsuring the sexual and reproductive health of the population is essential for the wellbeing of a nation. At least three aspects of sexual and reproductive health are among the key policy issues for present Australian governments: maintaining and increasing the birth rate; reducing the abortion rate; and preventing and controlling Chlamydia infections.The overall aim of the Australian Longitudinal Study of Health and Relationships is to document the natural history of the sexual and reproductive health of the Australian adult population.Methods/designA nationally representative sample of Australian adults 16–64 years of age was selected in a two-phase process in 2004–2005. Eligible households were identified through random digit dialling. We used separate sampling frames for men and women; where there was more than one eligible person in a household the participant was selected randomly. Participants completed a computer-assisted telephone interview that typically took approximately 25 minutes to complete. The response rate was 56%. A total of 8,656 people were interviewed, of whom 95% (8243) agreed to be contacted again 12 months later. Of those, approximately 82% have been re-contacted and re-interviewed in 2006–07 (Wave Two), with 99% of those agreeing to be contacted again for Wave Three.DiscussionALSHR represents a significant advance for research on the linked topics of sexual and reproductive health. Its strengths include the large sample size, the inclusion of men as well as women, and the wide age range of the participants.

Hidden Populations, Online Purposive Sampling, and External Validity Taking off the Blindfold

Online purposive samples have unknown biases and may not strictly be used to make inferences about wider populations, yet such inferences continue to occur. We compared the demographic and drug use characteristics of Australian ecstasy users from a probability (National Drug Strategy Household Survey, n = 726) and purposive sample (online survey conducted as part of a mixed-methods study of online drug discussion, n = 753) using nonparametric (bootstrap) and meta-analysis techniques. We found significant differences in demographics and drug use prevalence. Ideally, online purposive samples of hidden populations should be interpreted in conjunction with probability samples and ethnographic fieldwork.

Impact of introducing Practical Obstetric Multi-Professional Training (PROMPT) into maternity units in Victoria, Australia

To assess the introduction of Practical Obstetric Multi‐professional Training (PROMPT) into maternity units and evaluate effects on organisational culture and perinatal outcomes.

National prevalence of urogenital pain and prostatitis‐like symptoms in Australian men using the National Institutes of Health Chronic Prostatitis Symptoms Index

Study Type – Prognosis (cohort)
Level of Evidence 2a

Estimating population distribution and HIV prevalence among homosexual and bisexual men.

OBJECTIVES To estimate the extent of the homosexual and bisexual male population in inner Sydney and HIV prevalence within this population. METHODS Data from the 2000/2001 Sydney Gay Community Periodic Survey (SGCPS) and the Australian Study of Health and Relationships were used. RESULTS A re-analysis of responses from men in some inner east and inner west postcode areas of Sydney indicated that: the proportion of men who identified as homosexual or bisexual ranged from 4.4% to 48.1%; from 9.8% to 51.5% of men reported same-sex experiences during their lifetime; and 12.9% to 52.8% of men had ever experienced feelings of same-sex attraction. HIV prevalence among respondents to the SGCPS in these same areas varied from 9.1% to 21.3%. CONCLUSION These findings indicate elevated proportions of men with same-sex identity, experience or attraction living in these inner Sydney locations compared with other geographic areas and illustrate how gay communities cluster.

Surveying alcohol and other drug use through telephone sampling: A comparison of landline and mobile phone samples

BackgroundTelephone surveys based on samples of landline telephone numbers are widely used to measure the prevalence of health risk behaviours such as smoking, drug use and alcohol consumption. An increasing number of households are relying solely on mobile telephones, creating a potential bias for population estimates derived from landline-based sampling frames which do not incorporate mobile phone numbers. Studies in the US have identified significant differences between landline and mobile telephone users in smoking and alcohol consumption, but there has been little work in other settings or focussed on illicit drugs.MethodsThis study examined Australian prevalence estimates of cannabis use, tobacco smoking and risky alcohol consumption based on samples selected using a dual-frame (mobile and landline) approach. Respondents from the landline sample were compared both to the overall mobile sample (including respondents who had access to a landline) and specifically to respondents who lived in mobile-only households. Bivariate comparisons were complemented with multivariate logistic regression models, controlling for the effects of basic demographic variables.ResultsThe landline sample reported much lower prevalence of tobacco use, cannabis use and alcohol consumption than the mobile samples. Once demographic variables were adjusted for, there were no significant differences between the landline and mobile respondents on any of the alcohol measures examined. In contrast, the mobile samples had significantly higher rates of cannabis and tobacco use, even after adjustment. Weighted estimates from the dual-frame sample were generally higher than the landline sample across all substances, but only significantly higher for tobacco use.ConclusionsLandline telephone surveys in Australia are likely to substantially underestimate the prevalence of tobacco smoking by excluding potential respondents who live in mobile-only households. In contrast, estimates of alcohol consumption and cannabis use from landline surveys are likely to be broadly accurate, once basic demographic weighting is undertaken.