Marian Pitts

Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men

BACKGROUND The Men in Australia Telephone Survey (MATeS) describes the prevalence of self-reported reproductive health disorders as well as related concerns and health behaviours among middle-aged and older Australian men. METHODS A representative sample population (n=5990) of Australian men (>or=40 years) was obtained by contacting a random selection of households with unbiased sampling, stratified by age and state. A 20-min computer-assisted telephone interview was done to assess reproductive health and related knowledge and beliefs, sociodemographic factors, general health, and lifestyle factors. FINDINGS A response rate of 78% (5990/7636) was achieved. 34% (1627/4737) of men surveyed reported one or more reproductive health disorder, all of which were most common in the oldest age group. Age-standardised prevalence of significant lower urinary tract symptoms was 16%, erectile dysfunction was 21%, and prostate disease was 14%. About 50% of participants reported having had a prostate cancer test whereas only 30% (300/1012) of men with erectile dysfunction sought medical help. Willingness to seek medical help for erectile dysfunction was related to age and ethnic origin. Although men aged 40-69 years expressed a moderate or high level of concern about prostate cancer and loss of erectile function, concern about reproductive health was less in the oldest age group (>or=70 years). INTERPRETATION The high prevalence of reproductive health disorders and associated concerns in middle-aged and older Australian men draws attention to the need to develop appropriate services and education strategies specifically directed to improving reproductive health in these men.

The use of herbal and other agents to enhance sexual experience.

This study examines the use of herbal and other agents prior to sexual intercourse. This practice is thought to be common in central and southern Africa. The study comprises an analysis of the behavioural and psychological aspects of the practice. Structured interviews were conducted with 63 Zimbabwean women, 33 were attenders at an urban health clinic, 30 were nurses. Eighty-seven percent of the sample reported using herbs and other agents regularly as a preparation for sexual intercourse. The health and social consequences of such practices are examined; the problems of cervical cancer and HIV and their relation to these practices is discussed.

Associations between the sexual behaviour of men who have sex with men and the structure and composition of their social networks

Objective: This exploratory study identified associations between the number of sexual partners reported by men who have sex with men (MSM) and the structure and composition of their social networks. Methods: A cross sectional survey was conducted of men recruited as key informants, through advertising and chain referral. A face to face interview was conducted with 206 MSM. The interview included information on the number of sexual partners in the previous year and sociodemographic and behavioural characteristics of the participant. Social networks were enumerated and network size and density were calculated. Ordered logistic regression was used to assess the associations between number of sexual partners and personal and network characteristics. Results: The number of anal sex partners reported was higher if the participant had injected drugs in the past year rather than never having injected (odds ratio, 95% confidence interval: 3.23, 1.28 to 8.15), decreased with network density (0.014, 0.002 to 0.008) and increased if the network did not comprise only HIV negative people (1.77, 1.05 to 2.99). The number of additional oral sex partners increased with network size (1.06, 1.02 to 1.10) and decreased with increased network density (0.034, 0.006 to 0.205). In addition to similar effects of network size (1.05, 1.01 to 1.09) and network density (0.086, 0.013 to 0.563) the model for the number of additional manual sex partners also included age (1.03, 1.01 to 1.05). Conclusion: The density of the social networks of MSM appears strongly and consistently associated with patterns of sexual behaviour. This underlines the importance of using network approaches to understanding the sexual behaviour of MSM and their potential value in identifying novel strategies for intervention.

Knowledge and awareness of human papillomavirus (HPV): attitudes towards HPV vaccination among a representative sample of women in Victoria, Australia.

BACKGROUND A vaccine program is underway to protect women against human papillomavirus (HPV) and thus cervical cancer. Previous studies have reported very low levels of HPV knowledge and there has been concern that preventative vaccines might not be readily accepted, given that HPV is transmitted sexually and the optimal time for vaccination is before sexual debut. METHODS A computer-assisted telephone survey was carried out with a representative sample of 1100 women aged 18 to 61 years, randomly selected from households in Victoria, Australia, to investigate knowledge and attitudes about HPV and attitudes towards HPV vaccination. RESULTS Half of the participants (51%) had heard of HPV; most reported learning about it from the media. Most women indicated they would trust their general practitioner (96.3%), a gynaecologist or specialist doctor (99.6%), or a womens health service (97.0%) for information about HPV. Few women (11.9%) had ever sought information about HPV and only 14.8% of the total sample had ever discussed HPV with a friend. Strong support was found for vaccination in general and there was also significant support for a HPV vaccine. CONCLUSION The present study documents ways in which women learn about HPV and indicates the potential for success of a vaccination program.

Stigma or respect: Lesbian-parented families negotiating school settings

This article explores the interface between lesbian-parented families and mainstream society through the example of schools. Lesbian-parented families are an increasingly visible family form; they are diverse and complex and raise challenges for heteronormative social institutions. Based on qualitative family interviews with lesbian-parented families in Melbourne, we discuss the dialectic between schools and families. In many heteronormative school contexts family members were stigmatized and burdened by secrecy and fear about their family configuration. However, there were also a significant minority of family members who felt respected, supported and safe within the school environment.These parents and children were out and proud about their families, and schools had responded with acceptance in both the schoolyard and the curriculum. We discuss the contextual factors (including social location and family formation), impacting on and constraining the interface between the families and schools, and point to opportunities for change.

Human papillomavirus and cervical cancer : Gardasil® vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students.

The aim of this paper was to measure student knowledge of HPV and risks associated with cervical cancer, explore associated factors, correlate knowledge of HPV and cervical cancer with other domains of sexual health related knowledge and estimate student self-reported rates of HPV immunisation. Data were from a nationally representative cross-sectional stratified cluster sample of year 10 and 12 students in the Australian secondary school system. Contingency table, comparison of means, correlation and multiple OLS regression analyses of students answering HPV (n=1927) and cervical cancer (n=2680) knowledge questions was undertaken. Student HPV and cervical cancer knowledge was generally poor. Young women exhibited better knowledge than young men however the difference was, to some extent, accounted for by vaccination for HPV. Sexually active students and those having more sexual partners in the previous year did not report higher levels of HPV and cervical cancer knowledge. The large majority of young women surveyed reported a HPV vaccination as did a small proportion of young men. Students who reported being vaccinated had higher levels of knowledge about HPV and cervical cancer. Student knowledge of HPV and cervical cancer is considerably limited. There is some evidence that being vaccinated for HPV improves a persons level of understanding of the disease and cervical cancer. The recent national public health campaign focussing on cervical cancer vaccination for young women may be partly responsible for a lack of understanding of HPV as a common STI.

What do gay men know about human papillomavirus? Australian gay men's knowledge and experience of anal cancer screening and human papillomavirus

Objective: The objective of this study was to determine levels of experience and knowledge concerning anal dysplasia, anal Pap smear tests, and human papillomavirus (HPV) among gay and other homosexually active men. Study Design: Three hundred eighty-four men attending a large gay community event in Melbourne completed a short survey. Results: Ninety-two percent identified as gay and 4.8% as bisexual. A total of 6.4% were HIV-positive and a further 3.5% did not know their HIV status. On a range of measures, it was clear that the men knew very little about anal cancer (19% scored zero on a 12-point knowledge scale) and virtually nothing about HPV (47% scored zero on an 8-point knowledge scale). A total of 55.1% had never heard of an anal Pap smear and 44.8% had ever heard of HPV; 56.4% did not know whether it affected men and/or women. Conclusions: The test for anal dysplasia is still largely unknown among Australian gay men and they currently have poor sense of personal susceptibility to the disease. Health education strategies are suggested to improve this situation.

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.

Human Papillomavirus and Cervical Cancer in Australasia and Oceania: Risk-factors, Epidemiology and Prevention

The region encompassing Australasia and Oceania, including Australia, New Zealand, Fiji and Papua New Guinea, is a diverse one with respect to ethnicities, cultures and behaviours. It includes countries with comprehensive cervical cytology screening programmes which can be credited with significant reductions in cervical cancer incidence and mortality, and countries with no prevention programmes and significantly higher incidence and mortality. As elsewhere in the world, human papillomavirus (HPV)-16 and 18 are the commonest high-risk types, with the highest rates in women under 25 years of age. These two high-risk HPV types are found most frequently in cervical cancers and high-grade dysplasias, although there are minimal data for many countries in Oceania. In April 2007, Australia became the first country worldwide to commence a government funded universal HPV vaccine programme. The school-based programme targets 12-year old females in an ongoing schedule, with a catch-up programme up to 26 years of age, to be completed in mid-2009. Vaccine introduction has been comprehensively rolled out, with around 75% uptake of the complete vaccine schedule among school-girls in the first year of this initiative. This represents a successful model for other countries. We present data on cervical cancer, risk factors and prevention strategies, including epidemiology of HPV and HPV vaccine strategies.

Menstrual and Premenstrual Experiences of Women in a Developing Country

The menstrual and premenstrual experiences of black Zimbabwean women were examined. Twenty-five professional women and twenty-five domestic workers were interviewed using semistructured, open-ended interviews designed to explore their experiences. An analysis of consensual data indicated a number of predominant themes, including secrecy associated with menstruation, the negativity surrounding menarche, the breakdown of the traditional family network that passes on information about menstruation, and the acceptance of menstrual cycle experiences by the women. The main differences between the two groups concerned explanations of the functions and purpose of menstruation and the reporting of physical and affective symptoms. These differences are suggestive of the impact of educational level on experiences of menstruation.