Megan Passey

Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea

Background Treatable sexually transmitted infections are very common in developing countries and quite often are inadequately treated or remain untreated despite the fact that they enhance the transmission of human immunodeficiency virus (HIV). Goal To estimate the prevalence of HIV, syphilis, chlamydial infection, gonorrhea, and trichomoniasis among female sex workers in Port Moresby and Lae, Papua New Guinea, and to collect data on associated behaviors. Study Design Self-identified female sex workers recruited through our peer-mediated sexually transmitted disease (STD)/HIV risk-reduction community outreach program were invited to participate in the study. Participants underwent pretest counseling, were interviewed, and were asked to self-collect vaginal swab specimens for the detection of STDs and to provide 10 mL of blood for HIV and syphilis testing. Results A total of 407 female sex workers, 207 in Port Moresby and 200 in Lae, were enrolled in the study. The overall prevalence rates of HIV, syphilis, genital chlamydial infection, gonorrhea, and trichomoniasis among these women were estimated to be 10%, 32%, 31%, 36%, and 33%, respectively. The sex workers in Port Moresby had a significantly higher HIV infection rate (17%) than those in Lae (3%) and a significantly lower trichomoniasis rate (21%) than those in Lae (44%). Mixed infections were common, occurring in 45% of the cases. Despite a high rate of symptoms, the rate of treatment-seeking was low. Condom use among the sex workers was very inconsistent; 85% reported that they did not use condoms at all times when having sex with their clients. Common reasons cited were dislike by clients, unavailability, alcohol use, and familiarity with a client. Conclusions STDs are very common among female sex workers in Port Moresby and Lae and very often present as multiple infections. Despite STD/HIV awareness campaigns, unsafe sex—particularly irregular use of condoms—continues among sex workers and their clients. Barriers to safer sexual behavior need to be addressed, as do improvements in provision of STD services.

Tobacco, alcohol and cannabis use during pregnancy: clustering of risks

BACKGROUND Antenatal substance use poses significant risks to the unborn child. We examined use of tobacco, alcohol and cannabis among pregnant Aboriginal and Torres Strait Islander women; and compared characteristics of women by the number of substances reported. METHODS A cross-sectional survey with 257 pregnant Indigenous women attending antenatal services in two states of Australia. Women self-reported tobacco, alcohol and cannabis use (current use, ever use, changes during pregnancy); age of initiation of each substance; demographic and obstetric characteristics. RESULTS Nearly half the women (120; 47% (95%CI:40%, 53%) reported no current substance use; 119 reported current tobacco (46%; 95%CI:40%, 53%), 53 (21%; 95%CI:16%, 26%) current alcohol and 38 (15%; 95%CI:11%, 20%) current cannabis use. Among 148 women smoking tobacco at the beginning of pregnancy, 29 (20%; 95%CI:14%, 27%) reported quitting; with 80 of 133 (60%; 95%CI:51%, 69%) women quitting alcohol and 25 of 63 (40%; 95%CI:28%, 53%) women quitting cannabis. Among 137 women reporting current substance use, 77 (56%; 95%CI:47%, 65%) reported one and 60 (44%; 95%CI:35%, 53%) reported two or three. Women using any one substance were significantly more likely to also use others. Factors independently associated with current use of multiple substances were years of schooling and age of initiating tobacco. CONCLUSIONS While many women discontinue substance use when becoming pregnant, there is clustering of risk among a small group of disadvantaged women. Programmes should address risks holistically within the social realities of womens lives rather than focusing on individual tobacco smoking. Preventing uptake of substance use is critical.

It's almost expected: rural Australian Aboriginal women's reflections on smoking initiation and maintenance: a qualitative study

BackgroundDespite declining smoking rates among the general Australian population, rates among Indigenous Australians remain high, with 47% of the Indigenous population reporting daily smoking - twice that of other Australians. Among women, smoking rates are highest in younger age groups, with more than half of Aboriginal women smoking during pregnancy. A lack of research focused on understanding the social context of smoking by Aboriginal women in rural Australia limits our ability to reduce these rates. This study aimed to explore the factors contributing to smoking initiation among rural Aboriginal women and girls and the social context within which smoking behaviour occurs.MethodsWe conducted three focus groups with 14 Aboriginal women and service providers and 22 individual interviews with Aboriginal women from four rural communities to explore their perceptions of the factors contributing to smoking initiation among Aboriginal girls.ResultsFour inter-related factors were considered important to understanding the social context in which girls start smoking: colonisation and the introduction of tobacco; normalization of smoking within separate Aboriginal social networks; disadvantage and stressful lives; and the importance of maintaining relationships within extended family and community networks. Within this context, young girls use smoking to attain status and as a way of asserting Aboriginal identity and group membership, a way of belonging, not of rebelling. Family and social structures were seen as providing strong support, but limited the capacity of parents to influence children not to smoke. Marginalization was perceived to contribute to limited aspirations and opportunities, leading to pleasure-seeking in the present rather than having goals for the future.ConclusionsThe results support the importance of addressing contextual factors in any strategies aimed at preventing smoking initiation or supporting cessation among Aboriginal girls and women. It is critical to acknowledge Aboriginal identity and culture as a source of empowerment; and to recognise the role of persistent marginalization in contributing to the high prevalence and initiation of smoking.

Health problems and retirement due to ill-health among Australian retirees aged 45-64 years

OBJECTIVE To examine which health problems are associated with retirement due to ill-health among Australians aged 45-64 years. METHODS Cross-sectional analysis of self-reported data of 1933 retired men and 3160 retired women aged 45 and over, living in NSW in 2008, who took part in the 45 and Up Study. MAIN OUTCOME MEASURE retirement due to ill-health versus retirement for other reasons. RESULTS Among retired women, those who reported ever having been told by a doctor that they had thrombosis, depression, osteoarthritis or cancer (except melanoma and skin and breast cancer), were twice as likely to have retired early due to ill-health as those without these health problems. The number of health problems associated with early retirement due to ill-health appeared to be slightly greater for men than for women. From most to least significant stroke, cancer (except melanoma and skin and prostate cancer), osteoarthritis, depression, anxiety and heart disease had significant associations with early retirement. In men and women, the strongest association with retirement due to ill-health was in self-reported health status. CONCLUSION Legislators, decision-makers, and health policymakers should be aware that several health problems are associated with early retirement due to ill-health among men and women aged 45-64 years. Interventions to prevent or treat these health problems would not only bring immediate health gains to the individuals themselves but would increase their ability to participate in the workforce and/or be otherwise productive in society. Interventions would need to be tailored for men and women separately, given the gender differences in disease profiles and social roles.

Economic impacts of illness in older workers: quantifying the impact of illness on income, tax revenue and government spending.

BackgroundLong term illness has far reaching impacts on individuals, and also places a large burden upon government. This paper quantifies the indirect economic impacts of illness related early retirement on individuals and government in Australia in 2009.MethodsThe output data from a microsimulation model, Health&WealthMOD, was analysed. Health&WealthMOD is representative of the 45 to 64 year old Australian population in 2009. The average weekly total income, total government support payments, and total taxation revenue paid, for individuals who are employment full-time, employed part-time and not in the labour force due to ill health was quantified.ResultsIt was found that persons out of the labour force due to illness had significantly lower incomes (

How will we close the gap in smoking rates for pregnant Indigenous women

218 per week as opposed to

Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis

1167 per week for those employed full-time), received significantly higher transfer payments, and paid significantly less tax than those employed full-time or part-time. This results in an annual national loss of income of over

The personal and national costs of lost labour force participation due to arthritis: an economic study

17 billion, an annual national increase of

The financial vulnerability of individuals with diabetes

1.5 billion in spending on government support payments, and an annual loss of

The impact of back problems on retirement wealth

2.1 billion in taxation revenue.ConclusionsIllness related early retirement has significant economic impacts on both the individual and on governments as a result of lost income, lost taxation revenue and increased government support payments. This paper has quantified the extent of these impacts for Australia.