Murray Couch

Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals.

OBJECTIVES We examined the independent demographic and psychosocial factors associated with psychological distress and resilience among transgender men and women. METHODS Our data came from an online survey involving a national Australian sample of 169 transgender men and women in 2011. Survey questions assessed demographics; sources of support; contact with lesbian, gay, bisexual, and transgender peers; and experiences of victimization. We assessed the outcomes with the Kessler Psychological Distress Scale and the Brief Resilience Scale. RESULTS In all, 46.0% of the sample reported high or very high levels of psychological distress. Multivariable regression analyses identified considerably different independent factors for psychological distress and resilience. Younger age, feeling unable to turn to family for support, and victimization experiences were associated with greater psychological distress, whereas higher income, identifying as heterosexual, and having frequent contact with lesbian, gay, bisexual, and transgender peers were associated with greater resilience. CONCLUSIONS With different factors identified for psychological distress and resilience, these findings may help inform the development of tailored mental health interventions and resilience-building programs for this vulnerable population.

TranZnation - a report on the health and wellbeing of transgendered people in Australia and New Zealand

Studies investigating health and wellbeing of transgender people have typically been conducted in medical environments such as gender clinics and through sexual health centres. One of the primary concerns of transgender people is recognition of their gender status which is often difficult to achieve in ordinary medical practices. This research has its beginnings in an act of transgender activism, arising out of dissatisfaction with the capacity of the 2005 Private Lives project to capture the complexity of transgender lives. A central pivot in the concerns of the transgender communities about health services is that of recognition. Practices of medicine are implicated in many of the attempts by transgender people to achieve positive health and self- and social recognition for their preferred gender. Additionally, recognition on formal documentary records is, in many cases, dependent upon certified medical intervention.

Transgender people in Australia and New Zealand : health, well-being and access to health services.

This research had its beginnings in an act of trans activism, including a campaign by a number of trans organizations advocating the need for research dealing with health, well-being and access to health services in relation to this population. This study set out to recruit the broadest possible community sample by using a range of recruitment techniques and an online survey. In total, 253 respondents completed the survey. Of these, 229 were from Australia (90.5%) and 24 (9.5%) were from New Zealand. Respondents rated their health on a five-point scale; the majority of the sample rated their health as ‘good’ or ‘very good’. On the SF36 scale, respondents had poorer health ratings than the general population in Australia and New Zealand. Respondents reported rates of depression much higher than those found in the general Australian population, with assigned males being twice as likely to experience depression as assigned females. Respondents who had experienced greater discrimination were more likely to report being currently depressed. Respondents were asked about their best and worst experiences with a health practitioner or health service in relation to being trans. They contrasted encounters where they felt accepted and supported by their practitioners with others where they were met with hostility.

Age at first anal sex and HIV/STI vulnerability among gay men in Australia

Objectives To determine whether there is a link between age at first anal intercourse (AFAI) and gay mens HIV/sexually transmissible infection (STI) vulnerability, including tendencies to engage in higher risk sexual behaviour. Methods A nationwide cross-sectional survey was conducted online involving 845 Australian gay men born between 1944 and 1993. Results Median AFAI fell from 35 years for men born between 1944 and 1953 to 18 years for men born between 1984 and 1993. Of those who reported having had anal intercourse (N=822), HIV-positive men were found to be significantly younger on average when they first had anal intercourse compared with HIV-negative men (18.5 vs 21.3 years, p<0.001). Men with a history of other STIs were also significantly younger. Engaging in higher risk sexual behaviour is a likely factor, with AFAI generally younger among men who reported >10 sexual partners in the past year (p<0.001) and who engaged in group sex (p<0.001), receptive anal intercourse (p=0.008) or were drug or alcohol affected (p=0.06) during their most recent sexual encounter. Conclusions There appears to be a strong link between AFAI and infection with HIV/STIs, as well as tendencies to engage in higher risk sexual behaviour. While further research is needed to understand this link, these findings highlight a need for sexuality education aimed at gay-identified youth to ensure their sexual debut does not lead to poorer sexual health outcomes.

Versatility and HIV Vulnerability: Investigating the Proportion of Australian Gay Men Having Both Insertive and Receptive Anal Intercourse

INTRODUCTION There is a lack of recent data on the extent to which gay men engage in insertive anal intercourse (IAI) and receptive anal intercourse (RAI). Accurate assessments of the overall risk of infection from HIV and other sexually transmitted infections (STIs) require such data because versatile men who engage in both roles have heightened vulnerability for becoming infected and infecting others. AIM To investigate the extent to which gay men are versatile with regard to having IAI and RAI. MAIN OUTCOME MEASURES Percentages of gay men who reported engaging in IAI, RAI, or both during the past 12 months and in their most recent sexual encounter. METHODS Eight hundred fifty-six Australian gay men completed an online survey to retrospectively report on their sexual practices over the past 12 months. RESULTS Of men who had anal intercourse in the past 12 months, 83% had both IAI and RAI, of whom 57% were highly versatile in that they had approximately equal numbers of partners for IAI and RAI. Of men who had anal intercourse in their most recent sexual encounter, as many as one in five (20%) had reciprocal anal intercourse, having both IAI and RAI with the same partner in a single encounter. Condom use was significantly less likely with reciprocal (38%) than nonreciprocal anal intercourse (50%; P = 0.04). While highly versatile men were less likely to know their HIV status, practices at most recent sexual encounter such as reciprocal anal intercourse and condom use were not significantly related to either their HIV status or that of their partner. CONCLUSIONS Engaging in both IAI and RAI appears to be common among gay men. HIV/STI prevention strategies would benefit from paying attention to the implications of high rates of versatile sexual practices, particularly the tendency for condoms to be used less often when having reciprocal anal intercourse.

Sexual behavior and HIV testing among bisexual men: a nationwide comparison of Australian bisexual-identifying and gay-identifying men.

Men who have sex with men (MSM) are typically studied as though they were a homogeneous population. This has resulted in a lack of knowledge about the sexual health and behavior of bisexual men as distinct from gay men. In this study, patterns of sexual behavior and rates of HIV testing were compared between 854 gay-identifying and 164 bisexual-identifying men who participated in an Australian nationwide online survey. Approximately half of both groups engaged in unprotected anal intercourse (UAI) at their most recent sexual encounter, but bisexual-identifying men were more likely to have had sex with a partner who was either serodiscordant or with whom their seroconcordance was unknown. Despite these patterns, only 62% of bisexual-identifying men had ever been tested for HIV compared to 84% of gay-identifying men. Multivariate logistic regression focused on rates of UAI and HIV testing among bisexual-identifying men. Patterns were similar across all age groups and educational backgrounds. However, bisexual-identifying men were less likely to engage in UAI with a casual partner and were more likely to have been tested for HIV if they had multiple partners or had disclosed their sexual orientation to their social networks. In all, these data reveal important differences between gay- and bisexual-identifying men, particularly with regard to HIV testing, and highlight a need for HIV prevention strategies to focus more strategically on finding ways of promoting safer sex and HIV testing among all MSM.

Transgender people and the amendment of formal documentation: Matters of recognition and citizenship

Abstract In an online survey of transgender people conducted in Australia and New Zealand, half the respondents (50.6%) reported having made attempts to amend formal documentation to reflect their current gender identity, and that this was crucial to their sense of personal and identity recognition, as well as an affirmation of citizenship. Experiences and outcomes varied, even within the same organisation, leading to different degrees of difficulty and frustration. For gender to be changed on some documentation, the individual is required to show evidence of having had a related surgical procedure. Almost 90% of participants who had undergone surgery had also made attempts to change documentation, and a quarter of participants who had not undergone any surgical procedures had made similar attempts. Participants who had been able to successfully change their documentation experienced this as affirming of their gender, and as recognition of civil belonging.

Quiet Please! There's a Lady on the Stage--Boys, Gender and Sexuality Non-conformity and Class

In this paper we do two things. Initially, we explore the experience of gender and sexuality non-conformity for boys in school. Here, the designation sissy boy is interpreted through shame dynamics produced in part by the linguistic violence of designation. From this we consider the development of what we call epistemophilic resolutions--the falling in love with knowing that realigns the sissy boy within the schools discursive terrain. As a tentative and unstable resolution to gender and sexuality non-conformity, the epistemophilic resolution operates as a masquerade (after Riviere, 1986). Interpreting this resolution as masquerade allows us, in the second section of this paper, to speculate about the political potential inherent in the anxiety that underpins the operation of epistemophilia as a resolution to the shame of sexuality and gender non-conformity. This offers, in our interpretation, a resistance to (fore) closure and thus a disruption to discursive reproduction.

Private lives 2: the second national survey on the health and wellbeing of GLBT Australians

Private Lives 2 (PL2) is a report on the second national survey of the health and wellbeing of gay, lesbian, bisexual, and transgender (GLBT) Australians. The first Private Lives (PL1) was released in 2006 and was, at that time, the largest survey of its kind conducted anywhere in the world. In 2011, 3,835 GLBT respondents successfully completed PL2. PL2 was an on-line survey publicised, nationally, through GLBT-community networks and media, and social media such as Facebook, Twitter and YouTube. Hard copies of the survey were distributed to GLBT seniors organisations across the country. The questionnaire consisted, primarily, of forced-choice (quantitative) questions but included a small number of open-ended or qualitative questions. The project was supported by beyondblue with funds from The Movember Foundation, with additional funds provided by the Victorian Department of Health and a La Trobe University faculty grant. The project was managed jointly by Gay and Lesbian Health Victoria (GLHV) and the Australian Research Centre in Sex, Health and Society (ARCSHS) La Trobe University.

P2-S6.12 Sexual debut and sexual health: Is early age of first anal intercourse associated with heightened HIV vulnerability among gay men?

Background To explore the long-term sexual health implications for gay men having first anal intercourse (FAI) at an early age. Methods A nationwide online survey was conducted among 854 Australian gay men born between 1944 and 1993 (16–65 years). Results Age at FAI dropped sharply from a median of 35 years among men born 1944–1953 to 18 years among men born 1984–1993. At their most recent sexual encounter, men who reported FAI at age 16 years or younger were more than twice as likely to have had receptive anal intercourse or reciprocal anal intercourse (both insertive and receptive in the same sexual encounter), and were almost twice as likely to report having more than 10 sexual partners in the past year. These men were also nearly twice as likely to have become HIV-positive since their sexual debut and were several times as likely to report having had a hepatitis A or C diagnosis. Additional features of the sexual health and behaviour of gay men who report early FAI will be presented that further demonstrate a need to pay close attention to age at FAI. Conclusions Gay men who report early FAI are at higher risk of HIV than those who report later FAI, and are more likely to have recently engaged in risky sexual behaviour. Discussion will focus on explaining these patterns and why health service providers need to pay attention to age at FAI.