Pamela Gillies

The reliability of self-reported sexual behaviour

The quality of data collected by surveys of sexual behaviour may be subject to sources of error involving reliability, validity, and non-participation bias. A preliminary study of sexual behaviour, including perception of risk for HIV infection, knowledge of HIV transmission and attitudes towards AIDS, was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending clinic over a 3-month period; comparisons were made between different methods of data collection (questionnaires and interviews) and between responders and non-responders. High levels of agreement were found between questionnaire and interview. Some sexual behaviours were more frequently reported at interview. No significant differences were found between responders and non-responders to either questionnaire or interview.

Evaluation of the short-term impact of counseling in general practice

This paper describes the findings of a randomised controlled trial of the short-term impact of counseling in the general practice setting. Compared with patients who received usual advice from their general practitioner for acute problems such as relationship difficulties, anxiety and depression, those who received counseling from qualified counselors working within the primary health care context showed greater improvement in psychological health as measured by the General Health Questionnaire. Significantly fewer of those counselled were prescribed anti-depressant drugs by the general practitioners in the study, or were referred to psychiatrists or clinical psychologists for care. In addition those patients who attended sessions with the practice counselor were more likely to report that they were satisfied with their treatment and more expressed feelings of well-being.

Evaluation of a randomized controlled trial of HIV and sexually transmitted disease prevention in a genitourinary medicine clinic setting.

Objective:To evaluate outcomes of a sexual health promotion intervention to prevent transmission of sexually transmitted diseases (STD) including HIV among genitourinary medicine clinic attenders. Design:A randomized controlled trial using pre-test and post-test measurements after 4 months, with clinical follow-up at 18 months. Setting:A genitourinary medicine clinic in Nottingham, UK. Patients:A total of 492 patients were randomly assigned either to an individually focused counselling and skills training intervention, including written materials (n = 148), to receive written materials only (n = 162), or to usual clinic procedure (n = 182). Intervention:Social learning theory provided the theoretical framework for the intervention, which was informed by previous research in this setting, and aimed to alter perception of risk for HIV infection, increase knowledge and attitudes to condoms, and increase condom use. Main outcome measures:The main outcomes of interest were self-reported condom use and behaviour change. Other outcomes of interest were knowledge and attitudes to condoms, and re-attendance at the clinic with a diagnosis of STD. Results:Intervention subjects were significantly more likely than controls to report carrying condoms when anticipating sexual intercourse with a new sexual partner (P ≤ 0.05), and were more likely to perceive themselves at risk of HIV infection (P ≤ 0.001). There were no significant effects of the intervention on levels of knowledge about correct condom use, attitudes to condoms, self-reported condom use or incidence of STD. Conclusions:The limited effectiveness of the intervention suggests that condom promotion should continue, but that additional investment in clinic-based health promotion is unlikely to result in consequent health gain.

Using New Media to Build Social Capital for Health A Qualitative Process Evaluation Study of Participation in the CityNet Project

The present article presents an exploratory qualitative process evaluation study of ‘Ambassador’ participation in CityNet, an innovative informationcommunication technology-based (ICT) project that aims to build aspects of social capital and improve access to information and services among disadvantaged groups in Nottingham, UK. A purposive sample of 40 ‘Ambassadors’ interviewees was gathered in three waves of data collection. The two emergent analytic themes highlighted how improvements in confidence, self-esteem and social networks produced via participation were mitigated by structural problems in devolving power within the project. This illustrates how concepts of power are important for understanding the process of health promotion interventions using new media.

Reducing the risk of smoking amongst the young

Abstract This study reports the findings of a 2-year longitudinal cohort study involving 270 childrenfrom Sheffield, England. Children who took part in a primary school health education project had a significantlylower incidence of experimentation with smoking, up to 2 years after participation, than those from a control group. The control group had an increased risk of smoking estimated at more than twice the level of project pupils. In addition, participation was associated with an increase in childrens knowledge of smoking and some of its hazards.

Why do pregnant women smoke

This study aimed to record the main reasons given by pregnant women for smoking and to observe how these varied by age, education, marital status, social class and level of tobacco consumption. The study involved 498 smoking mothers who were all new antenatal clinic attenders. Data were collected by self-completed questionnaire containing closed and open response items. The participation rate was 95%. Main reasons given for smoking in pregnancy included those related to mood control (i.e. to relax, calm down, enjoyment, out of boredom) and addiction. Pregnant women were more likely to smoke to control their mood if they were older and smoked less than ten cigarettes per day. They were more likely to give addiction as their reason for smoking if they were older. Pregnant women were also more likely to smoke due to boredom if they were single, especially divorced or separated, from unskilled or semi-skilled occupational groups and if their husband or partner was unemployed. The implications of the findings for health education are discussed.

AIDS-Related Risk Perception and Sexual Behaviour among Sexually Transmitted Disease Clinic Attenders

Perception of risk has been suggested as an important element of sexual behaviour change among people who engage in behaviours which place them at risk of HIV infection. A study of the relationship between perception of risk of HIV infection and risk-related sexual behaviours was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending over a 3-month period; data collection was by self-completed questionnaire. A total of 574 questionnaires were suitable for analysis, representing a response rate of 75%. The majority of people in the sample reported behaviours which increased their risk of HIV infection, but only 19% (n = 112) of the sample perceived themselves to be personally ‘at risk’, despite adequate knowledge of HIV transmission and methods of risk reduction. Significant differences between social class groups were found for knowledge scores, with highest scores among professionals and lowest among unemployed subjects (Kruskal Wallis test χ2=24.6, P ≤ 0.001). Increasing age was significantly associated with better knowledge; significantly more young people aged 16–20 years who did not perceive themselves ‘at risk’ (64%), had lower knowledge scores than older people who did not perceive themselves ‘at risk’ (41%). Among heterosexuals who reported having sex with other people in addition to their regular partner, 79% did not perceive themselves as ‘at risk’ of HIV infection, and of these, 64% reported only infrequent condom use with casual sexual partners. Significantly more heterosexual men (67%) than women (44%) reported multiple sex partners. A high proportion of heterosexuals engaging in vaginal intercourse without a condom perceived the behaviour to be risky for HIV transmission, but of these, only 18% (n = 72) perceived themselves to be personally ‘at risk’ of HIV infection. An increasing number of sexual partners was significantly associated with more frequent reporting of active oral sex without a condom (χ2 trend=4.63, df=1, P ≤ 0.05) and vaginal intercourse without a condom (χ2 trend=6.61, df=1, P ≤ 0.05) among people perceiving these behaviours as risky for HIV transmission. Changes in sexual behaviour such as using condoms more often, were reported significantly more frequently by people who perceived themselves ‘at risk’ of HIV infection (51%) than people who perceived themselves to be ‘not at risk’ (33%). Subjects who perceived themselves to be ‘not at risk’ were significantly more likely to report not having made any changes in their behaviour (19% compared with 7%).

Surveying knowledge and attitudes towards Aids in young adults — Just 19

A QUESTIONNAIRE on health-related knowledge, attitudes and beliefs was returned by 766 nineteen- year-olds from Doncaster. The section on Aids showed that the majority of young adults were well informed about main transmission routes, and of how to avoid infection with HIV. Confusion remains about aspects of HIV infection, including transmis sion via blood and by saliva. Many do not show sym pathy for people with Aids who are homosexual or injecting drug users. Most believe that they are not at risk of catching HIV, including those whose sexual behaviour could be said to be promiscuous. One in five respondents say they have changed their be haviour as a result of the threat of Aids. Health edu cation programmes at school and after need to be apposite, unambiguous and accessible to augment and extend levels of knowledge and to encourage all young people to adopt sexual practices which carry the least risk of infection for all sexually transmitted diseases, including HIV.

Sex education and HIV/AIDS prevention

Abstract In reviewing intervention approaches to HIV/AIDS prevention such as mass media, school health education, clinic and service provision, outreach and community mobilization, this paper argues for educational approaches which take account of the contextual forces, in addition to the individual factors, which influence and shape sexual behaviour. The paper focuses attention on the necessity for a sociological as well as a biomedical framework for analysis, interpretation and educational intervention.

Sex education in schools: An overview with recommendations

Recommendations from official sources highlight a number of key principles which are essential for effective sex education within schools. These relate to the planning and teaching of the topic, in-service training of teachers, and the establishment of links between schools and parents. Models of practice in the teaching of sex education vary between schools throughout England; also the wide variations in quality and quantity of provision indicate considerable scope for improvement. Government, despite its key role in shaping provision of sex education in schools, does not appear to be consistently supportive. This paper examines and assesses the impact of a number of key policies, including those related to the 1993 Education Act, which will change the legal framework for the teaching of sex education within schools. It makes a series of practical recommendations for purchasers of health promotion services, with the intention of supporting and furthering the development of sex education in schools.