Priscilla Pyett

Difficult Relations: Sex Work, Love and Intimacy

Female sex workers in Western societies report high rates of condom use with clients. However, their continuing low rates of condom use with private partners place some sex workers at increased risk of STDs and HIV. While researchers have focused on the health risks for female sex workers in their private relationships, from the point of view of the women involved, these relationships are a site of more complex struggles. This paper reports findings from a qualitative study of female sex workers and examines the difficulties associated with sustaining a private relationship while engaging in sex work. Sex work practices, in so far as they parody the features of love-making, can profoundly disrupt the special characteristics of intimate sexual relationships. Any intervention designed to promote condom use in the private relationships of female sex workers must engage with the complexity of meanings that are attached to sex work, love and intimacy by these women.

Working together to reduce health inequalities reflections on a collaborative participatory approach to health research

With mounting evidence that health problems are related to social inequalities, health researchers increasingly need to engage with disadvantaged and marginalised groups. These groups can present specific challenges to conventional research method. This paper reflects on the need for health researchers to meet these challenges in order to gain a deeper understanding of the ways in which social disadvantage affects peoples health, and to develop appropriate interventions for those groups. Models of collaborative, participatory and action research are defined on a continuum. The value of a collaborative participatory approach to health research is discussed. Key processes in collaboration are outlined, and some of the methodological tensions and ethical issues that arise when using such an approach are addressed. The recognition that power is directly related to knowledge lies at the heart of the collaborative participatory research project. Collaborative participatory research offers a strategy that embraces self‐determination, encourages and even demands ongoing consultation and negotiation, and provides opportunities for capacity‐building and empowerment in the communities involved in the research. Nowhere is such a strategy more needed in Australia today than for research with Indigenous communities.

Successful chronic disease care for Aboriginal Australians requires cultural competence

Objective: To review the literature to determine the attributes of culturally appropriate healthcare to inform the design of chronic disease management (CDM) models for Aboriginal patients in urban general practice.

Women at risk in sex work : strategies for survival

This paper reports findings from a qualitative study of female sex workers who were identified as particularly vulnerable to risks to their sexual health and physical safety. In-depth interviews were conducted with 24 women to explore issues of safe sex and risk management in relation to their work, health and private lives. The main risks identified were client violence and client resistance to condom use. Non-use of condoms with private partners also placed many of these women at risk of STDs and HIV. Various approaches to avoidance or management of risk are described. The degree of control individual women were able to exert during sexual encounters with clients was affected not only by the legal context of sex work but also by the age, experience, self-esteem and self-confidence of the women and by their drug use at the time of the encounter. For some of these women, problems associated with homelessness, drug use and extreme social isolation far outweighed the risks associated with sex work.

Barriers and facilitators to the utilization of adult mental health services by Australia's Indigenous people: seeking a way forward.

Mental disorders are the second leading cause of disease burden among Australias Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people.

Risk practices for HIV infection and other STDs amongst female prostitutes working in legalized brothels

Most research investigating risk practices for HIV infection and other STDs amongst sex workers has focused on street prostitutes to the exclusion of those prostitutes who work in different sections of the industry. This is largely a consequence of methodological difficulties in accessing prostitutes other than those who work on the streets. HIV prevention research and interventions must address the fact that risk practices may vary according to the type of prostitution engaged in. This paper reports on risk practices for HIV infection and other STDs amongst prostitutes working in legalized brothels in Victoria, Australia. A self-administered questionnaire was distributed by representatives of a sex worker organization whose collaboration was an important factor in obtaining a large sample of prostitutes. The study found low levels of risk practices for prostitutes working in legal brothels in Victoria. The major risk practices indentified were injecting drug use and condom non-use with non-paying partners.

Engaging with Aboriginal communities in an urban context: some practical suggestions for public health researchers

Objective : In this paper, one Indigenous and two non‐Indigenous public health researchers reflect on our combined experience of over thirty years in Aboriginal health, in order to develop some practical guidelines, particularly for researchers working with urban Indigenous population groups.

Oestrogen treatment for tall stature in girls: estimating the effect on height and the error in height prediction

Objective  To determine the effect of oestrogen treatment on attenuating the growth of tall girls after adjusting for error in height prediction.

Postcoital Contraception: Who Uses the ‘Morning After Pill’?

Summary: Postcoital contraception (PCC) is a safe and effective method of avoiding unwanted pregnancy after an occurrence of unprotected sex. It nevertheless represents an absence or failure of preventive strategies. Women engaging in unprotected sex may have been exposed to risks of sexually transmissible diseases (STDs) including HIV/AIDS. Family planning service providers have expressed concern at the number of women using this emergency measure as a form of contraception, sometimes repeatedly, but little is known about the sort of women they are and the context in which unprotected sex has occurred. This paper reports the sociodemographic characteristics of women requiring PCC in the two clinical sites of Family Planning Victoria. A self‐administered questionnaire was completed by 206 women who required PCC during a 3‐month period. The women were aged 14–43 years with an average age of 23 years. Over half the women had used PCC previously and more than a quarter of these women had used it more than twice before. Most of the women had had sex with a regular boyfriend, husband or partner at their own or their partners home. The main reasons given for needing PCC were nonuse of condoms, condom breakage and missing an oral contraceptive pill.

Community development interventions to improve Aboriginal health: Building an evidence base

Abstract This paper explores the potential of community development interventions to contribute to improvements in Aboriginal health, the theory underpinning community development interventions, and the methods used to evaluate such interventions. This paper is based on a review of health literature to identify Australian and international examples of interventions utilising a community development approach with a view to directly addressing a health issue and contributing to the empowerment of Aboriginal people. Seventeen articles published over a ten year period from 1994 were identified which met the criteria for community development with a specific empowerment objective. Aboriginal communities are undoubtedly engaged in community development with the aim of improving health outcomes for their own communities. We argue that interventions promoting empowerment and control should be included as part of an overall strategy to reduce health inequalities in Aboriginal settings. There is an urgent need for further research in this area, particularly research which can engage with unpublished examples of community development in Aboriginal health contexts.