Vikki Sinnott

Risk factors for incident HIV infection in men having sex with men: a case-control study

BACKGROUND HIV notifications affecting men having sex with men (MSM) in Victoria, Australia have been increasing. This study aimed to determine current risk factors for HIV infection in this population. METHODS Case-control study. Cases were MSM infected within the previous year (incident cases) as indicated by a previous negative test or seroconversion illness. Controls were MSM with a negative HIV test at the same clinic. From May 2001 to May 2003, cases and controls were interviewed about sexual behaviour, drug and alcohol use and mental health and sexually transmissible infections (STI) in the year before their HIV diagnosis. RESULTS Twenty-six cases and 52 controls were recruited. Risk factors in the year before diagnosis of incident HIV infection included: receptive unprotected anal intercourse (UAI) with ejaculation with casual partners (odds ratio [OR] and 95% confidence interval 57.2 [6.7, 489.4]); insertive UAI with ejaculation with >1 casual partners (OR 19.2 [2.2, 168.9]); having >14 casual partners at sex venues (OR 3.2 [1.1, 9.1]); and consuming >60 g alcohol at one sitting at least weekly (OR 3.6 [1.1, 11.4]). Cases were also more likely to have anal sex with >100 partners in their life and cases had more casual partners than controls in the year before the test. Cases were more likely to have consumed alcohol or amphetamines during a high-risk sexual episode in the year before the test. CONCLUSIONS UAI remains the most important behavioural risk for HIV in Australian MSM. Risk is increased by larger numbers of partners, partners met at sex venues and sex under the influence of alcohol.

Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey.

Objective: Mistimed, unexpected or unwanted pregnancies occur in Australia, despite widespread contraception use. The objective was to estimate prevalence and ascertain modifiable social factors for prevention of unintended pregnancy.

Long-acting reversible contraception: Findings from the Understanding Fertility Management in Contemporary Australia survey

Objectives The aim of this research was to investigate awareness, perceived reliability and consideration of use of long-acting reversible contraception (LARC) among Australians of reproductive age. Methods A sample of 18- to 50-year-old women and men (N = 2235) was randomly recruited from the Australian electoral roll in 2013. Respondents completed a self-administered, anonymous questionnaire. Data were weighted to reduce non-response bias. Factors associated with perceived reliability and consideration of use of LARC were identified in multivariable analyses. Results Most respondents had heard of implants (76.5%) and intrauterine contraception (63.7%). However, most did not think implants (56.3%) or IUDs (63.9%) were reliable and would not consider using implants (71.6%) or IUDs (77.5%). Those significantly more likely to perceive LARC as reliable were younger, did not regard religion as important in fertility choices, had private health insurance, had been pregnant and had had an abortion; and women who had a partner. Those more likely to consider using LARC were younger and did not regard religion as important in fertility choices; women who had private health insurance, lived in an area of socioeconomic advantage and had had an abortion; and men without a partner, born in Australia and comfortable talking to a health care provider about contraceptive matters. Conclusions Despite high awareness of LARC among Australian adults, its perceived reliability and willingness to use it remain low in certain groups. Targeted interventions that aim to increase knowledge of the benefits and reliability of LARC and allow informed use are recommended.

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

Abstract Objective: Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia. Methods: In a cross-sectional national survey, 1544 women and men aged 18–51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use. Results: Most respondents (n = 1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p = .008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p = .026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p < .001), and not considering religion important to fertility choices (OR 0.43; 95%CI 0.31, 0.60; p < .001). A third used effective contraceptive methods (n = 534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p = .002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p < .001), and not have private health insurance (OR 0.52; 95% CI 0.38, 0.71; p < .001). Conclusions: Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.

Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group.

Background As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. Objective To identify public opinion about sexual and reproductive health in Australia. Methods To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. Results There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Conclusions Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health.

Subjective meanings of ‘unintended’ pregnancy: interviews from understanding fertility management in contemporary Australia

Abstract Unintended pregnancy can be difficult to identify and conceptualise. We aimed to understand how unintended pregnancies are constructed, explained and situated in a reproductive life. A total of 41 women and 7 men aged 20–50 years were interviewed in depth. Transcripts were analysed using iterative hermeneutic techniques informed by narrative theory. Of 34 participants who had been pregnant or had a partner in pregnancy, 12 women and 1 man described 23 ‘unintended’ pregnancies, about half of which ended in abortion. Their accounts reveal that an unintended pregnancy is identified subjectively, that the same pregnancy may be identified by one partner in the pregnancy as unintended and by the other as intended, and that a researcher’s supposedly objective assessment of an unintended pregnancy may be inconsistent with the assessment of the woman who experienced it. A pejorative discourse was evident, predominantly among participants who did not report having an unintended pregnancy: women use an ‘unintended’ pregnancy to entrap men. Accounts from five participants reporting an unintended pregnancy were selected for illustration. An appreciation of the role such a pregnancy might play in an individual life requires a nuanced understanding of the complexity of human experience and a resistance to simple binary categorisation.

Fertility management experiences of women with polycystic ovary syndrome in Australia

Abstract Background: Women with polycystic ovary syndrome (PCOS) are usually told that the condition is associated with fertility difficulties. However, little is known about their fertility management including contraceptive use, childbearing desires, and pregnancy outcomes. Aim: To compare the fertility management experiences and outcomes of Australian women with and without PCOS. Method: The 2013 Australian electoral roll was used to identify a random sample of 18- to 50-year-old women who were sent the Understanding Fertility Management in Australia survey to be completed anonymously. Factors associated with fertility management and outcomes were identified in multivariable analyses. Results: Among the 1543 women who completed and returned the survey, 113 (7.3%) reported having PCOS. Women with PCOS reported a similar rate of current contraceptive use as women without PCOS (50.4% vs. 52.6%, p = .66). However, they were significantly younger at first pregnancy (24.9 vs. 26.8 years, p = .015), more likely to have consulted a health professional about fertility management (OR: 3.86, 95% CI: 2.50–5.96, p < .001), and perceive that it would be difficult to conceive (OR: 2.31, 95% CI: 1.41–3.79, p = .001) than women without PCOS. There were no significant differences in the number of desired children, unintended pregnancies, live births, abortions or miscarriages between women with and without PCOS. Conclusion: These findings indicate that women with PCOS need more nuanced information about their fertility potential. While they may experience fertility difficulties because of their condition, they should also be informed that they can conceive spontaneously and need reliable contraception to avoid pregnancy when it is not wanted.

Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey

Background There are few reliable Australian abortion data. The aim was to investigate prevalence, sexual experiences and socioeconomic characteristics of women and men who report having had or being a partner in an abortion. METHODS A cross-sectional survey of women and men aged 18-50 years randomly selected from the Australian Electoral Roll was used. Weighted multivariable analyses were conducted. RESULTS Data from 2235 returned (of 15480) mailed surveys were analysed. One in six women and one in 10 men had experienced or been a partner in an abortion. In adjusted analyses, for women, experience of sexual coercion [adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) 1.46, 3.24] was associated with significantly increased odds of abortion, and socioeconomic advantage (AOR=0.57; 95% CI 0.39, 0.84), being comfortable negotiating contraceptive use (AOR 0.26; 95% CI 0.09, 0.73) and importance of religion in fertility choices (AOR=0.55; 95% CI 0.35, 0.87) were associated with significantly reduced odds. For men, sexual coercion (AOR=3.05; 95% CI 1.51, 6.18) and metropolitan residence (AOR=1.70; 95% CI 1.06, 2.75) significantly increased the odds of reporting being a partner in an abortion. CONCLUSIONS The findings contribute to scarce information about abortion in Australia. The high prevalence of abortion suggests that effective contraceptive counselling and accessible contraception services are not sufficient, and that there is a continuing need for universal pregnancy advice and abortion services. The association between sexual coercion and abortion warrants further investigation.

Factors contributing to pregnancies that end in termination of pregnancy: findings from the understanding fertility management in contemporary Australia survey

Introduction Information about factors that lead to pregnanciesthat end in termination of pregnancy (TOP) has the potential tocontribute to programmes that improve health literacy and assistpeople to manage their fertility effectively.Methods A population-based cross-sectional survey wasconducted. The questionnaire and a letter of invitation toparticipate were mailed to a random sample of people aged 18–50extracted from the Australian Electoral Roll. Information wascollected about management of fertility and participants wereasked to provide details about their pregnancies and factors whichcontributed to the timing and intendedness of conception.Results There were 2235 respondents to the survey, of whom 1543were women; 1045 women provided details on a total of 2786pregnancies, of which 290 ended in TOP for reasons other than fetalabnormality. This paper presents some features of these 290pregnancies. For most the pregnancy was considered accidental and44% did not or ‘not really’ think there was a risk of pregnancy at thetime of the sexual intercourse that caused it, while 38% thoughtthere was such a risk. Twenty-five percent of terminated pregnanciesoccurred following non-use of contraception for reasons includingforgetting, unexpected sex, dislike of side effects and partner refusal.Thirty-one percent occurred following contraceptive problemsincluding method failure, late withdrawal, missed pills and brokencondoms. Eleven percent occurred when women believed they couldnot conceive due to it being a non-fertile time, health conditions orother reasons. For 18% of the TOPs, women reported factors fromtwo or all three of the above groupings. For 6% the only contributingfactors reported were alcohol or drug use or forced sex or both, whilecontributing factors were not reported for 9% of TOPs.Conclusion There was a high rate of misperception of pregnancyrisk at the time of conception in this sample. Education directedtowards more accurate understanding of fertility has the potentialto support more effective use of contraception and possibly choiceof methods with lower failure rates.