Navigating trans visibilities, trauma and trust in a new cervical screening clinic.

Trans and gender diverse people are globally recognised as being under-served in clinical services, with significant implications for their health. During a national reorientation of the Australian cervical screening programme - from Papanicolaou smears to human papillomavirus screening - we conducted interviews with 12 key informants in cancer policy, sexual and reproductive health and trans health advocacy to understand how trans people's needs and experiences were being accounted for and addressed in health policy and practice. Themes captured the complexities of increasing visibility for trans people, including men and non-binary people with a cervix. These complexities reflect the extensive system and cultural change required in asking policymakers and practitioners to think differently about who is at risk of a disease typically associated with cisgender women. Informants drew on the language of trauma to explain the resistance many trans people feel when engaging with clinical services, particularly relating to sexual and reproductive health. In doing so, they argued for increasing resources and processes to elicit trans people's willingness to put their trust in such services. Thinking critically about the relationship between the politics of trans visibilities, trauma and trust can support effective and inclusive approaches to transgender health.

New Australian guidelines for the treatment of alcohol problems: an overview of recommendations.

OF RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE: Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).

ADOPTing a new method of partner management for genital chlamydia in New South Wales: findings from a pilot implementation program of patient-delivered partner therapy.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

Enhancing use of emergency contraceptive pills: A systematic review of women's attitudes, beliefs, knowledge, and experiences in Australia.

Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy.

Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review.

INTRODUCTION: Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities. AIMS: To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking. METHODS: We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations. RESULTS: We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences. CONCLUSIONS: Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men. IMPLICATIONS: This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.

Evaluation of Chlamydia Partner Notification Practices and Use of the "Let Them Know" Website by Family Planning Clinicians in Australia: Cross-Sectional Study.

BACKGROUND: Chlamydia, caused by Chlamydia trachomatis, is the most common reportable infection in many developed countries. Testing, treatment, and partner notification (PN) are key strategies for chlamydia control. In 2008 the Let Them Know (LTK) PN website was established, which provided means for people to send anonymous PN messages by text messaging (short message service, SMS), email, or letter. OBJECTIVE: We evaluated PN practices among Australian family planning clinicians following chlamydia diagnosis and assessed how often clinicians refer their patients to the LTK website. METHODS: A mixed methods approach included a Web-based cross-sectional survey of Australian family planning clinicians to examine PN attitudes and practices and focus groups to explore the context of LTK website use. RESULTS: Between May 2012 and June 2012, all clinicians from 29 different family planning services (n=212) were invited to complete the survey, and 164 participated (response rate=77.4%); of the clinicians, 96.3% (158/164) were females, 56.1% (92/164) nurses, and 43.9% (72/164) doctors. More than half (62.2%, 92/148) agreed that PN was primarily the client's responsibility; however, 93.2% (138/148) agreed it was the clinician's responsibility to support the client in informing their partners by providing information or access to resources. Almost half (49.4%, 76/154) of the clinicians said that they always or usually referred clients to the LTK website, with variation across clinics in Australian states and territories (0%-77%). Eleven focus groups among 70 clinicians at 11 family planning services found that the LTK website had been integrated into routine practice; that it was particularly useful for clients who found it difficult to contact partners; and that the LTK letters and fact sheets were useful. However, many clinicians were not aware of the website and noted a lack of internal clinic training about LTK. CONCLUSIONS: The LTK website has become an important PN tool for family planning clinicians. The variation in referral of patients to the LTK website and lack of awareness among some clinicians suggest further promotion of the website, PN training, and clinic protocols are warranted.

Has the Experience of Hepatitis C Diagnosis Improved Over the Last Decade? An Analysis of Canadian Women's Experiences.

Background In Canada, incidents of new hepatitis C virus infections are rising among women aged 15-29 years and now comprise 60% of new infections among this age group. A negative diagnosis experience continues to be a problem affecting women living with hepatitis C virus. With new effective treatments, nurses will have more involvement in hepatitis C virus care and diagnosis, which is a critical time to facilitate appropriate education and management. Purpose This study explored Canadian women's experience of hepatitis C virus diagnosis in order to develop recommendations to improve care at the point of diagnosis. Methods Purposive sampling was used to recruit and interview 25 women. Using narrative inquiry, we examined Canadian women's experience of hepatitis C virus diagnosis. Results Women's diagnosis experiences were shaped by the context of diagnosis, factors prompting the testing, the testing provider, and information/education received. The context of diagnosis foreshadowed how prepared women were for their results, and the absence of accurate information magnified the psychological distress that can follow an hepatitis C virus diagnosis. Conclusion Our findings provide a compelling case for a proactive nursing response, which will improve women's experiences of hepatitis C virus diagnosis and, in turn, enhance women's access to hepatitis C virus care and other healthcare services.

Newcomers in a hazardous environment: a qualitative inquiry into sex worker vulnerability to HIV in Bali, Indonesia.

BACKGROUND: Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs). METHODS: We conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women's experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices. RESULTS: A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk. CONCLUSIONS: Public health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women's sex work careers.

Research Ethics of Involving Adolescents in Health Research Studies: Perspectives From Australia.

PURPOSE: Adolescent participation in health research studies is critical yet complex given the lack of clarity around issues such as consent. This study aimed to understand how those conducting research in Australia navigate research ethics in health research involving adolescents, through qualitative interviews. METHODS: Purposive sampling was used to recruit 23 researchers involved in adolescent health research using semi-structured in-depth interviews. Interviews were conducted via Zoom and audio-recorded after obtaining informed consent. Thematic analysis was used to construct themes and data were organised using NVivo. RESULTS: Two contrasting positions emerged from the data: (1) framing of adolescents as inherently vulnerable, their participation in research understood in terms of risk and protection and (2) adolescent engagement in research is understood in terms of empowerment, emphasising their capacity to make decisions about research participation. We traced these positions through three key themes, particularly in relation to the role of ethics committees: (1) competing positions as a result of inferior or superior knowledge about adolescent lives, (2) competing positions resulting in a risk averse or an empowerment approach, and (3) reflections on processes of obtaining consent which involves gatekeeping and tokenism. DISCUSSION: Our study highlights the contentious topic of navigating ethics committee requirements for the needs of adolescents. Majority of participants felt the current research ethics establishment is not favourable for researchers or adolescents themselves. While it is imperative that perceptions of ethics committees also be studied in the future, our study provides preliminary understanding of how experiences and perceptions shape how researchers interact with the research ethics establishment.

HIV risk among Australian men travelling overseas: networks and context matter.

Increasing international mobility presents a risk for communicable disease transmission. Overseas-acquired HIV infections have been increasingly observed across Australian jurisdictions. This includes a mix of men emigrating from countries with high HIV prevalence and men travelling abroad. There is currently little research exploring international mobility and HIV risk, and as a consequence the increase of men acquiring HIV while travelling overseas is poorly understood. This paper draws on data from a qualitative study exploring the risk perspectives and experiences of 14 Australian men who acquired HIV while travelling overseas in the years between 2000 and 2009. Participants articulated a strong desire to distance themselves from the identity of a tourist. Social networks were highlighted as important entry points to engage with other foreign travellers and expatriates. These networks were highly influential and were understood by the participants to provide guidance on how they should negotiate the local scene, including where to meet sex partners. Limited discussion of safe sex and HIV was mentioned in these contexts. The findings suggest that prevalent social norms and social networks play an influential role in how participants negotiate sex and social relations in overseas settings. These networks could potentially provide sites for effective HIV-prevention programmes.

The sector is ready, and the community needs Australian alcohol and other drug treatment services to ask about sexuality and gender identity.

Sexuality and gender diverse Australians are a priority population in federal and state-based alcohol and other drug (AOD) strategies. Research evidence shows higher prevalence of AOD use by lesbian, gay, bisexual, transgender and queer (LGBTQ) people, riskier use and a higher proportion have accessed AOD treatment. Despite these disparities, Australian AOD treatment services do not routinely collect data on sexuality or gender identity. As a result, the treatment needs, experiences and outcomes of LGBTQ people remain largely invisible. The Australian Bureau of Statistics' recently released standardised indicators for the recording of sex, gender, variations of sex characteristics and sexual orientation presents an opportunity for the AOD sector to implement inclusive data collection as a foundational step towards achieving policy priorities for LGBTQ people. This commentary includes an implementation case study from the New South Wales non-government AOD treatment sector, where sexuality and gender identity indicators have been collected since 2016.

Alcohol and tobacco consumption among Australian sexual minority women: Patterns of use and service engagement.

BACKGROUND: Sexual minority women consume both alcohol and tobacco at higher rates than heterosexual women. However, various sociodemographic and cultural factors associated with these practices among sexual minority women in Australia are not well understood, nor are the factors associated with seeking alcohol-related support. METHODS: This study utilised data from cisgender sexual minority women respondents of Private Lives 3: a national, online, cross-sectional survey of the health and wellbeing of LGBTIQ adults in Australia aged 18+ conducted in 2019. Multivariable analyses were performed to identify co-existing smoking and alcohol use, sociodemographic factors associated with smoking, alcohol consumption and seeking alcohol-related support. RESULTS: Of 2,647 sexual minority women respondents, 16.90% were currently smoking tobacco, 7.67% smoking tobacco daily and 60.50% reported potentially risky patterns of alcohol consumption. Tobacco and potentially risky alcohol consumption were found to frequently co-occur. Women who identified as queer were more likely than lesbian identifying women to currently smoke tobacco and to smoke tobacco daily. Tobacco consumption was associated with increased age, unemployment, low-mid range income and secondary-school education, while potential risky drinking was associated with living in outer urban or rural areas and being Australian born . Self-reporting having struggled with alcohol in the past twelve months was associated with residential location. Less than 3% of the sample has sought help for alcohol use. Seeking support was more likely as women aged, and with potentially risky drinking, and much more likely with self-perceived struggles with alcohol. CONCLUSIONS: The findings highlight the need for future alcohol and tobacco use health promotion strategies focussing on sexual minority women to attend to within group differences that relate to risk of higher consumption. They also highlight the need for approaches that empower sexual minority women to self-identify when they are struggling with alcohol use and encourage seeking support with organisations that are affirming of sexual minority women.

Learning from the past: young Indigenous people's accounts of blood-borne viral and sexually transmitted infections as resilience narratives.

The Indigenous Resilience Project is an Australian community-based participatory research project using qualitative methods to explore young Aboriginal and Torres Strait Islander people's views of blood-borne viral and sexually transmitted infections (BBV/STI) affecting their communities. In this paper we present an analysis of narratives from young people who had a previous BBV/STI diagnosis to explore how they actively negotiate the experience of BBV/STI infection to construct a classic resilience narrative. We examine two overarching themes: first, the context of infection and diagnosis, including ignorance of STI/BBV prior to infection/diagnosis and, second, turning points and transformations in the form of insights, behaviours, roles and agency. Responding to critical writing on resilience theory, we argue that providing situated accounts of adversity from the perspectives of young Indigenous people prioritises their subjective understandings and challenges normative definitions of resilience.

Selling sex in unsafe spaces: sex work risk environments in Phnom Penh, Cambodia.

BACKGROUND: The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context. METHODS: As part of the Young Women's Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n = 33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content. RESULTS: The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol-related intoxication. Our data also indicate that exposure to violence and interactions with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or no oversight in the form of peer or managerial support or protection, may increase vulnerability to HIV/STI. CONCLUSIONS: Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings.

Conducting Qualitative Research Online: Challenges and Solutions.

What ways of thinking and concrete strategies can assist qualitative health researchers to transition their research practice to online environments? We propose that researchers should foreground inclusion when designing online qualitative research, and suggest ethical, technological and social adaptations required to move data collection online. Existing research shows that this move can aid in meeting recruitment targets, but can also reduce the richness of the data generated, as well as how much participants enjoy participating, and the ability to achieve consensus in groups. Mindful and consultative choices are required to prevent these problems. To adapt to ethical challenges, researchers should especially consider participant privacy, and ways to build rapport and show appropriate care for participants, including protocols for dealing with distress or disengagement, managing data, and supporting consent. To adapt to technological challenges, research plans should choose between online modalities and platforms based on a clear understanding of their particular affordances and the implications of these. Finally, successful research in virtual social environments requires new protocols for engagement before data collection, attention to group numbers and dynamics, altered moderator teams and roles, and new logistical tasks for researchers. The increasing centrality of online environments to everyday life is driving traditional qualitative research methods to online environments and generating new qualitative research methods that respond to the particularities of online worlds. With strong design principles and attention to ethical, technical and social challenges, online methods can make a significant contribution to qualitative research in health.

Early trauma and associations with altruistic attitudes and behaviours among young adults.

BACKGROUND: Childhood and adolescent traumas are exceptionally prevalent worldwide. Despite their high prevalence and substantial impact, little research has investigated the rates and specific types of early trauma by gender. It is also unknown whether the types of early trauma are differentially associated with heightened or hindered prosocial attitudes and behaviours. OBJECTIVE: To address this gap, this study aims to explore the rates of different types of early trauma (i.e., abuse: sexual, physical, and emotional; neglect: physical and emotional) among young Australian adults and investigate whether these differ according to participant gender (female, male and transgender/gender diverse). The study will also examine the associations between the different types of early trauma and current altruistic attitudes and behaviours (including the affective, behavioural and cognitive altruism domains), among a young adult Australian cohort. METHODS: Cross-sectional data was collected from 511 young Australians aged 18-20 years using an online self-report survey. RESULTS: Multiple regression analyses revealed that transgender/gender diverse individuals were over 3-times more likely to experience all types of maltreatment than females and over 3-times more likely to experience emotional and sexual abuse and emotional neglect than males. Experiencing one or more trauma types was negatively associated with the cognitive domain of altruism, experiencing physical neglect was associated with the affective domain, and having a family member involved in domestic violence was associated with the behavioural domain, after controlling for gender. CONCLUSIONS: Findings show how early traumatic experiences can influence individuals' attitudes and behaviours during the pivotal developmental period of young adulthood.

The Logic of Condom Use in Female Sex Workers in Bali, Indonesia.

Studies on human immunodeficiency virus (HIV) prevention practices of female sex workers often examine the use of condom as a single behaviour: using or not using condom. This study explores typologies of the logic of condom use as part of exercising meaningful identities from female sex workers' perspectives. We employed in-depth interviews with a purposely selected 35 female sex workers in Bali, Indonesia. Information from the in-depth interviews was analysed using thematic framework analysis to develop typologies of female sex workers' experiences on the logic of condom use and its relation to the construction of identity. We identified two main logics for not using condom: the prioritising of financial stability and romantic relationships over condom use. The main logic for using condom was to protect their health in order to improve their future economic security. Embedded within these logics, women chose to practise agency and negotiate meaningful identities consistent with their ideals of being responsible mothers, successful migrant workers and loyal partners. Our study concluded that female sex workers had clear logics for both the use and non-use of condom with their clients, highlighting the rational nature of female sex workers decision making.

Enhancing Aboriginal and Torres Strait Islander young people's resilience to blood-borne and sexually transmitted infections: findings from a community-based participatory research project.

ISSUE ADDRESSED: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However, we know very little about young Indigenous people's use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people's efforts to prevent infection. METHODS: University-researchers, a site co-ordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged between 17 and 26 years. Thematic analysis of interview notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS). RESULTS: Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for. Participants described the comfort and understanding they experienced at ACCHS; personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms and persisting with behavioural intentions despite feeling shame. CONCLUSION: Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of blood-borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people's strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment.

The Indigenous Resiliency Project: a worked example of community-based participatory research.

Community-based participatory research (CBPR) is often cited as a suitable methodological approach for academic researchers wanting to work collaboratively with Indigenous communities. This paper describes the Indigenous Resiliency Project currently being conducted in Redfern, Townsville and Perth. This case study is used to demonstrate how a group of university-based researchers and Aboriginal Community Controlled Health Services have used CBPR to work with young Indigenous Australians to explore young people's perspectives on resilience in relation to bloodborne viruses and sexually transmissible infections. This paper also describes some initial benefits gained through the process of developing the Indigenous Resiliency CBPR Project, such as: developing research capacity; establishing relationships between community organisations and research institutions; and prioritising ethical and social considerations in the conduct of research. A commentary on the experience of one health worker involved in the project accompanies the paper.