A Systematic Review of UK Educational and Training Materials Aimed at Health and Social Care Staff about Providing Appropriate Services for LGBT+ People.

BACKGROUND: There is greater dissatisfaction with health services by LGBT people compared to heterosexual and cisgender people and some of this is from lack of equality and diversity training for health professionals. Core training standards in sexual orientation for health professionals have been available since 2006. The purpose of this project is to systematically review educational materials for health and social care professionals in lesbian, gay, bisexual, and transgender (LGBT) issues. METHODS: A protocol was developed and searches conducted in six databases. SELECTION CRITERIA: any studies reporting delivery or evaluation of UK education of health and/or social care professionals in LGBT issues, with no language or setting restrictions. Inclusions and data extraction were conducted in duplicate. Narrative synthesis of educational evaluations was used. Educational materials were assessed using thematic synthesis. RESULTS: From the searches, 165 full papers were evaluated and 19 studies were included in the narrative synthesis. Three were successful action-research projects in cancer services and in residential care. Sixteen sets of educational/training materials have been available since 2010. These varied in length, scope, target audience, and extent of development as classroom-ready materials. CONCLUSIONS: Despite the availability of appropriate training programmes for post-qualifying staff, recommendations to undertake training, best practice examples, and statements of good intent, LGBT people continue to report that they are experiencing discrimination or direct prejudice from health and/or social care services. Better training strategies using behaviour change techniques are needed.

Factors related to positive mental health in a stigmatized minority: an investigation of older gay men.

OBJECTIVES: This study investigates factors related to the positive mental health of older Australian gay men, who are challenged by both age- and sexuality-related stigma. METHODS: A national online survey was conducted among 422 gay-identified men aged 40 years and older. Positive mental health was measured using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). RESULTS: Regression analyses revealed men were psychologically healthier if they were employed full-time, had a higher income, were in a relationship, received greater social support, had many close friends, felt connected to the gay community, believed the public felt positively toward their group, and had not experienced discrimination in the past year. A multivariate linear regression found social support to be the most important of all these factors, with support from friends particularly critical. DISCUSSION: These findings provide new guidance to health agencies that seek to improve the mental health and well-being of older gay men.

Trends in the location of the HIV-positive population in Australia: implications for access to healthcare services and delivery.

BACKGROUND: Examining existing and potential trends in the HIV-positive population in Australia is important for current and future healthcare service development and delivery. METHODS: A new analysis of existing data on this population from the HIV Futures 5 survey was based on linking a geographic breakdown of respondents based on 'area type'--capital city or inner suburban, outer suburban, regional centre and rural--with patterns of healthcare service access. In addition, the distance between the postcode of the respondent's residence and the postcode of the doctor seen for HIV-related treatment was calculated. An analysis of 'area type' by income and age was also conducted. RESULTS: The 'area type' analysis showed important differences in patterns of access to antiretroviral prescriptions and choice of provider for HIV-related and general healthcare. The median distance travelled to see a doctor for HIV-related treatment was higher for those living in outer suburbs than those living in regional centres. DISCUSSION: Differences in service use appear to be related to geographic accessibility of different service types. However, there may be other important social, economic and cultural factors involved. Ageing and socio-economic pressures may be influencing a move away from inner suburban areas where most HIV-specific care is located. This new analysis assists in finding the right balance between increasing the accessibility of HIV-specific services and 'mainstreaming'. Longitudinal data collection would further assist in tracking trends in geographic location, and how often and at what intervals people living with HIV utilise healthcare services.

Gay men's sex venues, the men who use them, and gay community perceptions: insights from a convenience sample of gay men attending a community festival in Melbourne.

BACKGROUND: Despite being understood as sites for the potential spread of sexually transmissible infections, we know remarkably little about gay men's sex venues and how they are perceived in the gay community. The present paper aims to describe community attitudes to sex venues and towards the gay men who use them. METHODS: Self-administered questionnaire at a gay community social event. RESULTS: Men who use gay men's sex venues differ from non-users in relation to their age, the number of casual sexual partners they have, their openness about their sexuality and their comfort with sexualised spaces. Also, not all venues are equal and appear to attract diverse clienteles with particular characteristics. CONCLUSION: Differentiation among gay men's sex venues and the men who use them may offer opportunities for targeting interventions for sexual health promotion.

Understanding gay men's sex venues as sites for sexual health promotion.

BACKGROUND: Despite being understood as sites for the potential spread of sexually transmissible infections, we know remarkably little about how men spend their time when they visit sex venues. The present paper aims to describe the nature of men's visits to sex venues in terms of where they arrived from, their use of alcohol and other drugs before and while at the venue, their expenditure of time in a range of activities at the venue, and their awareness of sexual health promotion materials at the venue. METHODS: Telephone interviews were conducted with 219 men completed within 2 days of them being recruited as they left a sex venue. RESULTS: The majority of men arrived from home or work and had not consumed alcohol or drugs in the 4 h before the visit. The visit lasted 201 min on average and time spent in particular sites or activities within venues varied somewhat with respect to the demographic and behavioural characteristics of the men. Most men reported seeing posters or pamphlets dealing with sexual health. CONCLUSION: Understanding how men use such venues should allow more effective health promotion in those venues.

Growing older with HIV: a study of health, social and economic circumstances for people Living with HIV in Australia over the age of 50 years.

The advent of highly active antiretroviral therapy means that we now have people living with HIV/AIDS (PLWHA) living longer, many of them surviving into old age. There has been relatively little attention paid to people aging with HIV. This study reports on a group of Australian PLWHA aged 50 years and over. They are compared to younger PLWHA on a range of social dimensions. Older PLWHA were significantly less likely to rate their health and well-being as good or excellent. A significantly larger percentage of older PLWHA reported additional health conditions (47.2% versus 35.5%), of which the most common was cardiovascular disease (12.2% of older PLWHA). There was no significant difference in the percentage of older PLWHA who reported a mental health condition. Younger PLWHA were significantly more likely to have been diagnosed with hepatitis C (15.3% versus 8.1% for older PLWHA). Older PLWHA were markedly less likely to be in contact with services, both those that were HIV related and those that were not. The financial circumstances of older PLWHA were significantly worse than for younger PLWHA, and personal support through a regular sexual relationship was also significantly less. The clinical and community needs of this group of PLWHA are likely to be of increasing concern. The challenges associated with this group will be the consequence both of the effects of long-term therapy, with potentially toxic side effects, and the natural aging process.

Who pays for sex and why? An analysis of social and motivational factors associated with male clients of sex workers.

A total of 1,225 men and women attending a commercial event in the state of Victoria, Australia were surveyed as to whether they had ever paid for sex. Of 612 men surveyed, 143 (23.4%) had paid for sex at least once. Men who had ever paid for sex were compared with male nonclients on 13 demographic and sexual history measures; only four significantly differentiated clients from nonclients. Clients were significantly older, less likely to have been educated beyond high school, less likely to report having a regular partner in the past 6 months, and more likely to report that their most recent sexual encounter was with a casual partner. Clients of sex workers reported the major reason for paying for sex was to satisfy their sexual needs (43.8%), followed by the belief that paying for sex was less trouble (36.4%), and that it would be entertaining (35.5%). A factor analysis of reasons for visiting sex workers identified three factors labelled Ease, Engagement, and Arousal. Together, these factors accounted for 55% of the variance associated with the factor solution of motivations for paying for sex. In a setting where commercial sex is legally available from brothels, it would appear that clients are unremarkable in their social characteristics and are motivated mainly by the ease of the commercial sex encounter, the need for engagement with another, and because they feel in need of sexual "relief."

Mate Aaraikore A Muri Ake Nei: experiences of Maori New Zealanders living with HIV.

BACKGROUND: This paper is drawn from the first comprehensive study in New Zealand of the health and social experiences of HIV positive people and specifically addresses the experiences of HIV positive Maori. METHODS: A total of 226 HIV positive men and women completed an anonymous, self-administered HIV Futures New Zealand questionnaire. Twenty-five Maori completed the survey (17 male, 7 female, 1 transgendered). The majority identified as takataapui (Maori and homosexual) five were heterosexual women, and four identified with other sexualities. RESULTS: Seven respondents indicated that they had received pre-test counselling, and 18 that they had received post-test counselling. The mean CD4 count at most recent test was 462.4 cells/microL. The mean HIV viral load result at most recent test was 558.1 copies/mL. Two-thirds of respondents were currently using antiretroviral treatments, and half had taken a break from them. The most commonly cited source of social support was their doctor. Eight respondents were in full-time work; most received benefits or a pension as their main income source; five were living below the poverty line. Only two respondents did not personally know another person with HIV. All had disclosed their status to someone; fifteen said that unwanted disclosure had occurred. Eight reported experiencing discrimination concerning accommodation, nine in a medical setting and seven in relation to employment. CONCLUSIONS: Maori people in New Zealand have access to a comprehensive health care system, nonetheless it is of concern that a number report discrimination and unwanted disclosure of their HIV status, most particularly within health care settings.