Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?

This paper evaluates the effectiveness of a bar-based, peer-led community-level intervention to promote sexual health amongst gay men. The intervention consisted of peer education within bars, gay specific genitourinary medicine (GUM) services and a free-phone hotline. Data were collected at baseline (1996) and at follow-up (1999) in gay bars in Glasgow (intervention city) and Edinburgh (control city). During the intervention peer educators interacted with 1484 men and new clients increased at the gay specific GUM service. However, the hotline was under-utilized and abused. The outcome measures were: reported hepatitis B vaccination; HIV testing; unprotected anal intercourse (UAI) with casual partners; negotiated safety; and amongst men reporting UAI with a regular partner, the proportion who knew their own and their partner's HIV status. Significant differences in sexual health behaviours were observed across locations and across time, but the only significant intervention effects were amongst men who had direct contact with the intervention, with higher uptake of hepatitis B vaccination and HIV testing. The intervention did not produce community-wide changes in sexual health behaviours. These results question the replication and transferability of peer-led, community-level sexual health promotion for gay men outwith the USA and across time.

Depression and disability in Parkinson's disease: a follow-up of 132 cases.

Patients with Parkinson's disease, 132 in number, were followed up after approximately one year, and measures of depression and disability re-administered. Depression was common on both occasions, and was characterized by dysphoria, pessimism and somatic symptoms, but not guilt or self-blame. Depression and disability were associated on both occasions. The relationship between changes in disability and depression across time was complex. In trying to understand changes in depression, the absolute change in disability may be less important than the relative change and rate of change. The results were discussed in relation to findings from other disease groups, and the implications for the clinical management of depression in Parkinson's disease.

Homosexual men's HIV related sexual risk behaviour in Scotland.

OBJECTIVE: To date, the epidemic of HIV infection in Scotland has been primarily associated with injecting drug use. However, the epidemiology of HIV in Scotland changed in the late 1980s, with homosexual men becoming the largest group at risk of HIV infection and AIDS. Our aim was to describe homosexual men's sexual risk behaviours for HIV infection in a sample of men in Scotland's two largest cities. DESIGN/SETTING: Trained sessional research staff administered a short self completed questionnaire, to homosexual men present in all of Glasgow's and Edinburgh's "gay bars," during a 1 month period. SUBJECTS: A total of 2276 homosexual men participated, with a response rate of 78.5%. Of these, 1245 were contacted in Glasgow and 1031 in Edinburgh. MAIN OUTCOME MEASURES: Sociodemographic data, recent (past year) sexual behaviour, information on last occasion of anal intercourse with and without condoms, and sexual health service use. RESULTS: Anal intercourse is a common behaviour; 75% of men have had anal intercourse in the past year. A third of our sample report anal intercourse with one partner in the past year, but 42% have had anal intercourse with multiple partners. Over two thirds of the total population have not had any unprotected anal intercourse (UAI) in the past year and a quarter of the sample have had UAI with one partner only. 8% report UAI with two or more partners. More men in Edinburgh (17% v 10%) reported unprotected sex with casual partners only, but more men in Glasgow (29% v 20%) reported UAI with both casual and regular partners (chi 2 = 12.183 p < 0.02). Multiple logistical regression found that odds of UAI are 30% lower for men with degree level education and 40% lower for men who claim to know their own HIV status, whereas they are 40% higher for those who have been tested for HIV and 48% higher for infrequent visitors to the "gay scene". Men who have had an STI in the past year are 2.4 times more likely to report UAI than those who have not. Men with a regular partner were significantly more likely to report UAI, as were those who had known their partner for longer, and who claimed to know their partner's antibody status. CONCLUSION: On the basis of current sexual risk taking, the epidemic of HIV among homosexual men in Scotland will continue in future years. The data reported here will prove useful both for surveillance of sexual risk taking, and the effectiveness of Scotland-wide and UK-wide HIV prevention efforts among homosexual men.

Gay men's HIV testing behaviour in Scotland.

This paper reports on the social and demographic factors associated with HIV testing in gay men in Scotland. Trained sessional research staff administered a short self-complete questionnaire to men in gay bars during January and February 1999 in Glasgow and Edinburgh, Scotland. Questionnaires were completed by 2,498 men (response rate of 77.5%). Half (1,190; 50%) reported ever having been HIV antibody tested, with men in Edinburgh more likely to report testing. Testing was associated with being older (26 years plus), higher education, reporting one unprotected anal intercourse (UAI) partner, or six or more UAI partners, in the last year, genitourinary medicine clinic service use, and lifetime experience of sexually transmitted infections. There was no relationship between HIV testing and treatment optimism, or evidence of a "post-Vancouver" effect. Over a fifth of men who said that they knew their own HIV status at last UAI had never been tested. Current testing policy needs to be challenged if there is to be an increase in the number of gay men who know their HIV status and, if tested HIV-positive, to then access antiretroviral treatments.

The Gay Men's Task Force: the impact of peer education on the sexual health behaviour of homosexual men in Glasgow.

OBJECTIVE: To assess the impact of a peer education intervention, based in the "gay" bars of Glasgow, which sought to reduce sexual risk behaviours for HIV infection and increase use of a dedicated homosexual men's sexual health service, and in particular increase the uptake of hepatitis B vaccination. DESIGN: Self completed questionnaires administered to men who have sex with men (MSM) in Glasgow's gay bars. SUBJECTS: 1442 men completed questionnaires in January 1999, 7 months after the end of the 9 month sexual health intervention. MAIN OUTCOME MEASURES: Self reported contact with the peer education intervention, reported behaviour change, and reported sexual health service use. RESULTS: The Gay Men's Task Force (GMTF) symbol was recognised by 42% of the men surveyed. Among men who reported speaking with peer educators 49% reported thinking about their sexual behaviour and 26% reported changing their sexual behaviour. Logistic regressions demonstrated higher levels of HIV testing, hepatitis B vaccination, and use of sexual health services among men who reported contact with the intervention. These men were more likely to have used the homosexual specific sexual health service. Peer education dose effects were suggested, with the likelihood of HIV testing, hepatitis B vaccination, and use of sexual health services being greater among men who reported talking to peer educators more than once. CONCLUSION: The intervention had a direct impact on Glasgow's homosexual men and reached men of all ages and social classes. Higher levels of sexual health service use and uptake of specific services among men who had contact with the intervention are suggestive of an intervention effect. Peer education, as a form of health outreach, appears to be an effective intervention tool in terms of the uptake of sexual health services, but is less effective in achieving actual sexual behaviour change among homosexual men.

Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors.

This paper examines sex differences in psychiatric morbidity, using data from a community sample. The PSE-CATEGO-ID system was used to evaluate psychopathology. Six sociodemographic factors and physical illness were taken as independent variables. Females exhibit both a significantly higher psychiatric morbidity than males and a predominance of syndromes closely related to depression (SD; OD syndromes) and anxiety (GA; SA; TE; IT syndromes). Logistic modelling analysis, carried out separately for each sex, yielded different models. Psychiatric illness in men was best predicted by physical illness, unemployment and the interaction between the two. In contrast, physical illness emerged, in women, as the only factor exerting significant effects on psychiatric morbidity.