Exploring professionals' perceptions of the barriers and enablers to young people with physical disabilities accessing sexual and reproductive health services in Australia.

Background There is a lack of research on young people with physical disabilities' access to sexual and reproductive health (SRH) services in Australia. Research has found that there are attitudinal, physical and communication barriers for people with disability, in general, accessing health services, including SRH services. This paper explores key informant perceptions of the barriers and enablers to young people with physical disabilities accessing SRH services in Australia. METHODS: This research used a qualitative approach and involved semi-structured interviews with key informants. Key informants were identified using purposive and snowball sampling, and included health professionals working in SRH services and disability-focussed organisations. Thematic analysis was used to analyse the data. RESULTS: Key informant interviews were carried out with nine health professionals and professionals from disability-focussed organisations. Key themes were: attitudes, role and capacity of health professionals; and additional supports. These three broad areas can either act as barriers or enablers for young people with physical disabilities to access SRH services. This research highlighted that heterosexual and gender bias creates additional barriers for young women with physical disabilities and young people with physical disabilities who identify as lesbian, gay, bisexual, queer, transgender or intersex (LGBQTI). CONCLUSION: Young people with physical disabilities face barriers accessing SRH services. Additional barriers are faced by young women and LGBQTI young people with physical disabilities. This paper suggests strategies to overcome these barriers.

Substance Use, Offending, and Participation in Alcohol and Drug Treatment Programmes: A Comparison of Prisoners with and without Intellectual Disabilities.

BACKGROUND: Many offenders with intellectual disabilities have substance use issues. Offending behaviour may be associated with substance use. MATERIALS AND METHODS: Prisoners with and without intellectual disabilities were compared in terms of their substance use prior to imprisonment, the influence of substance use on offending, and their participation in alcohol and drug treatment programmes. RESULTS: Substance use was similar in prisoners with and without intellectual disabilities in the year prior to their current prison terms. Prisoners with intellectual disabilities were much less likely to report that substance use was an antecedent to the offences leading to their imprisonment. The completion rate of alcohol and drug treatment programmes was much lower for those with intellectual disabilities. CONCLUSIONS: Substance use may be as common in prisoners with intellectual disabilities as those without this condition. Services may need to reflect on whether their treatment programmes are meeting the needs of all prisoners.

The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations. METHODS: Electronic databases and conference websites were searched from 1997-2011 using the terms 'Chlamydia trachomatis' OR 'chlamydia' AND 'prevalence' OR 'epidemiology' AND 'Australia'. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category. RESULTS: Seventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis. CONCLUSIONS: Chlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.

Effects of sexually transmitted infection status, relationship status, and disclosure status on sexual self-concept.

Research has indicated that having a sexually transmitted infection (STI) such as genital herpes and genital human papilloma virus (HPV) can have a negative impact on an individual's sexuality. The current study was designed to evaluate the effect of STI status, relationship status, and disclosure status on various dimensions of sexual self-concept. A questionnaire that evaluated the above variables was completed by 117 individuals with genital herpes, 82 individuals with HPV, and 75 individuals with no STI. The results demonstrated that having herpes or HPV had a significant negative impact on aspects of sexual self-concept. It does not appear that an individual's relationship status is a factor associated with the impact of having an STI on the sexual self-concept. Respondents who had disclosed their STI to their partners, however, had significantly more positive feelings about aspects of their sexual self-concept than those who had not disclosed their STI to their partners. The implications of these research findings for health practitioners are discussed.

Sexually transmitted infections: impact on individuals and their relationships.

The impact of having genital herpes and genital human papilloma virus (HPV) on individuals and their relationships was investigated. A qualitative research methodology explored the lived experiences of 30 adults with genital herpes (15 men, 15 women), and 30 adults with HPV (15 men, 15 women). This study addressed individuals' feelings about the impact of stigma associated with having an STI, the impact of having an STI on sexuality and on intimate relationships, and feelings surrounding the process of disclosure. Implications of the findings for research and clinical practice are discussed.

Australian sexual health practitioners' use of chaperones for genital examinations: a survey of attitudes and practice.

OBJECTIVES: To examine the current practice and attitudes of Australian sexual health practitioners towards the use of chaperones for genital examinations. METHODS: In July 2006, an anonymous, self-completed questionnaire was mailed to members of the Australasian Chapter of Sexual Health Medicine. RESULTS: Of the 166 questionnaires sent to practitioners, 110 (66%) were returned completed. Of the 110 respondents, only 9% and 19% reported that their clinic routinely provided chaperones for all male and female genital examinations, respectively. Among practitioners whose services did not offer chaperones routinely, chaperones were offered with a mean frequency of 19% for female examinations and 8% for male examinations (P = 0.01). Compared to female practitioners, significantly more male practitioners thought a chaperone was important for medico-legal purposes when examining females (72% v. 53%, P < 0.05). Compared to male practitioners, significantly more female practitioners thought a chaperone was sometimes important for patient support when examining male patients (52% v. 26%, P < 0.001). Only 39% (n = 18) of male practitioners and 36% (n = 23) of female practitioners felt that resources spent on chaperones were justified by the benefits they provided. CONCLUSIONS: Despite only a minority of practitioners offering chaperones to patients or using them during examinations, many feel they are important for medico-legal reasons and as support for the patient. Best practice may be for services to routinely offer a chaperone and record instances where an offer is declined. This provides patients with choice and practitioners with some level of protection.

A theoretical discussion of the impact of stigma on psychological adjustment to having a sexually transmissible infection.

This paper provides a discussion of the utility of stigma theory as a conceptual framework for the interpretation and analysis of the psychological impact of contracting a sexually transmissible infection (STI). Most particularly, it focuses on those viral infections that cannot be medically cured, such as genital herpes and genital human papilloma virus. Recent research in the area of STIs suggests that the stigma associated with these conditions can hinder psychosocial and sexual adjustment post-diagnosis, and provides support for the use of stigma theory as a conceptual framework with which to analyse these experiences. This paper defines the concept of stigma and presents a theoretical overview of the process of stigmatisation. Three dimensions of stigma relevant to the experience of having a STI are then presented: the degree of concealability of the condition including the social consequences of concealing a condition; the origin of the condition; and the degree of peril presented by the condition. An overview of the way in which the presence of a stigmatising condition such as a STI may affect a person's feelings of self and his/her intimate relationships is then presented. Finally, the implications of stigma theory as a conceptual framework for guiding future research in the area of personal and interpersonal reactions to STIs is discussed.