Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample.

BACKGROUND: Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015. METHODS: We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. RESULTS: The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60-92years (median 69years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. CONCLUSIONS: Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

How Much Do Young Australians Know About Syphilis Compared With Chlamydia and Gonorrhea? Findings From an Online Survey.

BACKGROUND: There is increased heterosexual transmission of syphilis in Australia, an infection with severe outcomes. Australian policy emphasizes increasing sexually transmissible infection knowledge/awareness. However, little is known about young Australians' perceptions and knowledge of syphilis. METHODS: Our online sexual health survey was open May 2 to June 21, 2022, to 16- to 29-year-olds in Australia. We asked participants if they were aware of syphilis, their personal risk perception, and perceived severity of infection and compared with results for chlamydia/gonorrhea. Multivariable and multinomial logistic regressions were used to assess characteristics associated with outcomes. We measured sexually transmissible infection knowledge using 10 true/false statements (5 syphilis, 5 chlamydia/gonorrhea). RESULTS: Among 2018 participants (69.1% women, 48.9% heterosexual), 91.3% had heard of syphilis (vs. 97.2% for chlamydia and 93.3% for gonorrhea). Older (25-29 years; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.4) and gay/lesbian (aOR, 2.8; 95% CI, 1.4-5.3) respondents were more likely to have heard of syphilis, as were those who were non-Aboriginal, sexually active, and with a school-based sex education. Syphilis knowledge was lower than chlamydia/gonorrhea knowledge ( P < 0.001). More than half (59.7%) perceived syphilis to have serious health impacts (vs. 36.4% for chlamydia and 42.3% for gonorrhea). Older respondents were more likely (25-29 years; aOR 2.1; 95% CI, 1.6-2.8), and gay/lesbian respondents less likely (aOR, 0.7; 95% CI, 0.6-1.0) to perceive syphilis to have serious health impacts. One-fifth of sexually active participants were unsure of their risk of syphilis. CONCLUSIONS: Most young Australians are aware of syphilis, but few have comprehensive knowledge about the infection relative to chlamydia/gonorrhea. Considering increasing heterosexual transmission, syphilis health promotion campaigns should expand their focus.

Who does what? Reproductive responsibilities between heterosexual partners.

Managing fertility and sexual and reproductive health across the life course is associated with numerous responsibilities disproportionately experienced by women. This extends beyond dealing with the physical side effects of contraception and can include the emotional burden of planning conception and the financial cost of accessing health services. This scoping review aimed to map how reproductive responsibilities were defined and negotiated (if at all) between heterosexual casual and long-term partners during any reproductive life event. Original research in high-income countries published from 2015 onwards was sourced from Medline (Ovid), CINAHL and Scopus. In studies that focused on pregnancy prevention and abortion decision making, men felt conflict in their desire to be actively engaged while not wanting to impede their partner's agency and bodily autonomy. Studies identified multiple barriers to engaging in reproductive work including the lack of acceptable male-controlled contraception, poor sexual health knowledge, financial constraints, and the feminisation of family planning services. Traditional gender roles further shaped men's involvement in both pregnancy prevention and conception work. Despite this, studies reveal nuanced ways of sharing responsibilities - such as companionship during birth and abortion, ensuring contraception is used correctly during intercourse, and sharing the costs of reproductive health care.

Contraceptive decision making among Chinese international students in Melbourne: findings from a qualitative investigation.

Compared to their non-Chinese peers in Australia, Chinese international students have very low rates of effective contraceptive use and this combined with other factors impacts unintended pregnancy rates. There is limited research exploring Chinese international students in Australia's decision-making with respect to contraceptive choices. In early 2020, 26 individual semi-structured interviews were conducted with 18-25-year-old Chinese international students to explore factors influencing their contraceptive choices. Using both deductive and inductive analysis, seven primary themes were identified. Of note was the identification of the strongly expressed cultural value of (ài xi, cherishing). Cherishing was used to describe the promotion of self-protection and the protection of loved ones from any negative outcomes related to contraceptive methods. Findings suggest that cherishing has an important role to play in Chinese students' decision-making around contraception. In particular, notions of cherishing may make it difficult for Chinese international students to accept and trust the advantages of hormonal contraceptives. Moreover, the confusing and inconsistent terminology students use to describe contraceptive options may hamper their ability to access effective forms of contraception in Australia.

The impact of removing financial incentives and/or audit and feedback on chlamydia testing in general practice: A cluster randomised controlled trial (ACCEPt-able).

BACKGROUND: Financial incentives and audit/feedback are widely used in primary care to influence clinician behaviour and increase quality of care. While observational data suggest a decline in quality when these interventions are stopped, their removal has not been evaluated in a randomised controlled trial (RCT), to our knowledge. This trial aimed to determine whether chlamydia testing in general practice is sustained when financial incentives and/or audit/feedback are removed. METHODS AND FINDINGS: We undertook a 2 × 2 factorial cluster RCT in 60 general practices in 4 Australian states targeting 49,525 patients aged 16-29 years for annual chlamydia testing. Clinics were recruited between July 2014 and September 2015 and were followed for up to 2 years or until 31 December 2016. Clinics were eligible if they were in the intervention group of a previous cluster RCT where general practitioners (GPs) received financial incentives (AU$5-AU$8) for each chlamydia test and quarterly audit/feedback reports of their chlamydia testing rates. Clinics were randomised into 1 of 4 groups: incentives removed but audit/feedback retained (group A), audit/feedback removed but incentives retained (group B), both removed (group C), or both retained (group D). The primary outcome was the annual chlamydia testing rate among 16- to 29-year-old patients, where the numerator was the number who had at least 1 chlamydia test within 12 months and the denominator was the number who had at least 1 consultation during the same 12 months. We undertook a factorial analysis in which we investigated the effects of removal versus retention of incentives (groups A + C versus groups B + D) and the effects of removal versus retention of audit/feedback (group B + C versus groups A + D) separately. Of 60 clinics, 59 were randomised and 55 (91.7%) provided data (group A: 15 clinics, 11,196 patients; group B: 14, 11,944; group C: 13, 11,566; group D: 13, 14,819). Annual testing decreased from 20.2% to 11.7% (difference -8.8%; 95% CI -10.5% to -7.0%) in clinics with incentives removed and decreased from 20.6% to 14.3% (difference -7.1%; 95% CI -9.6% to -4.7%) where incentives were retained. The adjusted absolute difference in treatment effect was -0.9% (95% CI -3.5% to 1.7%; p = 0.2267). Annual testing decreased from 21.0% to 11.6% (difference -9.5%; 95% CI -11.7% to -7.4%) in clinics where audit/feedback was removed and decreased from 19.9% to 14.5% (difference -6.4%; 95% CI -8.6% to -4.2%) where audit/feedback was retained. The adjusted absolute difference in treatment effect was -2.6% (95% CI -5.4% to -0.1%; p = 0.0336). Study limitations included an unexpected reduction in testing across all groups impacting statistical power, loss of 4 clinics after randomisation, and inclusion of rural clinics only. CONCLUSIONS: Audit/feedback is more effective than financial incentives of AU$5-AU$8 per chlamydia test at sustaining GP chlamydia testing practices over time in Australian general practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000595617.

Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study.

OBJECTIVES: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia. METHODS: In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT. RESULTS: The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use. CONCLUSION: GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.

Telehealth for sexual and reproductive health issues: a qualitative study of experiences of accessing care during COVID-19.

BACKGROUND: Medicare, the health insurance system underpinning free healthcare in Australia, introduced free telehealth items in 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. Their uptake among healthcare providers was significant, including among general practitioners and sexual health services. Here, we report people's experiences of accessing sexual and reproductive health (SRH)-related care via telehealth collected as part of a survey exploring the impact of COVID on SRH health. METHODS: This study utilises qualitative data from two online surveys conducted in 2020. Surveys were advertised through social media and professional and personal networks. Anyone aged≥18years and living in Australia was eligible to participate. Respondents were asked whether they accessed care for their SRH via telehealth. A free-text question asking for further detail about their experience was analysed using content analysis. RESULTS: A total of 114/1070 respondents (10.7%) accessed healthcare services via telehealth for SRH-related reasons within the previous 4weeks. Three themes were identified from 78 free-text comments: (1) accessibility and convenience of telehealth; (2) appropriateness of telehealth for SRH issues; and (3) connecting and communicating with clinicians via telehealth. Respondents had a wide range of experiences. Telehealth improved access to services for some participants, and it was appropriate for some, but not all SRH issues. Difficulties connecting with clinicians on both an interpersonal and technical level was a key barrier to a satisfactory patient experience. CONCLUSIONS: Telehealth can offer a viable alternative to face-to-face care, providing patients can overcome key connection and communication barriers.

A systematic review of international students’ sexual health knowledge, behaviours, and attitudes.

The demand for higher education has increased student mobility across the world. Studying abroad provides an opportunity for young adults to engage in sexual behaviours, some of which may be risky. Yet, little is known about international students' current sexual health knowledge or practices. The aim of this review was to identify their sexual health knowledge, behaviours, and attitudes. A search of five databases yielded 21 studies that met inclusion criteria. These studies used quantitative (n =13), qualitative (n =7) and mixed methods (n =1) and included a total of 4666 international and exchange students from diverse cultural backgrounds. Findings were grouped into three themes: sexual health knowledge, sexual behaviours, and sexual health attitudes. Asian international students had poorer levels of knowledge, suggesting a need for culturally appropriate sex education. They were less sexually experienced and were older than domestic students at first age of sex. Fewer engaged in risky sexual behaviours when compared to domestic students. They also reported fewer sexual partners and higher condom usage. However, culture influenced the sexual behaviours and attitudes of international students; in particular, Asian female international students, who tested risk-taking behaviours, such as casual sex, in more liberal Western countries. Appropriate intervention and further education are needed to decrease international students' sexual health risks.

Alcohol availability and prevalent Chlamydia trachomatis in young Australians: a multi-level analysis.

Background Prevalence of sexually transmissible infections (STIs) has been associated with availability of alcohol. This paper investigates potential associations between prevalent cases of chlamydia in young people in Australia and the availability of alcohol within their local area, defined as postcode of residence. Methods Alcohol availability was determined at the postcode level using liquor licensing data, classified as total number of licences, number of 'take-away' licences and number of licenses by population. Participant data were drawn from a survey targeting Australians aged 16-29years in rural and regional Australia, capturing demographic details including postcode of residence, indicators of sexual behaviour including condom use and chlamydia test results. Mixed-effects logistic regression was used to examine potential associations between first, alcohol availability and chlamydia, and second, between condom use and chlamydia. Results We found little evidence of associations between alcohol availability and chlamydia in either unadjusted or adjusted models. After adjusting for alcohol availability, we observed significant associations between inconsistent condom use and chlamydia prevalence, whether alcohol availability was measured as total number (adjusted odds ratio (AOR) 2.20; 95% confidence interval (CI) 1.20, 3.70), number of take-away licenses (AOR 2.19; 95% CI1.30, 3.69) or licenses per 1000 population (AOR 2.19; 95% CI 1.30, 3.68). Conclusion Little evidence of association between alcohol availability and chlamydia at the postcode level was found. Further research is required to determine appropriate measures of 'local area' and how characteristics thereof may impact on sexual health.

A psychological group intervention for high-risk pregnant women: a protocol of a feasibility and acceptability study of the STAR Mums program.

BACKGROUND: In pregnancy, the attachment relationship between a mother and her baby begins to develop and women are more motivated and willing to make changes to become more engaged and responsive mothers and have better relationships with their children. A transgenerational framework has proposed that dysfunctional relationship patterns are often repeated across generations and this has broadened the understanding of early difficulties in parenting. Despite this there has been little research specifically examining high-risk perinatal women and how their interactions with their infants are related to attachment or relational outcomes. METHODS: This pilot study aims to evaluate, and to explore the acceptability and feasibility, of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychodynamic attachment-based group intervention, for pregnant women with risk factors for attachment difficulties. The STAR Mums program aims to intervene during pregnancy to assist women with risk factors in the transition to parenthood with the desired outcome to improve the quality of mother-infant emotional interactions, regulation and the attachment relationship. This is a mixed-methods design study incorporating both qualitative and quantitative assessments of five groups of five first-time mothers over a 12-month period. CONCLUSIONS: This paper outlines the STAR Mums intervention and protocol for assessing acceptability and feasibility. The STAR Mums program takes a preventative approach and supports early intervention for parents at risk of attachment difficulties with their infants. The results of this study will inform revisions to the current treatment manual and a larger-scale program evaluation to further examine the efficacy of this intervention.

'It's literally giving them a solution in their hands': the views of young Australians towards patient-delivered partner therapy for treating chlamydia.

OBJECTIVES: Patient-delivered partner therapy (PDPT) is a method for providing antibiotic treatment for the sexual partners of an index patient with an STI by means of a prescription or medication that the index patient gives to their sexual partner(s). Qualitative research regarding barriers and enablers to PDPT has largely focused on the views of healthcare providers. In this study, we sought to investigate the views of young people (as potential health consumers) regarding PDPT for chlamydia. METHODS: Semi-structured telephone interviews were conducted with young Australian men and women. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Purposive and snowball sampling was used. Data were analysed thematically. RESULTS: We interviewed 22 people (13 women, 9 men) aged 18-30 years, 15 of whom had previously been tested for chlamydia. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Protecting their partners' privacy was essential, with participants expressing reluctance to provide their partners' contact details to a doctor without consent. Beyond logistical benefits, PDPT was viewed as a facilitator to partner notification conversations by offering partners a potential solution. However, most interviewees indicated a preference to consult with a healthcare provider (GP or pharmacist) before taking PDPT medication. Participants indicated that legitimacy of information when navigating a chlamydia diagnosis was crucial and was preferably offered by healthcare providers. CONCLUSIONS: Though PDPT is unlikely to fully replace partners' interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.

Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia.

INTRODUCTION: Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help 'flatten the curve'. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. METHODS: An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. RESULTS: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18-29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95% CI -7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI -26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= -14.8%; 95% CI -17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown. CONCLUSION: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey.

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. METHODS: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. RESULTS: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. CONCLUSION: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.

What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy.

BACKGROUND: Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment. AIM: This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). MATERIALS AND METHODS: The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located. RESULTS: These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. CONCLUSION: This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.

Contraceptive use and pregnancy plans among women of reproductive age during the first Australian COVID-19 lockdown: findings from an online survey.

PURPOSE: Australia introduced 'lockdown' measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive health (SRH). MATERIALS AND METHODS: Australians aged 18+ were eligible to participate in an online survey from 23 April to 11 May 2020. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using conventional content analysis. RESULTS: Most participants were aged 18-24 years, and indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used however nearly 20% reported they were not using contraception. Women who were employed had less trouble accessing contraception during lockdown. Participants reported delaying childbearing or deciding to remain childfree due to COVID-19. CONCLUSION: COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies.

The Views of Patients and Partners Toward Patient-Delivered Partner Therapy for Chlamydia: A Systematic Review.

BACKGROUND: The majority of research on patient-delivered partner therapy (PDPT) has focused on its impact on reinfections. This study aimed to systematically review the evidence regarding the acceptability of PDPT by patients and partners for chlamydia infection. METHODS: Three electronic databases were searched in March 2019 using terms related to PDPT. Studies were included if they reported on patient or partner acceptance of PDPT for chlamydia and were conducted in high-income countries. Actual and perceived acceptabilities of PDPT were assessed. RESULTS: Thirty-three studies were included: 24 quantitative, 3 qualitative, and 6 mixed methods. Most were clinic based. Quantitative data showed that participants' perceived willingness to give PDPT to their partner(s) ranged from 44.7% to 96.3% (median, 84%), and 24% to 71% (median, 65%) of people who offered PDPT for their partner(s) accepted it. Partners' perceived willingness to accept ranged from 42.7% to 67% (median, 62%), and actual acceptance ranged from 44.7% to 80% (median, 77%). Those in longer-term relationships were generally more likely to accept PDPT; however, beyond this, we identified few clear trends. Qualitative studies found that convenience of PDPT and assurance of partner treatment were benefits, whereas partners not seeing a health care professional was viewed as a downside. Packaging that appeared legitimate and coaching on delivering PDPT were facilitators. CONCLUSIONS: Because patients bear responsibility for the success of PDPT, this information is crucial in clinical settings. Acceptance, perceived and real, of PDPT was generally high. Patients are best placed to determine whether PDPT is appropriate for them, and it should be offered as an option.

A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of "The Gist".

BACKGROUND: The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy. OBJECTIVE: The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people. METHODS: In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team. RESULTS: Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point. CONCLUSIONS: This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues.

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018.

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018. METHODS: Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately. RESULTS: Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women. CONCLUSIONS: In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

A descriptive analysis of young women's pornography use: a tale of exploration and harm.

Background Despite viewing less often than young men, young women view pornography. This study used an online survey to describe young women's pornography use and their reflections on the influence of this use. METHODS: Young Australian women (15-29 years) were recruited via Facebook to complete an online survey in 2016. Respondents who had ever viewed pornography (n = 491) were asked 10 closed-ended questions related to their exposure to pornography and an open-ended question: 'How has pornography influenced your life?'. Quantitative responses were descriptively analysed. Qualitative responses were thematically analysed using a descriptive qualitative approach. RESULTS: Most respondents (89%) watched pornography alone for sexual arousal and openly reflected on the influence of their own use. Two overarching themes were identified across qualitative data. The first, exploration, included positive sub-themes of safety, independence, normalisation of sexuality and diversity in body type. The second, harm, included negative sub-themes related to conditioning, comparison and dependency. Themes were identified separately among two discrete groups, but were also described concurrently among a third group of (mostly older) respondents who experienced pornography both as a place for exploration and as a potential source of harm. CONCLUSION: Young women watch pornography and have positive, negative and mixed experiences that they link to their own viewing. Future research must provide a safe space for young women to be honest regarding their pornography use to ensure that their perspectives are heard and understood.

Sexually transmissible infections, partner notification and intimate relationships: a qualitative study exploring the perspectives of general practitioners and people with a recent chlamydia infection.

Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship. METHODS: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.? RESULTS: A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations. CONCLUSIONS: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital.