Body mass index, sexual difficulties and sexual satisfaction among people in regular heterosexual relationships: a population-based study.

BACKGROUND/AIMS: The aims of this study were to clarify the relationship between body mass index (BMI) and sexual difficulties and to investigate if BMI influenced sexual satisfaction, over and above the effects of sexual difficulties. METHODS: Cross-sectional analyses of a nationally representative computer-assisted telephone interview. Eight thousand, six hundred and fifty-six respondents were recruited by random digit dialling in 2004-2005. Only those in a sexually active, heterosexual relationship were included in the current analyses. RESULTS: After adjustments for demographic factors, both overweight and obese male and female participants were more likely to report worrying during sex about whether their body was unattractive. Among women, associations were also found between higher BMI and lack of interest in sex. No other significant associations between BMI and sexual difficulties were evident. There was an association between BMI and extreme physical pleasure for women but not men over and above the effects of sexual difficulties, with obese women being more likely than normal weight women to report extreme physical pleasure. No associations were found for either men or women between BMI and whether or not they reported extreme emotional or sexual satisfaction with their relationship. CONCLUSIONS: With the exception of body image difficulties, there is little association between BMI and self-reported sexual difficulties. Furthermore, extreme sexual and emotional satisfaction appeared to be associated with the presence or absence of sexual difficulties and not overly influenced by BMI. Overall, clinicians and patients should be aware that being overweight is not necessarily detrimental to sexual functioning.

State of the (positive) nation: findings from the fourth national Australian HIV futures survey.

This paper characterises the health and wellbeing of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 4 Survey is a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 1059 responses, approximately 8% of the estimated HIV-positive population. Respondents were aged between 18 and 92 years and 77% were homosexual men. In total, 60% reported a viral load of <500 copies/mL and 83% a CD4 count of over 250 cells/microL. A total of 44% reported another major health condition and 35% a mental health condition. A total of 71% were using antiretroviral therapy. More than half of the respondents had stopped working because of HIV and 25% were living in poverty. In conclusion, adequate planning for the future of our response to HIV/AIDS relies in no small part on our access to detailed information about how the epidemic affects those with the virus.

Client acceptability of the use of computers in a sexual health clinic.

Computers in sexual health medicine largely remain provider-centred for use in client care, data collection, administration and education. As a formative study for further work we undertook a cross-sectional survey of 679 consecutive new clients attending Melbourne Sexual Health clinic (MSHC) between 9 September 2002 and 15 October 2002 to establish client familiarity and experience with computers and acceptance of computer use in the clinic. A response rate of 616/679 (91%) was achieved. Important findings were: 1. 491/612 (80%) participants reported experience with a personal computer. 2. The majority 488/609 (80%) of clients expected computer technologies to be used in the clinic. 3. The proportion of clients not willing to supply their registration, general health or sexual behaviour details using a computer was 9%, 7% and 21%, respectively. 4. Clients assessed as being at higher risk of acquiring a sexually transmitted infection were no more reluctant than others to provide their details using a computer-assisted self-interview.

Does the Internet assist clients to carry out contact tracing? A randomized controlled trial using web-based information.

The primary outcome was to determine the acceptability of the Internet, specifically a website for use in standard partner notification. A secondary objective was to determine if a website would enhance the outcomes of currently used partner notification methods. In a randomized control trial, 105 participants diagnosed with chlamydia and non-gonoccocal urethritis (NGU) were randomized and 97 completed the study. About 30% of participants were provided a standard partner letter and 70% were provided the standard partner letter and website. All participants reported that their partners had no objections to the website (0%, 95% confidence interval [CI] 0-5%). There were no complaints received from any partner. The odds ratio for contacting partners was not significantly different between the two groups of participants. The results of this study indicate that providing a website with specific information about the infection to which a partner has been exposed is not harmful.

Now, later or never? Challenges associated with hepatitis C treatment.

BACKGROUND AND AIMS: Of the 259,000 Australians estimated to have a hepatitis C virus infection, very few have received antiviral therapy. This study identifies personal, psychological and structural barriers associated with decisions to begin treatment and the challenges associated with adhering to a demanding treatment regimen. METHODS: Between August 2003 and May 2004, 224 people living in Victoria who were hepatitis C antibody positive completed a 78-item survey instrument. Participants were recruited from a variety of settings and included those who were on treatment for hepatitis C (n=45); previously on treatment (n=65); and people who had never experienced treatment (n=114). RESULTS: The average age of the participants was 43 years. Men (n=29) were more likely than women (n=15) to be receiving treatment. Participants diagnosed in the past five years (31%) were more likely to be receiving treatment compared with those diagnosed more than five years ago (14%). Participants rated the effectiveness of treatment as the most important factor in influencing their decision to begin treatment. Side effects were rated the biggest challenge to adhering to treatment and were also rated as the most important consideration for those who decided against treatment. CONCLUSIONS: This study has shown many decisions and challenges affect the uptake of, and adherence to, hepatitis C treatment. Dissemination and promotion of information about increased effectiveness of new treatments will greatly influence decisions to begin treatment. Careful management and minimisation of side effects are also essential to improve uptake and increase adherence to hepatitis C treatment.

Health and wellbeing of HIV-positive Australians: findings from the third national HIV Futures Survey.

The aim of this paper is to characterize the health and well being of people living with HIV/AIDS (PLWHA) in Australia. The HIV Futures 3 Survey was a self-complete anonymous questionnaire distributed through multiple sites. Data were collected on health, clinical and social variables. There were 894 responses, 6% of the known HIV-positive population. Respondents were aged between 20 and 77; 79% were homosexual men. In all, 58% reported a viral load of <500 copies/mL, and 81% a CD4 count of over 250 cells/microL. In all, 38% reported another major health condition, and 26% a mental health condition. A total of 72% were using antiretroviral therapy. About 48% were in a regular relationship, and 42% of regular partners were HIV-positive. In all, 55% had stopped working because of HIV and 31% were living in poverty. While the overall picture for PLWHA in Australia is optimistic, there remain clear patterns of health and social disadvantage that require ongoing policy vigilance and service provision.

New technology and partner notification--why aren't we using them?

Partner notification is crucial to the effective control of sexually transmissible infections (STIs) and has not changed substantially over recent years. New technology for communication has been rapidly adopted in our communities but little work has been carried out about its role in contact tracing. Text messaging, emails and the Internet could be useful tools for both provider and patient referral but considerable ethical considerations are involved. Technology is available to help protect the basic tenets of confidentiality and privacy but more thorough exploration of these methods is required to establish efficacy and appropriateness in contact tracing. This research is important if we are to procure an evidence base for future contact tracing strategies rather than allowing these methods to become commonplace at the initiation of our clients.

Minor infection, minor life events and the four day desirability dip.

Sixty-five subjects volunteered to take part in an intensive prospective investigation into the role of minor life events in precipitating episodes of minor infectious illness of the upper respiratory tract, notably 'colds'. Subjects provided daily records of desirable and undesirable events, as well as information concerning their physical health. Information was collected using standardized methods which have proven useful in recent research. Among those subjects who both provided adequate data and experienced a suitable illness episode, it was found that, relative to carefully matched control days, illness episodes were characterized by a statistically significant decrease in desirable events during the 4 days prior to symptom onset. Undesirable events were unrelated to illness episodes. This replicates and extends the most recent findings in this area, is consistent with psychoimmunological hypotheses regarding aetiological mechanisms and illustrates the promise of the new life events research based on a consideration of minor daily events.

The experience of long-term hospital follow-up for women who have suffered early stage gynecological cancer: a qualitative interview study.

Bradley EJ, Pitts MK, Redman CWE, Calvert E. The experience of long term hospital follow-up for women who have suffered early stage gynecological cancer: a qualitative interview study. The objective of this paper is to investigate the factors involved in the wish for continuing long-term follow-up for early stage gynecological cancer in the absence of obvious clinical benefit. This qualitative study is comprised of semistructured, individual interviews. Twelve women who had been treated for early stage (I-II) gynecological cancer (cervical, vulval, ovarian, endometrial) and had been attending regular follow-up appointments at the hospital clinic for a minimum of six months were interviewed for this study. The primary outcome measures were women's views on their follow-up needs. Women who continue to express a need for follow-up appointments years after the treatment of active disease are seeking to alleviate anxiety regarding possible recurrent illness. The main element of follow-up that alleviates this recurrence anxiety is medical reassurance, this is only judged to be worthwhile when given by a gynecological consultant. There is a difficulty with regarding the period of remission as a healthy state, both cultural "lay" beliefs and family support exacerbate this difficulty. Although family support is deemed important initially, it may actually serve to maintain "sickness" identity, perpetuating views of cancer remission as another stage of illness. We conclude that the processes involved in follow-up for cancers with a very low recurrence risk are complex. Follow-up information is perhaps medical, but women who have a continued need for follow-up in the absence of any clinical disease are attending for psychological purposes. Further research is needed to study possible interventions that could be introduced to help alleviate anxiety during the period of cancer recovery.

Effects of a change from an appointment service to a walk-in triage service at a sexual health centre.

A walk-in triage system (WITS) was introduced at Melbourne Sexual Health Centre in August 2001 as a result of the perceived need to increase access to the clinic for clients requiring immediate assessment. An audit of this alteration to clinic operation resulted in a significant increase in the number of new clients attending the clinic who were younger and less likely to report using condoms, substantial increases in the number of investigations ordered for bacterial sexually transmitted infections (STIs) and an increase in the detection of genital herpes and chlamydia. There are a number of possible explanations for these changes other than the change to clinic operation but these are less likely causes for the observed changes. Our findings should complement the other reasons to adopt a WITS system, such as improving access for those most in need and vital to reach if STI rates are to fall.

Partner notification: preferences of Melbourne clients and the estimated proportion of sexual partners they can contact.

This study was conducted to determine the estimated proportion of contactable sexual partners, the most common types of contact information available and the most acceptable contact tracing strategies for our clients. Five hundred 'walk in' clients completed a questionnaire about their total number of sexual partners, the proportion of contactable partners and available contact information. Women had the highest estimated number of contactable partners (89-94%), men who have sex with men had the lowest (51-73%). The preferred contact tracing strategy was to give partners a website address (76%) and the least preferred was provider referral (33%). There was a difference in the type of information available for contacting sexual partners (P <0.001); most commonly clients reported partners contactable by phone or face to face and least commonly through a third person. The currently used method (doctor's letter) is not the preferred choice of these clients and more innovative methods using recent technology may prove more effective.

Factors influencing delay in treatment seeking by first-time attenders at a genitourinary clinic.

We examined treatment-seeking behaviours amongst a consecutive sample of 188 first-time attenders at a busy genitourinary (GU) clinic in a general hospital. Participants were interviewed and completed a battery of questionnaires prior to receiving diagnosis or treatment. Delay in treatment seeking was measured in 3 ways: utilization delay, illness behaviour delay and appraisal delay. Appraisal delay and illness behaviour were significantly related, but were unrelated to utilization delay. Substantial delays were reported before seeking treatment, with a median of 30 days elapsing between first noticing symptoms and attending the clinic. Analysis of age groups indicated that the oldest groups--45 and above were likely to delay longest, on all 3 measures of delay.

HIV partner notification: a 2002 Victorian audit.

This audit was carried out in August 2003 and examined HIV notification data in Victoria. We aimed to determine the proportion of partners reported as being traced from newly diagnosed HIV individuals, the type of contact tracing used and identify the number of HIV cases newly diagnosed from contact tracing. We compared men who have sex with men (MSM) with all other newly diagnosed HIV individuals in Victoria (non-MSM). Of the 215 newly diagnosed HIV-positive individuals, 49% (n = 105) could potentially carry out contact tracing. There was a difference between MSM and non-MSM in the proportion of contactable partners (44% vs 63% respectively, P = 0.017). MSM less commonly used provider referral than non-MSM (12% vs 53% respectively, P < 0.001) but more commonly used patient referral (41% MSM vs 9% non-MSM, P = 0.001). Of the 13 individuals found to be HIV-positive through contact tracing, nine (69%) were non-MSM.

Can we predict who will return to a genitourinary clinic?

One hundred and eighty-eight first-time attenders at a genitourinary (GU) clinic were monitored to establish who returned following discharge after treatment. Thirty-six (19%) returned within 2 years with a new infection. The re-attenders did not differ significantly from the rest of the cohort by age, gender or occupation, nor did they differ in their sexual history and psychological variables. Re-attenders were significantly more likely to have consulted their general practitioner (GP) in the 6 months prior to their first clinic attendance.

Illness Identity and the Self-regulatory Model in Recovery from Early Stage Gynaecological Cancer.

Women in recovery from early stage gynaecological cancer have extremely good survival and low recurrence rates. Despite this, women continue to feel vulnerable to cancer recurrence for years after treatment. Semi-structured interviews were utilized to explore the factors involved in recovery from gynaecological cancer. This article argues that the illness identity of gynaecological cancer perpetuates a vulnerability to cancer recurrence. The absence of self-diagnosis prior to medical diagnosis is important in the formation of gynaecological cancer illness identity. A lack of self-diagnosis may be due to the 'normalization' of initial symptomatology. It is suggested that illness identity is responsible for maintaining fears of symptom-free cancer recurrence. The self-regulatory model is employed to explore this process, looking in particular at the reinforcement of reassurance needs.

A randomised controlled trial comparing computer-assisted with face-to-face sexual history taking in a clinical setting.

AIM: To compare computer-assisted self-interview (CASI) with routine face-to-face interview (FTFI) for sexual history taking from patients in a clinical setting. METHODS: A randomised controlled trial was undertaken at the Melbourne Sexual Health Centre, Melbourne, Victoria, Australia, in 2005. New, walk-in patients triaged into the centre were eligible for the study. Those who consented to the study were randomly allocated (initially at a ratio of 2:1, then 1:1) to either CASI or FTFI. Those randomised to CASI also subsequently undertook FTFI. RESULTS: During the study period, of 713 patients approached, 611 agreed to participate in the study; 356 were randomised to FTFI and 255 to CASI. Overall, the responses to questioning using CASI and FTFI were similar except that women undertaking the CASI reported a significantly higher median number of male partners for the preceding 12 months (3 v 2, p = 0.05) and the CASI participants reported previous hepatitis B vaccination more often (50% v 37%, p = 0.01). Most participants found the CASI either easy (31; 13%) or very easy (193; 82%) to complete; 83 (35%) were comfortable and 121 (51%) were very comfortable with it. CONCLUSIONS: CASI may be a reliable, efficient and highly acceptable method for the screening of sexual risk in clinical sexual health settings and could be used routinely to improve the efficiency of clinical services.

Men, bodily change and urethritis: a qualitative study.

OBJECTIVES: To describe how men narrate the process of bodily change as a trigger to presentation for a suspected sexually transmissible infection. METHODS: The study was qualitative with 18 men presenting at a specialist sexual health centre in an urban setting. RESULTS: All men gave narratives that included accounts of bodily changes prior to presentation. The nature, severity and persistence of those changes were unrelated to subsequent diagnosis. Men responded particularly to visual changes as cues to action. CONCLUSIONS: The men exhibited limited skills in understanding the significance and the specifics of bodily change as they may relate to a sexually transmissible infection. While these men identified a broad range of changes as potentially indicative of a sexually transmissible infection, their ability to act on visceral rather than visual cues appears constrained in that they were less able to respond to the feel of their body than the way that it looked.

Correlates of antiretroviral treatment breaks.

OBJECTIVE: To identify key relationships between the decision to take a break from antiretroviral treatments and potential clinical and social antecedents. METHODS: An analysis of a self-completed survey of various clinical and social aspects of the lives of people living with HIV/AIDS (PLWHA) distributed nationally in Australia was carried out. RESULTS: The questionnaire was completed by a sample of 894 PLWHA. From this sample, three groups of interest were identified: a 'no break' group that had been using antiretrovirals continuously (n=378), a 'lifestyle break' group that had taken a break for purely lifestyle reasons on their last occasion (n=76), and a 'clinical break' group that had taken a break for purely clinical reasons on their last occasion (n=99). Clinical breaks were found to be longer than lifestyle breaks and involved more consultation with doctors. Differences were also found between the two break types in effects on the respondents' health and well-being. The clinical break group was further found to experience a higher level of health difficulties on a range of variables, while the lifestyle break group was younger, had a longer experience of HIV and its consequences, and engaged in greater participation in activities associated with both pleasure and risk. CONCLUSIONS: The analyses offer a pattern of health and social factors that places the HIV-positive individual, as a social actor, squarely within the experience of treatment interruptions. Understanding the social motivations and correlates of treatment interruption offers new challenges in maximizing the efficacy of health maintenance and support for PLWHA.

Current practice of sexual history taking by sexual health physicians in Australia and New Zealand.

OBJECTIVES: To document the current practice of fellows of the Australasian College of Sexual Health Physicians (ACSHP) when taking a sexual history from a new client. METHOD: A postal questionnaire was sent to all eligible fellows practising sexual health medicine in public sexual health centres in Australia and New Zealand (n = 93). The study period extended from 3 February to 4 April 2003 inclusive. RESULTS: 77 (83%) fellows returned the questionnaire and, of these, 71 (76%) were eligible for inclusion in the analysis. The median number of years of practising sexual health medicine was 16 (range 5-32) with 70% having worked in the field for 10 years or more. The generic questions that fellows asked most often concerned the presenting complaint/reason for attendance, the history of the presenting complaint, current sexual relationship status and last sexual contact, history of sexually transmitted infections (STIs), use of condoms during sexual intercourse in the past 3 months, and pattern (always, usually, sometimes, never) of condom use during that time period. The least frequently asked generic questions concerned age at first sexual activity, the number of sexual contacts, lifetime condom use, and hepatitis A status. CONCLUSION: This study establishes the consistency and variability of sexual health information currently collected by fellows of the ACSHP when taking a history from a new client.

Staffing patterns in rural community support programs.

OBJECTIVE AND METHODS: Rural mental health programs are thought to have difficulty recruiting and retaining qualified staff and to have excessively large caseloads per staff member. The authors surveyed 12 community support programs in small cities and rural areas of Wisconsin to determine staff size and characteristics, staff-to-client ratios, and the relative use of paraprofessional staff and professional staff, excluding psychiatrists. RESULTS: The programs surveyed had an average of 5.6 full-time-equivalent caregiving staff and an average caregiver-to-client ratio of 1 to 13. Caregiving staff were predominantly female, had been in the mental health field a mean of 8.8 years, and received an average salary of $20,732. Although program directors indicated that about one-fifth of staff left in the previous year, they reported little difficulty recruiting staff. Thirty-eight percent of all caregivers were paraprofessionals; in several programs, more than half the caregivers were paraprofessionals. Use of paraprofessionals is more common in rural programs; thus caregivers in those programs are likely to have lower levels of salary and experience. CONCLUSIONS: The community support programs in the sample employed experienced caregivers and had staff-to-client ratios that were close to the ratio recommended for such programs by Wisconsin legislation. The survey findings suggest that claims of acute staffing problems in rural community support programs need to be examined more closely, with attention to the relationship between staff characteristics and client outcomes.