Volume 14 Number 5 2017
Caring for Transgender People: Looking Beyond the Hype
This special issue presents a collection of articles that addresses issues facing transgender individuals that are particularly challenging.
This review provides an update on the epidemiology and quasi-epidemiology of Gender Dysphoria or a self-reported transgender identity in children, adolescents, and adults. Recent studies suggest an increased prevalence of Gender Dysphoria in adults although it remains a relatively rare behavioural phenomenon. Using the broader descriptor of a transgender identity, however, suggests a much higher prevalence, perhaps due to the influence of increased society acceptance and affirmation of gender-variant identities.
This article discusses transgender and gender diverse (TGD) student rights in a range of Australian laws and education policies. It shows how the inclusion of TGD students, particularly in sexuality education, is reinforced in the current Australian National Curricula. Finally, it considers research on Australian TGD students’ educational attainment, experiences of transphobic abuse and violence, and experiences in contexts where they do and do not have staff (and other) support. It promotes a shift from harmful approaches of victimising TGD students, towards celebrating their resilience and social contributions.
This article reviews problems with the Safe Schools program in Australia which seeks to protect lesbian, bisexual, gay, transgender and intersex young people from bullying. The information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm because it promotes gender transitioning without expert medical advice. The great majority of children resolve gender dysphoria issues around the time of puberty.
SH17086Gender trouble: The World Health Organization, the International Statistical Classification of Diseases and Related Health Problems (ICD)-11 and the trans kids
WHO is revising its ICD diagnostic manual; the most widely used diagnostic manual worldwide. There is controversy over a proposal for a Gender incongruence of childhood diagnosis targeting young children identifying in a gender other than the one matching the sex they were assigned at birth. The author argues that the proposed diagnosis is unnecessary, potentially harmful, and at odds with WHO’s thinking in regard to other forms of diversity in young people, and that WHO should now abandon the proposal.
Transgender people face legal barriers that can affect their physical and mental health. Health care providers’ awareness of the complexities transgender people often grapple with may help providers better identify negative factors affecting their clients or patients and deliver appropriate and timely interventions.
SH17009The Gender Feeling Amplitude: an instrument to assist clinicians with the assessment of gender diverse adolescents
A child’s anatomy does not always predict gender identity, however, children with gender variant behaviours experience intense pressure to conform to expectations based on assigned gender. Parent initial reactions of disorientation and overwhelm can develop through a process of acquiring information, acceptance, understanding and advocacy. Empowering parents through validation of their experiences, providing resources and strategies, while facilitating confidence and acceptance of their child’s needs, offers parents a solid foundation to support their child’s needs for gender identity integration.
For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.
Transgender people are vulnerable to HIV and STI through a range of intersecting psychosocial factors. As a consequence, transgender people bear a very high burden of HIV and STI, especially in resource- poor countries, although transgender men remain understudied everywhere. Health services can improve access to STI and HIV testing, care and prevention through developing transgender- friendly multidisciplinary services.
SH17096Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations
This systematic review focussed on HIV and STIs among transgender populations globally. The review underscored how more data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations.
HIV positive transgender women have poorer health outcomes than their cisgender counterparts. Resultsof this study confirm that transgender women are less likely to have suppressed HIV replication, a key indicator of HIV disease progression. Findings from the case-control analyses showed that social support predicts HIV-related health outcomes among transgender women over and above other common correlates of health disparities.
Gender dysphoria is associated with significant health disparity. Although specialised interventions such as endocrine therapy and surgery are safe and effective, mortality for the transgender population remains substantially higher than the general population. Primary health care is one of the components that contribute to health discrepancy for transgender individuals, but the medical needs of transgender patients are often misunderstood. This paper addresses some of the main primary care issues for transgender populations.
The peer-reviewed and edited version of record published online before inclusion in an issue
This study aimed to identify the different pathways of access to sexual health care and knowledge for university students with sexual health concerns. The Internet was identified as the most common first point of call for health information, followed by doctors. Of those who accessed the Internet, the majority subsequently went to a doctor.
Body image problems can impact one’s performance and enjoyment in the bedroom for both genders. This paper examines which body image factors predict these problems, and found that wanting to be thinner was the main cause of dysfunction. This highlights how the promotion of thinness can have far-reaching consequences, affecting not only how we feel about ourselves, but also our interactions and relationships with others.
SH16219Blood-borne virus transmission in an urban, culturally diverse neighbourhood: results from a cross-sectional bio-behavioural survey using innovative outreach methods in a hard-to-reach population
SH17080Substantial increase in yield of Neisseria gonorrhoeae testing 2008–2013 at a Sydney metropolitan sexual health clinic: an observational study
A substantial increase in gonorrhoea notifications to public health units in New South Wales has been observed in recent years, but whether this relates to more frequent testing or other factors is unknown. We assessed the proportion of gonorrhoea tests that were positive and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. While the number of tests performed almost double, we observed over a 3-fold increase in the proportion of positive tests from 2.2% in 2008 to 7.1% in 2013. This was observed at all anatomical sites and in all subgroups examined, and rates were highest amongst gay men. More frequent and comprehensive gonorrhoea testing and treatment to interrupt onward transmission to sexual partners could potentially reduce high and increasing rates of gonorrhoea in the community.
The genital wart burden in Taiwan was previously unavailable. In this study, the estimated prevalence of genital warts was 1.13%; the highest estimated prevalence was among female patients aged 18–24 years and male patients aged 25–29 years. Median GW costs were substantial, being estimated at US$213.8 for male and US$351.8 for female patients. Our study results provide evidence-based data that will allow for the implementation of measures to reduce genital wart prevalence and psychosocial impact on patients.
SH17113Evaluation of knowledge and utility of the 2014 Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men among general practitioners in Sydney
Men who have sex with men are disproportionately affected by sexually transmissible infections (STIs) and HIV and guidelines for general practitioners who diagnose the majority of STI/HIV in Australia are essential to ensure appropriate testing in this group. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians and found familiarity with the guidelines was associated with a range of positive outcomes on general practitioners’ clinical practice. Novel approaches are required to ensure more widespread distribution of future guidelines.
SH17099Kept clinical visits, as scheduled in the first 6 months of antiretroviral treatment, determine long-term treatment outcomes in people living with HIV: a large retrospective cohort study in China
This study conducted a retrospective cohort study to investigate the relationship between the first 6 months clinical monitoring status of antiretroviral treatment (ART) initiation and long-term treatment adherence rate and outcomes among people living with HIV (PLHIV). The result shows those completed four scheduled clinical visits in the first six months were at lower risk of mortality and loss to follow-up compared with otherwise during the study period. Factors associated with missed clinical visits included: acquiring HIV through unsafe blood donation or unsafe drug injection, being divorced, and concurrent drug injection without receiving methadone maintenance treatment. This study concluded that enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.
SH16237Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive
Many HIV-positive temporary residents living in Australia do not have access to subsidised antiretroviral treatment (ART). In this mathematical modelling study, we showed expanding access to subsidised ART to all HIV-positive temporary residents will substantially reduce HIV transmission to their sexual partners at little additional cost. Providing subsidised ART to people with HIV in Australia will remove inequities in the provision of HIV-related treatment and care and help Australia achieve its National HIV Strategy targets.
SH17042A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India
This multi-method study examined perceived health concerns for sexual minority females in Mumbai, India using an online survey and photo-elicitation interviews. Sexual minority females face obstacles in health care, mostly related to acceptability and quality of care and preventative screenings were low. Participants in photo-elicitation interviews described bodyweight issues and caretaking of family members in relation to physical health. Substance use functioned as both a protective and a risk factor for their health.
SH17036Retaining HIV-positive patients in HIV care: a personalised approach for those at risk of loss to follow-up at an inner city sexual health service
In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.
Relatively little is known about private sex workers (PSW) sexual health needs and engagement with services. We surveyed female, male and transgender PSW who advertise online and found that while all had attended a service for sexual health screening, there were issues with disclosure of sex work and the comprehensiveness of services offered. Services need to address all the sexual health care needs of private sex workers.
SH17089Stigma associated with sexually transmissible infection testing in an online testing environment: examining the perspectives of youth in Vancouver, Canada
Despite the increasing availability of online sexually transmissible infection (STI) testing, little is known about how stigma associated with STI testing may be experienced by youth in online settings. Youth were asked about their perceptions of stigma associated with STI testing in an online testing environment in Vancouver, BC, Canada. Online STI testing could ameliorate the experiences of participants regarding the stigma associated with STI testing; however, internalised feelings of shame and stigma around testing for STI may continue to persist.
SH17075Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China
This qualitative study identified factors influencing PrEP uptake among 32 self-identified MSM from a PrEP intervention study. Low perception of HIV risk, mistrust of PrEP program, concerns of side effects, lack of main sexual partner’s support, difficulties in adherence, and the inconvenient schedules in securing the medicine were the main reasons for not wanting to use or quitting PrEP. Perceived high HIV risk, beliefs in PrEP efficacy, and worries of transmitting HIV to families were the major motives for PrEP uptake.
SH17070Syndromic management of sexually transmissible infections in resource-poor settings: a systematic review with meta-analysis of the abnormal vaginal discharge flowchart for Neisseria gonorrhoea and Chlamydia trachomatis
SH16134Developing the evidence base for gender- and age-relevant school sex education: questionnaire findings from an adolescent sample using an augmented theory of planned behaviour
School sex education supports the development of positive adolescent sexual health, but it can be difficult to accommodate gender and age needs in group settings. To understand these needs better, a theory based survey (extended Theory of Planned Behaviour) was administered to 1378 12-16 year olds, focused on adolescents’ intentions to use condoms, the pill and emergency contraception. Results showed different influences on intentions towards each form of contraception, higher motivation in girls, and that year 10 is a crucial stage for intention formation. This study suggests there is clear scope to support adolescent sexual health and wellbeing by modifying school sex education accordingly
Cardiovascular disease has a higher incidence in patients with HIV infection. Our study sought to determine whether national guidelines were being met to address this issue. We found that while some targets were being met, current screening and management for this patient group falls short of guidelines.
SH17045Physician testing for HIV in patients treated with tenofovir disoproxil fumarate and lamivudine monotherapy for hepatitis B virus
Previously we found that local patients were often not tested for HIV prior to commencing nucleoside/nucleotide reverse transcription inhibitor (NRTI) therapy for hepatitis B virus. We performed a national cross-sectional cohort study of physician practices via an online survey. A small majority (23/44; 52%) of participants reported always testing their hepatitis B virus patients for HIV prior to NRTI therapy, and 8/44 (18%) reported testing for HIV the majority of the time. Thirteen (30%) respondents reported testing only if risk factors were present. One physician reported a patient seroconverting to HIV while on TDF monotherapy.
SH16117UriSwab: an effective transport medium for nucleic acid detection of Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae
Mailing of self-collected specimens for detection of sexually transmitted infections (STIs) is being used increasingly in Australia. However, postal regulations in Australia do not allow liquids such as urine to be sent in the post. The suitability of UriSwab for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium by polymerase chain reaction, compared with neat urine and a flocked swab dipped in urine, as well as its performance at high and prolonged temperatures to mimic potential harsh transport conditions were evaluated.
SH16164Attitudes to sexual health in the United States: results from a national survey of youth aged 15–25 years
Data from a large panel survey show that American youths’ attitudes to sexual health fit well with global sexual health definitions. Survey respondents believed dimensions of sexual health such as emotional fulfilment, pleasure, and mutual benefits in relationships were important components of overall sexual health. Increasing belief in the importance of sexual health was associated with sexual activity and also condom use and health care use.
SH16207Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001–2013: a population-based cohort study
This large data-linkage study of Western Australian women found significant increases in both chlamydia and gonorrhoea testing using nucleic acid amplification tests between 2001 and 2013. During this same period, chlamydia positivity remained highest in young Aboriginal women, at around 15%, with little change observed between overtime and despite increases in positivity in young non-Aboriginal women. Further gonorrhoea positivity was at least 10 times greater in young Aboriginal women than their non-Aboriginal counterparts. More effective prevention strategies and continued surveillance of chlamydia and gonorrhoea testing, positivity by age and risk groups are needed to address these disparities.
SH16190Analysis of transmitted HIV drug resistance from 2005 to 2015 in Victoria, Australia: a comparison of the old and the new
This study outlines HIV-1 transmitted drug resistance to HIV-1 protease, reverse transcriptase and integrase inhibitors in Melbourne, Victoria from 2005 to 2015. During this time, there was a statistically significant decline in the prevalence of mutations at codons M41, K103 and T215 in the reverse transcriptase gene, but none for the protease. The presence of integrase inhibitor resistance mutations was assessed from 2010 to 2015 and found to be negligible.
SH17068Rates of advertised condomless sex in the online profiles of private sex workers: a cross-sectional study
This study assessed the rate of condomless sex advertised in the online profiles of private sex workers in Sydney. None advertised condomless anal or vaginal sex and 50% advertised condomless oral sex. Age less than 25 years was associated with advertised condomless oral sex.
SH16198How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men
Regular sexual partnerships among gay and bisexual men who practice condomless anal intercourse have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships (i.e. ‘fuckbuddies’) are common among gay men, but have largely been ignored in research and HIV prevention. Condomless sex is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Partnerships where one or both partners’ serostatus is unknown present the greatest transmission risk, especially those of a primarily sexual nature.
SH17004Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey
This study of a population sample of women and men in Australia aged 18–50 years revealed that experience of abortion is common: one in six women and one in 10 men reported experiencing or being a partner in an abortion. Women who were socially disadvantaged, reported not being comfortable negotiating contraceptive use, and men who lived in a metropolitan area were more likely to report having experienced, or being a partner in, an abortion. Reporting past experiences of sexual coercion increased the likelihood of reporting abortion among both women and men.
SH16235Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service
This research analysed 2438 responses from men using an online dating site on contraceptive, knowledge attitudes and beliefs. We found high contraceptive use, especially vasectomy, and a desire to be part of the decision making, especially in long term relationships. However there was low awareness of some of the more effective methods and misperceptions about method safety, especially the emergency contraceptive pill.
SH17016Effect of attitudes towards patients on sexual history taking: a survey of Iranian–American physicians in California, USA
This is the first descriptive cross-sectional survey of Iranian–American physicians, a subpopulation of physicians, as providers of sexual health care practicing in California, USA (n = 354). The experience of dual process of cultural influences (i.e. both home and the main stream cultures) are important factors affecting these physicians’ involvement in sexual history taking. This is a significant neglected area in sexual health care which highlights the need to have a greater understanding of influential factors regarding physicians who share similar conservative cultural backgrounds. These findings support the need for development of new strategies that reflect on physicians’ attitude as providers of sexual health care.
SH16146Testing for chlamydial infection: are we meeting clinical guidelines? Evidence from a state-level laboratory data linkage analysis for 15- to 29-year-olds
This data linkage study of all chlamydia tests conducted in 15-29 year olds at a state population level over a 2-year period, enables population rates of testing and test positivity to be reported. Results are compared to clinical guidelines and to the estimated testing levels required to reduce chlamydia prevalence. Chlamydia testing rates are lower than recommended levels in both males and females. This study provides a robust methodology that can meet the requirements of the Australian National Sexually Transmissible Infections Strategy by monitoring testing coverage and providing evidence to evaluate prevention and control programs.
SH16240Prospective cohort study of childhood behaviour problems and adolescent sexual risk-taking: gender matters
Externalising (delinquent, aggressive) and internalising (anxious/depressed, withdrawn) behaviour problems are common in childhood. In a population-based birth cohort (the Western Australian Pregnancy Cohort (Raine) study), this study sought to determine relationships, by gender, between childhood behaviour problems and adolescent risky sexual behaviours and substance use. Externalising behaviour problems from as early as 5 years old in boys and 8 years old in girls predict a range of risky sexual behaviours in adolescence.
SH17073Sexual risk behaviours associated with unlicensed driving among young adults in Miami’s electronic dance music nightclub scene
This study examined sexual and other risk behaviours among young adults in Miami, Florida, comparing unlicensed driving (UD) offenders and non-UD offenders. Compared with others, UD offenders were more likely to report additional sexual risk behaviours. Results suggest that locating sexual risk reduction interventions inside of the justice system would benefit UD offenders.
SH16179Pregnant young women’s attitudes about microbicides: the anticipated influence of the grandmother and father of the baby on microbicide use
Pregnant young women’s attitudes about their grandmother and father-of-the-baby’s role in decision-making and involvement in microbicide use were assessed. Greater grandmother involvement in microbicide use was significantly associated with being younger, having no reproductive tract infection or contraceptive-ring-use history. Greater father involvement in use was associated with being in a relationship with him. Strategies for engaging grandmothers and fathers in microbicide use should be developed.
These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.
Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry
Diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium; an observational study of testing patterns, prevalence, and co-infection rates in northern New Zealand.
Intensive sex partying with GHB: Factors associated with using GHB for chemsex among Australian gay and bisexual men – Results from the Flux Study
Age differences in attitudes toward safer sex practices in heterosexual men using an Australian internet dating service
Beyond prevalence and risk: A qualitative study exploring pathways in and out of chemsex engagement amongst gay men living in London
“Sexual Content in Video games: an analysis of the Entertainment Software Rating Board classification from 1994-2013”
Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians
Comparisons of Vaginal Flora Patterns among Sexual Behavior Groups of Women – Implications for the Pathogenesis of Bacterial Vaginosis
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