Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Sexual Health

Sexual Health

Sexual Health publishes contributions on sexual health from the widest perspectives including HIV/AIDS, STIs, issues of sexuality, and reproductive health. Read more about the journalMore

Editors: Christopher Fairley and Roy Chan

Current Issue

Sexual Health

Volume 14 Number 6 2017

SH17013Estimating the burden of genital warts in Taiwan

Tsen-Fang Tsai, Smita Kothari-Talwar, Karen Yee, Amit Kulkarni, Nuria Lara, Montserrat Roset, Anna R. Giuliano and Suzanne M. Garland
pp. 485-491

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.

SH16240Prospective cohort study of childhood behaviour problems and adolescent sexual risk-taking: gender matters

S. Rachel Skinner, Jennifer Marino, Susan L. Rosenthal, Jeffrey Cannon, Dorota A. Doherty and Martha Hickey
pp. 492-501

Externalising (delinquent, aggressive) and internalising (anxious/depressed, withdrawn) behaviour problems are common in childhood.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.

SH16117UriSwab: an effective transport medium for nucleic acid detection of Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae

Anna-Maria G. Costa, Suzanne M. Garland, Rebecca Guy, Handan Wand and Sepehr N. Tabrizi
pp. 502-506

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.

SH16146Testing for chlamydial infection: are we meeting clinical guidelines? Evidence from a state-level laboratory data linkage analysis for 15- to 29-year-olds

Nicola Stephens, David Coleman, Kelly Shaw, Maree O' Sullivan, Alistair McGregor, Louise Cooley, Hassan Vally and Alison Venn
pp. 507-513

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.

SH17016Effect of attitudes towards patients on sexual history taking: a survey of Iranian–American physicians in California, USA

Mitra Rashidian, Victor Minichiello, Synnove F. Knutsen and Mark Ghamsary
pp. 514-522

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.

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.

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.

SH16164Attitudes to sexual health in the United States: results from a national survey of youth aged 15–25 years

Matthew Hogben, Christopher Harper, Melissa A. Habel, Kathryn Brookmeyer and Allison Friedman
pp. 540-547

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.

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

SH16190Analysis of transmitted HIV drug resistance from 2005 to 2015 in Victoria, Australia: a comparison of the old and the new

Jodie D'Costa, Megan Gooey, Nicole Richards, Rizmina Sameer, Elaine Lee and Doris Chibo
pp. 558-565

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.

SH17004Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey

Heather Rowe, Sara Holton, Maggie Kirkman, Christine Bayly, Lynne Jordan, Kathleen McNamee, John McBain, Vikki Sinnott and Jane Fisher
pp. 566-573

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.

SH16207Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001–2013: a population-based cohort study

Joanne Reekie, Basil Donovan, Rebecca Guy, Jane S. Hocking, John M. Kaldor, Donna B. Mak, Sallie Pearson, David Preen, Handan Wand, James Ward, Bette Liu and on behalf of the Chlamydia and Reproductive Health Outcome Investigators
pp. 574-580

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.

SH16179Pregnant young women’s attitudes about microbicides: the anticipated influence of the grandmother and father of the baby on microbicide use

Jenny K. R. Francis, Lauren Dapena Fraiz, Marina Catallozzi, Ariel M. deRoche, Christine Mauro and Susan L. Rosenthal
pp. 581-583

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.

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.

Online Early

The peer-reviewed and edited version of record published online before inclusion in an issue

Published online 23 January 2018

SH17118The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru

Lao-Tzu Allan-Blitz, Kelika A. Konda, Silver K. Vargas, Xiaoyan Wang, Eddy R. Segura, Boris M. Fazio, Gino M. Calvo, Carlos F. Caceres and Jeffrey D. Klausner

The incidence of syphilis has been on the rise since the early 2000s. We aimed to identify factors which might predict future syphilis among high-risk populations and developed an online risk calculator for future infection. The ability to predict future syphilis may inform screening recommendations and other prevention strategies.

This case review examines some of the steps that have helped formulate a policy response to chemsex in England. It highlights that although the evidence on chemsex and related harms for users is growing, there are still opportunities to improve drug treatment and other support for those negatively impacted by chemsex. It contributes to the literature on developing effective responses to problematic chemsex.

Published online 11 January 2018

SH17017Sexual content in video games: an analysis of the Entertainment Software Rating Board classification from 1994 to 2013

Dèsirée Vidaña-Pérez, Ariela Braverman-Bronstein, Ana Basto-Abreu, Inti Barrientos-Gutierrez, Rainer Hilscher and Tonatiuh Barrientos-Gutierrez

Video games are a source of exposure to sexual content for children and adolescents. We aimed to analyse the trends of sexual content in video games from 1994 to 2013. Our results suggest that sexual content in video games has increased for ratings ‘Teen’ and ‘Mature’. Top selling video games had more sexual content compared to non-top selling games.

Published online 11 January 2018

SH17166Chemsex as edgework: towards a sociological understanding

Ford Hickson

Combining sex and drugs shares many features with other voluntary high risk activities that involve specialist skills and intense sensations. This paper suggests some chemsex is a type of ‘edgework’, an exploration of personal limits when living under conditions of alienation. The consumptive nature of chemsex locates it as a quintessential activity in a sex and drugs ‘shopping culture’.

Published online 22 December 2017

SH17146Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men – results from the Flux Study

Mohamed A. Hammoud, Adam Bourne, Lisa Maher, Fengyi Jin, Bridget Haire, Toby Lea, Louisa Degenhardt, Jeffrey Grierson and Garrett Prestage

Gamma-hydroxybutyrate among gay and bisexual men has increased in recent years, and is accompanied by growing concerns about overdose and HIV risk behaviour. We examined factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use. Use of gamma-hydroxybutyrate to enhance sexual experiences often occurred in the context of sexual risk behaviour and frequent use was associated with overdose.

Published online 22 December 2017

SH17122Gay men's chemsex survival stories

Vivienne Smith and Fiona Tasker

This study considered factors affecting chemsex (the combined use of drugs and sexual experiences) engagement and remission by gay men. Participants’ identified multiple incidents and feelings as contributing to chemsex engagement, and engagement was connected with participants’ gay identity development. Chemsex journeys were perceived to spiral from exciting and exploratory into high-risk activity, but the association of chemsex with a gay identity gain explained participants’ ambivalence to remaining chemsex free.

We studied community prevalence and testing patterns for sexually transmitted infections in northern New Zealand. After Chlamydia trachomatis, Mycoplasma genitalium was the most common infection detected, though it is not routinely sought. There was a mismatch between testing rates and prevalence of infection in high risk patient groups. We conclude that testing strategies should be altered to better reflect need.

Published online 21 December 2017

SH17074Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service

Yan Cheng, Kevin McGeechan, Deborah Bateson, Todd Ritter, Edith Weisberg and Mary Stewart

STIs are increasing in older people globally. This cross-sectional study investigated STI knowledge, safe sex attitudes and behaviours of heterosexual men using an internet dating service. Results suggested that older men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Published online 07 December 2017

SH17087Comparisons of vaginal flora patterns among sexual behaviour groups of women: implications for the pathogenesis of bacterial vaginosis

Kristin M. Olson, Louis J. Boohaker, Jane R. Schwebke, Stella Aslibekyan and Christina A. Muzny

Among African-American women aged 19–45 years presenting to an STD clinic, women who have sex with women (WSW) and women who have sex with women and men (WSWM) were significantly more likely to have a diagnosis of BV based on Nugent score than women who have sex with men (WSM). Among women with a diagnosis of BV by Nugent score, there was no significant difference in the proportion of women with low-positive and high-positive Nugent scores by sexual behaviour group (WSW, WSWM, WSM). Women who reported participating in receptive vaginal sex within 30 days preceding study enrolment were significantly more likely to have BV.

Published online 07 December 2017

SH17111Concordance between monetary and sexual delay discounting in men who have sex with men

Jeb Jones, Jodie L. Guest, Patrick S. Sullivan, Michael R. Kramer, Samuel M. Jenness and Jessica M. Sales

Delay discounting is a measure of impulsivity, often measured in the context of financial choices, that is associated with multiple health outcomes and might be associated with sexual risk-taking. The current study assessed the concordance between monetary and sexual discount rates. No association was observed between monetary and sexual discount rates suggesting that these are distinct processes.

Published online 14 November 2017

SH17039Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians

Handan Wand, Joanne Bryant, Heather Worth, Marian Pitts, John M. Kaldor, Dea Delaney-Thiele and James Ward

Early age at sexual debut is known to be associated with high-risk sexual behaviours and school dropouts. The present study raised issues regarding the adverse effects of early age at sexual debut on low level of education as well as illicit drug use among young Indigenous men and women in Australia who are disproportionally affected by sexually transmitted infections. Our findings highlight the need for effective school and/or community-based sex education programs.

Published online 20 October 2017

SH17083Sexual health and students: the pathways travelled by those with sexual health concerns

Georgia Freeman, Lucy Watchirs Smith, Anna McNulty and Basil Donovan

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.

Published online 12 October 2017

SH17108Sexual (dys)functioning is related to drive for thinness, not drive for muscularity

Anandi Alperin and Fiona K. Barlow

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.

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.

Published online 20 September 2017

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

David J. Templeton, Phillipe C. G. Adam, Rajesh Varma, Phillip Read, Chistopher Bourne, Shih-Chi Kao and on behalf of the Sexually Transmissible

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.

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.

Published online 06 September 2017

SH16237Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive

Richard T. Gray, Jo Watson, Aaron J. Cogle, Don E. Smith, Jennifer F. Hoy, Lisa A. Bastian, Robert Finlayson, Fraser M. Drummond, Bill Whittaker, Matthew G. Law and Kathy Petoumenos

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.

Published online 01 September 2017

SH17042A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India

Jessamyn Bowling, Brian Dodge, Swagata Banik, Elizabeth Bartelt, Shruta Rawat, Lucia Guerra-Reyes, Devon Hensel, Debby Herbenick and Vivek Anand

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.

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.

Published online 01 September 2017

SH16243Private sex workers’ engagement with sexual health services: an online survey

C. Thng, E. Blackledge, R. McIver, L. Watchirs Smith and A. McNulty

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.

Published online 01 September 2017

SH17089Stigma associated with sexually transmissible infection testing in an online testing environment: examining the perspectives of youth in Vancouver, Canada

Mohammad Karamouzian, Rod Knight, Wendy M. Davis, Mark Gilbert and Jean Shoveller

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.

Published online 01 September 2017

SH17075Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China

Chunxing Liu, Yingying Ding, Zhen Ning, Meiyang Gao, Xing Liu, Frank Y. Wong and Na He

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.

Published online 20 July 2017

SH17035Patients with HIV and coronary disease: are we meeting national guidelines?

Sam Emmanuel, James Nadel, Damien Fagan, Sirinya Teeraananchai, Matthew Law and Cameron J. Holloway

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.

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.

Published online 23 June 2017

SH17068Rates of advertised condomless sex in the online profiles of private sex workers: a cross-sectional study

Edjoni Blackledge, Caroline Thng, Ruthy McIver and Anna McNulty

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.

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