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 15 Number 1 2018

Syndromic management of sexually transmissible infections is commonly used in resource-poor settings for the management of common STIs; abnormal vaginal discharge (AVD) flowcharts are used to identify and treat cervical infection including Neisseria gonorrhoea and Chlamydia trachomatis. A systematic review and meta-analysis was undertaken to measure the diagnostic test performance of AVD flowcharts, including both World Health Organization (WHO)- and locally-adapted AVD flowcharts.

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
pp. 13-19

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.

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.

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
pp. 29-38

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.

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.

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.

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

Elizabeth Peach, Shelley Cogger, Kat Byron, Penny Francis, Daniel O'Keefe, Peter Higgs, Mark Stoove, Kasey Elmore, Paul Dietze and Margaret Hellard
pp. 54-60

Following a HIV outbreak among Aboriginal people in a culturally diverse inner-city suburb of Melbourne, a blood-borne virus (BBV) screening program was conducted to inform public health interventions to prevent transmission and facilitate timely diagnosis and linkage to care.

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
pp. 61-67

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.

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
pp. 68-75

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.

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

Georgia Freeman, Lucy Watchirs Smith, Anna McNulty and Basil Donovan
pp. 76-78

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.

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.

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
pp. 83-85

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.

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
pp. 86-88

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.

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.

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.

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

C. Thng, E. Blackledge, R. McIver, L. Watchirs Smith and A. McNulty
pp. 93-95

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.

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 Infections in Gay Men Action Group (STIGMA)
pp. 96-98

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.

Online Early

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

Published online 21 March 2018

SH17158Anova Health Institute's harm reduction initiatives for people who use drugs

Johannes M. Hugo, Kevin B. Rebe, Evan Tsouroulis, Anthony Manion, Glenn de Swart, Helen Struthers and James A. McIntyre

Chemsex, the use of recreational drugs in the context of sex, is a potentially harmful behaviour that is of increasing concern among men who have sex with men. We describe two harm reduction programs aimed at mitigating these harms and discuss innovations and challenges that arose. Harm reduction programs are an effective response to the phenomenon of Chemsex.

Existing health and drug programming exists within blinkered silos, inappropriate for delivering multifaceted interventions which chemsex urgently needs. This narrative review aims to draw international health and drug policies into existing chemsex dialogue,and encourage health programming to widen its focus. It calls upon countries to honour their international commitments to health and vulnerable populations; advocates for data disaggregation; and endorses recent progressive changes within international drug policies.

Published online 16 March 2018

SH17148Re-Wired: treatment and peer support for men who have sex with men who use methamphetamine

Kent Burgess, Garth Parkhill, Jeremy Wiggins, Simon Ruth and Mark Stoovè

Methamphatime use amongst gay men and other men who have sex with men can be associated with significant harms, including increased risk of HIV and STI transmission. This paper outlines an innovative treatment and peer support program having success in reducing drug use and improving wellbeing, for men in this vulnerable population who use methamphetamine. This program has potential to be expanded into other similar settings.

Published online 16 March 2018

SH17163A ‘scoping review' of qualitative literature about engagement with HIV care in Indonesia

Elan Lazuardi, Stephen Bell and Christy E. Newman

There is a common misconception that qualitative research generates less trustworthy evidence for guiding the design and implementation of national HIV programs. A scoping review - conducted to undertake a comprehensive review of published qualitative evidence about engagement with HIV care in Indonesia - highlighted a range of factors influencing both successful engagement with HIV care and the broader HIV response in Indonesia. Future qualitative research which describes the experiences of clients and the role of clinics and providers in delivering care will give an important contribution in enhancing the understanding of engagement with HIV care in the Indonesian context.

Published online 16 March 2018

SH17134Links SU-Sex: development of a screening tool for health-risk sexual behaviours related to substance use among men who have sex with men

Mathieu Goyette, Jorge Flores-Aranda, Karine Bertrand, Frédérick Pronovost, Valérie Aubut, Roberto Ortiz and Marianne Saint-Jacques

ChemSex is a public health issue that is forcing stakeholders to improve care by addressing both sexual health and addiction in the gay, bisexual and trans men community. This article describes the development and foreseen use of the Links-SU Sex, a screening tool designed to assess sexual behaviours related to substance use among this population. The Link-SU Sex represents a crucial step in identifying at risk populations and in supporting clinical decision-making.

Published online 16 March 2018

SH17151Sex, drugs and social connectedness: wellbeing among HIV-positive gay and bisexual men who use party-and-play drugs

Jennifer Power, Gosia Miko?ajczak, Adam Bourne, Graham Brown, William Leonard, Anthony Lyons, Gary W. Dowsett and Jayne Lucke

This study considers whether use of ‘party drugs’, such as crystal methamphetamine, in a social or sex-based setting facilitates a sense of social connectedness for some men. A survey of Australian gay and bisexual men (GBM) living with HIV found that those who used party-and-play drugs reported greater connection with some social networks, which was associated with resilience and less concern about HIV-related stigma. While party drug use poses risks health risks, the social contexts in which these drugs by GBM) may provide wellbeing benefits linked to social connectedness.

Published online 06 March 2018

SH17064Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry

Ian Down, Garrett Prestage, Graham Brown, Jeanne Ellard, Rebecca Guy, Margaret Hellard, David Wilson, John de Wit, Mark Stoové and Martin Holt

Studies of recent seroconverters provide key insights for HIV-prevention. We sought to identify how representative of all recently diagnosed gay and bisexual men in Australia were those included in three study samples. Although undiagnosed men were somewhat younger, the study samples were broadly similar to all gay and bisexual men recently diagnosed with HIV, suggesting that these research approaches were reasonably effective."

Published online 06 March 2018

SH17097Leveraging a relationship-based sexual health framework for sexual risk prevention in adolescent men in the United States

Devon J. Hensel, Casey L. Bales, Julia F. Taylor and J. Dennis Fortenberry

Relationships are an important venue for sexual risk prevention. The current study links a collection of positive sexual attributes in relationships, such as communication and sexual satisfaction, to lower sexual risk behaviours, such as condom use and intimate partner violence, in adolescent men. These findings suggest that helping young men build positive relationships may also help them avoid sexual risk.

Published online 15 February 2018

SH16218Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Erik D. Storholm, Brett A. Ewing, Stephanie Brooks Holliday, Bradley D. Stein, Lisa S. Meredith, William G. Shadel and Elizabeth J. D'Amico

There is currently little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents. This study aimed to assess the association between use of marijuana, alcohol, and sexual risk behaviour among adolescents and found that combined alcohol and marijuana use or alcohol use alone was associated with greater sexual risk behaviour. Providers should screen and educate adolescents about these risks.

Published online 15 February 2018

SH17137HIV susceptibility among clients of female sex workers in Indonesia: a qualitative inquiry

Lillian Mwanri, Nelsensius Klau Fauk, Christina Yeni Kustanti, Atik Ambarwati and Maria Silvia Merry

The Clients of female sex workers (FSWs) in Belu and Malaka districts of Indonesia are a group at higher risk for HIV transmission due to their frequent engagement in sex with multiple female sex workers (FSWs). This study aimed to identify risk factors for acquiring HIV infections among them and found several behavioural and socioeconomic factors that increased their susceptibility to these infections.  These findings provide information about HIV susceptibility factors among FSWs’ clients, which can be used to develop programs and policies to help the study participants.

This case discusses a gay male participating in sexualised drug use. It raises several important issues which may not have been disclosed if the patient was not specifically asked about drug use during or before sex. It strengthens the case for routine screening for sexualised drug use in men who have sex with men so that better informed and higher quality health care can be provided.

Published online 06 February 2018

SH17139Towards a continuum of care concerning chemsex issues

Ingrid Bakker and Leon Knoops

In response to the apparent rise in chemsex in the Netherlands, Mainline foundation has been offering harm-reduction intervention for MSM and promoting the development of a continuum of care by building networks, training professionals and investing in advocacy. This case study describes the various interventions of Mainline foundation, that make up their continuum of care approach concerning chemsex issues.

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

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 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.

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