Health Sciences

Research Program

Australian Research Centre in Sex, Health and Society

Gay and Lesbian Health Victoria - www.glhv.org.au

Gay and Lesbian Health Victoria is situated within ARCSHS and in 2003 was set up in consortium with Women’s Health Victoria and the Victorian AIDS Council funded by the Victorian Department of Human Services. In 2007, following the completion of the pilot
project, it had its fi rst year on recurrent funding. The role of the Unit is to ‘to enhance and promote the health and well being of GLBTI people in Victoria’ by:
• establishing and implementing best practice standards of care
• training health care providers and health organisations about GLBTI health needs and appropriate service delivery
• developing health resources for GLBTI communities, in conjunction with mainstream services
• establishing a research and information clearinghouse as a resource for health care providers, researchers and individuals to use in researching their own health issues.
• providing advice to Government on the planning and development of future GLBTI programs.

Community Liaison and Education Unit

The Community Liaison and Education Unit (CLEU) is central to the work of the Centre. The Unit’s aims are to:
• build links between research and practice to ensure that research informs, and is informed by, policy and practice;
• develop and maintain research relationships with organisations and individuals.
• disseminate research outcomes in ways that are accessible and comprehensible to the community.
• promote the work of the Centre in the community.

Sex and Sexuality Program

Australian Longitudinal Study of Health and Relationships

Anthony Smith, Marian Pitts, Julia Shelley, Juliet Richters (University of New South Wales), Jason Ferris.
This NHMRC funded project was established in 2003. Its objective is to document the natural history of sexual and reproductive health in the Australian population. Evidence provided from this study will allow for more effective sexual health interventions and will enable us to understand the links between ‘risk events’ and health outcomes. In particular, it will answer the following questions:
• What is the relationship between the age of sexual debut, patterns of sexual activity, and subsequent sexual functioning and reproductive health including diagnosis with sexually transmissible infections?
• What are the sociodemographic, sexual and reproductive predictors of contraceptive choice
and change?
• What is the nature and magnitude of the relationship between experiencing sexual
forcing and subsequent sexual functioning and reproductive health?
• What are the sociodemographic, sexual and reproductive predictors of tubal ligation,
vasectomy and hysterectomy?
• What is the impact of tubal ligation, vasectomy and hysterectomy on subsequent sexual
functioning?
• What are the sociodemographic, sexual and reproductive predictors of pregnancy and
pregnancy outcomes, particularly abortion and miscarriage?
• What are the impacts of spontaneous and induced pregnancy losses on subsequent sexual
functioning and reproductive outcomes including contraceptive choice?
• What is the temporal sequencing of depression, anxiety and sexual functioning?
• What is the relationship between sexual functioning, reproductive health and satisfaction
with the physical and emotional aspects of people’s intimate relationships and subsequent
relationship breakdown?
• What is the impact of divorce or other relationship breakdown on subsequent sexual functioning and reproductive health?

In 2005 the first wave of data was collected. A random sample of 8656 Australian men and women, aged between 16 and 64, were interviewed by telephone. At the completion of the fi rst wave of data collection over 95% of those interviewed indicated they could be contacted for future waves. At the end of 2007 the third wave of data collection was completed
with almost 5600 men and women continuing to be interviewed. In 2007 a second NHMRC grant
million was obtained to extend data collection for an additional two years. It is foreseen that the results of this ground-breaking study will not only provide the foundations for future research but be used to inform government policies, health professionals, and the Australian public as a whole.

Pivotal, peripheral or positional: understanding SOPVs for intervention

Jeffrey Grierson, Anthony Smith, Henry Von Doussa

This project utilises multiple methods to critically summarise the current state of knowledge on sex on premises venues (SOPVs). It provides an in-depth characterisation of the patrons of SOPVs from the perspectives of the SOPV industry, the time-space dynamics of venues, the patrons of SOPVs, and the communities from which SOPV patrons are drawn. It models patron flow between and within venues and the impact interventions relating to SOPVs for
specific populations. The project consisted of four elements: key informant interviews; space-time sampling; patron interviews; and a community survey. In the patron interview element, 219 respondents completed interviews by telephone within 48 hours of their SOPV visit. Interviews detailed the precise pattern of visits to SOPVs using time sequences that plotted their trajectory through the venue. Each sexual episode within the venue was further detailed in terms of partner characteristics, sexual practices and sequencing. The community survey element achieved a sample of 287 men. Participants completed a brief questionnaire about types of sexual partnerships, degree of concurrency or seriality, health monitoring and testing behaviours, perceptions of SOPVs and their clients including characterisation of venues as being used by specifi c sub categories of gay men (HIV negative, older, bisexual etc), sources of HIV/STI information, and recreational drug use.

Seroconversion

Sean Slavin, Garrett Prestage, Fengyi Jin (National Centre in HIV Epidemiology and
Clinical Research, University of NSW)

The upcoming Seroconversion study will investigate risk factors for HIV seroconversion among MSM in Victoria and NSW. This project follows a similar study of recent HIV seroconverters in 2003 to 2006 that recruited about 150 participants from twelve clinical practices in Sydney and Melbourne. A Queensland arm of the study commenced in 2006. In this project interviews about behavioural risk factors associated with acquisition of HIV were conducted with
homosexual men who had recently seroconverted. Interviews were conducted at the medical practice where the participant was diagnosed with HIV and included a nurse administered section and a selfcompleted section. The study provided critical information to community organisations and other agencies seeking to respond to developments in HIV
transmission. For this latest phase we propose to recruit individuals who have participated in or used VAC/GMHC and PLWHA (Victoria) programs that service men who have seroconverted during late 2006 and 2007. The new data collection method will facilitate the recruitment of a number of participants over a relatively short period. This will provide continuity of data in anticipation of future reactivation of the study using the original research mechanism. The sample provided in this interim phase will not be identical to that which has been previously obtained, but will bebroadly comparable. Recruitment through already collaborating medical practices will continue, where feasible. The revised questionnaire will be internetbased and self-complete, with the content revised to address some issues raised in the earlier version of
the study. The reinstatement of interviews with recent seroconverters is seen as important as those individuals can potentially provide key information about risk factors. The contexts in which sexual behaviours known to lead to HIV infection are most likely to occur will continue to change over time as the epidemic evolves and as the community itself changes.

Risk, motivations and HIV among high risk gay men (Risky Pleasures Study: High risk men who have sex with men and understandings of risk)

Garrett Prestage, Michael Hurley, Marian Pitts.

This study aims to measure current attitudes toward HIV and other STIs, and beliefs about relative risk among MSM known to be at highest risk for transmission of these infections, including both HIV-negative and HIV-positive men as well as recent seroconverters, and a sub-sample of male-to-male sex workers. The project will explore in detail these beliefs about relative risk, both in terms of their understandings of the relative risk of transmission and the relative priority this understanding of risk takes with respect to other aspects of their lives such as sexual needs, the desire for intimacy and connectedness, a sense of adventure, personal relationships and broader issues of health and well-being.

The project aims to recruit at least five hundred Victorian men and an equivalent number in NSW, as well as about 200 Queensland men, into the survey, which will use a self-administered questionnaire. In addition about fifty depth interviews with gay men who are at high risk of HIV infection or transmission will be conducted. The qualitative and quantitative arms of the study will include both HIV-positive and HIV-negative men. Participants will be recruited using a variety of methods, both online and through community organisations, social groups and venues. Recruitment will be focused on, but not restricted to, men at highest risk of HIV transmission. There will be some targeted recruitment of men engaged in maleto-male sex work and high risk behaviour, and men
who have recently seroconverted.

National Cohort Study

Garrett Prestage, Marian Pitts.

There is growing concern about rising HIV notifications, converging HIV epidemics and rapidly increasing STI rates among homosexually active men in Australia. State and national-level policy planners and community organisations need a sustained flow of high quality social, behavioural and epidemiological data to develop, implement and evaluate new prevention strategies and health education campaigns and to assess the impact of these on both individual and population-level behaviour change. At present there are no continuing detailed longitudinal questionnaire-based data specifically focusing on HIV and STI risk in homosexually active men available to any Australian policy planners.

The ultimate aim of the National Cohort Study is the development of an internet-based cohort and repeat cross-sectional research program to provide detailed longitudinal data in explaining recent, and ongoing, HIV trends. A crucial innovation in this project is that the data collected will have a national reach, providing comparable data across all jurisdictions to examine the health of gay and other homosexually active men.

Late 2007 saw preliminary investigatory work evaluating contemporary research in the area. Planned for 2008 is development of a full project proposal to secure funding to conduct preparatory logistic and methodological development work, and to determine the feasibility of establishing an internet based cohort and repeat cross-sectional research program in advance of a full-funding submission for either a state-based or national study platform.

The Chief Investigators on the project are John Imrie of the National Centre in HIV Social Research (NCHSR), Garrett Prestage of the National Centre in HIV Epidemiology and Clinical Research (NCHECR) and the Australian Research Centre in Sex, Health and Society (ARCSHS), and Marian Pitts of ARCSHS. The National Cohort Study is a collaborative project involving Australian research centres NCHSR, NCHECR, ARCSHS, Burnet Institute and the Western Australian Centre for Health Promotion Research (WACHPR); the national and state-level community organisations AFAO, NAPWA, ACON, VAC/GMHC; and the Victorian Department of Human Services who have provided funding support for preliminary work.

An investigation of group sex behaviour among gay men

Garrett Prestage

The aims of this project are to investigate the contexts of risks associated with, and motivations for group sex activities among homosexually active men. It will investigate the social, sexual and demographic aspects of group sex behaviour and its relationship to risk of HIV and other sexually transmissible infections among these men and the sexual networks in which they participate, to guide a better understanding of this behaviour, promote education initiatives, support and explore risk factors.

Participation is open to men who have had sex with three or more other men in the past twelve months. A self-administered questionnaire will be used to assess demographic characteristics, sexual preferences, behaviour and activities within the specific context of group sex. Questionnaires will be distributed among men who have engaged in group sex with other men at gay sex on premises venues and organized group sex activities, and via commercial internet sites used by men who have sex with men.

A small number of qualitative interviews will be conducted to explore in further detail some of the survey findings and to explore particular contextual and motivational reasons underlying the behaviour patterns identified through the survey. Interviews will be conducted with a small number of survey participants who consent to be so interviewed, and a few key informants such as the organisers of group sex activities. The responses to depth interviews will provide data which can be analysed to identify key patterns regarding beliefs and attitudes toward risk and will provide data which will lend itself to close discourse analysis.

Activating the Internet

Michael Hurley

This was an internet based project directed at gay and other men who have sex with men in the Hunter Valley. The project investigated the viability of a standalone website for simultaneously delivering health promotion and providing a base for social research. It was carried out in partnership with the Hunter Region Office of the AIDS Council of New South Wales and in collaboration with Hunter New England Population Health.

The project successfully reached the target population. It concluded that while interactivity in website navigation design can be seen as a necessary condition of gay and msm site use, it is not by itself sufficient to prompt widespread health information seeking. In the wider context of gay men using web sites for entertainment, engagement with health information appears to be as much serendipitous as purposeful. In the absence of ‘hot’ news, it is driven by individual motivation rather than being contingently produced by presence, opportunity, curiosity and possibility.

The completed project was conducted in conjunction with the AIDS Council of New South Wales (ACON), and was funded by NSW Health.

Men, Sexuality and Health: New Issues, New Directions

Gary Dowsett - Senior Victorian Health Promotion Foundation Research Fellowship,
2005-2010

This year saw the Fellowship’s research progressing well, with the completion of the ‘Men and Relationship Study’ (MARS), funded by a La Trobe University Faculty Research Grant awarded in 2006. The project’s Research Assistant was Andrew Lavin. Also, a critical analysis was completed of one year’s (2006) issues of Men’s Health magazine for presentation at the National Men’s Health Conference, Adelaide, in October 2007. Ben Ciantar was the Research Assistant on that project. A new project emerged from international news on the efficacy of male circumcision for HIV prevention. I attended two WHO/UNAIDS consultations in Durban, South Africa, and Montreux, Switzerland, and presented two seminars in South Africa and an invited paper at the 18th Congress of the World Association for Sexual Health in Sydney. With co-author, Murray Couch, Senior Research Fellow, a critique of the evidence on male circumcision and HIV prevention was published and received considerable international attention. Editorial work continued for four international and two Australian journals focusing on sexuality and health, and on the book series, ‘Sexuality, Culture and Health’, published by Routledge/Taylor and Francis, UK.

During 2007, the second paper from a collaborative project on gay men, the internet and bareback sex, and co-authored with colleagues at Columbia University, New York, was accepted for publication in Sexualities, while a third co-authored paper was submitted for review. Planning for a new project on men’s internet use in Australia is underway, with a new paper of the role of gay community and HIV prevention, co-authored with another colleague from Columbia University will be published in Culture, Sexuality and Health in
2008. Finally, a chapter on the qualitative research methodology and gay men’s health was published in a new compendium, The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations, from Kluwer Academic/Plenum, New York.

Something borrowed, something new: Addressing increased rates of HIV and STI transmission among gay men in Victoria

Marian Pitts, William Leonard;
Report author: William Leonard.

In June 2007 ARCSHS was commissioned by the Victorian Department of Human Services (DHS) to draft an action plan on behalf of the HIV Prevention Task Force, addressing increased rates of HIV and STI transmission among gay men in Victoria. The Taskforce was established to advise DHS and the Minister for Health on the most effective actions aimed at reducing HIV and STI transmission among gay men. The action plan draws on state, national and where appropriate international epidemiological and behavioural data to understand the multiple factors underpinning increased rates of HIV and STI transmission among gay men. The action plan uses this understanding to develop an integrated policy, program and service system response that relies on a renewed partnership between government, gay and lesbian community and professional organisations and the health and academic sectors. The plan argues, however, that in order to maximise the effectiveness of gay men’s HIV and STI prevention, prevention must be part of a broader gay men’s health promotion strategy which in turn must be tied to whole-of-government legislative and social reforms aimed at reducing homophobia and its effects.

The strategy was launched by the Honourable Daniel Andrews, Victorian Minister for Health, in March 2008.

This project was completed in early 2008. It was commissioned by the Rural and Regional Health and Aged Care Services Division of the Department of Human Services, Victoria.

Crystal clear: The social determinants of gay men’s use of crystal methamphetamine in Victoria

Report authors: William Leonard, Gary Dowsett, Sean Slavin, Anne Mitchell, Marian Pitts

The project offers a comparative analysis of epidemiological, behavioural and social research on crystal methamphetamine use among gay men living in Melbourne and gay men living in other urban centres in Australia, the US, and the UK. It includes a survey of local expert opinion regarding the scale and scope of problematic crystal methamphetamine use among gay men resident in Victoria. The project focuses on the harms associated with gay men’s use of the drug and in particular on research that indicates an association between crystal methamphetamine use and increased sexual risk-taking and rising rates of HIV and STIs. The project reviews current crystal methamphetamine treatment and prevention options for gay men and provides a framework for the development of a coordinated research, policy and program response that will reduce the harms to gay men associated with the use of crystal methamphetamine and other illicit drugs.

A written report, including recommendations, has been provided to the Victorian Department of Human Services (DHS). A separate monograph has been produced for national and international distribution to key stakeholders with an interest in gay men’s health promotion, sexual health and drug use.

The completed project was funded by the Communicable Diseases Branch of the Department Human Services, Victoria.

TranZnation: New Australian and New Zealand data on a little-researched population

Report authors: Murray Couch, Marian Pitts, Hunter Mulcare, Samantha Croy, Anne Mitchell and Sunil Patel.

This research has its beginnings in an act of transgender activism, arising as it did out of dissatisfaction with the capacity of the 2005 Private Lives research into gay, lesbian, bisexual, transgender and intersex people to capture the complexity of transgender lives. The feedback that transgender participants provided about the earlier research was used as the basis of a research project specifically tailored to the issues relevant to this group.

Studies investigating health and wellbeing of transgender people have typically been conducted in medical environments such as gender clinics and through sexual health centres. This study set out to recruit the broadest possible community sample by using a range of recruitment techniques and an online survey which was ultimately completed by 253 people from Australia and New Zealand.

Although the survey was oriented towards health issues, the major finding was the degree to which transgender people face a difficult – and sometimes dangerous – struggle to amend key documentation so they can be recognised in their preferred gender. This is because the bureaucratic requirements can force people towards expensive and sometimes unwanted surgery in order to be legally and socially accepted.

More than half the participants had tried to amend important public documentation to reflect their new gender identity. Their experience, even within the same organisations, was unpredictable, frustrating and relied almost entirely on their capacity to prove they had undergone the surgery for a ‘sex change’. As surgery is expensive and difficult to obtain, it was not an option for many.

At least a quarter of participants who had not undergone surgery tried to change documentation and were unsuccessful, despite the fact that they were living in the gender they wished to adopt. It was also found that a mismatch between gender presentation and identifying documents such as passports could expose transgender people to discrimination and danger, especially in airports where their identity was frequently questioned.

Other key findings of the survey were that twenty per cent of the participants in the study had been physically attacked – and ninety per cent had experienced discrimination and abuse on the basis of gender, leading to a likelihood of depression and ongoing fears for their safety.

Despite this, the majority of participants were happy with their lives and frequently reported on their circumstances with wry humour. Almost two thirds reported they felt mostly, or extremely happy. Finding a way to live safely and comfortably in their preferred gender, and gaining legal and social recognition for the change, for many brought great happiness. So did support from friends, family and work colleagues.

Tranznation: A report on the health and wellbeing of transgender people in Australia and New Zealand was launched in December by Dee McLachlan whose film, The Jammed, won the top ‘Inside Film’ award for 2007.

Living with HIV Program

The Australian Research Centre in Sex, Health and Society continues to have a core commitment to research addressing the lived experience of HIV positive people.

This program of social research specifically aims to analyse the experience of Australian PLWHA in relation to both their health and social environment and to broaden understandings of the issues affecting Australian PLWHA. Key projects in this research program are the HIV Futures Surveys and the HIV Futures Qualitative Studies. In addition, there is a range of research projects addressing specific issues at the levels of individual experience, social and collective experiences, organisational and structural issues and policy issues.

• Our strategy for social research with HIV positive populations rests on five key components:
• Partnerships at the local level: including academic, community, professional and clinical
• Involvement of PLWHA in research design, conduct and dissemination
• Skills development and sharing as key outcomes of the research process
• A reflexive and responsive research focus
• A collective and shared responsibility to enhance the well being of PLWHA.

Historically the bulk of the research in this program has been funded through the Commonwealth Department of Health and Ageing core research grant. In real terms this grant has diminished over the past seven years, while the requirements for the domains that the research arising from it must address have expanded considerably and now include the four national strategies. This has meant that our capacity to conduct research that directly addresses the lived experience of HIV has been significantly curtailed. Increasingly this means that such research must be funded through competitive mechanisms, necessitating long delays in research lead time and a less responsive and strategic program of research.

Nonetheless, we retain our commitment to this research focus through the submission of research grant applications in this area and advocating for the meaningful inclusion of issues relevant to PLWHA in other research conducted within the centre and by our colleagues in other institutions. We also remain committed to processes that ensure this research contributes to vigorous community debate around the issues that are of greatest importance to HIV positive people.

HIV Futures

Background: This national project is a self-complete cross-sectional survey of Australian people living with HIV/AIDS (PLWHA). The first HIV Futures survey was undertaken in 1997, with a sample size of 925, the second in 1999 with a sample of 924, the third in
2001 with a sample size of 894 and the fourth in 2003 with a sample of 1059. HIV Futures 5 yielded a sample of 970 respondents. The survey aims are: to establish and maintain baseline data on social, economic, cultural and clinically related aspects of the experience of living with HIV; and to examine changes in, and newly emerging aspects of, the experience of living with HIV. The HIV Futures Survey collects information which is used in the development and provision of education and support services for PLWHA. This survey has provided valuable insights into the place of the new therapies in the lives of PLWHA and the social and personal impact of HIV on the lives of PLWHA. This study has added significantly to the discourse on living with HIV both nationally and internationally at both academic and community levels.

HIV Futures New Zealand 2

The HIV Futures New Zealand Survey 2 is a national survey of People Living with HIV/AIDS (PLWHA) in New Zealand. It is a replication of a similar study carried out by the same researchers in New Zealand in 2001. The survey aims are: to establish and maintain baseline data on social, economic, cultural and clinically related aspects of the experience of living with HIV; and to examine changes in, and newly emerging aspects of, the experience of living with HIV. The survey contains questions on demographics, health, treatments, community and services, sex and relationships, recreational drug use, accommodation and finances. The first HIV Futures New Zealand survey was undertaken in 2001 achieving a sample that represented 25% of the estimated population of PLWHA in the country. The second HIV Futures New Zealand survey achieved a sample of 261 participants representing 21% of the HIV positive population. This study has provided core analyses that have informed New Zealand HIV services within the community, service, professional and government sectors.

Common Threads

Report “Common Threads: Women’s Stories of Pregnancy, Parenting and Living with HIV” by Karalyn McDonald, was launched on Friday 23 February 2007 at the Positive Living Centre, Commercial Road, South Yarra, by Melbourne journalist and communications specialist Jo Pearson.

Author Karalyn McDonald was the recipient of a National Health and Medical Research Council scholarship for her PhD research on HIV positive women, pregnancy and motherhood. She also works on the Living with HIV research program at ARCSHS.

The aim of “Common Threads” was to create a resource driven by the voices of the women. It is the result of four years’ collaboration between McDonald and Positive Women Victoria (Inc), a support and advocacy group for women living with HIV/AIDS.

“Common Threads” highlights the complexities women face living with HIV through personal stories of women facing childbirth and child-rearing in the shadow of HIV. Many of the women were not yet mothers at the time of their diagnosis, and some had very young families. Some discovered they were pregnant and HIV positive at the same time. Others speak of their heartbreak after diagnosis when they believed they could not have children.

Hepatitis Social Research Program

ARCSHS’ Hepatitis Social Research Program promotes a collaborative, public health approach to hepatitis research, and policy development.

Hepatitis C

The Hepatitis Social Research program continues to work towards positioning hepatitis C as a chronic disease which is accepted and well understood by all people throughout Australia. Over the past year the research team has grown to six research staff including Dr Stephen McNally, Jack Wallace, Sophie Dutertre, Robyne Latham, Dr Penny Johnston and Dr
Jacqui Richmond.

Our vision is to broaden existing knowledge about what it is like to live with hepatitis C for the range of people infected, and to help normalise hepatitis as a public health issue. The program continues to consolidate its position as the leading research institute in Australia investigating the barriers to treatment for hepatitis C.

While we engage with clinical issues and settings, we do this in relation to the broader social and cultural issues associated with living with hepatitis. 2007 saw the completion of an important study Improving and Increasing Access to Hepatitis C Treatment: A research project exploring barriers to treatment for people of Vietnamese and Cambodian backgrounds. This study identified factors that contribute to a liver clinic’s success in attracting culturally and linguistically Research Program diverse (CALD) communities; increasing the number of people on treatment, and improving their experience of treatment and care.

Another study adding to Australia’s knowledge about the barriers to accessing treatment is the Victorian based Indigenous Study Improving Access to Hepatitis C Treatment Services: Recognising and responding to Hepatitis C in Indigenous Communities in Victoria. The field work has been completed and a report detailing the findings will be released mid 2008.

Our large national five year study Regulating Hepatitis C: Rights and Duties, funded by the Australian Health Ministers Advisory Council has completed its second year. The study focuses on identifying gaps in regulations and where conflicts and inconsistencies exist between different regulations across Australia in the areas of needle and syringe programs and correctional settings.

Hepatitis B

The past year was an important year for the Program as it began work in the area of hepatitis B by conducting the National Hepatitis B Needs Assessment 2007. This is the first research of its kind in Australia.

To date there has been no comprehensive response to chronic hepatitis B infection in Australia. This research fills a significant gap in the national response to this complex virus by identifying and reporting what the needs are of people infected with the virus and the views of health professionals. The study explores how the Australian health care system can best meet the needs of people with hepatitis B.

The research found that people infected with chronic hepatitis B often receive little or no information about the impact of the virus when they are diagnosed. This lack of information meant that people exposed to hepatitis B are often confused about how to best look after their health, and rely on unreliable sources of information found on the internet. Another finding of the report was that health care workers expressed a need to improve their skills in dealing with the health needs of people with hepatitis B.

The study calls for the development of a comprehensive strategic response to chronic hepatitis B by the national government as well as the state and territory governments. The research shows the Australian health care system response to hepatitis B has relied on the immunisation program, but many people with chronic hepatitis B need information that helps them live with the virus, and to reduce long term health care costs.

Human Papillomavirus (HPV) Program

Staff at ARCSHS continue to be involved in research concerning HPV and its links with cervical and anal cancer. Studies conducted in 2007 included:

What do women need to know about HPV as a ’test of cure’ following cervical dysplasia?

Marian Pitts, Suzanne Dyson
Collaborators: Robyn Mullins and Kate Broun: Cancer Council of Victoria

Objectives: National guidelines in Australia now recommend HPV testing as part of follow-up for women who have treatment for cervical dysplasia. This study aimed to establish the key messages about HPV for women who have received treatment for cervical dysplasia. The goal of this project was produce a resource for women who have had a high grade cervical abnormality, and will undergo human papillomavirus (HPV) testing at their 12 month follow up.

Methodology: The project involved two stages. The first stage focused on women’s understanding of HPV, by reviewing an existing brochure about HPV and Pap tests. Based on the results of stage one interviews, a draft brochure specifically for women with dysplasia was then developed, and a second round of interviews undertaken, seeking women’s responses to the draft brochure. Thirty women, who were attending a hospital clinic at least six months after treatment for cervical dysplasia, were interviewed. They were invited to indicate what they needed to know about receiving an HPV test as part of their clinical follow up.

Findings and Conclusions: Women had significant concerns that had not been addressed through brochures or clinical discussions. Their concerns about HPV included how, when and by whom they may have been infected; their likelihood of re-infection; how to communicate about the virus with their partners, particularly in relation to their treatment and cure; how HPV affects men particularly in regard to them as sexual partners; and how HPV develops into cancer. Women who have received treatment for cervical dysplasia have specific information needs beyond general information about HPV.

Gay Men’s Knowledge and Experience of Anal Cancer Screening and HPV.

Marian Pitts, Christopher Fox, and Jon Willis.

Collaborator: Jonathon Anderson, Carlton Clinic, Melbourne

Objective: To determine levels of experience and knowledge concerning anal dysplasia, anal pap smear tests and HPV amongst gay and other homosexually active men.

Study design: 384 men attending a large gay community event in Melbourne completed a short survey concerning their knowledge and experience of anal cancer and HPV.

Results: On a range of measures it was clear that the men knew very little about anal cancer, (19% scored zero on a twelve point knowledge scale) and virtually nothing about HPV, (47% scored zero on an eight point knowledge scale). 55.1% had never heard of an anal pap smear and 44.8% had ever heard of HPV; 56.4% did not know whether it affected men and / or women.

Conclusions: The test for anal dysplasia is still largely unknown among Australian gay men and they currently have poor sense of personal susceptibility to the disease. Health education strategies are suggested to improve this situation.

Knowledge, attitudes and behaviours of Singaporean women and men in relation to HPV.

Marian Pitts, Anthony Smith, Samantha Croy, Richard Ryall.

Collaborators: Professor Suzanne Garland, (Royal Women’s Hospital) Dr EH Tay (KK Hospital, Singapore and Dr. Wong Mee Lian (University of Singapore)

Objectives: To establish the current knowledge of people in Singapore concerning HPV and cervical cancer and to establish reliable information on sexual behaviour and practices of Singaporeans in relation to HPV.

Materials and methods: A sample of 3,075 women and men (in a ratio of 2:1) were selected to participate in the study. The sampling frame was the Residential Directory 2006/07; it contains 80% - 90% of the total households of Singapore. Households were selected and then randomly allocated to be interviewed by telephone using a computer assisted telephone interview (CATI) or face to face from randomly selected households. 1,044 women and 459 men were interviewed via CATI, while 1,101 women and 471 men were interviewed in the door to door component. The average age of the sample was 34.79 years for men and 35.38 years for women.

Results: Only 20.6% of women and 16.4% of men had heard of HPV. In contrast, 81.1% of women, but only 48.8% of men had heard of the cervical smear or Pap test. Overall, 77.6% of women had ever had a Pap test. Using a twelve item knowledge scale, the mean number of correctly answered items was 5.3. Attitudes towards an HPV vaccination were largely positive, with women significantly more positive in their attitudes than men. Refusal rates to questions were very low overall with the majority of questions not refused at all. However, questions concerning sexual behaviour had refusal rates that ranged from 5% to
13% for interviews administered via CATI, whilst refusal rates in the face to face interviews were higher.

Conclusions: Whilst knowledge of HPV is poor among Singaporean men and women, there is a willingness to be educated about the problem and positive attitudes in general towards a vaccination to protect against cervical cancer. It is likely that vaccination in late teenage years would offer good protection. In general, Singaporean men and women are prepared to participate in a survey that concerns cervical cancer, HPV and sexual behaviour and given indications that education delivered from credible sources would be well received.

Young People

Peers Outsmarting Homophobia – the POSH booklet

Lynne Hillier, Andrew Lavin, Anne Mitchell & Nicole Besley

Background: Analyses of the 800 stories sent to us in the Writing Themselves In Again project revealed that same sex attracted young people have many effective strategies developed to assist them in resisting other people’s homophobic beliefs. The strategies were collated under five umbrella discourses and a booklet produced with five sections, each devoted to one discourse including the impacts of the discourse, where it came from, ways to outsmart it and useful links.

Aim: To gather strategies of resistance to homophobia used by same sex attracted young people and make them accessible in booklet form.

Progress: The Peers Outsmarting Homophobia booklet was launched in May 2007 by Bernie Gueron. 10,000 booklets have been published.

POSH Interviews

Lynne Hillier

Background: This longitudinal study will gather the experiences of 30 same sex attracted young people, aged 16 – 21 years at regular intervals over two years. The study will focus particularly on critical events in these young people’s lives and the resources they call upon (internal and external) in dealing with them.

Aims:
• to document positive and negative change in their social networks and supports, the complex dynamics of that change, implications of that change for mental and physical health and young people’s responses to the change.
• to document the resources (internal and external) that young people access when these critical life events occur.
• to adapt/construct/extend theoretical models which can explain the important factors which impact on same sex attracted young people moving successfully and safely through adolescence.

Progress: recruitment of young people and first interviews.

International Program

AusAID Consortium

Marian Pitts, Stephen McNally, Murray Couch.

ARCSHS is one of ten organisations invited by the Australian Agency for International Development (AusAID) to join a consortium for the planning and delivery of the ‘Implementation of AusAID Regional HIVAIDS Capacity Building Program 2007-2011’ strategy.

Other invited agencies are Albion Street Centre, Australasian Society for HIV Medicine (ASHM) which will manage the consortium, Australian Federation of AIDS Organisations (AFAO), Australian Injecting and Illicit Drug Users League (AIVL), National Association of
People Living with HIV/AIDS (NAPWA), National Centre in HIV Epidemiology and Clinical Research (NCHECR), National Centre in HIV Social Research (NCHSR), National Serology Reference Laboratory (NRL), and Scarlett Alliance (Australian Sex Workers Association).

Total funding planned is $13 million over three years of which ARCSHS expects to receive approximately $1.2 million. The project involves work with HIV organisations in various locations in the South East Asia Pacific region developing appropriate programs for building capacity and expertise in the health management of HIV-AIDS. The priority regions are the Pacific, Indonesia and Greater Mekong.

This is an excellent opportunity to enhance the international profile of one of La Trobe University’s significant research centres where work is already being carried out in south-east Asia and the subcontinent.

Development of a Short Course in Advanced Sexuality Theory and Methodology in Developing Countries, in collaboration with the International Association for the Study of Sexuality, Culture and Society, funded by the Ford Foundation

Gary Dowsett, Sean Slavin, Maureen Reitze (Research Assistant).

2007 proved to be busy year for the members of the project team.

An audit of sexuality courses currently available internationally is complete and soon to be published on the website www.sexualitystudies.net. This, along with a review of journal articles in the final stages of development, will complete phase one of the project – the feasibility and scoping study. That phase established a definite need for such a course and confirmed East Africa and Southeast Asia as ideal places to pilot such a course.

The highlight of the year was the project’s Advisory Committee meeting held in Lima, Peru, following the very successful IASSCS biennial conference, this time entitled ‘Dis/organised Pleasures’. At this meeting, the project team met with an international group of acknowledged scholars in the field of sexuality studies and research to chart the course for the next phases of the project. The findings of the audit were presented in a paper to the conference.

Following the report on phase one and a second application to the Ford Foundation, the project has been re-funded for phases two and three —Curriculum Development; and Piloting and Evaluation.

In preparation for these phases, a series of site assessment visits have been undertaken to various countries to identify potential collaborators, institutional partners, course pilot sites, participants and audiences. Sites visited include Indonesia, Vietnam, South Africa, Uganda and Kenya. Kenya and Indonesia have been nominated as potential sites for piloting the course and collaborative relationships are being further developed with partners there.

The curriculum development phase is under way with plans for a meeting of an international Curriculum Working Group in Perth, Western Australia, in March
2008.

Student Social Networks: size, composition and stability

Anthony Smith, Marian Pitts, Vernon Solomon (University of KwaZulu Natal, South Africa),
Professor Graham Lindegger (University of KwaZulu Natal), Prof Kevin Durrheim (University of KwaZulu Natal).

This project arises from an emerging collaborative relationship between researchers at the
Pietermaritzburg campus of the University of KwaZulu Natal and researchers at the Australian Research Centre in Sex Health and Society at La Trobe University. The project represents a convergence of academic and social justice concerns of the two groups of researchers. The project consists of an all of campus survey of the size and structure of students’ social networks, paying particular attention to demographic mixing characteristics (e.g. race, gender, age) and health seeking practices. The project addresses the health seeking behaviour, including sexual health of a large population of sexually active young adults in a setting that has a high background HIV prevalence rate. The project provides key baseline data on this population that has hitherto been unavailable. The project will provide direct benefit to the planning and provision of sexual health services including HIV testing and HIV treatment and support for this population.

Evaluations

Evaluation of Xtribe: a sex and health positive website for men who have sex with men.

Lynne Hillier and Kylie Johnson (VAC)

Background: The project to be evaluated is a web-based Internet site for men who have sex with men, including gay attached, HIV positive and negative men and those who use the Internet to find partners for sex. The project aims to provide a website which is relevant and accessible, which provides information on a spectrum of safe sex strategies and other sexual health issues as well as providing safe spaces for the discussion of sensitive issues such as the pros and cons of testing and new diagnosis. The project will be sex positive, interactive and fun.

Aims: The evaluation will chart the development of the website, its effectiveness in achieving its aims and the learning’s from this.

Methods: Evaluation data will be gathered from the site.

Progress: Data collection is complete. Analysis is nderway.

Internet chat room STI awareness, screening and testing outcomes

Lynne Hillier, Brian Price and Gabriele Bennett (The Alfred)

Background: This project is an evaluation of a chat room intervention with men who have sex with men to increase their testing for, and awareness of, Chlamydia and other STIs. Two health educators will have a personal profile within the chat room identifying them as ‘Health Educators’. There will be a particular focus of the education strategy on STIs, HIV transmission and referral for testing. The Health Educators will respond in a private conversation to information requests and any individual deemed at risk for STIs will be approached to be part of the two phase study. Phase One involves filling out a questionnaire about sexual risk taking, previous sexual health history and testing along with basic demographic details. Phase Two involves a second questionnaire three months post the initial discussion. This will investigate sexual risk taking over the period, any follow up and any STI testing they undertook along with any reasons for not testing or barriers to accessing testing.

Aims: Assess the impact of providing factual, evidence based, practical, information about sexual health, Chlamydia and other STIs including HIV transmission risks on the sexual behaviours of men who have sex with men.

Assess the impact on the health seeking behaviours of men who have sex with men, of providing a health educator to discuss their sexual health concerns and provide referrals.

Progress: data collection is about to begin.

Evaluating the ‘value adding’ to the What is this hepC thing? project.

Lynne Hillier and Gabrielle Bennett (The Alfred)

Background: The project aimed to further develop the What is this Hep C thing? internet activity resource (developed in 2003) to make it a more accessible and valuable resource for secondary school teachers and students. The original resource was an internet based activity for secondary students that aimed to raise awareness of hepatitis C including methods of transmission. As well as giving young people the knowledge they need to protect themselves from hepatitis C, it also aimed to reduce discrimination against people who have hepatitis C by refuting myths about transmission. However the evaluation indicated that it needed to be more accessible to ensure good use.

Aims: to increase the ease of accessibility and usefulness of the What is this Hep C thing?

Progress: data collection and analysis are complete.
Report is being written.