Factors associated with HIV testing in people aged ⩾50 years: an integrated qualitative analysis of patients and healthcare providers

Background

Older people continue to be disproportionately affected by late HIV diagnosis, which results in increased morbidity and mortality. Despite high acceptance of HIV testing generally, older people are less likely to undergo testing than younger people. Two previous studies have been conducted, one focussing on patient-related and one focussing on clinician-related factors associated with HIV testing in older age (⩾50 years).

Objective

This study is an integrated analysis from two linked studies - one focussed on patients, and one focussed on clinicians - to understand overlap in views and experiences of HIV testing in older age, to outline the clinical implications of the findings, and to highlight potential interventions to improve testing in this group.

Methods

This qualitative study utilised semi-structured interviews conducted with 20 clinicians who were not HIV care specialists, but who had recently seen an older person prior to their HIV diagnosis, and 20 people who had been diagnosed late with HIV aged 50+. Interviews were audio recorded, transcribed verbatim and thematically analysed. The combined synthesis reported here was planned a priori as part of a sequential design.

Results

Seven clinician- and seven patient-related themes were associated with undergoing HIV testing in older age. This article discusses the four themes that were common to both groups: poor knowledge, incorrect symptom attribution, inaccurate perception of risk, and stigma.

Conclusion

Both clinician and patient factors associated with testing will have to be addressed in order to increase HIV testing in older people, and reduce the likelihood of late diagnosis. Findings from overlapping themes suggest several areas for intervention: (1) routine screening as part of existing clinical contacts aimed at older people to eliminate the need to attribute symptoms to HIV or assess risk; (2) specific and tailored education materials for clinicians and older people which utilise appropriate modalities; (3) tailored HIV testing services: either specific clinics for older people at existing sexual health services, or dedicated services in primary care.

Factors associated with offering HIV testing to people aged ≥ 50 years: A qualitative study

BACKGROUND

Individuals aged ≥ 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged ≥ 50 years.

METHODS

Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed.

RESULTS

Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues.

CONCLUSIONS

Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.

Changes in Sexual Identity Labels in a Contemporary Cohort of Emerging Adult Women: Patterns, Prevalence and a Typology

Sexual attraction, behavior and identity are subject to change across the life course for some individuals, and certain developmental periods such as emerging adulthood appear particularly conducive to this. However, the evidence documenting these phenomena comes overwhelmingly from data collected 10-20 years ago. In the brief interlude since, the socio-political context has changed markedly and increasing numbers of women are reporting non-heterosexuality. Drawing on contemporary data from the Australian Longitudinal Study on Women's Health (n = 16,870), we provide up to date evidence on changes in sexual identity labels among emerging adult women. We found that 19% of women changed their sexual identity label from one survey wave to the next, and 30.6% changed their identity label at least once across the four waves. Mostly heterosexual and bisexual labels were both more common and more stable in our sample than in previous studies. We propose a new typology of sexual identity sequences and fit this to our data, providing a blueprint for researchers looking to define sexual minority status longitudinally. Findings suggest that the ways women perceive and label their sexual orientation should be treated as dynamic phenomena situated within the nested temporalities of biographical and historical time.

Romantic Jealousy: A Test of Social Cognitive and Evolutionary Models in A Population-Representative Sample of Adults

Whereas sexually dimorphic evolutionary models argue for clear sex differences in responses to jealousy-evoking scenarios, social cognitive models emphasize the importance of other factors. This paper explores variables associated with responses to a commonly-used jealousy-evoking scenario in a population-representative sample. Data from 8,386 Australian men and women aged 16-69 were weighted to match the population. The results provided some support for evolutionary models among heterosexual respondents, but findings contrary to evolutionary models were found among non-heterosexual respondents. Support for social cognitive models was provided by the identification of six variables that had significant independent multivariate associations with jealousy: sex, age, education, lifetime number of partners, relationship status, and attitudes toward infidelity. The results suggest that although men and women may tend to respond differently to sexual or emotional infidelity scenarios, the anticipated experience of jealousy in each context is strongly influenced by biographical and cultural factors.

Sex counts: An examination of sexual service advertisements in a UK online directory

Internationally, sex work research, public opinion, policy, laws, and practice are predicated on the assumption that commercial sex is a priori sold by women and bought by men. Scarce attention has been devoted to lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) sex working as well as women who pay for sex. This is as much an empirical absence as it is a theoretical one, for the ideological claim that women comprise the "vast majority" of sex workers is rarely, if ever, exposed to empirical scrutiny. Focusing on the UK, we address this major gap in evidence in order to challenge the gendered and heterosexist logics that underpin contemporary debates. We do so by presenting large-scale data gained from the quantitative analysis of 25,511 registered member profiles of an online escort directory. Our findings point to heterogeneity rather than homogeneity in the contemporary sex industry including in terms of gender identity, sexual orientation, and advertised client base. For example, while two-thirds of advertisements self-identify as "Female," one in four are listed as "Male;" less than half list their sexual orientation as "Straight;" and nearly two-thirds advertise to women clients. Our study thus challenges prevailing heteronormative assumptions about commercial sex, which erase LGBTQ sex workers and other non-normative identities and practices, and which we argue have important political, practical, and theoretical consequences.

Negotiating sexual agency in marriage: The experience of migrant and refugee women

In this study, adult migrant and refugee women's negotiation of sexual agency in the context of marriage is explored. In Sydney, Australia and Vancouver, Canada, 78 semistructured individual interviews, and 15 focus groups, comprised of 82 participants, were conducted with women who had recently migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. Women's negotiation of sexual agency was evident with respect to husband choice, disclosure of sexual desire, pleasure, pain, and sexual consent. While some participants took up subjugated sexual subject positions reflecting dominant cultural or religious discourses, many women also resisted these discourses to enact sexual agency.

Regulation and Resistance: Negotiation of Premarital Sexuality in the Context of Migrant and Refugee Women

Constructions of normative sexuality shape the sexual scripts that women are permitted to adopt and the manner in which such sexuality can be expressed. We explored experiences and constructions of premarital sexuality among migrant and refugee women recently resettled in Sydney, Australia, and Vancouver, Canada. A total of 78 semistructured individual interviews and 15 focus groups composed of 82 participants were undertaken with women who had migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. We analyzed the data using thematic decomposition. Across all cultural groups, women's premarital sexuality was regulated through cultural and religious discourse and material practice. Such regulation occurred across three main facets of women's lives, shaping the themes presented in this article: (1) regulating premarital sex-the virginity imperative; (2) regulation of relationships with men; and (3) regulation of the sexual body. These themes capture women's reproduction of dominant discourses of premarital sexuality, as well as women's resistance and negotiation of such discourses, both prior to and following migration. Identifying migrant and refugee women's experiences and constructions of premarital sexuality is essential for culturally safe sexual health practice, health promotion, and health education.

A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2

BACKGROUND

Many studies on sexual attitudes and behavior have been performed to improve sexual health.

AIM

To evaluate changing trends in Korean female sexual life and attitudes in an internet-based survey at 10-year intervals.

METHODS

The survey was targeted toward 20- to 59-year-old women who were asked to complete the questionnaire only if they were sexually active. The survey contained 110 questions about demographic statistics, sexual life, and attitudes that were crafted based on the 2004 study.

OUTCOMES

Results of the 2004 study vs those of the 2014 study.

RESULTS

In total, 516 women participated in the study; the questionnaire response rate was 16.0%. The mean frequency of intercourse (FOI) per month was 3.46 ± 2.56 in 2014 vs 5.34 ± 3.84 in 2004. Women in their 20s and 30s in 2014 reported a lower mean FOI than those in 2004. There was no significant difference in the mean FOI in 2004 vs 2014 for women who in their 40s. Risk factors for lower FOI were being older, being single, and having dyspareunia. Most Korean women had positive attitudes toward sex (3.2 ± 0.6 of 5) and considered it as important (3.3 ± 0.7 of 5) as those surveyed in 2004. However, women 20 to 39 years old had less positive attitudes toward sex than in the past decade. Women in their 40s were more active and had more conversations with their partners. Of women using contraceptives, 63.8% were found to use less effective methods, such as intercourse withdrawal and the fertility awareness method.

CLINICAL IMPLICATIONS

Assessment of changing trends in Korean female sexual life, attitudes, and contraceptive methods could help to establish proper national sexual education programs and campaigns.

STRENGTHS AND LIMITATIONS

This study was not a cohort study, because subjects in the 2014 were not identical to those in the 2004 study. Nevertheless, we applied the same inclusion and exclusion criteria for this internet survey, a suitable tool to evaluate the sex life of women, which is often considered a sensitive and private issue in Asian culture.

CONCLUSIONS

Compared with the 2004 survey, young Korean women had fewer sexual relationships and had a less positive attitude toward sex. In addition, many women used less effective methods of contraception. Park J, Min B, Shin H, et al. A 10-Year Interval Study About the Sexual Life and Attitudes of Korean Women: The Korean Internet Sexuality Survey (KISS) 2014, Part 2. J Sex Med 2017;14:1142-1151.

Sexual Knowledge and Attitude among Girls Who are Getting Married Based on the Information from Yas Pre-marriage Counseling Center

Background:

High prevalence of sexual dysfunction results from inadequate knowledge or inappropriate attitude toward the natural phenomenon of sexual desire. This study aimed to define sexual knowledge and attitude among girls who were getting married and referred to Yas pre-marriage counseling center.

Materials and Methods:

This research was a descriptive analytical study. The information of 165 girls, who were about to get married, were collected through convenient sampling using a researcher-made questionnaire. Data were analyzed using SPSS version 16 software. Inferential statistical method and Pearson correlation were used for data analysis.

Results:

Results showed that the mean scores of sexual knowledge and attitude among the participants were 57.42 and 69.02, respectively. There was a significant association between the mean scores of sexual knowledge and sexual attitude (P < 0.001, r = 0.63).

Conclusions:

Results showed that the participants had relatively appropriate knowledge and attitude toward sexual relationship.

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

Background Several common global definitions of sexual health refer to physical, emotional and social well-being, with respect to sexuality, and also to the need for this well-being to be reflected for all individuals in relationships. How well sexual health definitions fit US youths' attitudes to sexual health, and associations between these attitudes, sexual behaviours and sexual health care were assessed.

METHODS

In total, 4017 youth aged between 15 and 25 years via an online survey panel, weighted to be representative of the US population, were surveyed. Respondents reported their attitudes towards seven dimensions of sexual health that we abstracted from existing global definitions (emotional fulfillment, social connectedness, spirituality, overall pleasure, physical intimacy, mental fulfillment, reciprocal benefits). Respondents also reported on sexual health-related discussions with partners, sexual behaviours, and their use of sexual health care. Outcomes through weighted frequency estimates and ordinal regression models were reported.

RESULTS

Youth generally construed all seven dimensions as important to sexual health, with the emotional dimension rated most favourably. Attitudes to the dimensions of overall pleasure, physical intimacy and spirituality were most consistently related to sexual health discussions and behaviours. The behaviours most consistently related to sexual health attitudes were going for a sexual health check-up, discussing birth control/pregnancy and discussing risk before sex without a condom.

CONCLUSIONS

Youth construal of sexual health fits well with global sexual health definitions. Attitudes to dimensions of sexual health were related to some sexual health-related behaviours, especially healthcare use and complex discussions.

A Profile of Pornography Users in Australia: Findings From the Second Australian Study of Health and Relationships

There are societal concerns that looking at pornography has adverse consequences among those exposed. However, looking at sexually explicit material could have educative and relationship benefits. This article identifies factors associated with looking at pornography ever or within the past 12 months for men and women in Australia, and the extent to which reporting an "addiction" to pornography is associated with reported bad effects. Data from the Second Australian Study of Health and Relationships (ASHR2) were used: computer-assisted telephone interviews (CASIs) completed by a representative sample of 9,963 men and 10,131 women aged 16 to 69 years from all Australian states and territories, with an overall participation rate of 66%. Most men (84%) and half of the women (54%) had ever looked at pornographic material. Three-quarters of these men (76%) and more than one-third of these women (41%) had looked at pornographic material in the past year. Very few respondents reported that they were addicted to pornography (men 4%, women 1%), and of those who said they were addicted about half also reported that using pornography had had a bad effect on them. Looking at pornographic material appears to be reasonably common in Australia, with adverse effects reported by a small minority.

Intergenerational variation in sexual health attitudes and beliefs among Sudanese refugee communities in Australia

The aim of this study was to develop intergenerational understanding of the factors perceived to be influencing the sexual health and wellbeing of young Sudanese refugees in Queensland, Australia. Data from 11 semi-structured, face-to-face interviews exploring sexual health knowledge, attitudes and behaviours with young people aged 16 to 24 years, and five focus groups with adults from the broader Queensland Sudanese community, were compared and contrasted. Findings indicate that sexual health-related knowledge, attitudes and beliefs, along with patterns of sexual behaviour, are changing post-resettlement and this creates considerable intergenerational discord and family conflict. Study findings provide an understanding of how the interplay between traditional cultural gender, parenting and relationship norms and perceived normative Australian beliefs and patterns of behaviour influence the construction of both young people's and their parents' attitudes to sexual health post-arrival. We suggest that sexuality education programmes adapted to the specific cultural- and age-related contexts need to be introduced early within the resettlement process for both young people and their families.

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia

INTRODUCTION

In Victoria, Australia, abortion was decriminalised in October 2008, bringing the law in line with clinical practice and community attitudes. We describe how experts in abortion service provision perceived the intent and subsequent impact of the 2008 Victorian abortion law reform.

METHODS

Experts in abortion provision in Victoria were recruited for a qualitative semi-structured interview about the 2008 law reform and its perceived impact, until saturation was reached. Nineteen experts from a range of health care settings and geographic locations were interviewed in 2014/2015. Thematic analysis was conducted to summarise participants' views.

RESULTS

Abortion law reform, while a positive event, was perceived to have changed little about the provision of abortion. The views of participants can be categorised into: (1) goals that law reform was intended to address and that have been achieved; (2) intent or hopes of law reform that have not been achieved; (3) unintended consequences; (4) coincidences; and (5) unfinished business. All agreed that law reform had repositioned abortion as a health rather than legal issue, had shifted the power in decision making from doctors to women, and had increased clarity and safety for doctors. However, all described outstanding concerns; limited public provision of surgical abortion; reduced access to abortion after 20 weeks; ongoing stigma; lack of a state-wide strategy for equitable abortion provision; and an unsustainable workforce.

CONCLUSION

Law reform, while positive, has failed to address a number of significant issues in abortion service provision, and may have even resulted in a 'lull' in action.

Support for gay men: an Australian study

Recently, research in the U.S.A. has shown that women, and young people in particular, have become increasingly supportive of gay men. The current study used a cross-sectional, correlational design to investigate these same issues in Australia. The sample included 575 heterosexual participants, 184 men and 390 women. Because a literature search failed to identify an Australian measure of support for gay men, a Support for Gay Men Scale was developed by the researchers. Multiple regression analyses were used to investigate whether scores on the Brief Multidimensional Measure of Religiousness/Spirituality and the respondents' sex predicted scores on the Support for Gay Men subscales, and the strength of these relationships. Findings reveal that this relatively young university undergraduate Australian sample indicated they strongly supported gay men.

Change and stasis in sexual health and relationships: comparisons between the First and Second Australian Studies of Health and Relationships

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First vaginal intercourse and oral sex among a representative sample of Australian adults: the Second Australian Study of Health and Relationships

Background Current information about the characteristics of Australian adults' first vaginal intercourse and contraception or precautions used on that occasion is needed, as well as whether these characteristics have changed between 2001-02 and 2012-13.

METHODS

Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents indicated their age at first vaginal intercourse and first oral sex. Those who reported vaginal intercourse were asked the age of their partner, their relationship to their partner, the duration of this relationship, and what contraception or precautions (if any) were used.

RESULTS

There was a significant decline in the median age of first vaginal intercourse for both men and women among those born between the 1940s and the 1960s, but no further decline since. There has also been a significant increase in the use of protection at first vaginal intercourse, from less than 20% of men and women in the 1950s to over 90% in the 2000s. For men and women, first vaginal sex before age 16 years was significantly associated with a greater number of lifetime and recent sexual partners, and a greater likelihood of having had a sexually transmitted infection.

CONCLUSION

Given the earlier age at first vaginal intercourse, sex education should begin earlier so that all young people have information about contraception and disease prevention before they begin their sexual careers.

Sexual identity, sexual attraction and sexual experience: the Second Australian Study of Health and Relationships

Background Behavioural and other aspects of sexuality are not always consistent. This study describes the prevalence and overlap of same-sex and other-sex attraction and experience and of different sexual identities in Australia. Methods: Computer-assisted telephone interviews were completed by a representative sample of 20 094 men and women aged 16–69 years recruited by landline and mobile phone random-digit dialling with a response rate (participation rate among eligible people) of 66.2%. Respondents were asked about their sexual identity (‘Do you think of yourself as’ heterosexual/straight, homosexual/gay, bisexual, etc.) and the sex of people with whom they had ever had sexual contact and to whom they had felt sexually attracted. Results: Men and women had different patterns of sexual identity. Although the majority of people identified as heterosexual (97% men, 96% women), women were more likely than men to identify as bisexual. Women were less likely than men to report exclusively other-sex or same-sex attraction and experience; 9% of men and 19% of women had some history of same-sex attraction and/or experience. Sexual attraction and experience did not necessarily correspond. Homosexual/gay identity was more common among men with tertiary education and living in cities and less common among men with blue-collar jobs. Many gay men (53%) and lesbians (76%) had some experience with an other-sex partner. More women identified as lesbian or bisexual than in 2001–02. Similarly, more women reported same-sex experience and same-sex attraction. Conclusion: In Australia, men are more likely than women to report exclusive same-sex attraction and experience, although women are more likely than men to report any non-heterosexual identity, experience and attraction. Whether this is a feature of the plasticity of female sexuality or due to lesser stigma than for men is unknown.