Sex in Australia: Injecting and sexual risk behaviour in a representative sample of adults

Gender Differences in How Parents, Peers, and Exposure to Sexually Explicit Materials Influence the Intention to Engage in Casual Sex among Adolescents and Young Adults in Taiwan: Applying the Theory of Planned Behavior

The aims of this study were to examine gender differences in how parent-child discussions on sex issues, peer interactions around sexual issues, and exposure to sexually explicit materials affect the intention to engage in casual sex among adolescents and young adults in Taiwan. This cross-sectional survey study recruited 767 participants (348 men and 419 women) aged 15-24 years. The survey collected data on participants' intention to engage in casual sex, their attitude toward and perception of casual sex based on the theory of planned behavior (TPB) (favorable attitude, perceiving positive social norms toward casual sex, and perceived control over involvement), parent-child and peer discussions about sexual issues, and exposure to sexually explicit materials. The results of multiple regression analysis revealed that parent-child discussions on sex issues, peer interactions around sexual issues, and exposure to sexually explicit materials were significantly associated with the intention to engage in casual sex. The results of structural equation modeling (SEM) further supported that favorable attitude, perceiving positive social norms toward casual sex, and control over involvement mediated the associations. For men, decreased favorable attitude mediated the negative association between parent-child discussions and casual sex intention; increased favorable attitudes and decreased control over involvement mediated the positive associations between peer interactions and casual sex intention. For women, decreased control over involvement mediated the positive association between exposure to sexually explicit materials and casual sex intention. The associations between peer interaction and subjective norms of acceptance, perceived control over involvement, and casual sex intention were stronger in men than in women; the association of favorable attitudes with casual sex intention was also stronger in men than in women.

Histopathologic Spectrum of Findings Associated With Tattoos: Multicenter Study Series of 230 Cases

IMPORTANCE

Reactions to tattoo may simulate common dermatosis or skin neoplasms. Histopathology allows diagnosis and helps determining the level and degree of inflammation associated, consequently orientating treatment.

OBJECTIVE

To describe the histological features found in biopsies of cutaneous reactions to tattoo.

DESIGN

This study was designed as a multicenter case series.

SETTING

All consecutive histopathological samples of tattoos referred from 1992 to 2019 to the Hospital General de Catalunya, Hospital Germans Trias i Pujol, and a private practice, all in Barcelona, Spain, and from the Kempf und Pfaltz Histologische Diagnostik in Zurich, Switzerland were retrieved from the files.

PARTICIPANTS AND EXPOSURE

The inclusion criteria were all cosmetic/permanent makeup, artistic/professional, and traumatic tattoos associated with either inflammatory reactions alone and/or with tumors and/or infections. Exclusion criteria were cases without any associated pathologic finding in the place of the ink, amalgam tattoos, and medical or temporary tattoos.

MAIN OUTCOMES AND MEASURES

In all patients, clinical features (age, sex, location, tattoo color, and presentation) were recorded. Histological features evaluated included ink color, associated tumors or infections, and inflammatory reaction pattern. Inflammation was graded in low to moderate or severe.

RESULTS

From 477 biopsies diagnosed as tattoos, 230 cases from 226 patients met the inclusion criteria. Samples corresponded to 107 male and 120 female subjects and 3 of unknown gender. Median age was 39 years (ranging from 9 to 84 years). Fifty-three samples were referred from centers in Spain and 177 from the center in Switzerland. The series was analyzed in 2 parts: tattoos associated only with inflammatory reactions (117/230) and tattoos associated with tumors or infections (113/230). The most common form of inflammatory pattern associated with tattoo was the fibrosing reaction (79/117, 68%), followed by granulomatous reaction (56/117, 48%), lichenoid reaction (33/117, 28%), epithelial hyperplasia (28/117, 24%), pseudolymphoma (27/117, 23%) and spongiotic reaction (27/117, 23%). Combined features of 2 or more types of inflammatory patterns were seen in 64% cases.

CONCLUSIONS AND RELEVANCE

Our series confirms that cutaneous reactions to tattoos are polymorphous. Inflammation tends to present with combined patterns. Infections are tending to decline, and pathologic findings are not specific to ink color or clinical features.

The Defendant with the Prison Tattoo: The Effect of Tattoos on Mock Jurors' Perceptions

Little is known about the potential for tattoos to bias how defendants are perceived. In Study 1, the participants (n = 30) viewed photographs of five men with a tattoo (prison or modern style) on the face and neck or arm. Individuals with prison-style tattoos were perceived more negatively, especially when the tattoos were located on the face and neck compared to the arm. In Study 2, participants (n = 120) were shown a photograph of a defendant who either had a prison-style tattoo or no tattoo, and read a scenario describing a physical assault (with either strong or weak evidence). Perceptions of defendant dangerousness mediated the relationship between the presence of a tattoo and mock jurors' perceptions of guilt.

The Sexual Health of Women in Lebanon: Are There Differences by Sexual Orientation?

PURPOSE

From studies conducted in Western countries (United States, United Kingdom, and Australia), we know that the sexual health of sexual minority women (SMW) differs in key ways from that of heterosexual women (HSW). To date, the sexual health of SMW living in the Middle East and North Africa region has not been studied. The purpose of this study was to compare the sexual health of SMW and HSW living in Lebanon.

METHODS

SMW and HSW living in Lebanon (N = 95) completed an anonymous, self-administered survey. SMW's risk perceptions and health promoting and sexual behaviors were compared to those of HSW. We examined differences by sexual orientation by using t tests and Fisher's exact tests.

RESULTS

The 45 SMW and 50 HSW had similar demographic characteristics. Significantly more SMW had heard of human papillomavirus, but only 22% of women from both groups knew of its association with abnormal Papanicolaou tests. Cervical cancer screening rates were similar in SMW and HSW, although remarkably low (42%) compared with rates in Western countries. Significantly more SMW (18%) reported difficulty with access to care than HSW (0%). Forty-four percent of SMW reported discomfort in disclosing their sexual orientation to their healthcare provider and 61% reported that healthcare providers lacked sensitivity toward lesbian, gay, bisexual, and transgender needs. Unwanted sexual contact occurred more frequently in SMW (53%) than HSW (23%).

CONCLUSION

The sexual health of women is affected by sociocultural factors. SMW living in Lebanon have unique health needs that should be addressed within their sociocultural context.

Australian Gay Men Describe the Details of Their HIV Infection Through a Cross-Sectional Web-Based Survey

Background

With emerging opportunities for preventing human immunodeficiency virus (HIV) transmission, it remains important to identify those at greatest risk of infection and to describe and understand the contexts in which transmissions occur. Some gay and bisexual men with recently diagnosed HIV infection are initially unable to identify high-risk behaviors that would explain their HIV infection. We explored whether Web-based data collection could assist them in identifying the circumstances of their infection.

Objective

To assess the capacity of a Web-based survey to collect reliable self-report data on the event to which gay and bisexual men ascribe their HIV infection.

Methods

The HIV Seroconversion Study included a Web-based survey of gay and bisexual men with recently diagnosed HIV infection in Australia. Participants were asked if they could identify and describe the event they believe led to their infection. Men were also asked about their sexual and other risk practices during the 6 months before their diagnosis.

Results

Most (403/506, 79.6%) gay and bisexual men with newly diagnosed HIV infection were able to identify and describe the circumstances that likely led to their infection. Among those who were initially unable to identify possible exposure events, many could nonetheless provide sensible information that ostensibly explained their seroconversion. Free-text responses allowed men to provide more detailed and contextual information, whereas questions about the totality of their sexual behavior before diagnosis provided opportunities for men to describe their sexual risk behavior in general. Overall, 84.0% indicated having engaged in condomless anal intercourse before their HIV diagnosis, including 71.8% in the receptive position.

Conclusions

This study demonstrates the effectiveness of using Internet-based technologies to capture sensitive information about the circumstances in which HIV infection occurs among gay and bisexual men. By providing a range of opportunities for relaying experience, this research reveals some of the complexity in how individuals come to understand and explain their HIV infection. These findings may assist in obtaining detailed sexual history in the clinical setting.

HIV and Hepatitis C Virus Infection and Risk Behaviors Among Heterosexual, Bisexual, and Lesbian Women Who Inject Drugs in Australia

PURPOSE

Women who inject drugs (WWID) are vulnerable to a range of harms, including exposure to sexually transmitted and blood-borne infections, abusive relationships, physical and sexual violence and mental health issues. Lesbians and bisexual women are at greater risk than heterosexual women for substance use disorders. This study aimed to compare a large sample of heterosexual, bisexual, and lesbian WWID and to identify correlates of sexual orientation.

METHODS

The Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional survey. People who inject drugs (PWID) who attend NSP services are invited to complete a brief self-administered questionnaire and provide a capillary dried blood spot. Of 22,791 survey respondents between 2004-2013, one third were women (n=7,604). Analyses were restricted to the first participation record for each respondent.

RESULTS

Of the 5,378 individual women, 4,073 (76%) identified as heterosexual, 1,007 (19%) identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was low (<1.0%). More than half (56%) had been exposed to hepatitis C virus (HCV), with prevalence highest among bisexual women (59%). In adjusted analysis, bisexual women had significantly greater odds of initiating injection at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection (AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI 1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater odds of reporting sex work than their heterosexual counterparts.

CONCLUSION

Results contribute to the literature on HIV and HCV transmission risk among WWID. Analysis of the relationship between sexual orientation and risk behavior identified bisexual orientation as independently associated with increased risk. Services that target PWID need to recognise and address a broad range of sexual identities and behaviors. Future research should explore reasons for increased risk in sexual minority women.

[Tattooed people, who are you? Demographic and behavioral characteristics of tattooed individuals]

Over the past 20 years, tattoos have become extremely popular in Western countries. In Germany for instance, 8.5% of the population (aged between 14 and 90 years) have tattoos. Trends in France are similar according to a recent poll (10%). However, tattoos are becoming increasingly common among the young, involving up to 25%, according to the individual country. Reasons for getting a tattoo are plentiful and personal. There is no specific profile of tattooed individuals nowadays but a rather wide spectrum of different types. Herein, we review the epidemiology of tattooed individuals in the light of the most recent publications on the subject.

Hepatitis C risk factors, attitudes and knowledge among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia

Background There are increasing reports of sexual transmission of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM). Still unclear is the level of HCV knowledge and the risk factors specific to HCV transmission among this population. This study compared HCV knowledge and risk practices among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia.

METHODS

Participants (n=534) completed an online survey assessing sexual risk practices, HCV knowledge, perceived risk of acquiring HCV and perceptions of people with HCV and who inject drugs.

RESULTS

HIV-positive participants were older, reported greater engagement in sexual risk and injecting drug practices, felt they were at greater risk of acquiring HCV, were less likely to socially and sexually exclude people with HCV and had more positive attitudes towards people who inject drugs and people with HCV compared with HIV-negative and HIV-untested participants. HIV-untested participants were younger, reported fewer HCV-related serosorting practices and were more likely to socially and sexually exclude people with HCV than the other groups.

CONCLUSIONS

Findings suggest that HCV education and prevention for gay men may be most effective if tailored according to HIV status. For HIV-positive men, health promotion could focus on specific sexual practices and biological factors linked to HCV transmission, regular HCV testing and better strategies for disclosure of HCV serostatus. For HIV-negative and HIV-untested men, there should be a more general focus on awareness, changing attitudes towards HCV testing and increasing general knowledge around HCV, including evidence of sexual transmission.

Understanding noncompliance with selective donor deferral criteria for high-risk behaviors in Australian blood donors

BACKGROUND

Using a predonation screening questionnaire, potential blood donors are screened for medical or behavioral factors associated with an increased risk for transfusion-transmissible infection. After disclosure of these risks, potential donors are deferred from donating. Understanding the degree of failure to disclose full and truthful information (termed noncompliance) is important to determine and minimize residual risk. This study estimates the prevalence of, and likely reasons for, noncompliance among Australian donors with the deferrals for injecting drug use, sex with an injecting drug user, male-to-male sex, sex worker activity or contact, and sex with a partner from a high-HIV-prevalence country.

STUDY DESIGN AND METHODS

An anonymous, online survey of a nationally representative sample of Australian blood donors was conducted. Prevalence of noncompliance with deferrable risk categories was estimated. Factors associated with noncompliance were determined using unadjusted and adjusted odds ratios.

RESULTS

Of 98,044 invited donors, 30,790 donors completed the survey. The estimated prevalence of overall noncompliance (i.e., to at least one screening question) was 1.65% (95% confidence interval CI, 1.51%-1.8%). Noncompliance with individual deferrals ranged from 0.05% (sex work) to 0.54% (sex with an injecting drug user). The prevalences of the disclosed exclusionary risk behaviors were three to 14 times lower than their estimated prevalence in the general population.

CONCLUSION

The prevalence of noncompliance is relatively low but our estimate is likely to be a lower bound. The selected high-risk behaviors were substantially less common in blood donors compared to the general population suggesting that self-deferral is effective. Nevertheless, a focus on further minimization should improve the blood safety.

At the intersection of marginalised identities: lesbian, gay, bisexual and transgender people's experiences of injecting drug use and hepatitis C seroconversion

Although the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high, we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the well-being of LGBT populations. Although some kinds of drug use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants' understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants' accounts. Drug use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream; enacting LGBT community norms of behaviour; and connection through shared drug use. Participants also described feeling afraid to come out about their drug use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the people who inject drugs (PWID) community. Thus, the combination of being LGBT/living with HIV (a gay disease) and injecting drugs/living with HCV (a junkie's disease) left them in a kind of no-man's-land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health-care for LGBT PWID.

Injecting drug use among gay and bisexual men in Sydney: prevalence and associations with sexual risk practices and HIV and hepatitis C infection

Injecting drug use is commonly reported among gay and bisexual men in Australia. We examined the prevalence and covariates of injecting drug use among men participating in the Sydney Gay Community Periodic Survey between 2004-06 and 2011. In 2004-06, data was collected about which drugs were injected, while in 2011, data was collected about hepatitis C (HCV) and esoteric sexual practices. In 2004-06, 5.6 % of men reported injecting drugs in the previous 6 months; 3.4 % reported methamphetamine injection and 0.4 % heroin injection. In 2011, men who injected drugs were less likely to be employed full-time, and more likely to be HCV-positive, HIV-positive, to have used party drugs for sex, and to have engaged in esoteric sexual practices. The strong associations between injecting drug use, sexual risk practices and blood-borne virus infection suggests the need for combined sexual health and harm reduction services for gay and bisexual men who inject drugs.

Sexually transmissible infections in aging HIV populations

There is limited published research on sexually transmissible infections (STI) among aging HIV populations. The available literature on sexual behaviour and STI among older people with HIV is reviewed here and contrasted with data from older individuals in the general population and from older populations at high risk of HIV. A sizeable minority of older people with HIV continue to engage in higher risk sexual behaviour and thus remain at high risk of STI. There is no clear evidence of a consistent effect of older age on STI rates, clinical presentation or clinical course among HIV-infected populations, although gay men with HIV aged in their 40s or older seem to be at higher risk than younger men of acquiring several STI, including syphilis and lymphogranuloma venereum. STI risks in older people living with HIV need to be regularly assessed. Higher risk sexual behaviour and disproportionately higher rates of STI indicate that regardless of age, a thorough STI assessment should be regularly undertaken for all HIV-positive gay men as part of their routine HIV care.

Sex in Australia: Reflections and recommendations for future research

OBJECTIVE

To review the content, method and process of the Australian Study of Health and Relationships (ASHR).

RESULTS

ASHR achieved a large sample, a high response rate and documented the sexual life histories and current sexual health-related knowledge, attitudes and practices of the Australian population aged 16-59. Its cross-sectional nature limited our ability to partition observed variation between age and time despite clear evidence of both age-related and cohort-related changes in sexual practice. Similarly, its reliance on a sample of individuals reporting on their sexual experiences rather than a sample of sexual relationships or encounters and their participants limits our ability to understand the dynamics of those relationships and encounters. Finally, our understanding of sexuality in Australia could have been improved through qualitative studies with a subsample of ASHR participants.

CONCLUSION

ASHR represents a significant contribution to our understanding of sexual health-related knowledge, attitudes and practices in Australia.

Sexual-risk behaviour, self-perceived risk and knowledge of sexually transmissible infections among young Australians attending a music festival

Background: Prevalences of sexually transmissible infections (STI), unsafe sex and abortions are increasing in Australia and people aged 16 to 29 are particularly at risk. We conducted a survey of behaviour, knowledge and perceptions of STI risk among young people attending a longstanding annual music festival called the Big Day Out. Methods: A structured questionnaire was administered to a cross-sectional sample of people aged 16 to 29 years attending a music festival (Big Day Out). Results: Completed questionnaires were collected from 939 participants (507 females, 432 males) whose median age was 20 years. Of the participants, 751 (80%) had ever had vaginal or anal sex. In the previous year, 48% had multiple partners and in the past 3 months 66% had a new partner. Of these, 224 (39%; 30% of those who had ever had sex) did not use condoms all or most of the time and were classified as being at risk of STI; however, only 24% of those so classified perceived that they were at risk of an STI. In total, 43% of all sexually experienced participants had not used a condom because they reported being drunk or high at the time. STI knowledge was poor overall and male participants, those living in non-metropolitan regions, those under the age of 20 and those with less schooling scored relatively poorly. Conclusions: Our data suggest that young men and women who attend the Big Day Out are sexually active young adults with limited knowledge of STI and blood-borne viruses who regularly engage in behaviours that put them at risk of infection.

Sexual behaviour and risk in Vietnamese men living in metropolitan Sydney

OBJECTIVE

To describe sexual risk in Vietnamese men who have sex with female sex workers by describing the prevalence of sexual risk behaviours among Vietnamese men living in inner Sydney and comparing this prevalence with national data.

METHOD

Telephone interviews were completed with a random sample of 499 Vietnamese men, selected from the electronic telephone book using a list of common Vietnamese surnames.

RESULTS

Of the 761 eligible men contacted, data were obtained from 499 men, giving a response rate of 66%. 20% reported having had sex with a sex worker, including 12% of Vietnamese men who had had sex with a sex worker outside Australia, predominantly in Vietnam. Of the men who had had sex with a sex worker in the past year, 28% had unprotected vaginal or anal sex at their most recent commercial sexual encounter. Ever having paid for sex was significantly associated with a higher lifetime number of sexual partners (p<0.001), history of a sexually transmitted infection (p<0.001) and ever having an HIV test. 1% of respondents reported injecting non-prescription drugs. Less than 1% said they had had sex with another man.

CONCLUSION

Vietnamese men living in Sydney generally show lower levels of sexual and related risk behaviours than other Australian men. However, sex with a sex worker is common among Vietnamese men in Sydney and also when they travel outside Australia. Unprotected vaginal sex with sex workers is surprisingly common. Programmes are needed to deal with vulnerabilities in these areas.

Men who have sex with men (MSM): how much to assume and what to ask?

In Australia, about 150,000 men aged 16-59 years identify as gay or bisexual, while a similar number identify as heterosexual but have some history of same-sex sexual contact. Pitts, Couch and Smith advise that the clinical implications for these men include more than sexual health concerns. They suggest several consultation skills that can help doctors to recognise these men and better meet their needs.

Prevalence and risk factors of hepatitis C in HIV-negative homosexual men in Sydney, Australia

OBJECTIVE

To determine the prevalence and risk factors for hepatitis C (HCV) in HIV-negative homosexual men in Sydney.

METHODS

A cohort study was conducted in a sample of community-based, HIV-negative, homosexual men in Sydney. Participants underwent a face-to-face interview regarding sexual behaviour, sexually transmissible infections, and injecting drug use (IDU).

RESULTS

Eight hundred and twenty-four men consented to HCV testing, and the prevalence was 0.85% (95% CI 0.34-1.74). HCV seropositivity was strongly associated with a history of IDU (OR = 60.43, 95% CI 6.70-544.79). All HCV seropositive individuals reported a history of either IDU or other means by which they may have had parenteral exposure to HCV. There was no evidence of an independent association between sexual behaviour and HCV infection.

CONCLUSION

The prevalence of HCV in this cohort was about the same as in the general population in Australia, and there was no evidence for sexual transmission in this population.

Random digit dialing and directory-based samples in telephone surveys of HIV risk: a comparison from the Australian Study of Health and Relationships

PURPOSE

To compare the estimates of HIV-related risk derived from a sample drawn through random digit dialing and that component of the sample drawn from households listed in a telephone directory.

METHODS

The prevalence of key outcomes, and their 95% confidence intervals, was estimated for the total sample and for that component of the sample drawn from households listed in a telephone directory.

RESULTS

On all outcome measures the sample derived from listed households was more conservative. With few exceptions, the estimates derived from the overall sample and from listed households were not significantly different.

CONCLUSION

A continued reliance on random digit dialing seems unwarranted.