Publications by authors named "Victor Minichiello"

69 Publications

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review.

Sex Transm Infect 2021 Mar 29. Epub 2021 Mar 29.

University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.

Objectives: The COVID-19 pandemic has exposed and exacerbated existing socioeconomic and health disparities, including disparities in sexual health and well-being. While there have been several reviews published on COVID-19 and population health disparities generally-including some with attention to HIV-none has focused on sexual health (ie, STI care, female sexual health, sexual behaviour). We have conducted a scoping review focused on sexual health (excluding reproductive health (RH), intimate partner violence (IPV) and gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours and sexual health outcomes.

Methods: A scoping review, compiling both peer-reviewed and grey literature, focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted on 15 September 2020. Multiple bibliographical databases were searched. Study selection conformed to Joanna Briggs Institute (JBI) Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. We only included English-language original studies.

Results: We found that men who have sex with men may be moving back toward pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem to have decreased. There was minimal focus on outcomes such as the economic impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI care of marginalised populations. In terms of population groups, there was limited focus on sex workers or on women, especially women's sexual behaviour and mental health. We noticed limited use of qualitative techniques. Very few studies were in low/middle-income countries (LMICs).

Conclusions: Sexual health research is critical during a global infectious disease pandemic and our review of studies suggested notable research gaps. Researchers can focus efforts on LMICs and under-researched topics within sexual health and explore the use of qualitative techniques and interventions where appropriate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/sextrans-2020-054896DOI Listing
March 2021

Sexual health and COVID-19: protocol for a scoping review.

Syst Rev 2021 01 23;10(1):37. Epub 2021 Jan 23.

University of North Carolina at Chapel Hill, Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.

Background: Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none has focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era.

Methods: A scoping review focusing on sexual health and COVID-19 will be conducted. We will search (from January 2020 onwards) CINAHL, Africa-Wide Information, Web of Science Core Collection, Embase, Gender Studies Database, Gender Watch, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, MEDLINE, and Sociological Abstracts. Grey literature will be identified using Disaster Lit, Google Scholar, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov , World Health Organization, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trial Number Registry). Study selection will conform to the Joanna Briggs Institute Reviewers' Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods.

Discussion: Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap.

Systematic Review Registrations: Systematic Review Registration: Open Science Framework osf/io/PRX8E.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13643-021-01591-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825389PMC
January 2021

Volunteering among Older Lesbian and Gay Adults: Associations with Mental, Physical and Social Well-Being.

J Aging Health 2021 Jan 28;33(1-2):3-13. Epub 2020 Aug 28.

289795COTA Australia, Australia.

Volunteering is associated with positive well-being among older people, providing opportunities to stay active and socially connected. This may be especially relevant for older lesbian and gay people, who are less likely than heterosexual people to have a partner, children or support from their family of origin. Patterns of volunteering and mental, physical and social well-being were examined in a sample of 754 lesbian and gay adults in Australia aged 60 years and older who completed a nationwide survey. Volunteers reported greater positive mental health than non-volunteers. Among the gay men, volunteers additionally reported higher self-rated health and social support and lower psychological distress. Both the lesbian women and gay men who volunteered for lesbian, gay, bisexual, transgender or intersex (LGBTI) organisations also reported greater LGBTI community connectedness than volunteers for non-LGBTI organisations. These findings provide further insight into potential factors associated with the well-being of older lesbian and gay adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0898264320952910DOI Listing
January 2021

Sex workers are returning to work and require enhanced support in the face of COVID-19: results from a longitudinal analysis of online sex work activity and a content analysis of safer sex work guidelines.

Sex Health 2020 08;17(4):384-386

Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY 10032, USA.

Sex workers confront unique challenges in the face of COVID-19. Data from an international sex work website popular with cisgender men and transgender men and women suggest that, after a period of physical distancing, many sex workers are returning to in-person work: from May to August 2020, active sex work profiles increased 9.4% (P < 0.001) and newly created profiles increased by 35.6% (P < 0.001). Analysis of sex work and COVID-19 guidelines published by five community-based organisations found that they focused on altering sexual practices, enhancing hygiene and pivoting to virtual work. To capitalise on these guidelines, funding and research for implementation and evaluation are needed to support COVID-19 risk reduction strategies for sex workers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/SH20128DOI Listing
August 2020

Older lesbian and gay adults' perceptions of barriers and facilitators to accessing health and aged care services in Australia.

Health Soc Care Community 2020 Aug 5. Epub 2020 Aug 5.

Silver Rainbow, National LGBTI Health Alliance, Sydney, NSW, Australia.

Older lesbian and gay people can face considerable marginalisation, which may affect their perceptions and experiences of accessing health and aged care services. To inform strategies promoting accessibility, this study aimed to investigate perceived barriers and facilitators to health and aged care service access among older lesbian and gay adults. A sample of 752 cisgender lesbian women and gay men aged 60 years and older living in Australia responded to questions on a broad range of potential barriers and facilitators to service access. Several barriers and facilitators were commonly reported, with some differences between the women and the men. LGBTI inclusiveness was among commonly reported concerns. A majority of participants reported a lack of LGBTI-inclusive service providers and professionals as a barrier. A majority also reported a perceived lack of professionals adequately trained and competent to work with LGBTI individuals, with significantly more women than men indicating this as a barrier. Almost all participants indicated LGBTI-inclusive mainstream services as a facilitator for access. In all, inclusiveness appears to be a key issue for service access among older lesbian and gay people, which may need to be further addressed by service providers and policy makers for improving service accessibility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hsc.13125DOI Listing
August 2020

Talking about sex with friends: perspectives of older adults from the study in Australia.

Cult Health Sex 2021 Mar 1;23(3):367-382. Epub 2020 Jul 1.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.

This qualitative study explored the barriers and facilitators to sexual communication between older adults and friends. Fifty-three women and men aged 58 and older were interviewed about their intimate relationships and sexual behaviours and attitudes. Findings indicated that talking about sex with friends played an important role in providing support and sharing information. The privacy of the topic meant that trust and confidentiality had to be in place before sexual conversations occurred, and that discretion was required for those married or in a relationship due to potential breaches of privacy. Stereotypes associated with older age made talking about sex 'risky' as participants were vulnerable to scrutiny. Growing-up during a time when sex was taboo influenced willingness and comfort in talking about sex today. Among those who did talk with friends, women tended to talk to women and men to men. These findings are significant in the context of an increasing global population of older adults and silence around sex and ageing. By exploring sexual communication outside of the healthcare context, where previous research has focused, the findings indicate novel ways to support the sexual health and well-being of older adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2019.1710568DOI Listing
March 2021

Investigating the effects of COVID-19 on global male sex work populations: a longitudinal study of digital data.

Sex Transm Infect 2021 03 26;97(2):93-98. Epub 2020 Jun 26.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

Objectives: Recommendations of 'social distancing' and home quarantines to combat the global COVID-19 pandemic have implications for sex and intimacy, including sex work. This study examined the effects of COVID-19 on male sex work globally and investigated how men who sold sex responded to and engaged with the virus in the context of work.

Methods: This study made use of an existing database of deidentified data extracted from the online profiles maintained by male sex workers on a large, international website. Website engagement metrics were calculated for the periods before (September to December 2019) and during COVID-19 (January to May 2020); Poisson regression analyses were used to assess changes over time before and after, while a content analysis was undertaken to identify modes of engagement with the virus.

Results: Data were collected from 78 399 profiles representing 19 388 individuals. In the 'before' period, the number of active profiles was stable (inter-rate ratio (IRR)=1.01, 95% CI 0.99 to 1.01, p=0.339) but during COVID-19 decreased by 26.3% (IRR=0.90, 95% CI 0.89 to 0.91, p<0.001). Newly created profiles also decreased during COVID-19 (59.4%; IRR=0.71, 95% CI 0.69 to 0.74, p<0.001) after a period of stability. In total, 211 unique profiles explicitly referenced COVID-19; 185 (85.8%) evoked risk reduction strategies, including discontinuation of in-person services (41.2%), pivoting to virtual services (38.9%), COVID-19 status disclosure (20.9%), enhanced sanitary and screening requirements (12.3%) and restricted travel (5.2%). Some profiles, however, seemed to downplay the seriousness of COVID-19 or resist protective measures (14.7%).

Conclusions: These findings support the contention that COVID-19 has dramatically impacted the sex industry; globally, male sex workers may be facing considerable economic strain. Targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies. Those involved with the sex industry must have access to state-sponsored COVID-19 financial and other aid programmes to support individual and public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/sextrans-2020-054550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371479PMC
March 2021

Comfort Among Older Lesbian and Gay People in Disclosing Their Sexual Orientation to Health and Aged Care Services.

J Appl Gerontol 2021 Feb 1;40(2):132-141. Epub 2020 Jun 1.

La Trobe University, Melbourne, Victoria, Australia.

Being comfortable in disclosing one's sexual orientation to health and aged care providers is important for older lesbian and gay adults, given that nondisclosure is associated with poorer health and well-being outcomes. In a sample of 752 lesbian and gay adults aged 60 years and older living in Australia, we found only 51% of lesbian women and 64% of gay men felt fully comfortable to disclose their sexual orientation to health and aged care service providers. For both the women and the men, those who felt fully comfortable to disclose reported significantly less internalized homophobia; had fewer experiences of discrimination in the past year; and reported greater lesbian, gay, bisexual, transgender, and intersex (LGBTI) community connectedness. Feeling fully comfortable was also predicted by fewer experiences of lifetime discrimination among the men. These findings may help those seeking to assist older lesbian and gay people in feeling comfortable and being open with health and aged care service providers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0733464820925330DOI Listing
February 2021

Mental health and identity adjustment in older lesbian and gay adults: Assessing the role of whether their parents knew about their sexual orientation.

Aging Ment Health 2020 May 13:1-8. Epub 2020 May 13.

Ageing with Pride, Sydney, Australia.

Research suggests that lesbian and gay people's disclosure of their sexual orientation to parents is associated with better mental health and identity adjustment. However, adolescents and younger adults have been the main focus with little known about the experiences of older people. The following study focused on older lesbian and gay adults, and examined whether believing that their parents knew about their sexual orientation is linked to better current mental health and identity adjustment. A survey of 548 lesbian and gay adults aged 60 years and older in Australia measured psychological distress, positive mental health, internalised homonegativity, sexual identity affirmation, and whether participants believed their parents knew about their sexual orientation After controlling for age of first disclosure, whether their parents were alive, and socio-demographic variables, women who reported at least one parent definitely knowing of their sexual orientation were significantly lower on psychological distress and higher on positive mental health and identity affirmation than those who reported neither parent knowing or were uncertain of their parents' knowledge. No significant effects were found for the men. Believing that at least one parent definitely knew about their sexual orientation was linked to better mental health outcomes among lesbian women, but not among older gay men. These findings reveal a potential risk factor for poorer mental health among older lesbian women, as well as important gender differences, and may be useful in understanding and supporting the well-being of older lesbian and gay adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13607863.2020.1765314DOI Listing
May 2020

Older lesbian and gay men's perceptions on lesbian and gay youth in Australia.

Cult Health Sex 2021 Feb 19;23(2):143-158. Epub 2020 Feb 19.

The National LGBTI Health Alliance, Sydney, New South Wales, Australia.

Older lesbian and gay people are increasingly open about their sexuality but have also experienced a lifetime of discrimination. These groups have experienced a long history of changes to lesbian and gay rights, and many were also at the forefront of activist movements during the latter half of the 20th century. A deeper knowledge is needed of the life experiences of these groups, including how they view their lives in relation to younger lesbian and gay people. This would assist agencies working with older lesbian and gay people, such as health and support services, to provide more informed engagement, support, understanding, and culturally safe services. Drawing on 33 qualitative interviews with older (60+ years) lesbian and gay people, we explored their experiences during their younger years and their perspectives on how these experiences compare with those of younger lesbian and gay people today. Our findings note that older lesbian and gay people feel life is, in some ways, easier, and in others, still challenging for young lesbian and gay people, and they articulate a need for mutual respect across age groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2019.1696984DOI Listing
February 2021

Health, well-being, and social support in older Australian lesbian and gay care-givers.

Health Soc Care Community 2020 01 13;28(1):204-215. Epub 2019 Sep 13.

Silver Rainbow, National LGBTI Health Alliance, Sydney, NSW, Australia.

Informal care-givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care-giver is known to be associated with poorer health and well-being, and lesbian and gay care-givers report experiences of stigma and discrimination in the care-giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care-givers. We compared care-givers to non-caregivers on a range of health and well-being measures, including psychological distress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care-givers who were caring for an LGBTI person to those who were caring for a non-LGBTI person. Among the lesbian women, care-givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indicators. Among the gay men, care-givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well-being compared to those caring for a non-LGBTI person. Overall, results from this study suggest that older lesbian and gay care-givers may be facing some challenges related to their well-being and feeling supported, especially if they are caring for another LGBTI person.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hsc.12854DOI Listing
January 2020

How Male Sex Workers and Their Clients Shifted from Reluctance About HIV Pre-exposure Prophylaxis to Advocating for Its Use: A Longitudinal Mixed Methods Study.

AIDS Behav 2020 Mar;24(3):782-790

Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, UNSW, High Street, Kensington, NSW, 2052, Australia.

We assessed individual and collective responses to HIV pre-exposure prophylaxis ('PrEP') among a network of male sex workers and clients. From 2011 to May 2017, keyword searches on an online discussion forum identified 668 posts that referenced PrEP. We conducted four analyses: (i) discourse analysis identifying reactions to PrEP, (ii) thematic analysis constructing rhetorical strategies, (iii) content analysis comparing discursive positions and rhetorical strategies, and (iv) longitudinal analyses assessing trends over time. Forum posts adopted one of three discursive positions (reluctance, interest, advocacy), drawing upon four non-exclusive strategies (deference to experts and evidence, acknowledging personal and shared experiences, establishing philosophical arguments, engaging in speculation). Posts from sex workers were more likely than clients to be supportive of PrEP (96% vs. 42%; χ = 18.46, p < 0.001) while over time this network moved from being predominantly reluctant about PrEP (61% of posts in 2012) to advocating for its use (65% of posts in 2017; Z = 5.01, p < 0.001).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10461-019-02618-1DOI Listing
March 2020

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.

Health Soc Care Community 2019 09 22;27(5):1251-1259. Epub 2019 Apr 22.

National LGBTI Health Alliance, Sydney, NSW, Australia.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential-care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential-care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hsc.12760DOI Listing
September 2019

Developmental regulation of lifelong dental experiences and beliefs in Guangzhou and Hong Kong.

Gerodontology 2019 Mar 14;36(1):18-29. Epub 2018 Dec 14.

Cooperative Research Centre for Oral Health Science Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia.

Aims: The aim of this study was to explain through the life-course and life-span perspectives of developmental regulation theory the controls on dental experiences and beliefs throughout the lives of older people in Guangzhou and Hong Kong.

Background: Dental diseases and disabilities among older people are serious public health concerns in China.

Methods: A facilitator conducted eight focus groups, three in Hong Kong and five in Guangzhou, involving a total of 51 participants. She encouraged discussions about lifetime events to explain dental experiences and beliefs. Transcripts were coded and analysed using a constant comparative approach to identify themes that explained the regulators of dental experiences throughout the participants' lives.

Results: Participants explained the influence of culture and history through critical events, and how external and internal factors regulated their current oral health status and beliefs. They emphasised the role of Traditional Chinese Medicine and family, and the stress of social upheaval compounded by a scarcity of dental services. They revealed also how current choice of dental services and health promotional programs, helped by personal food choice, self-reliance, and scepticism, helped them to adjust and cope with dental diseases and disabilities and the commercialisation of dental services.

Conclusions: Dental experiences and beliefs of older people living in Guangzhou and Hong Kong were regulated strongly during personal development by culture and history during critical events, and by various controlling factors, such as health promotion and choice of services supplemented by food choice, nutritional balance, self-reliance, scepticism and social adjustments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ger.12383DOI Listing
March 2019

Resilience strategies of HIV-positive parents who live with children within the family context in Bangladesh.

AIDS Care 2019 03 16;31(3):310-313. Epub 2018 Aug 16.

d Faculty of Law, School of Justice , Queensland University of Technology , Brisbane , Queensland , Australia.

We have limited knowledge about the vulnerabilities faced by HIV-positive parents in families and the strategies they use to manage these circumstances in Bangladesh. A qualitative research design was used to analyse in-depth interviews with 19 HIV-positive parents who lived with their children in Khulna and Dhaka, Bangladesh. The findings indicate that resilience of HIV-positive parents was fostered through interaction with informal and formal social networks. The findings of this study demonstrate that social support groups can play a crucial role to construct new ways of coping and reintegrate HIV people into their families and society.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09540121.2018.1510104DOI Listing
March 2019

Sexual Satisfaction Among Older Australian Heterosexual Men and Women: Findings from the Sex, Age & Me Study.

J Sex Marital Ther 2018 Apr 8;44(3):295-307. Epub 2017 Sep 8.

f National Ageing Research Institute , Melbourne , Australia.

This study explored sexual satisfaction in older heterosexual Australians using data from a national sample of 1,583 men and women aged 60+ who hoped or planned to have sex in the future. Data collection took place in 2015; participants were recruited using a variety of online and offline advertisements. Less than half the sample (46%) reported they were very or extremely satisfied with their sexual lives. Those who had sex more often and were more interested in sex were more likely to be satisfied, while those who wanted sex more often in the future were less likely to be satisfied, as were men who had experienced sexual difficulties. Sexual satisfaction was also associated with life satisfaction in men and positive mental health in women. Factors associated with satisfaction in this study will help guide strategies to support older people in realizing the sexual lives they desire.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/0092623X.2017.1366959DOI Listing
April 2018

Experiences of ageism and the mental health of older adults.

Aging Ment Health 2018 11 10;22(11):1456-1464. Epub 2017 Aug 10.

g National Ageing Research Institute , Parkville , Australia.

Objectives: This article examines relationships between experiences of ageism and four specific mental health outcomes among older Australian adults, including whether these relationships vary depending on age, gender, and sexual orientation.

Methods: A survey was conducted nationwide involving 2137 participants aged 60 years and older. Mental health variables included depressive symptoms, anxious symptoms, general stress, and positive mental health or flourishing.

Results: Recent experiences of ageism were found to be strongly related to poorer mental health on all four mental health variables. However, experiences of ageism appeared to have a greater effect on the mental health of those who were younger in age (specifically depression), of men more so than women (specifically depression), and of those who identified as heterosexual as opposed to other sexual orientations (specifically general stress).

Conclusion: These findings suggest that experiences of ageism may be an important factor in the health and well-being of older adults, especially for those who are younger, male, and heterosexual, and may need to be taken into account when devising strategies for supporting healthier and happier ageing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13607863.2017.1364347DOI Listing
November 2018

Talking to healthcare providers about sex in later life: Findings from a qualitative study with older Australian men and women.

Australas J Ageing 2017 Dec 22;36(4):E50-E56. Epub 2017 Jun 22.

Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.

Objective: Healthcare providers (HCPs) can play an important role in supporting the sexual health of older adults; however, we know little about the experiences of older people in talking to HCPs about sex. This article examines older adults' experiences and perceptions of talking to HCPs about sex.

Methods: Semi-structured interviews were conducted with 30 men and 23 women aged 60 and older recruited from a national, online survey of older Australians. Data were analysed using a thematic approach.

Results: Most participants did not discuss sex with their HCP, and their HCP did not raise it. For those who did discuss sex with a HCP, negative and stigmatising responses were common. Positive responses could facilitate access to sexual health care.

Conclusion: Older people benefit when HCPs are proactive and ask about sexual health. Education in how to talk about sex with older people would also be beneficial for HCPs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajag.12450DOI Listing
December 2017

Effect of attitudes towards patients on sexual history taking: a survey of Iranian-American physicians in California, USA.

Sex Health 2017 11;14(6):514-522

Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, California, 92350, USA (Retired).

Background: Although obtaining sexual history from patients is essential, the attitudes of physicians can become a barrier to sexual health care. Iranian-American physicians may face particular challenges because talking about sexuality is considered a taboo within their culture. Our study examined these physicians' attitudes when taking a sexual history from their patients.

Methods: In 2013, a self-administrated questionnaire was sent to 1550 Iranian-American physicians in California, USA. Using factor analysis, the principal components approach with a Varimax rotation was used on a set of 12-item questions (five-point Likert scales) to detect latent factors that explain attitudes affecting sexual history taking. Scores are generated to determine physicians' attitudes towards sexual history taking.

Results: In total, 354 questionnaires were returned (23% response rate). Three factors were identified as internally consistent (Cronbach's α=0.84 - 0.94): (1) attitude towards various patients; (2) female sexuality; and (3) age and marriage. Significant association were found between these three factors and some variables such as physicians' gender, country of medical graduation, religion, birthplace and age.

Conclusions: Results revealed that cultural attitudes are important factors affecting physicians' involvement in sexual history taking. Additional studies from this population and other subpopulations of US physicians are needed. New strategies that reflect on physicians' attitude on sexual healthcare delivery is needed. If confirmed in other studies, our findings could have implications for the training of medical graduates globally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/SH17016DOI Listing
November 2017

Improving the sexual lives of older Australians: Perspectives from a qualitative study.

Australas J Ageing 2017 Dec 3;36(4):E36-E42. Epub 2017 Apr 3.

Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.

Objective: To examine older Australian's perspectives on how their sexual lives can best be supported and/or improved.

Methods: Fifty-three, semi-structured interviews were conducted with Australian men (n = 30) and women (n = 23) aged 60 and over.

Results: Participants identified a range of key issues and areas where their sexual lives could be further supported or improved upon, including normalising the occurrence of sex and sexual desire in later life; increasing and improving on the quality of, cultural representations of older adults; introducing policy, educational and practice-based changes in age care facilities to support the consensual sexual expression of residents; and ensuring that sexual health campaigns and education are inclusive of older people.

Conclusion: Our findings present clear implications for further developing sexuality education and public health campaigns, training and education of health-care professionals, and generating social and cultural change pertaining to the acceptability of the diversity of sexual expression in later life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajag.12405DOI Listing
December 2017

The Importance of Sex and the Meaning of Sex and Sexual Pleasure for Men Aged 60 and Older Who Engage in Heterosexual Relationships: Findings from a Qualitative Interview Study.

Arch Sex Behav 2017 Oct 15;46(7):2097-2110. Epub 2017 Mar 15.

Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.

That many older individuals continue to engage in various forms of sexual expression well into later life is now well established in the literature. To date, however, only a small body of qualitative research has examined older men's experiences and understandings of sex in later life. Likewise, the ways in which older men's discussions on sex may be used as an avenue for "doing" masculinity remain underexplored. Older men are particularly interesting in this regard, as they inhabit an increasingly subordinated position in relation to hegemonic masculine ideals because of their age. To what extent might this limit or, alternatively, open up the possibilities for sexual expression and subjectivity in later life? Drawing on a subset of findings from Sex, Age, and Me: A National Study with Australian Women and Men Aged 60 and Older, data from qualitative interviews with 27 Australian men were explored in this article. The first Australian study of its kind, we argue that older men who engage in heterosexual relationships draw on a diverse and complex array of discursive positions regarding sex, relationships, and masculinity in making sense of their experiences of sex in later life. Older men are a heterogeneous group, and their experiences and understandings of sex do not simplistically follow "decline" or "success" narratives of aging. The findings of this research build upon and extend emerging research illustrating the centrality of intimacy to older men's sexual lives, while simultaneously highlighting the ways in which the body and discursive constructions of sex intersect to shape older men's sexual subjectivities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10508-016-0918-9DOI Listing
October 2017

Safer Sex in Later Life: Qualitative Interviews With Older Australians on Their Understandings and Practices of Safer Sex.

J Sex Res 2018 Feb 23;55(2):164-177. Epub 2017 Feb 23.

a Australian Research Centre in Sex, Health, and Society.

Rates of sexually transmitted infections (STIs) are increasing in older cohorts in Western countries such as Australia, the United Kingdom, and the United States, suggesting a need to examine the safer sex knowledge and practices of older people. This article presents findings from 53 qualitative interviews from the study Sex, Age, and Me: A National Study of Sex and Relationships Among Australians Aged 60+. Participants were recruited through an online national survey. We consider how participants understood "safer sex," the importance of safer sex to them, the safer sex practices they used (and the contexts in which they used them), and the barriers to using safer sex. Older adults had diverse understandings, knowledge, and use of safer sex practices, although participants tended to focus most strongly on condom use. Having safer sex was strongly mediated by relationship context, trust, perceived risk of contracting an STI, concern for personal health, and stigma. Common barriers to safer sex included erectile difficulties, embarrassment, stigma, reduced pleasure, and the lack of a safer sex culture among older people. The data presented have important implications for sexual health policy, practice, and education and health promotion campaigns aimed at improving the sexual health and well-being of older cohorts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00224499.2017.1280121DOI Listing
February 2018

The Sex, Age, and Me study: recruitment and sampling for a large mixed-methods study of sexual health and relationships in an older Australian population.

Cult Health Sex 2017 Sep 21;19(9):1038-1052. Epub 2017 Feb 21.

a Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia.

Older people are often excluded from large studies of sexual health, as it is assumed that they are not having sex or are reluctant to talk about sensitive topics and are therefore difficult to recruit. We outline the sampling and recruitment strategies from a recent study on sexual health and relationships among older people. Sex, Age and Me was a nationwide Australian study that examined sexual health, relationship patterns, safer-sex practices and STI knowledge of Australians aged 60 years and over. The study used a mixed-methods approach to establish baseline levels of knowledge and to develop deeper insights into older adult's understandings and practices relating to sexual health. Data collection took place in 2015, with 2137 participants completing a quantitative survey and 53 participating in one-on-one semi-structured interviews. As the feasibility of this type of study has been largely untested until now, we provide detailed information on the study's recruitment strategies and methods. We also compare key characteristics of our sample with national estimates to assess its degree of representativeness. This study provides evidence to challenge the assumptions that older people will not take part in sexual health-related research and details a novel and successful way to recruit participants in this area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13691058.2017.1288268DOI Listing
September 2017

Sexually active older Australian's knowledge of sexually transmitted infections and safer sexual practices.

Aust N Z J Public Health 2017 Jun 28;41(3):259-261. Epub 2017 Feb 28.

Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Victoria.

Objective: Rates of sexually transmitted infections (STIs) are rising among older Australians. We conducted a large survey of older people's knowledge of STIs and safer sexual practices.

Methods: A total of 2,137 Australians aged 60 years and older completed the survey, which included 15 questions assessing knowledge of STIs and safer sexual practices. We examined both levels of knowledge and factors associated with an overall knowledge score.

Results: In total, 1,652 respondents reported having sex in the past five years and answered all knowledge questions. This group had good general knowledge but poorer knowledge in areas such as the protection offered by condoms and potential transmission modes for specific STIs. Women had better knowledge than men. Men in their 60s, men with higher education levels, and men who thought they were at risk of STIs reported better knowledge than other men. Knowledge was also better among men and women who had been tested for STIs or reported 'other' sources of knowledge on STIs.

Conclusions: Many older Australians lack knowledge of STIs and safer sexual practices. Implications for public health: To reverse current trends toward increasing STI diagnoses in this population, policies and education campaigns aimed at improving knowledge levels may need to be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1753-6405.12655DOI Listing
June 2017

Self-reported testing and treatment histories among older Australian men and women who may be at risk of a sexually transmissible infection.

Sex Health 2017 04;14(2):139-146

Australian Research Centre in Sex, Health and Society; School of Psychology and Public Health; La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.

Background: Rates of sexually transmissible infections (STIs) are increasing among older adults in many countries. Little is known about the testing and treatment histories of these populations. Correlates of testing in the past 5 years among older adults who may be at risk of a STI were examined.

Methods: A cross-sectional survey of 2137 Australians aged 60+ years that involved questions on STIs and STI testing was conducted in 2015. To help inform potential education campaigns, analyses focused on those who may have been at risk of a STI (n=805, 38%).

Results: Less than one in three reported a STI test in the past 5 years (n=241, 30%) while 6% (n=51) reported a STI diagnosis. Those diagnosed typically received treatment from a family doctor or general practitioner. Among men, lower testing rates were associated with older age, identifying as heterosexual, lower educational attainment, not using online dating and reporting one partner in the past 5 years. For women, lower rates of testing were found among those who did not use a condom at their most recent sexual encounter and those with one partner in the past 5 years.

Conclusions: STI testing rates were low. This study indicates that consideration should be given to the way targeted education campaigns are formulated, such as emphasising the importance of STI testing to older people who are at risk, as well as encouraging healthcare professionals to discuss sexual health with their older patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/SH16075DOI Listing
April 2017

A Global Overview of Male Escort Websites.

J Homosex 2017 28;64(12):1731-1744. Epub 2016 Nov 28.

c School of Justice , Queensland University of Technology , Brisbane , Australia.

This article details a preliminary dataset of global male escort sites to give insight into the scale of the online market. We conducted a content analysis of 499 Web sites and also measured traffic to these sites. Our analysis examined the structural characteristics of escort services, geographical and regulatory contexts, and resilience of such services. Results suggest that most sites are independent and not affiliated to escort agencies, and the majority cater to male escorts soliciting male clients, with a number of sites for female clientele and couples. These Web sites are dispersed globally, with Asian, European, and South American countries the major hubs in the market and a small number of large multinational sites based in the United States and Europe figuring as a major presence in markets. Although still subject to high levels of regulation in many parts of the world, the data suggest that male escorting is becoming more visible in diverse cultural contexts as measured by the number of Web sites appearing in public spaces.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00918369.2016.1265356DOI Listing
November 2017

A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics.

Sex Transm Infect 2017 06 2;93(4):299-302. Epub 2016 Sep 2.

The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.

Objectives: Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers.

Methods: From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ and multiple logistic regression analyses were used to compare the prevalence of HIV and STIs among men attending these services who did and did not report sex work in the 12 months prior to consultation. All analyses were restricted to men who reported sex with other men and to each patient's first consultation at participating services.

Results: In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics; 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis.

Conclusions: These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/sextrans-2016-052578DOI Listing
June 2017

Barriers to sexual health care: a survey of Iranian-American physicians in California, USA.

BMC Health Serv Res 2016 07 15;16:263. Epub 2016 Jul 15.

Department of Biostatistics and Epidemiology, Loma Linda University, School of Public Health, Loma Linda, USA.

Background: Despite increasing numbers of Iranian-American physicians practicing in the United States, little is known about the barriers that may impact them as providers of sexual health care. This is an important topic as discussions of sexual topics are generally considered a taboo among Iranians. We aimed to identify barriers experienced by Iranian-American physicians that inhibit their willingness to engage in discussions of sexual health care with patients.

Methods: In 2013, a self-administrated questionnaire was sent to 1,550 Iranian-American physicians in California. Questions included demographics of the physicians as well as their perception of challenges in discussing various sexual health topics with their patients. Factor analysis: Principal components approach with a Varimax rotation was used to detect latent factors within the data that may help explain possible barriers to discussion of sexual health among physicians. The analysis was performed on 11 items, specifically focused on possible barriers, to detect a possible relationship between correlated variables within the data to produce a set of uncorrelated variables (factors).

Results: The overall response rate was 23 %. Data revealed specific barriers regarding sexual history taking, discussing STIs and sexual dysfunctions with patients based on their gender, and age. Three factors were identified as internally consistent (Cronbach's alpha = 0.82 to 0.91): (i) embarrassment, (ii) cultural and religious, (iii) lack of time and financial constraint. Significant associations were found between these 3 factors and some variables such as: country of medical graduation, religious affiliation, birthplace, age, and gender.

Conclusions: Our findings are the first to identify possible barriers among Iranian-American physicians in delivering effective sexual health care to patients. Additional studies from Iranian-American physicians as well as from other foreign-born/subpopulation of US physicians populations and mainstream US physicians are needed to assess the extent of such barriers, and changes over time. Effective strategies to better engage such physicians in these studies are needed. If confirmed from other studies, our findings could have implications for the training of US medical graduates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-016-1481-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946137PMC
July 2016

A qualitative exploration of parental experiences of stigma while living with HIV in Bangladesh.

AIDS Care 2016 17;28(2):247-9. Epub 2015 Aug 17.

c The Australian Research Centre in Sex, Health and Society , La Trobe University , Melbourne , Australia.

With much of the focus on the "risk" groups, families have often been less studied in HIV research. Further, because of a focus on the aetiology and epidemiology of HIV, the social impacts associated with HIV on families and neighbours are sometimes overlooked. This study examined parental experiences of stigma and discrimination while living with HIV within a family context in Bangladesh. A qualitative research design using a grounded theory approach was used for this research. Data was collected through in-depth interviews with 19 HIV-positive parents, recruited with the support of two self-help groups of HIV-positive people, in two settings namely Khulna and Dhaka in Bangladesh. The findings indicate that HIV-positive parents held the view that they continue to experience significant stigma and their narratives clearly show how this affected them and their children. A range of informal practices were enacted in everyday contexts by extended family and community members to identify, demarcate and limit the social interaction of HIV-positive parents. Parents highlighted a number of factors including negative thoughts and behaviours, rejection, isolation and derogatory remarks as manifestations of stigma and discrimination, impacting upon them and their children because of their association with HIV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09540121.2015.1074651DOI Listing
April 2018