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Preview: Sexual Health

Sexual Health

Recent research papers from the peer-reviewed journal Sexual Health


The development of an online risk calculator for the prediction of future syphilis among a high-risk cohort of men who have sex with men and transgender women in Lima, Peru


Lao-Tzu Allan-Blitz, Kelika A. Konda, Silver K. Vargas, Xiaoyan Wang, Eddy R. Segura, Boris M. Fazio, Gino M. Calvo, Carlos F. Caceres, Jeffrey D. Klausner

The incidence of syphilis has been on the rise since the early 2000s. We aimed to identify factors which might predict future syphilis among high-risk populations and developed an online risk calculator for future infection. The ability to predict future syphilis may inform screening recommendations and other prevention strategies.

Towards a supportive policy and commissioning environment for chemsex in England


Monty Moncrieff

This case review examines some of the steps that have helped formulate a policy response to chemsex in England. It highlights that although the evidence on chemsex and related harms for users is growing, there are still opportunities to improve drug treatment and other support for those negatively impacted by chemsex. It contributes to the literature on developing effective responses to problematic chemsex.

Sexual content in video games: an analysis of the Entertainment Software Rating Board classification from 1994 to 2013


Dèsirée Vidaña-Pérez, Ariela Braverman-Bronstein, Ana Basto-Abreu, Inti Barrientos-Gutierrez, Rainer Hilscher, Tonatiuh Barrientos-Gutierrez

Video games are a source of exposure to sexual content for children and adolescents. We aimed to analyse the trends of sexual content in video games from 1994 to 2013. Our results suggest that sexual content in video games has increased for ratings ‘Teen’ and ‘Mature’. Top selling video games had more sexual content compared to non-top selling games.

Chemsex as edgework: towards a sociological understanding


Ford Hickson

Combining sex and drugs shares many features with other voluntary high risk activities that involve specialist skills and intense sensations. This paper suggests some chemsex is a type of ‘edgework’, an exploration of personal limits when living under conditions of alienation. The consumptive nature of chemsex locates it as a quintessential activity in a sex and drugs ‘shopping culture’.

Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men – results from the Flux Study


Mohamed A. Hammoud, Adam Bourne, Lisa Maher, Fengyi Jin, Bridget Haire, Toby Lea, Louisa Degenhardt, Jeffrey Grierson, Garrett Prestage

Gamma-hydroxybutyrate among gay and bisexual men has increased in recent years, and is accompanied by growing concerns about overdose and HIV risk behaviour. We examined factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use. Use of gamma-hydroxybutyrate to enhance sexual experiences often occurred in the context of sexual risk behaviour and frequent use was associated with overdose.

Gay men's chemsex survival stories


Vivienne Smith, Fiona Tasker

This study considered factors affecting chemsex (the combined use of drugs and sexual experiences) engagement and remission by gay men. Participants’ identified multiple incidents and feelings as contributing to chemsex engagement, and engagement was connected with participants’ gay identity development. Chemsex journeys were perceived to spiral from exciting and exploratory into high-risk activity, but the association of chemsex with a gay identity gain explained participants’ ambivalence to remaining chemsex free.

Sexual transmission of Zika virus: a literature review


Miranda Sherley, Chong-Wei Ong

Diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium: an observational study of testing patterns, prevalence and co-infection rates in northern New Zealand


Arlo Upton, Liselle Bissessor, Peter Lowe, Xiaoying Wang, Gary McAuliffe

We studied community prevalence and testing patterns for sexually transmitted infections in northern New Zealand. After Chlamydia trachomatis, Mycoplasma genitalium was the most common infection detected, though it is not routinely sought. There was a mismatch between testing rates and prevalence of infection in high risk patient groups. We conclude that testing strategies should be altered to better reflect need.

Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service


Yan Cheng, Kevin McGeechan, Deborah Bateson, Todd Ritter, Edith Weisberg, Mary Stewart

STIs are increasing in older people globally. This cross-sectional study investigated STI knowledge, safe sex attitudes and behaviours of heterosexual men using an internet dating service. Results suggested that older men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Comparisons of vaginal flora patterns among sexual behaviour groups of women: implications for the pathogenesis of bacterial vaginosis


Kristin M. Olson, Louis J. Boohaker, Jane R. Schwebke, Stella Aslibekyan, Christina A. Muzny

Among African-American women aged 19–45 years presenting to an STD clinic, women who have sex with women (WSW) and women who have sex with women and men (WSWM) were significantly more likely to have a diagnosis of BV based on Nugent score than women who have sex with men (WSM). Among women with a diagnosis of BV by Nugent score, there was no significant difference in the proportion of women with low-positive and high-positive Nugent scores by sexual behaviour group (WSW, WSWM, WSM). Women who reported participating in receptive vaginal sex within 30 days preceding study enrolment were significantly more likely to have BV.

Concordance between monetary and sexual delay discounting in men who have sex with men


Jeb Jones, Jodie L. Guest, Patrick S. Sullivan, Michael R. Kramer, Samuel M. Jenness, Jessica M. Sales

Delay discounting is a measure of impulsivity, often measured in the context of financial choices, that is associated with multiple health outcomes and might be associated with sexual risk-taking. The current study assessed the concordance between monetary and sexual discount rates. No association was observed between monetary and sexual discount rates suggesting that these are distinct processes.

Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians


Handan Wand, Joanne Bryant, Heather Worth, Marian Pitts, John M. Kaldor, Dea Delaney-Thiele, James Ward

Early age at sexual debut is known to be associated with high-risk sexual behaviours and school dropouts. The present study raised issues regarding the adverse effects of early age at sexual debut on low level of education as well as illicit drug use among young Indigenous men and women in Australia who are disproportionally affected by sexually transmitted infections. Our findings highlight the need for effective school and/or community-based sex education programs.

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


Georgia Freeman, Lucy Watchirs Smith, Anna McNulty, Basil Donovan

This study aimed to identify the different pathways of access to sexual health care and knowledge for university students with sexual health concerns. The Internet was identified as the most common first point of call for health information, followed by doctors. Of those who accessed the Internet, the majority subsequently went to a doctor.

Gender trouble: The World Health Organization, the International Statistical Classification of Diseases and Related Health Problems (ICD)-11 and the trans kids


Sam Winter - Volume 14(5)

WHO is revising its ICD diagnostic manual; the most widely used diagnostic manual worldwide. There is controversy over a proposal for a Gender incongruence of childhood diagnosis targeting young children identifying in a gender other than the one matching the sex they were assigned at birth. The author argues that the proposed diagnosis is unnecessary, potentially harmful, and at odds with WHO’s thinking in regard to other forms of diversity in young people, and that WHO should now abandon the proposal.

Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations


Sarah MacCarthy, Tonia Poteat, Zhiyu Xia, Nicolette L. Roque, Ashley (Hyun Jin) Kim, Stefan Baral, Sari L. Reisner - Volume 14(5)

This systematic review focussed on HIV and STIs among transgender populations globally. The review underscored how more data are needed on how the interaction of individual determinants, including biological risks of transmission, programmatic determinants such as service-delivery models and policy-level determinants including institutionalised stigma in healthcare settings, influence the HIV- and STI-related outcomes of transgender populations.

Legal issues for transgender people: a review of persistent threats


Jamison Green - Volume 14(5)

Transgender people face legal barriers that can affect their physical and mental health. Health care providers’ awareness of the complexities transgender people often grapple with may help providers better identify negative factors affecting their clients or patients and deliver appropriate and timely interventions.

Caring for transgender people: looking beyond the hype


Jason J. Ong, Darren B. Russell, Kevan Wylie - Volume 14(5)

This special issue presents a collection of articles that addresses issues facing transgender individuals that are particularly challenging.

Sexual (dys)functioning is related to drive for thinness, not drive for muscularity


Anandi Alperin, Fiona K. Barlow

Body image problems can impact one’s performance and enjoyment in the bedroom for both genders. This paper examines which body image factors predict these problems, and found that wanting to be thinner was the main cause of dysfunction. This highlights how the promotion of thinness can have far-reaching consequences, affecting not only how we feel about ourselves, but also our interactions and relationships with others.

Blood-borne virus transmission in an urban, culturally diverse neighbourhood: results from a cross-sectional bio-behavioural survey using innovative outreach methods in a hard-to-reach population


Elizabeth Peach, Shelley Cogger, Kat Byron, Penny Francis, Daniel O'Keefe, Peter Higgs, Mark Stoove, Kasey Elmore, Paul Dietze, Margaret Hellard

Substantial increase in yield of Neisseria gonorrhoeae testing 2008–2013 at a Sydney metropolitan sexual health clinic: an observational study


Preethi Rajagopal, Sian L. Goddard, David J. Templeton

A substantial increase in gonorrhoea notifications to public health units in New South Wales has been observed in recent years, but whether this relates to more frequent testing or other factors is unknown. We assessed the proportion of gonorrhoea tests that were positive and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. While the number of tests performed almost double, we observed over a 3-fold increase in the proportion of positive tests from 2.2% in 2008 to 7.1% in 2013. This was observed at all anatomical sites and in all subgroups examined, and rates were highest amongst gay men. More frequent and comprehensive gonorrhoea testing and treatment to interrupt onward transmission to sexual partners could potentially reduce high and increasing rates of gonorrhoea in the community.

Estimating the burden of genital warts in Taiwan


Tsen-Fang Tsai, Smita Kothari-Talwar, Karen Yee, Amit Kulkarni, Nuria Lara, Montserrat Roset, Anna R. Giuliano, Suzanne M. Garland - Volume 14(6)

The genital wart burden in Taiwan was previously unavailable. In this study, the estimated prevalence of genital warts was 1.13%; the highest estimated prevalence was among female patients aged 18–24 years and male patients aged 25–29 years. Median GW costs were substantial, being estimated at US$213.8 for male and US$351.8 for female patients. Our study results provide evidence-based data that will allow for the implementation of measures to reduce genital wart prevalence and psychosocial impact on patients.

Evaluation of knowledge and utility of the 2014 Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men among general practitioners in Sydney


David J. Templeton, Phillipe C. G. Adam, Rajesh Varma, Phillip Read, Chistopher Bourne, Shih-Chi Kao, on behalf of the Sexually Transmissible

Men who have sex with men are disproportionately affected by sexually transmissible infections (STIs) and HIV and guidelines for general practitioners who diagnose the majority of STI/HIV in Australia are essential to ensure appropriate testing in this group. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians and found familiarity with the guidelines was associated with a range of positive outcomes on general practitioners’ clinical practice. Novel approaches are required to ensure more widespread distribution of future guidelines.

Kept clinical visits, as scheduled in the first 6 months of antiretroviral treatment, determine long-term treatment outcomes in people living with HIV: a large retrospective cohort study in China


Shu Su, Limin Mao, Jianmei He, Xiuqing Wei, Jun Jing, Xi Chen, Lei Zhang

This study conducted a retrospective cohort study to investigate the relationship between the first 6 months clinical monitoring status of antiretroviral treatment (ART) initiation and long-term treatment adherence rate and outcomes among people living with HIV (PLHIV). The result shows those completed four scheduled clinical visits in the first six months were at lower risk of mortality and loss to follow-up compared with otherwise during the study period. Factors associated with missed clinical visits included: acquiring HIV through unsafe blood donation or unsafe drug injection, being divorced, and concurrent drug injection without receiving methadone maintenance treatment. This study concluded that enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.

Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive


Richard T. Gray, Jo Watson, Aaron J. Cogle, Don E. Smith, Jennifer F. Hoy, Lisa A. Bastian, Robert Finlayson, Fraser M. Drummond, Bill Whittaker, Matthew G. Law, Kathy Petoumenos

Many HIV-positive temporary residents living in Australia do not have access to subsidised antiretroviral treatment (ART). In this mathematical modelling study, we showed expanding access to subsidised ART to all HIV-positive temporary residents will substantially reduce HIV transmission to their sexual partners at little additional cost. Providing subsidised ART to people with HIV in Australia will remove inequities in the provision of HIV-related treatment and care and help Australia achieve its National HIV Strategy targets.

Transgender women and HIV-related health disparities: falling off the HIV treatment cascade


Seth C. Kalichman, Dominica Hernandez, Stephanie Finneran, Devon Price, Redd Driver - Volume 14(5)

HIV positive transgender women have poorer health outcomes than their cisgender counterparts. Resultsof this study confirm that transgender women are less likely to have suppressed HIV replication, a key indicator of HIV disease progression. Findings from the case-control analyses showed that social support predicts HIV-related health outcomes among transgender women over and above other common correlates of health disparities.