Pap smear rates among Australian community-attached lesbian and bisexual women: some good news but disparities persist

Background: Research in the US and UK shows lesbian women are less likely than their heterosexual peers to attend for routine Pap smear tests. This study examined Pap smear test rates among community-attached lesbian, bisexual and queer (LBQ) women in New South Wales, to investigate if rates had changed between 2002 and 2012, compare rates to the general NSW population and identify predictive factors for Pap smear test attendance. Method: Data was taken from the Sydney Women and Sexual Health (SWASH) survey, a self-completed biennial questionnaire of LBQ women’s health and wellbeing. Results: Of the 4083 respondents, 83% had ever had a Pap smear test. Recent attendance rates were slightly higher than the general population. Significant predictors for ever having attended for a Pap smear test were older age, post-year 12 education, ever having had an STI test, being out about sexuality to a regular doctor and ever having had sex with men. Conclusions: Pap smear rates for LBQ women are encouraging when compared to rates in similar countries. A significant proportion of LBQ women are never receiving Pap smear tests. Predictive factors suggest a continued perception that women who have not had sex with men are not at risk of HPV, and highlight the importance of health providers providing a safe and welcoming environment for LBQ women to openly discuss their health.ACON (NSW’s largest community-based gay, lesbian, bisexual and transgender health and HIV/AIDS organisatio

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

While 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 wellbeing of LGBT populations. While 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 PWID community. Thus the combination of being LBGT/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 people who inject drugs. Key words: Hepatitis C; HIV; Drug Use; Sexuality; Culturally-appropriate; health car

Confirmation of co-denitrification in grazed grassland

peer-reviewedPasture-based livestock systems are often associated with losses of reactive forms of nitrogen (N) to the environment. Research has focused on losses to air and water due to the health, economic and environmental impacts of reactive N. Di-nitrogen (N2) emissions are still poorly characterized, both in terms of the processes involved and their magnitude, due to financial and methodological constraints. Relatively few studies have focused on quantifying N2 losses in vivo and fewer still have examined the relative contribution of the different N2 emission processes, particularly in grazed pastures. We used a combination of a high 15N isotopic enrichment of applied N with a high precision of determination of 15N isotopic enrichment by isotope-ratio mass spectrometry to measure N2 emissions in the field. We report that 55.8 g N m−2 (95%, CI 38 to 77 g m−2) was emitted as N2 by the process of co-denitrification in pastoral soils over 123 days following urine deposition (100 g N m−2), compared to only 1.1 g N m−2 (0.4 to 2.8 g m−2) from denitrification. This study provides strong evidence for co-denitrification as a major N2 production pathway, which has significant implications for understanding the N budgets of pastoral ecosystems.The authors are grateful for the funding that was provided through the Research Stimulus Fund Program administered by the Department of Agriculture & Food under the National Development Plan 2007–2013 RSF 07536. The first author is grateful for the funding provided by Teagasc through the Walsh Fellowship Scheme

Increasing repeat chlamydia testing in Family Planning clinics depends on perception of value and availability of low-burden flexible reminder systems.

Re‐infection after a chlamydia infection is common: 22% of young Australian women are re‐infected within 4‐5months (Walker, et al, 2012). Re‐infections increase the risk of pelvic inflammatory disease (PID) by 4‐6 fold (Bowring, et al, 2011). Retesting is an important strategy to detect re‐infection. Clinical guidelines note that repeat testing at least three months after a positive diagnosis be considered. AIM: To understand Australian Family Planning clinicians’ practices and perceptions of repeat chlamydia testing.CONCLUSION: Reminder systems to support repeat testing of positive chlamydia tests had been implemented in some FPCs, with low workload impact. It was too early for evaluation of clinical success. These FPCs could share locally developed systems and positive experiences with FPCs skeptical about their value. This may also enhance awareness of the clinical value of retesting and the consequences of re‐ infection. Audits may help determine if clients are indeed being caught through repeat visits and opportunistic testing

Women’s Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence

Background Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women’s views and experiences of the triggers for BV onset and factors associated with recurrence. Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. Results The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a ‘flare-up’ of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. Conclusion Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.Dr. Jade Bilardi is in receipt of an NHMRC Early Career Fellowship No 1013135

Increasing repeat chlamydia testing in Family Planning clinics depends on perception of value and availability of low-burden flexible reminder systems.

Re‐infection after a chlamydia infection is common: 22% of young Australian women are re‐infected within 4‐5months (Walker, et al, 2012). Re‐infections increase the risk of pelvic inflammatory disease (PID) by 4‐6 fold (Bowring, et al, 2011). Retesting is an important strategy to detect re‐infection. Clinical guidelines note that repeat testing at least three months after a positive diagnosis be considered. AIM: To understand Australian Family Planning clinicians’ practices and perceptions of repeat chlamydia testing.CONCLUSION: Reminder systems to support repeat testing of positive chlamydia tests had been implemented in some FPCs, with low workload impact. It was too early for evaluation of clinical success. These FPCs could share locally developed systems and positive experiences with FPCs skeptical about their value. This may also enhance awareness of the clinical value of retesting and the consequences of re‐ infection. Audits may help determine if clients are indeed being caught through repeat visits and opportunistic testing

Women’s Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

Background Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women’s recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. Results The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women’s frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. Conclusion In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.Dr. Jade Bilardi is in receipt of a National Health and Medical Research Council Early Career Fellowship (No. 1013135)

Women’s Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence

Background Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women’s views and experiences of the triggers for BV onset and factors associated with recurrence. Methods A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. Results The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a ‘flare-up’ of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. Conclusion Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.Dr. Jade Bilardi is in receipt of an NHMRC Early Career Fellowship No 1013135