Search

The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure. [ABSTRACT FROM AUTHOR]

There are particular complexities faced by people attempting to tell their stories in the context of social stigma, such as the hostility which often surrounds injecting drug use. In this article, we identify some of the distinct advantages of taking a narrative approach to understanding these complexities by exploring a single case study, across two life-history interviews, with “Jimmy,” a young man with a history of social disadvantage, incarceration, and heroin dependence. Drawing on Miranda Fricker’s notion of “hermeneutical injustice,” we consider the effects of stigmatization on the sociocultural practice of storytelling. We note the way Jimmy appears both constrained and released by his story—how he conforms to but also resists the master narrative of the “drug user.” Narrative analysis, we conclude, honors the complex challenges of the accounting work evident in interviews such as Jimmy’s, providing a valuable counterpoint to other forms of qualitative inquiry in the addictions field. [ABSTRACT FROM AUTHOR]

Background In Australia, liver cancer incidence is rising, particularly among people born in hepatitis B-endemic countries. We sought to build an understanding of the information needs of people affected by liver cancer, to inform the design of in-language consumer information resources. Methods We searched the World Wide Web for available in-language consumer information and conducted a literature search on consumers' information needs and their preferred means of accessing it. Qualitative data collection involved bilingual researchers conducting focus group discussions (26 participants) and in-depth interviews (22 participants) with people affected by liver cancer in English, Vietnamese, Cantonese and Mandarin. Sessions were audio-recorded, transcribed, translated and thematically analysed. The key themes and salient findings informed the development of in-language multimedia information resources. Results Many consumer resources did not cater for people with low literacy levels. The participants wanted more information on cancer diagnostic and treatment options, nutrition and Chinese Medicine and experienced communication challenges speaking to health professionals. While Vietnamese speakers relied entirely on information provided by their doctors, other participants actively searched for additional treatment information and commonly used the Internet to source it. We developed multilingual, multimedia consumer information resources addressing identified consumer information needs through an iterative process, in collaboration with our multilingual consumer panel. These resources are available in four languages, as separate modules accessible online and in DVD format. Conclusion This process enabled the development of user-friendly patient resources, which complement health-care provider information and supports informed patient decision making. [ABSTRACT FROM AUTHOR]

Expansion of Needle and Syringe Programs (NSPs) to non-specialised sites requires an NSP workforce with skills in engaging stakeholders who may have different opinions of NSP. This study examined the strategies used by NSP workers to develop and maintain NSP services and the emotional labour involved in performing this work. Qualitative interviews were undertaken with 12 staff of a NSP network in metropolitan Sydney, Australia. Participants had undertaken a range of activities to expand NSP sites, often in unwelcoming environments in which NSP was viewed as a “cowboy” service. Participants’ strategies included building positive, ongoing inter-group contact, being visible in external services, and maintaining their professionalism to promote NSP as a legitimate service and themselves as legitimate health workers. Some participants employed strategies which were at odds with their personal and professional values. Participants relied on cohesion within the NSP team to support and encourage each other. Dealing with external services to establish and maintain NSPs was a source of significant emotional labour for NSP workers and was grounded in the stigma attached to injecting drug use. NSP policies and procedures should account for this additional work undertaken by NSP staff and leadership is required to address stigmatisation of NSPs. [ABSTRACT FROM PUBLISHER]

Adherence to treatment for hepatitis C virus (HCV) infection is associated with the successful eradication of infection. However, patients often have difficulty adhering to HCV treatment because of factors such as the psychiatric side effects of regimens and social disadvantage. Commonly, health professionals including specialist physicians, nurses, social workers and psychologists work together under a multidisciplinary model of shared-care to support patients’ adherence to HCV treatment. In some HCV treatment clinics, shared-care is not always available, or only partially implemented and this has implications for patient adherence. To explore the facilitators of adherence, an interview-based study was conducted in 2012 with a purposive sample of Australian physicians and nurses (N = 20). The findings reveal that when comprehensive shared-care was limited or unavailable, physicians and nurses filled in the gaps by assuming roles outside of their expertise to help patients adhere to HCV treatment. Physicians and nurses applied instrumental support strategies based on psychosocial interventions, namely patient advocacy, pragmatic problem-solving, treatment engagement and emotional support. These strategies were provided by dedicated physicians and nurses to address shortfalls in multidisciplinary shared-care. Although these interventions were reported to assist adherence, there is an increased risk of complications when physicians and nurses move beyond the bounds of their disciplinary training, for example, to assess and manage patients’ psychiatric side effects or advocate on their behalf for social services. Future research should measure the effectiveness of instrumental support strategies on HCV treatment adherence, and explore the costs associated with physicians and nurses providing instrumental support in the absence of comprehensive multidisciplinary shared-care. [ABSTRACT FROM PUBLISHER]

AimThis paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses’ clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine.BackgroundIn international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia.MethodsData for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce.FindingsViewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients’ exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV. [ABSTRACT FROM AUTHOR]

Research indicates that patients treated with interferon-based regimens can experience persistent neurotoxicity after treatment ceases and new symptoms attributable to the regimens can emerge post-treatment. To explore post-hepatitis C virus (HCV) treatment outcomes, in-depth interviews were conducted with a self-selected sample of people from two Australian states who had completed an interferon-based regimen at least 24-weeks prior to being interviewed. Participants comprised almost equal numbers of men and women aged from 26 to 57 years, who were treated for HCV genotypes 1 through to 4, and included treatment responders, non-responders and those who had relapsed after treatment. Of 27 participants who volunteered to be part of this study, 25 reported persistent physical and psychological side-effects after treatment. Participants perceived a direct causal link between the treatment regimen and their ongoing symptoms. Reportedly, recovery from treatment was inhibited by an absence of a follow-up protocol that identified and addressed patients’ post-treatment needs, including medical care for persistent side-effects, referral, and information and advice about lifestyle issues. Although the study’s sample was not representative of all people treated for HCV, it is likely that persistent side-effects and their impact can affect other patients following completion of HCV treatments. Further prospective studies of HCV treatment outcomes are needed. In the meantime, the systematic implementation of a follow-up protocol in liver clinics might expedite recovery in patients who experience ongoing adverse health. [ABSTRACT FROM PUBLISHER]

The term "needle fixation" is increasingly used by researchers and health professionals to explain a range of drug injecting attitudes and practices. This article employs an innovative discourse analysis approach to consider this notion of needle fixation. Foucault's theories of power, knowledge and discourse are taken up in examining a recent literature review of material considered to support the idea of needle fixation, and in conducting a secondary analysis of transcripts of interviews with people who inject methadone. Some correspondence in definitions of needle fixation was found between the literature and the interview subjects, but significant differences, both within and between literature and interviews were also observed. We argue that needle fixation can be understood as a product of discourse, and as such, as both fact and fiction. Considering that the term encompasses very different behaviours, is in some ways limiting, and has negative connotations, careful consideration should be given to it before it is accepted as a useful diagnostic and therapeutic tool. [ABSTRACT FROM AUTHOR]

The Life Story Board (LSB) is a visual tool used in therapeutic circumstances to coconstruct a lifescape that represents the personal, relational and temporal aspects of a person's lived experiences. We conducted a study of the drug use and harm reduction experiences of people who inject drugs through research interviews using the LSB to determine whether it has the potential to enhance qualitative research. Our team included community researchers who were current or former drug users and academic researchers. Interviews were conducted by two community researchers: an interviewer and a storyboarder who populated the LSB. Results showed that interviewers and participants interacted with the LSB in different ways. The board functioned to situate the interviewers in the interview schedule, whereas participants often used the board as a way to validate or reinforce their life story. Participants expressed a variety of emotional and cognitive responses to the board. Overall, the LSB helped participants focus on their life story to recall specific occasions or incidents and enabled them to gain perspective and make greater sense of their lives. Both participants and interviewers engaged with the LSB in nuanced ways that enabled them to work together to represent the participant's life story. [ABSTRACT FROM AUTHOR]