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Objectives: In early 2021, Western Sydney school principals expressed heightened concern about rising e-cigarette usage among high school students. This prompted us to assess knowledge, attitudes and perceptions surrounding adolescent vaping in students, school staff and parents, and their preferred strategies to effectively communicate prevention messages. Design: Exploratory qualitative study. Setting: Participants included students (aged 12–16 years), school staff and parents from government high schools in Greater Western Sydney, Australia. Methods: We held research workshops with 162 students, 133 school staff and 29 parents across seven schools. We used interactive activities which included individual written responses, small-group brainstorming and open group discussions. Data analysis was undertaken by two researchers using Framework Analysis. Results: Findings demonstrated differing perceptions among students, staff and parents regarding reasons why adolescents vape. Although common motives emerged, such as the perception that vaping differs from smoking, social normalisation, peer pressure and mental health considerations, there were important differences in emphasis. Students were concerned about dependency and vaping to cope, staff were concerned about the impact of vaping on students' learning and behaviour, and parents were concerned about being ill-equipped to support their children. Strategies to tackle vaping also differed, with an emphasis on education and engagement over surveillance and consequences. Conclusion: Adolescent vaping is a pressing concern within Australian school communities, necessitating a comprehensive, holistic approach supported by strong partnerships between the health and education sectors. Addressing this issue effectively demands heightened education and engagement among students, staff and parents. [ABSTRACT FROM AUTHOR]

Twenty-five years ago, the first Sydney Women and Sexual Health (SWASH) survey sought to generate knowledge about HIV risk for women in contact with Sydney's gay and lesbian community. SWASH has gone on to become the longest running periodic survey of lesbian, bisexual and queer (LBQ) women's health. It reflects LBQ women's lives back to them and makes LBQ women knowable for Australian public policy. But, like all research, the social reality SWASH produces is a partial representation of the target population. As it entered its 12th iteration, it became clear the survey needed to change to better represent trans and gender diverse people's lives. In this paper, we describe our process of first adding inclusive gender indicators, and then applying a gender diversity lens to all survey questions, data collection and reporting. We reflect on our motivations and fears, and where we can, the consequences on data of previous and new research design choices. Reflexive analysis such as ours, though still rare in quantitative research, promotes accountability to communities we research and the sectors who use the knowledge we produce. [ABSTRACT FROM AUTHOR]

Background: Lesbian, bisexual, and queer (LBQ) women exhibit high rates of alcohol and tobacco use, yet there is limited qualitative research examining why. Previous research has focused on minority stress explanations, linking alcohol and tobacco use to experiences of discrimination. However, other work considers the social contexts and cultural practices associated with alcohol and tobacco consumption. This confirms the need for more in-depth understandings of LBQ women's lived experiences in a contemporary Australian context. Aims: To address gaps in existing research, this project aims to develop a more nuanced contemporaneous theorising of what alcohol and tobacco mean to LBQ women in Australia. Drawing on feminist and critical drugs studies, this research will examine the complexities of alcohol and tobacco in LBQ women's lives, including how patterns of use change over time. We will also critically consider how LBQ women understand risk in relation to these substances, including factors leading to harm reduction and help-seeking. Method: We will employ a longitudinal qualitative approach to explore LBQ women's experiences over time, including three waves of semi-structured interviews and participant photography. We aim to recruit approximately 60 women in Victoria and New South Wales. Interview and visual data will be analysed using a range of narrative and thematic techniques. Conclusion: This study seeks to explore the complexities of individual experiences with alcohol and tobacco use, including pleasure and support-seeking, and to provide a nuanced understanding of the cultural dimensions of use that may change over time. In doing so, we propose a shift from deficit approaches to LBQ women's substance use towards more meaningful strengths-based engagement with the function of substances for LBQ women. Findings will be significant in their contribution to the current understandings of substance use patterns among LBQ women and the implications for harm reduction and health interventions. [ABSTRACT FROM AUTHOR]

Background: Lesbian, bisexual, and queer (LBQ) women exhibit high rates of alcohol and tobacco use, yet there is limited qualitative research examining why. Previous research has focused on minority stress explanations, linking alcohol and tobacco use to experiences of discrimination. However, other work considers the social contexts and cultural practices associated with alcohol and tobacco consumption. This confirms the need for more in-depth understandings of LBQ women's lived experiences in a contemporary Australian context. Aims: To address gaps in existing research, this project aims to develop a more nuanced contemporaneous theorising of what alcohol and tobacco mean to LBQ women in Australia. Drawing on feminist and critical drugs studies, this research will examine the complexities of alcohol and tobacco in LBQ women's lives, including how patterns of use change over time. We will also critically consider how LBQ women understand risk in relation to these substances, including factors leading to harm reduction and help-seeking. Method: We will employ a longitudinal qualitative approach to explore LBQ women's experiences over time, including three waves of semi-structured interviews and participant photography. We aim to recruit approximately 60 women in Victoria and New South Wales. Interview and visual data will be analysed using a range of narrative and thematic techniques. Conclusion: This study seeks to explore the complexities of individual experiences with alcohol and tobacco use, including pleasure and support-seeking, and to provide a nuanced understanding of the cultural dimensions of use that may change over time. In doing so, we propose a shift from deficit approaches to LBQ women's substance use towards more meaningful strengths-based engagement with the function of substances for LBQ women. Findings will be significant in their contribution to the current understandings of substance use patterns among LBQ women and the implications for harm reduction and health interventions. [ABSTRACT FROM AUTHOR]

Trans and gender diverse people are globally recognised as being under-served in clinical services, with significant implications for their health. During a national reorientation of the Australian cervical screening programme – from Papanicolaou smears to human papillomavirus screening – we conducted interviews with 12 key informants in cancer policy, sexual and reproductive health and trans health advocacy to understand how trans people's needs and experiences were being accounted for and addressed in health policy and practice. Themes captured the complexities of increasing visibility for trans people, including men and non-binary people with a cervix. These complexities reflect the extensive system and cultural change required in asking policymakers and practitioners to think differently about who is at risk of a disease typically associated with cisgender women. Informants drew on the language of trauma to explain the resistance many trans people feel when engaging with clinical services, particularly relating to sexual and reproductive health. In doing so, they argued for increasing resources and processes to elicit trans people's willingness to put their trust in such services. Thinking critically about the relationship between the politics of trans visibilities, trauma and trust can support effective and inclusive approaches to transgender health. [ABSTRACT FROM AUTHOR]

Sexuality and gender diverse Australians are a priority population in federal and state‐based alcohol and other drug (AOD) strategies. Research evidence shows higher prevalence of AOD use by lesbian, gay, bisexual, transgender and queer (LGBTQ) people, riskier use and a higher proportion have accessed AOD treatment. Despite these disparities, Australian AOD treatment services do not routinely collect data on sexuality or gender identity. As a result, the treatment needs, experiences and outcomes of LGBTQ people remain largely invisible. The Australian Bureau of Statistics' recently released standardised indicators for the recording of sex, gender, variations of sex characteristics and sexual orientation presents an opportunity for the AOD sector to implement inclusive data collection as a foundational step towards achieving policy priorities for LGBTQ people. This commentary includes an implementation case study from the New South Wales non‐government AOD treatment sector, where sexuality and gender identity indicators have been collected since 2016. [ABSTRACT FROM AUTHOR]

Of Recommendations and Levels Of Evidence: Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A).Summary Of Key Recommendations and Levels Of Evidence: Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A). [ABSTRACT FROM AUTHOR]

Introduction and Aims: Lesbian, bisexual and queer (LBQ) women in Australia and internationally are smoking at least twice the rate of women in the general population. An understanding of smoking behaviours in this population is essential in order to develop effective interventions. Our analysis aimed to investigate differences in smoking patterns and contexts of smoking between current smokers and recent quitters (<2 years to 1 month).Design and Methods: Data were collected through an online anonymous survey conducted in mid-2015. Participants were recruited online from a variety of social networking sites and community-based mailing groups.Results: Overall 257 lesbian, bisexual and queer women completed the survey, 73% current smokers and 27% recent quitters; nearly all had smoked daily at some point in their lives. Multivariate analysis showed recent quitters were less likely to have some (adjusted odds ratio [aOR] 0.19, 95% confidence interval [CI] 0.05-0.71) or half/most/all (aOR 0.12, 95% CI 0.03-0.048) close friends who smoked compared to none, and were more likely to have a non-smoking (aOR 10.2, 95% CI 3.86-27.0) or no regular partner (aOR 4.01, 95% CI 1.47-10.9) than one who smoked. Non-Anglo-Australian women were also more likely to be recent quitters (aOR 2.45 [95% CI 1.10-5.42]) than Anglo-Australian women.Discussion and Conclusions: Understanding the social significance of partners and friends in lesbian, bisexual and queer women's smoking and cessation efforts will be important for developing meaningful, effective and targeted interventions to address the persistent high rates of smoking in this population. [ABSTRACT FROM AUTHOR]

Gay men and lesbian women often demonstrate unique settlement patterns, forming what have been referred to as 'gayborhoods'. This study sought to provide the first postcode-level estimates of population size and prevalence of gay and lesbian people in Australia. Data on same-gender-partnered households from the Australian Census were combined with information from six different surveys conducted from 2011 to 2017. We estimated that in 2016 there were 132,203 gay men (1.5% of adult males; 95% CI: 1.4–1.6) and 79,931 lesbian women (0.9% of adult females; 95% CI: 0.8–1.0) in Australia. While many postcodes were sparsely populated by gay and lesbian people (40.1% had prevalences of <0.1%), 24.6% were moderately populated (prevalences in the 50-95th percentile) and 2.7% were highly populated (95th percentile). By jurisdiction, the Australian Capital Territory had the highest prevalences of gay men (2.1%; 95% CI: 2.0–2.2) and lesbian women (1.5%; 95% CI: 1.4–1.6). Although the majority of highly populated postcodes were found in major cities (83.7%), some were also found in regional and remote area (16.3%). This method can be applied in other countries to enhance populate estimates. The accompanying dataset can be used to guide service delivery, conduct geographically contextualised research and develop policies relevant to gay men and lesbian women in Australia. [ABSTRACT FROM AUTHOR]

This article reports on a study that explored what it means to be a mature-age Aboriginal and Torres Strait Islander university graduate in the context of age, life-stage, history, culture, socioeconomic status, race and place. Using narrative interview data and fieldwork observation, we focus on the graduates' workplace experiences and take a case study approach to amplify their voices. We argue that the data challenges the ideological construct of Australia as a 'post-racial' society and illustrates how interrelated variants of structural racism function to sanction, silence and control educated Aboriginal and Torres Strait Islander people, divide communities into quasi-hierarchies, and sustain white power and privilege. We show how these variants are expressed as low expectations, shadeism, culturism and privilege protectionism, and argue that their enactment can erect an invisible barrier to Aboriginal and Torres Strait Islander professional progression: a 'white ceiling' above which many graduates struggle to ascend. [ABSTRACT FROM AUTHOR]

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT).Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake.Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners.Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice. [ABSTRACT FROM AUTHOR]

Over a decade after emergency contraceptive pills (ECPs) became available without a prescription, the rate of unintended pregnancies remains high in many settings. Understanding women's experiences and perceptions of ECPs may provide insights into this underutilization. We systematically searched databases to identify qualitative and quantitative primary studies about women's beliefs, knowledge, and experiences of ECPs in Australia. Findings demonstrate persistent misunderstandings around access, how ECPs work, and a moral discourse around acceptable versus unacceptable use. Addressing knowledge and the stigma around ECPs use is fundamental to increasing the use of this medically safe and effective strategy. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities.Aims: To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking.Methods: We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations.Results: We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences.Conclusions: Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men.Implications: This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success. [ABSTRACT FROM AUTHOR]

It is difficult to consider, describe or address the ethical issues particular to qualitative research without experience and understanding of the technicalities of qualitative methodologies. The Australian National Statement on the Ethical Conduct of Research Involving Humans charges researchers with a responsibility to demonstrate that they have the appropriate experience, qualifications and competence for their proposed research. Ethical review committees have the responsibility to judge claimed research competence. This article provides practical guidance to researchers and review committees on using formal qualifications and training, explicit claims of competence, and markers of in/competence to assess qualitative research competence. [ABSTRACT FROM AUTHOR]

Introduction and Aims: To investigate smoking prevalence trends and correlates among lesbian, bisexual and queer-identifying (LBQ) women in Sydney, Australia.Design and Methods: Data from 5007 respondents to a repeated cross-sectional community survey were used to examine smoking trends between 2004 and 2014. Multinomial logistic regression was used to examine smoking correlates.Results: Thirty percent of respondents were current smokers, including 48% of 16 to 24-year-olds. A slight decrease in all-ages smoking over time was not reflected in the youngest age group. LBQ women who smoke have fewer economic, social and psychological resources than both women who never smoke and ex-smokers. High levels of alcohol and illicit drug use are also correlated with current smoking.Discussion and Conclusions: Population-wide interventions have failed to address the persistently high prevalence of smoking among this sample of LBQ women. Tailored interventions may find utility focusing on personal resilience to deal with general and sexuality-specific stressors, as well as attending to poly-substance use. Acknowledgment of LBQ women as a priority group for tobacco reduction is urgently needed. We call on tobacco control agencies to consider sexuality and gender orientation in policy and partner with lesbian, gay, bisexual and transgender community organisations to develop culturally appropriate interventions. [Deacon RM, Mooney-Somers J Smoking prevalence among lesbian, bisexual and queer women in Sydney remains high: Analysis of trends and correlates Drug Alcohol Rev 2017;36:546-554]. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women’s views and experiences of the triggering factors associated with BV onset and recurrence. Methods: Women aged 20–49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV. Results: 103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical–and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV. Conclusion: These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use. [ABSTRACT FROM AUTHOR]

Purpose: As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.Methods: We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.Results: Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'.Conclusions: If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.Implications For Cancer Survivors: The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The aim of this article is to critically review and analyse the public representations of mature-age university students in developed and some developing nations and how they compare to the public representations of mature-age Aboriginal and Torres Strait Islander university students in Australia (‘students’ also refers to graduates unless the context requires specificity). Relevant texts were identified by reviewing education-related academic and policy literature, media opinion and reportage pieces, conference proceedings, and private sector and higher education reviews, reports and submissions. What this review reveals is striking: very few commentators are publicly and unambiguously encouraging, supporting and celebrating mature-age Aboriginal and Torres Strait Islander university students. This strongly contrasts with the discussions around mature-age university students in general, where continuous or lifelong learning is acclaimed and endorsed, particularly as our populations grow older and remain healthier and there are relatively lower numbers of working-age people. While scholars, social commentators, bureaucrats and politicians enthusiastically highlight the intrinsic and extrinsic value of the mature-age student's social and economic contributions, the overarching narrative of the mature-age Aboriginal and Torres Strait Islander student is one of ‘the horse has bolted’, meaning that it is too late for this cohort and therefore society to benefit from their university education. In this article we examine these conflicting positions, investigate why this dichotomy exists, present an alternative view for consideration, and make recommendations for further research into this area. [ABSTRACT FROM PUBLISHER]

Unlabelled: Background Research in the US and UK shows that 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 (NSW), 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.Methods: 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 similar to the general NSW population. Significant predictors for ever having attended for a Pap smear test were older age, post Year 12 education, ever having had a sexually transmissible infection 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 with rates from countries such as the US or UK. 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 human papillomavirus, and highlight the importance of health providers providing a safe and welcoming environment for LBQ women to openly discuss their health. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Compared with non-Indigenous Australians, Aboriginal and Torres Strait Islander people have higher rates of sexually transmissible infections (STI). The identification of the sexual risk and healthcare seeking behaviours of young Aboriginal and Torres Strait Islander people in a regional Australian setting was sought.Methods: A cross-sectional survey of 155 young Aboriginal and Torres Strait Islander people (16-24 years) in Townsville was conducted.Results: Most participants (83%) reported ever having had sex, with a median age of 15 years at first sex and a range from 9 to 22 years. While young men reported more sexual partners in the last 12 months than young women, they were also more likely to report condom use at the last casual sex encounter (92% vs 68%, P=0.006). Young women were significantly more likely than young men to report never carrying condoms (35% vs 16%); however, they were more likely to have had STI testing (53% vs 28%, P=0.004). Of those reporting previous STI testing, 29% reported ever being diagnosed with an STI.Conclusions: The sample of young Aboriginal and Torres Strait Islander people reported an early age at first sex, variable condom use and low uptake of STI testing. The high prevalence of self-reported STI diagnoses indicate a need for opportunistic sexual health education and efforts designed to promote the uptake of STI screening in this group. [ABSTRACT FROM AUTHOR]

Many young people with cancer have a parent or parents who care for them during their hospitalisation and treatment, and remain an important part of their lives after the 'crisis' has passed and young people have moved into survivorship. This qualitative study explored the impact of cancer diagnosis, treatment and survival during adolescence and young adulthood on the practice and experiences of parenting. We conducted focus groups with a total of 22 parents of young people diagnosed with various cancers between the ages of 11 and 19 years old. The results indicated that parents advocated for their offspring in different ways at different points of the cancer journey. Parents used their parental knowledge of their offspring to secure a medical diagnosis and treatment, developed medical knowledge to advocate for appropriate treatment within the medical system, and then used parental and medical knowledge to advocate for their offspring's successful psychosocial survival. In this final point in the journey, parents entered social worlds from which they would normally be absent and some went to great lengths to ensure their offspring were not socially disadvantaged. [ABSTRACT FROM AUTHOR]

Background: Increasing international mobility has led to a growth of cross-border HIV transmission around the world. In Australia, increasing rates of HIV infections acquired overseas have been reported, particularly among men. This qualitative study explored experiences and risk perceptions of 14 Australian men who acquired HIV while living or travelling overseas from the year 2000. Methods: Symbolic interaction provided the study's theoretical perspective and analytical framework. Australian men living with HIV who were aged 18 years and older, believed they had acquired their infection while working or travelling overseas during or after the year 2000, and were diagnosed from 2003 onwards were eligible to participate. A semistructured interview schedule was developed and tested for content validity with the study reference group. Analysis was conducted using an adapted form of grounded theory to form the basis for the development of the experiences domains. Results: Analysis produced four domains of experience: (1) a fantasy realised, (2) escaping and finding a new self or life, (3) living a life less ordinary and (4) living local but still an outsider. The description of the four experience domains highlights how risk generally, particularly sexual risk, did or did not feature in these men's understanding of their experiences. Conclusion: Perceptions and experiences of long-term travel played a decisive role for men who acquired HIV when travelling overseas. Appealing to desired experiences such as connection to local culture or sustaining a new or adventurous life may provide important implications for guiding health promotion programs and policy. [ABSTRACT FROM AUTHOR]

In 2011, the Australian National Health and Medical Research Council (NHMRC) initiated an inquiry to determine whether there is a need for expanded ethical guidance in the form of a discrete guidance document for alcohol and other drug (AOD) research. An issues paper was developed to frame the inquiry. AOD researchers, Human Research Ethics Committees and others were invited to discuss whether there are distinctive ethical issues facing researchers and Human Research Ethics Committees in the AOD setting. Based on the public submissions, the NHMRC recommended that no AOD research-specific guidance is required. The inquiry and the NHMRC decision were not widely publicized, and we feel there is a need for further discussion. In order to do so, we have analysed the public inquiry submissions and described the central themes. Few submissions in the inquiry explicitly agreed AOD research warrants a specific guidance framework. Most were concerned that the NHMRC issues paper unfairly targeted people who use drugs as complex research participants. The inquiry highlights tensions around research governance and ethics review boards dealing with illicit and stigmatised behaviours. While we agree that a specific guidance framework for AOD research is not needed and could potentially be harmful and restrictive, we are concerned that the wholesale rejection of a guidance framework has closed the door to much needed debate. There remains, we argue, a need for alternative strategies and tools to support ethical research, inform and streamline institutional ethics approval, and engage and protect participants. [ABSTRACT FROM AUTHOR]

Background: Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs). Methods: We conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women's experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices. Results: A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk. Conclusions: Public health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women's sex work careers. [ABSTRACT FROM AUTHOR]

Adolescence and young adulthood are transitional periods of rapid and dramatic personal change. Few events can cause as unpredictable and challenging alterations to this process as the onset of a serious illness, such as cancer. Although we know much about the physical and psychological consequences of having cancer at this time, we know little about the effect of cancer on young people’s relationships. We conducted interviews with 15 women and 12 men aged between 16 and 29 years, who had survived cancer. Our findings demonstrate that the experience of cancer and how it affects relationships is complex. It arrests young people’s development by increasing their dependence on parents, giving them life experiences unavailable to peers, and complicating the process of establishing new relationships. However, it also accelerates development by facilitating closer and more mature relationships with parents and giving young people wisdom and insight not shared by peers. Cancer profoundly shapes how young people conduct their relationships. These changes require ongoing accommodation by young people with cancer, their parents, peers, and new acquaintances. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women’s experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women. Methods: A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis. Results: Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, ‘dirty’ and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women’s self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence. Conclusion: Women’s experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis. [ABSTRACT FROM AUTHOR]

Objectives: HIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women's Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation. Design: Cross-sectional analysis of baseline data from two prospective cohorts. Setting: Community-based study in Phnom Penh, Cambodia. Participants: Women aged 15-29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended. Primary outcomes: HIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law. Results: Participants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS- 1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%). Conclusions: Sex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission. [ABSTRACT FROM AUTHOR]

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

Cambodia's 100% Condom Use Programme is credited with an increase in consistent condom use in commercial sexual interactions and a decrease in HIV prevalence among female sex workers (FSWs). There has been little improvement in condom use between FSWs and non-commercial partners, prompting calls for more innovative approaches to increasing condom use in these relationships. To understand why condoms are used or not used in sexual interactions involving FSWs, we examined condom negotiation across different types of relationships. We conducted 33 in-depth interviews with young (15 to 29 years) women engaged in sex work in Phnom Penh. There was an important interplay between the meanings of condom use and the meanings of women's relationships. Commercial relationships were characterised as inherently risky and necessitated condom use. Despite a similar lack of sexual fidelity, sweetheart relationships were rarely construed as risky and typically did not involve condom use. Husbands and wives constructed their sexual interactions with each other differently, making agreement on condom use difficult. The lack of improvement in condom use in FSWs' non-commercial sexual relationships needs to be understood in relation to both sex work and the broader Cambodian sexual culture within which these relationships are embedded. [ABSTRACT FROM AUTHOR]

ABSTRACT National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always 'risky' or always 'safe', as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter and access to condoms. Tangible strengths such as young Indigenous people's commitments to condoms and STI screening should be celebrated and bolstered to enhance their ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article draws on a discursive analysis of individual and group interviews with forty-five heterosexual men to examine how men take up and resist discourses of sexuality and gender to (re)produce a recognizable heterosexual subjectivity. It explores the commodification of sex in men's accounts and the various practices men described undertaking to obtain sex. The article argues that the contexts in which men (re)produce sexual subjectivity have significant implications for how they negotiate the discursive positions available to them. Three themes are presented to demonstrate the different discursive practices undertaken by single and partnered men. Finally, the article explores the difficulties, dilemmas, and ambivalences produced by the project of subjection and how individual men resolve them. [ABSTRACT FROM AUTHOR]

Issue addressed: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However , we know very little about young Indigenous people's use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people's efforts to prevent infection. Methods: University-researchers, a site co-ordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged between 17 and 26 years. Thematic analysis of interview notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS). Results: Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for . Participants described the comfort and understanding they experienced at ACCHS; personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms and persisting with behavioural intentions despite feeling shame. Conclusion: Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of blood-borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people's strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment. [ABSTRACT FROM AUTHOR]

Issue Addressed: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However, we know very little about young Indigenous people's use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people's efforts to prevent infection.Methods: University-researchers, a site co-ordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged between 17 and 26 years. Thematic analysis of interview notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS).Results: Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for. Participants described the comfort and understanding they experienced at ACCHS; personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms and persisting with behavioural intentions despite feeling shame.Conclusion: Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of blood-borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people's strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment. [ABSTRACT FROM AUTHOR]

Recent research has demonstrated the importance of family relationships in women's experience of premenstrual changes, their construction of these changes as "PMS." However, the discursive process by which women take up the subject position of "PMS" sufferer through the explicit naming of "PMS" to an intimate partner has received little research attention. Drawing on 60 individual interviews with Australian women, conducted between 2004 and 2006, we examined accounts of naming "PMS" in intimate relationships, women's explanations for naming or not naming, their experiences of their partner naming them as premenstrual. The analysis process identified an overarching theme of naming "PMS," which was made up of three themes: naming to explain; "PMS" becoming the only explanation for distress; "PMS" as not a legitimate explanation for distress. The findings suggest that clinicians need to be aware of women's complex, often ambivalent, experiences of naming "PMS" within their relationships, when working with women, couples, seeking treatment or support for premenstrual distress. [ABSTRACT FROM AUTHOR]

In both the popular and academic media, lesbian and gay parenting is the issue of the moment. Recent examples include the case of two gay men fathering twins with a surrogate mother in the US; the results of a study of gay fathers by Gill Dunne at the London School of Economics (Guardian, 12 January, 2000); and comments from Dame Elizabeth Butler-Sloss, President of the Family Court, on the appropriateness of lesbian women and gay men as adoptive or foster parents (Guardian, 16 October, 1999). These examples show that current debates focus on gay fathers, assisted reproduction and fostering/adoption. Does this mean that the concerns first raised in child custody disputes in the 1970s-that children raised in lesbian mother families would be at risk for psychological problems and atypical gender development-have been laid to rest? [ABSTRACT FROM AUTHOR]

This article examines the negotiation and interpretation of first experiences of sexual desire in a group of eight young women who identify as Lesbian Avengers, using in-depth narrative interviews. Accounts of desire and its relationship to sexual subjectivity were organized under four broad themes: The significance of a kiss: Is this desire? describes the difficulty in categorizing first experiences of desire towards another woman as sexual; My desire makes me a dyke examines accounts of desire leading to sudden self-identification as a lesbian or, conversely, to the repression of desire and avoidance of lesbian identity; Lesbian desire is dangerous considers the negative representation of lesbian desire as perverse, sex being seen as central to lesbian identity, and the experience of being subjected to condemnation and abuse; Dealing with dangerous desire looks at the main strategies adopted in response to the above: the positioning of self as outsider, but strong because of it, embracing a transformation of self through becoming lesbian or remaining in the closet. [ABSTRACT FROM AUTHOR]

The article describes the design of an interactive, data-generating poster created by the authors for a workshop at a national general practitioner (GP) conference. Particular attention is given to how the poster incorporated the social media platform Twitter as well as QR (quick response) bar codes to engage conference attendees in discussions.

The authors propose that techniques from art and design can be used within social science research as part of a speculative methodology and provide a set of heuristic principles for speculative method, characterizing it as processual, performative, playful, promising and propositional. [ABSTRACT FROM AUTHOR]

Background: Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs).Methods: We conducted interviews with 11 newcomer FSWs (worked < six months), 9 mobile FSWs (experienced but worked at the current brothel < six months), and 14 senior FSWs (experienced and worked at current brothel > six months). The interviews explored women's experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices.Results: A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk.Conclusions: Public health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women's sex work careers. [ABSTRACT FROM AUTHOR]