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Research has documented the negative impact of stigma on health outcomes for people living with HIV (PLHIV). How central HIV is to the identity of the individual may increase the negative effects of stigma, including greater psychological distress, while having strong social supports may play a buffering role. This study aimed to establish whether internalised stigma mediates the relationship between the centrality of HIV identity and psychological distress, while also assessing the role of social support as a moderator. PLHIV (n = 181) responded to a survey assessing experiences of living with HIV focussed on centrality of HIV identity, internalised stigma, and wellbeing. After controlling for age and education, findings from the mediation analysis show that the more central HIV is to an individual's identity, the more stigma is internalised and the greater the negative impact on psychological wellbeing. However, this is only the case for people with low levels of social support. Regardless of how central HIV is to identity, social support appears to act as a buffer and promote positive wellbeing. For those working with PLHIV, promoting the importance of good social support systems may be one way to address some of the negative impacts of stigma.

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.

Complex lifestyle issues associated with injecting drug use may make it difficult to provide care to people who inject drugs (PWID). Negative attitudes towards PWID can undermine the provision of good quality care, hence, it is important to explore the impact of health workers' attitudes in the delivery of care to PWID. An online survey was administered to 336 health workers assessing contact with and attitudes towards PWID, concerns about these clients as well as whether health workers feel stigmatised by working with PWID. Health workers were also asked whether they supported the discriminatory behaviour of a colleague in a series of hypothetical scenarios about working with PWID. In correlational analyses, negative attitudes towards PWID, greater concerns about the behaviour of PWID, not feeling stigmatised by colleagues and seeing fewer clients who inject were associated with greater support for discriminatory actions in the hypothetical scenarios. Multiple regression analysis results showed that only attitudes towards PWID and concerns about the behaviour of injecting clients remain independent predictors of participant support for the hypothetical scenarios. This research highlights the role of attitudes toward PWID in understanding health workers' decisions, practices and potential behaviour.

In Australia, there are five strategies that set out a national response to HIV, viral hepatitis and sexually transmissible infections.1-5 Each strategy contains a set of objectives that work towards reducing the transmission, morbidity and mortality associated with these infections, with progress monitored via a set of related indicators. A clear objective exists within each of the five strategies to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people's health”.1-5 However, until recently, there has been no indicator to measure stigma and monitor progress against these objectives. This commentary outlines an approach taken to develop a stigma indicator and lessons learned from its implementation in surveys of priority population groups.

In Australia, there are five strategies that set out a national response to HIV, viral hepatitis and sexually transmissible infections.1-5 Each strategy contains a set of objectives that work towards reducing the transmission, morbidity and mortality associated with these infections, with progress monitored via a set of related indicators. A clear objective exists within each of the five strategies to “eliminate the negative impact of stigma, discrimination, and legal and human rights issues on people's health”.1-5 However, until recently, there has been no indicator to measure stigma and monitor progress against these objectives. This commentary outlines an approach taken to develop a stigma indicator and lessons learned from its implementation in surveys of priority population groups.

Supplementary Material, JHP_supplementary_material_case_studies_Oct_2015 for Health workers’ support for hepatitis C treatment uptake among clients with a history of injecting by Loren Brener, Courtney von Hippel, Hannah Wilson and Max Hopwood in Journal of Health Psychology

BACKGROUND: Gay and bisexual men typically report high rates of illicit drug use, including methamphetamine use. This paper aimed to analyse trends in crystal methamphetamine ('crystal') and powder methamphetamine ('speed') use among gay and bisexual men in Australia, and characterise the sociodemographic, drug use, and sexual risk practices of men who reported crystal use. METHODS: The Gay Community Periodic Surveys, routinely conducted behavioural surveillance surveys of gay men in Australia, were analysed to examine trends in recent crystal and speed use during 2005-14 (any use in the previous 6 months), and trends in regular crystal and speed use during 2007-14 (at least monthly use in the previous 6 months). Covariates of recent and regular crystal use were analysed using 2014 data. RESULTS: Speed use declined from 25.0% to 10.2% during 2005-14 (p-trend

This report reviews behavioural data relevant to the transmission of human immunodeficiency virus (HIV), viral hepatitis and sexually transmissible infections (STIs) in Australia. It also examines behavioural data relevant to the social aspects of treatment and care of those who have been infected, including those who are living with acquired immune deficiency syndrome (AIDS)., Monograph 3/2011

Available literature indicates that clinical factors, social factors, personal values and knowledge are all important in determining whether or not people decide to have treatment for hepatitis C. Therefore this study sought to investigate a range of factors associated with making the decision to take up treatment. Additionally, to explore how Australian clients of Opiate Substitute Treatment (OST) centres made decisions about treatment, this study interviewed a sample of OST clients and health professionals in Sydney about their perceptions of a proposed model of delivery of treatment for hepatitis C through OST clinics.

This report reviews behavioural data relevant to the transmission of human immunodeficiency virus (HIV), viral hepatitis and sexually transmissible infections (STIs) in Australia. It also examines behavioural data relevant to the social aspects of treatment and care of those who have been infected, including those who are living with acquired immune deficiency syndrome (AIDS)., NCHSR Monograph; 4/2010

The findings presented throughout this report raise concerns about current government strategies which are committed to increasing the number of people who undertake hepatitis C treatment by 2012. Evidently, many people do not clear their infection after having treatment and some people experience ongoing ill health caused by persistent side effects. Therefore, either the development of a more efficacious and tolerable treatment is required, or significantly more resources need to be allocated toward increasing the range of supports and health care services that are available to people during and after treatment for hepatitis C infection before more people with hepatitis C can be expected to consider treatment., NCHSR MONOGRAPH 6/2009

Summary of findings

A qualitative study of both hepatitis C treatment experiences and the management of hepatitis C treatment, using in-depth semi-structured interviews, was conducted in Sydney, Australia, during 2004 and 2005. The study aimed to uncover some of the strategies that people in treatment deployed to cope with the side effects associated with treatment. A purposive sampling frame was used to recruit participants to the study. A total of 20 people who either were receiving treatment or had completed treatment within the six months prior to interview were recruited. Six health professionals who managed treatment regimens were also interviewed. Treatment and its side effects were explored from the perspectives of both patients and clinic staff. The impact of treatment on personal relationships, work, socialising, physical and emotional health and wellbeing, sense of self and future outlook were investigated. Thematic content analysis highlighted key issues reported by patients and health professionals regarding treatment experiences and approaches to treatment management., Monograph 4/2006

The report explores exigent conditions associated with living with hepatitis C infection. Intersecting these demands are the effects of stigma and social marginalisation. Many people with hepatitis C have to navigate and negotiate daily a field strewn with misinformation, conflicting identities and unequal power relations, often while labouring under significant ill-health and surviving on low incomes., Monograph 6/2003

The injection of methadone is relatively common within certain geographic areas of New South Wales, especially Sydney. Our sample comprised people who were in general poorly educated, unemployed and had been long term injecting drug users with fair to poor health. Many respondents had been injecting illicit drugs besides methadone for many years. High rates of frequent injecting were reported for both illicit drugs and methadone. Respondents described the fast acting relief of injected methadone as the reason for continuing the practice.

In general, the key findings describe the impact of the closure and subsequent relocation of WAHS primary NSP to a mobile service on IDUs living in or near St Marys. Given the high population density of Penrith LGA compared to the other LGAs within WAHS, and the reported historical concentration of IDUs around St Marys, the emphasis on the needs of IDUs within this area is not unwarranted. Moreover, it is vital to call attention to the link between area of greatest need and IOU concentration, lack of access to primary NSP services and re-use and sharing of injecting equipment. The interconnection of these factors has implications for the transmission and spread of blood-borne viruses such as HIV and HCV and other harms related to the re-use of used injecting equipment, such as septicemia, thrombosis and vein damage. Significantly, participants reported sharing and re-using injecting equipment with greater frequency since the advent of the mobile service., NCHSR Monograph 5/2000

The DUGM project aimed to provide comparative qualitative data on drug use from two geographically and culturally distinct yet connected gay communities from mid 1997 to late 1998. DUGM grew out of a smaller study, the Gay Men and Drug Use (GMADU) project, and sought to explore patterns of use first identified in the Sydney Men and Sexual Health (SMASH) study.