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Objective: To determine the opinions and current practice of obstetricians and gynaecologists and trainees in the specialty with regard to induced abortion. Design, setting and participants: A voluntary, anonymous survey of Australian Fellows and specialist trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted between 23 June and 31 July 2009 using an email invitation to proceed to an online questionnaire. Main outcome measures: Attitudes to abortion; self-reported usual practice of induced abortion. Results: Of 1498 Fellows and trainees invited to complete the questionnaire, 740 (49%) did so. Of these respondents, 632 (85%) stated that they did not hold religious or conscientious views that would make them totally opposed to abortion; 463 of these (73%) reported performing abortion as part of their personal practice, with 204 (44%) doing so only for severe fetal abnormality or serious maternal medical conditions. 108 respondents reported holding views that made them totally opposed to abortion — 60 (56%) opposed it in any situation at all and 48 (44%) opposed it with limited exceptions. Of those opposed, 34 (32%) added comment that they perform abortion for severe fetal abnormality or serious maternal medical conditions, and a further 17 (16%) commented that they refer women requesting abortion in these circumstances to colleagues. Of the respondents not opposed to abortion, 89% supported the availability of induced abortion within the public health system, and half felt that national availability of mifepristone would modify their practice of induced abortion. Conclusions: There was broad support among responding specialist obstetricians and gynaecologists and trainees for the availability of induced abortion in Australia. This study highlights the difficulties of accurately reporting a wide range of views on a contentious issue.

Objective: To describe the partner notification experiences of individuals diagnosed with chlamydia and to determine what supports might best assist them. Goal: To determine what supports might best assist chlamydia infected individuals to notify their partners. Study Design: A telephone survey was undertaken with men and women recently diagnosed with chlamydia across 3 Australian jurisdictions between August 2007 and January 2008. Results: Of the 286 individuals who agreed to be contacted about the study, 202 (71%) completed the survey. Twenty-three percent (333/1458) of recent partners were notified: men who had sex with men (MSM) notified 15% (133/880) of their partners, heterosexual men 31% (114/370), and women 46% (86/188) of their partners (P < 0.001). Overall, 84% (169/202) of individuals notified at least one partner. The main reasons for informing partners were out of concern for them (44%) or because it was considered “the right thing to do” (37%). The preferred methods for contacting partners were telephone (52%) and face-to-face (30%). E-mail (8%) and short message service (SMS) (11%) were less commonly used; however, if offered a website with anonymous e-mail and SMS services, nearly half of individuals indicated they would find this useful. Of those who had not informed all partners with known contact details (n = 94), 34% reported that if web-based tools were available they would have contacted more partners. Over half of participants would like to have been given antibiotics to give to their partner. Conclusion: The availability of tailored resources may assist in improving partner notification for chlamydia.

Objective: To examine practices of general practitioners' (GPs) in relation to partner notification for chlamydia and identify the supports they would find most useful to assist them. Goal: To identify innovative resources that could improve partner notification for chlamydia in primary care. Study Design: A postal survey was undertaken that involved GPs from several jurisdictions across Australia between August and December 2007. GPs were randomly selected from a national database. Results: Of 521 eligible GPs, 234 (45%) returned a completed questionnaire. Ninety-five percent (n = 223) felt that it was their role to discuss partner notification with patients diagnosed with chlamydia; however, only 45% (105/232) were sure how best to assist their patients with this. Considerable variation was shown in the way partner notification was undertaken, including how far back in time GPs recommended contacting partners. GPs considered a wide range of possible resources useful, including a website supporting patients (90%), information sheets generated by practice software when chlamydia is diagnosed (90%), printed information packs for patients (85%), a website designed to assist GPs (80%), and referral to these websites via positive laboratory results (85%). Forty-three percent currently undertook patient delivered partner therapy for chlamydia. Conclusion: GPs want and need greater guidance and resources to assist them with partner notification for chlamydia. Resources utilizing the internet and practice software and mechanisms where GPs are automatically directed to these when chlamydia is diagnosed have wide appeal and the potential to improve the effectiveness of partner notification for chlamydia.

Background: There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations. Aim: To develop and evaluate the short-term impact of a clinical indicator set for general medicine. Methods: A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003–2005) and after (2006) implementation. Results: Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process. Conclusion: Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.

Gender dysphoria is the distress or discomfort that may occur when a person's biological sex and gender identity do not align. The true prevalence of gender dysphoria is unknown in Australia because of varying definitions, different cultural norms and paucity of data. Individuals who identify as transgender are vulnerable, and have higher rates of discrimination, depression and suicidality, compared with the general population.The aim of this article is to familiarise general practitioners (GPs) with the principles of transgender care so they may provide a safe and supportive environment for patients presenting with concerns.It is important to have a basic understanding of how to conduct an initial consultation of gender dysphoria even if it is an uncommon presentation in general practice. Management should be individualised and may involve a combination of social work, education, counselling, hormone therapy and surgery.

Background: Integrase inhibitors (INSTI) are a newer class of antiretroviral (ARV) drugs that offer additional treatment options for experienced patients. Our aim is to describe treatment durability and virological outcomes in treatment-experienced HIV-positive patients using INSTI-based regimens. Methods: All patients in the Australian HIV Observational Database who had received an INSTI-based regimen ≥ 14 days as well as previous therapy were included in the study. We defined two groups of treatment-experienced patients: (1) those starting a second-line regimen with INSTI; and (2) highly experienced patients, defined as having prior exposure to all three main ARV classes, nucleoside reverse transcriptase inhibitor, nonnucleoside reverse transcriptase inhibitors and protease inhibitors, before commencing INSTI. Survival methods were used to determine time to viral suppression and treatment switch, stratified by patient treatment experience. Covariates of interest included age, gender, hepatitis B and C co-infection, previous antiretroviral treatment time, patient treatment experience and baseline viral load. Results: Time to viral suppression and regimen switching from INSTI initiation was similar for second-line and highly experienced patients. The probability of achieving viral suppression at 6 months was 77.7% for second-line patients and 68.4% for highly experienced patients. There were 60 occurrences of regimen switching away from INSTI observed over 1274.0 person-years, a crude rate of 4.71 (95% CI: 3.66–6.07) per 100 person-years. Patient treatment experience was not a significant factor for regimen switch according to multivariate analysis, adjusting for relevant covariates. Conclusions: We found that INSTI-based regimens were potent and durable in experienced HIV-positive patients receiving treatment outside clinical trials. These results confirm that INSTI-based regimens are a robust treatment option.

Gay and bisexual men (GBM) are a major risk group for HIV acquisition, yet the majority of higher-risk GBM test for HIV less often than recommended (3–6 monthly). HIV self-testing has the potential to increase testing frequency and improve awareness of personal HIV status. HIV self-tests have been approved in some countries, however there are concerns whether self-testing would increase HIV testing frequency enough to compensate for the reduced sensitivity of self-tests in early infection. We describe here a randomised controlled trial to assess the effectiveness of self-testing in increasing HIV testing frequency among higher-risk GBM, and its acceptability. Participants are higher-risk HIV negative GBM (>5 partners or condomless anal intercourse in previous 3 months; n = 350), including 50 GBM who tested for HIV over two years ago or never tested before (‘infrequent-testers’). Participants are recruited from sexual health clinics and community-based organisations, and randomised 1:1 to either self-testing or standard-care (routine clinic-based testing) arms. The trial employs a wait-list control design: participants in the standard-care arm switch to self-testing arm in the second year, and gain access to self-test kits. Participants in the self-testing arm receive four oral-fluid self-test kits at enrolment, with additional kits provided on request. Demographics, sexual behaviour and HIV testing preferences are collected at baseline, and the frequency and pattern of HIV and sexually transmissible infection (STI) testing is collected via online 3-monthly questionnaires. The acceptability of self-testing is assessed at 12 months via an online questionnaire and in-depth interviews. A 24-h telephone support is provided, with expedited follow-up of those with reactive self-test results. The primary outcome is HIV testing frequency (mean number of HIV tests per person) over 12 months, and the secondary outcomes are: mean number of STI tests (chlamydia, gonorrhoea, syphilis) per person; reasons for HIV testing; and acceptability of HIV self-testing. This is the first trial to evaluate the use of self-testing among GBM in Australia, and the first internationally among infrequent testers. The study will provide evidence on whether self-testing increases HIV testing frequency, and its acceptability among GBM. The findings will improve our understanding of self-testing patterns, and whether GBM supplement or replace their existing testing routine. Australian and New Zealand Clinical Trial Registration number: ACTRN12613001236785 , registered on November 12, 2013.

Background There are few data regarding clinical care and outcomes of Indigenous Australians living with HIV and it is unknown if these differ from non-Indigenous HIV-positive Australians. Methods AHOD commenced enrolment in 1999 and is a prospective cohort of HIV-positive participants attending HIV outpatient services throughout Australia, of which 20 (74 %) sites report Indigenous status. Data were collected up until March 2013 and compared between Indigenous and non-Indigenous participants. Person-year methods were used to compare death rates, rates of loss to follow-up and rates of laboratory testing during follow-up between Indigenous and non-Indigenous participants. Factors associated with time to first combination antiretroviral therapy (cART) regimen change were assessed using Kaplan Meier and Cox Proportional hazards methods. Results Forty-two of 2197 (1.9 %) participants were Indigenous. Follow-up amongst Indigenous and non-Indigenous participants was 332 & 16270 person-years, respectively. HIV virological suppression was achieved in similar proportions of Indigenous and non-Indigenous participants 2 years after initiation of cART (81.0 % vs 76.5 %, p = 0.635). Indigenous status was not independently associated with shorter time to change from first- to second-line cART (aHR 0.95, 95 % CI 0.51-1.76, p = 0.957). Compared with non-Indigenous participants, Indigenous participants had significantly less frequent laboratory monitoring of CD4 count (rate:2.76 tests/year vs 2.97 tests/year, p = 0.025) and HIV viral load (rate:2.53 tests/year vs 2.93 tests/year, p

OBJECTIVE To estimate the rate of combination antiretroviral treatment change and factors associated with combination antiretroviral treatment change among patients recruited in the Australian HIV Observational Database (AHOD). METHODS Analyses were based on patients in the AHOD who had commenced combination antiretroviral treatment after 1 January 1997. Combination antiretroviral treatment change was defined as the addition or change of at least one antiretroviral drug. A random-effect Poisson regression model was used to assess factors associated with increased rates of combination antiretroviral treatment change. RESULTS A total of 596 patients in the AHOD were included in the analysis, with a median follow-up of 2.3 years. The overall rate of antiretroviral treatment change in this group was 0.45 combinations per year. In a multivariate analysis, a low CD4 count (< 200 cells/microL) at baseline was associated with an increased rate of treatment change [rate ratio (RR)=1.43; 95% confidence interval (CI), 1.13, 1.80; P=0.003)]. Combinations including a nonnucleoside reverse transcriptase inhibitor were also associated with slower rates of change than treatment combinations including a protease inhibitor (RR=0.64, 95% CI, 0.51, 0.80, P < 0.001). CONCLUSION Initiating combination antiretroviral at a CD4 cell count < 200 cells/microL may be associated with poorer patient outcomes. However, the possibility that clinician or patient concerns about low immunological status led to faster rates of treatment change in this group cannot be discounted.

ObjectiveThere are limited data on the patterns of early sexual behaviours among Australian teenage heterosexual boys. This study describes the nature and onset of early sexual experiences in this population through a cross-sectional survey.DesignA cross-sectional survey between 2014 and 2015SettingMajor sexual health clinics and community sources across AustraliaParticipantsHeterosexual men aged 17–19 yearsResultsThere were 191 men in the study with a median age of 19.1 years. Median age at first oral sex was 16.4 years (IQR: 15.5–17.7) and 16.9 years (IQR: 16.0–18.0) for first vaginal sex. Most men had engaged in oral sex (89.5%) and vaginal sex (91.6%) in the previous 12 months with 32.6% reporting condom use at last vaginal sex. Of the total lifetime female partners for vaginal sex reported by men as a group (n=1187): 54.3% (n=645) were the same age as the man, 28.3% (n=336) were a year or more younger and 17.4% (n=206) were a year or more older. Prior anal sex with females was reported by 22% with 47% reporting condom use at last anal sex. Median age at first anal sex was 18.2 years (IQR: 17.3–18.8). Anal sex with a female was associated with having five or more lifetime female sexual partners for oral and vaginal sex.ConclusionsThese data provide insights into the trajectory of sexual behaviours experienced by teenage heterosexual boys following sexual debut, findings which can inform programme promoting sexual health among teenage boys.

Background Regular testing of individuals at higher-risk of HIV is central to current prevention strategies. The aim of the present study was to examine the extent to which confidence in one’s perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) affected HIV testing outcomes. We assessed factors, including self-efficacy, associated with HIV testing frequency and the likelihood to self-test among gay and bisexual men (GBM). Methods: Participants were HIV-negative GBM at an increased risk of HIV (more than five partners or condomless anal intercourse in the previous 3 months) enrolled in a randomised controlled trial of HIV self-testing. The baseline questionnaire captured data regarding sociodemographic characteristics, HIV and/or sexually transmissible infection testing history, sexual behaviour, beliefs and attitudes towards HIV and eight items capturing confidence in HIV testing ability that were combined as a single broad measure of HIV testing self-efficacy (α = 0.81). Factors associated with three or more HIV tests in the past year and the likelihood of self-testing in the future were determined using logistic regression. Results: Of 354 GBM, 34% reported three or more HIV tests in the past year, and 64% reported being ‘very likely’ to self-test. Factors independently associated with three or more HIV tests in the past year were: higher self-efficacy (adjusted odds ratio (aOR) 1.08 per unit increase; 95% confidence interval (CI) 1.02–1.14; P = 0.004); >10 male partners in the past 6 months (aOR 1.79; 95% CI 1.05–3.04; P = 0.031) and higher optimism regarding the effects of HIV treatments on HIV transmission (aOR 1.14; 95% CI 1.00–1.29; P = 0.044). Only higher self-efficacy was independently associated with reporting a greater likelihood to self-test in the future (aOR 1.10; 95% CI 1.05–1.15; P < 0.001). Conclusions: Improving self-efficacy by enhancing GBM’s knowledge and experience may lead to higher testing frequency. The self-efficacy measure used in the present study could be useful in identifying GBM likely to face difficulties with HIV testing and self-testing.

Background Loss to follow-up (LTFU) in HIV-positive cohorts is an important surrogate for interrupted clinical care, which can potentially influence the assessment of HIV disease status and outcomes. After preliminary evaluation of LTFU rates and patient characteristics, we evaluated the risk of mortality by LTFU status in a high-resource setting. Methods Rates of LTFU were measured in the Australian HIV Observational Database for a range of patient characteristics. Multivariate repeated measures regression methods were used to identify determinants of LTFU. Mortality by LTFU status was ascertained using linkage to the National Death Index. Survival following combination antiretroviral therapy initiation was investigated using the Kaplan–Meier (KM) method and Cox proportional hazards models. Results Of 3,413 patients included in this analysis, 1,632 (47.8%) had at least one episode of LTFU after enrolment. Multivariate predictors of LTFU included viral load (VL)>10,000 copies/ml (rate ratio [RR] 1.63; 95% CI 1.45, 1.84; ref ≤400), time under follow-up (per year; RR 1.03; 95% CI 1.02, 1.04) and prior LTFU (per episode; RR 1.15; 95% CI 1.06, 1.24). KM curves for survival were similar by LTFU status ( P=0.484). LTFU was not associated with mortality in Cox proportional hazards models (univariate hazard ratio [HR] 0.93; 95% CI 0.69, 1.26) and multivariate HR 1.04 (95% CI 0.77, 1.43). Conclusions Increased risk of LTFU was identified amongst patients with potentially higher infectiousness. We did not find significant mortality risk associated with LTFU. This is consistent with timely re-engagement with treatment, possibly via high levels of unreported linkage to other health-care providers.

This study examined the prevalence of Mycoplasma genitalium in incarcerated men from Far North Queensland as well as the prevalence of macrolide resistance in identified isolates. Overall, eight out of 140 [5.71% (95% CI 1.82–9.60)] urine samples tested positive and two out of eight (25%) samples carried a mutation in the 23S rRNA gene associated with macrolide resistance.

Purpose: To describe the occurrence of bilateral iris and retinal crystals in a patient with benign HIV-related gammopathy. Design: Observational case report. Methods: A 45-year-old HIV-positive male with a known, benign hypergammaglobulinemia was referred for routine ophthalmic assessment because of right ophthalmic zoster. Results: Ophthalmoscopic examination revealed the presence of bilateral, multiple, refractile iris and macular crystals. No other signs of uveitis or stigmata of HIV were found. Conclusion: Intraocular crystals are a rare finding, usually seen in chronic uveitis with or without hypergammaglobulinemia. This finding has not been previously described in non-inflamed eyes, nor as an ocular manifestation of HIV. We hypothesize that HIV-related disruption of the blood-aqueous and blood-retinal barriers allows intraocular immunoglobulin deposition in patients with hypergammaglobulinemia.

Mycoplasma genitalium (M. genitalium) was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. Published prevalence rates vary greatly between populations studied. A number of urogenital conditions have been ascribed to M. genitalium, which is recognised to cause a sexually transmitted infection. The association of M. genitalium with non-specific urethritis is now well established, but the evidence supporting its role in both male and female infertility remains inconclusive. Laboratory methods are challenging and there is a lack of test standardisation. The recommended treatment of the infection is azithromycin as a single 1 gm dose. However, in recent years macrolide resistance has been observed. More studies are required to establish the clinical importance of M. genitalium in urogenital conditions, particularly infertility, and to establish the role for screening and treatment in high-risk populations.

Background In HIV-positive people, sexually transmissible infections (STIs) probably increase the infectiousness of HIV. Methods: In 2010, we established a cohort of individuals (n = 554) from clinics in the Australian HIV Observational Database (AHOD). We calculated retrospective rates for four STIs for 2005–10 and prospective incidence rates for 2010–11. Results: At baseline (2010), patient characteristics were similar to the rest of AHOD. Overall incidence was 12.5 per 100 person-years. Chlamydial infections increased from 3.4 per 100 person-years (95% confidence interval (CI): 1.9–5.7) in 2005 to 6.7 per 100 person-years (95% CI: 4.5–9.5) in 2011, peaking in 2010 (8.1 per 100 person-years; 95% CI: 5.6–11.2). Cases were distributed among rectal (61.9%), urethral (34%) and pharyngeal (6.3%) sites. Gonococcal infections increased, peaking in 2010 (4.7 per 100 person-years; 95% CI: 5.6–11.2; Ptrend = 0.0099), distributed among rectal (63.9%), urethral (27.9%) and pharyngeal (14.8%) sites. Syphilis showed several peaks, the largest in 2008 (5.3 per 100 person-years; 95% CI: 3.3–8.0); the overall trend was not significant (P = 0.113). Genital warts declined from 7.5 per 100 person-years (95% CI: 4.8–11.3) in 2005 to 2.4 per 100 person-years (95% CI: 1.1–4.5) in 2011 (Ptrend = 0.0016). Conclusions: For chlamydial and gonococcal infections, incidence was higher than previous Australian estimates among HIV-infected men who have sex with men, increasing during 2005–2011. Rectal infections outnumbered infections at other sites. Syphilis incidence remained high but did not increase; that of genital warts was lower and decreased.

With many parts of the world seeing an aging cohort of people living with HIV (PLHIV), it is becoming clear that some organ systems in these individuals are at a greater risk of disease. There are effects on sexual functioning in aging PLHIV, with many studies finding higher levels of sexual dysfunction in HIV-positive individuals compared with those who are HIV-negative. HIV itself, along with antiretroviral agents, may cause dysfunction. Treatment involves making an assessment of the dysfunction and using the usual methods available, although treatment may be complicated by hormonal deficiencies in HIV-positive individuals, along with the effects of antiretroviral therapy, and drug interactions involving such medications. Furthermore, the issue of HIV transmission needs to be addressed in those seeking treatment for sexual dysfunction.

Anal pruritus affects up to 5% of the population. It is often persistent and the constant urge to scratch the area can cause great distress. Although usually caused by a combination of irritants, particularly faecal soiling and dietary factors, it can be a symptom of serious dermatosis, skin or generalised malignancy or systemic illness.This article discusses the assessment and management of pruritus ani.It is important not to trivialise the symptom of anal pruritus and to enquire about patient concerns regarding diagnosis. Once serious pathology has been excluded, management involves education about the condition; elimination of irritants contributing to the itch-scratch cycle including faecal soiling, dietary factors, soaps and other causes of contact dermatitis; and use of emollients and topical corticosteroid ointments. Compounded 0.006% capsaicin appears to be a safe and valid option for pruritus not responding despite adherence to these conservative measures.

Background: Partner notification for patients diagnosed with chlamydia is a strategy recommended to interrupt transmission of infection, and patients are commonly encouraged by health practitioners to contact their sexual partners themselves. Few studies, however, have ascertained the psychosocial impact of the chlamydia diagnosis and its effect on partner notification. Methods: In-depth telephone interviews were conducted with 25 women and 15 men aged 18–55 years, diagnosed with chlamydia from clinics in Victoria, Australian Capital Territory and Queensland. Reactions to chlamydia diagnosis, as well as reasons for, and feelings about, telling their sexual partners about this infection were explored. Results: Common reactions to initial diagnosis were surprise, shock and shame. The majority of both men and women saw partner notification as a social duty. Some cited concerns about their own health and the health of others as a reason for telling partners and ex-partners about the diagnosis. An infrequent reason offered for partner notification was to confront a partner to clarify fidelity. Reasons for not contacting a partner were typically fear of reaction or a lack of contact details. Although participants reported sexual partners exhibiting a variety of reactions when told of the diagnosis, results showed that for almost everyone, the experience of notifying their partner was better than they had expected. Conclusions: Findings suggested that partner notification by people diagnosed with chlamydia is achievable but that many require support from their health practitioner to achieve the skills and confidence necessary during this difficult time.

Background: In the absence of guidelines for sexual health medicine (SHM) curriculum for medical schools in Australia and New Zealand, little is known about the current curriculum. We therefore, sought to quantitatively and qualitatively measure the existing SHM teaching at medical schools in the region. Methods: SHM specialists and Deans (or their nominated delegates) were requested to complete a questionnaire with respect to the SHM teaching in their associated medical schools. Results: Forty-two specialists completed the questionnaire. Wide variations were found in the time spent on various topics in SHM. ‘Training to teach’ was found to be a major unmet need of SHM specialists. Four (16.7%) of 24 medical schools completed the questionnaire. The total time allocated to SHM in these medical schools varied from 13.6 to 39.0 h, with a median of 31.1 h. At least 70% of key SHM topics were covered in all curricula. Conclusion: SHM teaching varied markedly in terms of subject matter, allocated time and teaching modalities. National guidelines for the teaching of SHM to medical students could facilitate the development of more consistent standards within the medical workforce. Training in teaching and learning methods to specialists may improve dissemination of sexual health skills to the wider medical workforce.

Background Partner notification is accepted as a vital component in the control of chlamydia. However, in reality, many sexual partners of individuals diagnosed with chlamydia are never informed of their risk. The newer technologies of email and SMS have been used as a means of improving partner notification rates. This study explored the use and acceptability of different partner notification methods to help inform the development of strategies and resources to increase the number of partners notified. Methods Semi-structured telephone interviews were conducted with 40 people who were recently diagnosed with chlamydia from three sexual health centres and two general practices across three Australian jurisdictions. Results Most participants chose to contact their partners either in person (56%) or by phone (44%). Only 17% chose email or SMS. Participants viewed face-to-face as the "gold standard" in partner notification because it demonstrated caring, respect and courage. Telephone contact, while considered insensitive by some, was often valued because it was quick, convenient and less confronting. Email was often seen as less personal while SMS was generally considered the least acceptable method for telling partners. There was also concern that emails and SMS could be misunderstood, not taken seriously or shown to others. Despite these, email and SMS were seen to be appropriate and useful in some circumstances. Letters, both from the patients or from their doctor, were viewed more favourably but were seldom used. Conclusion These findings suggest that many people diagnosed with chlamydia are reluctant to use the new technologies for partner notification, except in specific circumstances, and our efforts in developing partner notification resources may best be focused on giving patients the skills and confidence for personal interaction.

Background Some human cancers demonstrate cellular hierarchies in which tumor-initiating cancer stem cells generate progeny cells with reduced tumorigenic potential. This cancer stem cell population is proposed to be a source of therapy-resistant and recurrent disease. Ewing sarcoma family tumors (ESFT) are highly aggressive cancers in which drug-resistant, relapsed disease remains a significant clinical problem. Recently, the cell surface protein CD133 was identified as a putative marker of tumor-initiating cells in ESFT. We evaluated ESFT tumors and cell lines to determine if high levels of CD133 are associated with drug resistance. Methods Expression of the CD133-encoding PROM1 gene was determined by RT-PCR in ESFT tumors and cell lines. CD133 protein expression was assessed by western blot, FACS and/or immunostaining. Cell lines were FACS-sorted into CD133+ and CD133- fractions and proliferation, colony formation in soft agar, and in vivo tumorigenicity compared. Chemosensitivity was measured using MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxy-methoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assays. Results PROM1 expression was either absent or extremely low in most tumors. However, PROM1 was highly over-expressed in 4 of 48 cases. Two of the 4 patients with PROM1 over-expressing tumors rapidly succumbed to primary drug-resistant disease and two are long-term, event-free survivors. The expression of PROM1 in ESFT cell lines was similarly heterogeneous. The frequency of CD133+ cells ranged from 2-99% and, with one exception, no differences in the chemoresistance or tumorigenicity of CD133+ and CD133- cell fractions were detected. Importantly, however, the STA-ET-8.2 cell line was found to retain a cellular hierarchy in which relatively chemo-resistant, tumorigenic CD133+ cells gave rise to relatively chemo-sensitive, less tumorigenic, CD133- progeny. Conclusions Up to 10% of ESFT express high levels of PROM1. In some tumors and cell lines the CD133+ fraction is relatively more drug-resistant, while in others there is no apparent difference between CD133+ and CD133- cells. These studies reveal heterogeneity in PROM1/CD133 expression in ESFT tumors and cell lines and confirm that high levels of PROM1 expression are, in at least some cases, associated with chemo-resistant disease. Further studies are required to elucidate the contribution of PROM1/CD133 expressing cells to therapeutic resistance in a large, prospective cohort of primary ESFT.

SUMMARYA prospective cohort study estimated the incidence of hepatitis C virus (HCV) in drug injectors in South Wales (UK). In total, 286/481 eligible seronegative individuals were followed up after approximately 12 months. Dried blood spot samples were collected and tested for anti-HCV antibody and behavioural data were collected at baseline and follow-up. HCV incidence was 5·9/100 person-years [95% confidence interval (CI) 3·4–9·5]. HCV incidence was predicted by community size [incident rate ratio (IRR) 6·6, 95% CI 2·11–20·51,P=0·001], homelessness (IRR 2·9, 95% CI 1·02–8·28,P=0·047) and sharing injecting equipment (IRR 12·7, 95% CI 1·62–99·6,P=0·015). HCV incidence was reduced in individuals in opiate substitution treatment (IRR 0·34, 95% CI 0·12–0·99,P=0·047). In order to reduce follow-up bias we used multiple imputation of missing data using switching regression; after imputation estimated HCV incidence was 8·5/100 person-years (95% CI 5·4–12·7). HCV incidence varies with community size, equipment sharing and homelessness are associated with increased HCV incidence and opiate substitution treatment may be protective against HCV.

A 42-year-old Thai man was administered the combination drugs liponavir/ritonavir and abacavir/lamivudine. On day 3 he was admitted and his electrocardiogram demonstrated sinus arrest with junctional escape rhythm with a rate of 42 min−1. Three days after stopping the medication he reverted to normal sinus rhythm. A 55-year-old Caucasian man was admitted to hospital with triple vessel disease. He had a permanent pace maker inserted 4 years previously for Mobitz type II AV block detected on stress electrocardiogram, which developed 1 month after initiation of lopinavir/ritonavir. These two cases highlight the importance of considering lopinavir/ritonavir induced arrhythmias when dealing with HIV-positive individuals.

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

* Mifepristone (RU486), which is used for early medical abortion, can only be obtained in Australia under the Authorised Prescriber legislation (Section 19[5] of the Therapeutic Goods Act 1989 [Cwlth]); two of the authors have permission to obtain, prescribe and administer this drug in Cairns, Queensland. * From July 2006 to April 2007, 10 women who fulfilled the Therapeutic Goods Administration (TGA) criteria of “life-threatening or otherwise serious” indications underwent medical abortion with mifepristone/misoprostol, and 12 women conforming with abortion requirements of Queensland law, but not TGA legislation for mifepristone administration, had medical abortions with the less preferable methotrexate/misoprostol combination. * Although it is now more than a year since the cross-party vote in federal Parliament in February 2006 confirmed wide support for the right of Australian women to a medical abortion, we believe we are at present the only medical practitioners in Australia with permission to use mifepristone. * Obtaining Authorised Prescriber status from the TGA is of necessity a complex and protracted process, involving ethics committee approval and auditing, and regular reporting to the TGA. * Because of the current restrictions, we believe that women seeking medical abortion in Australia face barriers not experienced by women in other comparable countries, and that drug manufacturing and distributing companies may be discouraged from seeking to market mifepristone in Australia.

Background Most HIV diagnoses in Australia are among gay and bisexual men (GBM), yet less than a quarter of higher-risk GBM are testing at the recommended frequency (3–6 monthly). In the context of a randomised trial of HIV self-testing (FORTH), we examined the predictors of more frequent use of HIV self-testing among higher-risk GBM. Methods Participants in FORTH trial included higher-risk GBM (>5 sexual partners or condomless anal intercourse in the past 3 months). The trial is being conducted over 12 months, and men in the intervention arm receive 4 self-tests (OraSure’s OraQuick home test) at baseline and additional self-tests on request. Using data from the baseline and 6 month surveys, we used logistic regression to examine predictors of using >2 self-tests over 6 months among participants in the intervention arm. Results Of the GBM (n = 154) in the intervention arm, 59% reported in the baseline survey they had condomless anal intercourse with casual partners (CLAIC) in the past 6 months and 56% had a HIV test every six months. Men who reported CLAIC in the past 6 months were more likely to use >2 HIV self-tests in the first 6 months of the trial (odds ratio:2.8,95% CI: 1.2–6.7). No other baseline survey factors were associated with >2 self-tests, including; demographics, testing frequency, likelihood to self-test in the future, and reported testing barriers (the process of getting tested is too much hassle, I don’t like having to return for results, I don’t want to go to a clinic/doctor to get tested). Conclusion These findings indicate men who report sexual risk behaviour are more likely to increase their testing frequency through self-tests, which is a key HIV prevention goal. However there is also a need to ensure the longer window period of the OraQuick self-test is understood to avoid infections being missed. Disclosure of interest statement The research is funded through a NHMRC Program grant from the NHMRC and self-test kits were purchased from OraSure Technologies Inc. (Bethlehem, PA, USA). The Kirby Institute and the Centre for Social Research in Health receive funding from the Australian Government Department of Health.

Introduction Regular testing of individuals at high risk of HIV is central to current prevention strategies, and crucial to decrease the time-to-diagnosis. Little research has been conducted on ‘self-efficacy’: the perceived ability to undertake HIV testing among gay and bisexual men (GBM). We examined self-efficacy in relation to HIV testing frequency and likelihood to self-test among GBM. Methods Participants were HIV-negative GBM at increased risk of HIV (>5 partners or any condomless anal intercourse in previous 3 months) in a randomised controlled trial of HIV self-testing (FORTH). Participants completed a baseline survey at enrolment. We constructed a HIV Testing Self-Efficacy (HTSE) scale measuring confidence in one’s perceived ability to undertake HIV testing comprising 8 items (‘not at all confident’ = 0 to ‘completely confident’ = 4; Cronbach’s α = 0.81). Total HTSE score consisted of the sum of scores for all items. We determined the factors associated with HIV testing frequency in the past 12 months and perceived likelihood to self-test in the future using logistic regression. Results A total of 355 GBM were included. Median age was 33 years (inter-quartile range [IQR] = 26–41), and 63% were Australian-born. Overall, 95% reported having previously tested for HIV, and 65% reported being ‘very likely’ to self-test for HIV. The median HTSE score was 26 (IQR = 23–29, range = 8–32). In multivariate analysis, factors independently associated with ≥3 HIV tests in past 12 months were: HTSE score (adjusted odds ratio [AOR] = 1.07 for one unit increase, 95% CI = 1.02–1.13, p = 0.011); and >10 partners in past 6 months (AOR = 1.85,95% CI = 1.10–3.12, p = 0.020). Only HTSE score was associated with being ‘very likely’ to self-test (OR = 1.08, 95% CI = 1.03–1.13, p = 0.001). Conclusion HIV testing self-efficacy is independently associated with testing frequency and likelihood to self-test. Improving GBM’s confidence in HIV testing, by improving their knowledge and experience may lead to higher testing frequency. Future longitudinal analysis will provide information about the causal pathways between HTSE, testing frequency and actual self-testing measured in the trial. Disclosure of interest statement The research is funded through a NHMRC Program grant from the NHMRC and self-test kits were purchased from OraSure Technologies Inc. (Bethlehem, PA, USA). The Kirby Institute and the Centre for Social Research in Health receive funding from the Australian Government Department of Health.

Introduction Post-exposure prophylaxis (PEP) is a pharmacological method of preventing seroconversion following a high-risk exposure to human immunodeficiency virus (HIV). The Cairns Sexual Health Service is the central prescribing organisation for all occupational and non-occupational PEP presentations in the Cairns greater region. A retrospective analysis of presentations from 2011 to 2014 was performed to identify patterns of PEP use, re-presentation, follow-up and patient outcomes. Methods Pharmacy records for all patients prescribed PEP at the Cairns Sexual Health Service from 01/01/2011 to 31/12/2014 were obtained. 121 presentations were identified of which 14 were excluded for incomplete patient details. A remaining 107 presentations for 81 clients were included for assessment. Charts for all 81 patients were audited with patient demographics, exposure type, follow-up attendance and outcome data collated. An excel format of the information was generated for analysis. Results Non-occupational exposures accounted for 92% (n = 98) of presentations, whilst occupational exposures accounted for 8% (n = 9). 91% of presentations were males, 75% of which were men who have sex with men. Unprotected anal intercourse was responsible for 76% of non-occupational PEP. Re-presentations for PEP were high at 24%. Patient follow up was low with only 51% returning within 12 weeks of PEP completion, however, 13% were travellers who may have left the region. One patient who was lost to follow-up later underwent seroconversion to HIV. Two individuals with multiple presentations went on to access pre-exposure prophylaxis (PrEP). Conclusion High rates of re-presentation and loss to follow-up indicate areas for improved response from our service. The rates of re-presentation reveal a need for further education and counselling of patients to reduce their exposure risks. At present there is no formal follow-up system at CSHS for patients prescribed PEP. Given the number of patients lost to follow-up an active system may be considered in the future. Disclosure of interest statement No conflicts of interest to declare.

We report the case of a male-to-female transgender individual who inflicted radio-frequency injuries to her testicles in an attempt to damage them. Important consideration should be given by medical practitioners when they are faced with an individual who believes he or she is transgender. A sympathetic approach should be taken and a referral made to a clinician or service experienced in dealing with transgender patients.

This thesis project compares the performance of a homogeneous sample of United States Navy Bachelor Enlisted Quarters built using the Military Construction process. Projects will be broken into two sub-samples of design/bid/build and design/build projects to see if one project delivery method is superior in regards to time and cost. Project duration, project duration per bed, project time growth, cost growth and cost per bed will be statistically compared. Upon completion of the analysis the hypothesis that design/build projects are superior to design/bid/build projects in regards to time and cost will be tested. http://archive.org/details/anempiricalcompa109451722 Contract number: N62271-97-G-0073. Approved for public release; distribution is unlimited.

Background: Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), with infections often being unrecognised by patients and/or clinicians. HSV-2 infections may be a risk factor for the transmission of human immunodeficiency virus (HIV) infection. Reliable tests for type-specific HSV antibodies are now readily available. Objectives: To determine the seroprevalence of HSV-1 and -2 in HIV-seronegative gay men in a primary care setting in Melbourne, Australia, and to compare it with the rate in HIV-infected gay men. To assess the utility in a clinical setting of a type-specific HSV enzyme linked immunosorbent assay (ELISA) as compared with western blot. Study design: We recruited a total of 300 HIV-seronegative homosexual men attending for HIV antibody testing, and HIV-infected men attending for CD4 lymphocyte count and viral load estimation. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Selected serum samples were retested by western blotting and the results analysed. Results: In total, 168 HIV-antibody negative men and 132 HIV-antibody positive men were recruited. Of all subjects, 73.3% had HSV-1 antibodies. This proportion did not differ between HIV-seronegative and seropositive men (P = 0.48). About twenty percent of HIV-seronegative men and 61% of HIV-seropositive men had antibodies to HSV-2 (P < 0.0001); 75.6% of HIV-seronegative men with antibodies to HSV-2 gave no history of genital herpes, as did 66.7% of HIV-seropositive men. Overall, in using the type-specific ELISA (Gull) assay, false negative, false positive or equivocal results were obtained in 33/300 (11%) of samples tested compared with western blot. Conclusions: High rates of HSV-2 infection were found in homosexual males, with the rate for HIV-seropositive men being over twice that for HIV uninfected men. Most subjects were not aware of their infection with HSV-2. HIV-infected individuals were also older and had higher numbers of sexual partners, but we were unable to unambiguously establish that these variables contributed to the difference in HSV-2 seroprevalence rates. The Gull type-specific assay for HSV antibodies has significant problems with sensitivity and specificity at a discrepancy rate of 11%. Caution is advised in using this type-specific commercial assay for clinical purposes.

[Extract] Sexual health is rather a difficult thing to define. A current Medline search for ‘sexual health’ throws up over 1000 articles since 1975, and it becomes clear that, despite its widespread use, sexual health as a concept has a number of different meanings to a number of different people.

The government of Queensland, Australia, recently announced that there will be no reform of the state’s antiquated abortion laws during the current term of office. The announcement was in response to Australian pro-choice groups’ concerns over the prosecution of a young Queensland couple for procuring an abortion for the woman, allegedly using drugs bought overseas—charges carrying penalties of up to 7 years’ imprisonment.

The use of combination antiretroviral therapy for HIV infection is a rapidly changing field. To assess the impact of recent studies on prescribing patterns, two surveys of 21 high HIV caseload Australian GPs were undertaken in June 1996 and June 1997 to plot changes in the choice of combination antiviral therapy. Of the 17 GPs who responded to the survey in each year, the number of HIV-infected patients seen at their practices were estimated to be 5,061 in 1996 and 5,912 in 1997. In 1996, 40% of their patients were estimated to be on antiretroviral therapy compared to 60% in 1997 (p < 0.05). In 1996, most GPs preferred using dual combination therapy (59%); whereas in 1997, triple combination therapy was preferred (82%). Between 1996 and 1997, there was a significant change by high caseload Australian GPs in the choice of antiretroviral drugs with many combinations being preferred prior to presentation of efficacy data for those combinations, or recommendation through national guidelines.

Microdilution methodology was used to study the interaction of imipenem with erythromycin and tetracycline, a combination therapy that might be used for the treatment of serious pelvic inflammatory disease. The combination of imipenem and erythromycin showed no antagonism for Escherichia coli and Haemophilus influenzae but was antagonistic for Staphylococcus aureus, Enterococcus faecalis, and group B streptococci; the combination of imipenem and tetracycline was antagonistic for all strains except H. influenzae. Correlation between the results of kill curves and the measurement of fractional bactericidal concentration (FBC) indices was good, although FBC indices showed less antagonism than kill curves. Fractional inhibitory concentration indices showed poor correlation, rarely showing antagonism, and indeed showed synergy in three cases. If erythromycin or tetracycline is considered necessary in addition to imipenem in the treatment of pelvic inflammatory disease, it is probably more effective when given after the course of imipenem has been completed.

Latent Mycobacterium tuberculosis infection is a significant risk for those infected with HIV. We examined the use of an interferon-gamma release assay for the diagnosis of latent tuberculosis among HIV-infected clients attending two sexual health services in Far North Queensland. Of 240 clients tested, 19 returned a positive result (7.9%, 95% confidence interval (CI): 4.5–11.3%) and three were indeterminate (1.3%, 95% CI: –0.2%–2.7%). Low CD4 count was found to be significantly associated with an indeterminate test result (P = 0.004). However, we found no significant association between test results and client demographics, self-reported prior tuberculosis infection, Bacille Calmette-Guérin vaccine status or selected tuberculosis risk factors (P-values = 0.2–0.9).

BackgroundLife expectancy has increased for newly diagnosed HIV patients since the inception of combination antiretroviral treatment (cART), but there remains a need to better understand the characteristics of long-term survival in HIV-positive patients. We examined long-term survival in HIV-positive patients receiving cART in the Australian HIV Observational Database (AHOD), to describe changes in mortality compared to the general population and to develop longer-term survival models.MethodsData were examined from 2,675 HIV-positive participants in AHOD who started cART. Standardised mortality ratios (SMR) were calculated by age, sex and calendar year across prognostic characteristics using Australian Bureau of Statistics national data as reference. SMRs were examined by years of duration of cART by CD4 and similarly by viral load. Survival was analysed using Cox-proportional hazards and parametric survival models.ResultsThe overall SMR for all-cause mortality was 3.5 (95% CI: 3.0-4.0). SMRs by CD4 count were 8.6 (95% CI: 7.2-10.2) for CD4ConclusionObserved mortality remained fairly constant by duration of cART and was modelled accurately by accepted prognostic factors. These rates did not vary much by duration of treatment. Changes in mortality with age were similar to those in the Australian general population.

Background Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. Methods: Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. Results: Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200 cells μL–1 and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. Conclusion: Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.

Background: The objective of this study was to obtain representative seroprevalence data for the Indigenous population of Far North Queensland by measuring the age- and sex-specific seroprevalence of the herpes simplex viruses (HSV-1 and HSV-2) in Cape York. Methods: A cross-sectional seroprevalence study was conducted using de-identified serum samples collected from Indigenous patients living in Cape York, aged 16 years or older, who sought medical care between August 2007 and May 2008. An age- and sex-stratified random sample of 270 sera was tested for the presence of antibodies to HSV-1 and HSV-2 using commercially available enzyme-linked immunosorbent assays. Indeterminate results were resolved with western blot. Results: The overall seroprevalence for the Indigenous population of Cape York was 97.8% for HSV-1 and 58.5% for HSV-2. There was a statistically significant difference in HSV-2 seroprevalence according to sex (P

As part of a larger, combined qualitative-quantitative methods study of partner notification, 40 in-depth telephone interviews were conducted with patients diagnosed with Chlamydia from clinics in Victoria, ACT and Queensland to determine their usage and opinions of different methods partner notification. Overwhelmingly, personal methods such as telling partners face-to-face or over the phone were preferred to impersonal methods such as email, SMS and letter. Face-to-face was considered the "gold standard" in partner notification because it demonstrated courage, caring and respect. Phone contact, while considered insensitive and cowardly by some, was often used because it was quick, convenient and less confronting. Email was viewed as only being acceptable in certain circumstances, such as if the partner was overseas, because it was seen as impersonal and uncaring. SMS was considered the least acceptable method for telling partners with most interviewees seeing it as cold, disrespectful and "gutless". However, interviewees who were fearful of their partner's reaction or who had high numbers of casual partners were enthusiastic about an anonymous SMS facility. For both emails and SMS, interviewees were concerned that the message could be misunderstood, not taken seriously or shown to others. Letters, both from the patients or from their doctor, while not viewed as unfavourably as the newer technologies were less likely to be used. These findings suggest that people diagnosed with Chlamydia are reluctant to use the new technologies for partner notification, except in specific circumstances, and our efforts in developing partner notification resources may best be focused on giving patients the skills and confidence for personal interaction.

Partner notification for patients diagnosed with chlamydia is recommended to assist in controlling the increasing incidence of this often asymptomatic but treatable infection. Few studies, however, have ascertained the views on partner notification from those who are often expected to perform it - the individuals who have been diagnosed with chlamydia. As part of a larger combined qualitative-quantitative methods study of partner notification, 40 in-depth telephone interviews were conducted with people diagnosed with chlamydia from clinics in Victoria, ACT and Queensland. Reactions to chlamydia diagnosis, as well as reasons for, and feelings about, telling their sexual partners about this infection were explored. Common reactions to initial diagnosis were surprise, shock and shame, as well as relief about being able to put a name to symptoms. Many spoke of relief on learning the condition was treatable. Both men and women commonly saw partner notification as a social duty, and cited concerns about their own health and the health of others as a reason for telling partners and ex-partners about the diagnosis. An infrequent reason offered for partner notification was to confront a partner to clarify fidelity. Reasons for not contacting a partner were typically fear of reaction, or a lack of contact details. Although participants reported sexual partners exhibiting a variety of reactions when told of the diagnosis, results showed that for almost everyone, the experience of notifying their partner was better than they had expected. Views about taking antibiotics to the partner varied according to the currency of the relationship, with some feeling it could be offered as appeasement, and others feeling it might be seen as intrusive. Overall, the findings from this study suggest that partner notification by people diagnosed with chlamydia is achievable, with many of these results likely to be transferable to other settings.

As part of a larger, combined qualitative-quantitative study of partner notification, 40 semi-structured in-depth telephone interviews were conducted with General Practitioners (GPs), from Victoria, ACT and Queensland, who had diagnosed at least one case of chlamydia in the last year. Rural doctors and those who had experience working with Aboriginal patients were over-sampled to ensure their views were represented in the study. The interviews explored GPs' current practices with regard to partner notification for chlamydia, barriers they perceived to partner notification for chlamydia in the general practice setting and what resources/incentives they felt would improve partner notification for chlamydia. The GPs in our study primarily ask the index patient to carry out partner notification themselves. It was relatively rare for GPs to have experience of notifying partners on the patient's behalf. Half of the GPs report that they only encourage notification of the patient's current/immediate past partners. There was considerable confusion amongst the GPs interviewed as to the role of government partner notification officers. Many thought that support from a government agency would allow partner notification to occur more effectively. Some were under the impression that this process is automatically activated when they 'notify' that they have diagnosed someone with chlamydia. Some of the main barriers perceived include confusion about issues of privacy and confidentiality with regard to partner notification and the sense that there is a lack of clarity as to what is expected of them in terms of partner notification for chlamydia. Most GPs feel that access to decision support tools and clear guidelines would be helpful. Financial incentives for doing partner notification were seen as particularly important to fund allied health workers' time rather than to pay GPs themselves e.g. for practice nurses and Aboriginal health workers. GPs were enthusiastic about computer based resources to aid in partner notification