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The incidence of cancer in patients receiving immune suppression after kidney transplantation was compared to cancer incidence during end-stage kidney disease before commencement of renal replacement therapy (RRT) and during dialysis in a population-based cohort study. Results revealed that cancer incidence is increased across a number of organ systems after kidney transplantation, suggesting an important role for the interaction between common viral infections and the immune system in the etiology of cancer.

Objective: To determine the prevalence and risk factors for hepatitis C (HCV) in HIV-negative homosexual men in Sydney. Methods: A cohort study was conducted in a sample of community-based, HIV-negative, homosexual men in Sydney. Participants underwent a face-to-face interview regarding sexual behaviour, sexually transmissible infections, and injecting drug use (IDU). Results: Eight hundred and twenty-four men consented to HCV testing, and the prevalence was 0.85% (95% CI 0.34-1.74). HCV seropositivity was strongly associated with a history of IDU (OR=60.43, 95% CI 6.70-544.79). All HCV seropositive individuals reported a history of either IDU or other means by which they may have had parenteral exposure to HCV. There was no evidence of an independent association between sexual behaviour and HCV infection. Conclusion: The prevalence of HCV in this cohort was about the same as in the general population in Australia, and there was no evidence for sexual transmission in this population.

Objective: To review the content, method and process of the Australian Study of Health and Relationships (ASHR). Results: ASHR achieved a large sample, a high response rate and documented the sexual life histories and current sexual health-related knowledge, attitudes and practices of the Australian population aged 16-59. Its cross-sectional nature limited our ability to partition observed variation between age and time despite clear evidence of both age-related and cohort-related changes in sexual practice. Similarly, its reliance on a sample of individuals reporting on their sexual experiences rather than a sample of sexual relationships or encounters and their participants limits our ability to understand the dynamics of those relationships and encounters. Finally, our understanding of sexuality in Australia could have been improved through qualitative studies with a subsample of ASHR participants. Conclusion: ASHR represents a significant contribution to our understanding of sexual health-related knowledge, attitudes and practices in Australia. (Aust N Z J Public Health 2003; 27:251-6)

Objective: Some blood-borne and sexually transmissible agents may be spread by using non-sterile injecting equipment and by unprotected sexual intercourse. The objective of this study was to describe the prevalence of these risk factors in the general population of Australia. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Results: 3% of respondents had ever injected non-prescription drugs; men were more likely than women to have done so. Predictors of injecting in men and women included being aged 20-29, homosexual or bisexual identity, and lower levels of education and income. Injecting was not more common in cities than elsewhere. Among people who had injected in the past year, 12.4% had shared needles and 43.0% had shared other paraphernalia. Sharing was significantly related to lower income. Unprotected sex with casual partners was more common in heterosexual activity than in male homosexual activity. Among heterosexually active respondents, 3.3% reported unprotected vaginal sex with casual partners (59% of those with such partners) and among homosexually active males 2.1% reported unprotected anal sex with casual partners (12% of those with such partners). Predictors of unprotected sex included indices of lower socio-economic status. Conclusion: Sexual and injecting risks are reported by substantial minorities of the Australian population and are associated with indices of lower socio-economic status and bisexual identity. Programs are needed to address vulnerabilities to these infections. (Aust N Z J Public Health 2003; 27: 242-50)

Objective: To describe knowledge related to sexually transmitted infection (STY) and blood-borne virus (BBV) infection in a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). Respondents were read a series of statements about STIs and BBVs and asked to say if they believed they were true or false. Predictors of knowledge were examined. Results: Respondents were more likely to answer correctly questions about hepatitis C than questions about herpes, gonorrhoea, genital warts and chlamydia. Women had better knowledge than men. Other predictors of better knowledge included speaking English at home, homosexual or bisexual identity, higher educational levels, higher income, higher occupational level and a previous STI diagnosis. Conclusion: Knowledge of transmission routes and health consequences of the most common STIs was poor. Although knowledge is only one prerequisite for effective disease prevention, the findings suggest that improving public knowledge of STIs is an urgent task in reducing the morbidity associated with these common infections. Implications: Education campaigns to increase knowledge of the transmission and health consequences of STIs are urgently required if the substantial morbidity associated with these common infections is to be reduced. (Aust N Z J Public Health 2003; 27: 230-3)

Objective: To describe the lifetime and recent history of STIs and BBV, including place of seeking treatment, in a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). Results: Overall, 20.2% of men and 16.9% of women had ever been diagnosed with an STI or BBV, and 2.0% and 2.2% respectively had been diagnosed in the past year. The participant's usual general practitioner was the most common location of treatment. Sexual health clinics accounted for a small proportion of treatment locations. Predictors of recent STI or BBV diagnosis in men included homosexual or bisexual identity, a history of sex work as a worker or client, a history of injecting drugs and having more than one partner in the past year. In women, predictors included bisexual identity, history of sex work as a worker, injecting drug use, and having more than one partner in the past year. Around 40% of men and women had been tested for HIV and in homosexually identified men, 77% had been tested. Conclusion: STIs and BBVs are common infections in Australia and care is mostly received from general practitioners. Although a variety of predictors, including homosexual or bisexual identity, injecting drug use and sex work were related to STI diagnosis, STIs were not uncommon among people without these risk factors. Implications: General practitioners in Australia require a high level of expertise to recognise, offer testing, and manage common STIs and BBVs. (Aust N Z J Public Health 2003; 27:234-41)

Objective: To describe selected characteristics of Australian adults' regular or ongoing sexual relationships. Method: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated how often they had sex in the past four weeks, contraceptive use, their own and their partners' expectations about having sex with other people during their relationship, whether they had discussed these expectations with their partners and whether they had an explicit agreement about sex with other people. Results: 85.3% of men and 89.5% of women were in a regular heterosexual relationship, among whom 81.4% of men and 89.3% of women reported contraceptive use. Men and women who had a regular partner for the past 12 months had had sex with their partners an average of 1.84 times per week in the four weeks before interview; younger people had sex more often. Most respondents expected themselves and their partners to not have sex with other people, although men were less likely than women to have discussed these expectations with their partner. Bisexually identified men and women were significantly less likely than heterosexually identified men and women to support having sex only with their regular partner. Only 4.9% of men and 2.9% of women in regular heterosexual relationships had concurrent sexual partners in the past 12 months. Conclusion: Australians' attitudes to not having sex with people while in a regular relationship are highly consistent with their behaviour.

Objectives: To document the use of contraception by a representative sample of Australian women aged 16-59 years. Method: Between mid-2001 and mid-2002, computer-assisted telephone interviews were completed by 9,134 women aged 16-59 years from all States and Territories selected by modified random-digit dialling of households (response rate 77.6%). Respondents were asked about contraceptive methods used in their current regular relationship(s) and during recent sexual encounters, or in general, or their reasons for non-use. Responses were allocated to 14 categories. Results: 70.8% of respondents were using a method of contraception, over 95% of those apparently at risk of pregnancy. Most common reasons for non-use were not having intercourse (41.6%) and being past menopause (21.6%). Among those apparently at risk of unplanned pregnancy (i.e. who were heterosexually active and fertile but not pregnant or trying to become pregnant; 13.0% of non-users), the most common reasons for non-use were experience of side-effects or contraindications (23.0%), leaving it to chance (20.2%), forgetting/not caring (18.9%), breast feeding (16.5%) and believing it unnatural/unhealthy (13.7%). No women cited religious objections or lack of access to services. The most used methods were oral contraceptives (33.6% of users), tubal ligation/hysterectomy (22.5%), condom (21.4%) and vasectomy of partner (19.3%). Tubal ligation rates were higher and condom use lower in regional and remote areas. Conclusion: Given the high levels of use and knowledge and lack of evidence of unmet service need, most unplanned pregnancies in Australian adults are likely to be attributable to method failure or inconsistent use.

Objective: To provide reliable estimates of the frequency of condom use and correlates of condom use among Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1% (69.4% men, 77.6% women). Results: Although the majority of respondents had used a condom at some time in their lives, fewer than half of the respondents who were sexually active in the year before being interviewed had used a condom in the past year. Condom use in the past year was associated with youth, greater education, residence in major cities, lower incomes, white-collar occupations, being a former smoker, and having more sexual partners in the past year. In the six months prior to interview, 7.1% of respondents always used condoms with regular cohabiting partners, 22.5% always used condoms with regular non-cohabiting partners, and 41.4% always used condoms with casual partners. Approximately 20% of respondents used a condom the last time they had vaginal intercourse, and one in eight of these condoms were put on after genital contact. Condom use during the most recent sexual encounter was associated with youth, living in a major city, having a lower income, having sex with a casual partner, and not using another form of contraception. Conclusion: As in other studies, condom use was strongly associated with partner type and use of other contraception. Implications: People with multiple sexual partners need to be aware that non-barrier methods of contraception (and condoms applied late) do not protect against sexually transmitted infections. (Aust N Z J Public Health 2003; 27: 223-9)

Objective: Condom use is a central part of strategies to prevent the transmission of human immunodeficiency virus and other sexually transmissible infections. The objective of this study was to provide reliable estimates of the prevalence and correlates of condom failure among a representative sample of Australian men. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men aged 16-59 years from all States and Territories. The response rate was 69.4%. Results: Among men who used condoms in the year prior to being interviewed, 23.8% experienced at least one condom breakage in the past year and 18.1% experienced at least one condom slippage in the past year. Experience of condom breakage in the past year was significantly related to younger age, having a blue-collar occupation, and using more condoms. Neither condom slippage nor condom failure was significantly related to use of water-based lubricants or oil-based lubricants. Conclusion: Condom failure is related to certain characteristics of individuals and is not randomly distributed across all condom users. Lubricant use did not affect condom failure. Implications: There may not be a need to promote lubricant use for vaginal intercourse, as there was no association between lubricant use and condom failure. (Aust N Z J Public Health 2003; 27: 217-22)

Objectives: To describe the prevalence of a range of autoerotic and other non-coital sexual practices among Australians. Method: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years (response rate 73.1%). Respondents were asked whether in the past year they had: masturbated, engaged in various other autoerotic activities, or engaged in any of six other non-coital or esoteric practices. Results: Half of the respondents (65% men, 35% women) had masturbated in the past year. Nearly half (48%) of the men and 25% of the women had masturbated in the past four weeks, among whom men had done so a mean of 5.8 times and women 3.3 times. About a quarter of all respondents had watched an X-rated film (37% men, 16% women), 12% of men and 14% of women had used a sex toy, and 17% of men and 2% of women had visited an Internet sex site. 17% of men and 14% of women had engaged in digital-anal stimulation with a partner. Phone sex, role play or dressing up, bondage and discipline, sadomasochism or dominance and submission (BDSM-DS), fisting (rectal or vaginal, insertive or receptive) and rimming (oral-anal stimulation) were all engaged in by less than 5% of the sample. Conclusion: Most of the practices studied were engaged in by more men than women. A range of autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.

Objective: To describe the prevalence and features of homosexual experience and recent homosexual encounters among a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). Results: Overall, 8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives (p Conclusion: Homosexually and bisexually identified men and women had higher total numbers of partners than heterosexuals. Improved societal attitudes towards homosexuality are likely to lead to further increases in estimates of the prevalence of homosexual experience in the community.

Objective: To document the reproductive experiences of a representative sample of Australian women aged 16-59 years. Method: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men, and 77.6% among women). Women were asked the number of times they had experienced a live birth, a still birth, a miscarriage and a termination of pregnancy. Results: Of the women surveyed, 15.5% reported having experienced difficulty in becoming pregnant and 76.1% had been pregnant at least once. Nearly all the women who had been pregnant reported experiencing a live birth. Substantial minorities of women reported having experienced a miscarriage (33.4%) or a termination of pregnancy (22.6%). The percentage of women who reported becoming pregnant the first time as a teenager declined from 22.8% among women aged 50-59 to 16.9% among women aged 20-29. Of those who had had vaginal intercourse, 19.2% had used emergency contraception, 53.3% of them only once. Conclusion: There was clear evidence of substantial changes in the fertility of Australian women over the past 40 years.

Objectives: To document sexual and emotional satisfaction with their relationships and desired and actual frequency of sex among a representative sample of Australian adults. Method: Between mid-2001 and mid-2002, computer-assisted telephone interviews were completed by 10,173 men and 9,134 women aged 16-59 years from all States and Territories selected by modified random-digit dialling of households (response rate 73.1%). Respondents in a regular relationship were asked how physically pleasurable they found sex with the partner to be and how emotionally satisfying the relationship was. All respondents were asked how often they would ideally like to have sex and how often they had sex in the past four weeks. Results: Most people in heterosexual relationships found sex very or extremely pleasurable (90.3% men, 79.1% women) and the relationship emotionally satisfying (87.5% men, 79.2% women); men were more satisfied with both. Physical pleasure in sex was correlated with emotional satisfaction. One person in four had had no sex in the past four weeks; most people had had sex less than twice a week. Most people wanted ideally to have sex more often than they did. However, 24.3% of men but only 8.3% of women said they ideally wanted sex daily or more often. Conclusion: Men on average express higher levels of relationship satisfaction and of sexual interest, but the overlap between men and women is large.

Objective: To provide reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1% (69.4% men, 77.6% women). Results: Overall, 4.8% of men and 21.1% of women had experienced sexual coercion, i.e. being forced or frightened into unwanted sexual activity, and 2.8% of men and 10.3% of women had been coerced when aged 16 or younger. Although women were significantly more likely than men to have been sexually coerced, correlates of sexual coercion were similar for men and women and were not limited to effects on sexual behaviour. People who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex, and more likely to have acquired a sexually transmitted infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. Conclusion: Sexual coercion is an unacceptably common experience. Sexual coercion has detrimental effects on various aspects of people's lives. It most commonly occurs at the ages at which people become sexually active and women are more likely than men to be sexually coerced. Implications: There may be need for more readily accessible services that are better able to minimise the detrimental effects of sexual coercion. This is in addition to a more general need to reduce the incidence of sexual coercion.

Objective: To describe the characteristics of Australian adults' experience of commercial sex. Method: Telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years (response rate 73.1%; 69.4% men, 77.6% women). Respondents were asked about their experiences both as clients and as sex workers. Socio-demographic and health factors associated with experience of commercial sex were explored for men. Results: Almost one in six Australian men (15.6%) have ever paid for sex; 1.9% had done so in the past year. Of men who had ever paid for sex, 97% had paid for sex with a woman and 3% for sex with a man. Very few women (0.1%) had ever paid for sex. Twice as many men (0.9%) as women (0.5%) had ever been paid for sex; two-thirds of these men (0.6%) were paid by other men. Condom use during vaginal sex was highest in parlours and brothels and with escorts, and lowest for street sex work. Two-thirds of women who had ever been paid for sex had done so only overseas. One in 10 men who had paid for sex had only done so overseas. Men who had paid for sex were more likely than other men to smoke, to drink more alcohol, to have had a sexually transmitted infection or been tested for HIV, to have more sexual partners, to have first had vaginal intercourse before 16, and to have had heterosexual anal intercourse. Conclusion: Sex work overseas, where condom use may not be common, represents a potential source of HIV or sexually transmitted infection.

Objective: To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women). Results: Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters. Conclusion: Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. Implications: There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.

Objectives: The Australian Study of Health and Relationships reports on sexual behaviours in a representative sample of Australian adults. Method: Between May 2000 and June 2001, computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16 to 59 years (response rate 73.1%). Respondents were asked whether in the past year they had for a period of at least one month experienced a range of sexual difficulties. Results: The most common sexual difficulty was lack of interest in having sex (24.9% men, 54.8% women). Women were more likely than men to report being unable to come to orgasm (28.6% vs. 6.3%), not finding sex pleasurable (27.3% vs. 5.6%), physical pain during intercourse (20.3% vs. 2.4%) or worrying during sex about their body looking unattractive (35.9% vs. 14.2%). Men were more likely to report coming to orgasm too quickly (23.8% vs. 11.7%). Men (16.0%) and women (17.0%) were equally likely to have felt anxious about their ability to perform sexually. Erectile difficulties and lack of interest in sex were higher among the over-40s. Anxiety about performance was highest among men under 20. Experience of sexual difficulties correlated with self-reported ill health. Conclusion: The assumption that everyone should be interested in sex, should want to have it and should enjoy having it is a socially normative prescription and not a description of the actual state of affairs. Women reported less interest in sex, less pleasure and more pain than men.

Objective: To describe the characteristics of Australian adults' first vaginal intercourse and contraceptive use on that occasion, as well as first oral sex. Method: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated their age at first vaginal intercourse (if ever), the partner's age, their relationship to their partner, the duration of the relationship before first intercourse, and what contraception (if any) was used. Respondents also indicated their age when they first had oral sex. Results: For men, the median age at first intercourse declined from 18 among men aged 50-59 to 16 for men aged 16-19. For women the decline in median age was from 19 to 16. For women born between 1941 and 1950 the difference in median age at first vaginal intercourse and subsequent first oral sex was six years but for women born between 1981 and 1986 the difference in medians was one year. For men, a similar convergence was observed. Contraceptive use at first intercourse has increased significantly, from less than 30% of men and women in the 1950s to over 90% in the 2000s. For men, first intercourse before age 16 was significantly associated with greater numbers of lifetime and recent sexual partners, ever having paid for sex and having had a sexually transmitted infection (STI), and for women, with greater numbers of lifetime and recent sexual partners, ever having been paid for sex and ever having had an STI. Conclusion: Sex education should be given so that all young people have information about contraception and disease prevention before they begin their sexual careers.

Objective: To describe the prevalence of same-sex and opposite-sex attraction and experience in Australia and the prevalence of different sexual identities. Method: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories of Australia. The overall response rate was 73.1% (men, 69.4%; women, 77.6%). Men and women were asked about their experience of same-sex and opposite-sex attraction and experience along with their sexual identity. The agreement and disagreement between sexual attraction and sexual experience were explored. Results: Among men, 97.4% identified as heterosexual, 1.6% as gay or homosexual and 0.9% as bisexual. Among women, 97.7% identified as heterosexual, 0.8% as lesbian or homosexual and 1.4% as bisexual. Among men, 91.4% reported only opposite-sex attraction and experience, as did 84.9% of women. Thus, some same-sex attraction or experience was reported by 8.6% of men and 15.1% of women. Of men, 4.2% reported sexual attraction and sexual experience that was inconsistent, as did 8.2% of women. Factors associated with this agreement or disagreement included age group, non-English-speaking background, education and socio-economic status. Conclusion: Relatively few Australians reported a sexual identity other than heterosexual. However, both same-sex attraction and homosexual experience are more common than homosexual or bisexual identity would suggest. Reporting same-sex attraction or experience was associated with poorer mental health and is likely to reflect responses to homophobia in Australian society.

Objective: To describe the methods and process of the Australian Study of Health and Relationships. Methods: A computer-assisted telephone interview was developed and applied to a stratified sample of the Australian population. After initially weighting to reflect the study design, the sample was further weighted to reflect the location, age and sex distribution of the 2001 Census. Results: Interviews were completed with 10,173 men and 9,134 women aged 16-59 years from all states and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). After accounting for the survey design and weighting to the 2001 Census, the sample appears broadly representative of the Australian population. Conclusion: The combination of methods and design in the Australian Study of Health and Relationships, coupled with the high response rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.

Objective: To describe social attitudes towards sex of Australian adults and correlates of a scale of sexual liberalism. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents were asked about their agreement with nine attitude statements. Factor analysis and examination of internal consistency resulted in a six-item scale of liberalism. Correlates of attitude statements and the liberalism scale were examined. Results: Most people agreed that premarital sex was acceptable, that oral sex was considered 'sex', that sex was important for a sense of well-being and that extramarital sex was unacceptable. Men were more likely (36.9%) to disapprove of sex between two men than women were to disapprove of sex between two women (25.1%). Higher levels of education were associated with increased liberalism for men and women, as was speaking English at home, identifying as homosexual or bisexual, vaginal intercourse before age 16, having had more than one sexual partner in the year before interview, having had heterosexual anal intercourse, having no religion or faith, smoking tobacco, and drinking more alcohol. Conclusion: Sexual attitudes of Australians largely support a heterosexual paradigm with no sex outside the relationship. High levels of approval of premarital sex are consistent with decreasing age of first intercourse in Australia. Higher levels of liberalism were associated with greater sexual adventurism and health risk taking.