Category: Sexual health services

Invitation to workshop: role of stigma and shame in the access to sexual health clinics

A workshop on philosophical aspects of sexual health is being held at

Seminar Room 3.28, New Business School, Manchester Metropolitan University Manchester, United Kingdom

The workshop is run by Dr Phil Hutchinson and was part funded by a research grant from Sexually Transmitted Infections Research Foundation (STIRF). Project STIRF-026

Workshop 1: The Problem of Selection Bias in Biomedical & Public Health Research. Wednesday September 16

Workshop 2: Shame, Stigma and HIV. Thursday September 17

Venue: Seminar Room 3.28, New Business School, Manchester Metropolitan University, Manchester, UK

Mandatory registration: contact: marie.chollier@stu.mmu.ac.uk

Further information can be obtained from Phil Hutchinson p.hutchinson@mmu.ac.uk

 

 

One in ten men in Britain report paying for sex sometime in their life – a national study

The National Survey of Sexual Attitudes and Lifestyles (NATSAL) is a survey of men and women carried out in the Britain every 10 years. It remains the most extensive and accurate study of sexual behaviour in a carefully selected population of men and women in the UK that reflect the population of sexually active individuals.

Natsal-3 is a  sample survey of 15,162 men and women (6,293 men) aged 16–74 years, resident in Britain, undertaken between September 2010 and August 2012. Participants were interviewed using a combination of face-to-face, computer-assisted, personal interviewing (CAPI) and computer-assisted self-interviewing (CASI). The more sensitive questions, including those on paying for sex and sex while outside the UK, were asked in the CASI.  

Kyle Jones and her colleagues reported on the results of the questions relating to men who admitted to have paid for sex. 

Their results show that round one in 10 men in Britain report having ever paid for sex at some time. These men are more sexually active than men who do not report having had paid for sex. They have a higher number of sexual partners, only a minority (18.4%) of which are paid.

They are also more likely to report a diagnoses of a sexually transmitted infection (STI) even when accounting for their disproportionately larger number of sexual partners (which is considered the most important behavioural variable associated with STI diagnoses).

This evidence strongly supports the idea that this subgroup of men are a bridge for the sort of sexual mixing (dissociative mixing) that increases the spread of STIs.

Men who pay for sex (MPS) are most likely to be aged between 25 and 34 years, single, in managerial or professional occupations, and have high partner numbers.

After adjusting for the key risk behaviour of sexual partner numbers, these men still report many other sexual behaviours, such as having new foreign partners while outside the UK, less attendance at STI clinic and less condom use. They therefore show an increased vulnerability to STI without taking the necessary precautions.

Interestingly, for some reported behaviours, such as sex partners outside the UK, same sex contact, sex partners found online, and concurrent partners (more than one partner at any time), total and paid partner numbers increase.

This suggests that MPS exhibiting these behaviours have higher lifetime partner numbers than other MPS as well as higher paid partner numbers, putting them at a higher risk for STIs than other MPS.

Call for HPV vaccination for school age boys

In a recent editorial in the British Medical Journal (available only on subscription), Margaret Stanley and coauthors urged the UK government to introduce a gender neutral vaccination programme against HPV in schools for boys and girls aged 12-13 to reduce not only ano-genital warts but HPV-related cancers. These include cervical cancer in women, anal cancers in men who have sex with men and oropharyngeal cancers.

The authors point out that  oropharyngeal cancers have the fastest rising incidence (15% per year) and anal cancer rates in the UK have risen by nearly 300% in the last 40 years..

Transmitting an STI and the law

On May 8 2014 the UK Court of Appeal dismissed the appeal of David Golding against a 14 month prison sentence for transmitting herpes to his partner.

An Editorial in the BMJ by Emily Clarke an colleagues highlights the numerous and  complicated issues that arise from this verdict including:

what constitutes grievous bodily harm,

how you determine that sexual transmission has occurred,

how serious is herpes infection, and

what this judgement means both for health care workers who advise and inform patients on the risks of transmission and on the infected individual and their duty of informing all partners of potential risk of transmitting an infection even during asymptomatic shedding.

The Editorial correctly highlights the dangers of criminalizing sexually transmitted infections and the various problems that arise from this judgement which was based on a law passed 170 years ago addressing totally unrelated issues and at a time when STI’s were not understood as they are today.

Human rights violations against sex workers: burden and effect on HIV

This is part of a series of articles on HIV and sex workers published by The Lancet and freely available.

In this article Michelle Decker et al  reviewed evidence from more than 800 studies and reported on the burden and HIV implications of human rights violations against sex workers.

Abuses of human rights are  perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts.

Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing.

Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law.

The authors conclude that protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing.

Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.

Important new research on lymphogranuloma venereum (LGV) in gay men in the UK

Lymphogranuloma venereum (LGV), previously predominantly a tropical disease, re-emerged in Western Europe in 2003, and has arguably now regained endemic status in many countries. It remains largely contained within in a population of men who have sex with men (MSM) with high rates of other sexually transmitted infections (STIs) including HIV, though a first female case was reported in Sexually Transmitted Infections in 2012.

A recent series of papers in Sexually Transmitted Infections sheds further light on the risk factors for rectal LGV in men who have sex with men in the UK, the key symptoms and ways in which LGV presents to the clinician, and pitfalls in the currently recommended treatment and prevention strategies.

Moreover, microbiological  characteristic of LGV repeaters using surveillance data has convinced Rönn and colleagues that behaviour alone does not explain reinfection, which they see as related to centrality in sexual networks.

Together these four articles add important information on the clinical presentation, epidemiology and treatment of LGV in MSM.

Proposed research on why Somalis do not access sexual health services in UK

STIRF had agreed to fund a project by Steve Wordsworh and colleagues from the Faculty of Health, Birmingham City University  investigating the reasons why Somali refugees appear not to access sexual heaalth services. Below is a brief description of the propsed project:

In the United Kingdom there is an established and growing refugee population that have arrived from Somalia. Despite this, the Somali population are often not included in ‘official’ statistics largely because the community is rarely recognised as a distinct ethnic category.

Because of this we often unaware of the health or social needs of those who arrive in the UK from a Somalia background, therefore it is inevitable that the support and needs of this community is often sadly neglected. So despite a very real need for help and support the uptake of health services is very low.

We are particular concerned with low access to sexual health service from of our local Somali community in Birmingham. So building on expertise in both working with the Somali community and in sexual health, staff from BCU are planning to undertake a study that seeks to explore just what exactly are the sexual health needs of Somali refugees, importantly we will be seeking to gather their views and perspectives directly from the community itself, we aim to found out  what they know about sexual health services, the challenges that may prevent them taking up these services and how services could be adapted to best support their needs.

Furthermore, it is our intention that that results from this research can be used to inform service provision by identifying barriers to access and any opportunities that may help to overcome them.

Project on the role of shame in failure to attend for STI and HIV testing shame approved for funding

The 2013 round of applications for funding has resulted in approval for the following pilot project:

Designing a Research project for understanding the role of stigma and shame in STI and HIV testing 

The project will be headed by Phil Hutchinson, Ph.D. (Man.), M.A. (Man.), B.A. (London), Senior Lecturer in Philosophy, Manchester Metropolitan University.

The aim of the preliminary project is to find the methodology to test the hypothesis: is shame one of the reasons for failing  to attend for STI and HIV testing. The project will be completed within six months involving setting up workshops with groups involved with both patient groups and those sexual health care.

HIV testing in the street: a useful tool for widening coverage

The March issue of the journal STI included an article by Sonia Fernandez-Balbuena and colleagues in Madrid which demonstrated that offering HIV testing on the street  may allow a significant number of hard-to reach populations to offer themselves for HIV testing.

Of 7552 persons in various Spanish cities who were asked to full a brief questionnaire and offered HIV testing 3517 participants (47%) were first-time testers. These included 24% of men who have sex with men , 56% of exclusively heterosexual men and 60% of women. 22 undiagnosed HIV infections were detected with a global prevalence of 0.6% and 3.1% in MSM.

The authors concluded that their community programme attracted a substantial number of persons previously untested and particularly hard to reach, such as those with low education and MSM who were least involved in the gay community.

In their view a decisive in decisive factor for almost two of every three persons who had never been tested. was the visibility of the programme.