Social factors associated with Major Depressive Disorder in homosexually active, gay men attending general practices in urban Australia

Objectives : Social factors associated with Major Depressive Disorder (MDD) were identified among gay men attending high HIV caseload general practices in Sydney and Adelaide.
Methods : Men who visited four participating practices were invited to self-complete a survey. A self-screening tool (PHQ-9), based on the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV), was used to measure depressive disorders.
Results : The rate of MDD (PHQ-9 score 10 or above) among the 195 HIV-positive gay men was significantly higher than that among the 314 non-HIV-positive gay men (31.8% vs 20.1%, p=0.002). Current MDD was independently associated with younger age, lower income, recent major adverse life events, adopting denial and isolation as coping strategies, less social support, less gay community involvement and recent sexual problems. HIV-status, however, was not independently associated with MDD.
Conclusion : Socio-economic hardship, interpersonal isolation and personal withdrawal were significantly and independently associated with major depression in this population of gay men.
Implications : The study provides further evidence of health inequity affecting gay men in Australia. Structural health promotion approaches focused on homophobia and discrimination, as well as community-engaged primary health care responses are called for to mitigate this inequity.     

Sexual practices in a broad cross–sectional sample of Sydney gay men

Abstract: The aim of this study was to provide current data on the sexual practices in a broad cross–sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo–Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV–positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or noncon–cordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross–sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.     

Prejudice among health care workers toward injecting drug users with hepatitis C: Does greater contact lead to less prejudice?

The current research measured explicit (self-reported) and implicit (or unconscious) attitudes of health care workers and their drug injecting clients with hepatitis C virus (HCV) toward each other, and the association of these attitudes with contact. Sixty health care workers and 120 of their clients with HCV acquired from injecting drug use were administered attitude measures to determine whether greater contact with HCV positive clients would result in more favourable attitudes on the part of health care workers toward these clients, and also on the part of these clients towards their health care workers. Findings suggest that increased contact with clients with HCV is associated with more favourable explicit attitudes and more negative implicit attitudes among health care workers toward injecting drug users. Health care workers who had greater contact with HCV positive clients also had HCV positive clients who held more favourable explicit attitudes toward health care workers, but contact was uncorrelated with implicit attitudes of clients toward health care workers.     

Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample

Abstract: The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.     

Sensitivity of Candida albicans from patients with chronic oral candidiasis.

Many patients with oral candidiasis respond very slowly or not at all to therapy with amphotericin. Strains of Candida albicans were collected from 17 patients clinically resistant and from 15 who responded to a normal course of amphotericin treatment. Minimal inhibitory concentrations (MIC) determined on diagnostic sensitivity test agar plates gave values of: amphotericin 0-5 mg/l; nystatin 50 i.u./ml; chlorhexidine 12.5 mg/l. No clear MIC could be determined with plates containing miconazole. No difference was noted in MIC values between the 2 groups of patients. Tube-dilution tests in Sabouraud''s broth gave MIC values of: amphotericin 0.25 mg/l; nystatin 12.5 i.u./ml; chlorhexidine 1.5 mg/l; miconazole 8-32 mg/l; ketonazole 64 mg/l. Persistence of oral candidiasis is not an indication of infection with resistant organisms. Despite difficulties in in vitro sensitivity testing of miconazole a clinical trial of the drug for treating oral candidiasis is indicated.