Pre-Exposure Prophylaxis Counseling in a Community Sexual Health Clinic for Men Who Have Sex with Men in Lisbon, Portugal.

INTRODUCTION: Pre-exposure prophylaxis is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal pre-exposure prophylaxis in Portugal, CheckpointLX, a community clinic targeted to men who have sex with men in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize pre-exposure prophylaxis users attending CheckpointLX before formal pre-exposure prophylaxis introduction in Portugal, and those who were referred to pre-exposure prophylaxis in the National Health Service following formal approval of pre-exposure prophylaxis. MATERIAL AND METHODS: Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed the European AIDS Clinical Society recommendations for pre-exposure prophylaxis eligibility, initiation and follow-up. For formal pre-exposure prophylaxis, the General-Directorate for Health's Pre-exposure Prophylaxis guidelines checklist was used. RESULTS: Until the end of May 2018, CheckpointLX had a total of 90 appointments for wild pre-exposure prophylaxis, of which 64 (71%) were first time visits. As for the 380 service users referred to the National Health Service, most were Portuguese (n = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (n = 59, 83%). DISCUSSION: Pre-exposure prophylaxis delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care. CONCLUSION: Much remains to be done in Portugal to ensure that pre-exposure prophylaxis is available to those who need it the most. Offering pre-exposure prophylaxis at community clinics could be a first step.

Introdução: A profilaxia pré-exposição pode ser definida como o uso de medicamentos anti-retrovirais para prevenir a aquisição do VIH em indivíduos não infectados. Reconhecendo o uso crescente da profilaxia pré-exposição informal em Portugal, o CheckpointLX, uma clínica comunitária destinada a homens que têm sexo com homens em Lisboa, Portugal, começou a oferecer aconselhamento e serviços de acompanhamento antes da introdução formal. Este estudo pretende caracterizar os utilizadores da profilaxia pré-exposição que frequentam o CheckpointLX antes da introdução formal da profilaxia pré-exposição em Portugal, e aqueles que foram encaminhados para a profilaxia pré-exposição no Serviço Nacional de Saúde após a aprovação formal da profilaxia pré-exposição. Material e Métodos: Os dados foram colhidos por pares entre maio de 2015 e setembro de 2018 e inseridos numa base de dados. Os cuidados médicos seguiram as recomendações da European AIDS Clinical Society para elegibilidade, iniciação e acompanhamento da profilaxia pré-exposição. Para a profilaxia pré-exposição formal, foi utilizada a lista de verificação da Norma de Profilaxia Pré-exposição da Direção-Geral da Saúde. Resultados: Até ao final de maio de 2018, o CheckpointLX fez um total de 90 consultas para o wild pre-exposure prophylaxis, das quais 64 (71%) foram primeiras consultas. Quanto aos 380 utilizadores referenciados ao Serviço Nacional de Saúde, a maioria era de nacionalidade portuguesa (n = 318, 84%) e a idade média era de 31 (8,9) anos. Sexo sem preservativo nos últimos seis meses com parceiros com estatuto VIH desconhecido foi o critério de elegibilidade mais reportado (n = 59, 83%). Discussão: A dispensa da profilaxia pré-exposição deve ser complementada com informações eficazes sobre a importância da imunização e da educação em práticas mais seguras de administração de medicamentos, no âmbito de cuidados de saúde sexual preventivos mais amplos. Conclusão: Ainda há muito a ser feito em Portugal para garantir que a profilaxia pré-exposição esteja disponível para aqueles que mais dela precisam. Oferecer profilaxia pré-exposição em clínicas comunitárias pode ser um primeiro passo.

Use of levonorgestrel as emergency contraception in overweight women.

OBJECTIVE: Levonorgestrel (LNG) emergency contraception (EC) may have decreased efficacy for women with body mass indices (BMI)≥26kg/m2. This study aims to evaluate the prevalence of LNG EC use and EC counseling among overweight women. METHODS: The 2013-2015 dataset from the National Survey of Family Growth was analyzed to determine the proportion of women with BMI≥26kg/m2 who report recent use of LNG EC and EC counseling. RESULTS: Overall, 2.4% of respondents reported recent use of LNG EC. Among women using oral LNG for EC, 29.8% of survey participants reported BMI≥26kg/m2. Additionally, 40.2% of women with BMI≥26kg/m2 using oral LNG EC reported having a doctor or medical provider talk to them about emergency contraception within the last 12 months, compared to 18.3% of LNG EC users with BMI<26kg/m2 (p<0.001). CONCLUSIONS: Despite recent counseling from clinicians and concerns for decreased efficacy, a significant number of overweight women continue to use LNG for EC. Clinicians should counsel women with BMI≥26kg/m2 on the potential limitations of oral LNG for EC and offer more effective EC methods, including the copper intrauterine device and oral ulipristal acetate.

Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015. / Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015.

OBJECTIVE: To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. METHODS: Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. RESULTS: The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. CONCLUSION: There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.

OBJETIVO: Analisar indicadores de saúde sexual e reprodutiva de adolescentes com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) em 2015, comparando-os aos de 2009 e 2012. MÉTODOS: Estudo transversal que analisou dados de escolares do nono ano da PeNSE 2015, 2012 e 2009. Estimou-se a prevalência com intervalos de confiança de 95% para indicadores de iniciação sexual, uso do preservativo na última relação sexual, ter recebido orientação para gravidez, infecções sexualmente transmissíveis e preservativo grátis nas três edições. Prevalências dos indicadores de 2015 foram estimadas segundo sexo, dependência administrativa da escola e região. Utilizou-se o teste do χ2 de Pearson para diferenças estatísticas. RESULTADOS: A prevalência de iniciação sexual apresentou queda, de 30,5% em 2009 para 27,5% em 2015, assim como do uso de preservativo, de 75,9 para 66,2%. Notou-se queda da orientação para prevenção de gravidez nas escolas públicas, de 81,1 para 79,3% e de preservativo gratuito nas escolas privadas, de 65,4 para 57,3%. Cerca de 30% relataram uso combinado de preservativo e outro método e 19,5% não fizeram uso de método algum. Observou-se que meninos apresentaram maior prevalência de iniciação sexual, maior número de parceiros e menor uso de preservativo. As regiões norte, nordeste e centro-oeste apresentaram pior desempenho dos indicadores. CONCLUSÃO: Evidenciou-se diminuição da iniciação sexual e do uso de preservativo entre adolescentes, maior vulnerabilidade às infecções sexualmente transmissíveis nos meninos e à gravidez entre as adolescentes de escolas públicas.

A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol.

BACKGROUND: In the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM. METHODS: This study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits. DISCUSSION: Effective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov number NCT03175159 , registered June 5, 2017.

Private sex workers' engagement with sexual health services: an online survey.

This study examined where private sex workers (PSW) present for sexual health services, disclosure, services received, and their satisfaction with care. An online anonymous survey was conducted via SurveyMonkey (surveymonkey.com). Among the 53 participants, 42% attended a sexual health clinic, 24% attended a general practitioner (GP) and 34% attended both. Participants attending GPs were less likely to be offered a throat swab and opportunities for cervical screening, contraception and vaccination were often missed in both service models. Participants attending GPs were less likely to disclose sex work and were less satisfied. Better awareness of the sexual health needs of PSWs is important in GP services.

Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015 / Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015

RESUMO: Objetivo: Analisar indicadores de saúde sexual e reprodutiva de adolescentes com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) em 2015, comparando-os aos de 2009 e 2012. Métodos: Estudo transversal que analisou dados de escolares do nono ano da PeNSE 2015, 2012 e 2009. Estimou-se a prevalência com intervalos de confiança de 95% para indicadores de iniciação sexual, uso do preservativo na última relação sexual, ter recebido orientação para gravidez, infecções sexualmente transmissíveis e preservativo grátis nas três edições. Prevalências dos indicadores de 2015 foram estimadas segundo sexo, dependência administrativa da escola e região. Utilizou-se o teste do χ2 de Pearson para diferenças estatísticas. Resultados: A prevalência de iniciação sexual apresentou queda, de 30,5% em 2009 para 27,5% em 2015, assim como do uso de preservativo, de 75,9 para 66,2%. Notou-se queda da orientação para prevenção de gravidez nas escolas públicas, de 81,1 para 79,3% e de preservativo gratuito nas escolas privadas, de 65,4 para 57,3%. Cerca de 30% relataram uso combinado de preservativo e outro método e 19,5% não fizeram uso de método algum. Observou-se que meninos apresentaram maior prevalência de iniciação sexual, maior número de parceiros e menor uso de preservativo. As regiões norte, nordeste e centro-oeste apresentaram pior desempenho dos indicadores. Conclusão: Evidenciou-se diminuição da iniciação sexual e do uso de preservativo entre adolescentes, maior vulnerabilidade às infecções sexualmente transmissíveis nos meninos e à gravidez entre as adolescentes de escolas públicas.

ABSTRACT: Objective: To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. Methods: Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. Results: The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. Conclusion: There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.

American Indian and Alaska Native Men's Use of Sexual Health Services, 2006-2010.

CONTEXT: American Indian and Alaska Native men experience poorer sexual health than white men. Barriers related to their sex and racial identity may prevent them from seeking care; however, little is known about this population's use of sexual health services. METHODS: Sexual health service usage was examined among 923 American Indian and Alaska Native men and 5,322 white men aged 15-44 who participated in the 2006-2010 National Survey of Family Growth. Logistic regression models explored differences in service use by race and examined correlates of use among American Indians and Alaska Natives. RESULTS: Among men aged 15-19 and those aged 35-44, men with incomes greater than 133% of the federal poverty level, men with private insurance, those living in the Northeast and those living in rural areas, American Indians and Alaska Natives were more likely than whites to use STD or HIV services (odds ratios, 1.5-3.2). The odds of birth control service use did not differ by race. Differences in service use were found among American Indian and Alaska Native men: For example, those with a usual source of care had elevated odds of using sexual health services (1.9-3.4), while those reporting no recent testicular exam had reduced odds of using these services (0.3-0.4). CONCLUSIONS: This study provides baseline data on American Indian and Alaska Native men's use of sexual health services. Research exploring these men's views on these services is needed to help develop programs that better serve them.

Physicians' response to sexual dysfunction presented by a younger vs. An older adult.

AIM: The aim of this study is to determine whether physicians have an age bias regarding sexual dysfunction presented by older vs. younger patients in terms of attributed diagnosis, etiology, proposed treatment and perceived prognosis. METHOD: An on-line survey consisting of one of two, randomly administered, case vignettes, which differed only by the age of the patient (28 or 78). In both cases, the patient was described as suffering from occasional erectile dysfunction with a clear psychosocial indication. A total of 236 physicians responded to the survey. Overall, 110 physicians received an "old" vignette and 126 physicians received a "young" vignette. RESULTS: Even though both cases presented with a clear psychosocial etiology, the "older" vignette was more likely to be diagnosed with erectile dysfunction whereas the "younger" vignette was more likely to be diagnosed with performance anxiety. The "older" vignette's dysfunction was more likely to be attributed to hormonal changes, health problems and decreased sexual desire. Physicians were more likely to recommend testosterone replacement therapy (TRT) and PDE5 inhibitors (PDE5i; such as Sildenafil; Vardenafil; Tadalafil) as well as a referral to urology to the "older" vignette. In contrast, the "younger" vignette was more often referred to a sexologist and received a more positive prognosis than the older patient. CONCLUSIONS: This study demonstrates an age bias among physicians regarding sexuality in later life. Of particular note is the tendency to prescribe PDE5i to the older patient, despite the clear psychosocial indication presented in the case vignette. Copyright © 2016 John Wiley & Sons, Ltd.

Changes in sexual risk behavior among MSM participating in a research cohort in coastal Kenya.

OBJECTIVE: To describe changes in sexual risk behavior among Kenyan MSM who received regular risk reduction counseling (RRC). DESIGN: Data were derived from two cohorts of HIV-1-negative and HIV-1-positive MSM in Kenya. Behavioral data were collected at enrollment and at monthly or quarterly scheduled follow-up visits. At each visit, RRC was provided to all men and HIV-1 testing to seronegative men. METHODS: Random effects logistic and Poisson regression models with time since study entry as main variable of interest were used to evaluate changes in number of sex partners and unprotected sex in the past week, and insertive, receptive, and unprotected anal intercourse in the past 3 months. Analyses were adjusted for HIV-1-status, calendar year of follow-up, and several baseline characteristics. Trends over follow-up time were allowed to differ by HIV-1-status. Men were censored when they seroconverted for HIV. RESULTS: Number of regular and casual sex partners and unprotected anal intercourse decreased in both HIV-1-negative and HIV-1-positive men. Unprotected sex with both regular and casual sex partners decreased more strongly early in follow-up in HIV-1-positive men than in HIV-1-negative men. Decreases in insertive anal intercourse were found for HIV-1-positive men only, whereas decreases in receptive anal intercourse were found for HIV-1-negative men only. CONCLUSION: MSM who were regularly exposed to RRC showed some reductions in sexual risk behavior, but it is uncertain if these reductions are sustained over time. As HIV-1 incidences in Kenyan MSM are very high, RRC should be supported by comprehensive biomedical interventions.

The effect of sex counselling in the sexual activity of acute myocardial infarction patients after primary percutaneous coronary intervention.

BACKGROUND: Primary percutaneous coronary intervention has improved the outcome of acute myocardial infarction (AMI) patients. Counsel-guided sex rehabilitation efficacy in acute myocardial infarction patients receiving percutaneous coronary intervention remains unknown. OBJECTIVE: The aim of the study was to study counsel-guided sex rehabilitation efficacy in AMI patients receiving percutaneous coronary intervention. METHODS: 240 AMI patients who received percutaneous coronary intervention were randomly divided into a control and a counselling group. Control group patients were given written sex rehabilitation instruction before discharge, while counselling group patients were given written instruction before discharge and monthly counselling with healthcare providers. Before discharge, the first evaluation was performed for frequency of and satisfaction with sexual activity before AMI. At one year of follow-up, the time of resuming, frequency of and satisfaction with sexual activity was evaluated. The main adverse event rates were also investigated. RESULTS: No significant differences in age, sex, smoking status, hypertension, diabetes, PVD (peripheral vascular disease), EF (ejection fraction) or GRACE (Global Registry of Acute Coronary Events) score were found between the groups. Both groups suffered reduced frequency of and satisfaction with sexual activity after AMI as compared with prior to presentation with AMI. However, compared with controls, the counselling group had higher scores for frequency of and satisfaction with sexual activity after AMI. The time to resume sexual activity after AMI in the counselling group was significantly shorter than was found for the control group.There were no significant differences between the groups for recurrent AMI, non-fatal stroke, admitting the patient for angina, all-cause death or adverse events. CONCLUSIONS: Intermittent discussions between healthcare providers and AMI patients improved resumption of sexual activity. Encouraging patients who received complete coronary revascularization to resume sexual activity shortly after AMI was safe.

[Sexuality after radical prostatectomy: Evaluation of erectile function and patient counseling regarding their sex life]. / Sexualität nach radikaler Prostatektomie : Erhebung der erektilen Funktion und Beratung von Patienten bezüglich ihres Sexuallebens.

BACKGROUND: Patient counseling by using the IIEF to assess erectile function (EF) before and after radical prostatectomy (RPX) is only possible under limited circumstances. The aim of this study was to evaluate if the Erection Hardness Score (EHS) could be used in addition to the IIEF for the assessment of EF and patient preference regarding counseling for their sex life. MATERIAL AND METHODS: EF was evaluated in 307 patients 3-60 months after RPX using the IIEF-EF and EHS. Questionnaires assessed sexual activity/intercourse as well as satisfaction with sex life irrespective of EF (10-point Likert scale). Patients were further asked concerning development of new sexual methods independent of erection firm enough for penetration and further wishes regarding counseling for their sex life. RESULTS: Of 272 patients, 82.0% underwent bilateral nerve-sparing prostatectomy, 30.5% (n=83; mean age: 68.1 years) had sexual intercourse and 41.9% (n=114) were sexually active. EH Scores 1-2 and 4 coincided with compatible IIEF-EF Scores 1-21, and ≥ 26, respectively. Of the patients with an EHS of 3, 55.9% had an IIEF-EF score that was notably lower. Of patients with sexual intercourse, 65.8% were satisfied with their sex life; 53.2% of sexually active patients were satisfied without sexual intercourse. Alternative methods were manual/oral stimulation, cuddling, and the use of vibrators. Patients request individually tailored, realistic counseling. CONCLUSION: The advantage of the EHS compared to the IIEF is that the erectile function can be assessed irrespective of sexual intercourse and sexual partner. Counseling should assist patients towards the attainment of a satisfying sex life-even without an erection.

Prevalence and correlates of childhood sexual abuse in adults consulting for sexual problems.

The main objectives of the study were to assess the prevalence of childhood sexual abuse in individuals consulting for sexual therapy and to explore the association between a history of childhood sexual abuse and psychological and couple functioning. A sample of 218 adults receiving sex therapy completed questionnaires assessing depressive and anxious symptomatology, as well as dyadic adjustment. Prevalence of childhood sexual abuse was high in women (56%) and men (37%), and clients with a history of childhood sexual abuse were more likely to report psychological and relationship problems. Findings should aware clinicians of the need to assess sexual trauma and related outcomes.

Barriers faced by Ugandan university students in seeking medical care and sexual health counselling: a cross-sectional study.

BACKGROUND: Meeting the medical and sexual health care needs of young people is crucial for sustainable development. In Uganda, youth are faced with a number of challenges related to accessing medical care and sexual health counselling services. This study sought to investigate the barriers faced by Ugandan university students in seeking medical care and sexual health counselling. METHODS: This study is part of a cross-sectional survey conducted in 2005 among 980 students at Mbarara University of Science and Technology. Data was collected by means of a self-administered 11-page questionnaire. The barriers encountered by respondents in seeking medical care and sexual health counselling were classified into three categories reflecting the acceptability, accessibility, or availability of services. RESULTS: Two out of five students reported unmet medical care needs, and one out of five reported unmet sexual health counselling needs. Acceptability of services was the main barrier faced by students for seeking medical care (70.4%) as well as for student in need of sexual health counselling (72.2%), regardless of age, gender, self-rated health, and rural/peri-urban or urban residence status. However, barriers differed within the various strata. There was a significant difference (p-value 0.01) in barriers faced by students originally from rural versus peri-urban/urban areas in seeking medical care (acceptability: 64.8%/74.5%, accessibility: 22.0% /12.6%, availability 13.2%/12.9%, respectively). Students who reported poor self-rated health encountered barriers in seeking both medical care and sexual health counselling that were significantly different from their other counterparts (p-value 0.001 and 0.007 respectively). CONCLUSIONS: Barriers faced by students in seeking medical and sexual health care should be reduced by interventions aimed at boosting confidence in health care services, encouraging young people to seek early treatment, and increasing awareness of where they can turn for services. The availability of medical services should be increased and waiting times and cost reduced for vulnerable groups.

What keeps nurses from the sexual counseling of patients with heart failure?

OBJECTIVES: We sought to examine the current practice of discussing sexual health by heart failure (HF) nurses, and to explore which barriers prevent nurses from discussing sexuality. METHODS: The Nurses' Survey of Sexual Counseling of Myocardial Infarction Patients and a list of barriers were used to form a questionnaire, which was sent to all HF clinics (n = 122) in the Netherlands. RESULTS: The majority (75%) of nurses (n = 146) felt a certain responsibility to discuss patients' sexual health. However, in practice, 61% of the nurses rarely or never addressed sexuality. Barriers that prevented nurses from addressing sexuality and that differed between nurses who do (n = 58) and do not (n = 88) discuss sexuality include a lack of organizational policy (49% vs. 79%, respectively; P < .001) and lack of training (43% vs. 80%, respectively; P < .001), and not knowing how to initiate the subject (24% vs. 72%, respectively; P < .001). Nurses preferred to address sexuality during a follow-up visit or when discussing medication. CONCLUSIONS: Although HF nurses feel responsible for discussing sexuality, this topic is rarely addressed in clinics. Several barriers were identified, relating to personal, patient, and organizational factors.

[Is there adequate discussion between psychiatrists and their patients regarding patients' sexual problems?]. / Het bespreken van seksuele problemen door psychiaters en aiossen.

BACKGROUND: Sexual problems arise frequently among psychiatric patients, either as a symptom of psychiatric disorders or as a side effect of psychotropic medication. However, it is questionable whether in daily practice psychiatrists and trainee psychiatrists give enough attention to patients' sexual problems. GOAL: To investigate how much attention psychiatrists and trainees give to patients' sexual problems and to discover what factors influence the amount of attention they give. METHODS: All psychiatrists and trainees working at two academic psychiatric centres and three mental health institutes in the province of North Holland were asked to complete an online questionnaire about the discussion of sexual problems. RESULTS: 164 psychiatrists and trainee psychiatrists completed the questionnaire (response rate 44%). About 50% of the respondents stated that they spent less than five minutes per week discussing sexual problems with their patients. When prescribing antidepressants and antipsychotics, psychiatrists and trainees often failed to inform patients about sexual side effects (33% in the case of antidepressants and 50% for antipsychotics). CONCLUSIONS: The investigation reveals that psychiatrists and trainees give little attention to sexuality problems of patients. The main reason for this seems to be feelings of shame and incompetence. Lack of time was not identified as a significant factor. We believe that the situation will improve considerably if psychiatrists and trainees involved in training programmes and supervisory activities give more attention to sexual problems.

High levels of acceptability of couples-based HIV testing among MSM in South Africa.

The acceptability of couples-based voluntary HIV counseling and testing (CVCT) has not been previously investigated among men who have sex with men (MSM) in South Africa. Using online advertisements, data were collected from 486 MSM, who were 18 years of age or older with a current residence in South Africa and had at least one male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT services. The willingness to utilize CVCT services was compellingly high (89%) among this sample of mostly White/European African (89%) and HIV-negative (83%) men. MSM who reported higher numbers of completed school years were less likely to report willingness to use CVCT. Willingness did not vary significantly across other individual demographic or behavioral characteristics. Our results show an overwhelmingly high acceptance of CVCT services. Future studies should survey a more heterogeneous population of MSM, explore the complex nature of same-sex male relationships, and why respondents would or would not use these HIV testing services.

Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study.

BACKGROUND: Despite the vast literature examining disparities in medical care, little is known about racial/ethnic and mental health disparities in sexual health care. The objective of this study was to assess disparities in safe sex counseling and resultant behavior among a patient population at risk of negative sexual health outcomes. METHODS: We conducted a cross-sectional analysis among a sample of substance dependent men and women in a metropolitan area in the United States. Multiple logistic regression models were used to explore the relationship between race/ethnicity (non-Hispanic black; Hispanic; non-Hispanic white) and three indicators of mental illness (moderately severe to severe depression; any manic episodes; ≥ 3 psychotic symptoms) with two self-reported outcomes: receipt of safe sex counseling from a primary care physician and having practiced safer sex because of counseling. RESULTS: Among 275 substance-dependent adults, approximately 71% (195/275) reported ever being counseled by their regular doctor about safe sex. Among these 195 subjects, 76% (149/195) reported practicing safer sex because of this advice. Blacks (adjusted odds ratio (AOR): 2.71; 95% confidence interval (CI): 1.36,5.42) and those reporting manic episodes (AOR: 2.41; 95% CI: 1.26,4.60) had higher odds of safe sex counseling. Neither race/ethnicity nor any indicator of mental illness was significantly associated with practicing safer sex because of counseling. CONCLUSIONS: Those with past manic episodes reported more safe sex counseling, which is appropriate given that hypersexuality is a known symptom of mania. Black patients reported more safe sex counseling than white patients, despite controlling for sexual risk. One potential explanation is that counseling was conducted based on assumptions about sexual risk behaviors and patient race. There were no significant disparities in self-reported safer sex practices because of counseling, suggesting that increased counseling did not differentially affect safe sex behavior for black patients and those with manic episodes. Exploring the basis of how patient characteristics can influence counseling and resultant behavior merits further exploration to help reduce disparities in safe sex counseling and outcomes. TRIAL REGISTRATION: NCT00278447.

Changes in myocardial infarction-specific sexual counseling by cardiac nurses.

It is largely unknown if changes in the practice of sexual counseling of myocardial infarction (MI) patients by cardiac nurses have occurred over time. Therefore, the purpose of this study was to examine changes in the practice of MI-specific sexual counseling by cardiac nurses, comparing the years 1994 and 2009. Based on these results, suggestions for sexual counseling of MI patients are provided.

Sexual counselling of cardiac patients: nurses' perception of practice, responsibility and confidence.

BACKGROUND: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients. METHOD: An adapted version of the nurses' survey of sexual counselling of MI patients was administered during a scientific meeting of the Council on Cardiovascular Nursing and Allied Professionals within the European Society of Cardiology. RESULTS: Most of the 157 cardiovascular nurses (87%) who completed the survey felt responsible to discuss sexual concerns with their clients, especially when patients initiated a discussion. However in practice, most respondents rarely addressed sexual issues. The items that nurses reported to counsel patients were closely related to the cardiac disease, symptoms and medications and seldom more sensitive subjects (e.g. foreplay, positions). Nurses estimated that their patients could be upset (67%), embarrassed (72%) or anxious (68%) if they were asked about sexual concerns. One-fifth of the nurses felt they had insufficient knowledge and 40% sometimes hesitated to discuss sexual concerns with clients because they might not know how to answer questions. Additional education on sexuality was significantly related to being more comfortable and active in sexual counselling. CONCLUSION: Although cardiac nurses feel responsible and not anxious discussing patients' sexual concerns, these issues are not often discussed in daily practice. Nurses might need more knowledge and specific practical training in providing information on sexual concerns and sexual counselling to cardiac patients.

STD/HIV prevention practices among primary care clinicians: risk assessment, prevention counseling, and testing.

OBJECTIVE: To describe current practices of primary care (PC) clinicians for STD/HIV control services: risk assessment, prevention counseling, and offering tests. STUDY DESIGN: We identified clinical strategies through qualitative interviews. We then surveyed by mail a random sample of Washington State family physicians, general internists, obstetrician-gynecologists, nurse practitioners, and certified nurse midwives. We identified characteristics of clinicians and their practices associated with each strategy and universal provision of each service. RESULTS: We report on 519 clinicians (80% adjusted response rate). Clinicians provided services to selected patients they considered high risk. Universal practices were less common: risk assessment (56%), prevention counseling (60%), STD tests (30%), and HIV tests (19%). Universal services were more common among nurses, those recently trained, and those seeing more STD patients. CONCLUSION: Different types of PC clinicians use widely differing clinical strategies and many use selective rather than universal approaches to STD/HIV control services. Further research is needed to develop tailored interventions to improve provision of these services.