Background Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. Methods This qualitative longitudinal study involved 2–4 interviews each over 6 to 12 months with marginalised young people aged 12–24 years living in NSW. The analysis used Nvivo software and grounded theory. Results We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes: Technology brings opportunities to understand, connect and engage with services Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. Multiple marginalisation makes health system navigation more challenging The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support Conclusions The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues. Electronic supplementary material The online version of this article (10.1186/s12939-019-0941-2) contains supplementary material, which is available to authorized users.
Background Herpes simplex virus type 1 (HSV-1) is prevalent worldwide and causes mucocutaneous infections of the oral area. We aimed to define the frequency and anatomic distribution of HSV-1 reactivation in the facial area in persons with a history of oral herpes. Methods Eight immunocompetent HSV-1 seropositive adults were evaluated for shedding of HSV-1 from 12 separate oro-facial sites (8 from oral mucosa, 2 from nose, and 2 from conjunctiva) five days a week and from the oral cavity seven days a week for approximately 5 consecutive weeks by a HSV DNA PCR assay. Symptoms and lesions were recorded by participants. Results HSV-1 was detected at least from one site on 77 of 291 (26.5%) days. The most frequent site of shedding was the oral mucosa, with widespread shedding throughout the oral cavity. Lesional shedding rate was 36.4% (4 of 11 days with lesions) and the asymptomatic rate was 27.1% (65 of 240 non-lesional days). In individual participants, the median rate of HSV shedding by HSV PCR was 19.7% of days (range 11%-63%). Conclusions Reactivation of HSV-1 on the oral mucosa is common and usually asymptomatic. However, HSV-1 is rarely found in tears and nasal mucosa. Frequent oral shedding of HSV-1 may increase the risk for transmitting the virus to both oral and genital mucosa of sexual partners.
Objective: To quantify barriers to healthcare for young people (12-24 years) and identify sociodemographic correlates and predictors. Methods:This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. Results:A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%).Conclusions: Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access.Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
The known The Australian HPV vaccination program has led to significant declines in a number of HPV-related conditions, including diagnoses of genital warts in young women and heterosexual men at sexual health clinics.The new We found marked declines in the proportions of young Indigenous women and men attending sexual health clinics for the first time who were diagnosed with genital warts following introduction of the HPV vaccination program, similar to declines among non-Indigenous young women and men.The implications Sustained high HPV vaccine coverage rates and monitoring are needed to close the gap between Indigenous and non-Indigenous Australians in the rates of cervical and other HPV-related cancers in older women.T he Australian national human papillomavirus (HPV) vaccination program commenced in April 2007. Free vaccination was provided to 12e13-year-old girls in schools; this was supplemented by a 3-year catch-up program for 13e18-year-old girls in schools and for 18e26-year-old women through family doctors in July 2007.1 In 2013, boys were added to the program, providing free HPV vaccination to 12e13-year-old boys in schools and, for 2 years, a catch-up program for 14e15-year-old boys. Australia uses the quadrivalent HPV vaccine (Gardasil), protecting against HPV types 6 and 11, which cause ano-genital warts, and HPV types 16 and 18, which cause cancer. 2,3The Australian HPV vaccination program has had very promising results. High coverage rates among vaccine-eligible girls have been achieved, 73% receiving all three doses in 2010. 4 Significant reductions in the prevalence of HPV-related conditions have been seen; diagnoses of genital warts in young women and heterosexual men at sexual health clinics, 5,6 inpatient treatment of genital warts at private hospitals, 7 hospital admissions for genital warts, 8 the prevalence in young women of HPV types targeted by the quadrivalent vaccine, 9,10 and the incidence of high grade cervical abnormalities 11 have all declined.Measuring the impact of the HPV vaccination program in Aboriginal and/or Torres Strait Islander (Indigenous) people is important because cervical cancer rates among Indigenous women are twice as high as among non-Indigenous women. 12 Similar findings have been reported overseas; a meta-analysis of data from 35 studies found that indigenous women had elevated risks of invasive cervical cancer and related mortality (pooled risk ratios, 1.72 and 3.45 respectively).13 Indigenous Australians experience poorer outcomes than non-Indigenous people for a range of conditions, 14 including some sexually transmissible infections (STIs). [15][16][17] In response to these inequities, the Australian Government initiated the Closing the Gap program in 2008, 18 followed in 2014 by the Fourth NationalAboriginal and Torres Strait Islander Blood-borne Viruses and STI Strategy, 2014e2017, which includes the aim of achieving high rates of HPV vaccination. 19Despite their disproportionately high rates of cervical cancer, there is a lack of information on HPV vacc...
Objectives: To evaluate the effect of targeted and catch‐up hepatitis B virus (HBV) vaccination programs in New South Wales on HBV prevalence among women giving birth for the first time. Design: Observational study linking data from the NSW Perinatal Data Collection for women giving birth during 2000–2012 with HBV notifications in the NSW Notifiable Conditions Information Management System. Main outcome measures: HBV prevalence in Indigenous Australian, non‐Indigenous Australian‐born, and overseas‐born women giving birth. Results: Of 482 944 women who gave birth to their first child, 3383 (0.70%) were linked to an HBV notification. HBV prevalence was 1.95% (95% CI, 1.88–2.02%) among overseas‐born women, 0.79% (95% CI, 0.63–0.95%) among Indigenous Australian women, and 0.11% (95% CI, 0.09–0.12%) among non‐Indigenous Australian‐born women. In Indigenous Australian women, prevalence was significantly lower for those who had been eligible for inclusion in the targeted at‐risk newborn or universal school‐based vaccination programs (maternal year of birth, 1992–1999: 0.15%) than for those who were not (born ≤ 1981: 1.31%; for trend, P < 0.001). There was no statistically significant downward trend among non‐Indigenous Australian‐born or overseas‐born women. HBV prevalence was higher among Indigenous women residing in regional and remote areas than those in major cities (adjusted odds ratio [aOR], 2.23; 95% CI, 1.40–3.57), but lower for non‐Indigenous (aOR, 0.39; 95% CI, 0.28–0.55) and overseas‐born women (aOR, 0.61; 95% CI, 0.49–0.77). Conclusion: Among women giving birth, there was a significant reduction in HBV prevalence in Indigenous women associated with the introduction of the HBV vaccination program in NSW, although prevalence remains higher than among non‐Indigenous Australian‐born women, and it also varies by region of residence. Continuing evaluation is needed to ensure that the prevalence of HBV infections continues to fall in Australia.
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