Objective: To investigate current levels of sexual activity, enjoyment, condom use, and other factors affecting sexual behaviour in a sample of women living with HIV. Method: Participants were self selected. A cross sectional design using semi-structured questionnaires was employed. 82 HIV positive women completed questionnaires asking about demographics, relationships, sexual behaviour, and safer sex practices. The Hospital Anxiety and Depression Scale (HADS) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were administered. Results: 28% of women had had no sexual partners since diagnosis. Mean time diagnosed was 69 months, range 4-191 months. Time since diagnosis was not associated with having had a sexual partner. 59% of women had a current sexual partner, half reporting intercourse in the past month. Infrequent sex (84%), avoidance (84%), non-communication (69%), and dysfunction (60%) were among the most prevalent sexual difficulties. Endorsement of HIV impaired sexual enjoyment was associated with reduced sexual frequency (p = 0.006) and sexual dysfunction (p = 0.042). Sexual dissatisfaction was associated with infrequency of sex (p = 0.037), avoidance (p = 0.02), and non-communication (p = 0.032). Clinically significant levels of anxiety and depression were reported in 60% and 38% of cases, respectively. Depression was associated with avoidance of sex and higher total GRISS scores (p = 0.006 and p = 0.042). 60% of respondents stated that they ''always'' used condoms; a trend was observed between reduced condom use and higher levels of depression and anxiety (p = 0.09 and p = 0.06, respectively). Conclusion: Sexual difficulties, including abstinence, were prevalent in this sample indicating the potential for interventions addressing the psychosexual needs of HIV positive women and their partners.
There is little available on HIV-positive women's sexual relationships other than within-risk behavior paradigms. Increased life expectancy with the advent of highly active antiretroviral therapies (HAART) may increase the opportunity for women to develop sexual relationships. This study investigates sexual functioning in HIV-positive women and presents the analysis of interviews with 21 seropositive heterosexual women (age range, 22-54). Fourteen (67%) were black African, 6 (29%) white European, and 1 (5%) "other." Thirteen (62%) were currently or had been sexually active since becoming aware of their diagnosis. Dominant themes identified included: (1) difficulties with sexual functioning, in particular lowered libido and enjoyment and reduced intimacy; (2) barriers to forming new relationships: fears of HIV disclosure, fears of infecting partners; (3) coping strategies: included relationship avoidance and having casual partners to avoid disclosure; (4) safer sex: personal dislike of condoms, lack of control, lack of suitable alternatives. Women are experiencing a range of sexual and relationship difficulties that appear to be relatively unchanged despite the advent of HAART. Culturally appropriate, focused psychosexual and couples work should be more readily available for women living with HIV and their partners.
Gay and bisexual men (GBM) report higher rates of methamphetamine use compared to heterosexual men, and thus have a heightened risk of developing problems from their use. We examined treatment outcomes among GBM clients receiving outpatient counseling at a lesbian, gay, bisexual, transgender and intersex (LGBTI)-specific, harm reduction treatment service in Sydney, Australia. GBM receiving treatment for methamphetamine use from ACON’s Substance Support Service between 2012–15 (n = 101) were interviewed at treatment commencement, and after 4 sessions (n = 60; follow-up 1) and 8 sessions (n = 32; follow-up 2). At each interview, clients completed measures of methamphetamine use and dependence, other substance use, injecting risk practices, psychological distress and quality of life. The median age of participants was 41 years and 56.4% identified as HIV-positive. Participants attended a median of 5 sessions and attended treatment for a median of 112 days. There was a significant reduction in the median days of methamphetamine use in the previous 4 weeks between baseline (4 days), follow-up 1 (2 days) and follow-up 2 (2 days; p = .001). There was a significant reduction in the proportion of participants reporting methamphetamine dependence between baseline (92.1%), follow-up 1 (78.3%) and follow-up 2 (71.9%, p < .001). There were also significant reductions in psychological distress (p < .001), and significant improvements in quality of life (p < .001). Clients showed reductions in methamphetamine use and improved psychosocial functioning over time, demonstrating the potential effectiveness of a LGBTI-specific treatment service.
Tourette's syndrome is a complex neuropsychiatric disorder characterized by involuntary vocal and motor tics. Sufferers may also exhibit features common to attention deficit hyperactivity disorder and obsessive-compulsive disorders, in addition to anxiety, depression and low self-esteem. Parents attending the monthly Tourette's Syndrome Clinic at Great Ormond Street Hospital voiced concerns about their child's apparent social isolation and difficulty making friends. These children were offered the opportunity to participate in a social skills programme. Just over half of the children had low self-esteem in relation to social and academic situations. We adapted an existing programme with the intention of addressing some of the social difficulties associated with Tourette's syndrome and also to bring these children together in order to share their experiences. At the end of the programme children showed small increases in overall self-esteem. Reports from both parents and children suggested that all had benefitted from participation. This project resulted in the setting-up of a monthly support group for parents and children, an evaluation of which is currently underway.
A B S T R A C TWe describe various components of a specialist service for children and adolescents with Tourette's syndrome, and their parents. The clinical demand was such that the structure of the service has had to be changed several times. Support groups, one for the parents, one for the adolescents and one for the children have proved very helpful. A drop-in format, initially considered to be a useful way of coping with demand, has not worked well. These developments and changes are described and discussed, and future developments considered.
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