Cost-effectiveness of adult circumcision in a resource-rich setting for HIV prevention among men who have sex with men

Background.  We examined the effects and cost‐effectiveness of 4 strategies of circumcision in a resource‐rich setting (Australia) in a population of men who have sex with men (MSM).

Method.  We created a dynamic mathematical transmission model and performed an economic analysis to estimate the costs, outcomes, and cost‐effectiveness of different strategies, compared with those of the status quo. Strategies included circumcision of all MSM at age 18 years, circumcision of all MSM aged 35–44 years, circumcision of all insertive MSM aged 18 years, and circumcision of all MSM aged 18 years . All costs are reported in US dollars, with a cost‐effectiveness threshold of $42,000 per quality‐adjusted life‐year.

Results.  We find that 2%–5% of human immunodeficiency virus (HIV) infections would be averted per year, with initial costs ranging from $3.6 million to $95.1 million, depending on the strategy. The number of circumcisions needed to prevent 1 HIV infection would range from 118 through 338. Circumcision of predominately insertive MSM would save $21.7 million over 25 years with a $62.2 million investment. Strategies to circumcise 100% of all MSM and to circumcise MSM aged 35–44 years would be cost‐effective; the latter would require a smaller investment. The least cost‐effective approach is circumcision of young MSM close to their sexual debut. Results are very sensitive to assumptions about the cost of circumcision, the efficacy of circumcision, sexual preferences, and behavioral disinhibition.

Conclusions.  Circumcision of adult MSM may be cost‐effective in this resource‐rich setting. However, the intervention costs are high relative to the costs spent on other HIV prevention programs.

Does the theory of planned behaviour explain condom use behaviour among men who have sex with men? A meta-analytic review of the literature

The aim of this meta-analysis was to explore whether the constructs in the theory of planned behaviour (TPB; i.e., attitude, subjective norm, perceived behavioural control, intention) explain condom use behaviour among men who have sex with men (MSM). Electronic databases were searched for studies that measured TPB variables and MSM condom use. Correlations were meta-analysed using a random effects model and path analyses. Moderation analyses were conducted for the time frame of the behavioural measure used (retrospective versus prospective). Attitude, subjective norm and perceived behavioural control accounted for 24.0 % of the variance in condom use intention and were all significant correlates. Intention and PBC accounted for 12.4 % of the variance in condom use behaviour. However, after taking intention into account, PBC was no longer significantly associated with condom use. The strength of construct relationships did not differ between retrospective and prospective behavioural assessments. The medium to large effect sizes of the relationships between the constructs in the TPB, which are consistent with previous meta-analyses with different behaviours or target groups, suggest that the TPB is also a useful model for explaining condom use behaviour among MSM. However, the research in this area is rather small, and greater clarity over moderating factors can only be achieved when the literature expands.

On the borders of sexuality research: young people who have sex with both males and females

As D' Augelli and Grossman point out, there is an underrepresentation in LGB research of "youth who have had sexual experiences with both males and females." Indeed, Heath (2005) refers to the "silent B" in much GLBT research. And, Owens (1998, p. 55) discusses how heterosexism "formalizes a societal dichotomy of heterosexuality versus homosexuality with little room for bisexuals" in educational research. Most of the information on bisexuality has been obtained from studies with adult samples, and it is "unclear to what extent a separate bisexual cultural identity is consolidated during adolescence" (Ryan & Rivers, 2003, p.105). As Bryan, a 17-year-old bisexual young man in my research, declared: "It's simple bullshit logic! They don't have evidence of bi kids in schools because they don't want to find it and so don't write their research looking for it."

Gay men from heterosexual marriages : attitudes, behaviors, childhood experiences and reasons for marriage

In the current study, the attitudes, behaviors and experiences of 26 gay or bisexual men who were married to a woman are examined. Data are provided on childhood family background and experiences, sexual practices with men, reasons for entering marriage, and the “coming out” process. The frequency of childhood sexual experiences was associated with unsafe sexual practices with other men in adulthood. Attitudes toward lesbians and gay men were more negative now than at the time of marriage. The two most frequent reasons for marriage were that it seemed natural, and a desire for children and family life. The results support the hypothesis that internalised homophobia is a factor that leads men into mixed-orientation marriages. Cognitive consistency theory is used to explain the eventual marriage breakdown.

Producing animations to educate MSM and MSW to fashion safe sex practices and address low perceptions of personal risk

This project will produce animations in order to increase understandings of safe sex practices and address low perceptions of personal risk among two of the most vulnerable groups to HIV infection in Thailand. The animations will be incorporated into a prevention outreach program via Ipods, mobile phones and mobile-based portable devices to men who have sex with men (MSM) in their 'hide-outs', that is, parks, clubs and public toilets and male sex workers (MSW) in sex venues such as brothels, go-go bars and beats. To produce these animations, the project is first researching the sexual practices of MSM and MSW because of the lack of any substantive investigation of their social and sexual networks. This use of technology, informed by social research rather than behavioral studies, offers new possibilities to stem rapidly rising infection rates because it takes into account the diverse MSM and MSW identities. Overall, an estimated one- fifth (21%) of new HIV infections in Thailand occur in men who have unsafe sex with men. This disquieting increase highlights the fact that MSM are not adequately reached through HIV prevention programmes, most likely because little is known about their particular situations, contexts and practices.

The nature and impact of incontinence in men who have undergone prostate surgery and implications for nursing practice

Aim: The aim of this study was to increase knowledge and understanding of the nature and experiences of incontinence in men one or more years post prostate surgery.

Methods: This descriptive study used a sample of convenience. Two hundred and twelve male participants who had undergone prostate surgery more than a year ago were asked about their experiences of incontinence. Participants were asked to fill in two questionnaires: The Expanded Prostate Cancer Index Composite and the Incontinence Impact Questionnaire. Participants were also asked about their prostate surgery, their health seeking behaviour in relation to incontinence, the type of discharge information they were given, and demographic information.

Results: Sixty-six percent of participants indicated that, in the last four weeks, their overall urinary function had been a problem and 36.3% reported their bowel habits were problematic, which affected the quality of their lives. In addition, 41% of participants reported that they were not given discharge information regarding the possibility of developing urinary incontinence and sexual problems post prostate surgery.

Conclusions: Health care professionals should pay more attention to routinely providing information to all men regarding the possibility of developing incontinence or sexual problems post prostate surgery. This may assist them to better manage these problems.

Clinical usefulness and feasibility of using Reality Orientation with patients who have dementia in acute care settings

Reality Orientation (RO) was developed as a strategy to assist people with dementia to improve their orientation and everyday function. Although its efficacy has been extensively studied in long-term care facilities, its effectiveness has rarely been examined in acute care settings. The aim of this review was to examine the studies cited in systematic reviews of RO to determine the potential clinical usefulness and the feasibility of using RO in acute care settings. Based on this information, the authors make recommendations for future research in this area. The feasibility of implementing RO in acute care poses challenges because of the short time a patient is in hospital and their ability to participate given their acute medical condition. Although the efficacy and feasibility of using RO in acute care settings have not been sufficiently examined, its potential to improve care should not be ignored. A comprehensive and rigorous study is necessary to investigate the usefulness of RO in the acute care setting and to help establish clinical guidelines for dementia care in the context of acute care nursing.

Towards co-design with users who have autism spectrum disorders

People with cognitive disorders, such as autism or Asperger’s syndrome, face many barriers when being involved in the co-design of information and communications technologies (ICT). Cognitive disorders may require that co-design techniques be modified to fit with individual abilities. Up until recently, with technology design, purpose and use being in the hands of ‘experts’ there was little opportunity for customisation. However, ICT bring together various threads that make open many new possibilities. Not only are technologies cheaper, more powerful and more available than ever, but now parents, support agencies and people with autism spectrum disorders expect information technologies to be part of their worlds, and they have the capacity to participate in co-design for customisation. However, co-design techniques have not evolved to the extent that they capture this potential democratisation of the ICT. This paper reports on an investigation of the potential to develop a set of guidelines for co-design techniques to enable people with autism spectrum disorders to participate in ICT design.

Nursing care of clients treated with atypical antipsychotics who have a risk of developing metabolic instability and/or type 2 diabetes

Objective : The aim of this article is to present a current discussion related to the nursing care of clients treated with atypical antipsychotic medicines and who have a risk of developing metabolic instability and/or Type 2 diabetes. The importance of such a discussion is to provide both the novice and the experienced nurse with additional knowledge of this current health issue with which to inform their nursing practice.

Discussion : The potential for psychosis to be a chronic condition is very high, and often people require antipsychotic medicine for lengthy periods throughout their lives. Sometimes, treatment is for life. The second generation of antipsychotic medicines was greeted with much enthusiasm since it was better tolerated than the first generation. However, each medication has desired and adverse effects and, when taken for lengthy periods, these effects may produce physical illness. Studies show that the prevalence of Type 2 diabetes and the metabolic syndrome was significantly higher in clients with a chronic psychiatric disorder, particularly schizophrenia.

Conclusions : Metabolic instability, especially weight gain, is associated with some psychotropic medicines. Nursing interventions need to include care assessment, planning, intervention, and evaluation for clients treated with antipsychotic medicines in terms of risk minimization strategies in routine nursing care.

Identification of five fundamental implicit theories underlying cognitive distortions in child abusers : a preliminary study

Qualitative analysis of interviews with 22 child abusers found strong evidence for Ward and Keenan's (1999) proposal that there are five implicit theories in child abusers that account for the majority of their cognitive distortions/thinking errors. These implicit theories are: Child as a sexual being where children are perceived as being able to and wanting to engage in sexual activity with adults and also are not be harmed by such sexual contact; Nature of harm where the offender perceives that sexual activity does not cause harm (and may in fact be beneficial) to the child; Entitlement where the child abuser perceives that he is superior and more important than others: and hence is able to have sex with whoever, and whenever, he wants; Dangerous world where the offender perceives that that others are abusive and rejecting and he must fight to regain control; and Uncontrollable where the offender perceives the world as uncontrollable and hence he believes that circumstances are outside of his control. There was no evidence for any other type of implicit theory. Results of the study also indicated that there was a significant difference in terms of the endorsement of the Dangerous world implicit theory between participants reporting a history of child sexual abuse and those who did not. Offenders against male victims were significantly more likely to endorse the Child as a sexual being and Dangerous world implicit theories compared to men who had offended against female children.