Commercial sex work, survival sex, sexual violence and HIV/AIDS prevention in Arumeru District, Arusha region Of Tanzania

Objective: To examine the knowledge and practices about HIV/AIDS among female Tanzanian commercial sex workers (CSWs) and assess the contextual dynamics that prevent safer sexual behaviours.

Method: The study used mixed methods and was implemented in two phases. Phase one assessed the knowledge and practices about HIV/AIDS among CSWs. Data were obtained with 54 CSWs, who were selected by using a snowball sampling approach. Semi-structured, face-to-face interviews with the CSWs were undertaken to allow the research participants to describe and discuss their lived realities as they perceive and experience them. In phase two, three discrete focus group discussions, each comprising 6-10 women, were carried out with 26 of the 54 CSWs who were interviewed in phase one.

Results: There was exploitation and inequity in the women's lives due to the multiple and overlapping oppressions of poverty and patriarchy. Sexual violence was framed, legitimised and reinforced by structural and cultural inequities. Such exploitation impacted not only on CSWs' lives as sex workers, but on their previous and/or simultaneous lives as mothers, wives, girlfriends and daughters. The women practised ‘survival sex’ as CSWs and/or sexual partners of men, and experienced sexual violence from their clients/partners. This violence was either culturally legitimised within a patriarchal framework or manifested itself as ‘displaced aggressive sex’ by men experiencing marginalisation in socio-economic spheres.

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.

Occupational health and safety among commercial sex workers

The concept of occupational health and safety (OHS) for commercial sex workers has rarely been investigated, perhaps because of the often informal nature of the workplace, the associated stigma, and the frequently illegal nature of the activity. We reviewed the literature on health, occupational risks, and safety among commercial sex workers. Cultural and local variations and commonalities were identified. Dimensions of OHS that emerged included legal and policing risks, risks associated with particular business settings such as streets and brothels, violence from clients, mental health risks and protective factors, alcohol and drug use, repetitive strain injuries, sexually transmissible infections, risks associated with particular classes of clients, issues associated with male and transgender commercial sex workers, and issues of risk reduction that in many cases are associated with lack of agency or control, stigma, and legal barriers. We further discuss the impact and potential of OHS interventions for commercial sex workers. The OHS of commercial sex workers covers a range of domains, some potentially modifiable by OHS programs and workplace safety interventions targeted at this population. We argue that commercial sex work should be considered as an occupation overdue for interventions to reduce workplace risks and enhance worker safety.

A method for the quantitative analysis of the layering of HIV-related stigma

HIV-related stigma is regarded as one of the major barriers in the development of effective prevention and care programs; but the stigma associated with HIV stigma is not a singular entity. The stigma of the infection is layered with other stigmas, such as those associated with the routes of transmission (e.g., sex work and injecting drug use) and personal characteristics (e.g., race, religion, ethnicity and gender). In developing programs and policies to overcome HIV-related stigma, cognisance needs to be taken of all the sources of stigma, and how they may interact. A novel method is described for examining the layers of HIV/AIDS-related stigma, and secondary data are adapted to illustrate this. The importance of understanding the layering of stigma for the development of effective interventions is also discussed.

Addressing the contradiction between discourse and practice in health promotion

The main theme of this thesis is the contradiction between discourse and practice in health promotion. Many health promoters continue to exert power-over the community through top-down programming whilst at the same time using an emancipatory discourse. The thesis has addressed this contradiction in three parts. The first part determines how the emancipatroty discourse has evolved and eplores the role of social movements in the development of contemporary health discourses and their influence on the legitimisation of empowerment. Central to this discourse is the empowerment of communities. To understand the role of this concept the thesis provides an interpretation of the different meanings of power and community, and the different levels of analysis of empowerment in the context of health promotion programming. The second part identifies the nature of health programming and the dominance of top-down, and to a much lesser extent, bottom-up approaches. The thesis argues that these two approaches are not, and do not have to be, mutually exclusive. To address this issue the thesis presents a new methodology is situated within a framework developed for the accomodation of empowerment goals within health promotion programmes. The study also identifies the organisational areas of influence on the processs of community empowerment and it is these which are used for the assessment of this concept. Both the framework and the methodology address the contradiction in health promotion by making community empowerment operational within a programme context. The third part of the thesis supports the rationale for the design of the methodology with field work in rural Fijian communities. The findings are presented as a composite case study to highlight the experiences of implementing the methodolgy and the main themes that emerged during the field work. the final chapter of the thesis brings together the central themes of the study and draws from these and 'emergent agenda' as a way forward for health promotion research and practice.

Sex does not matter: gender bias and gender differences in peer assessments of contributions to group work

This paper considers the possibility of gender bias in peer ratings for contributions to team assignments, as measured by an online self-and-peer assessment tool. The research was conducted to determine whether peer assessment led to reliable and fair marking outcomes. The methodology of Falchikov and Magin was followed in order to test their finding that gender has no discernable impact on peer ratings. Data from over 1500 participants at two universities enrolled in four different degree programmes were analysed. The research indicates an absence of gender bias in six case studies. The research also found that women received significantly higher ratings than men.

Discussing sex at work can be a costly business: Translating the science, language and law behind M v A & U (2007) QADT 8...

On 16 March 2007, in the matter of M v A & U [2007] QADT 8, the Anti-Discrimination Tribunal of Queensland found that a complaint of discrimination in the supply of goods and services had been made out by the complainant on two grounds: her female sex and lawful sexual activity. The decision would have been quite unremarkable except that ‘M’, as the complainant was known for the purposes of the hearing, is a woman of difference, one who had unusually arrived at her legal female state by completing the sex reassignment process now more commonly described as ‘sex affirmation’.

This article seeks to elaborate on the language and law of transsexualism used by the Tribunal. Its aim is to enhance practitioners’ understanding of the legal and social issues peculiar to those who affirm a sex opposite that first assigned to them so that those practitioners may better interpret the law to their clients. As the instant decision shows, the failure by an employer to take reasonable steps to avoid infringing the Anti-Discrimination Act 1991 (Qld), either on its own part or by the actions of its employees, can prove a costly business indeed.

The author offers a brief synopsis of the current medical viewpoint regarding transsexualism and reviews recent Australian legal developments in the jurisprudence. She reminds practitioners that the Anti-Discrimination Act 1991 (Qld) has since been further strengthened by the inclusion of ‘gender identity’ as a protected attribute, and concludes by proposing the existence of a heightened duty on the part of practitioners to ensure business clients are aware of the full extent of their legal obligations to not discriminate against employees or clients.

Understanding resilience in same-sex parented families : the work, love, play study

Background: While families headed by same-sex couples have achieved greater public visibility in recent years, there are still many challenges for these families in dealing with legal and community contexts that are not supportive of same-sex relationships. The Work, Love, Play study is a large longitudinal study of same-sex parents. It aims to investigate many facets of family life among this sample and examine how they change over time. The study focuses specifically on two key areas missing from the current literature: factors supporting resilience in same-sex parented families; and health and wellbeing outcomes for same-sex couples who undergo separation, including the negotiation of shared parenting arrangements post-separation. The current paper aims to provide a comprehensive overview of the design and methods of this longitudinal study and discuss its significance.
Methods/Design: The Work, Love, Play study is a mixed design, three wave, longitudinal cohort study of same-sex attracted parents. The sample includes lesbian, gay, bisexual and transgender parents in Australia and New Zealand (including single parents within these categories) caring for any children under the age of 18 years. The study will be conducted over six years from 2008 to 2014. Quantitative data are to be collected via three on-line surveys in 2008, 2010 and 2012 from the cohort of parents recruited in Wave1. Qualitative data will be collected via interviews with purposively selected subsamples in 2012 and 2013. Data collection began in 2008 and 355 respondents to Wave One of the study have agreed to participate in future surveys. Work is currently underway to increase this sample size. The methods and survey instruments are described.
Discussion: This study will make an important contribution to the existing research on same-sex parented families.
Strengths of the study design include the longitudinal method, which will allow understanding of changes over time within internal family relationships and social supports. Further, the mixed method design enables triangulation of qualitative and quantitative data. A broad recruitment strategy has already enabled a large sample size with the inclusion of both gay men and lesbians.

Evaluation methodology for work integrated learning - placements : a discussion paper

Background: This paper will address the evaluation of WIL (placements) in order to provide a strategy to improve performance in universities' WIL as benchmarked in the AUSSE, GDS and placement unit feedback.
Overview of issue: Although WIL placements are important and valuable for student engagement, learning, graduate employability and industry partnerships, there are few empirical studies or reviews that inform evaluation methodology for them. The assessment of placement outcomes and the student experience is typically more complex than evaluation of a standard university unit because of the wide variation that occurs with placements. Students are likely to be working in different organisations, and working on different projects within their various disciplines. Adding to this complexity, the organisation supervisor is an additional stakeholder critical to the placement experience, and who ultimately makes the judgment of student performance. Although an organisation supervisor may complete an individual feedback form for their students, generally this information is not strategically aligned within a broader university evaluation process. Initial examination of available literature revealed that the multi-dimensional perspective (organisational supervisor, placement co-ordinator and student) is not usually incorporated into evaluation of placements to inform continuous improvement for example. There are gaps in the evaluation process which could be addressed through more  comprehensive evaluation that could be utilised across Faculties and Institutions. In 2010, we will conduct an inter-faculty project to develop and trial an evaluation methodology for WIL placements. It will incorporate a triangulated approach including student, organisation and university supervisor feedback. Preliminary results gained from this project will be discussed.
Argument: An evaluation methodology that is inclusive of a triangulated approach, would provide university stakeholders with comprehensive feedback that could be used to strategically inform continuous improvement efforts in Institutions in the areas of WIL placements.
Implications: The importance of triangulated data gathering leading to a comprehensive evaluation and subsequent improvement strategies will be concluded. Suggested evaluation process and potential tools will be presented.

Evaluation of the use of Assessment Centre methodology to enhance development planning, work placement outcomes and work readiness for postgraduate students : a pilot

Background: Placements as a form of Work Integrated Learning are widely recognised for the positive impact they have on improving student employability and work readiness. Students can maximise strengths, improve areas of weakness, and develop a strong understanding of the requirements of their chosen field within the confines of a well monitored and rich learning environment. Assessment Centres (ACs) are commonly used in corporate settings for recruitment, selection and more recently to provide developmental feedback to participants. Based on a recent literature review, the present the present project evaluates the application of AC methodology as a developmental tool within the placement milieu. The review, which is also included the current conference proceedings details the benefits of utilising the AC process forming the impetus for the present pilot (Sturre; von Treuer & Keele 2010).
Aims: The primary aim of the paper was to evaluate the application of AC methodology as a tool for measuring and subsequently enhancing professional competencies in a sample of postgraduate students in organisational psychology (n=15).
Method: A longitudinal design was utilised with numerous evaluation points from placement stakeholders. This paper presents the first wave of findings. Students undertook a range of activities, including an in-tray exercise, role play, written report, leaderless group discussion and a personality assessment. Comprehensive feedback was provided by organisational psychologists who also fulfil the role of placement co-ordinators. With the assistance of Placement Co-ordinators, students prepared development plans relating to the competencies identified as requiring development. These plans were to be addressed and progress monitored during consecutive placements.
Results: Initial perceptions gathered from students regarding the AC process were very encouraging. Performance
evaluations collected to date, as measured by behaviourally based ratings scales completed by the students themselves and their workplace supervisors illustrate the positive effect of this methodology. The rigour and comprehensive techniques offered by the methodology enabled students to focus on and improve areas identified for development.
Conclusions: It is important to note that the present design formed a pilot study and as mentioned was undertaken with a limited sample. Future implementation is planned with larger samples, enabling a more comprehensive analysis of the methodology. Nevertheless, the methodology appears to provide a much needed strategy for the assessment and ongoing development of students prior to and during work placements. The application provides early intervention enabling students to address development needs with input from both university and organisational stakeholders based on an established, standardised process.

Building healthcare workers' confidence to work with same-sex parented families.

This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.