This qualitative study of young people and health care workers in Adjumani, northern Uganda, foun... more This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents. This, along with inadequate access to SRH services for young people, accounts for the failure to adequately deal with young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility. Socio-economic, religious and cultural factors affect sexual behaviour and outcomes in Adjumani district, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.
Objective-To investigate the travel history of clients presenting at a genitourinary medicine (GU... more Objective-To investigate the travel history of clients presenting at a genitourinary medicine (GUM) clinic in order to assess the contribution made by sexual partnerships abroad to STD transmission in the UK. Subjects-386 old and new clients who attended during a 3-month period and who had travelled abroad in the 3 months preceding their visit. Methods-All participating clients selfcompleted a confidential questionnaire, the results of which were then linked to their clinical diagnosis (if any). Results-25% of participants reported a new sexual partner during their most recent trip abroad. In comparison to those not reporting a new partner, they were more likely to be male, travelling alone, to have visited the clinic previously and to have no regular sexual partner. Two-thirds reported never or inconsistently using condoms with these new partners. A total of 11.6% of the STDs diagnosed in the study participants may have been acquired abroad. Conclusion-We have found a high rate of new sexual relationships reported by attendees at our GUM clinic, and a low rate of reported condom use. With high HIV incidence rates in many tourist regions, the need for further studies to establish the true extent of imported STDs in the UK is a priority, and primary prevention campaigns to inform travellers are of paramount importance.
Background: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men... more Background: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. Methods: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. Results: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. Conclusions: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant hearth promotion amongst homosexual men in the UK.
Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK f... more Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK following the expansion of the European Union. This paper examines the factors associated with GUM clinic attendance and STI diagnosis among CEE migrants in ...
A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 ... more A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 3-month periods in 1993 and 1994. Three hundred and twenty-® ve attendees who had travelled abroad in the preceding 3 months completed anonymous self-administered questionnaires about their sexual behaviour during these recent journeys abroad. There were 112 women and 213 men (185 heterosexuals and 28 homosexuals). Twenty-two (19.6%) women, 56 (31%) heterosexual men and 13 (42%) homesexual men had a sexual contact with a new partner while abroad. Of those who had had a new sexual contact abroad, 11 women (50% of those who had sex with a new partner) and 33 heterosexual men (59% of those who had sex with a new partner) were inconsistent users of condoms. Analysis of data found that homosexual and heterosexual men, and business travellers, are at increased risk of exposure to sexually transmitted diseases, including HIV infection, and should be targeted with safer sex health promotion prior to travel.
There are no routine outcome measures to judge the effectiveness of this NICE guidance. The proce... more There are no routine outcome measures to judge the effectiveness of this NICE guidance. The process measures above have demonstrated variable implementation in GUM services in England. With present resources, as one example providing 15e20 min of one-to-one structured discussions based on behavioural change theories is not deliverable. Service commissioners should ensure that services are implementing guidance and using recognised standards for the management of sexually transmitted infections. Prevention of sexually transmitted infections should be targeted, informed by the sexual health profile of local populations with resources identified by commissioners for prevention activities as integral to service delivery.
Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies f... more Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-de...
This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviou... more This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.
Introduction: The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in ... more Introduction: The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in an ageing HIV-diagnosed population. It has been suggested that adverse physical and psychological effects of HIV may be higher among older people. However, few studies have examined the effect of older age on well-being for people with HIV. Materials and Methods: The ASTRA study included 3258 HIV-diagnosed individuals (2248 MSM; 373 heterosexual men; 637 women) recruited from eight UK clinics in 2011Á12 (64% response rate). Participants completed a questionnaire that included standard inventories on symptoms and health-related quality of life (HrQoL). Associations of age group with: physical symptom distress (reporting significant distress for ]1 of 26 symptoms), depression and anxiety (score ]10 on PHQ-9 and GAD-7, respectively) and HrQoL problem (reporting problems on ]1 of 5 Eurqol-5D domains) were assessed; adjustment was made for gender/sexuality and time with diagnosed HIV. Results: Of all participants, 87% were taking ART, 76% had VL 550c/mL and 19% had CD4 B350/mm 3. Mean age was 45 years (range 18Á88) with 5% B30, 23% 30Á39, 43% 40Á49, 22% 50Á59 and 7% ]60 years. The most prevalent distressing physical symptoms were: lack of energy/tiredness (26%), difficulty sleeping (24%), muscle-ache/joint pain (21%) and pain (18%). With older age, there was no clear trend in prevalence of physical symptom distress, but prevalence of depression and anxiety decreased, while prevalence of HrQoL problems increased. This pattern remained after adjustment for gender/sexuality and time diagnosed with HIV. The increase with age in overall prevalence of HrQoL problem was due to increased problems for ''mobility,'' ''self-care'' and ''performing usual activities'' domains, not an increase in ''depression/anxiety.'' Longer time with diagnosed HIV was strongly associated with higher prevalence of all symptoms measures and HrQoL problem (p B0.001 for trend, adjusted models). Conclusions: Physical and psychological symptoms are common among people living with HIV, but the burden of these symptoms is not highest among the older age group. While HrQoL tended to worsen with older age, physical symptom distress did not, and mental health improved. This may reflect greater resilience in older adults, or the potential for ''successful ageing'': maintaining mental health despite age-related health losses.
This qualitative study of young people and health care workers in Adjumani, northern Uganda, foun... more This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents. This, along with inadequate access to SRH services for young people, accounts for the failure to adequately deal with young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility. Socio-economic, religious and cultural factors affect sexual behaviour and outcomes in Adjumani district, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.
Objective-To investigate the travel history of clients presenting at a genitourinary medicine (GU... more Objective-To investigate the travel history of clients presenting at a genitourinary medicine (GUM) clinic in order to assess the contribution made by sexual partnerships abroad to STD transmission in the UK. Subjects-386 old and new clients who attended during a 3-month period and who had travelled abroad in the 3 months preceding their visit. Methods-All participating clients selfcompleted a confidential questionnaire, the results of which were then linked to their clinical diagnosis (if any). Results-25% of participants reported a new sexual partner during their most recent trip abroad. In comparison to those not reporting a new partner, they were more likely to be male, travelling alone, to have visited the clinic previously and to have no regular sexual partner. Two-thirds reported never or inconsistently using condoms with these new partners. A total of 11.6% of the STDs diagnosed in the study participants may have been acquired abroad. Conclusion-We have found a high rate of new sexual relationships reported by attendees at our GUM clinic, and a low rate of reported condom use. With high HIV incidence rates in many tourist regions, the need for further studies to establish the true extent of imported STDs in the UK is a priority, and primary prevention campaigns to inform travellers are of paramount importance.
Background: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men... more Background: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. Methods: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. Results: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. Conclusions: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant hearth promotion amongst homosexual men in the UK.
Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK f... more Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK following the expansion of the European Union. This paper examines the factors associated with GUM clinic attendance and STI diagnosis among CEE migrants in ...
A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 ... more A survey of patients attending 2 Glasgow genitourinary medicine (GUM) clinics was conducted in 2 3-month periods in 1993 and 1994. Three hundred and twenty-® ve attendees who had travelled abroad in the preceding 3 months completed anonymous self-administered questionnaires about their sexual behaviour during these recent journeys abroad. There were 112 women and 213 men (185 heterosexuals and 28 homosexuals). Twenty-two (19.6%) women, 56 (31%) heterosexual men and 13 (42%) homesexual men had a sexual contact with a new partner while abroad. Of those who had had a new sexual contact abroad, 11 women (50% of those who had sex with a new partner) and 33 heterosexual men (59% of those who had sex with a new partner) were inconsistent users of condoms. Analysis of data found that homosexual and heterosexual men, and business travellers, are at increased risk of exposure to sexually transmitted diseases, including HIV infection, and should be targeted with safer sex health promotion prior to travel.
There are no routine outcome measures to judge the effectiveness of this NICE guidance. The proce... more There are no routine outcome measures to judge the effectiveness of this NICE guidance. The process measures above have demonstrated variable implementation in GUM services in England. With present resources, as one example providing 15e20 min of one-to-one structured discussions based on behavioural change theories is not deliverable. Service commissioners should ensure that services are implementing guidance and using recognised standards for the management of sexually transmitted infections. Prevention of sexually transmitted infections should be targeted, informed by the sexual health profile of local populations with resources identified by commissioners for prevention activities as integral to service delivery.
Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies f... more Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-de...
This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviou... more This paper aims to assess the effects of voluntary anti-HIV testing on homosexual sexual behaviour. A sample of 502 men were recruited from four different areas of England. The criterion for inclusion was 'any man who had had sex with another man in the previous 5 years'. Men were interviewed about their recent sexual behaviour, histories of sexually transmitted diseases, experience of HIV tests and attitudes to the test. Men with a history of sexually transmitted diseases were more likely to have had the test. Thirty-one percent of men reported passive anal sex in the last month and 19% had had unprotected passive anal sex. These behaviours were most often reported by those testing HIV antibody positive and least by those never tested. The findings suggest that homosexually active men who volunteer for an anti-HIV test are broadly similar to those who do not. The absence of any clear effects of the test alone on sexual behaviour suggests that the quality of counselling in this area needs urgent attention.
Introduction: The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in ... more Introduction: The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in an ageing HIV-diagnosed population. It has been suggested that adverse physical and psychological effects of HIV may be higher among older people. However, few studies have examined the effect of older age on well-being for people with HIV. Materials and Methods: The ASTRA study included 3258 HIV-diagnosed individuals (2248 MSM; 373 heterosexual men; 637 women) recruited from eight UK clinics in 2011Á12 (64% response rate). Participants completed a questionnaire that included standard inventories on symptoms and health-related quality of life (HrQoL). Associations of age group with: physical symptom distress (reporting significant distress for ]1 of 26 symptoms), depression and anxiety (score ]10 on PHQ-9 and GAD-7, respectively) and HrQoL problem (reporting problems on ]1 of 5 Eurqol-5D domains) were assessed; adjustment was made for gender/sexuality and time with diagnosed HIV. Results: Of all participants, 87% were taking ART, 76% had VL 550c/mL and 19% had CD4 B350/mm 3. Mean age was 45 years (range 18Á88) with 5% B30, 23% 30Á39, 43% 40Á49, 22% 50Á59 and 7% ]60 years. The most prevalent distressing physical symptoms were: lack of energy/tiredness (26%), difficulty sleeping (24%), muscle-ache/joint pain (21%) and pain (18%). With older age, there was no clear trend in prevalence of physical symptom distress, but prevalence of depression and anxiety decreased, while prevalence of HrQoL problems increased. This pattern remained after adjustment for gender/sexuality and time diagnosed with HIV. The increase with age in overall prevalence of HrQoL problem was due to increased problems for ''mobility,'' ''self-care'' and ''performing usual activities'' domains, not an increase in ''depression/anxiety.'' Longer time with diagnosed HIV was strongly associated with higher prevalence of all symptoms measures and HrQoL problem (p B0.001 for trend, adjusted models). Conclusions: Physical and psychological symptoms are common among people living with HIV, but the burden of these symptoms is not highest among the older age group. While HrQoL tended to worsen with older age, physical symptom distress did not, and mental health improved. This may reflect greater resilience in older adults, or the potential for ''successful ageing'': maintaining mental health despite age-related health losses.
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Papers by Graham J Hart