Biomedical subjects

Andrew E Grulich

Publications and source records attributed to Andrew E Grulich.

At least 37 records · Page 2Linked to original sources

PubMed2004

Human immunodeficiency virus-related primary central nervous system lymphoma: factors influencing survival in 111 patients.

BACKGROUND: The current study evaluated factors influencing survival in patients diagnosed with human immunodeficiency virus (HIV)-related primary central nervous system lymphoma (PCNSL), with a focus on the effects of therapeutic radiotherapy (RT) and highly active antiretroviral therapy (HAART). METHODS: A retrospective chart review of patients with a diagnosis of HIV-related PCNSL at one of five university hospitals between 1987 and 1998 was performed. Clinical details including antiretroviral agent use, brain imaging scan results, RT use, and survival outcomes were recorded. RESULTS: One hundred eleven patients with HIV-related PCNSL were identified. The annual incidence decreased significantly between 1992 and 1995 and between 1996 and 1998 (P = 0.04). The median survival period was 50 days (mean, 109 days; range, 4-991 days), with improved survival for patients diagnosed after 1993. Patients treated with two or more antiretroviral agents had improved survival (P = 0.01), as did patients who received RT (P < 0.0001). For patients who received RT, completion of the prescribed course and treatment to > or = 30 Gray (Gy) independently predicted a more favorable outcome. RT used in conjunction with antiretroviral therapy involving two or more agents had an additive positive effect on survival. For patients who did not receive RT, poor performance status and encephalopathy predicted a shorter survival duration. CONCLUSIONS: The results of the current study suggest that HAART and treatment with RT to > or = 30 Gy improve survival for patients with HIV-related PCNSL. This combination of therapies may provide a standard of care as the basis for further trials of chemotherapy, novel adjunctive treatment, and quality of life assessment.

Adult↗

PubMed2004

Is screening for anal cancer warranted in homosexual men?

Some investigators have proposed screening homosexual men for anal cancer and its probable precursor, high grade anal intraepithelial neoplasia (AIN). Using widely accepted criteria for the introduction of screening programmes, this paper reviews the current evidence for screening for this condition in this high risk population and highlights areas where additional research is required. While it is accepted that the incidence of anal cancer is at least 20 times higher in homosexual men than the general population, the natural history of anal cancer and its precise relationship with AIN is not clearly understood. Anal intraepithelial neoplasia is a very highly prevalent disease among homosexual men, but little is known about what predicts progression to invasive disease. The screening tests, exfoliate cytology and high resolution anoscopy, have a sensitivity of between 45 and 70%. Treatment options for AIN are limited by morbidity and high recurrence rates and there are no randomised controlled trials studying the efficacy of therapeutic agents or surgery for high grade AIN, although immunotherapies show very early promise. Theoretically, early detection may lead to better treatment outcomes. Studies of the potential negative consequences of screening programmes on the homosexual population are needed. The currently available data does not support the implementation of a screening programme for AIN and anal cancer in homosexual men in Australia.

Anus Neoplasms↗

PubMed2004

Hepatitis A and B infection and vaccination in a cohort of homosexual men in Sydney.

OBJECTIVES: To determine the prevalence and incidence of hepatitis A (HAV) and B (HBV) infection and vaccination in HIV-negative homosexual men in Sydney, and associated risk factors. METHODS: An open prospective cohort study was conducted among a community-based sample of HIV-negative homosexual men in Sydney in 2001-02. Participants underwent a face-to-face interview, regarding demographics, sexual behavioural risk factors and sexually transmitted infections, and blood samples were collected. They were followed annually. RESULTS: Nine hundred and three men completed a baseline interview by the end of 2002. Among them, 68% were seropositive to hepatitis A. The seroprevalence of prior hepatitis B infection was 19%, and 53% had serological evidence of HBV vaccination. Younger men were much more likely to be seronegative, with 48% and 46% of <25-year-olds being seronegative to HAV and HBV respectively. In multivariate analysis HAV and HBV infection were associated with increasing age, greater number of lifetime sex partners and HBV infection was also associated with previous sexually transmitted infections. HAV vaccination was associated with increasing age, greater number of lifetime sex partners, overseas travel in the last year and self-reported anogenital warts. HBV vaccination was associated with higher occupational status, greater lifetime number of sex partners and previous sexually transmitted infections. CONCLUSION: Substantial proportions of gay community-attached young homosexual men are still at risk of HAV and HBV infection. This study points to a need for vaccination strategies which ensure high levels of hepatitis A and B immunity in young sexually active gay men.

Adult↗

PubMed2003

Hepatitis C transmission and HIV post-exposure prophylaxis after needle- and syringe-sharing in Australian prisons.

OBJECTIVES: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting. DESIGN: Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV followed up for up to 14 months. SETTING: Two Australian prisons between November 2000 (time of exposure) and December 2001. PARTICIPANTS: Two index patients (both infected with HIV and HCV; one also infectious for HBV) from two different prisons, and 104 inmates who shared needles and syringes. MAIN OUTCOME MEASURES: Seroconversions to HIV, HBV and HCV related to the high-risk exposure and uptake and completion of HIV PEP determined from medical records of inmates. RESULTS: There were four seroconversions to HCV within 14 months of the potential exposure (14% of those susceptible in the cohort), but no recorded HIV or HBV seroconversions. Forty-six inmates (82% of those eligible) were offered PEP, and 34 of these (74%) elected to receive it. Only eight (24% of the 34) completed the full PEP course. CONCLUSIONS: HCV transmission in the prison setting is related to high-risk needle- and syringe-sharing. Administering HIV PEP in the prison setting is complicated by challenging risk assessment and follow-up.

Anti-HIV Agents↗

PubMed2003

Sex in Australia: a guide for readers.

The Australian Study of Health and Relationships (ASHR), a survey of 19,307 people aged 16-59 years which had a broad focus across many aspects of sexual and reproductive health. Our primary goal in presenting these data is to describe the overall prevalence of key outcomes and the ways in which they are patterned with respect to a range of sociodemographic factors. The socio-demographic factors used include age, gender, language spoken at home, highest level of education completed, region of residence, household income and occupational category. Where appropriate we also include stated sexual identity. Our choice of these factors reflects the fact that they are major elements in the structure of the Australian population and Australian society. For the purpose of reporting the initial results, we have grouped these outcomes into 18 papers. They are bracketed by an introductory methods paper which provides a detailed account of the design and execution of the study, and a concluding paper reflecting on the key themes emerging from the findings, the strengths and limitations of our approach and recommendations for future research.

Adolescent↗

PubMed2003

Sex in Australia: the rationale and methods of the Australian Study of Health and Relationships.

OBJECTIVE: To describe the methods and process of the Australian Study of Health and Relationships. METHODS: A computer-assisted telephone interview was developed and applied to a stratified sample of the Australian population. After initially weighting to reflect the study design, the sample was further weighted to reflect the location, age and sex distribution of the 2001 Census. RESULTS: Interviews were completed with 10,173 men and 9,134 women aged 16-59 years from all states and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). After accounting for the survey design and weighting to the 2001 Census, the sample appears broadly representative of the Australian population. CONCLUSION: The combination of methods and design in the Australian Study of Health and Relationships, coupled with the high response rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.

Adolescent↗

PubMed2003

Sex in Australia: attitudes towards sex in a representative sample of adults.

OBJECTIVE: To describe social attitudes towards sex of Australian adults and correlates of a scale of sexual liberalism. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents were asked about their agreement with nine attitude statements. Factor analysis and examination of internal consistency resulted in a six-item scale of liberalism. Correlates of attitude statements and the liberalism scale were examined. RESULTS: Most people agreed that premarital sex was acceptable, that oral sex was considered 'sex', that sex was important for a sense of well-being and that extramarital sex was unacceptable. Men were more likely (36.9%) to disapprove of sex between two men than women were to disapprove of sex between two women (25.1%). Higher levels of education were associated with increased liberalism for men and women, as was speaking English at home, identifying as homosexual or bisexual, vaginal intercourse before age 16, having had more than one sexual partner in the year before interview, having had heterosexual anal intercourse, having no religion or faith, smoking tobacco, and drinking more alcohol. CONCLUSION: Sexual attitudes of Australians largely support a heterosexual paradigm with no sex outside the relationship. High levels of approval of premarital sex are consistent with decreasing age of first intercourse in Australia. Higher levels of liberalism were associated with greater sexual adventurism and health risk taking.

Adolescent↗

PubMed2003

Sex in Australia: selected characteristics of regular sexual relationships.

OBJECTIVE: To describe selected characteristics of Australian adults' regular or ongoing sexual relationships. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated how often they had sex in the past four weeks, contraceptive use, their own and their partners' expectations about having sex with other people during their relationship, whether they had discussed these expectations with their partners and whether they had an explicit agreement about sex with other people. RESULTS: 85.3% of men and 89.5% of women were in a regular heterosexual relationship, among whom 81.4% of men and 89.3% of women reported contraceptive use. Men and women who had a regular partner for the past 12 months had had sex with their partners an average of 1.84 times per week in the four weeks before interview; younger people had sex more often. Most respondents expected themselves and their partners to not have sex with other people, although men were less likely than women to have discussed these expectations with their partner. Bisexually identified men and women were significantly less likely than heterosexually identified men and women to support having sex only with their regular partner. Only 4.9% of men and 2.9% of women in regular heterosexual relationships had concurrent sexual partners in the past 12 months. CONCLUSION: Australians' attitudes to not having sex with people while in a regular relationship are highly consistent with their behaviour.

Adolescent↗

PubMed2003

Sex in Australia: first experiences of vaginal intercourse and oral sex among a representative sample of adults.

OBJECTIVE: To describe the characteristics of Australian adults' first vaginal intercourse and contraceptive use on that occasion, as well as first oral sex. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated their age at first vaginal intercourse (if ever), the partner's age, their relationship to their partner, the duration of the relationship before first intercourse, and what contraception (if any) was used. Respondents also indicated their age when they first had oral sex. RESULTS: For men, the median age at first intercourse declined from 18 among men aged 50-59 to 16 for men aged 16-19. For women the decline in median age was from 19 to 16. For women born between 1941 and 1950 the difference in median age at first vaginal intercourse and subsequent first oral sex was six years but for women born between 1981 and 1986 the difference in medians was one year. For men, a similar convergence was observed. Contraceptive use at first intercourse has increased significantly, from less than 30% of men and women in the 1950s to over 90% in the 2000s. For men, first intercourse before age 16 was significantly associated with greater numbers of lifetime and recent sexual partners, ever having paid for sex and having had a sexually transmitted infection (STI), and for women, with greater numbers of lifetime and recent sexual partners, ever having been paid for sex and ever having had an STI. CONCLUSION: Sex education should be given so that all young people have information about contraception and disease prevention before they begin their sexual careers.

Adolescent↗

PubMed2003

Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults.

OBJECTIVE: To describe the prevalence of same-sex and opposite-sex attraction and experience in Australia and the prevalence of different sexual identities. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories of Australia. The overall response rate was 73.1% (men, 69.4%; women, 77.6%). Men and women were asked about their experience of same-sex and opposite-sex attraction and experience along with their sexual identity. The agreement and disagreement between sexual attraction and sexual experience were explored. RESULTS: Among men, 97.4% identified as heterosexual, 1.6% as gay or homosexual and 0.9% as bisexual. Among women, 97.7% identified as heterosexual, 0.8% as lesbian or homosexual and 1.4% as bisexual. Among men, 91.4% reported only opposite-sex attraction and experience, as did 84.9% of women. Thus, some same-sex attraction or experience was reported by 8.60% of men and 15.1% of women. Of men, 4.2% reported sexual attraction and sexual experience that was inconsistent, as did 8.2% of women. Factors associated with this agreement or disagreement included age group, non-English-speaking background, education and socio-economic status. CONCLUSION: Relatively few Australians reported a sexual identity other than heterosexual. However, both same-sex attraction and homosexual experience are more common than homosexual or bisexual identity would suggest. Reporting same-sex attraction or experience was associated with poorer mental health and is likely to reflect responses to homophobia in Australian society.

Adolescent↗

PubMed2003

Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults.

OBJECTIVE: To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS: Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters. CONCLUSION: Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. IMPLICATIONS: There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.

Adolescent↗

PubMed2003

Sex in Australia: homosexual experience and recent homosexual encounters.

OBJECTIVE: To describe the prevalence and features of homosexual experience and recent homosexual encounters among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS: Overall, 8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives (p<0.001); these figures fell to 5.7% and 5.0% respectively (p=0.106) when non-genital sexual experience was excluded. 1.9% of men and 1.5% of women reported homosexual experience in the past year. Men who reported homosexual experience reported more same-sex partners than did women (means 31.6 and 3.2, p<0.001), and men and women who identified as homosexual or bisexual reported more sexual partners in total than those who identified as heterosexual. Respondents reporting homosexual experience were significantly more likely to be from an English-speaking background, have higher levels of education, live in a major city, and report a white-collar or managerial/professional occupation. Women who reported homosexual experience were less likely to have a middle or high income. In the most recent homosexual encounter, genital touching was the most commonly reported practice, and oral sex was reported much more frequently than in heterosexual encounters. CONCLUSION: Homosexually and bisexually identified men and women had higher total numbers of partners than heterosexuals. Improved societal attitudes towards homosexuality are likely to lead to further increases in estimates of the prevalence of homosexual experience in the community.

Adolescent↗

PubMed2003

Sex in Australia: sexual difficulties in a representative sample of adults.

OBJECTIVES: The Australian Study of Health and Relationships reports on sexual behaviours in a representative sample of Australian adults. METHOD: Between May 2000 and June 2001, computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16 to 59 years (response rate 73.1%). Respondents were asked whether in the past year they had for a period of at least one month experienced a range of sexual difficulties. RESULTS: The most common sexual difficulty was lack of interest in having sex (24.9% men, 54.8% women). Women were more likely than men to report being unable to come to orgasm (28.6% vs. 6.3%), not finding sex pleasurable (27.3% vs. 5.6%), physical pain during intercourse (20.3% vs. 2.4%) or worrying during sex about their body looking unattractive (35.9% vs. 14.2%). Men were more likely to report coming to orgasm too quickly (23.8% vs. 11.7%). Men (16.0%) and women (17.0%) were equally likely to have felt anxious about their ability to perform sexually. Erectile difficulties and lack of interest in sex were higher among the over-40s. Anxiety about performance was highest among men under 20. Experience of sexual difficulties correlated with self-reported ill health. CONCLUSION: The assumption that everyone should be interested in sex, should want to have it and should enjoy having it is a socially normative prescription and not a description of the actual state of affairs. Women reported less interest in sex, less pleasure and more pain than men.

Adolescent↗

PubMed2003

Sex in Australia: sexual and emotional satisfaction in regular relationships and preferred frequency of sex among a representative sample of adults.

OBJECTIVES: To document sexual and emotional satisfaction with their relationships and desired and actual frequency of sex among a representative sample of Australian adults. METHOD: Between mid-2001 and mid-2002, computer-assisted telephone interviews were completed by 10,173 men and 9,134 women aged 16-59 years from all States and Territories selected by modified random-digit dialling of households (response rate 73.1%). Respondents in a regular relationship were asked how physically pleasurable they found sex with the partner to be and how emotionally satisfying the relationship was. All respondents were asked how often they would ideally like to have sex and how often they had sex in the past four weeks. RESULTS: Most people in heterosexual relationships found sex very or extremely pleasurable (90.3% men, 79.1% women) and the relationship emotionally satisfying (87.5% men, 79.2% women); men were more satisfied with both. Physical pleasure in sex was correlated with emotional satisfaction. One person in four had had no sex in the past four weeks; most people had had sex less than twice a week. Most people wanted ideally to have sex more often than they did. However, 24.3% of men but only 8.3% of women said they ideally wanted sex daily or more often. CONCLUSION: Men on average express higher levels of relationship satisfaction and of sexual interest, but the overlap between men and women is large.

Adolescent↗

PubMed2003

Sex in Australia: autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults.

OBJECTIVES: To describe the prevalence of a range of autoerotic and other non-coital sexual practices among Australians. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years (response rate 73.1%). Respondents were asked whether in the past year they had: masturbated, engaged in various other autoerotic activities, or engaged in any of six other non-coital or esoteric practices. RESULTS: Half of the respondents (65% men, 35% women) had masturbated in the past year. Nearly half (48%) of the men and 25% of the women had masturbated in the past four weeks, among whom men had done so a mean of 5.8 times and women 3.3 times. About a quarter of all respondents had watched an X-rated film (37% men, 16% women), 12% of men and 14% of women had used a sex toy, and 17% of men and 2% of women had visited an Internet sex site. 17% of men and 14% of women had engaged in digital-anal stimulation with a partner. Phone sex, role play or dressing up, bondage and discipline, sadomasochism or dominance and submission (BDSM-DS), fisting (rectal or vaginal, insertive or receptive) and rimming (oral-anal stimulation) were all engaged in by less than 5% of the sample. CONCLUSION: Most of the practices studied were engaged in by more men than women. A range of autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.

Adolescent↗

PubMed2003

Sex in Australia: experiences of commercial sex in a representative sample of adults.

OBJECTIVE: To describe the characteristics of Australian adults' experience of commercial sex. METHOD: Telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years (response rate 73.1%; 69.4% men, 77.6% women). Respondents were asked about their experiences both as clients and as sex workers. Socio-demographic and health factors associated with experience of commercial sex were explored for men. RESULTS: Almost one in six Australian men (15.6%) have ever paid for sex; 1.9% had done so in the past year. Of men who had ever paid for sex, 97% had paid for sex with a woman and 3% for sex with a man. Very few women (0.1%) had ever paid for sex. Twice as many men (0.9%) as women (0.5%) had ever been paid for sex; two-thirds of these men (0.6%) were paid by other men. Condom use during vaginal sex was highest in parlours and brothels and with escorts, and lowest for street sex work. Two-thirds of women who had ever been paid for sex had done so only overseas. One in 10 men who had paid for sex had only done so overseas. Men who had paid for sex were more likely than other men to smoke, to drink more alcohol, to have had a sexually transmitted infection or been tested for HIV, to have more sexual partners, to have first had vaginal intercourse before 16, and to have had heterosexual anal intercourse. CONCLUSION: Sex work overseas, where condom use may not be common, represents a potential source of HIV or sexually transmitted infection.

Adolescent↗

PubMed2003

Sex in Australia: experiences of sexual coercion among a representative sample of adults.

OBJECTIVE: To provide reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The response rate was 73.1% (69.4% men, 77.6% women). RESULTS: Overall, 4.8% of men and 21.1% of women had experienced sexual coercion, i.e. being forced or frightened into unwanted sexual activity, and 2.8% of men and 10.3% of women had been coerced when aged 16 or younger. Although women were significantly more likely than men to have been sexually coerced, correlates of sexual coercion were similar for men and women and were not limited to effects on sexual behaviour. People who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex, and more likely to have acquired a sexually transmitted infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. CONCLUSION: Sexual coercion is an unacceptably common experience. Sexual coercion has detrimental effects on various aspects of people's lives. It most commonly occurs at the ages at which people become sexually active and women are more likely than men to be sexually coerced. IMPLICATIONS: There may be need for more readily accessible services that are better able to minimise the detrimental effects of sexual coercion. This is in addition to a more general need to reduce the incidence of sexual coercion.

Adolescent↗

PubMed2003

Sex in Australia: reproductive experiences and reproductive health among a representative sample of women.

OBJECTIVE: To document the reproductive experiences of a representative sample of Australian women aged 16-59 years. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men, and 77.6% among women). Women were asked the number of times they had experienced a live birth, a still birth, a miscarriage and a termination of pregnancy. RESULTS: Of the women surveyed, 15.5% reported having experienced difficulty in becoming pregnant and 76.1% had been pregnant at least once. Nearly all the women who had been pregnant reported experiencing a live birth. Substantial minorities of women reported having experienced a miscarriage (33.4%) or a termination of pregnancy (22.6%). The percentage of women who reported becoming pregnant the first time as a teenager declined from 22.8% among women aged 50-59 to 16.9% among women aged 20-29. Of those who had had vaginal intercourse, 19.2% had used emergency contraception, 53.3% of them only once. CONCLUSION: There was clear evidence of substantial changes in the fertility of Australian women over the past 40 years.

Abortion, Legal↗