Early medical abortion: reflections on current practice

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O&G Magazine (RANZCOG), by Dr Lisa Rasmussen

In the last 30 years, medical abortion has globally become an established, safe and straightforward method for pregnancies of less than nine weeks gestation. It is now recommended by the Royal College of Obstetricians and Gynaecologists as the method of choice for women up to nine weeks gestation.

The reality of providing medical abortion for women, however, is a more complex matter. Abortion services are contextualised by the specific and, at times, changing abortion laws in each country and state. These laws, in turn, are determined and maintained by each jurisdiction’s specific gendered social and political histories, practices and attitudes.

In Australia and New Zealand, this context continues to affect who can provide medical abortions, the models of care adopted, the ongoing struggle to provide affordable and accessible care to all women, and the level to which medical abortion is accepted as a normal and important part of women’s healthcare.

Within the context of these histories and challenges, this article will attempt to guide you through the process of providing a medical abortion as a health practitioner.

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Psychosocial mediators of perceived stigma and suicidal ideation among transgender women

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Kota, K.K., Salazar, L.F., Culbreth, R.E. et al. Psychosocial mediators of perceived stigma and suicidal ideation among transgender women. BMC Public Health 20, 125 (2020). https://doi.org/10.1186/s12889-020-8177-z

Abstract

Background

Transgender women (TGW) in the U.S. experience high rates of stigma, depression, and elevated rates of suicide. This study examined correlates of suicidal ideation and estimated the conditional indirect effects of perceived stigma and psychosocial mediators on suicidal ideation.

Methods

Using a cross-sectional study design, TGW (N = 92) were recruited through snowball sampling in Atlanta, Georgia. Structured interviews were conducted. Suicidal ideation was assessed by combining two variables that measured suicidal thoughts. Logistic regression models were performed to identify the potential risk and protective factors for suicidal ideation. We examined hypothesized psychosocial factors, including anxiety, depression, psychosocial impact of gender minority status, and substance use behaviors as potential mediators for the relationship between perceived stigma and suicidal ideation. All models were controlled for age, race, education, and homelessness.

Results

Suicidal ideation was reported by 33% (N = 30) of the study participants. In multivariable analysis, suicidal ideation was associated with sexual abuse (AOR = 3.17, 95% CI = 1.10–9.30), anxiety (AOR = 1.74, 95% CI = 1.10–2.73), family verbal abuse (AOR = 2.99, 95% CI = 1.10–8.40), stranger verbal abuse (AOR = 3.21, 95% CI = 1.02–10.08), and psychosocial impact of gender minority status (AOR = 3.42, 95% CI = 1.81–6.46). Partner support was found to be the protective factor for suicidal ideation (AOR = 0.34, 95% CI = 0.13–0.90). In the mediation analysis, the psychosocial impact of gender minority status mediated the relationship between perceived stigma and suicidal ideation. The estimated conditional indirect effect was 0.46, (95% CI = 0.12–1.11).

Conclusion

Interventions that aim to reduce suicidal behaviors among TGW should address stigma, psychosocial imfamilpact of gender minority status, and different forms of violence and abuse.

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“I’m never having sex with anybody ever again”: what helps PLHIV get over these feelings

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nam/aidsmap, 27 January 2020

For people living with HIV, sexual adjustment after diagnosis is affected by fears of transmitting the virus and of possible rejection by sexual partners, new qualitative research shows. Healthy sexual adjustment over time is facilitated by partner acceptance; peer, community and professional support; and up-to-date knowledge of HIV transmission, including U=U.

Barriers to healthy sexual adjustment include the persistence of undue fears of transmission and rejection long after diagnosis, which may result in avoiding sex or pairing it with drugs and alcohol. Based on these findings, Dr Ben Huntingdon and colleagues at the University of Sydney propose a new model of sexual adjustment to HIV, published in the BMC Infectious Diseases journal.

Thirty participants (19 male, 11 female) out of 45 PLWH who agreed to be contacted completed the interview and questionnaire as part of the study.

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Calls for segregated mental health wards to reduce sexual assault risk

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ABC (Katherine Gregory on AM), February 2020

Sexual violence against women in mental health wards is going unchecked, despite service providers’ awareness of the problem.

A new report has found women in Victorian mental health wards are vulnerable to sexual assault, harassment and violence from male patients and staff.

It’s calling for stricter separation of male and female patients in mental health wards and an overhaul of how assault complaints are dealt with.

Broadcast: 
Duration: 3min 49sec
Featuring:

– Doctor Juliet Watson, RMIT University
– Charlotte Jones, Victorian Mental Health Legal Centre

 

 

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A sex-positive approach in Sexual and Reproductive Health and Rights programming for youth

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The International Planned Parenthood Federation (IPPF), February 2020

IPPF have created the new resource pack: A sex-positive approach in Sexual and Reproductive Health and Rights programming for youth.

Please start with opening the toolkit which provides additional guidelines on how to use the resources. The toolkit is interlinked with the videos and the presentation hence going through the manual will navigate you through all materials available.

 

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Delayed linkage to HIV care among asylum seekers

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Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, Canada. BMC Public Health 19, 1683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

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