Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible MSM

Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men

Australian and New Zealand Journal of Public Health

Anysha M. Walia, Christopher K. Fairley, Catriona S. Bradshaw, Marcus Y. Chen, Eric P.F. Chow

First published: 31 August 2020
https://doi.org/10.1111/1753-6405.13029
Abstract:

Objectives: Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men (MSM) in Melbourne, Australia.

Methods: We conducted a retrospective, cross‐sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare‐eligible and Medicare‐ineligible MSM.

Results: We included 5,085 Medicare‐eligible and 2,786 Medicare‐ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare‐eligible compared to Medicare‐ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare‐eligible and Medicare‐ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare‐ineligible MSM were more likely to have anorectal chlamydia compared to Medicare‐eligible MSM (10.6% vs. 8.5%; p=0.004).

Conclusions: Medicare‐ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high‐risk behaviour.

Implications for public health: Scaling up access to HIV and STI testings for Medicare‐ineligible MSM is essential.

Sex and gender: modifiers of health, disease, and medicine

The Lancet, Volume 396, Issue 10250, 22–28 August 2020, Pages 565-582
Mauvais-Jarvis, F., et al

Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men’s and women’s health.

 

Closing the Gap report 2020 shows only two targets on track

ABC, 12/02/2020

The 12th Closing the Gap report, tabled in Parliament today, shows Aboriginal children still trail far behind non-Indigenous children in literacy, numeracy and writing skills.

The report also shows the country is on track to meet just two of seven government targets to reduce the disparity in health, education and employment outcomes.

Gains in Indigenous health have been the same or smaller than those for non-Indigenous Australians — meaning gaps are persisting and, in the case of child mortality, widening. There has been no progress on a goal to close the life expectancy gap by 2031.

  • Read more of news article here
  • Read the report online here
  • Download full report PDF here

The health and wellbeing of Australian lesbian, gay and bisexual people: a systematic assessment

Australian and New Zealand Journal of Public Health, I04 June 2019

https://doi.org/10.1111/1753-6405.12855

Abstract

Objective: This study revisits disparities in health and wellbeing by sexual identity in Australia, identifying which domains demand priority policy intervention, documenting differences between gay/lesbian vs. bisexual populations, and examining change over time in the relative health and wellbeing of sexual minorities.

Method: I fitted multivariable ordinary least squares and random‐effect panel regression models on 20 outcomes to compare the health and wellbeing of heterosexual, gay/lesbian and bisexual people, using 2012/2016 data from a national probability sample – the Household, Income and Labour Dynamics in Australia (HILDA) Survey.

Results: I found strong associations between sexual minority identities and most health and wellbeing outcomes. These were comparatively larger for: role‐emotional health, mental health and general health; bisexual compared to gay/lesbian people; and minority women compared to minority men. I found no change over time in the relative health and wellbeing outcomes of gay/lesbian people, but evidence of worsening circumstances among bisexual people.

Conclusion: There are important disparities in the health and wellbeing profiles of different sexual minority populations in Australia, based on sex (male vs. female), sexual identity (gay/lesbian vs. bisexual), and observation time (2012 vs. 2016).

Implications for public health: Sexual identity remains an important marker of risk for health and wellbeing outcomes within Australia, underscoring the importance of fully integrating sexual identity in health policy and practice.

Connecting country: busting myths about Indigenous Australians (podcast)

Diversity Council of Australia, 2 Oct 2018

This 20-minute episode doesn’t just feature a beautiful Welcome to Country, but also attempts to connect Country by exploring the cultural and professional gaps that exist for Indigenous Australians at work and asking: where do these issues come from? Why do they persist? And what can we do to finally close the gap?

Helping answer these questions is Linda Burney – the first Aboriginal woman to serve in the House of Representatives, and the first Aboriginal person to serve in the NSW Parliament – as well as Karen Mundine, CEO at Reconciliation Australia.

Researched and hosted by: Andrew Maxwell. Produced and written by: Andrea Maltman Rivera. Executive produced by: Lisa Annese. Contributions from: Catherine Petterson and Simone Empacher Earl. Special thanks to Audiocraft. Welcome to Country by Aunty Norma Ingram.peer

Aboriginal and Torres Strait Islander listeners are warned.  The following podcast may contain voices of deceased people.

The everyday experiences of LGBTI people living with disability

GLHV@ARCSHS, La Trobe University,  July 2018

This report documents the effects of systemic discrimination on the health and wellbeing of LGBTI people with disability.

It is divided into two key sections. The first reviews the national and international research and policy literatures on the impacts of systemic discrimination, disadvantage and social exclusion on the health and wellbeing of LGBTI people with disability and their access to services.

The second, smaller section presents preliminary analyses of unpublished data on LGBT people with disability from Private lives 2: The second national survey of the health and wellbeing of LGBT Australians (2012).

KEY FINDINGS:

The review found that research, policy and practice on the health and wellbeing of LGBTI people with disability in Australia is fragmented, under-resourced and relies on different, sometimes contrary definitions of ‘disability’.

The review documents higher rates of discrimination and reduced service access among LGBTI people with disability compared with people with disability and LGBTI people without disability; greater restrictions on freedom of sexual expression (particularly for LGBTI people with intellectual disability); and reduced social support and connection from both LGBTI and disability communities.

It documents a lack of professional training, resources and support for disability and allied health care workers for LGBTI people with disability. It also found that many disability services and workers are unwilling to address the sexual and gender identity rights and freedoms of LGBTI people with disability.