Physicians' inadequate involvement in sexual risk assessment has the potential to miss many asymptomatic cases. The present study was conducted to explore sexual risk assessment by physicians in clinical practice and to identify barriers in eliciting sexual histories from patients. Methods: A stratified random sample of 15% of general practitioners (GP) from New South Wales was surveyed to assess their management of sexually transmissible infections (STI). In total, 409 GP participated in the survey with a response rate of 45.4%. Results: Although nearly 70% of GP regularly elicited a sexual history from commercial sex workers whose presenting complaint was not an STI, this history taking was much lower (<10%) among GP for patients who were young or heterosexual. About 23% never took a sexual history from Indigenous patients and 19% never elicited this history from lesbian patients. Lack of time was the most commonly cited barrier in sexual history taking (55%), followed by a concern that patients might feel uncomfortable if a sexual history was taken (49%). Other constraints were the presence of another person (39%) and physician's embarrassment (15%). About 19% of GP indicated that further training in sexual history taking could improve their practice. Conclusions: The present study identifies inconsistent involvement by GP in taking sexual histories, which can result in missed opportunities for early detection of many STI. Options for overcoming barriers to taking sexual histories by GP are discussed.

Several studies reported premarital and extra-marital sex in Bangladesh society, including among migrant workers. Some studies documented extra-marital sex among the wives of the migrant workers, confirmed prevalence of HIV among migrant workers' families and transmission of HIV from migrant workers to their wives and children. However, most of these studies concentrated on risky behaviors and knowledge about HIV/AIDS. The social and cultural factors that may shape the risk behaviours of migrant workers and their wives while they live away from each other have largely been ignored. Against this backdrop, the present research aimed to understand and explain the factors associated with risky sexual behaviours of the wives of the migrants and non-migrant workers and their vulnerability to HIV infection. The research particularly focused on the socio-economic factors, and the religious-cultural context that could influence the risk behaviours of migrant and non-migrant men and wives of the migrant men in a rural area in Bangladesh. The present research consists of two components: (i) a descriptive, quantitative part that analyses a secondary data set on the wives of migrants and non-migrant workers, and (ii) an exploratory, qualitative component that probes the socio-cultural issues from in-depth interviews with migrant and non-migrant men and wives of the migrant and non-migrant men.

The purpose of this qualitative research is to explore the perception of Iranian-American women about their sexual-selves and gender role formations. Additionally, the research discusses issues which contributed to the formation of their sexual-selves, gender roles, and gender identity, as well as the role culture plays in the lives of these women. The snowball sampling technique was used to identify the 24 participants, aged 18 years and older, among the first generation Iranian-American women living in Southern California, United States. A feminist perspective was selected to provide the theoretical framework to understand each woman's unique experience with respect to her sexual-self and life circumstances. Narrative analysis was utilized to explore the sexual life stories via individual in-depth interview. These stories included childhood to marriage in Iran, the undoing and unlearning process underpinning the development of their sexual-selves, and the influences of the socio-cultural factors that framed the experiences of the participants in both their home and host cultures. ... The thesis argues that the concept of the sexual rights of women has to be equated with human rights for significant advances to be made in the equality of women with men. The findings have policy and practice implications of Iranian-American women benefiting from educational programs and community discussion groups. Health professionals will see greater therapeutic gain in their patients by having adequate sensitivity to and familiarity with their patients' culture and language. Researchers will have an information base from which to pursue further research, not only with Iranian women, but also with women of similar cultural backgrounds.

Purpose of the paper: This paper will present the findings from a qualitative study that explored the meaning and experiences of people in relation to sexually transmitted infections (STIs) and how such experiences influence access to relevant services in the region. Methods: Participants for the study were recruited through the use of snowballing and self selection. Interviews were conducted with 24 participants aged between 19 and 65 years and living in rural communities. The interview data was transcribed and analysed using grounded theory methodology principles. The study is part of a larger project that includes quantitative data from NSW Health Notifiable Diseases Database on syphilis notifications for the Hunter New England Area Health, Northern region. Results: Findings from this study indicate infividuals engage in a process of regulating the flow of private information about STIs. The paper describes conditions that influence an individual's capacity to identify, seek and utilise the most appropriate service. It becomes apparent that close connections with other people is particularly relevant when accessing services within a rural town. Findings: The implications of this study for policy and practice highlight the need to reconsider the current conceptualisation of STIs, particularly in relation to the complex social ties that exist in rural communities. Anonymity and confidentiality are important aspects for influencing the way in which people make decisions when seeking health care for STIs.

This study explored the reasons general practitioners (GPs) are reluctant to participate in a postal survey. A cross-sectional postal survey was conducted among currently practising GPs in New South Wales, Australia, in 2002, who were asked to complete a questionnaire on the management of sexually transmitted infections (STIs). The overall response rate for the main STI survey was 45.4%. The GPs who did not respond to the STI questionnaire were sent a one-page non-response questionnaire asking them to report their reasons for not participating in the STI survey. Of the 491 non-responding GPs, 116 (23.6%) completed the non-response questionnaire and form the basis of the present paper. The key reasons reported by GPs for not participating in postal surveys were acute time constraints imposed by increasing workload including substantially increased paperwork, receiving too many survey requests, low STI caseload, and few incentives or returns on their time spent on completing surveys. While researchers need to be cognisant of constraints in general practice, it is also important to develop strategies for increasing GP involvement in research activities. To help improve participation of GPs in postal surveys, we recommend involvement of GPs in the design and conduct of research on issues relevant to general practice along with provision of feedback of survey results.

Although there is considerable research on the status of women as it relates to culture, religion, politics and the dominant male presence in Iranian societies, there is paucity of research that examines these issues of sexuality from the perspective of Iranian-American women. This study explores the experience of Iranian-American women regarding their sexuality using a narrative methodology. Twenty in-depth interviews have been conducted so far and the interview data is being analysed to understand the socio-cultural issues that frame the experiences of migrant Iranian-American woman in both cultures - ie Iranian and Western traditional orientation to sexual values and behaviour. The paper discusses some of the preliminary findings from the on-going study.

Background: Sexually transmitted infections (STIs) are a public health problem in Vietnam with sub-optimal care in medical practice. Identifying practitioners' perceived barriers to STI care is important to improve care for patients with STIs. Methods: A cross-sectional survey was conducted among 451 physicians. These physicians were dermatology and venereology (D&V) doctors, obstetrical/gynaecological (Ob/Gyn) doctors, general practitioners, and assistant doctors working in health facilities at provincial, district and communal levels in three provinces in Vietnam. Results: Almost all (99%) respondents mentioned at least one barrier to STI care. The barriers were "lack of STI training" (57%), "lack of professional resources" (41%), "lack of time" (38%), "lack of reimbursement" (21%), "lack of privacy/ confidentiality" (17%), "lack of counselling" (15%), and "not the role of primary care provider" (7%). Multivariable logistic regression analysis showed that "lack of professional resources" was associated with respondents being in medical practice for ten years or under (vs. 11-20 years), and working at district or communal health facilities (vs. provincial facilities); "lack of time" were associated with respondents being female, seeing more than 30 patients a week (vs. <15 patients/week); and "lack of privacy/confidentiality" was associated with physicians' seeing more than 30 patients a week (vs. <15 patients/week). Conclusion: The study has identified several barriers to STI care in medical practice in Vietnam. Results of the study can be used to improve areas in STI care including policy and practice implications.

This research aims to improve understanding and surveillance of syphilis in rural and remote communities in Northern NSW. While simultaneously, examining the factors involved and the experiences of people with an STI in accessing health care. Preliminary findings will be discussed which includes the difficulties and issues related to research in rural areas. Syphilis notifications over a ten year period from 1994 to 2004 in Northern NSW were extracted from NSW Health Notifiable Diseases Database for the geographic area covered by the Hunter New England Area Health Service, Northern Area. This study uses the Index of Relative Socioeconomic Disadvantage developed by the Australian Bureau of Statistics. The sample consisted of 254 notifications for the Hunter New England Northern Area over the 10 year period. Preliminary results show that notifications were highest in the most disadvantaged areas with high levels of advantage associated with lower numbers of notifications for syphilis <1 year duration. Reported rates of syphilis declined from 1996 until 2001 when the trend began to reverse. People aged between 15-29 years had a prevalence proportion of 5.2 per 1,000 population compared to 0.8 for those over the age of 30 years. The reported rate of infection is higher among women than men. Questions raised from this analysis will be explored in further detail in in-depth interviews with approx 40-60 people. The study reveals there a number of differentials in the notification of syphilis. The implications of this study for policy and practice highlights that people under the age of 30 years and those from disadvantaged areas require extra targeting to reduce syphilis infection. In addition, the challenge of research in rural areas, coupled with hidden nature of STIs and the isolated and scattered nature of the population with STIs in rural areas make access to people for research purposes complex.

Background: Primary care providers are well placed to control the spread of sexually transmitted infections (STI); however, care is likely to be influenced by their attitudes and beliefs. The present study investigates the relationship between general practitioner’s (GP) self-reported level of comfort in dealing with patients with STI and the care they deliver. Methods: A postal survey was conducted using a stratified random sample of 15% of GPs practising in New South Wales, Australia, to assess practitioners’ management of STI. A total of 409 GPs participated in the study yielding a response rate of 45.4%. Results: Although over two-thirds (69–72%) of GPs were comfortable in managing STI in heterosexual or young patients, fewer than half (40–46%) felt comfortable caring for patients who were sex workers, indigenous, people who inject drugs, gay or lesbian. Practitioners who were comfortable were more likely to offer sexual risk assessment, safe-sex counselling, and were less likely to report limited ability to influence patients’ risk behaviours. Practitioner discomfort was positively associated with reporting constraints in sexual history-taking and the need for training in sexual health. Conclusions: Practitioners' care and support for patients with STI are influenced by their inexperience, lack of skills and/or attitudes. The reasons for GP discomfort in managing STI patients need further exploration as does its impact on patient care.

Objective: To assess whether some demographic and practice characteristics of general practitioners (GPs) are associated with the use of bulk billing. Methods: A cross-sectional postal survey was conducted in late 2002 with a 15% stratified random sample, based on sex and area of practice, of currently practising GPs in New South Wales. Multinomial logistic regression was used to look at GPs' characteristics associated with their self-reported use of bulk billing. Results: Of the 494 GPs who participated in the study, 44% bulk billed for all patient consultations, 34% for selective patients, while 22% did not bulk bill for any patient. Multivariate analysis revealed that GPs practising in metropolitan areas were six times more likely to bulk bill for all patients compared with GPs in rural areas (OR 6.7, 95% CI 3.8–11.9). Overseas-trained GPs were twice as likely to bulk bill for all patients compared with locally trained GPs (OR 2.3, 95% CI 1.2–4.3). The likelihood of bulk billing for all patients also increased with an increase in GPs' caseload. Conclusions: This paper discusses some of the policy and programmatic implications of the changing pattern of bulk billing. Special efforts are needed to provide increased practice support for GPs in rural and remote areas in order to ensure affordable and accessible GP services.