Denton Callander

Background: Significant social, technological and medical changes highlight a need for timely and representative sexual and reproductive health surveys, while also posing challenges to their design. This paper describes methods of the Third Australian Study of Health and Relationships (ASHR3). Methods: From March 2023 to April 2024, data were collected from people aged 16–69 years via an anonymous survey of holistic sexual and reproductive health. ASHR3 collected data via random selection of mobile phone numbers for an interviewer-administered survey and via an online probability panel for a self-administered digital survey. Potential differences between the two modes of sampling and data collection were investigated. Sample-specific design weights were applied and calibrated to the 2021 Australian Census regarding gender, country of birth, education, religion and area of residence. Results: The final sample was 12,833 people: 5693 men (48.63% weighted proportion), 6984 women (49.98%), and 156 non-binary people (1.39%) from every state and territory. Telephone interviews were conducted with 7226 participants and online surveys with 5607. The survey cooperation and response rates for the telephone sample were 86.11% and 3.54%, respectively, whereas the online completion rate was 98.73%. Few participants said the survey made them feel embarrassed (10.96%) and most said they were very honest in their responses (96.54%). Comparisons with the most recent Census found the weighted ASHR3 sample was generally representative of the general population of Australia, with a mean of 1.22% difference across key sociodemographic characteristics (s.d. 2.37). There were no differences observed in sociodemographic characteristics and other responses between the telephone and online samples. Conclusions: ASHR3 compiled rich, robust, and representative data on sexual and reproductive health from a large national sample. The inclusion of an online probability panel complemented the more traditional telephone-based methods. With more than 20 years of data, ASHR is an important resource for monitoring trends in sexual and reproductive health.

We investigated the association between sleep health and HIV care and prevention outcomes among transgender women of color (TWOC). We used data from TWOC living in New York City collected from 2020 to 2022. Our exposures of interest were short sleep (sleeping for less than seven hours per night), poor-quality sleep (self-rated quality of sleep as “very bad” or “fairly bad”), and long sleep onset latency (taking at least 30 min to fall asleep). We asked participants about their HIV care and prevention outcomes, including HIV/STI testing, condom use, PrEP use, and HIV viral load suppression. We used Targeted Maximum Likelihood Estimation to estimate the association between sleep and these outcomes and included age, education, income, US-born nativity, and hormone replacement therapy use as potential confounders. Among the 314 participants, 54.5% had short sleep, 35.0% had poor-quality sleep, and 24.8% experienced long sleep onset latency. Among people living with HIV (51.6%), those who had short amounts of sleep were less likely to always use a condom (Adjusted Prevalence Ratio [aPR]: 0.67; 95% CI: 0.51–0.87) and be virally suppressed (aPR: 0.87; 95% CI: 0.79–0.96), and those who had poor-quality sleep were less likely to be virally suppressed (aPR: 0.83; 95% CI: 0.72–0.96). Among people living without HIV (46.2%), experiencing long sleep onset latency decreased the likelihood of always using condoms (aPR: 0.36; 95% CI: 0.15–0.85). Improving sleep health among TWOC could improve HIV care and prevention outcomes and reduce health inequities.

Background: Previous efforts to synthesise sexual and reproductive health (SRH) literature have primarily focused on singular services, specific migrant groups, or mostly individual-level influencers. In this systematic review we assessed access to comprehensive SRH services, including multilevel barriers and facilitators, among migrant and refugee women in high-income English-speaking countries. Methods: We searched seven databases for peer-reviewed studies involving quantitative and mixed methods, published between 2010 and 2024. We extracted data following PRISMA-Equity guidelines and assessed the risk of bias using the ‘quality appraisal for diverse studies’ tool. We used a socio-ecological framework to organise results into multilevel barriers and facilitators. Results: Twenty-nine studies met inclusion criteria across four countries. Fifteen studies focused on cervical screening, 7 on maternity care, 5 on contraception, 4 on HIV and other sexually transmissible infections, and 2 on intimate partner violence. Summary findings from these studies indicate that migrant and refugee women utilise SRH services less often than native-born women. Barriers to SRH services included knowledge and risk perception gaps at the individual level; implicit bias, discrimination, and language barriers at the interpersonal level; lack of culturally sensitive practices and environments at the organizational level; and lack of health insurance coverage and anti-immigration and racist discourse at societal and policy levels. Discussion: Migrant and refugee women face significant inequities in accessing SRH services in high-income countries. Eliminating these disparities will require culturally sensitive solutions that encompass multiple levels of influence, especially moving beyond an individual focus to consider interventions at interpersonal, institutional, societal, and policy-level.

Objectives. To examine how one’s community connectedness may act as a source of resilience and promote HIV prevention and care behaviors among transgender women of color. Methods. We analyzed survey data from 313 transgender women of color living in New York City collected from August 2020 to November 2022. The Community Connectedness Scale asks participants about their baseline feelings of connection, feelings of inclusion, feelings of belonging, feelings of isolation, and feelings of being unlike in relation to the transgender community. The HIV prevention and care outcomes of interest were measured at 6-month follow-up and included consistent condom usage, recent testing for sexually transmitted infections (STIs), current preexposure prophylaxis use, and HIV viral load suppression. Results. Those with a high (compared to low) community connectedness were 62% more likely to consistently use condoms and 16% more likely to test for STIs. Conclusions. Community connectedness was associated with a greater likelihood of HIV prevention behaviors. Public Health Implications. Future interventions could include strategies to strengthen community connectedness to improve HIV status neutral care continuums. ( Am J Public Health. 2025;115(10):1631–1641. https://doi.org/10.2105/AJPH.2025.308144 )

In the United Kingdom, drug use has been reported to be higher among individuals involved in the sex industry through in‐person work compared with those not engaged in such work. In addition, those who engage in more visible forms of in‐person work in the sex industry—such as street‐based exchange—are more likely to have challenges with drug and alcohol use compared with individuals working in less visible, in‐person settings. Services often struggle to adequately support people who participate in the sex industry, particularly those with intersecting health and social care needs, including problematic drug and alcohol use. It is, therefore, important to understand how services can better support the needs of individuals who engage in the sex industry and who have experienced challenges with their drug and alcohol use. This critical review examined available literature to assess how individuals who engage in the sex industry, particularly individuals participating in visible and in‐person forms of sexual commerce, currently access support for drug and alcohol use and how this could be improved within the UK. Written contributions on the most important considerations in service provision for substance use treatment for individuals who participate in the sex industry were gathered from six experts—four academics and two practitioners—who work and conduct research in this field. These insights were thematically analysed alongside relevant literature they recommended. Findings suggest that individuals who engage in the sex industry would benefit from nonjudgmental and flexible care that considers their specific and intersecting needs both as someone who uses drugs and alcohol and as an individual engaged in sexual commerce. It is vital that individuals engaged in the sex industry have access to gender and trauma informed, sex industry specific services that provide support for intersectional health and social care needs. Multiagency working in this field is essential so that individuals have access to integrated support that prioritises relationships and builds trust between service providers and the individuals they support.

Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients’ lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.