Dana Paquette - Academia.edu (original) (raw)

Papers by Dana Paquette

The British Journal of Development Disabilities, 1999

The British Journal of Developmental Disabilities Vol. 45, Part 2, JULY 1999, No. 89 ... PICA AND... more The British Journal of Developmental Disabilities Vol. 45, Part 2, JULY 1999, No. 89 ... PICA AND TRACE METAL DEFICIENCIES IN ADULTS WITH DEVELOPMENTAL DISABILITIES ... Irene Swift, Dana Paquette, Kristina Davison and Haider Saeed ... *Irene Swift, MB, BS ...

American Journal of Epidemiology, 2013

Venue sampling is a common sampling method for populations of men who have sex with men (MSM); ho... more Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.

Chronic Diseases in Canada, Feb 1, 2006

The following information is taken from a survey (Bryant, Wilson, Hull, & Treloar, 2010) of almos... more The following information is taken from a survey (Bryant, Wilson, Hull, & Treloar, 2010) of almost 600 people who obtained injecting equipment from pharmacies in 2008. The following are points for discussion: • 20% of respondents self-identified as Aboriginal people • Among Aboriginal respondents, 35% lived in regional areas of NSW, almost 40% had been in prison in the previous year, 38% reused needles and syringes in the previous month, and 65% shared another's injecting equipment. • Compared to non-Aboriginal respondents, Aboriginal respondents had significantly more risk factors for the acquisition of hepatitis C, including being more likely to have been in prison in the previous year, inject on a daily basis, share ancillary equipment, and have poorer hepatitis C-related knowledge. • Importantly, Aboriginal respondents were no more or less likely to have used services such as hepatitis C testing and drug treatment. • The information reported here is from a descriptive survey...

International Journal of Drug Policy, 2011

Background: Respondent-driven sampling (RDS) is a method for recruiting hidden populations, such ... more Background: Respondent-driven sampling (RDS) is a method for recruiting hidden populations, such as people who inject drugs (PWID). In RDS, participants recruit their peers into the study; who recruited who into the study is tracked, and thus information is gathered on the population's social networks. The purpose of this study was to use information collected from an RDS study of PWID to determine the size and structure of injecting networks and whether network characteristics are associated with sharing injecting equipment. Methods: A study was launched in Sydney, Australia in 2009 with five seeds, who were asked to recruit three participants each into the survey. This process was repeated until the target sample size was reached. The median size of injecting networks and the homophily (a measure of in-group affiliation) of different subgroups were calculated. Participants' information was linked with that of their recruiter to form dyads, and multivariate analysis was conducted to determine whether dyad and injecting network characteristics were associated with sharing injecting equipment within the dyads. Results: The injecting networks were large, the lowest median subgroup network size being 12. Homophily estimates indicated a lack of strong ties both within and across groups. In the multivariate analysis, factors significantly associated with sharing injecting equipment within dyads were feeling very close to their recruiter and having one or both members of the dyad identify as Aboriginal or Torres Strait Islander and one or both members having not been tested for hepatitis C in the previous year. Conclusion: RDS provided valuable information on injecting networks in Sydney. PWID were shown to be socially connected with a large number of other injectors, and affiliations were formed without regard to demographic or drug use characteristics. Linking information from the recruits with that of their recruiter was a useful way of organizing information to gain a more complete understanding of risk behaviour.

CMAJ open, 2014

Much of the recent increase in hospital admission rates and mortality associated with hepatitis C... more Much of the recent increase in hospital admission rates and mortality associated with hepatitis C in Canada is believed to be because of a higher prevalence of hepatitis C virus infection among those born between 1945 and 1965 (the baby boomer generation). We explored the effects of birth cohort on the rates of and projected trends in hospital admissions associated with hepatitis C. The hospital records of 17 344 inpatients with a diagnosis of chronic hepatitis C and liver disease, including liver cancer, were extracted from the Canadian Discharge Abstract Database for April 2004 to March 2011. For each 5-year birth cohort from 1915 to 1984, regression analysis was used to estimate the temporal trends associated with the average age of the cohort during the study period. Future hospital admissions were predicted based on the assumption that past trends would continue. Hospital admissions associated with hepatitis C and liver disease increased an average of 6.0% (95% confidence inter...

Chronic diseases in Canada, 2006

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002

This study describes characteristics of psychiatry inpatients with developmental disabilities (DD... more This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD. A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD. The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admiss...

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 31, 2000

The results of randomized trials show that breast cancer screening by mammography reduces breast ... more The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. Analyses of interim performance indicators for screening mammography have been calculated from data submitted to the Canadian Breast Cancer Screening database. The data set consisted of data from 7 provincial programs and was limited to mammographic screens for women aged 50-69 years (n = 203,303). Screening outcomes and performance indicators were calculated for abnormalities detected by screening mammography only. The abnormal recall rate was 9.5% for first screens and 4.6% for subsequent screens, and the cancer detection rate per 1000 women screened was 6.9 for firs...

Contemporary Drug Problems, 2010

ABSTRACT

Canadian journal of public health = Revue canadienne de santé publique

Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care... more Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards transmission within the community. This review describes HIV testing coverage in populations disproportionately affected by HIV and in the general population in Canada. A search of published and grey literature on HIV testing uptake in Canada was conducted. Studies reporting quantitative data on testing practices (ever tested, recent testing, and regular testing), published in either English or French from 2008-2012, were included. Studies that involved testing for immigration or prenatal purposes, and post-intervention studies, were excluded. Included studies were assessed using a modified version of the Public Health Agency of Canada's Descriptive Study Critical Appraisal Tool. Pooled prevalence for percent ever tested was calculated for subpopulations and heterogeneity was estimated using the I2 statistic. A to...

We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in res... more We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in resource-rich countries and examine the potential interactions between TasP and other prevention strategies by reviewing mathematical models of TasP. Multiple databases were searched for mathematical models published in the previous 5 years (from July 2007 to July 2012). The nine models located were set in Canada, Australia and the United States. These models' predictions suggested that the impact of expanding treatment rates on expected new infections could range widely, from no decrease to a decrease of 76%, depending on the time horizon, assumptions and the form of TasP modeled. Increased testing, reducing sexually transmitted infections and reducing risky practices were also predicted to be important strategies for decreasing expected new infections. Sensitivity analysis suggests that current uncertainties such as the effectiveness of highly active antiretroviral therapy outside of heterosexual transmission, less than ideal adherence, and risk compensation, could impact on the success of TasP at the population level. The results from large scale pilots and community randomized controlled trials will be useful in demonstrating how well this prevention approach works in real world settings, and in identifying the factors that are needed to support its effectiveness.

Sexuality Research and Social Policy, 2013

Kidd, M.R. (2013) The new cultural politics of the waiting room: Straight men, gay-friendly clini... more Kidd, M.R. (2013) The new cultural politics of the waiting room: Straight men, gay-friendly clinics and 'inclusive' HIV care. Sexuality Research and Social Policy, 10(2): 87-96. http://dx.2 The new cultural politics of the waiting room: Straight men, gay-friendly clinics and 'inclusive' HIV care Abstract

International Journal of Mental Health and Addiction, 2012

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay... more Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social, behavioural and AOD variables. Participants were classified into those with (n=130) and without major depression (n=401) using the PHQ-9 screening tool. Although rates of drug use were very high in the sample, multivariate logistic regression analysis showed that the majority of variables independently associated with major depression were social and behavioural factors. Only one AOD variable was associated with major depression: the use of three or more drug types in the past 6 months. Attending to specific patterns of AOD use may assist in the identification of gay men most at risk of major depression.

Health & Social Care in the Community, 2012

1. Comparing 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's de... more 2012) Comparing 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's depression. Health and Social Care in the Community, 20(4): 412-419. Abstract High rates of both illicit drug use and depression are consistently reported among gay men. However, little is known about how beliefs about drug use shape clinical encounters between gay men and health professionals, and that in turn affect clinical communication and care, particularly in relation to depression. We compared 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's depression. Semi-structured interviews were conducted in August-December 2006 with 16 general medical practitioners working in seven 'gay-friendly' practices in Sydney, Adelaide and a rural-coastal city in New South Wales, and in February-May 2008 with 40 gay men with depression recruited through four Sydney and Adelaide practices. A thematic analysis of these two sets of interviews found that doctors expressed the beliefs that: illicit drug use is related to depression in gay men; illicit drug use impedes effective diagnosis and treatment of depression in gay men; and illicit drug use increases the level of complexity involved in caring for gay men with depression. Gay men expressed the beliefs that: illicit drug use is closely related to depression; illicit drug use can be helpful in dealing with difficult experiences; and illicit drug use is just what you do as a gay man living in a big city. Both groups believed drug use and depression were related but doctors emphasised the negative outcomes of drug use and interpreted these in relation to health. Gay men believed that drugs could have both negative and positive uses and differentiated between health and social outcomes. While the doctors articulated a pragmatic position on drug use, which is consistent with harm reduction principles, communication with gay male patients could be enhanced if both groups acknowledged their divergent views of illicit drugs and their potential role in mental health.

Drugs: Education, Prevention, and Policy, 2012

ABSTRACT Aims: Respondent-driven sampling (RDS) is increasingly being used to sample hidden popul... more ABSTRACT Aims: Respondent-driven sampling (RDS) is increasingly being used to sample hidden populations, such as people who inject drugs (PWIDs). This study compared samples of PWID recruited from RDS and service-based sampling methods to explore whether RDS captured a less visible group of PWID that differed in their risk profile than those captured using service-based sampling. Methods: An RDS study of PWID was conducted in Sydney, Australia in 2009. RDS participants’ frequency of use of NSP and pharmacies was calculated. Population estimates were calculated for RDS participant characteristics and were compared with sample proportions from two separate studies, which recruited participants from needle and syringe programmes (NSP) and pharmacies. Findings: Only 12% of the RDS sample may not have been accessible through either an NSP or a pharmacy. RDS participants were just as risky in their injecting practices and were more likely to access HCV prevention services than participants recruited from service-based sampling methods. Conclusions: This comparison was useful in evaluating who might be missed in service-based sampling methods. Given that RDS was not able to capture a less visible group of PWID, the choice of sampling method should take into account the availability of services through which to conduct a study.

Drug and Alcohol Dependence, 2011

Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being ... more Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being used for HIV behavioural surveillance. When used for surveillance purposes, a sampling method should be relatively inexpensive and simple to operate. This study examined whether an RDS survey of people who inject drugs (PWID) in Sydney, Australia, could be successfully conducted through the use of minimal and existing resources. The RDS survey was conducted on the premises of a local needle and syringe program (NSP) with some adjustments to take into account the constraints of existing resources. The impact of the survey on clients and on staff was examined by summarizing NSP service data and by conducting post-survey discussions with NSP staff. From November 2009 till March 2010, 261 participants were recruited in 16 waves. A significant increase was found in the number of services provided by the NSP during and after data collection. Generally, staff felt that the survey had a positive impact by exposing a broader group of people to the NSP. However, conducting the survey may have led to privacy issues for NSP clients due to an increased number of people gathering around the NSP. This study shows that RDS can be conducted with the use of minimal and existing resources under certain conditions (e.g., use of a self-administered questionnaire and no biological samples taken). A more detailed cost-utility analysis is needed to determine whether RDS' advantages outweigh potential challenges when compared to simpler and less costly convenience methods.

Australian Journal of Primary Health, 2012

General practitioners (GPs) identify that depression can be difficult to diagnose in populations ... more General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients' scores on the Patient Health Questionnaire-9 screening tool, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria, and GPs' ratings of the likelihood of depression for each participant. We observed high concordance between GPs' assessments of major depression and patients' scores on the PHQ-9 (79% agreement), although our analysis also suggested that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients' AOD use, with the exception of frequent use of crystal methamphetamine. Here, men who reported frequent use of methamphetamine were significantly less likely to have concordant assessments (adjusted odds ratio 0.3, 95% CI 0.1-0.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal methamphetamine use, other AOD use may have less impact on the diagnosis of depression.

AIDS and Behavior, 2013

This paper describes patterns of injecting drug use and blood borne virus (BBV)-related risk prac... more This paper describes patterns of injecting drug use and blood borne virus (BBV)-related risk practices among Australian Aboriginal and non-Aboriginal people who inject drugs (PWID). A total of 588 participants, 120 of whom self-identified as Aboriginal completed a questionnaire. Aboriginal participants were more likely to have been in prison (37.6 vs. 16.5 %), to inject daily (72.7 vs. 55.0 %), to share ancillary equipment (64.9 vs. 44.8 %) and less likely to know about BBV transmission (72.0 vs. 87.7 %) and treatment (47.2 vs. 67.6 %). Aboriginal participants used services such as BBV testing and drug treatment at a comparable rate to non-Aboriginal participants. The findings suggest that Aboriginal PWID are at greater risk for acquiring BBV. The prison setting should be used to deliver health promotion information and risk reduction messages. More information is needed on Aboriginal people's access and use of services to ensure beneficial services are received in the most appropriate settings.

The British Journal of Development Disabilities, 1999

The British Journal of Developmental Disabilities Vol. 45, Part 2, JULY 1999, No. 89 ... PICA AND... more The British Journal of Developmental Disabilities Vol. 45, Part 2, JULY 1999, No. 89 ... PICA AND TRACE METAL DEFICIENCIES IN ADULTS WITH DEVELOPMENTAL DISABILITIES ... Irene Swift, Dana Paquette, Kristina Davison and Haider Saeed ... *Irene Swift, MB, BS ...

American Journal of Epidemiology, 2013

Venue sampling is a common sampling method for populations of men who have sex with men (MSM); ho... more Venue sampling is a common sampling method for populations of men who have sex with men (MSM); however, men who visit venues frequently are more likely to be recruited. While statistical adjustment methods are recommended, these have received scant attention in the literature. We developed a novel approach to adjust for frequency of venue attendance (FVA) and assess the impact of associated bias in the ManCount Study, a venue-based survey of MSM conducted in Vancouver, British Columbia, Canada, in 2008-2009 to measure the prevalence of human immunodeficiency virus and other infections and associated behaviors. Sampling weights were determined from an abbreviated list of questions on venue attendance and were used to adjust estimates of prevalence for health and behavioral indicators using a Bayesian, model-based approach. We found little effect of FVA adjustment on biological or sexual behavior indicators (primary outcomes); however, adjustment for FVA did result in differences in the prevalence of demographic indicators, testing behaviors, and a small number of additional variables. While these findings are reassuring and lend credence to unadjusted prevalence estimates from this venue-based survey, adjustment for FVA did shed important insights on MSM subpopulations that were not well represented in the sample.

Chronic Diseases in Canada, Feb 1, 2006

The following information is taken from a survey (Bryant, Wilson, Hull, & Treloar, 2010) of almos... more The following information is taken from a survey (Bryant, Wilson, Hull, & Treloar, 2010) of almost 600 people who obtained injecting equipment from pharmacies in 2008. The following are points for discussion: • 20% of respondents self-identified as Aboriginal people • Among Aboriginal respondents, 35% lived in regional areas of NSW, almost 40% had been in prison in the previous year, 38% reused needles and syringes in the previous month, and 65% shared another's injecting equipment. • Compared to non-Aboriginal respondents, Aboriginal respondents had significantly more risk factors for the acquisition of hepatitis C, including being more likely to have been in prison in the previous year, inject on a daily basis, share ancillary equipment, and have poorer hepatitis C-related knowledge. • Importantly, Aboriginal respondents were no more or less likely to have used services such as hepatitis C testing and drug treatment. • The information reported here is from a descriptive survey...

International Journal of Drug Policy, 2011

Background: Respondent-driven sampling (RDS) is a method for recruiting hidden populations, such ... more Background: Respondent-driven sampling (RDS) is a method for recruiting hidden populations, such as people who inject drugs (PWID). In RDS, participants recruit their peers into the study; who recruited who into the study is tracked, and thus information is gathered on the population's social networks. The purpose of this study was to use information collected from an RDS study of PWID to determine the size and structure of injecting networks and whether network characteristics are associated with sharing injecting equipment. Methods: A study was launched in Sydney, Australia in 2009 with five seeds, who were asked to recruit three participants each into the survey. This process was repeated until the target sample size was reached. The median size of injecting networks and the homophily (a measure of in-group affiliation) of different subgroups were calculated. Participants' information was linked with that of their recruiter to form dyads, and multivariate analysis was conducted to determine whether dyad and injecting network characteristics were associated with sharing injecting equipment within the dyads. Results: The injecting networks were large, the lowest median subgroup network size being 12. Homophily estimates indicated a lack of strong ties both within and across groups. In the multivariate analysis, factors significantly associated with sharing injecting equipment within dyads were feeling very close to their recruiter and having one or both members of the dyad identify as Aboriginal or Torres Strait Islander and one or both members having not been tested for hepatitis C in the previous year. Conclusion: RDS provided valuable information on injecting networks in Sydney. PWID were shown to be socially connected with a large number of other injectors, and affiliations were formed without regard to demographic or drug use characteristics. Linking information from the recruits with that of their recruiter was a useful way of organizing information to gain a more complete understanding of risk behaviour.

CMAJ open, 2014

Much of the recent increase in hospital admission rates and mortality associated with hepatitis C... more Much of the recent increase in hospital admission rates and mortality associated with hepatitis C in Canada is believed to be because of a higher prevalence of hepatitis C virus infection among those born between 1945 and 1965 (the baby boomer generation). We explored the effects of birth cohort on the rates of and projected trends in hospital admissions associated with hepatitis C. The hospital records of 17 344 inpatients with a diagnosis of chronic hepatitis C and liver disease, including liver cancer, were extracted from the Canadian Discharge Abstract Database for April 2004 to March 2011. For each 5-year birth cohort from 1915 to 1984, regression analysis was used to estimate the temporal trends associated with the average age of the cohort during the study period. Future hospital admissions were predicted based on the assumption that past trends would continue. Hospital admissions associated with hepatitis C and liver disease increased an average of 6.0% (95% confidence inter...

Chronic diseases in Canada, 2006

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002

This study describes characteristics of psychiatry inpatients with developmental disabilities (DD... more This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD. A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD. The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admiss...

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 31, 2000

The results of randomized trials show that breast cancer screening by mammography reduces breast ... more The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. Analyses of interim performance indicators for screening mammography have been calculated from data submitted to the Canadian Breast Cancer Screening database. The data set consisted of data from 7 provincial programs and was limited to mammographic screens for women aged 50-69 years (n = 203,303). Screening outcomes and performance indicators were calculated for abnormalities detected by screening mammography only. The abnormal recall rate was 9.5% for first screens and 4.6% for subsequent screens, and the cancer detection rate per 1000 women screened was 6.9 for firs...

Contemporary Drug Problems, 2010

ABSTRACT

Canadian journal of public health = Revue canadienne de santé publique

Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care... more Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards transmission within the community. This review describes HIV testing coverage in populations disproportionately affected by HIV and in the general population in Canada. A search of published and grey literature on HIV testing uptake in Canada was conducted. Studies reporting quantitative data on testing practices (ever tested, recent testing, and regular testing), published in either English or French from 2008-2012, were included. Studies that involved testing for immigration or prenatal purposes, and post-intervention studies, were excluded. Included studies were assessed using a modified version of the Public Health Agency of Canada's Descriptive Study Critical Appraisal Tool. Pooled prevalence for percent ever tested was calculated for subpopulations and heterogeneity was estimated using the I2 statistic. A to...

We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in res... more We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in resource-rich countries and examine the potential interactions between TasP and other prevention strategies by reviewing mathematical models of TasP. Multiple databases were searched for mathematical models published in the previous 5 years (from July 2007 to July 2012). The nine models located were set in Canada, Australia and the United States. These models' predictions suggested that the impact of expanding treatment rates on expected new infections could range widely, from no decrease to a decrease of 76%, depending on the time horizon, assumptions and the form of TasP modeled. Increased testing, reducing sexually transmitted infections and reducing risky practices were also predicted to be important strategies for decreasing expected new infections. Sensitivity analysis suggests that current uncertainties such as the effectiveness of highly active antiretroviral therapy outside of heterosexual transmission, less than ideal adherence, and risk compensation, could impact on the success of TasP at the population level. The results from large scale pilots and community randomized controlled trials will be useful in demonstrating how well this prevention approach works in real world settings, and in identifying the factors that are needed to support its effectiveness.

Sexuality Research and Social Policy, 2013

Kidd, M.R. (2013) The new cultural politics of the waiting room: Straight men, gay-friendly clini... more Kidd, M.R. (2013) The new cultural politics of the waiting room: Straight men, gay-friendly clinics and 'inclusive' HIV care. Sexuality Research and Social Policy, 10(2): 87-96. http://dx.2 The new cultural politics of the waiting room: Straight men, gay-friendly clinics and 'inclusive' HIV care Abstract

International Journal of Mental Health and Addiction, 2012

Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay... more Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social, behavioural and AOD variables. Participants were classified into those with (n=130) and without major depression (n=401) using the PHQ-9 screening tool. Although rates of drug use were very high in the sample, multivariate logistic regression analysis showed that the majority of variables independently associated with major depression were social and behavioural factors. Only one AOD variable was associated with major depression: the use of three or more drug types in the past 6 months. Attending to specific patterns of AOD use may assist in the identification of gay men most at risk of major depression.

Health & Social Care in the Community, 2012

1. Comparing 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's de... more 2012) Comparing 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's depression. Health and Social Care in the Community, 20(4): 412-419. Abstract High rates of both illicit drug use and depression are consistently reported among gay men. However, little is known about how beliefs about drug use shape clinical encounters between gay men and health professionals, and that in turn affect clinical communication and care, particularly in relation to depression. We compared 'doctor' and 'patient' beliefs about the role of illicit drug use in gay men's depression. Semi-structured interviews were conducted in August-December 2006 with 16 general medical practitioners working in seven 'gay-friendly' practices in Sydney, Adelaide and a rural-coastal city in New South Wales, and in February-May 2008 with 40 gay men with depression recruited through four Sydney and Adelaide practices. A thematic analysis of these two sets of interviews found that doctors expressed the beliefs that: illicit drug use is related to depression in gay men; illicit drug use impedes effective diagnosis and treatment of depression in gay men; and illicit drug use increases the level of complexity involved in caring for gay men with depression. Gay men expressed the beliefs that: illicit drug use is closely related to depression; illicit drug use can be helpful in dealing with difficult experiences; and illicit drug use is just what you do as a gay man living in a big city. Both groups believed drug use and depression were related but doctors emphasised the negative outcomes of drug use and interpreted these in relation to health. Gay men believed that drugs could have both negative and positive uses and differentiated between health and social outcomes. While the doctors articulated a pragmatic position on drug use, which is consistent with harm reduction principles, communication with gay male patients could be enhanced if both groups acknowledged their divergent views of illicit drugs and their potential role in mental health.

Drugs: Education, Prevention, and Policy, 2012

ABSTRACT Aims: Respondent-driven sampling (RDS) is increasingly being used to sample hidden popul... more ABSTRACT Aims: Respondent-driven sampling (RDS) is increasingly being used to sample hidden populations, such as people who inject drugs (PWIDs). This study compared samples of PWID recruited from RDS and service-based sampling methods to explore whether RDS captured a less visible group of PWID that differed in their risk profile than those captured using service-based sampling. Methods: An RDS study of PWID was conducted in Sydney, Australia in 2009. RDS participants’ frequency of use of NSP and pharmacies was calculated. Population estimates were calculated for RDS participant characteristics and were compared with sample proportions from two separate studies, which recruited participants from needle and syringe programmes (NSP) and pharmacies. Findings: Only 12% of the RDS sample may not have been accessible through either an NSP or a pharmacy. RDS participants were just as risky in their injecting practices and were more likely to access HCV prevention services than participants recruited from service-based sampling methods. Conclusions: This comparison was useful in evaluating who might be missed in service-based sampling methods. Given that RDS was not able to capture a less visible group of PWID, the choice of sampling method should take into account the availability of services through which to conduct a study.

Drug and Alcohol Dependence, 2011

Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being ... more Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being used for HIV behavioural surveillance. When used for surveillance purposes, a sampling method should be relatively inexpensive and simple to operate. This study examined whether an RDS survey of people who inject drugs (PWID) in Sydney, Australia, could be successfully conducted through the use of minimal and existing resources. The RDS survey was conducted on the premises of a local needle and syringe program (NSP) with some adjustments to take into account the constraints of existing resources. The impact of the survey on clients and on staff was examined by summarizing NSP service data and by conducting post-survey discussions with NSP staff. From November 2009 till March 2010, 261 participants were recruited in 16 waves. A significant increase was found in the number of services provided by the NSP during and after data collection. Generally, staff felt that the survey had a positive impact by exposing a broader group of people to the NSP. However, conducting the survey may have led to privacy issues for NSP clients due to an increased number of people gathering around the NSP. This study shows that RDS can be conducted with the use of minimal and existing resources under certain conditions (e.g., use of a self-administered questionnaire and no biological samples taken). A more detailed cost-utility analysis is needed to determine whether RDS' advantages outweigh potential challenges when compared to simpler and less costly convenience methods.

Australian Journal of Primary Health, 2012

General practitioners (GPs) identify that depression can be difficult to diagnose in populations ... more General practitioners (GPs) identify that depression can be difficult to diagnose in populations with high rates of alcohol and other drug (AOD) use. This is a particular concern with gay men who are a population known to engage in high rates of AOD use and who are vulnerable to depression. This paper uses data from 563 gay men and their GPs to describe concordance between assessments of major depression and, in particular, whether AOD use undermines concordance. Data were collected as part of a larger study of male patients and GPs at high HIV-caseload general practices in Australia. Concordance was measured by comparing patients' scores on the Patient Health Questionnaire-9 screening tool, which is based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria, and GPs' ratings of the likelihood of depression for each participant. We observed high concordance between GPs' assessments of major depression and patients' scores on the PHQ-9 (79% agreement), although our analysis also suggested that concordance was better when it related to cases in which there was no depression. The high concordance observed in our study did not appear to be undermined by gay male patients' AOD use, with the exception of frequent use of crystal methamphetamine. Here, men who reported frequent use of methamphetamine were significantly less likely to have concordant assessments (adjusted odds ratio 0.3, 95% CI 0.1-0.8). Overall, GPs appear to identify depression among many of their gay male patients. While GPs should be aware of the potential complications presented by frequent crystal methamphetamine use, other AOD use may have less impact on the diagnosis of depression.

AIDS and Behavior, 2013

This paper describes patterns of injecting drug use and blood borne virus (BBV)-related risk prac... more This paper describes patterns of injecting drug use and blood borne virus (BBV)-related risk practices among Australian Aboriginal and non-Aboriginal people who inject drugs (PWID). A total of 588 participants, 120 of whom self-identified as Aboriginal completed a questionnaire. Aboriginal participants were more likely to have been in prison (37.6 vs. 16.5 %), to inject daily (72.7 vs. 55.0 %), to share ancillary equipment (64.9 vs. 44.8 %) and less likely to know about BBV transmission (72.0 vs. 87.7 %) and treatment (47.2 vs. 67.6 %). Aboriginal participants used services such as BBV testing and drug treatment at a comparable rate to non-Aboriginal participants. The findings suggest that Aboriginal PWID are at greater risk for acquiring BBV. The prison setting should be used to deliver health promotion information and risk reduction messages. More information is needed on Aboriginal people's access and use of services to ensure beneficial services are received in the most appropriate settings.