Sonali Wayal | University College London (original) (raw)

Papers by Sonali Wayal

Sexually Transmitted Infections, 2015

ABSTRACT Sexual ill-health is a global concern. Digital technology offers enormous potential for ... more ABSTRACT Sexual ill-health is a global concern. Digital technology offers enormous potential for health promotion. This systematic review assessed the effectiveness of interactive digital interventions (IDIs) for sexual health promotion compared with minimal interventions (eg, waiting list), face-to-face interventions, and compared effectiveness of different designs of digital intervention.

Sexually Transmitted Infections, 2015

ABSTRACT Introduction HIV incidence among men who have sex with men (MSM) has remained unchanged ... more ABSTRACT Introduction HIV incidence among men who have sex with men (MSM) has remained unchanged over the last decade despite increases in HIV testing and antiretroviral (ARV) coverage, suggesting sexual risk behaviours have increased.

Sexually Transmitted Infections, 2015

PloS one, 2015

To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whet... more To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whether the availability of HSK would increase STI testing rates amongst HIV infected MSM, and those attending a community-based HIV testing clinic compared to historical control. Prospective observational study in three facilities providing STI/HIV testing services in Brighton, UK was conducted. Adult MSM attending/contacting a GUM clinic requesting an STI screen (group 1), HIV infected MSM attending routine outpatient clinic (group 2), and MSM attending a community-based rapid HIV testing service (group 3) were eligible. Participants were required to have no symptomatology consistent with STI and known to be immune to hepatitis A and B (group 1). Eligible men were offered a HSK to obtain self-collected specimens as an alternative to routine testing. HSK uptake compared to conventional clinic-based STI/HIV testing in group 1, increase in STI testing rates due to availability of HSK compared...

BMJ (Clinical research ed.), 2015

Promoting sexual health is a public health priority in the UK, but there are many challenges. For... more Promoting sexual health is a public health priority in the UK, but there are many challenges. For example, universal access to comprehensive sex and relationships education in schools is lacking; prevention and health promotion are less of a funding priority than diagnosis and treatment; sexual health services struggle to meet demand; and teachers, pupils, clinicians, and patients can be reluctant to discuss sexual health in school or clinic settings.

Sexually Transmitted Infections, 2012

Sexually Transmitted Infections, 2011

ABSTRACT Background Partner notification (PN) involves contacting the sexual and needle-sharing p... more ABSTRACT Background Partner notification (PN) involves contacting the sexual and needle-sharing partners of patients diagnosed with STI/HIV. Effective PN can prevent onward STI/HIV transmission. However, little is known about the socio-cultural factors affecting PN. We synthesised qualitative literature on views and experiences of PN among people recently diagnosed with STI/HIV and their contacts. Methods We conducted a systematic search of 4 electronic databases for PN literature from 1990 to August 2009. Meta-ethnography was used to synthesise data from the 16 studies that met our inclusion criteria. We identified key metaphors and themes from individual studies and compared them and their explanations with other studies to enable further interpretations. We then examined the emerging concepts that have implications for STI/HIV PN policy and programs. Results Our synthesis revealed that PN is influenced not only by type of partnership or infection but also by the socio-cultural, religious, and legal framework governing sex and sexuality. Paradoxically while PN is perceived as altruistic, and as a moral responsibility towards partners, it is also feared as 'social suicide'. 'Breaking the bad news' is perceived as a difficult and potentially troublesome task; however, patient referral is preferred to provider referral. STI/HIV diagnosis invokes 'embodied shame' which can result in non-disclosure, or selective disclosure, or confronting and blaming the partner, especially a main current partner. While the experience of notifying partners is typically not as bad as expected, it occasionally results in violence against women. Injecting drug users felt less able to notify drug-using partners due to legal implications. Provider-led notification is considered protective against fear of violence and social stigma. Conclusions Meta-ethnography enabled the synthesis of qualitative literature to derive new interpretations and comparative explanations from these data. Our synthesis reveals that PN should be voluntary and confidential and a choice of patient and provider referral methods should be offered. PN programmes should support patients in coping with feelings of shame and guilt to assist notification and facilitate timely testing and treatment of sexual partners. Further research on the sexual health outcomes of PN, its effect on partnerships and how best to reduce the fear of stigma and discrimination associated with STI and PN is needed.

Sexually Transmitted Infections, 2013

Sexually Transmitted Infections, 2013

Sexually Transmitted Infections, 2011

ABSTRACT

The Lancet, 2013

Background In the UK in 2010, recent HIV diagnoses increased despite 80% of diagnosed HIV-positiv... more Background In the UK in 2010, recent HIV diagnoses increased despite 80% of diagnosed HIV-positive men who have sex with men (MSM) being on antiretroviral therapy (ART) with an undetectable viral load (UVL). We examined the prevalence of non-concordant unprotected anal sex (ncUAI) in 2010 and 2000 by partnership type among HIV-positive MSM and by factors associated with ncUAI. Methods A piloted survey questionnaire was used for data collection. In 2000, 411 men, and in 2010, 423 men, participated in the survey. Data on recent plasma viral load (detectable [DVL] or UVL); ART status (treatment naive or receiving ART); unprotected anal sex (UAI) with a boyfriend (main partner) and casual partners in the past 6 and 12 months, respectively, and most recent casual partner (only 2010); partners' HIV status (unknown or negative, or positive); attitudes towards ART for HIV prevention; and ART adherence were collected. ncUAI was defi ned as UAI with unknown or negative HIV status partner or partners. Odds ratios (ORs) for 2010 compared with 2000 for ncUAI with casual partners and boyfriend were derived by multiple logistic regression (MLR) adjusted for age and DVL or UVL. MLR was done to examine factors associated with ncUAI with a boyfriend and the most recent casual partner in 2010. This analysis was restricted to men reporting a HIV-negative or unknown status partner.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014

Objective: To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART ... more Objective: To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART naïve people with HIV with high CD4 counts.

The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual ... more The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual health care among men who have sex with men are a major public health concern in the UK. This qualitative study, involving semi-structured interviews with 24 men recruited from a genitourinary medicine clinic in Brighton, UK, explored their views towards the introduction of home sampling kits for STI into clinical practice. Participants had previously self-sampled for rectal and oropharyngeal specimens and completed a survey on the acceptability of self-sampling. Interviews were audio-recorded, transcribed and analyzed using a framework approach. Participants preferred to access home sampling kits from medical venues rather than gay social venues due to privacy concerns and fear of being ridiculed by peers. Perceived societal homophobia led to skepticism towards accessing home sampling kits in commercial venues. Assurance about specimen delivery and receiving test results from clinics was important. Views about using home sampling kits for HIV testing were mixed. Home sampling kits were viewed as an adjunct to clinics, but clinic attendance was preferred if symptomatic. Home sampling kits could be a viable alternative to meet the increasing demand for sexual health services, but to improve the home sampling kit uptake the method of service provision must be culturally sensitive and acceptable.La prévalence croissante des infections sexuellement transmissibles (IST) et les retards dans l'accès aux soins de santé sexuelle parmi les hommes qui ont des rapports sexuels avec des hommes sont une préoccupation majeure de Santé Publique au Royaume Uni. Cette étude qualitative basée sur des entretiens semi-structurés avec 24 hommes recrutés dans un centre de soins génito-urinaire à Brighton, a exploré les points de vue de ces hommes sur l'introduction de kits de tests par auto-prélèvement à domicile (Home Tests) dans la pratique clinique. Avant les entretiens, les participants s'étaient auto-prélevé des échantillons rectaux et oropharyngés, et avaient répondu à une enquête sur l'acceptabilité de l'auto-prélèvement. Les entretiens ont été audio-enregistrés, transcrits et analysés dans une approche du cadre logique. Les participants ont indiqué qu'ils préfèrent obtenir les Home Tests dans les établissements de soins, plutôt que dans les établissements gays, pour des raisons de confidentialité et par peur d'être raillés par leurs pairs. L'homophobie sociétale, telle que perçue par eux, les rendait sceptiques vis-à-vis de la possibilité d'obtenir les kits dans le commerce. La garantie que les échantillons seraient bien livrés aux centres de soins et que ceux-ci leur communiqueraient les résultats des tests leur semblait très importante. Les points de vue sur la possibilité d'utiliser ces kits pour dépister le VIH étaient mitigés. Les Home Tests étaient perçus comme annexes aux centres de soins qui se révélaient toutefois préférables en cas de symptômes. Les Home Tests pourraient être une alternative viable pour répondre à la demande croissante de services de santé sexuelle, mais afin d'encourager leur adoption, la dispensation de ces services doit être culturellement sensible et acceptable.La creciente prevalencia de las infecciones de transmisión sexual (ITS) y los retrasos al acceso de los servicios sanitarios en materia sexual en hombres que tienen relaciones sexuales con otros hombres es un problema grave en la salud pública del Reino Unido. En este estudio cualitativo se llevaron a cabo entrevistas semiestructuradas con 24 hombres captados a través de una clínica de medicina genitourinaria en Brighton, el Reino Unido, con el objetivo de analizar qué opinaban del uso en la práctica clínica de un kit de muestra para usar en casa para la detección de ITS. Los participantes ya habían recogido ellos mismos previamente muestras rectales y bucofaríngeas y habían completado un cuestionario sobre la aceptabilidad de tomar ellos mismos las muestras. Las entrevistas fueron grabadas, transcritas y analizadas mediante un enfoque marco. Los participantes preferían obtener los kits para tomar muestras en casa de centros médicos en vez de centros sociales para homosexuales debido a cuestiones de intimidad y por el temor de ser ridiculizados por otros compañeros. Debido a la homofobia percibida en la sociedad se mostraron escépticos con la idea de adquirir en centros comerciales los kits de tomar muestras en casa. Un aspecto importante fue la garantía de suministrar las muestras y recibir los resultados de las pruebas en las clínicas. Se observaron puntos de vista muy diferentes en cuanto a estos kits de muestra para hacerse la prueba del sida. Los participantes opinaban que los kits eran como un complemento a las clínicas pero preferían asistir a las clínicas si la enfermedad era sintomática. Los kits para tomar muestras desde el hogar serían una alternativa viable para responder a la creciente demanda de servicios de salud sexual pero si queremos que estos kits se acepten, el método para suministrar este servicio debería tener en cuenta los diferentes factores culturales.

Lancet, Jan 1, 2004

Argues that it is time to rethink how to protect commercial sex-workers in Goa, India from AIDS. ... more Argues that it is time to rethink how to protect commercial sex-workers in Goa, India from AIDS. Decision of the government of Goa to bulldoze the red-light area of Baina, rendering thousands of peopl.

British Medical …, Jan 1, 2008

Sexually Transmitted Infections, 2015

ABSTRACT Sexual ill-health is a global concern. Digital technology offers enormous potential for ... more ABSTRACT Sexual ill-health is a global concern. Digital technology offers enormous potential for health promotion. This systematic review assessed the effectiveness of interactive digital interventions (IDIs) for sexual health promotion compared with minimal interventions (eg, waiting list), face-to-face interventions, and compared effectiveness of different designs of digital intervention.

Sexually Transmitted Infections, 2015

ABSTRACT Introduction HIV incidence among men who have sex with men (MSM) has remained unchanged ... more ABSTRACT Introduction HIV incidence among men who have sex with men (MSM) has remained unchanged over the last decade despite increases in HIV testing and antiretroviral (ARV) coverage, suggesting sexual risk behaviours have increased.

Sexually Transmitted Infections, 2015

PloS one, 2015

To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whet... more To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whether the availability of HSK would increase STI testing rates amongst HIV infected MSM, and those attending a community-based HIV testing clinic compared to historical control. Prospective observational study in three facilities providing STI/HIV testing services in Brighton, UK was conducted. Adult MSM attending/contacting a GUM clinic requesting an STI screen (group 1), HIV infected MSM attending routine outpatient clinic (group 2), and MSM attending a community-based rapid HIV testing service (group 3) were eligible. Participants were required to have no symptomatology consistent with STI and known to be immune to hepatitis A and B (group 1). Eligible men were offered a HSK to obtain self-collected specimens as an alternative to routine testing. HSK uptake compared to conventional clinic-based STI/HIV testing in group 1, increase in STI testing rates due to availability of HSK compared...

BMJ (Clinical research ed.), 2015

Promoting sexual health is a public health priority in the UK, but there are many challenges. For... more Promoting sexual health is a public health priority in the UK, but there are many challenges. For example, universal access to comprehensive sex and relationships education in schools is lacking; prevention and health promotion are less of a funding priority than diagnosis and treatment; sexual health services struggle to meet demand; and teachers, pupils, clinicians, and patients can be reluctant to discuss sexual health in school or clinic settings.

Sexually Transmitted Infections, 2012

Sexually Transmitted Infections, 2011

ABSTRACT Background Partner notification (PN) involves contacting the sexual and needle-sharing p... more ABSTRACT Background Partner notification (PN) involves contacting the sexual and needle-sharing partners of patients diagnosed with STI/HIV. Effective PN can prevent onward STI/HIV transmission. However, little is known about the socio-cultural factors affecting PN. We synthesised qualitative literature on views and experiences of PN among people recently diagnosed with STI/HIV and their contacts. Methods We conducted a systematic search of 4 electronic databases for PN literature from 1990 to August 2009. Meta-ethnography was used to synthesise data from the 16 studies that met our inclusion criteria. We identified key metaphors and themes from individual studies and compared them and their explanations with other studies to enable further interpretations. We then examined the emerging concepts that have implications for STI/HIV PN policy and programs. Results Our synthesis revealed that PN is influenced not only by type of partnership or infection but also by the socio-cultural, religious, and legal framework governing sex and sexuality. Paradoxically while PN is perceived as altruistic, and as a moral responsibility towards partners, it is also feared as 'social suicide'. 'Breaking the bad news' is perceived as a difficult and potentially troublesome task; however, patient referral is preferred to provider referral. STI/HIV diagnosis invokes 'embodied shame' which can result in non-disclosure, or selective disclosure, or confronting and blaming the partner, especially a main current partner. While the experience of notifying partners is typically not as bad as expected, it occasionally results in violence against women. Injecting drug users felt less able to notify drug-using partners due to legal implications. Provider-led notification is considered protective against fear of violence and social stigma. Conclusions Meta-ethnography enabled the synthesis of qualitative literature to derive new interpretations and comparative explanations from these data. Our synthesis reveals that PN should be voluntary and confidential and a choice of patient and provider referral methods should be offered. PN programmes should support patients in coping with feelings of shame and guilt to assist notification and facilitate timely testing and treatment of sexual partners. Further research on the sexual health outcomes of PN, its effect on partnerships and how best to reduce the fear of stigma and discrimination associated with STI and PN is needed.

Sexually Transmitted Infections, 2013

Sexually Transmitted Infections, 2013

Sexually Transmitted Infections, 2011

ABSTRACT

The Lancet, 2013

Background In the UK in 2010, recent HIV diagnoses increased despite 80% of diagnosed HIV-positiv... more Background In the UK in 2010, recent HIV diagnoses increased despite 80% of diagnosed HIV-positive men who have sex with men (MSM) being on antiretroviral therapy (ART) with an undetectable viral load (UVL). We examined the prevalence of non-concordant unprotected anal sex (ncUAI) in 2010 and 2000 by partnership type among HIV-positive MSM and by factors associated with ncUAI. Methods A piloted survey questionnaire was used for data collection. In 2000, 411 men, and in 2010, 423 men, participated in the survey. Data on recent plasma viral load (detectable [DVL] or UVL); ART status (treatment naive or receiving ART); unprotected anal sex (UAI) with a boyfriend (main partner) and casual partners in the past 6 and 12 months, respectively, and most recent casual partner (only 2010); partners' HIV status (unknown or negative, or positive); attitudes towards ART for HIV prevention; and ART adherence were collected. ncUAI was defi ned as UAI with unknown or negative HIV status partner or partners. Odds ratios (ORs) for 2010 compared with 2000 for ncUAI with casual partners and boyfriend were derived by multiple logistic regression (MLR) adjusted for age and DVL or UVL. MLR was done to examine factors associated with ncUAI with a boyfriend and the most recent casual partner in 2010. This analysis was restricted to men reporting a HIV-negative or unknown status partner.

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014

Objective: To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART ... more Objective: To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART naïve people with HIV with high CD4 counts.

The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual ... more The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual health care among men who have sex with men are a major public health concern in the UK. This qualitative study, involving semi-structured interviews with 24 men recruited from a genitourinary medicine clinic in Brighton, UK, explored their views towards the introduction of home sampling kits for STI into clinical practice. Participants had previously self-sampled for rectal and oropharyngeal specimens and completed a survey on the acceptability of self-sampling. Interviews were audio-recorded, transcribed and analyzed using a framework approach. Participants preferred to access home sampling kits from medical venues rather than gay social venues due to privacy concerns and fear of being ridiculed by peers. Perceived societal homophobia led to skepticism towards accessing home sampling kits in commercial venues. Assurance about specimen delivery and receiving test results from clinics was important. Views about using home sampling kits for HIV testing were mixed. Home sampling kits were viewed as an adjunct to clinics, but clinic attendance was preferred if symptomatic. Home sampling kits could be a viable alternative to meet the increasing demand for sexual health services, but to improve the home sampling kit uptake the method of service provision must be culturally sensitive and acceptable.La prévalence croissante des infections sexuellement transmissibles (IST) et les retards dans l'accès aux soins de santé sexuelle parmi les hommes qui ont des rapports sexuels avec des hommes sont une préoccupation majeure de Santé Publique au Royaume Uni. Cette étude qualitative basée sur des entretiens semi-structurés avec 24 hommes recrutés dans un centre de soins génito-urinaire à Brighton, a exploré les points de vue de ces hommes sur l'introduction de kits de tests par auto-prélèvement à domicile (Home Tests) dans la pratique clinique. Avant les entretiens, les participants s'étaient auto-prélevé des échantillons rectaux et oropharyngés, et avaient répondu à une enquête sur l'acceptabilité de l'auto-prélèvement. Les entretiens ont été audio-enregistrés, transcrits et analysés dans une approche du cadre logique. Les participants ont indiqué qu'ils préfèrent obtenir les Home Tests dans les établissements de soins, plutôt que dans les établissements gays, pour des raisons de confidentialité et par peur d'être raillés par leurs pairs. L'homophobie sociétale, telle que perçue par eux, les rendait sceptiques vis-à-vis de la possibilité d'obtenir les kits dans le commerce. La garantie que les échantillons seraient bien livrés aux centres de soins et que ceux-ci leur communiqueraient les résultats des tests leur semblait très importante. Les points de vue sur la possibilité d'utiliser ces kits pour dépister le VIH étaient mitigés. Les Home Tests étaient perçus comme annexes aux centres de soins qui se révélaient toutefois préférables en cas de symptômes. Les Home Tests pourraient être une alternative viable pour répondre à la demande croissante de services de santé sexuelle, mais afin d'encourager leur adoption, la dispensation de ces services doit être culturellement sensible et acceptable.La creciente prevalencia de las infecciones de transmisión sexual (ITS) y los retrasos al acceso de los servicios sanitarios en materia sexual en hombres que tienen relaciones sexuales con otros hombres es un problema grave en la salud pública del Reino Unido. En este estudio cualitativo se llevaron a cabo entrevistas semiestructuradas con 24 hombres captados a través de una clínica de medicina genitourinaria en Brighton, el Reino Unido, con el objetivo de analizar qué opinaban del uso en la práctica clínica de un kit de muestra para usar en casa para la detección de ITS. Los participantes ya habían recogido ellos mismos previamente muestras rectales y bucofaríngeas y habían completado un cuestionario sobre la aceptabilidad de tomar ellos mismos las muestras. Las entrevistas fueron grabadas, transcritas y analizadas mediante un enfoque marco. Los participantes preferían obtener los kits para tomar muestras en casa de centros médicos en vez de centros sociales para homosexuales debido a cuestiones de intimidad y por el temor de ser ridiculizados por otros compañeros. Debido a la homofobia percibida en la sociedad se mostraron escépticos con la idea de adquirir en centros comerciales los kits de tomar muestras en casa. Un aspecto importante fue la garantía de suministrar las muestras y recibir los resultados de las pruebas en las clínicas. Se observaron puntos de vista muy diferentes en cuanto a estos kits de muestra para hacerse la prueba del sida. Los participantes opinaban que los kits eran como un complemento a las clínicas pero preferían asistir a las clínicas si la enfermedad era sintomática. Los kits para tomar muestras desde el hogar serían una alternativa viable para responder a la creciente demanda de servicios de salud sexual pero si queremos que estos kits se acepten, el método para suministrar este servicio debería tener en cuenta los diferentes factores culturales.

Lancet, Jan 1, 2004

Argues that it is time to rethink how to protect commercial sex-workers in Goa, India from AIDS. ... more Argues that it is time to rethink how to protect commercial sex-workers in Goa, India from AIDS. Decision of the government of Goa to bulldoze the red-light area of Baina, rendering thousands of peopl.

British Medical …, Jan 1, 2008