L26 Sexuality, Sexual behaviour, STI epidemic and prevention Flashcards
What is sexual orientation vs gender identity
Sexual orientation is separate from romantic attraction, levels can change over time and is unrelated to
Gender identity: Cis, trans, non binary, genderfluid.
Gender identity is not necessarily the same as gender expression or sex assigned at birth.
There are also intersex for sex characteristics
What does Heteronormativity mean vs Cisnormativity
Heteronormative systems presume, privilege and police heterosexuality, often based on conforming to assigned gender and sexuality binaries with non conformity being immoral.
Cisnormative structures presume and police the alignment of a person’s gender identity with their binary biological sex assigned at birth. It delegitimizes trans existence and visibility
What are the healthcare issues facing LGBTIQ+
Healthcare system is based on heternormative and cisnormative beliefs, therefore there is invisibility of the rainbow experience, exclusion/lack of inclusion, and prejudice. Assumptions of het mean that patients have to disclose their sexuality to health professionals.
Fear leads to health problems becoming more complex, expensive to manage and leaves specific healthcare needs unaddressed- unable to diagnose STI, HIV testing.
What are the trends in sexual behaviour, partners between het vs gay men
Heterosexual men report 1.3x mean no. of partners compared to women (- social fallibility/sex worker,) but have median of 1.
Gay males have median of 7 partners
Highest for Hets is vaginal sex followed by oral and anal but condom use is less than half than Gay men who have oral sex highest then anal.
However the rates of anal sex in hets has been increasing every 10 years
What are the main modes of HIV transmission. Which is the riskiest
Through penetrative sex intercourse, childbirth, breastfeeding and blood-blood contact.
The riskiest is receptive anal sex without a condom because there is a high density of CD4 cells targeted by HIV in the gut which is only protected by a single layer of epithelium.
What are the factors that influence HIV partnership level transmission
HIV is an asymptomatic or non-specific symptom disease.
- Stage of infection: Infectiousness is increased in the early acute phase.
- Co-infection with syphilis/ulcerative STIs amplify transmission
- Type of sexual contact- oral doesn’t transmit as well as anal
- Sub type of HIV
- ARV treatments and condom use: protective prophylaxis
Why are there higher rates of HIV transmission in msm communities vs hets
There is higher prevalence in MSM communities which drives incidence of HIV despite personal practices.
20% unaware HIV+.
This is because HIV has a very low inherent infectiousness but an long duration of infectiousness so it will thrive only when the sexual contact pattern is dense.
How are syphilis and gonorrhoea diagnosed and what are the general trends in NZ
Syphilis: diagnosed by blood test. Can lead to congenital
Gonorrhoea: urine, rectal and pharynx swab. Lower prevalence than chylamidia.
Both are increasing incidence, higher rate in men - esp gay/bisexual men.
Define reproductive rate (Ro) and the 3 factors of this.
> 1 =gets bigger
1= replaces itself
<1 = decaying chains of transmission
Average number of 2ndary cases generated by each infected person over the infectious lifespan
B. Probability of Transmission: partnership level factors
C. Structure of sexual contacts: sexual networks, number of partners, mixing across place, ages, gap between relationships, bridging across communities, HIV status,
D. Duration of infectiousness; HIV lifelong but duration of infectiousness is dependent on availability of testing, treatment and adherence.
What creates risk within a Sexual network
Not the number of partners but rather the placement within the network.
Having a structure with highly connected superspreaders, as well as reservoirs of infection means proximity to infected more likely
What are some primary and secondary prevention
1st: Preventing uninfected person getting infected.
- PreP
Some low risk behaviours- eg oral sex can be reccomended compared to higher risk ones.
-Rational non moralistic approach.
2nd: Preventing further spread from infected person.
address the contact tracing,
-Condom use
- Early diagnosis and ART
Partnerships with community organisations help with setting norms, direct people to your services, campaign correct messages.
