The scientific study of the sexual dynamics that come into play during residency training seems to both fascinate and repel trainees and their supervisors. One of the more provocative and shameful dimensions of this area of inquiry, the abuse of residents, causes a good deal of distress. How do we respond to findings of significant psychological abuse, discrimination on the basis of sex or sexual orientation and sexual harassment in medical settings? How can we ignore over a decade of research? How can we not heed the experience of so many young physicians? Given the uncertain times in Canadian medicine and the insecurity in our professional and personal lives, we must work together to improve the culture of our teaching institutions and implement measures nationally and locally to close this dark chapter.
Acceptability of human papillomavirus vaccination and sexual experience prior to disclosure to health care providers among men who have sex with men in Vancouver, Canada: implications for targeted vaccination programs.
Men who have sex with men (MSM) may benefit from human papillomavirus (HPV) vaccine due to increased risk for HPV infection and related disease. We assessed HPV vaccine acceptability and sexual experience prior to disclosure to Health Care Providers (HCP) to understand implications of targeted vaccination strategies for MSM.
From July 2008 to February 2009, 1169 MSM aged =19 years were recruited at community venues in Vancouver. We assessed key variables from a self-administered questionnaire and independent predictors of HPV vaccine acceptability using multivariate logistic regression.
Of 1041 respondents, 697 (67.0%) were willing to receive HPV vaccine and 71.3% had heard of HPV. Significant multivariate predictors of higher vaccine acceptability were (adjusted odds ratio [95% CI]): previous diagnosis of genital warts (1.7 [1.1, 2.6]), disclosure of sexual behavior to HCP (1.6 [1.1, 2.3]), annual income at least $20,000 (1.5 [1.1, 2.1]), previous hepatitis A or B vaccination (1.4 [1.0, 2.0]), and no recent recreational drug use (1.4 [1.0, 2.0]). Most MSM (78.7%) had disclosed sexual behavior to HCP and median time from first sexual contact with males to disclosure was 6.0 years (IQR 2-14 years); for men =26 years these were 72.0% and 3.0 years (IQR 1-8 years) respectively.
Willingness to receive HPV vaccine was substantial among MSM in Vancouver; however, acceptability varied by demographics, risk, and health history. HPV vaccine programs delivered by HCP would offer limited benefit given the duration of time from sexual debut to disclosure to HCP.
American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Mail Stop F800, P.O. Box 6508, Aurora, CO 80045-0508, USA. firstname.lastname@example.org
OBJECTIVE: To illustrate successful strategies in working with American Indian (AI) and Alaska Native (AN) communities in aging and health research by emphasizing access, local relevance, and decision-making processes. METHODS: Case examples of health studies involving older AIs (greater than or equal to 50 years) among Eastern Band Cherokee Indians, a federally recognized reservation; the Cherokee Nation, a rural, nonreservation, tribal jurisdictional service area; and Lakota tribal members living in Rapid City, South Dakota. RESULTS: Local review and decision making reflect the unique legal and historical factors underpinning AI sovereignty. Although specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders. CONCLUSIONS: Most investigators are unprepared to address the demands of health research in AI communities. Community-based participatory research in this setting conflicts with investigators' desire for academic freedom and scientific independence. Successful collaboration promises to enhance research efficiencies and move findings more quickly to clinical practice.
Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services.
Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses.
Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic.
Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.