11 results on '"Smith, Anthony K J"'
Search Results
2. Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people
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Davis, Mark D. M., Schermuly, Allegra, Smith, Anthony K. J., and Newman, Christy
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- 2023
- Full Text
- View/download PDF
3. Dosing practices made mundane: Enacting HIV pre‐exposure prophylaxis adherence in domestic routines.
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Smith, Anthony K. J., Lancaster, Kari, Rhodes, Tim, and Holt, Martin
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CLINICAL drug trials , *HIV prevention , *ANTI-HIV agents , *MEN'S health , *ORAL drug administration , *HUMAN sexuality , *INTERVIEWING , *PRE-exposure prophylaxis , *QUALITATIVE research , *SEX customs , *RESEARCH funding , *PATIENT compliance , *PSYCHOLOGICAL adaptation , *GAY men - Abstract
Maintaining routines of medication dosing requires effort amidst the variabilities of everyday life. This article offers a sociomaterial analysis of how the oral HIV prevention regimen, pre‐exposure prophylaxis (PrEP), is put to use and made to work, including in situations which disrupt or complicate dosing regimes. Other than a daily pill, PrEP can be taken less frequently based on anticipated sexual activity and HIV risk, including 'on‐demand' and 'periodic' dosing. Drawing on 40 interviews with PrEP users in Australia in 2022, we explore PrEP and its dosing as features of assemblages in which bodies, routines, desires, material objects and the home environment interact. Dosing emerges as a practice of coordination involving dosette boxes, blister packs, alarms, partners, pets, planning sex, routines and domestic space, and as an effect of experimentations with timing to suit life circumstances and manage side effects. Dosing is materialised in the mundane; a practice that is made to work, as well as domesticated, in its situations. Although there are no 'simple' solutions to adherence, our analysis offers practical insights into how routine, planning and experimentation come together to capacitate PrEP to work in people's lives, in sometimes unexpected ways, including through adaptations of PrEP dosing. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: results of a national cross-sectional survey.
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MacGibbon, James, Cornelisse, Vincent J., Smith, Anthony K. J., Broady, Timothy R., Hammoud, Mohamed A., Bavinton, Benjamin R., Heath-Paynter, Dash, Vaughan, Matthew, Wright, Edwina J., and Holt, Martin
- Abstract
Background: In mid-2022, a global mpox (formerly 'monkeypox') outbreak affecting predominantly gay and bisexual men emerged in non-endemic countries. Australia had never previously recorded mpox cases and there was no prior research on knowledge or attitudes to mpox among gay and bisexual men across Australia. Methods: We conducted a national, online cross-sectional survey between August 2022 and September 2022. Participants were recruited through community organisation promotions, online advertising, and direct email invitations. Eligible participants were gay, bisexual or queer; identified as male (cisgender or transgender) or non-binary; aged 16 years or older; and lived in Australia. The main outcome measures were: knowledge and concern about mpox; recognition of mpox symptoms and transmission routes; vaccination history; acceptability of behavioural changes to reduce mpox risk, and willingness to be vaccinated. Results: Of 2287 participants, most participants were male (2189/2287; 95.7%) and gay (1894/2287; 82.8%). Nearly all had heard about mpox (2255/2287; 98.6%), and the majority were concerned about acquiring it (1461/2287; 64.4%). Most of the 2268 participants not previously diagnosed with mpox correctly identified skin lesions (2087; 92%), rash (1977; 87.2%), and fever (1647; 72.6%) as potential symptoms, and prolonged and brief skin-to-skin contact as potential ways to acquire mpox (2124, 93.7%; and 1860, 82%, respectively). The most acceptable behavioural changes were reducing or avoiding attendance at sex parties (1494; 65.9%) and sex-on-premises venues (1503; 66.4%), and having fewer sexual partners (1466; 64.6%). Most unvaccinated and undiagnosed participants were willing to be vaccinated (1457/1733; 84.1%). Conclusions: People at risk of mpox should be supported to adopt acceptable risk reduction strategies during outbreaks and to seek vaccination. Mid-2022 saw a global mpox outbreak among primarily gay and bisexual men. During August–September 2022, we surveyed 2287 gay, bisexual and queer men and non-binary people about their knowledge of mpox, willingness to make behavioural changes, and be vaccinated. Nearly all participants had heard of mpox and most were familiar with common symptoms and transmission routes. We found very high willingness to be vaccinated against mpox but we identified some groups who may benefit from targeted information about vaccination. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
- View/download PDF
5. Understanding the health care needs of transgender and gender diverse people engaging with rural Australian sexual health centres: a qualitative interview study.
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Del Tufo, Ava, Foster, Rosalind, Haire, Bridget, Newman, Christy E., Smith, Anthony K. J., Crowley, Margaret, Burn, Donna, and McNulty, Anna
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Background: Although there is a presumption that LGBTQ+ people living in rural Australia will have poorer health outcomes than those living in metropolitan areas, minimal research has focused specifically on the perspectives of transgender and gender diverse (henceforth referred to as 'trans') people living in these regions. The purpose of this study was to understand what health and wellbeing means to trans people in a regional or rural community and identify their health needs and experiences. Methods: A total of 21 trans people were recruited through two regional sexual health centres (SHC) and interviewed between April and August 2021. Data were analysed via reflexive thematic analysis. This paper focuses on participants' accounts of health and wellbeing regarding gender affirmation, the experience of rural living, respectful holistic care, safety in rural communities, isolation, loneliness, and employment. Results: The experience of living rurally can have both positive and negative impacts on the experiences of trans people. Participants reported experiences of stigma and discrimination, reduced employment opportunities and limited social interactions, which led to feelings of isolation and loneliness; however, they also reported high quality of care, particularly with the specific SHCs which supported this research. Conclusion: Living rurally can impact both positively and negatively on the health and wellbeing of trans peoples, and the experiences of living in this environment are diverse. Our findings challenge the perception that rural trans people experience only poor health outcomes and shows the difference that key health services such as SHCs can make in supporting trans health. What does health and wellbeing mean to transgender and gender diverse individuals in rural Australia? As the first study of its kind, the findings are complex; there are higher rates of discrimination and feelings of social isolation for those living in rural areas and yet many people also report positive experiences. This diverse range of experiences was unexpected and could inform policy changes for national health service models. [ABSTRACT FROM AUTHOR]
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- 2023
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6. PrEP in Practice: a sociological study of HIV pre-exposure prophylaxis prescribing
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Smith, Anthony K J
- Subjects
HIV Prevention ,Sociology ,Clinicians ,440506 Sexualities ,Australia ,Pre-exposure prophylaxis ,4203 Health services and systems ,4410 Sociology ,Qualitative ,441011 Sociology of health ,FOS: Sociology - Abstract
HIV pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing new HIV infections. Since 2015, PrEP has been rapidly implemented with gay and bisexual men in Australia. While there is recognition of the importance of optimising the clinical delivery of PrEP, there has been scarce empirical research in Australia documenting how clinicians engage with prescribing PrEP, and minimal international social science research considering how PrEP has (re)shaped clinical practice. In this thesis I explore the role of clinicians in delivering PrEP in Australia. Drawing on the sociology of prescribing, I approach PrEP prescribing as a social practice, and attend to how clinicians anticipate and imagine patients, and how they think and feel about PrEP. This study draws on qualitative methodologies, including findings from semi-structured interviews conducted with clinicians who provide PrEP in New South Wales and Western Australia between 2019 and 2020, and with HIV expert stakeholders across Australia in 2017. Through empirical findings, I consider debates about which types of clinicians are best suited to prescribing PrEP and workforce challenges for providing PrEP in different clinical settings. I analyse clinician imaginaries of PrEP users and broader patient collectives, as well as clinicians’ views on providing PrEP to alleviate different types of ‘HIV anxiety’. I also examine prescribing as an affective clinical practice. I identify recommendations for supporting clinical workforces to improve the implementation of PrEP across Australian communities. This thesis demonstrates how PrEP has transformed HIV prevention for clinicians, requiring them to adapt to new ways of approaching HIV and sexual health. Clinicians develop expertise through routine opportunities to prescribe, and they develop imaginaries about patients and communities through consultations that shape their future interactions with patients. Conversely, a lack of patient demand makes it challenging for general practitioners to develop confidence and competence with PrEP prescribing. Providing PrEP involves the complexity of discussing sex and managing ideas about risk and responsibility, which are persistent challenges for both HIV-experienced and inexperienced clinicians. I argue for the value of sociological perspectives on clinical workforces to support and sustain effective HIV prevention.
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- 2022
- Full Text
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7. Clinician imaginaries of HIV PrEP users in and beyond the gay community in Australia.
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Smith, Anthony K J, Newman, Christy E., Haire, Bridget, and Holt, Martin
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PRE-exposure prophylaxis , *GAY community , *GAY men , *MEDICAL personnel , *CONDOM use , *HIV - Abstract
Through the development and implementation of HIV pre-exposure prophylaxis (PrEP), the characteristics of PrEP users have been configured in a range of ways. Drawing on the concept of 'imaginaries', we consider how clinicians imagine PrEP users and related communities. We conducted 28 semi-structured interviews in 2019–2020 with PrEP-providing clinicians based in New South Wales and Western Australia. Participants included general practitioners, sexual health nurses and sexual health doctors. We inductively developed three themes through a reflexive thematic analysis: 'PrEP users as 99% gay men/MSM', 'The informed and connected PrEP user', and 'Condom users in the PrEP era'. Participants imagined PrEP users primarily as gay men, and so we focused on how gay community was imagined in relation to PrEP users. Users were imagined as supporting one another to use PrEP effectively, but some were imagined as threatening norms of condom use amongst gay community. Analysing clinician imaginaries of PrEP users reveals insight into how clinicians speculate about and engage with changing community norms related to condom use and accessing PrEP. These imaginaries reveal ongoing tensions about who is believed to be best suited to PrEP, and PrEP's impact on norms of conduct in imagined biosocial communities like gay men. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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8. Prescribing as affective clinical practice: Transformations in sexual health consultations through HIV pre‐exposure prophylaxis.
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Smith, Anthony K J, Newman, Christy E., Haire, Bridget, and Holt, Martin
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HIV prevention , *PROFESSIONAL ethics , *NURSES' attitudes , *RESEARCH methodology , *INTERVIEWING , *UNCERTAINTY , *PHYSICIANS' attitudes , *QUALITATIVE research , *PSYCHOLOGY of nurses , *DRUG prescribing , *MEDICAL referrals , *PHYSICIAN practice patterns , *MEDICAL practice , *CONDOMS , *THEMATIC analysis , *OCCUPATIONAL adaptation , *SEXUAL health , *GAY men , *PSYCHOLOGY of physicians - Abstract
New medicines can transform routines and priorities in clinical practice, but how do clinicians think and feel about these changes, and how does it affect their work? In Australia, the HIV prevention regimen pre‐exposure prophylaxis (PrEP) has been rapidly rolled out, transforming the sexual cultures and practices of users, but less attention has been given to the ways PrEP has reconfigured clinical practice. This paper draws on 28 qualitative semi‐structured interviews conducted between 2019 and 2020 with PrEP‐providing doctors and nurses in Australia to consider how they have affectively engaged with PrEP and put it into practice. Through a reflexive thematic analysis, we explore how clinicians adapted to PrEP, how the field of HIV prevention has been transformed, and how these developments have changed how clinicians approach patients. While the introduction of PrEP was initially received with uncertainty and shock, clinicians described PrEP as enjoyable to prescribe, and better aligned with the moral duties of sexual health consultations than existing HIV prevention strategies like condoms. Through approaching clinical work as an 'affective practice', we argue for attending not only to how new interventions change expectations and practices, but also how these changes are felt and valued by clinicians. [ABSTRACT FROM AUTHOR]
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- 2022
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9. Family imaginaries in the disclosure of a blood‐borne virus.
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Smith, Anthony K J, Persson, Asha, Drysdale, Kerryn, Bryant, Joanne, valentine, kylie, Wallace, Jack, Hamilton, Myra, Gray, Rebecca M., and Newman, Christy E.
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DIAGNOSIS of HIV infections , *HEPATITIS C diagnosis , *HEPATITIS B , *RESEARCH methodology , *PERSONAL space , *INTERVIEWING , *SOCIAL stigma , *SELF-disclosure , *PATIENTS' attitudes , *FAMILY attitudes , *ATTITUDES toward illness , *QUALITATIVE research , *PATIENT-family relations , *DESCRIPTIVE statistics , *THEMATIC analysis , *BLOODBORNE infections , *PSYCHOLOGICAL distress , *PSYCHOLOGY of HIV-positive persons - Abstract
Contemporary sociological work has emphasised that family is not static, but actively shaped by ideas of who and what makes family. Disclosure of an illness, including diagnosis of stigmatised infections such as HIV, hepatitis B virus and hepatitis C virus, can change the dynamics of family relationships. This paper draws on 61 qualitative semi‐structured interviews conducted between 2017 and 2019 with people in Australia with one or more of these blood‐borne viruses (BBVs) and their family members, to understand the experiences of serodiscordant (mixed viral status) families. Through a thematic analysis, we explore the family imaginaries that participants evoked when describing their disclosure practices in relation to (self‐defined) family members, revealing how some participants disclosed in ways that enabled them to shape their family, to maintain boundaries between self and family or to protect family from distress. Participants' accounts of disclosure to family revealed imaginaries of family as a precious web of connections to be nurtured or protected, but also as sites of ambivalent belonging and complex history. We conclude that BBV disclosure practices within families reveal important ideas about families that are imagined in response to the threat of loss, change and stigma. [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
- View/download PDF
10. Tasmanian healthcare professionals' & students' capacity for LGBTI + inclusive care: A qualitative inquiry.
- Author
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Grant, Ruby, Smith, Anthony K. J., Newett, Lyndsay, Nash, Meredith, Turner, Richard, and Owen, Louise
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PSYCHOLOGY of medical students , *HEALTH policy , *RESEARCH , *HEALTH services accessibility , *RESEARCH methodology , *HUMAN sexuality , *PROFESSIONAL employee training , *MEDICAL personnel , *HEALTH status indicators , *INTERVIEWING , *MEDICAL care , *QUALITATIVE research , *SEX distribution , *PSYCHOSOCIAL factors , *LGBTQ+ people , *DESCRIPTIVE statistics , *WORKING hours , *REFLEXIVITY , *THEMATIC analysis , *CURRICULUM planning , *JUDGMENT sampling , *DATA analysis software , *HEALTH equity , *MEDICAL needs assessment - Abstract
The health disparities and care needs of lesbian, gay, bisexual, transgender and intersex (LGBTI+) patients are becoming well known. However, healthcare practitioners (HCPs) and medical students across the Global North report limited understanding of this population and express concern about their capacity to meet the needs of LGBTI + patients. To address these gaps in literature and practice, this study draws on qualitative interviews with 12 clinicians and five health professional students exploring their understandings and approaches to LGBTI + inclusive practice in Tasmania, Australia. Through a reflexive thematic analysis, we identified that both practicing clinicians and students did not believe that their training adequately prepared them to treat LGBTI + patients. Other key barriers included reduced awareness of LGBTI + community needs due to the lack of exposure to LGBTI + patients and unfamiliarity with appropriate referral pathways in the regional Tasmanian context. Conversely, factors enabling provision of LGBTI + inclusive care included prior experience working with LGBTI + patients and establishing a network of supportive colleagues and local services. Participants who identified as LGBTI + themselves saw their personal experiences as a strength in supporting LGBTI + patients. While awareness of LGBTI + inclusive health practice is increasing, Tasmanian practitioners report insufficient training and practical difficulties with referral as key challenges. [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
- View/download PDF
11. PrEP in Practice: a sociological study of HIV pre-exposure prophylaxis prescribing
- Author
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Smith, Anthony K J ; https://orcid.org/0000-0002-0005-9542
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- HIV Prevention, Sociology, Pre-exposure prophylaxis, Clinicians, Australia, Qualitative, anzsrc-for: 441011 Sociology of health, anzsrc-for: 4203 Health services and systems, anzsrc-for: 440506 Sexualities, anzsrc-for: 4410 Sociology
- Abstract
HIV pre-exposure prophylaxis (PrEP) is a highly effective strategy for preventing new HIV infections. Since 2015, PrEP has been rapidly implemented with gay and bisexual men in Australia. While there is recognition of the importance of optimising the clinical delivery of PrEP, there has been scarce empirical research in Australia documenting how clinicians engage with prescribing PrEP, and minimal international social science research considering how PrEP has (re)shaped clinical practice. In this thesis I explore the role of clinicians in delivering PrEP in Australia. Drawing on the sociology of prescribing, I approach PrEP prescribing as a social practice, and attend to how clinicians anticipate and imagine patients, and how they think and feel about PrEP. This study draws on qualitative methodologies, including findings from semi-structured interviews conducted with clinicians who provide PrEP in New South Wales and Western Australia between 2019 and 2020, and with HIV expert stakeholders across Australia in 2017. Through empirical findings, I consider debates about which types of clinicians are best suited to prescribing PrEP and workforce challenges for providing PrEP in different clinical settings. I analyse clinician imaginaries of PrEP users and broader patient collectives, as well as clinicians’ views on providing PrEP to alleviate different types of ‘HIV anxiety’. I also examine prescribing as an affective clinical practice. I identify recommendations for supporting clinical workforces to improve the implementation of PrEP across Australian communities. This thesis demonstrates how PrEP has transformed HIV prevention for clinicians, requiring them to adapt to new ways of approaching HIV and sexual health. Clinicians develop expertise through routine opportunities to prescribe, and they develop imaginaries about patients and communities through consultations that shape their future interactions with patients. Conversely, a lack of patient demand makes it challenging for general practitioners to develop confidence and competence with PrEP prescribing. Providing PrEP involves the complexity of discussing sex and managing ideas about risk and responsibility, which are persistent challenges for both HIV-experienced and inexperienced clinicians. I argue for the value of sociological perspectives on clinical workforces to support and sustain effective HIV prevention.
- Published
- 2022
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