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Rosario conceptualized and directed all aspects of the study. Birkett supervised data management and assisted with data analysis.


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Bisexual people have consistently been found to have poorer mental health than their gay, lesbian or heterosexual counterparts.

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Women may experience gynaecological problems throughout their reproductive years and beyond, and are at risk from symptoms associated with hormonal changes, heart disease and stroke, gynaecological malignancies, osteoporosis, and various genitourinary conditions. The incidence and impact of STIs is uneven across the Australian population, and interventions that are targeted and tailored to identified priority populations are essential.

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Sexual and reproductive health promotion should be a component of early resettlement services for people from refugee backgrounds. For patients with impaired decision-making capacity, surrogate consent must be in the best interests of the patient, not the interests of others, including carers, other family members, or the wider community. Services to support the sexual and reproductive health of Aboriginal peoples and Torres Strait Islanders should be accessible and culturally safe. National policy leadership is imperative in overcoming policy fragmentation, maximising the linkages between interdependent strategies, and to support cooperation across federal, state and territory levels.

Medical practitioners, healthcare workers and other caregivers should have access to comprehensive sexuality education, as well as training in understanding and supporting sexual development, behaviour, and related healthcare for individuals with disabilities. Engaging priority populations in turn requires an understanding of the social and cultural contexts that shape sexual behaviours and the specific risk and protective factors in different population groups.

Policy and programmatic responses need to be implemented to increase understanding and capacity for reproductive choice among young women with refugee backgrounds, and to provide support for teenage parents in order to facilitate successful settlement. Young people should have access to affordable, confidential, and comprehensive clinical services to address their sexual and reproductive health needs.

There are ificant disparities in sexual and reproductive health in Australia. The AMA recommends that a national strategy for sexual and reproductive health be developed as a priority. Cross-referencing this data with wider social indicators of health and wellbeing e. Medical workforce training with respect to sexual and reproductive health should include content on supporting sexual relationships and sexual and reproductive health needs for people with a disability, as well as the associated ethical and legal aspects of informed consent, substitute and supported decision making and fertility control.

The relationship between pornography, social media, and the sexualisation of children are additional emerging issues, and further efforts are required to better understand these relationships and appropriate interventions.

Prisoners are a high-risk group in terms of their sexual health, exposure to STIs, and engagement in risky sexual behaviours.

Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled youth risk behavior surveys

For intersex, trans and gender diverse people, structural barriers to accessing to preventive health screenings, gender affirming procedures and necessary medications should be removed. Health promotion interventions should engage CALD communities to promote community-level dialogue and to address stigma surrounding sexuality and STIs.

Barriers to accessing such services should be identified and minimised, particularly in relation to young people who are at risk. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

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People from countries with a high HIV prevalence are over-represented in the s of new HIV notifications and, within this population group, there is a much higher proportion of heterosexual transmission and late diagnosis. Policies and procedures should be in place to support the sexual and reproductive health of intersex and trans prisoners, including placement in the gender housing of their choice. Older adults also face particular issues that are often overlooked in existing sexual and reproductive health strategies, and which require a renewed focus in the context of an ageing population.

Epidemiological studies have consistently shown that sex workers in Australia have lower rates of STIs than the general population, and very high rates of condom use. The policies and procedures of sexual and reproductive health services should ensure that healthcare is provided to all persons without discrimination because of disability.

Sexual and reproductive health is an essential element of good health and human development. Aboriginal people and Torres Strait Islanders experience poorer sexual and reproductive health outcomes than other Australians, including substantially higher rates of STIs, particularly for chlamydia, gonorrhoea, syphilis and hepatitis B.

Improving the sexual and reproductive health of Aboriginal and Torres Strait Islanders should be prioritised in national sexual and reproductive health strategies, and supported by an action plan and sustained investment at both federal and state levels. Reproductive health refers to a state of physical, mental and social wellbeing — and not merely the absence of disease or infirmity — in all matters relating to the reproductive system and to its functions and processes, and across all stages of life.

Comprehensive data on the sexual health of young Australians should be regularly collected and reported. However, many experience poor sexual and reproductive health outcomes due to the underutilisation of sexual health services, lack of knowledge, and social stigma associated with discussions of sexuality.

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Policies and programs to improve the sexual and reproductive health of young people need to be integrated and linked with wider health and welfare initiatives relating to mental health, alcohol and drug use, and youth poverty and homelessness. To support better sexual and reproductive health outcomes, the AMA believes that polices, programs and service delivery should be informed by the following principles:. Adolescence is a critical time for the development of sexual identity and interpersonal relationships, and the onset of sexual attraction and related behaviours.

Twenty-one percent of Australian men over 40 are affected by erectile dysfunction and, despite a proliferation of products and services in the media, important links to associated conditions such as chronic disease and diabetes are rarely made.

Data collection and health surveillance methods should be improved, and research gaps addressed, to better capture and understand the sexual and reproductive health needs of GLB people. The AMA supports the proactive recruitment and retention of Aboriginal and Torres Strait Islander staff within the sexual and reproductive health sector.

Continued funding and support should be provided for programs and services that promote sexual health among sex workers, including peer education and support services that work in collaboration with mainstream health providers. This includes ensuring access to, and subsidies for, healthcare and pharmaceuticals is determined by the health needs and actual body parts of individuals, rather than their recorded gender. Sexual and reproductive health services, information and resources should be available in a range of languages and formats, and sensitive to cross-cultural variations in understandings of sexuality and gender roles and relations.

Groups at increased risk of poor sexual and reproductive health include young people, Aboriginal people and Torres Strait Islanders, immigrants and refugees, people with disabilities, gay, lesbian, bisexual, transgender and intersex people, sex workers, and people in prisons.

While some young mothers and their babies do well, on a population basis, teenage pregnancy is associated with a wide range of indicators of poor health.

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There is evidence that STI prevalence is increasing among older Australian women, partly due to re-partnering after divorce or death of a spouse. Studies investigating the rates of STIs among migrant sex workers have generally found low rates of STIs and high rates of condom use [43][44]however ongoing health promotion and outreach is required to sustain sexual health outcomes among a constantly changing and increasingly diverse workforce.

Strategies need to take of pre-migration and resettlement contexts, and cultural understandings of sexuality and gender relations, including the needs of LGB and trans and intersex people from CALD and refugee backgrounds. To maintain good sexual health and low rates of STI transmission among sex workers, all Australia governments should develop a legislative and policy framework that protects and supports the health and safety of sex industry workers.

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The sexual and reproductive health outcomes of young people do not emerge in isolation, but are shaped by a range of social determinants and behavioural risk factors, including homelessness, substance use, and mental disorder. Identifying and minimising risk factors is fundamental to improving sexual and reproductive health. The AMA advocates that people with disabilities should have access to information, education and resources to make informed choices about their sexuality and sexual and reproductive health. Federal, state and territory governments have a range of policies on individual aspects of sexual and reproductive health, but a coordinated approach is lacking.

The AMA recommends that the sexual and reproductive health needs of midlife and older adults be recognised and supported in policy and programs, including targeted sexual and reproductive health education, health promotion and prevention strategies. The AMA advocates on behalf of the medical profession and the public - operating at a federal level and within each state and territory. No policy or strategy has been developed that addresses sexual and reproductive health as a whole, or that attends to interconnections with other relevant areas, such as mental health, education, or drug and alcohol strategies.

Targeted health promotion programs should be developed in partnership with communities and tailored to the needs of people from Aboriginal and Torres Strait Islander backgrounds.

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Although sexual and reproductive health remain intrinsic elements of health and wellbeing in older age, older Australians are often overlooked in sexual and reproductive health policies and research. Comprehensive, clinically accurate and culturally appropriate sexual and reproductive health education programs should be implemented in schools. This involves redressing the wider social determinants underlying sexual and reproductive health, as well as implementing strategies that focus on behavioural risk and protective factors.

Sexual and reproductive ill health disproportionately affects gay, lesbian and bisexual GLB people. Monitoring should include STI notification rates, birth and abortion rates, and frequency of contraception use. While sexual health is vital for and therefore a part of reproductive health, it is important to also consider sexual health in its own right.

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Unwanted pregnancy, sexual violence, sexually transmissible infections STIs and infertility are major contributors to morbidity and associated costs in Australia. While trans and intersex people may experience barriers to healthcare that mirror many of the obstacles faced by GLB people, they also face unique challenges and particular needs relating to their sexual and reproductive health.

Women prisoners and adolescent juvenile detainees should have access to appropriate antenatal, obstetric and postnatal care. However, the sexual and reproductive needs of persons with disabilities are often overlooked or neglected, and variations in sexuality or gender identity may be pathologised for people with developmental or cognitive disabilities.

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An exclusive focus on sexual behaviours, without consideration of the context in which these behaviours occur, is less likely to be successful. This includes access to screening and treatment for STIs; vaccination for hepatitis B; prevention information, education and counselling for STIs and sexual assault; screening for cancers of the reproductive tract; access to hormone therapies and gender affirmation interventions for intersex and trans prisoners; and access to condoms and dental dams. There is ificant variation in the sexual and reproductive health outcomes among people from culturally and linguistically diverse CALD backgrounds.

Sexual health education, campaigns and information should be developed that is relevant and targeted to gay, lesbian and bisexual people, including resources that promote safe sex practices. For example, lesbian women access breast and cervical screenings less regularly than recommended, and often have limited access to information about safe sex practices. Intersex, trans and gender diverse people should have equitable access to quality sexual and reproductive healthcare, and to health services that are inclusive, free of discrimination and stigma, and responsive to their individual healthcare needs.

Cultural respect strategies should be a part of all sexual and reproductive health services. Teenage mothers are more likely to experience economic disadvantage, compromised educational outcomes, and higher levels of psychological distress. Cultural and social attitudes and expectations can also contribute to unhealthy or risky sexual behaviours, including sexualised media representations of girls and women, stigma associated with STIs, stereotypes about masculinity, and stigma surrounding the sexual needs or preferences of older people and people living with disabilities. Competent patients, regardless of disability, have the right to make their own informed decisions regarding sterilisation.

Primary prevention aims to support and promote good health and eliminate or reduce the factors contributing to poor health. Sexual health refers to a state of physical, emotional, mental and social black girls looking for sex in veldhuizen related to sexuality; it is not merely the absence of disease, dysfunction or infirmity.

Systems should be in place that support continuity of treatment when prisoners are transferred between prisons and released into the community, and comprehensive prison programs should be developed to respond to the social determinants of sexual and reproductive health. People with disabilities are a diverse group, and this diversity translates into a diversity of particular issues and needs relating to sexual and reproductive health.

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Although hormone therapies are medically necessary and beneficial for people who have undergone sterilisation or for people who are affirming their own gender, access to such therapies is restricted when coverage is defined by gender. An essential element in the sexual health and wellbeing of young people is developing a positive body image and the skills and confidence to negotiate interpersonal relationships and make informed choices about sex. Conjugal visitation programs should be supported by access to safe sex equipment and make provision for same-gender partners.

A coordinated national approach is required to overcome gaps in policy provision, reduce the isolation of existing sexual and reproductive health strategies from each other, improve the delivery of services, increase the efficacy of existing strategies, and improve public health outcomes. Data collection and health surveillance methods should be improved, and research gaps addressed, to better understand the sexual and reproductive health needs of transgender and intersex people. Implicit in this is the right to be informed of, and to have access to, safe, effective, affordable and acceptable methods of fertility regulation, and the right to access health care services to support a safe and healthy pregnancy and childbirth, and to provide parents with the best chance of having a healthy infant.

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There is evidence that investing in sexual and reproductive health is cost effective, with the potential to minimise future health system costs and to realise ificant benefits at the personal, family and societal levels. The early onset of sexual activity during adolescence is associated with a greater risk of unplanned pregnancy and STIs. Individuals with physical, cognitive, or psychiatric disabilities have a right to education about sexuality, sexual health care, and opportunities for sexual expression and affirmation of their gender.

This includes access to health screening for STIs and cancers of the reproductive tract, and access to information about contraceptive and reproductive options.

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Further research needs to be undertaken to establish the safest and most effective ways of providing long-term hormonal therapy, and clinical guidelines and practice updated accordingly. Priority populations should be determined on the basis of the epidemiology of specific STIs and associated risk factors, and social or structural factors that may act as barriers to STI prevention.

Many experience structural barriers to accessing subsidised medications and health screening, or to health services that presuppose binary gender that are ased at birth. The impacts of sexual and reproductive health are human and economic, and direct and indirect.

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Medicare and private health insurers should provide equitable coverage of gender affirmation interventions for which intersex, trans and gender diverse people have given fully informed consent. All prisoners and juvenile justice detainees should have access to comprehensive and confidential sexual and reproductive health services.

Ongoing research and data collection should be undertaken to improve understanding of the behavioural and environmental risk factors contributing to poor sexual and reproductive health, and to develop interventions to minimise these risk factors. GLB people should access to healthcare that is free from discrimination and responsive to their sexual and reproductive health needs.

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These policies and programs should be underpinned by ongoing research and the provision of information and education to health and aged care service providers on strategies to promote the sexual health of older people, and to ensure services are inclusive of the full diversity of sexual orientations, gender identities, and sexual health needs. Opportunities to prevent many sexual and reproductive health problems before they occur are more likely to be effective when a range of coordinated and mutually reinforcing strategies are targeted across individual, community and societal levels.