Graham J Hart
University College London, Infection and Population Health, Faculty Member
This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health... more
This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents. This, along with inadequate access to SRH services for young people, accounts for the failure to adequately deal with young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility. Socio-economic, religious and cultural factors affect sexual behaviour and outcomes in Adjumani district, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.
Research Interests: Psychology, Health Care, Culture, Qualitative Research, Adolescent, and 15 moreMedicine, Counseling, Humans, Child, Reproductive health, Female, Male, Confidentiality, Questionnaires, Adult, Public health systems and services research, Cross Sectional Studies, Choice Behavior, AIDS care, and Health Personnel
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Research Interests: Information Systems, Medicine, Library and Information Studies, Pregnancy, Humans, and 14 moreFemale, Confidence intervals, Patient Compliance, Health Technology Assessment, Newborn Infant, Great Britain, Adult, Public health systems and services research, Analysis of Variance, Prenatal Diagnosis, Chi Square Distribution, Sensitivity and Specificity, Prenatal Care, and HIV infections
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Research Interests: Family Medicine, Medical Microbiology, Risk Taking, Medicine, Homosexuality, and 15 moreTravel, Humans, Female, Sexually transmitted infections, Male, Sexual Behavior, Confidentiality, Clinical Sciences, Adult, Condom, Condoms, Sexually Transmitted Diseases, Primary Prevention, Clinical Diagnosis, and Partner Notification
Research Interests: Demography, Health Promotion, Medicine, European Public Health Policies, Multivariate Analysis, and 15 moreLondon, Disease Outbreaks, Humans, Alcohol Drinking, Male, European, HIV testing, Adult, Edinburgh, Chi Square Distribution, Cross Sectional Studies, Anal INtercourse, Logistic Models, Hiv Test, and HIV infections
Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK following the expansion of the European Union. This paper examines the factors associated with GUM clinic attendance and STI diagnosis among... more
Objectives: There has been a large influx of Central and East European (CEE) migrants to the UK following the expansion of the European Union. This paper examines the factors associated with GUM clinic attendance and STI diagnosis among CEE migrants in ...
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Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although... more
Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men's well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-de...
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Research Interests: Health Behavior, Focus Groups, Gender, Masculinity, Qualitative Research, and 15 moreMasculinities, Medicine, Gender Identity, Malawi, Humans, Chronic Disease, Female, Male, Men, Adult, Public health systems and services research, Cough, Healthcare Utilisation, Residence Characteristics, and HIV infections
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This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral... more
This paper focuses on the relationship of HIV medical technologies to current styles of medical practice and highlights issues posed by the technologies for those working and/or living with HIV. The paper examines HIV anti-retroviral combination therapies and associated tests from the perspective of their prescribers. The prescribers were interviewed during the later part of 2002 at three London HIV clinics. Their comments, considered in light of other recent studies in the field, suggest that current therapies are part of a transitional phase in the epidemic which informs the identification and negotiation of known risks and uncertainty. An undetermined but extended life expectancy, afforded by anti-retroviral therapies, is understood against risk of iatrogenic diseases and/or viral drug resistance. The tension arising in this situation of unwanted and even uncertain phenomena poses ethical dilemmas and affects doctor/patient relations. Indeed, it also contributes to a reconfigurin...
Research Interests: Sociology, Psychology, Medicine, London, Humans, and 15 moreHuman Resources for Health, Female, Male, Physicians, Questionnaires, Hiv Aids, Public health systems and services research, Organizational Innovation, Highly Active Antiretroviral Therapy, Drug Utilization, Euphoria, attitude to health, Health Resources, HIV infections, and Drug prescriptions
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Research Interests: Sexual Behaviour, Health Education, Health Belief Model, Risk Taking, Social Perception, and 15 moreEngland, Bisexuality, Homosexuality, Humans, Social Context, Male, Sexual Behavior, Gay men, Psychological Tests, Public health systems and services research, Internal- External Locus of Control, Costs and Benefits, attitude to health, Interviews as topic, and High risk
There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases (STDs) and HIV. The success of such methods will not only depend on their acceptability to women but also to... more
There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases (STDs) and HIV. The success of such methods will not only depend on their acceptability to women but also to their male partners. This paper reports on men's attitudes to female controlled methods in south west Uganda. Data was gathered in individual interviews with 50 men and 7 focus group discussions with 42 men. Male attitudes to the male condom, the female condom and female controlled methods of ...
Research Interests: Sociology, Cultural Studies, Psychology, Contraception, Behavior, and 15 moreAfrica, Uganda, Developing Countries, Culture and Mental Health, Eastern Africa, Disease, Infection, Attitudes, Men, Attitude, Public health systems and services research, Condoms, Virus diseases, Sexually Transmitted Diseases, and HIV infections
Research Interests: Health Behavior, Research Design, Heterosexuality, Medicine, Humans, and 14 moreSex Education, Male, Psychological Intervention, Risk factors, Systematic review, Human immunodeficiency virus, Risk Factors, Sexual Partners, Sexually Transmitted Diseases, Randomized Controlled Trials as Topic, attitude to health, Outcome assessment (Health care), Medical and Health Sciences, and HIV infections
The following colleagues reviewed papers for Culture, Health & Sexuality in 1999; we are grateful for their freely given time and assistance. ... Charles Abraham Calle Almedal Ana Amuchastegui Maxine Ankrah Sevgi Aral Andrew Ball Michael... more
The following colleagues reviewed papers for Culture, Health & Sexuality in 1999; we are grateful for their freely given time and assistance. ... Charles Abraham Calle Almedal Ana Amuchastegui Maxine Ankrah Sevgi Aral Andrew Ball Michael Bartos Stef Bertozzi Mildred Blaxter Carlos CaÂceres Michel CaraeÈl Lisa Catan Helen Chalmers Margaret Chesney John Cleland John Coleman Carol Coupland June Crawford Mary Crewe Jocelyn DeJong Ralph DiClemente Gary Dowsett Debbie Epstein Jane Fitzpatrick Paul Flowers Martin Foreman Philip Gatter Alain Giami ...
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Include data in the abstract with key N’s and confidence intervals. Data has been added as requested. Methods The methods a little unclearI suggest more detail is needed rather than just asking readers to find another paper.. For example... more
Include data in the abstract with key N’s and confidence intervals. Data has been added as requested. Methods The methods a little unclearI suggest more detail is needed rather than just asking readers to find another paper.. For example which survey is this study referring tothe initial one or the one where people were called back? How was the sub sample chosen for the second study? What is an ‘education’ centre? What type of workplace was chosen and why? When exactly was the study undertaken (dates of the 4 weeks). How did they know the age of the individuals they approached? Additional information on these details has now been provided in the method section (p4-5). Results The results are unclear. OR are presented but it is not clear what they refer to....what is the referent group? In table 2what does the OR refer to? Is not clear enough...needs to be spelt out really clearly. Findings have been re-written (p9-10). Table 4 shows men are the referent group. In table one....I’m no...
In Britain, young people continue to bear the burden of sexually transmitted infections (STIs) so efforts are required, especially among men, to encourage STI testing. The SPORTSMART study trialled an intervention that sought to achieve... more
In Britain, young people continue to bear the burden of sexually transmitted infections (STIs) so efforts are required, especially among men, to encourage STI testing. The SPORTSMART study trialled an intervention that sought to achieve this by offering chlamydia and gonorrhoea test-kits to men attending amateur football clubs between October and December 2012. With football the highest participation team sport among men in England, this paper examines the potential public health benefit of offering STI testing to men in this setting by assessing their sociodemographic characteristics, sexual behaviours, and healthcare behaviour and comparing them to men in the general population. Data were collected from 192 (male) members of 6 football clubs in London, United Kingdom, aged 18-44 years via a 20-item pen-and-paper self-completion questionnaire administered 2 weeks after the intervention. These were compared to data collected from 409 men of a similar age who were resident in London ...
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Sexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed results.... more
Sexually transmitted infections (STI) are a major public health problem. Condoms provide effective protection but there are many barriers to use. Face-to-face health promotion interventions are resource-intensive and show mixed results. Interactive digital interventions may provide a suitable alternative, allowing private access to personally tailored behaviour change support. We have developed an interactive digital intervention (the Men's Safer Sex (MenSS) website) which aims to increase condom use in men. We describe the protocol for a pilot trial to assess the feasibility of a full-scale randomised controlled trial of the MenSS website in addition to usual sexual health clinical care. Men aged 16 or over who report female sexual partners and recent unprotected sex or suspected acute STI. PARTICIPANTS (N=166) will be enrolled using a tablet computer in clinic waiting rooms. All trial procedures will be online, that is, eligibility checks; study consent; trial registration; au...
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... Correspondence to Professor Jonathan Elford, City University London, Institute of Health Sciences and St Bartholomew School of Nursing and Midwifery, 24 Chiswell Street ... 14 Van de Ven P,Rawstorne P, Treloar C ... 19 Van de Ven P,... more
... Correspondence to Professor Jonathan Elford, City University London, Institute of Health Sciences and St Bartholomew School of Nursing and Midwifery, 24 Chiswell Street ... 14 Van de Ven P,Rawstorne P, Treloar C ... 19 Van de Ven P, Mao L, Fogarty A, Rawstone P, Crawford J ...
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Burns, Fiona M; Evans, Alison R; Mercer, Catherine H; Parutis, Violetta; Gerry, Christopher J; Mole, Richard CM; French, Rebecca S; Imrie, John; Hart, Graham J.
Research Interests: Eastern Europe, Medical Microbiology, Health Education, Adolescent, London, and 15 moreHumans, Health Services, Female, Male, Attitudes, Injecting Drug Use, Impact, Information Service, Clinical Sciences, Condom use, Aged, Adult, Central and Eastern European Studies, General Population, and HIV infections
The objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods , using two groups of HIV-negative men who have sex... more
The objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods , using two groups of HIV-negative men who have sex with men (MSM) attending the same sexual health clinics in London and Brighton, in two consecutive periods of time from 2013 to 2016. Data from MSM in the cross-sectional Attitudes to and Understanding Risk of Acquisition of HIV (AURAH) study (June 2013 to September 2014) were compared with baseline data from different MSM in the prospective cohort study Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2) (November 2014 to April 2016). Prevalence of polydrug use, drug use associated with chemsex and specific drug use, and 10 measures of HIV-related behaviours including condomless sex, post-exposure prophylaxis (PEP) use, pre-exposure prophylaxis (PrEP) use, and HIV testing, were compared. Prevalence ratios (PRs) for the assoc...
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ObjectivesA key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in... more
ObjectivesA key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015.DesignA qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework.SettingParticipants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015.ParticipantsAll MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and a...
Research Interests: Social Media, Qualitative Research, Risk Taking, Social Norms, England, and 15 moreUnited Kingdom, London, Humans, Male, Sexual Behavior, Social Environment, Risk factors, Middle Aged, Adult, Risk Factors, Sexual and Gender Minorities, Sexual Partners, Environment, Cohort Studies, and HIV infections
Recreational drug use and associated harms continue to be of significant concern in men who have sex with men (MSM) particularly in the context of HIV and STI transmission. Data from 1484 HIV-negative or undiagnosed MSM included in the... more
Recreational drug use and associated harms continue to be of significant concern in men who have sex with men (MSM) particularly in the context of HIV and STI transmission. Data from 1484 HIV-negative or undiagnosed MSM included in the AURAH study, a cross-sectional, self-completed questionnaire study of 2630 individuals from 20 sexual health clinics in the United Kingdom in 2013-2014, was analysed. Two measures of recreational drug use in the previous three months were defined; (i) polydrug use (use of 3 or more recreational drugs) and (ii) chemsex drug use (use of mephedrone, crystal methamphetamine or GHB/GBL). Associations of socio-demographic, health and lifestyle factors with drug use, and associations of drug use with sexual behaviour, were investigated. Of the 1484 MSM, 350 (23.6%) reported polydrug use and 324 (21.8%) reported chemsex drug use in the past three months. Overall 852 (57.5%) men reported condomless sex in the past three months; 430 (29.0%) had CLS with ≥2 part...
Research Interests: HIV and AIDS education, Gender and Sexuality, Gay And Lesbian Studies, Life Style, Drug Policy, and 15 moreHumans, Male, Men who have Sex with Men, Recreational Drug Use, Prevalence, Middle Aged, Hiv Aids, Adult, Attitudes and Behaviour of Sexually Transmitted Disease Prevention, Illicit Drug Use, Cross Sectional Studies, ChemSex, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
Disclosure of HIV status to family, friends, and a stable partner may be linked to improved health outcomes for people living with HIV. This study assessed whether non-disclosure is associated with psychological symptoms, non-adherence to... more
Disclosure of HIV status to family, friends, and a stable partner may be linked to improved health outcomes for people living with HIV. This study assessed whether non-disclosure is associated with psychological symptoms, non-adherence to antiretroviral therapy (ART), and viral load (VL) non-suppression. A total of 3258 HIV-diagnosed individuals in the UK completed the confidential ASTRA study questionnaire (2011-2012). Participants reported whether they told anyone they had HIV; to which confidant(s) (friends, family, work colleagues, stable partner) and to what extent (none, some, most/all). The prevalence and factors associated with non-disclosure were assessed. Associations between non-disclosure and the following factors were established using modified Poisson regression with adjustment for socio-demographic factors (gender, age group, ethnicity), HIV-related factors (time since HIV diagnosis, ART status), and clinic: low social support (score ≤ 12 on modified Duke-UNC FSSQ); d...
Research Interests: Heterosexuality, Depression, Family, Medication Adherence, Social Support, and 15 moreAnxiety, Humans, Disclosure, Female, Male, Self Disclosure, Ethnic Groups, Middle Aged, Adult, European Continental Ancestry Group, ANXIETY, Sexual and Gender Minorities, Sexual Partners, Friends, and HIV infections
HIV incidence in men who have sex with men (MSM) in the UK has remained unchanged over the past decade despite increases in HIV testing and antiretroviral therapy (ART) coverage. In this study, we examine trends in sexual behaviours and... more
HIV incidence in men who have sex with men (MSM) in the UK has remained unchanged over the past decade despite increases in HIV testing and antiretroviral therapy (ART) coverage. In this study, we examine trends in sexual behaviours and HIV testing in MSM and explore the risk of transmitting and acquiring HIV. In this serial cross-sectional study, we obtained data from ten cross-sectional surveys done between 2000 and 2013, consisting of anonymous self-administered questionnaires and oral HIV antibody testing in MSM recruited in gay social venues in London, UK. Data were collected between October and January for all survey years up to 2008 and between February and August thereafter. All men older than 16 years were eligible to take part and fieldworkers attempted to approach all MSM in each venue and recorded refusal rates. Data were collected on demographic and sexual behavioural characteristics. We analysed trends over time using linear, logistic, and quantile regression. Of 13 86...
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... Violence against women is reported not just by women, but admit-ted to by men themselves (see, for example, Martin et al., 1999b; Schafer, Caetano and Clark, 1998). In Uttar Pradesh, India a study found that men who engaged ...
Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out... more
Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known. To assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16-24 years. (1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews. Participants were recruited from sexual health services in the UK. Young people...
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... Care and Decision Making in KwaZulu-Natal, South Africa 53 Gill Seidel and Rosalind Coleman Chapter 5 Narratives of Care, Love and Commitment: AIDS/HIV and Non-Heterosexual Family Formations 67 Brian Heaphy, Jeffrey Weeks and... more
... Care and Decision Making in KwaZulu-Natal, South Africa 53 Gill Seidel and Rosalind Coleman Chapter 5 Narratives of Care, Love and Commitment: AIDS/HIV and Non-Heterosexual Family Formations 67 Brian Heaphy, Jeffrey Weeks and Catherine Donovan Chapter 6 ...
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To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London. Cross-sectional surveys using self-administered questionnaires. National Health Service (NHS)... more
To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London. Cross-sectional surveys using self-administered questionnaires. National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms. HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494). Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e.g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months. The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P < 0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (> 80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e.g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P < 0.001. Cause and effect could not be established. Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently--only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.