Papers by Karalyn McDonald
I think initially [with treatments] there was the sort of feeling of hopefulness and yes, we've g... more I think initially [with treatments] there was the sort of feeling of hopefulness and yes, we've got the cure and things changed from a certainty-there was a certain death to more of a complex uncertainty. Because yes, it was good now but-huge buts in there for a lot of people and for me too. But I suppose now that that uncertainty has just been changed to in limbo. It's like well I'm in limbo as it's working now and I'm getting older and I'm in a really stable, happy relationship. This is really good now. Yes, I can think about the future. Patricia, 45, diagnosed 1985 I think that as each year goes by my hope for the future doesn't change. But I think that the issues and means that arise are becoming more complex not just for me, but for all positive people I think around decision making for treatments and other options that may be available, around work and that sort of thing. I think that that's the only thing that seems to have changed, the complexity of things to think about. I think sometimes when you don't know how long you'll be around it's quite simple really. You focus on just the day to day things and things that make you happy. But, you know, thinking about living a life that you know you could be around for any length of time. Just the complexity of life is huge.
Sexual Health, 2019
Background: Recruitment of people to randomised trials of online interventions presents particula... more Background: Recruitment of people to randomised trials of online interventions presents particular challenges and opportunities. The aim of this study was to evaluate factors associated with the recruitment of people with HIV (PWHIV) and their doctors to the HealthMap trial, a cluster randomised trial of an online self-management program. Methods: Recruitment involved a three-step process. Study sites were recruited, followed by doctors caring for PWHIV at study sites and finally PWHIV. Data were collected from study sites, doctors and patient participants. Factors associated with site enrolment and patient participant recruitment were investigated using regression models. Results: Thirteen study sites, 63 doctor participants and 728 patient participants were recruited to the study. Doctors having a prior relationship with the study investigators (odds ratio (OR) 13.3; 95% confidence interval (CI) 3.0, 58.7; P = 0.001) was positively associated with becoming a HealthMap site. Most patient participants successfully recruited to HealthMap (80%) had heard about the study from their HIV doctor. Patient enrolment was associated with the number of people with HIV receiving care at the site (b coefficient 0.10; 95% CI 0.04, 0.16; P = 0.004), but not with employing a clinic or research nurse to help recruit patients (b coefficient 55.9; 95% CI-2.55, 114.25; P = 0.06). Conclusion: Despite substantial investment in online promotion, a previous relationship with doctors was important for doctor recruitment, and doctors themselves were the most important source of patient recruitment to the HealthMap trial. Clinic-based recruitment strategies remain a critical component of trial recruitment, despite expanding opportunities to engage with online communities.
HIV Australia, Feb 1, 2012
In Australia, women represent a small proportion of the total population of people living with HI... more In Australia, women represent a small proportion of the total population of people living with HIV. As of 31 December 2010, a total of 21,391 people were estimated to be living with a diagnosed HIV infection in Australia, of whom 1,984 (9.3%) were women. Due to Australia's large size and moderate population, the small number of women living with HIV are widely dispersed, often isolated and almost invisible within the epidemic.
Qualitative health research, Jan 18, 2015
As HIV has transitioned into a chronic disease, reappraisal of clinical management has occurred w... more As HIV has transitioned into a chronic disease, reappraisal of clinical management has occurred with chronic disease self-management (CDSM) as one possibility. However, despite extensive work on CDSM across a range of diseases, little attention has focused on psychosocial contexts of the lives of people for whom programs are intended. This article reports semi-structured interviews used to explore health practices and motivations of 33 people with HIV (PWHIV) in Australia. Within participants' accounts, different forms of subjectivity and agency emerged with implications for how they understood and valued health-related behaviors. Four themes arose: health support and disclosure, social support and stigma, employment/structure, and health decisions beyond HIV. The experience of stigma and its intersection with CDSM remains relatively un-chartered. This study found stigma shapes agency and engagement with health. Decisions concerning health behaviors are often driven by perceived...
Background Female genital cosmetic surgery (FGCS) changes the structure and appearance of healthy... more Background Female genital cosmetic surgery (FGCS) changes the structure and appearance of healthy external genitalia. We aimed to identify discourses that help explain and rationalise FGCS and to derive from them possibilities for informing clinical education. Methods We interviewed 16 health professionals and 5 non-health professionals who deal with women’s bodies using a study-specific semi-structured interview guide. We analysed transcripts using a three-step iterative process: identifying themes relevant to indications for FGCS, identifying the discourses within which they were positioned, and categorising and theorising discourses. Results We identified discourses that we categorised within four themes: Diversity and the Normal Vulva (diversity was both acknowledged and rejected); Indications for FGCS (Functional, Psychological, Appearance); Ethical Perspectives; and Reasons Women Seek FGCS (Pubic Depilation, Media Representation, Pornography, Advertising Regulations, Social Pr...
Background: Although most Australian mothers initiate breastfeeding and some continue to breastfe... more Background: Although most Australian mothers initiate breastfeeding and some continue to breastfeed through exceptional difficulties, 50% stop breastfeeding before they had originally planned to. While studies have explored women's experiences of breastfeeding, there is a gap in our knowledge of how breastfeeding problems relate to the experience of becoming a mother. Method: We report a phenomenographical analysis of an online forum discussion with 25 Australian new mothers, who had previously been participants in a quantitative study (the CASTLE study) about early breastfeeding experiences. Key findings: Three themes were identified: 'unpreparedness, out of control and on your own'. Within these themes were experiences that included bodily transformation, vulnerability and burden. The women constructed these experiences as problems that they needed to resolve, and they tackled them practically, cognitively and emotionally. In describing their physical transformation and the challenges of initiating breastfeeding, the women's stories mapped their pathways into motherhood. Conclusion: The women described unsettling journeys, which were only understandable from the other side of the experience, and ultimately transformative. The experience of participation in the CASTLE study during the early postpartum period was described as reassuring and supportive, not only of breastfeeding but also of mental wellbeing, during a time of isolation and transformation.
1Standing on shifting sand
Society (ARCSHS) at La Trobe University. ARCSHS is funded by the Victorian Health Promotion Found... more Society (ARCSHS) at La Trobe University. ARCSHS is funded by the Victorian Health Promotion Foundation to undertake a program of social research into social, psychological and cultural aspects of human sexuality and sexual health. The Living with HIV Program at ARCSHS is funded by the Commonwealth Department of Health & Ageing as a collaborating centre to the National Centre in HIV Social Research at the University of New South Wales.
There are nearly 20 million women living with HIV/AIDS worldwide, comprising half of the total nu... more There are nearly 20 million women living with HIV/AIDS worldwide, comprising half of the total number of people living with this virus. Like the women overseas, women living with HIV in Australia have diverse in their experiences, values, needs and expectations. This report surveys the diversity of the experiences of HIV positive women.
This report provides details about Aboriginal and Torres Strait Islander Australians living with ... more This report provides details about Aboriginal and Torres Strait Islander Australians living with HIV who filled in and returned questionnaires as part of the HIV Futures II survey. The HIV Futures II survey was conducted by the Living with HIV research program at the Australian Research Centre in Sex, Health and Society, La Trobe University, in the second half of 1999. The survey asked PLWHA about their health, use of antiretroviral and complementary treatments, use of information and support services, and their housing and financial situation. It also asked about sex and relationships, people's social supports, recreational drug use, work situation and future planning.
INTRODUCTION Motherhood and HIV positive women in Australia collects together as a report three c... more INTRODUCTION Motherhood and HIV positive women in Australia collects together as a report three conference papers delivered between 1999 and 2001. This report is aimed at health service providers, policy makers and people living with HIV and AIDS. It details empirical information and informed discussion about the ways motherhood is understood amongst HIV positive women in Australia, and how this affects their lives. It is a background briefing document that supports critical reflection on specific aspects of the experience of women living with HIV in Australia. ACKNOWLEDGEMENTS The conference papers and posters reproduced here are derived primarily from the HIV Futures I and II Studies. These studies are major research projects conducted over several years (1997-2000) and have involved a number of researchers in gathering and analysing quantitative and qualitative data. Readers will be aware of the quantitative arm of the Studies which has produced a number of major reports since 19...
The HIV Futures 6 survey was completed by 1106 HIV positive Australians from all states and terri... more The HIV Futures 6 survey was completed by 1106 HIV positive Australians from all states and territories. This represents approximately 6.6% of the estimated HIV positive population. 92.4% were male (1018), 7.4% were female (81) and 0.3% were transgender (3). 78.5% were gay men, 7.5% heterosexual women, 7.0% heterosexual men, 4.5% bisexual men, 0.5% lesbian women and 0.7% bisexual women. The remaining 1.3% fell into other categories. The respondents’ ages ranged from 18 to 80 years with a mean of 48.0 years and a median of 47.0 years. The majority of participants were Australian born (75.0%). Twenty five respondents (2.3%) were of Aboriginal/Torres Strait Island origin. The survey takes note of respondents' physical and mental health, reactions to treatment and other drugs, social support, employment etc.
Feminism & Psychology, 2020
In Australia and many countries, pornography offers omnipresent, stimulating, easily accessible s... more In Australia and many countries, pornography offers omnipresent, stimulating, easily accessible sexual content; it is an increasing contributor to social meaning-making in women’s sexual lives, including their relationships. Previous research tended to focus on adverse outcomes without considering how women might experience pornography’s interaction with intimacy and relationships. We therefore sought women’s perspectives through in-depth interviews about pornography conducted with 27 young self-identified women, who have or intended to have sex with men, living in Australia. Analysis of their accounts revealed that young women are perplexed by the interaction of pornography with relationships and attempt to make sense of what it means through discourses of intimacy, fidelity, and sexual freedom. Seven associated (often contradictory) systems of statements contributing to these discourses were identified: Pornography mediates intimacy; Men are the gatekeepers of intimacy; For intima...
Culture, Health & Sexuality, 2019
Female genital cosmetic surgery (FGCS) is increasingly popular. Medical organisations report conc... more Female genital cosmetic surgery (FGCS) is increasingly popular. Medical organisations report concern about adverse outcomes and inadequate clinical indications. Given the Internet's role in health decisions, we aimed to discover what was being communicated about FGCS on Australian provider websites. Thematic analysis of 31 prominent websites identified six themes: seeking aesthetic perfection; resisting natural diversity; gaining from FGCS; indications for surgery; a simple procedure; and ethical practice. Desirable vulvas were represented as 'neat' and 'youthful'. Sites promoted a discourse in which to be 'feminine' means having no visible sex organs, consistent with the historical repression of women's sexuality. FGCS was constructed as a simple and empowering solution, improving women's comfort, hygiene, selfesteem and sexual relationships. The apparent primary concern was commercial. Attention was rarely paid to ethics. Sites reinforced women's responsibility to strive for aesthetic perfection, implied that vulvar diversity is pathological, made unfounded claims for the benefits of FGCS and downplayed adverse consequences. Findings have implications for public health and medical authorities in countries where FGCS is practised and advertised. Enforcing the first do no harm principle would reduce websites' capacity to promote discourses and practices that damage women's bodies and wellbeing.
Feminism & Psychology, 2019
Understanding how young women experience pornography is a modern imperative in promoting sexual h... more Understanding how young women experience pornography is a modern imperative in promoting sexual health. There has been, until now, no Australian research exploring what pornography means to women in relation to sexual pleasure. We conducted in-depth interviews with 27 women from around Australia. A thematic analysis of their accounts, supported by narrative theory, revealed that pornography both enhanced and interfered with pleasure. Women described pornography’s contributions to the enhancement of pleasure through solo pleasure, shared viewing with partners, discovering new sexual preferences, and reassurance about body appearance. Pornography was constructed as interfering with pleasure through its misrepresentation (of bodies, sexual acts, and expression of pleasure), women’s concern for actors’ wellbeing, and its disruption of intimacy. Accounts were consistent with women’s place in a culture that subordinates female pleasure to male pleasure. It was evident in women’s accounts ...
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Papers by Karalyn McDonald