Objectives To investigate the psychosocial impact for women of a diagnosis of Chlamydia trachomatis and discuss the implications for the proposed UK chlamydia screening programme. Design Qualitative study with semistructured interviews. Interview transcripts analysed to identify recurrent themes. Participants Seventeen women with a current or recent diagnosis of chlamydia. Setting A family planning clinic and a genitourinary medicine clinic in Glasgow.

This paper draws upon a qualitative study of Scottish gay men's understandings of HIV testing to explore the importance and changing understandings of ‘community’ within gay men's HIV risk‐management. Nineteen men took part in one‐to‐one interviews, and 18 men took part in focus group discussions concerning HIV testing, HIV status and HIV risk‐management. These discussions were subsequently analysed for recurrent themes using Interpretive Phenomenlogical Analysis. We focus on the ways in which new health technologies have afforded a process of ‘othering’: creating the social exclusion of known or assumed HIV positive men, and thus contributing to the fragmenting of the gay community. Further, we argue that, through shifting HIV avoidance mechanisms from their originally collective level to that of the individual, such technologies have had the unintended consequence of facilitating inadequate lay constructions of risk‐management, potentially putting gay men at risk of HIV infection. Copyright © 2000 John Wiley & Sons, Ltd.

This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups (n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from 'death sentence' to 'life sentence'. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.

In response to a recent expert advisory group report to the chief medical officer, the government has announced the setting up of two pilot schemes to assess the feasibility of a Chlamydia trachomatis screening programme in the United Kingdom. [1][2][3] Chlamydia is the most common, curable, sexually transmitted infection in the Western world. Chlamydia infection is largely asymptomatic, but if it is left untreated it can have particularly severe long term consequences for women. These sequelae include pelvic inflammatory disease, ectopic pregnancy, and infertility. 4 The expert advisory group has recommended that the following groups be targeted for screening: everyone with symptoms of chlamydia infection, all those attending genitourinary medicine clinics, and women seeking termination of pregnancy.1 There should also be opportunistic screening of young sexually active women under 25 years and of women over 25 with a new sexual partner or two or more sexual partners in the past year. The report identifies family planning clinics and general practice as key sites for screening. It also emphasises the importance of follow up management of infected individuals, which should be carried out in conjunction with genitourinary medicine clinics. Costs and benefits of screeningThe rationale behind targeting women for this screening programme is based on health benefits, cost effectiveness, and accessibility. Firstly, and most importantly, the purpose of the programme is to reduce the morbidity associated with pelvic inflammatory disease. Evidence from countries such as Sweden and the United States shows that screening can reduce the prevalence of chlamydia infection in women 5 and the incidence of pelvic inflammatory disease. 6 In addition, computer modelling of the British programme suggests that screening could result in 30 000 fewer cases of pelvic inflammatory disease after five years. Modelling also suggests that screening asymptomatic women-and not men-is the most cost effective option. Finally, no screening programme is likely to be successful if the target population cannot be accessed. Young women are more likely to be current users of a variety of healthcare services and are therefore easier to reach than men of a similar age. 1While the health benefits of the proposed screening programme are evident, the costs in terms of the psychosocial wellbeing of participants are less readily quantifiable. The social and cultural implications of screening for a sexually transmitted infection, especially when that screening is specific to one sex, are far from clear. One specific cost to be considered is that the screening programme may disadvantage women as it will require them to submit to what amounts to surveillance of their sexual behaviour by health professionals. The possible ramifications of the proposed screening programme go beyond the laudable aim of reducing infection and morbidity; the impact on women's lives, in terms of public scrutiny of their sexuality, may be considerable. Women, sexuality, and cervical ...