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1
Jansson, James, Cliff C. Kerr, and David P. Wilson. "Predicting the population impact of increased HIV testing and treatment in Australia." Sexual Health 11, no. 2 (2014): 146. http://dx.doi.org/10.1071/sh13069.
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Introduction The treatment as prevention strategy has gained popularity as a way to reduce the incidence of HIV by suppressing viral load such that transmission risk is decreased. The effectiveness of the strategy also requires early diagnosis. Methods: Informed by data on the influence of diagnosis and treatment on reducing transmission risk, a model simulated the impact of increasing testing and treatment rates on the expected incidence of HIV in Australia under varying assumptions of treatment efficacy and risk compensation. The model utilises Australia’s National HIV Registry data, and simulates disease progression, testing, treatment, transmission and mortality. Results: Decreasing the average time between infection and diagnosis by 30% is expected to reduce population incidence by 12% (~126 cases per year, 95% confidence interval (CI): 82–198). Treatment of all people living with HIV with CD4 counts <500 cells μL–1 is expected to reduce new infections by 30.9% (95% CI: 15.9–37.6%) at 96% efficacy if no risk compensation occurs. The number of infections could increase up to 12.9% (95% CI: 20.1–7.4%) at 26% efficacy if a return to prediagnosis risk levels occur. Conclusion: Treatment as prevention has the potential to prevent HIV infections but its effectiveness depends on the efficacy outside trial settings among men who have sex with men and the level of risk compensation. If antiretroviral therapy has high efficacy, risk compensation will not greatly change the number of infections. If the efficacy of antiretroviral therapy is low, risk compensation could lead to increased infections.
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Bernard, Diana, Susan Kippax, and Don Baxter. "Effective partnership and adequate investment underpin a successful response: key factors in dealing with HIV increases." Sexual Health 5, no. 2 (2008): 193. http://dx.doi.org/10.1071/sh07078.
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Background: Australia has mounted an effective response to HIV and AIDS by investing in evidence-informed policy. Recently, in response to increases in HIV in some states in Australia, the New South Wales Department of Health set up a ‘think tank’ to examine differences in epidemiological and behavioural data, policies, strategies and community responses in order to account for state-based differences and ensure an effective ongoing response to HIV. Methods: The National Centre in HIV Social Research undertook key informant interviews with major stakeholders to help understand differences in responses by the three states most affected by HIV in Australia – Queensland, New South Wales and Victoria. In parallel, the Australian Federation of AIDS Organisations completed an analysis of the investments in HIV-prevention activities targeting gay men in all jurisdictions in Australia. The Australian Federation of AIDS Organisations also analysed the strategic contexts and government responses to HIV in the three states. Results: There were significant differences between New South Wales, Queensland and Victoria in the way the HIV partnership functions. Type of prevention strategy and level of financial investment in prevention activities appear to be related to the effectiveness of the ongoing response to HIV. Conclusions: An active commitment to and adequate resourcing of HIV prevention by all stakeholders in the HIV partnership – government and non-government departments, researchers and gay community organisations – is crucial if Australia is to respond effectively to HIV among gay and other men who have sex with men.
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Feigin, Anita, Carol El-Hayek, Margaret Hellard, Alisa Pedrana, Ellen Donnan, Christopher Fairley, B. K. Tee, and Mark Stoové. "Increases in newly acquired HIV infections in Victoria, Australia: epidemiological evidence of successful prevention?" Sexual Health 10, no. 2 (2013): 166. http://dx.doi.org/10.1071/sh12064.
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Background Rates of newly acquired HIV notifications provide useful data for monitoring transmission trends. Methods: We describe 10-year (2001–10) trends in newly acquired HIV notifications in Victoria, Australia. We also examine recent trends in HIV testing and incidence and risk behaviours among gay and other men who have sex with men (MSM) attending four high MSM caseload clinics. Results: Between 2001 and 2010 there was a significant increasing linear trend in newly acquired HIV that was driven primarily by increases between 2009–2010. MSM accounted for 85% of newly acquired HIV notifications. Between 2007–10, the total number of HIV tests per year at the high caseload clinics increased 41% among MSM and HIV incidence declined by 52%; reported risk behaviours remained relatively stable among these MSM. Conclusion: More newly acquired HIV notifications may reflect recent increased testing among MSM; continued scrutiny of surveillance data will assess the sustained effectiveness of testing as prevention, health promotion and the contribution of risk and testing behaviours to HIV surveillance outcomes.
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Zablotska, Iryna B., Susan Kippax, Andrew Grulich, Martin Holt, and Garrett Prestage. "Behavioural surveillance among gay men in Australia: methods, findings and policy implications for the prevention of HIV and other sexually transmissible infections." Sexual Health 8, no. 3 (2011): 272. http://dx.doi.org/10.1071/sh10125.
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Background The Australian HIV and sexually transmissible infection (STI) behavioural surveillance system (the repeated cross-sectional Gay Community Periodic Surveys, GCPS) has been conducted since 1998 and covers six main Australian jurisdictions. In this paper, we review its history and methodology, and the available indicators, their trends and their use. Methods:We describe the design and history of GCPS. For analyses of indicators, we use Pearson’s χ2-test and test for trend where appropriate. Results: About 90% of gay men in Australia have been tested for HIV (60% to 70% of men who were not HIV-positive) have been tested as recommended in the preceding 12 months. STI testing levels (~70% in the preceding 12 months) are high, but remain insufficient for STI prevention. In general, unprotected anal intercourse with regular (UAIR) and casual (UAIC) sex partners has increased over time. The prevalence and increasing trends in UAIR were similar across jurisdictions (P-trend <0.01), while trends in UAIC differed across the states: during 2001–08, UAIC declined in NSW (P-trend <0.01) and increased elsewhere (P-trend <0.01). Trends in UAIC were associated with HIV diagnoses. Conclusion: This review of the design, implementation and findings of the Australian HIV/STI behavioural surveillance highlights important lessons for HIV/STI behavioural surveillance among homosexual men, particularly the need for consistent data collection over time and across jurisdictions. Investment in systematic behavioural surveillance appears to result in a better understanding of the HIV epidemic, the availability of a warning system and a better targeted HIV prevention strategy.
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Guy, Rebecca J., Ann M. McDonald, Mark J. Bartlett, Jo C. Murray, Carolien M. Giele, Therese M. Davey, Ranil D. Appuhamy, et al. "Characteristics of HIV diagnoses in Australia, 1993-2006." Sexual Health 5, no. 2 (2008): 91. http://dx.doi.org/10.1071/sh07070.
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Objective: To describe recent trends in the diagnosis of HIV infection in Australia. Methods: National HIV surveillance data from 1993 to 2006 were analysed with a focus on geographic differences by HIV exposure route and late presentation (HIV within 3 months of a first AIDS-defining illness or a CD4 count of less than 200 cells μL–1). Results: In 1993–99, the number of HIV diagnoses declined by 32%, and then increased by 39% from 1999 to 2006. From 2000 onwards, rates increased significantly in Victoria, Queensland, South Australia and Western Australia. The most frequently reported routes of HIV exposure were male to male sex (71%) and heterosexual contact (18%), and the population rate of diagnoses have increased in both categories. Among the cases reported as heterosexually acquired (n = 2199), 33% were in people born in a high-prevalence country and 19% in those with partners from a high-prevalence country. Late presentation was most frequent in heterosexually acquired infections in persons who had a partner from a high-prevalence country: 32% compared with 20% overall. Conclusions: Recent increases in annual numbers of HIV diagnoses in Australia underline the continuing need for HIV-prevention programs, particularly among men having male to male sex. Early diagnosis and access to care and treatment should also be emphasised, as a substantial proportion of people with HIV infection are unaware of their status until late in the course of disease.
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Ghimire, Hallett, Gray, Lobo, and Crawford. "What Works? Prevention and Control of Sexually Transmitted Infections and Blood-Borne Viruses in Migrants from Sub-Saharan Africa, Northeast Asia and Southeast Asia Living in High-Income Countries: A Systematic Review." International Journal of Environmental Research and Public Health 16, no. 7 (April 10, 2019): 1287. http://dx.doi.org/10.3390/ijerph16071287.
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Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.
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Wilson, David P., Alexander Hoare, David G. Regan, and Matthew G. Law. "Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men." Sexual Health 6, no. 1 (2009): 19. http://dx.doi.org/10.1071/sh08081.
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Background: We address the research questions: (i) what proportion of new HIV infections is transmitted from people who are (a) undiagnosed, (b) in primary HIV infection (PHI), (c) on antiretroviral therapy?; and (ii) what is the expected epidemiological impact of (a) increasing the proportion of newly acquired HIV infections receiving early treatment, and (b) increasing HIV testing rates? Methods: We used a mathematical model to simulate HIV transmission in the population of men who have sex with men (MSM) in Australia. We calibrated the model using established biological and clinical data and a wide range of Australian MSM epidemiological and behavioural data sources. Results: We estimate that ~19% of all new HIV infections are transmitted from the ~3% of Australian HIV-infected MSM who are in PHI; ~31% of new HIV infections are estimated to be transmitted from the ~9% of MSM with undiagnosed HIV. We estimate that the average number of infections caused per HIV-infected MSM through the duration of PHI is ~0.14–0.28. Conclusions: The epidemiological impact of increasing treatment in PHI would be modest due to insufficient detection of newly-infected individuals. In contrast, increases in HIV testing rates could have substantial epidemiological consequences. The benefit of testing will also increase over time. Promoting increases in the coverage and frequency of testing for HIV could be a highly-effective public health intervention, but the population-level impact of interventions based on promoting early treatment of patients diagnosed in PHI is likely to be small. Treating PHI requires further evaluation of its long-term effects on HIV-infected individuals.
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Heymer, Kelly-Jean, and David P. Wilson. "Treatment for prevention of HIV transmission in a localised epidemic: the case for South Australia." Sexual Health 8, no. 3 (2011): 280. http://dx.doi.org/10.1071/sh10084.
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Background Discussion is currently taking place among international HIV/AIDS groups around increasing HIV testing and initiating earlier use of antiretroviral therapy (ART) among people diagnosed with HIV as a method to reduce the spread of HIV. In this study, we explore the expected epidemiological impact of this strategy in a small population in which HIV transmission is predominantly confined to men who have sex with men (MSM). Methods: A deterministic mathematical transmission model was constructed to investigate the impacts of strategies that increase testing and treatment rates, and their likely potential to mitigate HIV epidemics among MSM. Our novel model distinguishes men in the population who are more easily accessible to prevention campaigns through engagement with the gay community from men who are not. This model is applied to the population of MSM in South Australia. Results: Our model-based findings suggest that increasing testing rates alone will have minimal impact on reducing the expected number of infections compared to current conditions. However, in combination with increases in treatment coverage, this strategy could lead to a 59–68% reduction in the number of HIV infections over the next 5 years. Targeting men who are socially engaged with the gay community would result in the majority of potential reductions in incidence, with only minor improvements possible by reaching all other MSM. Conclusions: Investing in strategies that will achieve higher coverage and earlier initiation of treatment to reduce infectiousness of HIV-infected individuals could be an effective strategy for reducing incidence in a population of MSM.
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Peach, Elizabeth, Chris Lemoh, Mark Stoove, Paul Agius, Carol El Hayek, Nasra Higgins, and Margaret Hellard. "Aiming for 90–90–90 – the importance of understanding the risk factors for HIV exposure and advanced HIV infection in migrant populations and other groups who do not report male-to-male sex." Sexual Health 15, no. 5 (2018): 441. http://dx.doi.org/10.1071/sh17192.
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Background In Australia, new HIV diagnoses increasingly occur among people who do not report male-to-male sex. Among migrants, it is not clear what proportion acquired infection before migration. Similarly, among Australian-born people, it is not clear what proportion acquired infection in-country. There is a need to better understand the epidemiology of HIV in people who do not report male-to-male sex. Methods: Victorian public health surveillance data were used to classify migrants as having likely acquired HIV before or after arrival to Australia using a CD4 cell count decline method to estimate date of infection. Place of exposure for Australian-born people was estimated based on self-report. Factors associated with place of HIV acquisition, advanced infection and newly acquired infection were explored among migrants and among Australian-born people. Results: Between July 1996 and June 2014, there were 821 new non-MSM HIV diagnoses. Most (58%) were migrants, and of these, half (54%) were estimated to have acquired HIV before migration. Among Australian-born people, 27% reported exposure likely occurring abroad; the majority of these were men who reported exposure in South-East Asia. Advanced infection was common in migrants (45%) and Australian-born people (35%). Among migrants, birth in South-East Asia was associated with increased odds of advanced infection. Conclusion: These results highlight the potential vulnerability of migrants after arrival in Australia, especially those from South-East Asia and Sub-Saharan Africa, and that of Australian-born men travelling to these regions. Public health practice must be strengthened to meet prevention needs of these populations in line with Australian policy.
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Tachedjian, Gilda. "Microbicides for HIV." Microbiology Australia 31, no. 4 (2010): 188. http://dx.doi.org/10.1071/ma10188.
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Microbicides are chemical entities that can be incorporated in gels, films, tablets or rings for application to the vagina or rectum to prevent the transmission of HIV and other sexually transmitted infections. Leading Australian microbicide efforts include the development of a dendrimer nanoparticle with broad-spectrum activity against HIV, HSV and HPV, and a natural factor produced by lactobacilli in the healthy female genital tract. Clinical trials have revealed that nonspecific agents such as nonoxynol-9 and moderately specific linear polyanions lack efficacy in preventing male to female HIV transmission. In contrast, the CAPRISA 004 study demonstrates that a gel containing an antiretroviral agent, 1% tenofovir, provides women with 39% protection against HIV infection. While this proof of concept study is arguably one of the most encouraging results seen in the HIV prevention field, efficacy and adherence could be improved by developing combination microbicides and coitally independent dosing strategies, respectively.
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Holt, Martin, Toby Lea, Limin Mao, Iryna Zablotska, Evelyn Lee, John B. F. de Wit, and Garrett Prestage. "Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys." Sexual Health 14, no. 1 (2017): 72. http://dx.doi.org/10.1071/sh16072.
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Background In Australia, the preventative use of antiretroviral drugs [pre-exposure prophylaxis (PrEP) and treatment as prevention] is being embraced to protect individuals at high risk of HIV and reduce onward transmission. Methods: The adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, was reviewed to monitor the uptake and effect of new prevention strategies in Australia’s primary HIV-affected population (gay and bisexual men, GBM). The national trends in key indicators during 2000–15 were reviewed and a new measure to take account of antiretroviral-based prevention was developed. Results: Between 2000 and 2015, there were significant increases (P < 0.001) in annual HIV testing (56.1–64.8%), condomless sex with casual partners (26.8—38.8%) and the proportion of HIV-positive men on HIV treatment (72.5–88.4%) and with an undetectable viral load (73.7–94.7%). The proportion of casual partners who were HIV negative, not on PrEP and who engaged in receptive condomless sex also increased between 2000 and 2015 from 12.8 to 19.3%. Two scenarios anticipating the effect of PrEP highlighted the need to target GBM who engage in receptive condomless sex while also sustaining condom use at a population level. Conclusions: Behavioural surveillance can be successfully adapted to follow the effect of antiretroviral-based prevention. It is anticipated that HIV testing and HIV treatment will continue to increase among Australian GBM, but to prevent new infections, intervention in the growing proportion of GBM who have condomless sex with casual partners is needed. For PrEP to have its desired effect, condom use needs to be sustained.
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Wilkinson, Anna L., Bridget L. Draper, Alisa E. Pedrana, Jason Asselin, Martin Holt, Margaret E. Hellard, and Mark Stoové. "Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses." Sexually Transmitted Infections 94, no. 4 (November 21, 2017): 309–14. http://dx.doi.org/10.1136/sextrans-2017-053375.
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IntroductionContemporary responses to HIV embrace biomedical prevention, particularly treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP). However, large-scale implementation of biomedical prevention should be ideally preceded by assessments of their community acceptability. We aimed to understand contemporary attitudes of gay and bisexual men (GBM) in Australia towards biomedical-based HIV prevention and propose a framework for their measurement and ongoing monitoring.MethodsA cross-sectional, online survey of GBM ≥18 years has been conducted annually in Victoria, Australia, since 2008. In 2016, 35 attitudinal items on biomedical HIV prevention were added. Items were scored on five-point Likert scales. We used principal factor analysis to identify key constructs related to GBM’s attitudes to biomedical HIV prevention and use these to characterise levels of support for TasP and PrEP.ResultsA total of 462 HIV-negative or HIV-status-unknown men, not using PrEP, provided valid responses for all 35 attitudinal items. We extracted four distinct and interpretable factors we named: ‘Confidence in PrEP’, ‘Judicious approach to PrEP’, ‘Treatment as prevention optimism’ and ‘Support for early treatment’. High levels of agreement were seen across PrEP-related items; 77.9% of men agreed that PrEP prevented HIV acquisition and 83.6% of men agreed that users were protecting themselves. However, the agreement levels for HIV TasP items were considerably lower, with <20% of men agreeing treatment (undetectable viral load) reduced HIV transmission risk.ConclusionsBetter understanding of community attitudes is crucial for shaping policy and informing initiatives that aim to improve knowledge, acceptance and uptake of biomedical prevention. Our analyses suggest confidence in, acceptability of and community support for PrEP among GBM. However, strategies to address scepticism towards HIV treatment when used for prevention may be needed to optimise combination biomedical HIV prevention.
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Heron, Jack E., Suzanne Rix, Rick Varma, and David M. Gracey. "Renal impairment: an unnecessary barrier to HIV prevention." Sexual Health 17, no. 3 (2020): 299. http://dx.doi.org/10.1071/sh20037.
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The use of tenofovir disoproxil fumarate (TDF) in combination with emtricitabine, prescribed for pre-exposure prophylaxis (PrEP), is highly effective at reducing incident sexually transmissible HIV infection among those at risk. TDF is associated with proteinuria, Fanconi syndrome and chronic kidney disease, and is not recommended for use in patients with an estimated creatinine clearance <60 mL min−1. There are currently no Pharmaceutical Benefits Scheme (PBS)-funded PrEP options for patients at risk of HIV infection with moderate renal impairment in Australia. This report describes the case of a patient who acquired HIV soon after PrEP was suspended due to moderate renal impairment. The various clinical and regulatory issues this case raises are discussed.
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Brener, Loren, Dean A. Murphy, Elena J. Cama, and Jeanne Ellard. "Hepatitis C risk factors, attitudes and knowledge among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia." Sexual Health 12, no. 5 (2015): 411. http://dx.doi.org/10.1071/sh14239.
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Background There are increasing reports of sexual transmission of hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM). Still unclear is the level of HCV knowledge and the risk factors specific to HCV transmission among this population. This study compared HCV knowledge and risk practices among HIV-positive, HIV-negative and HIV-untested gay and bisexual men in Australia. Methods: Participants (n = 534) completed an online survey assessing sexual risk practices, HCV knowledge, perceived risk of acquiring HCV and perceptions of people with HCV and who inject drugs. Results: HIV-positive participants were older, reported greater engagement in sexual risk and injecting drug practices, felt they were at greater risk of acquiring HCV, were less likely to socially and sexually exclude people with HCV and had more positive attitudes towards people who inject drugs and people with HCV compared with HIV-negative and HIV-untested participants. HIV-untested participants were younger, reported fewer HCV-related serosorting practices and were more likely to socially and sexually exclude people with HCV than the other groups. Conclusions: Findings suggest that HCV education and prevention for gay men may be most effective if tailored according to HIV status. For HIV-positive men, health promotion could focus on specific sexual practices and biological factors linked to HCV transmission, regular HCV testing and better strategies for disclosure of HCV serostatus. For HIV-negative and HIV-untested men, there should be a more general focus on awareness, changing attitudes towards HCV testing and increasing general knowledge around HCV, including evidence of sexual transmission.
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McGregor, Skye, Gilda Tachedjian, Bridget G. Haire, and John M. Kaldor. "The seventh (and last?) International Microbicides Conference: from discovery to delivery." Sexual Health 10, no. 3 (2013): 240. http://dx.doi.org/10.1071/sh12211.
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The most recent estimates indicate that in 2011, 34 million people were living with HIV, the majority in sub-Saharan Africa. Even though the estimated number of new infections is decreasing, there remains an urgent need for new prevention technologies, particularly those controlled by women and men who have receptive sex. Microbicides are products designed to be applied vaginally or rectally to prevent acquisition of HIV and other sexually transmissible infections and, as such, provide a great hope for female-controlled HIV prevention. Oral prevention drugs are a more recent development that also has great potential. The field changed radically in 2010–2011 with the first trials demonstrating effectiveness of a microbicide and oral prevention drugs. The seventh biannual Microbicides conference, which took place in Sydney, Australia, in April 2012, was the first conference in this series since these new results and represented a transition from the discovery phase of research to considerations of implementation. Researchers, advocates, community representatives, funders and the media came together over 3 days to talk about the realities of implementation, particularly in regard to challenges in adherence and funding, and also examined early findings for new prevention technologies. This report of the 2012 International Microbicides Conference provides a summary of recent developments and ongoing challenges in the field of microbicides research.
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Jeffreys, Elena, Janelle Fawkes, and Zahra Stardust. "Mandatory Testing for HIV and Sexually Transmissible Infections among Sex Workers in Australia: A Barrier to HIV and STI Prevention." World Journal of AIDS 02, no. 03 (2012): 203–11. http://dx.doi.org/10.4236/wja.2012.23026.
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Wodak, Alex. "HIV Infection and Injecting Drug Use in Australia: Responding to a Crisis." Journal of Drug Issues 22, no. 3 (July 1992): 549–62. http://dx.doi.org/10.1177/002204269202200307.
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Multiple data sources indicate low levels of HIV infection among injecting drug users (IDUs) in Australia despite a high prevalence of behaviours associated with considerable risk of transmission of infection in this population and a high prevalence of HIV infection among homosexual/bisexual males. The containment of HIV infection among IDUs in Australia in the 1980s, a remarkable public health achievement by national and international standards, probably represents the most important national accomplishment in the alcohol and drug field during the past decade. A number of factors can be identified which have probably been responsible for the early adoption and vigorous implementation of multiple complementary prevention strategies. Complacency and supply restriction drug policy are now among the most critical factors limiting further containment efforts. Progress in implementing strategies to reduce HIV transmission among IDUs in prisons proceeds far slower than all other areas associated with control of HIV infection in this population.
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Persson, Asha, Graham Brown, Ann McDonald, and Henrike Körner. "Transmission and Prevention of HIV Among Heterosexual Populations in Australia." AIDS Education and Prevention 26, no. 3 (June 2014): 245–55. http://dx.doi.org/10.1521/aeap.2014.26.3.245.
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Cullen, Trevor, and Ruth Callaghan. "Improving HIV and STI responses through media and community engagement." Pacific Journalism Review 22, no. 1 (July 31, 2016): 231. http://dx.doi.org/10.24135/pjr.v22i1.21.
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HIV (Human Immunodeficiency Virus) and other sexually transmitted infections (STIs) in Western Australia are at their highest in 20 years. In response to this worrying escalation and the public need for accurate and balanced information about these diseases, the journalism department at Edith Cowan University, in partnership with the WA AIDS Council (WAAC), developed a pilot project that consisted of a series of media training and education programmes to enable WAAC staff to share information and stories with the media on HIV and STIs in a more confident and proactive way. The project offers a model framework for media and community engagement that can be applied to a broader range of health promotion and disease prevention issues.
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Holt, Martin, James MacGibbon, Brandon Bear, Toby Lea, Johann Kolstee, David Crawford, Dean Murphy, Cherie Power, Jeanne Ellard, and John de Wit. "Trends in Belief That HIV Treatment Prevents Transmission Among Gay and Bisexual Men in Australia: Results of National Online Surveys 2013–2019." AIDS Education and Prevention 33, no. 1 (February 2021): 62–72. http://dx.doi.org/10.1521/aeap.2021.33.1.62.
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We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013–2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.
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Lemoh, Chris, Beverley-Ann Biggs, and Margaret Hellard. "Working with West African migrant communities on HIV prevention in Australia." Sexual Health 5, no. 4 (2008): 313. http://dx.doi.org/10.1071/sh08060.
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Natoli, Lisa, Rebecca J. Guy, Mark Shephard, Basil Donovan, Christopher K. Fairley, James Ward, David G. Regan, Belinda Hengel, and Lisa Maher. "Chlamydia and gonorrhoea point-of-care testing in Australia: where should it be used?" Sexual Health 12, no. 1 (2015): 51. http://dx.doi.org/10.1071/sh14213.
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Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia. Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise. Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities. Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact.
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Callander, Denton, Rebecca Guy, Christopher K. Fairley, Hamish McManus, Garrett Prestage, Eric P. F. Chow, Marcus Chen, et al. "Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics." Sexual Health 16, no. 5 (2019): 457. http://dx.doi.org/10.1071/sh18097.
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Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. Results: The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P<0.001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P<0.001) and rectum (6.6–14.8/100 PY, P<0.001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7–2.2), using injecting drugs (HR=1.7, 95%CI: 1.4–2.0), being HIV positive (HR=1.4, 95%CI: 1.2–1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2–1.6). Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
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Lea, Toby, Michael Costello, Limin Mao, Garrett Prestage, Iryna Zablotska, James Ward, John Kaldor, John de Wit, and Martin Holt. "Elevated reporting of unprotected anal intercourse and injecting drug use but no difference in HIV prevalence among Indigenous Australian men who have sex with men compared with their Anglo-Australian peers." Sexual Health 10, no. 2 (2013): 146. http://dx.doi.org/10.1071/sh12097.
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Background Although half of the HIV notifications among Aboriginal and Torres Strait Islander people (‘Indigenous Australians’) are attributed to homosexual transmission, there has been little research examining sexual and drug use risk practices among Indigenous Australian men who have sex with men (MSM). Methods: Respondents were Indigenous Australian (n = 1278) and Anglo-Australian men (n = 24 002) participating in the routine cross-sectional Gay Community Periodic Surveys conducted in Australia from 2007 to 2011. Sociodemographic characteristics, sexual risk practices, drug use, HIV testing and HIV status of Indigenous and Anglo-Australian men were compared and evaluated to discover whether Indigenous status was independently associated with HIV risk practices. Results: Although an equivalent proportion of Indigenous and Anglo-Australian men reported being HIV-positive (9.6%), Indigenous MSM were more likely to report unprotected anal intercourse with casual partners in the previous 6 months (27.9% v. 21.5%; Adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.11–1.49). Indigenous men were more likely than Anglo-Australian men to report use of several specific drugs and twice as likely to report injecting drug use in the previous 6 months (8.8% v. 4.5%; AOR = 1.43, 95% CI: 1.11–1.86). Conclusions: Despite a higher proportion of Indigenous men reporting sexual and drug use practices that increase the risk of HIV transmission, there were no differences in the HIV status of Indigenous and Anglo-Australian men. However, the elevated rates of risk practices suggest that Indigenous MSM should remain a focus for HIV prevention, care and support.
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Zablotska, I. B., J. Imrie, C. Bourne, A. E. Grulich, A. Frankland, and G. Prestage. "Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007." International Journal of STD & AIDS 19, no. 11 (November 2008): 758–60. http://dx.doi.org/10.1258/ijsa.2008.008193.
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In order to be effective, sexually transmitted infection (STI) testing should be comprehensive based on the clients' sexuality and risk practices. Using data from the Sydney Gay Community Periodic Survey, we explored trends in and factors associated with STI testing among gay men during 2003–2007. Among men who were not HIV-positive, 68% were tested for HIV in 2007. HIV testing was more common than STI testing and remained stable during 2003–2007. Use of swabs and urine samples increased significantly ( P-trend < 0.001 for each). However, until 2007, 33% of men were not tested. Sexual behaviours (higher number of partners, having casual partners and engaging in unprotected anal intercourse with them) were associated with STI testing. HIV-negative men were tested for STI less often than HIV-positive men (prevalence ratio = 0.56; 95% CI: 0.47–0.68). STI testing among HIV-negative men has improved significantly but remains inadequate for STI control and HIV prevention. It should not be assumed that appropriate and comprehensive STI screening is always provided to clients.
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Down, Ian, Garrett Prestage, Kathy Triffitt, Graham Brown, Jack Bradley, and Jeanne Ellard. "Recently diagnosed gay men talk about HIV treatment decisions." Sexual Health 11, no. 2 (2014): 200. http://dx.doi.org/10.1071/sh13100.
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Background In recent years, there has been increasing evidence that early initiation of antiretroviral therapy (ART) may provide health benefits for those infected with HIV. There has also been significant discussion about the role of HIV treatment in preventing onward transmission of the virus. Early provision and uptake of ART to people recently diagnosed with HIV could achieve both individual and public health outcomes. The success of such an initiative relies, in part, on the preparedness of those recently diagnosed with HIV to engage with the therapy. Methods: The HIV Seroconversion Study collects both quantitative and qualitative data from people in Australia who have recently been diagnosed with HIV. During 2011–2012, 53 gay or bisexual men recruited across Australia took part in semistructured interviews as part of the study. The men were asked about their knowledge and experience of, and their decisions about whether or not to commence, HIV treatment. Results: The interviews identified differing levels of knowledge about HIV treatments and divergent views about the health and prevention benefits of ART. For some, treatments provided a sense of control over the virus; others were apprehensive and distrustful, and preferred to resist commencing treatments for as long as possible. Conclusions: If early initiation of treatment is to be encouraged, appropriate measures must be in place to ensure recently diagnosed individuals have access to the appropriate information and the support they need to enable them to make informed choices and, if necessary, to address their fears.
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Hall, T. "HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP): What mental health providers should know." European Psychiatry 33, S1 (March 2016): S70—S71. http://dx.doi.org/10.1016/j.eurpsy.2016.01.983.
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Pharmacologic methods of treating and preventing HIV have advanced tremendously in recent years. Understandings of HIV risk and recommendations for risk-reduction strategies have also changed substantially. A majority of new cases of HIV in many developed countries are now acquired through sex with long-term partners who are unaware of their HIV-positive status, rather than from casual or anonymous sexual encounters. Persons with bipolar disorder and substance use disorders are at particularly high risk. Mental health providers who work with LGBT persons and other populations at higher risk for HIV need to understand strategies their patients are using for HIV risk reduction, and to refer appropriate patients for consideration for pre-exposure prophylaxis (PrEP). PrEP is the daily use of an antiretroviral (ARV) medication for prevention of HIV infection in higher-risk individuals. The United States approved tenofovir + emtracitabine for PrEP in 2012; this is under review in several European countries, Canada, and Australia, and is already prescribed off-label in many. Additionally, studies have shown that treatment with ARV medications to an “undetectable viral load” greatly reduces the risk of further transmission by persons already infected with HIV, called “treatment as prevention” (TasP). As of September 2015, WHO recommends early ARV treatment for all persons with HIV, and consideration of PrEP for men who have sex with men. This paper reviews findings from the PrEP studies (especially iPrEx, iPrEx Ole, IPERGAY, and PROUD) and TasP, and looks at their impact on LGBT and HIV+ communities, with relevance for mental health providers.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Down, Ian, Garrett Prestage, Graham Brown, Jeanne Ellard, Rebecca Guy, Margaret Hellard, David Wilson, John de Wit, Mark Stoové, and Martin Holt. "Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry." Sexual Health 15, no. 3 (2018): 276. http://dx.doi.org/10.1071/sh17064.
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Background Gay and bisexual men (GBM) with recent HIV infection are a key population to inform HIV-prevention. The National HIV Registry (NHR) provides details about all individuals diagnosed with HIV, but it is unclear how. Methods: Basic sociodemographic characteristics of GBM in the NHR who were diagnosed between 2010 and 2014 were compared with three samples of GBM: men with undiagnosed HIV infection from the Community-Based Study of Undiagnosed HIV and Testing (COUNT) study of HIV prevalence and undiagnosed infection that was conducted during 2013–14; men in the Australian Gay Community Periodic Surveys (GCPS) who were diagnosed with HIV between 2010 and 2014; and men in the HIV Seroconversion Study (SCS) who were also diagnosed in those years. Results: The NHR identified 3629 men who reported male-to-male sex as the exposure risk for their diagnosis between 2010 and 2014. COUNT identified 19 (8.9% of all men who tested HIV positive) men as having undiagnosed HIV. In the GCPS sample, 185 (2.5%) reported being diagnosed with HIV in 2010–14. In total, 367 men in the SCS received their diagnosis during 2010–14. The mean age of men in the NHR (36.8 years) was similar to that in GCPS (36.3 years) and SCS (35.1 years), while undiagnosed men in COUNT were younger (32.6 years), with no other significant differences between the samples. Conclusions: The undiagnosed men were somewhat younger than diagnosed men. To achieve earlier diagnosis of new HIV infections, improved HIV testing frequency is needed among younger men.
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Read, Phillip, Karen J. Chronister, Catherine Kostovski, Mary Ellen Harrod, Allison Salmon, and Marianne Jauncey. "Perceptions of people who inject drugs towards HIV pre-exposure prophylaxis in Australia." Sexual Health 16, no. 4 (2019): 383. http://dx.doi.org/10.1071/sh18228.
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Background People who inject drugs (PWID) are a priority for HIV prevention. This study aimed to determine perceptions, potential eligibility and willingness to use PrEP among PWID in Sydney. Methods: Clients completed a cross-sectional survey to collect data on demographics, perceived risk of HIV and willingness to use PrEP, which were then analysed. Results: Twelve (7%) of 172 HIV-negative participants were eligible for PrEP under current guidelines for injecting reasons, of whom three would also be eligible for sexual risk, leaving nine (5%) eligible for injecting reasons alone. Half had heard of PrEP and, of these, 65% would consider taking it. Most (88%) thought they would continue using needle syringe program services. A minority (8%) indicated they may be likely to share needles and syringes or be less concerned about injecting partners’ HIV status (26%). Conclusions: Although PrEP will benefit a small proportion of PWID, this may equate to a significant number nationally. Policy development around PrEP incorporating affected populations will best support the community of people currently injecting to keep rates of HIV low.
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Newman, Christy E., Michael R. Kidd, Susan C. Kippax, Robert H. Reynolds, Peter G. Canavan, and John B. F. de Wit. "Engaging nonHIV specialist general practitioners with new priorities in HIV prevention and treatment: qualitative insights from those working in the field." Sexual Health 10, no. 3 (2013): 193. http://dx.doi.org/10.1071/sh12157.
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Background The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage nonHIV specialist Australian general practitioners (GPs) with these new priorities. Methods: Content related to the engagement of nonHIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n = 24) and general practice clinicians (n = 47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of ‘issues’ described by participants. Results: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more ‘routine’ in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response. Conclusions: To successfully engage nonHIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed.
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Tsai, R., B. Pharm, EH Goh, P. Webeck, and J. Mullins. "Prevention of Human Immunodeficiency Virus Infection Among Intravenous Drug Users in New South Wales, Australia: The Needles and Syringes Distribution Programme Through Retail Pharmacies." Asia Pacific Journal of Public Health 2, no. 4 (October 1988): 245–51. http://dx.doi.org/10.1177/101053958800200408.
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Prevalence of Human Immunodeficiency Virus (HIV) infection among 12, 000 intravenous (i.v.) drug users in New South Wales (NSW) was estimated to be very low in 1985. However, a large increase of HIV infection in this population group could result within a short period. The NSW government amended existing legislation to permit the sale and possession of sterile needles and syringes. A programme to promote the sale of needles and syringes was launched jointly with the Pharmacy Guild of Australia (NSW Branch) in December 1986. Favourable changes in pharmacists' attitudes were noted four months later. The distribution scheme became an important component of the NSW prevention programme. There are 2, 039 retail pharmacies throughout NSW. The number of sterile needles and syringes sold through these outlets increased from 4, 200 in January 1987 to 51, 000 in November 1987 with a total of 422, 000 dispensed over this period. The percentage of Pharmacy Guild members involved in the programme increased from 0.5% to 22.5%, covering 38% of the state by November 1987. During 1987, HIV infection among i.v. drug users remained low. This suggests that the needles and syringes distribution programme contributed significantly towards limiting the spread of HIV infection among i.v. drug users.
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Guy, Rebecca J., Tim Spelman, Mark Stoove, Carol El-Hayek, Jane Goller, Christopher K. Fairley, David Leslie, et al. "Risk factors for HIV seroconversion in men who have sex with men in Victoria, Australia: results from a sentinel surveillance system." Sexual Health 8, no. 3 (2011): 319. http://dx.doi.org/10.1071/sh10095.
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Objectives HIV diagnosis rates in men who have sex with men (MSM) began increasing in Australia 10 years ago, and there has been a major resurgence of syphilis. We determined predictors of HIV positivity and seroconversion among MSM in Victoria, Australia. Methods: We conducted a retrospective longitudinal analysis of data from MSM who underwent HIV testing between April 2006 and June 2009 at three primary care clinics. Logistic regression was used to determine predictors of HIV positivity and seroconversion. Results: During the study period, 7857 MSM tested for HIV. Overall HIV positivity was 1.86% (95% confidence interval (CI): 1.6–2.2). There were 3272 repeat testers followed for 4837 person-years (PY); 60 seroconverted and HIV incidence was 1.24 (95% CI: 0.96–1.60) per 100 PY. Independent predictors of HIV seroconversion were: an infectious syphilis diagnosis within the last 2 years (adjusted hazard ratio (AHR) = 2.5, 95% CI: 1.1–5.7), reporting six or more anal sex partners in the past 6 months (AHR = 3.3, 95% CI: 1.8–6.3), reporting an HIV-positive current regular partner (AHR = 3.4, 95% CI: 1.1–10.6) and reporting inconsistent condom use with casual partners in the past 6 months (AHR = 4.4, 95% CI: 1.7–11.5). Conclusion: Our results call for HIV prevention to target high-risk MSM, including men with a recent syphilis diagnosis or a high numbers of partners, men who have unprotected anal sex with casual partners and men in serodiscordant relationships. The HIV incidence estimate will provide a baseline to enable public health officials to measure the effectiveness of future strategies.
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Lemoh, Chris N., Samia Baho, Jeffrey Grierson, Margaret Hellard, Alan Street, and Beverley-Ann Biggs. "African Australians living with HIV: a case series from Victoria." Sexual Health 7, no. 2 (2010): 142. http://dx.doi.org/10.1071/sh09120.
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Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.
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Graham, Simon, Catherine C. O'Connor, Stephen Morgan, Catherine Chamberlain, and Jane Hocking. "Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis." Sexual Health 14, no. 3 (2017): 201. http://dx.doi.org/10.1071/sh16013.
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Background Aboriginal and Torres Strait Islanders (Aboriginal) are Australia’s first peoples. Between 2006 and 2015, HIV notifications increased among Aboriginal people; however, among non-Aboriginal people, notifications remained relatively stable. This systematic review and meta-analysis aims to examine the prevalence of HIV among Aboriginal people overall and by subgroups. Methods: In November 2015, a search of PubMed and Web of Science, grey literature and abstracts from conferences was conducted. A study was included if it reported the number of Aboriginal people tested and those who tested positive for HIV. The following variables were extracted: gender; Aboriginal status; population group (men who have sex with men, people who inject drugs, adults, youth in detention and pregnant females) and geographical location. An assessment of between study heterogeneity (I2 test) and within study bias (selection, measurement and sample size) was also conducted. Results: Seven studies were included; all were cross-sectional study designs. The overall sample size was 3772 and the prevalence of HIV was 0.1% (I2 = 38.3%, P = 0.136). Five studies included convenient samples of people attending Australian Needle and Syringe Program Centres, clinics, hospitals and a youth detention centre, increasing the potential of selection bias. Four studies had a sample size, thus decreasing the ability to report pooled estimates. Conclusions: The prevalence of HIV among Aboriginal people in Australia is low. Community-based programs that include both prevention messages for those at risk of infection and culturally appropriate clinical management and support for Aboriginal people living with HIV are needed to prevent HIV increasing among Aboriginal people.
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Blondell, Sarah J., Joseph Debattista, Mark P. Griffin, and Jo Durham. "'I think they might just go to the doctor': qualitatively examining the (un)acceptability of newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Queensland, Australia." Sexual Health 18, no. 1 (2021): 50. http://dx.doi.org/10.1071/sh20064.
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Background In high-income countries (HICs), migrants often have higher rates of late diagnosis of HIV than the host population. Timely HIV testing has significant implications for HIV prevention and management. Newer HIV testing approaches, namely provider-initiated testing and counselling (PITC), HIV rapid testing (HIV RT) and HIV self-testing (HIV ST), aim to reach those populations most at risk and, particularly, those who have not previously tested for HIV. Methods: This study used semi-structured interviews to examine the (un)acceptability, barriers and facilitators to newer HIV testing approaches (i.e. PITC, HIV RT and HIV ST) among Vietnamese-born migrants (n = 10) in greater-Brisbane, Queensland, Australia. Results: Vietnamese-born migrants had mixed perspectives on the (un)acceptability of newer HIV testing approaches. PITC was largely viewed by participants as a facilitator to HIV testing for Vietnamese-born migrants. Likewise, HIV RT (undertaken by a doctor in a medical setting, as opposed to a trained community member in a community setting) was generally considered to facilitate HIV testing. HIV ST was largely not considered acceptable to Vietnamese-born migrants and they would prefer to go to a doctor for HIV testing. Several factors were identified that either facilitate or act as barriers to newer HIV testing approaches, including privacy; cost of (accessing) HIV testing; comfort and convenience; healthcare provider relationship; risk perception; symptoms; and technical and emotional support. Conclusions: There is a need to understand migrants’ HIV testing preferences if poorer HIV-related outcomes are to be overcome. The findings from this study show a preference for doctor-centred HIV testing, due to enhanced privacy, accuracy and support.
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Schmidt, Heather-Marie A., Ruthy McIver, Rebecca Houghton, Christine Selvey, Anna McNulty, Rick Varma, Andrew E. Grulich, and Joanne Holden. "Nurse-led pre-exposure prophylaxis: a non-traditional model to provide HIV prevention in a resource-constrained, pragmatic clinical trial." Sexual Health 15, no. 6 (2018): 595. http://dx.doi.org/10.1071/sh18076.
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There is little evidence and no standardised model for nurse-led HIV pre-exposure prophylaxis (PrEP). In 2016, public sexual health clinics in the state of New South Wales (NSW), Australia, participating in the population-scale PrEP access trial Expanded PrEP Implementation In Communities in New South Wales (EPIC-NSW) were authorised to adopt a nurse-led model of PrEP provision in order to facilitate the rapid expansion of PrEP access to more than 8000 participants in under 2 years without additional resources. The model has been implemented successfully in public clinics in 10 of 14 local health districts, with widespread support and no serious safety events reported. With the increasing importance of PrEP as an HIV prevention tool, non-traditional models of care, including nurse-led PrEP, are needed.
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Li, Bin, Peng Bi, Alison Ward, Charlotte Bell, and Christopher K. Fairley. "Trends and predictors of recent HIV testing over 22 years among a clinic sample of men who have sex with men in South Australia." Sexual Health 14, no. 2 (2017): 164. http://dx.doi.org/10.1071/sh16091.
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Background Increasing the frequency of HIV testing is crucial for effective HIV prevention and care. The aim of the present study was to determine whether there has been a change in HIV testing among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) clinic over the past two decades. Methods: Computerised medical records of MSM who attended the SASSH at their first visit between 1994 and 2015 were used to determine whether HIV testing had changed among MSM. First HIV tests in each calendar year and return tests within 12 months were analysed. Factors associated with recent HIV testing were also examined. Results: There were 24 036 HIV tests conducted among 8163 individual MSM over the study period. The proportion of newly registered MSM who reported ever being tested for HIV declined (Ptrend = 0.030), the proportion who reported recent HIV testing did not change (Ptrend = 0.955) and the proportion who have had current HIV testing increased (Ptrend = 0.008). The proportion of MSM who returned to the clinic for HIV testing within 12 months did not change (Ptrend >0.05), with less than 40% of MSM returning for HIV testing. Factors independently associated with recent HIV testing included MSM aged ≥20 years, (odds ratio (OR) 1.79; 95% confidence interval (CI) 1.53–2.10), higher education (OR 1.28; 95% CI 1.12–1.45), non-Caucasian (African OR 1.68; 95% CI 1.30–2.17), having multiple sex partners (OR 1.47; 95% CI 1.29–1.69), having had sex interstate (OR 1.61; 95% CI 1.42–1.82) or overseas (OR 1.53; 95% CI 1.33–1.76) and injecting drug use (OR 1.56; 95% CI 1.29–1.88). Conclusions: HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population.
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Mauck, Daniel E., Merhawi T. Gebrezgi, Diana M. Sheehan, Kristopher P. Fennie, Gladys E. Ibañez, Eric A. Fenkl, and Mary Jo Trepka. "Population-based methods for estimating the number of men who have sex with men: a systematic review." Sexual Health 16, no. 6 (2019): 527. http://dx.doi.org/10.1071/sh18172.
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The objective of this systematic review was to summarise population-based methods (i.e. methods that used representative data from populations) for estimating the population size of men who have sex with men (MSM), a high-risk group for HIV and other sexually transmissible infections (STIs). Studies using population-based methods to estimate the number or percentage of MSM or gay men were included. Twenty-eight studies met the inclusion criteria. Seven studies used surveillance data, 18 studies used survey data, and six studies used census data. Sixteen studies were conducted in the US, five were conducted in European countries, two were conducted in Canada, three were conducted in Australia, one was conducted in Israel, and one was conducted in Kenya. MSM accounted for 0.03–6.5% of men among all studies, and ranged from 3.8% to 6.4% in the US, from 7000 to 39100 in Canada, from 0.03% to 6.5% in European countries, and from 127947 to 182624 in Australia. Studies using surveillance data obtained the highest estimates of the MSM population size, whereas those using survey data obtained the lowest estimates. Studies also estimated the MSM population size by dimensions of sexual orientation. In studies examining these dimensions, fewer people identified as MSM than reported experience with or attraction to other men. Selection bias, differences in recall periods and sampling, or stigma could affect the estimate. It is important to have an estimate of the number of MSM to calculate disease rates, plan HIV and STI prevention efforts, and to allocate resources for this group.
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Goddard, Sian Louise, Isobel M. Poynten, Kathy Petoumenous, Fengyi Jin, Richard J. Hillman, Carmella Law, Jennifer M. Roberts, et al. "Prevalence, incidence and predictors of anal Chlamydia trachomatis, anal Neisseria gonorrhoeae and syphilis among older gay and bisexual men in the longitudinal Study for the Prevention of Anal Cancer (SPANC)." Sexually Transmitted Infections 95, no. 7 (April 24, 2019): 477–83. http://dx.doi.org/10.1136/sextrans-2019-054011.
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ObjectivesSexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM.MethodsThe Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire (‘interval diagnoses’) and STI testing occurred (‘study visit diagnoses’). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI.ResultsAmong 617 GBM, the median age was 49 years (range 35–79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with ‘fuck-buddies’ was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI.DiscussionThere was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.
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Ryan, Kathleen E., Anna L. Wilkinson, David Leitinger, Carol El-Hayek, Claire Ryan, Alisa Pedrana, Margaret Hellard, and Mark Stoové. "Characteristics of gay, bisexual and other men who have sex with men testing and retesting at Australia’s first shop-front rapid point-of-care HIV testing service." Sexual Health 13, no. 6 (2016): 560. http://dx.doi.org/10.1071/sh16027.
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Background: HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia’s first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers. Methods: Univariable and multivariable logistic regression using data collected at clients’ first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!. Results: In the first year, 1226 GBM tested at PRONTO! (median age = 30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.10–2.0), reporting a regular check-up as reason to test (AOR = 1.53, 95% CI = 1.01–2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR = 1.73, 95% CI = 1.09–2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (<30 years; AOR = 1.78, 95% CI = 1.18–2.71) and negatively associated with reporting a regular check-up as reason to test (AOR = 0.45, 95% CI = 0.29–0.71) and recent group sex (AOR = 0.37, 95% CI = 0.23–0.59). Conclusion: Despite PRONTO! being designed to reduce barriers to HIV testing, return testing rates in the first year were low and not associated with client risk. Service refinements, including the provision of comprehensive sexually transmissible infection testing, are needed to increase testing frequency and enhance population HIV prevention benefits.
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Waling, Andrea, Roz Bellamy, Paulina Ezer, Lucille Kerr, Jayne Lucke, and Christopher Fisher. "‘It’s kinda bad, honestly’: Australian students’ experiences of relationships and sexuality education." Health Education Research 35, no. 6 (September 15, 2020): 538–52. http://dx.doi.org/10.1093/her/cyaa032.
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Abstract Relationships and sexuality education for young people in Australia and elsewhere is a controversial topic. Numerous studies in Australia have focused on curriculum, policy, teachers, schools, sexting and other behaviours, and knowledge regarding sexually transmitted infection (STI)/human immunodeficiency virus (HIV) and pregnancy prevention. Few large-scale national studies have engaged with young people about what they want out of their sex education, and what they suggest would be most valuable for future programs in Australia. Data for the study included qualitative comments about experiences of sex education (n = 2316) provided in a national survey of adolescent sexual health. An initial thematic inductive analysis identified comments falling into two dominant themes: positive and negative experiences of their sex education. Results indicate that young people in Australia are articulate and understanding of the gaps in their sex education. A majority of comments highlighted negative experiences. These comments primarily discussed issues of delivery (timing, environment, person) and content quality (comprehensiveness). A minority highlighted positive commentary also around delivery (environment, person) and content quality (comprehensiveness). The findings of this study illuminate contemporary adolescent concerns regarding their experiences of education. Understanding these experiences can inform future curriculum development, teacher training and the design and implementation of policy.
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Macdonald, Virginia, Gregory J. Dore, Janaki Amin, and Ingrid van Beek. "Predictors of completion of a hepatitis B vaccination schedule in attendees at a primary health care centre." Sexual Health 4, no. 1 (2007): 27. http://dx.doi.org/10.1071/sh06008.
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Background: In Australia, rates of hepatitis B (HBV) transmission continue to be higher in certain populations, including commercial sex workers and injecting drug users (IDU). This study aims to identify rates and predictors of completion of a HBV vaccination schedule in ‘high-risk’ attendees of a primary health care centre in Sydney. Methods: All clients who attended Kirketon Road Centre, a primary health care centre located in Kings Cross, Sydney, with no evidence of HBV immunity were included in the cohort. The study design was observational with historical controls. The main outcome measure was completion of a three-dose HBV vaccine schedule in the study period. Results: Among 2085 clients who received a first vaccination, 1013 (49%) received a second and 435 (21%) received a third vaccination. Univariate analysis found that significant predictors of completion of the vaccine schedule were intention to administer an accelerated schedule (OR 1.49, P = 0.004), not being an IDU (OR 1.29, P = 0.02) and shorter time between first visit and first vaccine dose (OR 1.24, P for trend <0.0001); however, on multivariate analysis, not being an IDU was no longer a predictor of vaccine completion. Conclusion: Implementation of an accelerated vaccination schedule improved completion rates but they were still low, despite the provision of free vaccination in a service specifically targeting the needs of sex workers, IDU and other marginalised populations. Increasing HBV vaccine uptake and completion rates in Australian adults is an important public health issue not only for the prevention of HBV but also for the future application of other potential vaccines, including those against HIV and hepatitis C.
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Cornelisse, Vincent J., Christopher K. Fairley, Tiffany Phillips, Sandra Walker, and Eric PF Chow. "Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk." International Journal of STD & AIDS 29, no. 1 (July 6, 2017): 44–50. http://dx.doi.org/10.1177/0956462417717647.
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‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).
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Barber, Bridget, Margaret Hellard, Rebecca Jenkinson, Tim Spelman, and Mark Stoove. "Sexual history taking and sexually transmissible infection screening practices among men who have sex with men: a survey of Victorian general practitioners." Sexual Health 8, no. 3 (2011): 349. http://dx.doi.org/10.1071/sh10079.
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Background HIV notifications among men who have sex with men (MSM) in Victoria, Australia, have increased recently. Early HIV diagnosis is a prevention strategy that requires general practitioners (GP) to recognise at-risk individuals and perform screening. Sexual history taking is part of this process. Methods: A cross-sectional survey of 354 Victorian GP to investigate attitudes and practices regarding sexual history taking and screening for HIV in MSM. Results: In total, 185 (53%, 95% CI: 47–58%) GPs reported being ‘very likely’ to take a sexual history from MSM presenting for a routine check-up; however 161 (46%, 95% CI: 40–51%) would not do so during the initial consultation. Barriers to sexual history taking included time constraints (28%, 95% CI: 24–36%), feeling inadequately trained (25%, 95% CI: 21–30%), discomfort discussing sex (24%, 95% CI: 20–29%) and fear of patient embarrassment (24%, 95% CI: 20–29%). Factors associated with a reduced likelihood included being male, time constraints, fear of patient embarrassment, and moral or religious views. Most GP (63%, 95% CI: 58–68%) reported they would offer HIV screening 3–6 monthly for MSM with casual partners; 54 (16%, 95% CI: 12–20%) would offer screening only on request. Being unlikely to take a sexual history and fear of patient embarrassment were associated with a decreased likelihood of offering an HIV test. Conclusion: GP often fail to take a sexual history from MSM, limiting opportunities to offer HIV screening. Strategies are required to increase GPs’ awareness of sexual health as a priority for MSM.
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Peel, Joanne, Eric P. F. Chow, Ian Denham, Tina Schmidt, Andrew Buchanan, Christopher K. Fairley, Deborah A. Williamson, Melanie Bissessor, and Marcus Y. Chen. "Clinical Presentation of Incident Syphilis Among Men Who Have Sex with Men Taking HIV Pre-Exposure Prophylaxis in Melbourne, Australia." Clinical Infectious Diseases 73, no. 4 (February 1, 2021): e934-e937. http://dx.doi.org/10.1093/cid/ciab052.
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Abstract Background Current international guidelines on human immunodeficieny virus (HIV) Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine 3-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled3-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. Methods This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at 3-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. Results There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary, and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. Conclusions Syphilis screening at routine 3-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.
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Tagaya, Yutaka, Masao Matsuoka, and Robert Gallo. "40 years of the human T-cell leukemia virus: past, present, and future." F1000Research 8 (February 28, 2019): 228. http://dx.doi.org/10.12688/f1000research.17479.1.
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It has been nearly 40 years since human T-cell leukemia virus-1 (HTLV-1), the first oncogenic retrovirus in humans and the first demonstrable cause of cancer by an infectious agent, was discovered. Studies indicate that HTLV-1 is arguably one of the most carcinogenic agents to humans. In addition, HTLV-1 causes a diverse array of diseases, including myelopathy and immunodeficiency, which cause morbidity and mortality to many people in the world, including the indigenous population in Australia, a fact that was emphasized only recently. HTLV-1 can be transmitted by infected lymphocytes, from mother to child via breast feeding, by sex, by blood transfusion, and by organ transplant. Therefore, the prevention of HTLV-1 infection is possible but such action has been taken in only a limited part of the world. However, until now it has not been listed by the World Health Organization as a sexually transmitted organism nor, oddly, recognized as an oncogenic virus by the recent list of the National Cancer Institute/National Institutes of Health. Such underestimation of HTLV-1 by health agencies has led to a remarkable lack of funding supporting research and development of treatments and vaccines, causing HTLV-1 to remain a global threat. Nonetheless, there are emerging novel therapeutic and prevention strategies which will help people who have diseases caused by HTLV-1. In this review, we present a brief historic overview of the key events in HTLV-1 research, including its pivotal role in generating ideas of a retrovirus cause of AIDS and in several essential technologies applicable to the discovery of HIV and the unraveling of its genes and their function. This is followed by the status of HTLV-1 research and the preventive and therapeutic developments of today. We also discuss pending issues and remaining challenges to enable the eradication of HTLV-1 in the future.
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Stardust, Zahra, Johann Kolstee, Stefan Joksic, James Gray, and Siobhan Hannan. "A community-led, harm-reduction approach to chemsex: case study from Australia’s largest gay city." Sexual Health 15, no. 2 (2018): 179. http://dx.doi.org/10.1071/sh17145.
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Rates of drug use remain substantially higher among gay and bisexual men (GBM) and people living with HIV (PLHIV) in Sydney, New South Wales, Australia. The use of drugs to enhance sexual pleasure within cultures of Party and Play creates opportunities to discuss sexual health, mental health, consent and wellbeing. Community organisations with a history of HIV prevention, care, treatment are well-placed to respond. ACON’s (formerly the AIDS Council of New South Wales) multi-dimensional response to ‘chemsex’ includes: direct client services support for individuals seeking to manage or reduce their use; health promotion activities that support peer education; partnerships with research institutions to better understand cultures of chemsex; and policy submissions that call for drug use to be approached as a health, rather than a criminal, issue. The approach speaks the language of Party and Play subcultures; employs culturally relevant terminology and imagery; uses content designed, created and delivered by peers; and operates within a pleasure-positive, harm-reduction and community-led framework. These interventions have led to increased service uptake, strong community engagement, robust research partnerships and the recognition of GBM as a priority population in relevant strategies.
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Horn, Ryan, Denton Callander, and Bridget Haire. "Perceptions of sexually transmissible infection pre-exposure prophylaxis: a qualitative study of high-risk gay and bisexual men in Sydney, New South Wales." Sexual Health 17, no. 2 (2020): 129. http://dx.doi.org/10.1071/sh19175.
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Background Novel sexually transmissible infection (STI) prevention strategies are needed to combat increasing bacterial STI incidences alongside decreasing condom use among gay and bisexual men (GBM) in Australia. Sexually transmissible infection pre-exposure prophylaxis (STI-PrEP) using regular doxycycline is one such strategy that is the subject of ongoing research. However, a lack of qualitative data regarding the conceptualisation, perceived risks, perceived benefits and preferred dosing strategies of STI-PrEP may impede future research and implementation efforts. Methods: Semistructured in-depth interviews were conducted with 13 high-risk GBM residing in Sydney, Australia. Interviews were audio recorded, transcribed verbatim and then analysed thematically. Results: STI-PrEP was largely conceptualised using pre-existing knowledge of HIV-PrEP. The perceived benefits, including a reduced incidence of STIs, destigmatisation and a ‘peace of mind’, often outweighed the perceived risks, including side effects, antibiotic resistance and stigmatisation of consumers. A daily dosing regimen was preferred unanimously by participants when compared with event-driven or episodic strategies. Conclusions: Participants of this study were cautiously optimistic regarding the concept of STI-PrEP. The findings suggest that, in addition to examining the effectiveness of STI-PrEP, future implementation studies should also focus on concerns regarding side effects and monitoring antibiotic resistance, as well as considering the acceptability and potential for stigmatisation of STI-PrEP consumers.
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Ward, James, Michael Costello-Czok, Jon Willis, Mark Saunders, and Cindy Shannon. "So Far, So Good: Maintenance of Prevention Is Required to Stem HIV Incidence in Aboriginal and Torres Strait Islander Communities in Australia." AIDS Education and Prevention 26, no. 3 (June 2014): 267–79. http://dx.doi.org/10.1521/aeap.2014.26.3.267.
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Body, Amy, Jennifer F. Hoy, Allen C. Cheng, and Michelle L. Giles. "Incident hepatitis B infection subsequent to the diagnosis of HIV infection in a Melbourne cohort: missed opportunities for prevention." Sexual Health 11, no. 1 (2014): 5. http://dx.doi.org/10.1071/sh13019.
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Background The characteristics associated with incident hepatitis B (HBV) infection in HIV-positive individuals are not well described in the Australian setting. The aim of this study is to determine the characteristics of and risk factors for HBV infection within HIV-infected individuals in a Melbourne cohort between 1985 and 2011. Methods: Individuals susceptible to HBV at their HIV diagnosis were identified using their HBV serology stored within the Victorian HIV database. Within this group, those who had a subsequent positive test for hepatitis B surface antigen or hepatitis B core antibody were identified as infected with HBV after their HIV diagnosis. Incident cases were matched with controls from the initially susceptible group who did not seroconvert for analysis. An incidence rate was calculated from the number of seroconversions and the cumulative time at risk (in 1000 patient-years of follow-up). Results: Of the 4711 patients with HIV seen more than once, 3223 had HBV testing. Of the 174 with positive HBV test results, 39 individuals met the definition of seroconversion after HIV diagnosis, representing the incident cases. The estimated HBV incidence rate was 1.81 (95% confidence interval: 1.28–2.47) per 1000 patient-years at risk. These individuals form the basis of a detailed case series and case–control study. Data collected include demographic details, immunological and virological characteristics, antiretroviral treatment and vaccination history. Conclusions: HIV-infected individuals should be screened for HBV and monitored for incident infection. Optimal control of HIV and improved vaccination coverage provide the best opportunity for prevention.