Journal articles on the topic 'HIV infections – Australia'
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1
Mallitt, Kylie-Ann, David P. Wilson, Ann McDonald, and Handan Wand. "HIV incidence trends vary between jurisdictions in Australia: an extended back-projection analysis of men who have sex with men." Sexual Health 9, no. 2 (2012): 138. http://dx.doi.org/10.1071/sh10141.
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Background Trends in HIV diagnoses differ across Australia and are primarily driven by men who have sex with men (MSM). We use national population surveillance data to estimate the incidence of HIV infections among MSM by jurisdiction and infer the proportion of undiagnosed infections. Methods: Annual surveillance data for AIDS diagnoses, HIV diagnoses and recently acquired HIV infections were obtained from 1980 to 2009. A modified statistical back-projection method was used to reconstruct HIV incidence by jurisdiction. Results: HIV incidence among MSM peaked for all jurisdictions in the early 1980s and then declined into the early 1990s, after which incidence increased. Trends then differ between jurisdictions. In New South Wales (NSW) and South Australia, estimated HIV incidence peaked at 371 and 50 cases respectively in 2003, and has since decreased to 258 and 24 cases respectively in 2009. HIV infections in Queensland (Qld) have more than doubled over the past decade, from 84 cases in 2000 to 192 cases in 2009. Victoria and Western Australia have seen a rise in HIV incidence from 2000 to 2006 (to a peak of 250 and 38 incident cases respectively), followed by a plateau to 2009. HIV incidence in the Northern Territory, Tasmania and Australian Capital Territory have increased since 2000; however, case numbers remain small (<20 per year). The estimated proportion of HIV infections not yet diagnosed to 2009 ranges from 10% (NSW) to 18% (Qld), with an average of 12% across Australia. Conclusions: HIV diagnosis trends among MSM in Australia reflect changes in estimated incidence to 2009, and reveal the largest increase in the past 10 years in Qld.
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Gray, Richard T., Jo Watson, Aaron J. Cogle, Don E. Smith, Jennifer F. Hoy, Lisa A. Bastian, Robert Finlayson, et al. "Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive." Sexual Health 15, no. 1 (2018): 13. http://dx.doi.org/10.1071/sh16237.
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Background The aim of this study is to estimate the reduction in new HIV infections and resultant cost outcomes of providing antiretroviral treatment (ART) through Australia’s ‘universal access’ health scheme to all temporary residents with HIV infection living legally in Australia, but currently deemed ineligible to access subsidised ART via this scheme. Methods: A mathematical model to estimate the number of new HIV infections averted and the associated lifetime costs over 5 years if all HIV-positive temporary residents in Australia had access to ART and subsidised medical care was developed. Input data came from a cohort of 180 HIV-positive temporary residents living in Australia who are receiving free ART donated by pharmaceutical companies for up to 4 years. Results: Expanding ART access to an estimated total 450 HIV+ temporary residents in Australia for 5 years could avert 80 new infections. The model estimated the total median discounted (5%) cost for ART and associated care to be A$36 million, while the total savings in lifetime-discounted costs for the new infections averted was A$22 million. Conclusions: It is estimated that expanded access to ART for all HIV-positive temporary residents in Australia will substantially reduce HIV transmission to their sexual partners at little additional cost. In the context of Australia’s National HIV strategy and Australia’s endorsement of global goals to provide universal access to ART for all people with HIV, this is an important measure to remove inequities in the provision of HIV-related treatment and care.
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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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David Lum, Gary. "Problems in diagnosing sexually transmitted infections in remote Australia." Microbiology Australia 28, no. 1 (2007): 18. http://dx.doi.org/10.1071/ma07017.
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Times are changing. The National Aboriginal and Torres Strait Islander Sexual Health and Blood Borne Virus Strategy 2005-2008 provides current commentary on the problems facing Australia?s Indigenous population. While the rates of sexually transmitted infections have always been higher in Indigenous Australians, there is some evidence of increasing rates of HIV infection. The rate of Chlamydia infection in non-Indigenous Australians has doubled between 1999 and 2003, while the rate of infection in some populations of Indigenous Australians has moved from 658 per 100 000 to 1140 per 100 000 population. Indigenous Australians are forty-times more likely to be infected with the gonococcus than non-Indigenous Australian men and women. It should not be surprising that Indigenous Australian rates of syphilis are unacceptably high at ~250 per 100 000 population and almost non-existent in the non-Indigenous population.
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Drummond, Peter D., Ayse Mizan, and Bernadette Wright. "HIV/AIDS knowledge and attitudes among West African immigrant women in Western Australia." Sexual Health 5, no. 3 (2008): 251. http://dx.doi.org/10.1071/sh07077.
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Background: Most women who live in sub-Saharan countries have heard of HIV/AIDS, but there is still widespread misunderstanding about how HIV is spread, the consequences of infection, and how to protect against infection. The aim of the present study was to investigate knowledge about HIV and attitudes towards condom use in West African refugees who had settled in Perth, Western Australia, within the past 5 years. Methods: Knowledge about transmission of HIV, myths about how HIV is spread, incorrect beliefs about protective factors, the effectiveness of condoms in protecting against sexually transmissible infections, and attitudes towards condom use were investigated by survey in 51 West African women, and in 100 Australian women for comparison. Where possible, each West African woman was matched for age and level of education with an Australian woman. Results: Knowledge of HIV was poorest in the least educated West African women, but many of the more highly educated women also had misconceptions about how HIV is spread, how to protect against HIV, and the effectiveness of condoms in protecting against HIV. Moreover, most West African women held negative attitudes towards condom use. Within the Australian sample, HIV knowledge was greatest in women with tertiary qualifications, and was greater in younger than older women; in addition, attitudes towards condom use differed across the age span. Conclusions: The findings in the present study suggest that educational programs that focus on knowledge about HIV should be tailored to meet the needs and cultural sensitivities of newly emerging immigrant communities, and should target particular demographic groups within the Australian population.
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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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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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Middleton, Melanie G., Andrew E. Grulich, Ann M. McDonald, Basil Donovan, Jane S. Hocking, and John M. Kaldor. "Could sexually transmissible infections be contributing to the increase in HIV infections among men who have sex with men in Australia?" Sexual Health 5, no. 2 (2008): 131. http://dx.doi.org/10.1071/sh07086.
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Background: To review existing data on sexually transmissible infections (STI) in men who have sex with men in Australia in order to determine the possible contribution of STI to diverging trends in HIV notifications in different states. Methods: We reviewed data from multiple sources, including routine national surveillance data, laboratory surveillance data, self-reported information on STI testing in men who have sex with men and ad hoc reports of STI prevalence. Results: We found increasing rates of gonorrhoea and infectious syphilis notifications in urban men in Australia between 1997 and 2006, and increasing rates of chlamydia notifications in men aged 30–49 years. There was little difference in these trends by state. Differences in the population groups sampled meant we were unable to gain further information on trends in men who have sex with men from these studies. Data on STI testing showed an increase in anal STI testing between 2003 and 2006, which may have increased the number of diagnoses of chlamydia and gonorrhoea for men who have sex with men during this period. Conclusions: Over the past 10 years, there has been a substantial increase in diagnoses of gonorrhoea and infectious syphilis, and probably chlamydia, in men who have sex with men in Australia. However, it is unlikely that changes in the pattern of STI transmission are responsible for the recent divergence in HIV rates between Australian states because there is little evidence that trends in STI also differ by state.
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Heymer, Kelly-Jean, Matthias Wentzlaff-Eggebert, Elissa Mortimer, and David P. Wilson. "An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia." Sexual Health 9, no. 3 (2012): 220. http://dx.doi.org/10.1071/sh10148.
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Background As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. Methods: Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. Results: It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0–42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17 860 per infection averted (median, $13 651–24 287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. Conclusions: The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.
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Bennett, Charles L., Lauren E. Frohlich, Kathryn R. McCaffrey, June M. McKoy, Glenn E. Ramsey, and Julia S. Lindenberg. "National Responses to HIV Versus HCV-Infection from Virally Contaminated Blood Products among Persons with Hemophilia (PWH): More Different Than Alike." Blood 106, no. 11 (November 16, 2005): 3213. http://dx.doi.org/10.1182/blood.v106.11.3213.3213.
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Abstract Background: 95% of HIV- and HCV-infections among PWHs occurred with use of contaminated blood products prior to 1985. Overall, 20% to 90% of PWHs in developed countries have HIV- and/or HCV-infection. We compared country-specific public health approaches, judicial activities, and compensation for these viral infections. Methods: Reports from hemophilia organizations, national ministries of health, published articles, and the World Federation of Hemophilia were reviewed. Results: Except for the United States, the number of PWHs who developed HCV-infection from contaminated blood products was 1.5 to 3-fold as great as for HIV-infection- as a result of delayed use of heat-treated blood products, importation in late 1984 of HCV-infected non-heat treated blood products from the United States, and failure to use surrogate laboratory marker hepatitis screening tests. Compensation funds for HIV-infected PWHs were established in Japan ($521,000 at Dx); France ($305,000 at Dx; $102,000 for AIDS); the United States ($115,000 at Dx); Ireland ($106,000 at Dx); the United Kingdom ($55,000 at Dx); Australia ($48,000 at Dx); Canada ($13,000 at Dx/$18,000/yr); Germany ($12,000/yr for HIV; $24,000/yr for AIDS); and Italy ($6,000/yr; $82,000 at death). Compensation has also been provided to HCV-infected PWHs in Ireland ($266,000 at Dx); Canada ($251,000 at Dx); the United Kingdom ($33,000 at Dx; $42,000 if w/liver damage); and Italy ($10,000/yr; $37,000 at death). Conclusions: In most developed countries, despite a greater number of HCV-versus HIV-infected PWHs, markedly less attention has been paid to HCV-infected PWHs. All countries should review HCV-related blood safety decisions made in the 1980s and consider providing compensation to HCV-infected PWHs. A comparison of national responses to HIV and HCV infections from blood products Country -PWH (thousands) % PWH with HIV:HCV Man-dated HIV ELISA (date) Man-dated heat Rx factor (date) Anti-HBc marker screening (date) Nat’l Funds for HIV/HCV among PWHs (year) Nat’l Panels for HIV/HCV decisions (year) USA-20 50%:30% Mar 85 Oct 84 Oct 84 96/none 95/none Italy- 8.7 23%:55% Mar 85 Jul 85 None 92/98 92/05 GDR- 6 47%:90% Oct 85 Oct 85 None 95/none 94/none UK-6 28%:80% Oct 85 Jun 85 None 88/03 87/05 France-4 50%:90% Aug 85 Oct 85 None 89/none 91/none Japan-3.4 60%:90% Nov 86 Jun 86 None 88/none 96/none Canada-2 40%:88% Nov 85 Jul 85 None 89/98 97/none Australia-1.5 31%:90% May 85 Jan 85 None 89/none 88/none Ireland-0.3 36%:76% Oct 85 Feb 85 None 91/97 91/97
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Thng, Caroline Chun Mei. "A Review of Sexually Transmitted Infections in Australia – Considerations in 2018." Academic Forensic Pathology 8, no. 4 (December 2018): 938–46. http://dx.doi.org/10.1177/1925362118821492.
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Sexually transmitted infections (STIs) bear a high burden of disease and, subsequently, high health costs globally. Chlamydia, gonorrhoea, syphilis, and trichomoniasis contribute to nearly one million infections every day worldwide. Sexually transmitted infections continue to be the most frequently notified condition to the Australian National Notifiable Diseases Surveillance System and the numbers continue to increase. Australia has achieved several significant successes in reducing STIs and blood-borne viruses (BBV) including the significant decrease in genital warts in those less than 30 years old since 2007 following the launch of human papillomavirus vaccines in women, the virtual elimination of mother to child transmission of HIV, and the increased uptake of successful hepatitis C treatment following the availability of direct acting antiviral treatment on the Pharmaceutical Benefits Scheme. However, several challenges remain, including the ongoing rise of chlamydia, gonorrhoea, and syphilis over the last five years; the emergence of antibiotic resistance; and the increasing disparity in the prevalence of STIs and BBV in men who have sex with men, young people, and Aboriginal and Torres Strait Islander people, and challenges in the delivery of services to rural and remote Australia. In this paper, we aim to provide a snapshot of the current landscape and challenges for chlamydia, gonorrhoea, mycoplasma, syphilis and HIV infections in Australia.
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Richardson, Daniel, Hubert Chan, Rohan Bopage, David A. Lewis, Shailendra Sawleshwarkar, Charles Chung, and Jen Kok. "HIV-1 subtype variability and transmitted drug resistance in a culturally diverse population in Western Sydney, New South Wales, Australia." Sexual Health 17, no. 4 (2020): 377. http://dx.doi.org/10.1071/sh20013.
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Abstract Background Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) is an important contributor to antiretroviral treatment failure, and is associated with HIV-1 transmission among men who have sex with men (MSM), non-MSM clusters and individuals diagnosed with concurrent sexually transmissible infections (STI). Western Sydney has a culturally diverse population, with a high proportion of non-Australian-born individuals. This study describes the prevalence of TDR and non-B HIV-1 subtypes in a clinic-based population. Methods: A clinic database was examined for all newly diagnosed treatment-naïve HIV-1 patients and information on their HIV-1 resistance and subtype, demographics including country of birth and diagnosis of a bacterial sexually transmissible infection was collected. Results: Data were available from 74/79 individuals (62 cis-male, 16 cis-female and 1 transgender woman). Of the 74 genotypes, the prevalence of non-B subtypes and TDR was 43/74 (58%; 95%CI = 46.9–69.3) and 14/74 (19%; 95%CI = 10.0 to 27.8). It was also found that 30/79 (38%) had a concurrent bacterial STI. TDR was associated with subtype B infection (OR 3.53; 95%CI = 1.41–8.82; P = 0.007) and being born in Australia (OR 12.0; 95%CI = 2.45–58.86; P = 0.002). Conclusion: The relative prevalence of non-B HIV-1 subtypes and TDR is higher in Western Sydney than in the rest of Australia. TDR is associated with subtype B HIV-1 and being Australian born, suggesting ongoing local transmission. This highlights the diversity of the HIV epidemic locally and the need for interventions to prevent ongoing HIV transmission.
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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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Combs, Barry C., and Carolien M. Giele. "An increase in overseas acquired HIV infections among heterosexual people in Western Australia." Sexual Health 6, no. 1 (2009): 35. http://dx.doi.org/10.1071/sh08010.
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Background: There has been a recent increase in the number of heterosexually acquired HIV infections among non-Aboriginal people in Western Australia (WA), which has not been reported in other Australian jurisdictions. This report describes the epidemiological features of this increase. Methods: A descriptive analysis was conducted of newly diagnosed HIV infections among non-Aboriginal WA residents notified to the Department of Health from 2002 to 2006. Analysis outcomes included demographics, exposure categories, and place of HIV acquisition. Results: From 2002 to 2006, 258 new HIV diagnoses were notified among non-Aboriginal WA residents. Over this period, the number of notifications increased from 41 cases in 2002 (2.2 cases/100 000 population) to 66 cases in 2006 (3.4 cases/100 000 population). Overall, 107 (42%) of the cases were heterosexually acquired, and the annual number increased threefold from 2002 to 2006 (12 to 36 cases, respectively). Of these cases, 64 (60%) were male and 43 (40%) were female. The majority (89%) of male cases acquired HIV overseas, mostly in countries other than their region of birth; South-east Asia was the most common place of acquisition reported. Over half (56%) of the female cases acquired HIV overseas, mainly in their region of birth (83%), and sub-Saharan Africa was the most common place of acquisition. Conclusion: There has been a recent increase in heterosexually acquired HIV infections among male and female WA residents, many of whom reported acquiring HIV overseas. Safe sex campaigns in WA should continue to reinforce safe sex messages among people travelling overseas.
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Fairley, Christopher K., Glenda Fehler, Sharon R. Lewin, Marian Pitts, Marcus Y. Chen, Catriona S. Bradshaw, and Jane S. Hocking. "Sexually transmissible infection and HIV management among men who have sex with men with and without HIV: survey of medical practitioners who are members of the Australasian Society for HIV Medicine." Sexual Health 5, no. 2 (2008): 155. http://dx.doi.org/10.1071/sh07094.
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Background: Rates of HIV in New South Wales (NSW) have been stable, but have increased significantly in other Australian states. The reasons for this are unknown and may be associated with differences in the management of sexually transmissible infections (STI) and HIV in different states in Australia. Our aim was to determine if the use of suppressive treatment for genital herpes, the treatment of HIV or STI screening practices were different between states in Australia. Methods: This study was a cross-sectional survey of medical practitioners who are S100 prescribers and members of the Australian Society for HIV Medicine. Results: In general, there were no differences between the clinical practices of practitioners in NSW and other states except that in NSW fewer practitioners tested HIV-positive men who have sex with men (MSM) for syphilis annually (NSW 78% v. others 87%, P = 0.04) or treated MSM with advanced HIV disease (CD4 < 150 × 106 cells L–1) with acicylovir in the absence of herpes simplex virus (HSV) (NSW 4% v. others 13%, P = 0.03), and more practitioners in NSW tested HIV-negative MSM for HSV type-specific serology (NSW 21% v. others 11%, P = 0.02). Conclusions: It is unlikely that the minor differences in HSV and HIV treatment or STI screening practices among practitioners in NSW and other Australian states explains the differences in HIV notifications between these two areas.
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Bourne, Christopher, Meeyin Lam, Christine Selvey, Rebecca Guy, and Denton Callander. "Changing pattern of sexually transmissible infections and HIV diagnosed in public sexual health services compared with other locations in New South Wales, 2010–14." Sexual Health 15, no. 4 (2018): 366. http://dx.doi.org/10.1071/sh17183.
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Background In Australia, testing and treatment for HIV and other sexually transmissible infections (STIs) is usually managed in general practice, while publicly funded sexual health clinics (PFSHC) attract people at higher risk for infection. The proportion of HIV and STI diagnoses in New South Wales (NSW) occurring in PFSHC stratified by priority population was investigated. Methods: From 2010 to 2014, NSW notification frequencies for chlamydia, gonorrhoea, infectious syphilis, and HIV were compared with the number of diagnoses in PFSHC. The annual proportion of diagnoses at PFSHC was calculated and Wilcoxon rank-sum tests assessed trends. Diagnoses from PFSHC were also organised by priority population, including gay and bisexual men (GBM), people living with HIV, Aboriginal and Torres Strait Islander people, people who use injecting drugs, sex workers and young people. Results: The annual proportion of HIV and STIs diagnosed at PFSHC increased (all P < 0.001): chlamydia from 12% to 15%, gonorrhoea 23% to 38%, infectious syphilis 21% to 40% and HIV 22% to 30%. Overall, the majority of all infections diagnosed at PFSHC were among GBM, with the proportional distribution of chlamydia increasing from 32% to 46% among GBM (P < 0.001) and decreasing among young people (50% to 40%; P < 0.001). There were no other significant changes by population or infection at PFSHC. Conclusions: Increasing proportions of STI and HIV are being diagnosed at NSW PFSHC, mostly among GBM. PFSHC reorientation to priority populations continues to make a large and increasing contribution to STI and HIV control efforts in NSW.
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Di Giallonardo, Francesca, Angie Pinto, Phillip Keen, Ansari Shaik, Alex Carrera, Hanan Salem, Christine Selvey, et al. "Increased HIV Subtype Diversity Reflecting Demographic Changes in the HIV Epidemic in New South Wales, Australia." Viruses 12, no. 12 (December 6, 2020): 1402. http://dx.doi.org/10.3390/v12121402.
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Changes over time in HIV-1 subtype diversity within a population reflect changes in factors influencing the development of local epidemics. Here we report on the genetic diversity of 2364 reverse transcriptase sequences from people living with HIV-1 in New South Wales (NSW) notified between 2004 and 2018. These data represent >70% of all new HIV-1 notifications in the state over this period. Phylogenetic analysis was performed to identify subtype-specific transmission clusters. Subtype B and non-B infections differed across all demographics analysed (p < 0.001). We found a strong positive association for infections among females, individuals not born in Australia or reporting heterosexual transmission being of non-B origin. Further, we found an overall increase in non-B infections among men who have sex with men from 50 to 79% in the last 10 years. However, we also found differences between non-B subtypes; heterosexual transmission was positively associated with subtype C only. In addition, the majority of subtype B infections were associated with clusters, while the majority of non-B infections were singletons. However, we found seven non-B clusters (≥5 sequences) indicative of local ongoing transmission. In conclusion, we present how the HIV-1 epidemic has changed over time in NSW, becoming more heterogeneous with distinct subtype-specific demographic associations.
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Murray, John M., Garrett Prestage, Jeffrey Grierson, Melanie Middleton, and Ann McDonald. "Increasing HIV diagnoses in Australia among men who have sex with men correlated with the growing number not taking antiretroviral therapy." Sexual Health 8, no. 3 (2011): 304. http://dx.doi.org/10.1071/sh10114.
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Background Australia has experienced rising notifications of HIV diagnoses despite widely available combination antiretroviral therapy (CART). New HIV diagnoses have also been younger than the average age of those living with HIV. We investigated the degree to which several risk factors could explain this rise in notifications and the younger age profile. Methods: Numbers and ages of men who have sex with men (MSM) living with HIV in Australia from 1983 to 2007 were calculated from notifications of HIV diagnoses and deaths. We compared the trend over time as well as the average ages of MSM newly diagnosed with HIV infection from 1998 to 2007 with those for: notifications of gonorrhoea and syphilis, total MSM living with HIV infection, and the component not on CART. Results: The percentage of younger MSM not taking CART has increased since 1998 (aged <30 years P < 0.001; 30–39 years P = 0.004). The trend of new HIV diagnoses was most significantly correlated with the total number of MSM living with HIV infection and the sector not taking CART (P < 0.0001). Based on similarity of average ages, MSM living with HIV infection and not taking CART was the best predictor of the increasing trend in new HIV diagnoses (99.9999% probability, Akaike information criterion). Conclusions: Our analyses suggest MSM living with HIV infection and not taking CART could be the source of the increase in HIV infections. Consequently, greater CART enrolment should decrease HIV incidence, especially in younger MSM.
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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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Flexman, James. "Cat scratch disease in Australia." Microbiology Australia 33, no. 4 (2012): 174. http://dx.doi.org/10.1071/ma12174.
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Companion animals such as cats are important for their health benefits. However, one of the risks of bringing cats into the household is cat scratch disease (CSD), with kittens or stray cats posing the highest risk. CSD is a clinical syndrome caused mainly by Bartonella henselae and is characterised by regional lymphadenopathy in patients with a history of close cat contact within three months of onset of symptoms. In most cases, CSD is a benign, self-limited infection, with more severe infections occurring only rarely in immunocompetent people. However, in immunocompromised patients, including those post-organ transplantation or with advanced HIV infection, the disease can be more severe and avoiding exposure needs to be considered. Improving flea control is also important, as transmission among cats occurs via the cat flea Ctenocephalides felis. To add to the data on B. henselae in Australia, I will report on some previously unpublished data on the seroprevalence and percentage of culture positives in WA domestic cats.
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Hoare, Alexander, Richard T. Gray, and David P. Wilson. "Could implementation of Australia's National Gay Men's Syphilis Action Plan have an indirect effect on the HIV epidemic?" Sexual Health 9, no. 2 (2012): 144. http://dx.doi.org/10.1071/sh10145.
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Objectives The number of incident infections of syphilis and HIV have increased over the past decade across Australia, particularly among gay men. In other industrialised settings, syphilis epidemics have also resurged coincidentally with increases in HIV diagnoses. Sexually transmissible infections (STI) are a biologically plausible cofactor for increasing HIV transmission. We pose the question: could strategies purely targeting syphilis also have an indirect impact on HIV incidence? Methods: We developed an agent-based computer model that simulates the transmission and disease progression of HIV and syphilis among a population of sexually active gay men, calibrated to reflect the epidemics in Victoria, Australia. The model was informed by detailed behavioural data from a variety of sources and was used to investigate the potential epidemiological impact of different public health interventions. Results: Assuming that syphilis could act as a biological cofactor for HIV transmission, from no effect to increasing risk by five-fold, our model indicates that if Australia’s syphilis action plan is effectively implemented then the number of HIV infections could decrease by up to 48% over the next decade in the absence of any specific HIV interventions. Conclusion: It is plausible that effective implementation of interventions targeting syphilis epidemics can have an indirect effect of mitigating the spread of HIV. The possible effects of STI should be considered in the design, implementation and evaluation of public health strategies and programs.
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Huang, Rae-Lin, and Paul J. Torzillo. "Challenging STIs in remote Central Australia." Microbiology Australia 30, no. 5 (2009): 202. http://dx.doi.org/10.1071/ma09202.
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Sexually transmitted infections (STIs) are endemic in remote Central Australia in Aboriginal communities, but usually don?t prompt individuals to seek testing or treatment. Untreated, a proportion of such infections result in ectopic pregnancies, miscarriages, infertility and enhanced transmission of HIV. The majority of STIs in Central Australia can be diagnosed with current nucleic acid amplification test (NAAT) technologies and treated with single-dose antibiotic treatment. Successful long-term STI control has been achieved in some areas of remote Central Australia by increasing access to testing and treatment for STIs as part of a comprehensive program. Successful control of gonorrhoea also depends on adequate antimicrobial surveillance, which is particularly difficult to achieve in remote areas of Australia.
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Gray, Richard T., David P. Wilson, Rebecca J. Guy, Mark Stoové, Margaret E. Hellard, Garrett P. Prestage, Toby Lea, John de Wit, and Martin Holt. "Undiagnosed HIV infections among gay and bisexual men increasingly contribute to new infections in Australia." Journal of the International AIDS Society 21, no. 4 (April 2018): e25104. http://dx.doi.org/10.1002/jia2.25104.
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Di Giallonardo, Francesca, Angie N. Pinto, Phillip Keen, Ansari Shaik, Alex Carrera, Hanan Salem, Barbara Telfer, et al. "Limited Sustained Local Transmission of HIV-1 CRF01_AE in New South Wales, Australia." Viruses 11, no. 5 (May 27, 2019): 482. http://dx.doi.org/10.3390/v11050482.
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Australia’s response to the human immunodeficiency virus type 1 (HIV-1) pandemic led to effective control of HIV transmission and one of the world’s lowest HIV incidence rates—0.14%. Although there has been a recent decline in new HIV diagnoses in New South Wales (NSW), the most populous state in Australia, there has been a concomitant increase with non-B subtype infections, particularly for the HIV-1 circulating recombinant form CRF01_AE. This aforementioned CRF01_AE sampled in NSW, were combined with those sampled globally to identify NSW-specific viral clades. The population growth of these clades was assessed in two-year period intervals from 2009 to 2017. Overall, 109 NSW-specific clades were identified, most comprising pairs of sequences; however, five large clades comprising ≥10 sequences were also found. Forty-four clades grew over time with one or two sequences added to each in different two-year periods. Importantly, while 10 of these clades have seemingly discontinued, the remaining 34 were still active in 2016/2017. Seven such clades each comprised ≥10 sequences, and are representative of individual sub-epidemics in NSW. Thus, although the majority of new CRF01_AE infections were associated with small clades that rarely establish ongoing chains of local transmission, individual sub-epidemics are present and should be closely monitored.
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Hoare, Alexander, David P. Wilson, David G. Regan, John Kaldor, and Matthew G. Law. "Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections." Sexual Health 5, no. 2 (2008): 169. http://dx.doi.org/10.1071/sh07099.
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Background: Since 1999 there has been an increase in the number of HIV diagnoses in Australia, predominantly among men who have sex with men (MSM), but the magnitude of increase differs between states: ~7% rise in New South Wales, ~96% rise in Victoria, and ~68% rise in Queensland. Methods: Epidemiological, clinical, behavioural and biological data were collated into a mechanistic mathematical model to explore possible reasons for this increase in HIV notifications in MSM. The model was then used to make projections to 2015 under various scenarios. Results: The model suggests that trends in clinical and behavioural parameters, including increases in unprotected anal intercourse, cannot explain the magnitude of the observed rise in HIV notifications, without a substantial increase in a ‘transmission-increasing’ factor. We suggest that a highly plausible biological factor is an increase in the prevalence of other sexually transmissible infections (STI). It was found that New South Wales required an ~2-fold increase in other STI to match the data, Victoria needed an ~11-fold increase, and Queensland required an ~9-fold increase. This is consistent with observed trends in Australia for some STI in recent years. Future projections also indicate that the best way to control the current rise in HIV notifications is to reduce the prevalence of other STI and to promote condom use, testing for HIV, and initiation of early treatment in MSM diagnosed during primary infection. Conclusions: Our model can explain the recent rise in HIV notifications with an increase in the prevalence of other STI. This analysis highlights that further investigation into the causes and impact of other STI is warranted in Australia, particularly in Victoria.
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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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Leidel, Stacy, Gavin Leslie, Duncan Boldy, Andrew Davies, and Sonya Girdler. "‘We didn’t have to dance around it’: opt-out HIV testing among homeless and marginalised patients." Australian Journal of Primary Health 23, no. 3 (2017): 278. http://dx.doi.org/10.1071/py16120.
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This study explored opt-out HIV testing in an Australian general practice. The aims were to: (1) determine the effect of the opt-out approach on the number of HIV tests performed; and (2) explore the acceptability of opt-out HIV testing from the healthcare providers’ perspective. A prospective mixed-methods study of opt-out HIV testing over a 2-year period (March 2014–March 2016) was conducted. Implementation was based on a theoretical framework that was developed specifically for this study. The setting was Homeless Healthcare, a health service in Perth, Western Australia. The number of HIV tests conducted during the control year (usual practice) was compared with the intervention year (opt-out testing). After the intervention, the healthcare providers (n=8) were interviewed about their experiences with opt-out HIV testing. Directed content analysis was used to explore the qualitative data. HIV testing rates were low during both the control year and the intervention year (315 HIV tests (12% of the patient cohort) and 344 HIV tests (10%) respectively). Opt-out HIV testing was feasible and acceptable to the participating healthcare providers. Other health services could consider opt-out HIV testing for their patients to identify people with undiagnosed infections and sustain Australia’s low HIV prevalence.
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Brown, Graham, Jeanne Ellard, Julie Mooney-Somers, Garrett Prestage, Gemma Crawford, and Trish Langdon. "‘Living a life less ordinary’: exploring the experiences of Australian men who have acquired HIV overseas." Sexual Health 11, no. 6 (2014): 547. http://dx.doi.org/10.1071/sh13155.
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Background Increasing international mobility has led to a growth of cross-border HIV transmission around the world. In Australia, increasing rates of HIV infections acquired overseas have been reported, particularly among men. This qualitative study explored experiences and risk perceptions of 14 Australian men who acquired HIV while living or travelling overseas from the year 2000. Methods: Symbolic interaction provided the study’s theoretical perspective and analytical framework. Australian men living with HIV who were aged 18 years and older, believed they had acquired their infection while working or travelling overseas during or after the year 2000, and were diagnosed from 2003 onwards were eligible to participate. A semistructured interview schedule was developed and tested for content validity with the study reference group. Analysis was conducted using an adapted form of grounded theory to form the basis for the development of the experiences domains. Results: Analysis produced four domains of experience: (1) a fantasy realised, (2) escaping and finding a new self or life, (3) living a life less ordinary and (4) living local but still an outsider. The description of the four experience domains highlights how risk generally, particularly sexual risk, did or did not feature in these men’s understanding of their experiences. Conclusion: Perceptions and experiences of long-term travel played a decisive role for men who acquired HIV when travelling overseas. Appealing to desired experiences such as connection to local culture or sustaining a new or adventurous life may provide important implications for guiding health promotion programs and policy.
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Templeton, David J., Phillip Read, Rajesh Varma, and Christopher Bourne. "Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence." Sexual Health 11, no. 3 (2014): 217. http://dx.doi.org/10.1071/sh14003.
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Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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Ooi, Catriona, Fabian Y. S. Kong, David A. Lewis, and Jane S. Hocking. "Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies." Sexual Health 17, no. 2 (2020): 135. http://dx.doi.org/10.1071/sh19150.
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Background In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services. Methods: EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site. Results: Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants’ mean age was 41.1 years (95% confidence interval (CI) 37.0–43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9–5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7–2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6–2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8–4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied. Conclusion: This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons.
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Wright, Michael R., Carolien M. Giele, Phyll R. Dance, and Sandra C. Thompson. "Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia." Medical Journal of Australia 183, no. 3 (August 2005): 124–28. http://dx.doi.org/10.5694/j.1326-5377.2005.tb06955.x.
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McDonald, Ann. "HIV infection, AIDS, hepatitis C and sexually transmissible infections in Australia: national surveillance results to December 1998." New South Wales Public Health Bulletin 11, no. 4 (2000): 58. http://dx.doi.org/10.1071/nb00030.
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Chan, D. J., and D. L. Bradford. "A sexual health strategy for Australia — time for action." Sexual Health 1, no. 4 (2004): 197. http://dx.doi.org/10.1071/sh04008.
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Australia still does not have a national sexual health strategy. Sexually transmissible infections such as chlamydia continue to plague the community, and the incidence of HIV is increasing. But a cohesive sexual health strategy cannot merely be disease-focussed, it must include the broader social and cultural aspects of sexual behaviour and sexuality. We propose a public health framework for the development of a national sexual health strategy that will bring Australia in line with the United Kingdom and New Zealand.
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Sheorey, Harsha, and Richard S. Bradbury. "Parasitic infections: overlooked, under-diagnosed and under-researched." Microbiology Australia 37, no. 1 (2016): 3. http://dx.doi.org/10.1071/ma16002.
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Professor George Nelson (1924–2009) once stated that, ‘Parasitology is the preserve of the diagnostically destitute’. Little has changed to this day, with potentially relevant parasitic causes of illnesses often not being considered early in the differential diagnoses of clinical presentations. Parasitic infections are sometimes overlooked as causes of morbidity and (in some cases) mortality in both the medical and veterinary fields. In Australia there remain significant problems associated with giardiasis, cryptosporidiosis, strongyloidiasis and other parasitic diseases, particularly in remote, underserved and tropical regions of the country and also in the immuno-compromised individuals (HIV, immunosuppressive drugs etc.). The burden of many parasitic diseases is greater in tropical and sub-tropical areas of non-industrialised countries. With increasingly adventurous travel and dining, increasing numbers of Australians returning from travel overseas with added souvenirs of common or exotic parasitoses every year and refugees and migrants arriving in Australia, these infections are becoming increasingly important.
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Read, Tim R. H., Jane Hocking, Vikki Sinnott, and Margaret Hellard. "Risk factors for incident HIV infection in men having sex with men: a case-control study." Sexual Health 4, no. 1 (2007): 35. http://dx.doi.org/10.1071/sh06043.
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Background: HIV notifications affecting men having sex with men (MSM) in Victoria, Australia have been increasing. This study aimed to determine current risk factors for HIV infection in this population. Methods: Case-control study. Cases were MSM infected within the previous year (incident cases) as indicated by a previous negative test or seroconversion illness. Controls were MSM with a negative HIV test at the same clinic. From May 2001 to May 2003, cases and controls were interviewed about sexual behaviour, drug and alcohol use and mental health and sexually transmissible infections (STI) in the year before their HIV diagnosis. Results: Twenty-six cases and 52 controls were recruited. Risk factors in the year before diagnosis of incident HIV infection included: receptive unprotected anal intercourse (UAI) with ejaculation with casual partners (odds ratio [OR] and 95% confidence interval 57.2 [6.7, 489.4]); insertive UAI with ejaculation with >1 casual partners (OR 19.2 [2.2, 168.9]); having >14 casual partners at sex venues (OR 3.2 [1.1, 9.1]); and consuming >60 g alcohol at one sitting at least weekly (OR 3.6 [1.1, 11.4]). Cases were also more likely to have anal sex with >100 partners in their life and cases had more casual partners than controls in the year before the test. Cases were more likely to have consumed alcohol or amphetamines during a high-risk sexual episode in the year before the test. Conclusions: UAI remains the most important behavioural risk for HIV in Australian MSM. Risk is increased by larger numbers of partners, partners met at sex venues and sex under the influence of alcohol.
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Goller, Jane L., Rebecca J. Guy, Judy Gold, Megan S. C. Lim, Carol El-Hayek, Mark A. Stoove, Isabel Bergeri, et al. "Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings." Sexual Health 7, no. 4 (2010): 425. http://dx.doi.org/10.1071/sh09116.
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Objective: To describe the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria, Australia. Methods: The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites. Target populations included men who have sex with men (MSM), young people and injecting drug users (IDU). Sites collected demographic and risk behaviour information electronically or using paper surveys from patients undergoing routine HIV or STI (syphilis, chlamydia (Chlamydia trachomatis)) or hepatitis C virus (HCV) testing. These data were linked with laboratory results. Results: Between April 2006 and June 2008, data were received for 67 466 tests and 52 042 questionnaires. In clinics providing electronic data, >90% of individuals tested for HIV, syphilis and chlamydia had risk behaviour information collected. In other clinics, survey response rates were >85% (HIV), 43.5% (syphilis), 42.7–66.5% (chlamydia) and <20% (HCV). Data completeness was >85% for most core variables. Over time, HIV, syphilis and chlamydia testing increased in MSM, and chlamydia testing declined in females (P = 0.05). The proportion of positive tests among MSM was 1.9% for HIV and 2.1% for syphilis. Among 16–24-year-olds, the proportion positive for chlamydia was 10.7% in males and 6.9% in females. Among IDU, 19.4% of HCV tests were antibody positive. Conclusions: The VPCNSS has collected a large, rich dataset through which testing, risk behaviours and the proportion positive can be monitored in high-risk groups, offering a more comprehensive BBV and STI surveillance system for Victoria. Building system sustainability requires an ongoing focus.
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Prestage, G., I. Zablotska, A. Frankland, J. Imrie, and A. Grulich. "30. TESTING FOR SEXUALLY TRANSMISSIBLE INFECTIONS AMONG GAY MEN IN SYDNEY, AUSTRALIA." Sexual Health 4, no. 4 (2007): 296. http://dx.doi.org/10.1071/shv4n4ab30.
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Introduction: Recently, rates of sexually transmissible infections (STIs) have been increasing among gay men in Australia and elsewhere. We explored trends in STI testing among gay men in Sydney. Methods: We used behavioural data from the six-monthly Sydney Gay Community Periodic Survey (SGCPS). Men are recruited through gay community venues, clinics and events in Sydney. Since 2003 men were asked whether they had received the following tests in the previous year: Anal swab, throat swab, penile swab, urine sample, and blood test for STIs other than HIV. Men recruited from clinics were excluded from the following analyses. Results: In 2006, 3145 completed questionnaires were received from non-clinic sites, with 40.9% of respondents reporting having received an anal swab, 45.4% a throat swab, 34.6% a penile swab, 52.7% a urine sample, and 56.1% a blood test for STIs other than HIV. The majority (67.2%) reported at least one test for STIs, with 25.5% having received all five forms of STI test. Although there was no increase during 2003-2006 in having any STI tests, the proportion of men having received all five types of test increased. The largest increase was in the proportion reporting anal swabs: from 23.8% in 2003 to 40.9% in 2006. Among men reporting unprotected anal intercourse with casual partners (UAIC), as well as among men with more than ten casual partners in the previous six months, rates of STI testing were higher but the time trends were similar. Conclusion: The majority of men report STI testing in the previous year, and this testing has become more comprehensive, with men receiving a broader range of STI tests over time. Men at higher risk for STIs tested at increased rates.
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Jin, Fengyi, Garrett P. Prestage, David J. Templeton, I. Mary Poynten, Basil Donovan, Iryna Zablotska, Susan C. Kippax, Adrian Mindel, and Andrew E. Grulich. "The Impact of HIV Seroadaptive Behaviors on Sexually Transmissible Infections in HIV-Negative Homosexual Men in Sydney, Australia." Sexually Transmitted Diseases 39, no. 3 (March 2012): 191–94. http://dx.doi.org/10.1097/olq.0b013e3182401a2f.
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Aronoff, David M. "The first year of Infectious Disease Reports." Infectious Disease Reports 2, no. 2 (November 3, 2010): 16. http://dx.doi.org/10.4081/idr.2010.2138.
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It is exciting to note that within our first year IDR has published original studies, review articles, and case reports from Australia, Brazil, Cuba, Italy, Thailand, Tunisia, Saudi Arabia, Uganda, the UK, and the USA. The first two volumes of IDR have touched upon major problems in our field, including HIV, influenza, Clostridium difficile, neglected tropical diseases, and infections in transplant recipients.
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Down, Ian, David P. Wilson, Pol Dominic McCann, Richard Gray, Alexander Hoare, Jack Bradley, Basil Donovan, and Garrett Prestage. "Increasing gay men’s testing rates and enhancing partner notification can reduce the incidence of syphilis." Sexual Health 9, no. 5 (2012): 472. http://dx.doi.org/10.1071/sh12023.
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Background We sought to determine whether gay men would be willing to increase syphilis testing and partner notification, and assessed the possible epidemiological impact these changes might have in the Australian population. Methods: We conducted an online survey (n = 2306) and focus groups to determine whether interventions to increase testing for syphilis and enhanced partner notification are likely to be acceptable to gay men in Australia. An individual-based mathematical model was developed to estimate the potential population-level impact of changes in these factors. Results: Of all men surveyed, 37.3% felt they should test more frequently for sexually transmissible infections. Men who recent unprotected anal intercourse with casual partners and men who reported a higher number of partners were more likely to indicate a greater willingness to increase testing frequency. HIV-positive men were more likely to indicate that their frequency of syphilis testing was adequate, incorporated as part of their regular HIV monitoring. Lack of convenience was the main barrier reported. Partner notification was broadly acceptable, although perceived stigma presented a potential barrier. The mathematical model indicated that increasing testing rates would have a substantial impact on reducing rates of syphilis infection among gay men and partner notification would further reduce infections. Conclusions: Interventions promoting testing for syphilis among gay men and increases in partner notification may be acceptable to gay men and are likely to result in decreased infection rates. Rapid testing and modern communication technologies could strengthen these interventions, and have an impact on the syphilis epidemic.
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Polizzotto, Mark N., Erica M. Wood, Helen Ingham, and Anthony J. Keller. "Choosing Donors Wisely. Reducing the Risk of Transfusion-Transmissible Viral Infection through Blood Donor Selection: The Australian Experience 2000–2006." Blood 110, no. 11 (November 16, 2007): 2910. http://dx.doi.org/10.1182/blood.v110.11.2910.2910.
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Abstract Selection of voluntary donors who are at low risk of transfusion-transmissible viral infection (TTVI) is central in maintaining the safety of the blood supply. Evaluation of the effectiveness of donor selection and the dynamics of the process may offer opportunities to further improve transfusion safety. We analysed the impact of donor selection on the relative prevalence of TTVIs in all allogeneic donations in Australia between July 2000 and June 2006. We further explored the donor selection process where donors were found to have a TTVI despite pre-donation screening. Donors repeat reactive for a TTVI were offered counselling and confidential interview where potential infective risk exposures were reassessed, and disclosure of risk exposures at initial screening re-evaluated. 6,274,144 donations were received during the study period and tested for HCV, HBV, HIV, and HTLVI/II; of these, 1449 (0.02%) were repeat reactive for at least one TTVI and were discarded. Twenty-nice (2.5%) positive donors were not contactable or declined interview, giving an interview participation rate of 98.5%; all 1449 positive donors are included in the prevalence analysis. This comprised 605 (42%) positive for Hepatitis B; 818 (56%) positive for Hepatitis C; 18 (1%) positive for HIV; and 20 (1%) positive for HTLVI/II. The prevalence of HBV in accepted donors was at least 50 times lower than that in the Australian population; for HCV, 75 times lower; and HIV for 350 times lower. In new donors the prevalence was at least 6 times lower for HBV, 12 times lower for HCV and 140 times lower for HIV. In 1158 of 1420 donors interviewed (80%) an infective risk was identified; 509 donors (44%) had more than one risk. The most common identified were country of birth and parental ethnicity (N=682, 26% of reported risks); tattoos/piercings (N=448, 18%); and intravenous drug use (N=302, 12%). Other common risks included surgery or endoscopy (201 donors, 8%); receipt of blood products (N=144, 6%); and other blood contact, such as following sporting injuries (N=232, 10%). High-risk sexual contacts were uncommon risk exposures, but disproportionately significant in donors with HIV. Many of the identified risk exposures were temporally remote. The relative importance of risks varied significantly between TTVIs. In 302 cases (21%) disclosure of the identified risk exposures at pre-donation screening would have resulted in donor deferral. The proportion of positive donations which would not have been accepted had exposures been reported accurately was 3% for HBV; 35% for HCV; 39% for HIV; and 5% for HTLVI/II. Factors influencing non-disclosure included the temporal remoteness or isolated nature of the exposure, belief behaviour was not high-risk (eg, that needles were not shared during drug use), and perceptions that laboratory testing rendered disclosure unnecessary. Concerns about privacy or confidentiality of personal information were uncommon. These findings affirm the effectiveness of current stringent donor selection criteria in reducing the residual risk of TTVI. Ongoing donor education regarding the importance of risk disclosure is required. The development of screening criteria for use with emerging infections also offers continued opportunity for further improvements in transfusion safety.
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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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Bradley, Isabella, Rick Varma, Vickie Knight, Dimitra Iliakis, Leon McNally, Dean Jalocon, Neisha Jeoffreys, Sharon Chen, and Anna McNulty. "Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre." Sexual Health 17, no. 2 (2020): 114. http://dx.doi.org/10.1071/sh18221.
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Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. Methods: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). Results: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27–39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3–9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09–3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4–86.4%) of infections. Conclusion: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.
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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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AITKEN, C. K., P. HIGGS, and S. BOWDEN. "Differences in the social networks of ethnic Vietnamese and non-Vietnamese injecting drug users and their implications for blood-borne virus transmission." Epidemiology and Infection 136, no. 3 (May 17, 2007): 410–16. http://dx.doi.org/10.1017/s0950268807008679.
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SUMMARYThe social networks of 49 ethnic Vietnamese injecting drug users (IDUs) and 150 IDUs of other ethnicities recruited in Melbourne, Australia, were examined for ethnic differences in distribution of hepatitis C virus infection risk using social network analysis and molecular epidemiology. Vietnamese IDUs were more highly connected than non-Vietnamese IDUs, and more likely to be members of dense injecting sub-networks. More related infections were detected in IDUs with discordant ethnicities than were captured in the social network data; nonetheless, most dyads and most IDU pairs with related infections had matching ethnicity, confirming that mixing was assortative on that criterion. Mixing was not obviously dissortative by risk; low-risk Vietnamese IDUs injected more frequently than did correspondingly low-risk non-Vietnamese IDUs, but results for other measures were reversed or equivocal. Network measurements suggest that ethnic Vietnamese IDUs are at elevated risk of blood-borne infection, a conclusion supported by their relatively high HIV prevalence.
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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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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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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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McCarthy, Melissa, Lewis J. Haddow, Virginia Furner, and Adrian Mindel. "Contact tracing for sexually transmitted infections in New South Wales, Australia." Sexual Health 4, no. 1 (2007): 21. http://dx.doi.org/10.1071/sh06019.
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Background: Contact tracing is an important strategy in the control of sexually transmitted infections (STI) because it encourages individuals who may be unaware they have been exposed to an infection to be tested and treated. The aim of this study was to review STI contact tracing procedures in NSW by sexual health clinics (SHC), public health units (PHU) and general practitioners (GP). Methods: A questionnaire study carried out in 2004–2005 of SHC, PHU and a random sample of GP in NSW. SHC and PHU participated in structured interviews and GP completed questionnaires at educational workshops or through a mail-out. Interviews and questionnaires addressed current contact tracing practice and methods of improving the service. Results: All 35 SHC, 6/18 (33%) PHU and 172/212 (81%) of the GP who responded to the survey undertook contact tracing for STI. Chlamydia was the STI most commonly traced by SHC (34/35, 97%) and GP (165/172, 96%). HIV was the STI most commonly traced by PHU (5/6, 83%). Only 23/172 (13%) GP were familiar with the ‘Australasian contact tracing manual’. The commonest barriers to tracing for SHC and GP included patient reluctance (SHC 60%, GP 71%), and the lack of contact details for partners (SHC 46%, GP 60%). GP identified the availability of information for patients (82%) and more training (55%) as necessary resources for optimal contact tracing. Conclusions: SHC and GP frequently undertook contact tracing for some STI; PHU do so less frequently. Barriers to contact tracing are similar for all health-care providers. For GP, there is a need for increased training and the development of written policies and agreed pathways for referral.