The Symposium recordings are now available to view on the SiREN Symposium website. CLICK HERE to access the recordings. 

This evidence update provides an overview of the presentations delivered at the SiREN Symposium 2022. The theme, Breaking out and breaking through: outbreak response lessons for and from the sexual health and blood-borne virus sector, recognises that the COVID-19 pandemic has impacted upon the way in which services are delivered and research is conducted in the sexual health and blood-borne virus sector. Presentations highlight how knowledge from the sector informed successful responses to COVID-19 and reflected on the ways sector knowledge and expertise can be applied to other health challenges. Presentations reflected five sub-themes, summarised below.  

The impact of COVID-19 on sexual health and blood-borne viruses

COVID-19 has caused changes in sexual activity, help-seeking behaviour, and service delivery. Among priority populations, a decline in HIV and STI testing amongst gay and bisexual men was observed (1). Further, a nationwide study found adults delayed care for routine check-ups such as cervical screening and sexually transmissible infection (STI) screening (3). Changes to service delivery (such as reduced opening hours, intake of patients exhibiting STI or BBV symptoms only, and cessation of walk-in patients) resulted in a decline in service visits (3). Notably, adults delayed seeking care despite feeling unwell or exhibiting symptoms (such as abnormal bleeding, ongoing pain, and issues with contraception). Some marginalised populations were further marginalised from sexual health services during the pandemic (2). 

Targeted risk reduction strategies are recommended to reduce the incidence of STI and blood-borne virus (BBV) in the context of outbreaks (1). With regards to STI and BBV testing, appropriate systems are required to implement point-of-care testing (POCT) programs (4), involving training and protocols to reduce the risk of POCT contamination and to ensure a quick incident response (4). The continuation of telehealth is recommended (3). Strong governance systems should be in place to ensure timely adaption and responsiveness to outbreaks (4). The impact of COVID exacerbated inequalities faced by priority and sub-populations, and they should not be overlooked in research, policy, and practice (2). Research is recommended to explore the ongoing effects of multiple lockdowns, particularly in priority populations (1, 2).

Ways the sexual health and blood-borne virus sector has adapted to COVID-19

Several SHBBV organisations responded quickly to the pandemic restrictions to ensure service provision could continue (5, 6, 8). Efforts to sustain engagement with priority populations required the adaption of current strategies and the development of new community-informed strategies. Strategies were most effective when they involved collaboration with stakeholders and an understanding of the populations they served (5, 7). For example, the development of online sexual health strategies (such as online resources and social media) was well-received by young people who have strong digital literacy (5, 6). Several Needle and Syringe Programs (NSP) employed strategies such as contactless home delivery of safe injecting equipment, free postal services, and modification of clinical services, reflecting a strong adaptive response to the pandemic restrictions (8). Embedding contingency planning processes in organisational policies and procedures is recommended to help services adapt to pandemics (8). 

Systemic issues that existed prior to the pandemic came into focus, with further exacerbation of inequities evident in research conducted during this time. This was demonstrated in a global study exploring barriers to participation in research exploring the impact of COVID-19 on sexual and reproductive health. Conflicting priorities caused by the pandemic such as changes in working conditions, loss of income, and family hardship were identified as barriers to research participation. The exacerbation of inequities during the pandemic acted as a barrier to the recruitment of some population groups, particularly where online-only recruitment methods excluded populations with poor digital navigation skills (7). Evidently, not all populations responded to the pandemic in the same way. Participation was most effective when it involved collaboration with the sector. The involvement of the target population is recommended to ensure better engagement in both services and research (5, 7).

Other outbreaks and areas of emerging concern within the sexual health and blood-borne virus sector

Transmission of other STIs such as syphilis continued to occur during the pandemic. Research into prevention strategies conducted during this time encountered barriers to implementation and recruitment due to pandemic restrictions slowing the SHBBV response (9). The outbreak of other STIs and continued transmission of BBVs presented an emerging challenge for the sector in addressing other outbreaks coinciding with COVID-19 (10, 11, 12).

To address this, strategies needed to be innovative and targeted. Knowledge gaps in the workforce, changes in priority population behaviour, and disruption of service provision highlighted the critical need for planning to ensure strategies were effective (10, 11, 12). Involvement of the target populations via stakeholder and reference groups (10, 11) and through needs assessment tools (12) helped inform strategy development. Strategies that were culturally appropriate and peer-led resulted in strong engagement in STI prevention, testing, and treatment amongst priority populations (10, 11). Importantly, the pandemic increased health literacy among the general population, evident in the normalisation of contact tracing and increased awareness of transmission risks. This has had a positive flow-on effect on STIs and BBVs, which can be leveraged in research, health communication messaging, and service provision (10, 11, 12). 

Reaching and engaging with priority populations

Several SHBBV pilot programs were implemented during the pandemic (15, 16, 18, 20). The success of these programs demonstrates the SHBBV sector's ability to work together to overcome existing barriers compounded by pandemic-related challenges, and to continue to deliver effective services. Evidence-based strategies that considered barriers such as stigma, discrimination, geographic isolation, economic hardship, and low sexual health literacy were effective in engaging priority populations such as people from culturally and linguistically diverse backgrounds, young parents, and trans and gender-diverse young people (14, 15, 18, 20). Ongoing evaluation is recommended to support the successful provision and adaption of programs to respond to behavioural and structural changes caused by pandemics (16, 20). 

Studies during the pandemic highlighted the ongoing demand for sexual health initiatives. Research conducted with school parents found overwhelming support for school-based relationships and sexuality education, yet just under a third believed it was not being delivered effectively in schools, and dissent or caution towards certain topics such as gender diversity was evident (17). Studies of young people aged 16-25 found a proportion encountered negative experiences when seeking sexual health information, testing, and treatment from a healthcare provider, which hindered patient pathways to seeking care (19). An understanding of the diverse needs and experiences of priority populations is recommended to inform the development of targeted strategies. Furthermore, research is needed to better understand emerging priority groups, such as fly-in-fly-out workers in the context of the pandemic (21). 

Identifying and responding to structural and systematic factors that impact community transmission and outbreak

Structural and systematic factors have widened the inequalities faced by priority populations during the pandemic, having impacted determinants that are strongly associated with vulnerability to infectious diseases (such as economic stability, neighbourhood and built environment, education, and access to quality healthcare). Therefore, resources for public health infrastructure that meets the needs of already marginalised communities are needed now more than ever (22). Harm reduction, community-based, and strengths-based approaches to complex SHBBV issues are recommended to overcome social inequities, particularly among populations affected by the intersections of stigma and racism (23, 25). Structural factors such as supportive environments, social justice-oriented policies, and multi-level and intersectional interventions need to be implemented now to better respond to future pandemics (23).

Collaboration between researchers, community organisations, and priority populations is needed to address complex SHBBV issues, particularly during pandemics where systemic determinants such as stigma are heightened (24). Involving members of the target populations as peers in service design and delivery assists with the communication of information to ‘hardly reached’ groups and ensures responsive adaption of services. Cultural safety should also be considered (25, 26). There is a need to identify ways to better support service providers, such as GPs who prescribe PrEP, to ensure current strategies continue through outbreak responses. Telehealth is recommended as a cost- and time-efficient way to engage existing and new patients in PrEP provision (27).

Presentation Summaries

1. The impact of COVID-19 on gay and bisexual men's HIV-related behaviour: results from the Perth Gay Community Periodic Survey. Holt & Chan, 2022. Conducted every 2 years, the Gay Community Periodic Survey explores sexual practices and health service engagement gay and bisexual men (GBM). The findings are used to guide HIV and sexual health programs in Australia. The 2021, the Perth Gay Community Periodic Survey included questions to explore the impact of COVID-19 on GBM's sexual behaviour, HIV testing, treatment, and use of prevention. Cross-sectional surveys of GBM were conducted during PrideFEST (Oct-Nov) with peer recruitment by WAAC at venues and events. Data from 5 rounds (2014-21) were analysed for trends in key indicators. Apart from a decline in testing frequency, most HIV-related indicators have improved among GBM in WA, despite COVID-19. Prevention coverage has increased, although GBM appear to have modified the way they take pre-exposure prophylaxis (PrEP) in response to the pandemic. Risk reduction strategies used by GBM were identified, including condom use, alternatives to anal sex and PrEP. Harm reduction strategies must consider the impact COVID-19 has had with respect to changes in behaviour, such as changes in PrEP use. 

2. Close contact: Single people's experiences of connection and isolation in lockdown. Saltis et al., 2022. Research was conducted exploring Australian single people’s relationships, sexual health and wellbeing during lockdown measures, as part of the International Sexual Health and Reproductive Health (I-SHARE) Study, a global consortium exploring the impact of COVID-19 on sexual and reproductive health and wellbeing across 30 countries. Qualitative interviews were conducted with 12 adults aged 18-35 years old. Interviews were transcribed, with data thematically analysed using a realist method. The socio-ecological model of health was also applied. Four themes were identified: (1) we live in a society (recognising the societal norms that are associated with being a single person), (2) pushing boundaries (where single people exhibited behaviour they had not previously engaged in, due to lockdown restrictions), (3) home alone (heightened feelings of loneliness and need for connection), (4) storm clouds and silver linings (displays of resilience and coping strategies utilised by singles to overcome feelings of social isolation). Lack of physical human connection and online-dating fatigue were found to be drivers of stress. Maintaining connections was a protective factor from isolation and bolstered mental health. All participants demonstrated resilience in the face of multifaceted challenges during this time. The adverse impact COVID-19 had on young singles in Australia highlights the need for targeted mental health interventions. These findings can assist in informing policy and practice to enhance sexual health and wellbeing.

3. The sexual and reproductive health impact of COVID-19 on people living in Australia. Coombe, 2022. Research was conducted to explore the impact of COVID-19 on adults living in Australia, with regards to their sexual and reproductive health. A survey exploring sexual activity, intimate relationships, plans for pregnancy, and access to sexual and reproductive health services and products was administered at four timepoints during 2020. A decrease in sexual activity and dating app use was observed over time. Changes in service delivery (e.g., migration to telehealth, restriction of opening hours, and services accepting symptomatic patients only) caused delays in seeking routine check-ups (such as cervical and STI screening), and difficulty in accessing contraceptive, menstrual and incontinence products. Most participants reported a delay in seeking care despite experiencing abnormal symptoms (e.g., abnormal bleeding, ongoing pain, low libido). Evidently, restrictions caused by the COVID-19 pandemic impacted sexual activity and practices, access to healthcare services, and plans for pregnancy. It is recommended that sexual and reproductive health services find ways to remain accessible during periods of restrictions. 

4. Lessons learned from false positive COVID-19 point of care tests in remote Aboriginal communities and the implications for point of care testing for other infections, including STIs and BBVs. Speers, 2022. In July 2020, cases of false positives in COVID-19 point-of-care tests (POCT) were detected in Perth. Shortly after, several testing clinics in remote Aboriginal communities reported an increase in cases of false positives. After investigation, POCT specimens were found to be virally contaminated and were tested to determine the cause of contamination. Results indicated contamination was caused by the mishandling of cartridges used for testing. Several lessons were identified, which can be applied to other STI and BBV POCT contexts. Appropriate training of staff, protocols to reduce contamination risk, and strong governance systems to enable responsiveness are recommend when implementing POCT programs, to reduce potential adverse impacts to patients, local populations, and organisations involved.

5. Innovative adaptions in youth sexual health education, in response to COVID-19. Geraghty, 2022. In response to the COVID-19 restrictions in WA, the Youth Affairs Council of WA (YACWA) adapted their services to continue engagement of the youth sector and young people in sexual health messaging. Strategies were developed by peer-workers, involving a suite of online content including social media posts (e.g., Instagram tiles, TikTok videos), educational tutorial videos, infographics and online professional development for the youth sector. The resources promoted local self-testing services and provided instructions to self-collect from a young person’s perspective. Development involved collaboration with young people, to ensure appropriateness to young people, and maximum reach and engagement. Evaluation was conducted throughout the process, which resulted in further adaption of the resources to ensure they were appropriate for young people with low health literacy or living with a disability.

6. Achieving sexual health promotion during a pandemic. Kristnasawmy, 2022. In response to a syphilis outbreak affecting Aboriginal and Torres Strait Islander people, the Aboriginal Health Council of Western Australia (AHCWA) developed informative, evidence-based and entertaining syphilis education for the Aboriginal Community Controlled Health Services (ACCHS) workforce and community (particularly young community members). This involved development and adaption of creative strategies, including a Syphilis Flipchart and board game, social media campaigns, and online sexual health sessions. Developed in consultation with the young Aboriginal community in WA, these strategies have received consistent positive feedback and engagement by Aboriginal young people, demonstrating the need for strategies that consider the needs of the target population.

7. We are one but we are many: Implementing and disseminating the International Reproductive and Sexual Health (I-SHARE) study in the context of a global pandemic. Saltis et al., 2022. The International Reproductive and Sexual Health (I-SHARE) study is a global consortium of researchers exploring the impact of COVID-19 on sexual and reproductive health and wellbeing across 33 countries. Led by the Australian team, research was conducted to better understand the barriers and enablers of recruitment and dissemination methodologies used by countries within the I-SHARE consortium. Qualitative and quantitative data were collected from a survey disseminated with country sites, with questions exploring the varied approaches to survey implementation. Data were statistically analysed and coded using a deductive thematic analysis approach. Successful recruitment was attributed to adaptation and flexibility of methods. Research conducted in partnership with stakeholders resulted in better recruitment. The exacerbation of inequity during the pandemic acted as a barrier to recruitment of some population groups, particularly where online-only recruitment methods excluded populations with low digital navigation skills. The impact of COVID-19 caused conflicting priorities that prevented participation, such as economic stress and family hardship. These findings have implications for research conducted in future pandemics.  

8. Harm reduction during a pandemic: Impact of COVID-19 on service delivery, PBHRWA's response and contingency planning as an essential service. Winder & Savage, 2022. To continue delivery of harm reduction services to populations impacted by blood-borne viruses (BBVs), Peer Based Harm Reduction WA (PBHRWA) adapted services when COVID-19 pandemic restriction came into effect. Rigorous contingency planning enabled the development of policies and procedures to ensure service provision could continue and populations would continue to be engaged with services. Policies and procedures considered the safety of staff and consumers. This resulted in the development of harm reduction and COVID-19 safety information produced by peer-workers. Several existing services were adapted, resulting in contactless home delivery and free postal services of safe injecting equipment. Through these adaptions PBHRWA was able to successfully maintain service delivery throughout the pandemic. It is recommended that services working with populations impacted by BBVs should embed contingency planning processes in their operations.

9. Syphilaxis study: Investigating the impact of doxycycline pre-exposure prophylaxis (PrEP) on the incidence of syphilis, gonorrhoea and chlamydia in sexually active gay and bisexual men and transgender people during COVID. Haire, 2022. The Syphilaxis study aimed to investigate the impact of doxycycline PrEP on the incidence of syphilis, gonorrhoea and chlamydia in sexually active GBM and transgender people. The study involved observational research of a clinical trial, where participants received doxycycline PrEP for 12 months. Behavioural surveys were completed at the beginning of the study, and every 3 months thereafter. Participants acted as their own ‘control case’ where STI results were compared pre- and post-trial. Participants were also matched with participants who were not taking doxycycline with the same STI history. However, implementation of the study during COVID resulted in a number of setbacks. The study methods have since been adapted, as the concept of the control case is no longer relevant due to pandemic restrictions causing changes in participant behaviour. Future research should consider the impact of restrictions on the behaviour of populations under study.

10. #syphilisoutbreakwa - a youth-led response to the syphilis outbreak in Western Australia. Geraghty, 2022. In response to the syphilis outbreak in Western Australia, YACWA developed an intervention specifically targeting syphilis in young people. A needs assessment to identify knowledge gaps and preferred methods for receiving education was conducted through consultation with young people from syphilis high risk communities, a youth and sexual health and blood-borne virus (SHBBV) sector reference group, and youth workers. This resulted in the development of a peer-led social media campaign, and youth friendly resources including infographics, social media tiles, posters, educational videos and short form comedic content. The campaign was accompanied by professional development for youth workers. Strong engagement has been observed among young people and the youth sector, as well as increased knowledge of the syphilis outbreak, prevention, testing and treatment. A community-informed multicultural and multimedia approach is recommended to address STI outbreaks in the youth population. Further, communities should be supported to co-design targeted resources.

11. Delivering an alternative community response to the recent syphilis outbreak in priority populations. Myers et al., 2022. Innovative strategies were required to respond to the syphilis outbreak during the pandemic. PBHRWA delivered mobile syphilis point-of-care testing (SPOCT) in the Perth Metropolitan area and the South West, to ensure clinical STI services were approachable, affordable, and accessible to people who inject drugs. As part of this program, nurses and outreach workers received syphilis education training, and nurses were trained in performing SPOCT. Resources were developed using targeted messaging, to enhance service engagement and to communicate messaging in relation to STI transmission and risk behaviours. SPOCT was offered to patients. During the program, 42 SPOCT and 22 syphilis serology tests were performed. Eight cases of current hepatitis C infection were identified, and one case of syphilis. The mobile health outreach service was found to be an effective strategy for syphilis screening, BBV testing, engaging patients in sexual health education and overcoming barriers to testing.

12. Syphilis is on the move - the development and implementation of a state-wide Gap Analysis Tool. Laing, 2022. To inform the development of resources and education to address rising syphilis notifications, a gap analysis on syphilis knowledge among clinical and community workers across WA was conducted by Sexual Health Quarters. A needs assessment was conducted through a 40-item syphilis Gap Analysis Tool (GAT) in mid-late 2021. The tool was pilot tested with 25 Perth metropolitan and Pilbara health workers. After refinement, the final GAT was disseminated in October 2021 for two weeks. The GAT was shared directly by email to 405 contacts in the SHBBV and wider health sectors, via QR codes on social media tiles, and through SHQ promotion channels (e-news, social media and training courses). The GAT was completed by clinicians (n=100) and non-clinicians (n=62). Awareness of the outbreak varied between clinicians and non-clinicians; however, knowledge gaps and low confidence in talking about syphilis with community were evident across both groups. There were differences in their preferences for future educational resourcing and professional development. These findings were used to inform the development of educational resources and professional development activities to be produced, implemented, and evaluated in 2022. These findings demonstrate the value of conducting a thorough needs analysis with the target population for any health promotion intervention.

13. Unique antimicrobial susceptible lineages of neisseria gonorrhoeae predominate in remote regions of Western Australia. Kahler et al., 2022. In 2016, a surge in gonococcal notifications causing gonorrhoea was reported in WA and was accompanied by an increase in antimicrobial susceptible (AMS) isolates in the urban/rural regions of WA. To better understand the rising incidence of gonococcal notifications and to determine if differences existed between incidences in urban, rural and remote regions, testing and sequencing of isolates was conducted. Testing found the rise was due to interstate and overseas importation of AMS susceptible lineages in urban and rural regions whilst the local AMS lineages remained largely in the remote regions. Continued surveillance is required to prevent ingress of antimicrobial resistant gonorrhoea into the remote regions of WA. Two community-based approaches are currently in development to reduce gonorrhoea incidence: vaccination and PrEP/post-exposure prophylaxis (PEP).

14. Impact of interventions that aim to increase hepatitis B testing, treatment and/or monitoring among migrants from CaLD backgrounds: a rapid review. Rajkumar et al., 2022. Research is needed to determine appropriate strategies for addressing hepatitis B (HBV) among migrants from culturally and linguistically diverse (CaLD) backgrounds. A rapid review was conducted which aimed to identify, collate, and synthesise literature on interventions addressing hepatitis B testing, treatment, and/or monitoring among migrants from CaLD backgrounds living in Australia, the United Kingdom, Canada, New Zealand and the United States. Seventeen studies were included for review. Effective interventions to prevent HBV transmission and related morbidity and mortality were comprehensive public health approaches that utilised linguistically specific and culturally appropriate resources. Additionally, community outreach programs that educated participants about hepatitis B transmission, screening and treatment can promote community dialogue and understanding to reduce stigma and discrimination. Interventions should include the simultaneous use of evidence-based individual, community, and structural strategies.

15. Multicultural community leader regional extension project - hepatitis B. Siebert & Pitts, 2022. Innovative strategies have continued to be implemented during the pandemic. Led by HepatitisWA, the Hepatitis B Multicultural Program aims to connect people from CaLD backgrounds with HBV vaccinations, testing, and treatment. Throughout the program, 10 regional community partnerships were established with multicultural groups in the South West, Gascoyne and Pilbara regions. Seven community ‘champions’ were upskilled to deliver HBV related education, resulting in 7 sessions delivered and reaching 160 multicultural community members. Of those, 91% (n=80) indicated they intended to be screened for HBV through regional pathways. Furthermore, three General Practitioner Pathways were established in the South West. Strategies to address HBV in CaLD communities should consider target population involvement and tailored education sessions to overcome barriers such as stigma and poor health literacy. These holistic approaches are recommended to address BBV issues in priority populations.

16. Promoting sexual health through a whole-school approach. O’Keeffe, 2022. Adolescents continue to be a priority population for sexual health issues. A pilot program has been developed by Sexual Health Quarters in partnership with Wesley College, a co-education secondary school in WA, to create and deliver a sexual health and respectful relationships program. Underpinned by an evidence-based, whole-school approach, the program was developed in consultation with the school, informing the creation of teaching materials for teaching staff to deliver brief introductory and follow-up sessions before and after workshops delivered by Sexual Health Quarters. Targeted resources for parents and parent workshops are also in development. Ongoing feedback from staff and students has been positive, with preliminary findings indicating 91% of students have enjoyed the program and 85% of students learnt something new. Partnerships and consultation between sexual health organisations and organisations outside the health sector are recommended to develop effective, evidence-informed interventions to improve the sexual health and wellbeing of young people.  

17. Western Australian parents and their support for school-based relationships and sexuality education. Hendriks et al., 2022. Despite significant international and interstate evidence that parents support school-based delivery of relationships and sexuality education (RSE), limited WA data are available. Such evidence is vital, as perceptions of parental attitudes are known to impact RSE delivery. As part of a broader national survey, a data subset was analysed to explore the attitudes of WA parents towards school-based RSE. Items replicated a recent Canadian study, and a market research company supported recruitment efforts. In total, 643 WA parents completed the online survey. Overall, 92.6% of parents supported the provision of school-based RSE. A range of potential associations were analysed. Across the board, there was approval for schools to address a range of RSE-related topics and even topics with the least support were strongly endorsed, such as masturbation (88.2%), gender identity (87.3%) and abstinence (87.2%). Whilst most parents rated the quality of current RSE delivery to be good/excellent (52.8%), 29.4% were unsure if it was being delivered. Open-ended comments revealed a small amount of strong dissent toward the idea of school-based RSE. The findings indicate WA parents are overwhelmingly supportive of school-based RSE. These findings provide a wealth of information to support RSE advocacy efforts and to contest overstated levels of parental dissent.

18. Sexual health and relationships education program for young parents. Jones, 2022. Developed by Sexual Health Quarters, the Balga Teen Family sexual health education program aims to upskill and empower young parents by increasing their knowledge around sexual and reproductive health. Delivered in partnership with Balga Senior High School, the program serves parents who: are stigmatised or experience discrimination; experience social and/or economic barriers; are from CaLD backgrounds; and/or have low levels of health literacy. Consideration of these factors was crucial in developing education sessions covering several sexual and reproductive health topics. Success has been demonstrated in positive feedback and demand for more sessions. This success is attributed to relationships building between facilitators and participants, the adult learning environment and involvement of multidisciplinary team from Sexual Health Quarters (involving a clinical team, education team, research team and disabilities team) and the school (youth workers). Sexual health programs for young parents should be collaborative and consider barriers such as stigma and discrimination.

19. Western Australian youth and their experiences of sexual health services: an online survey and qualitative interviews. McCausland et al., 2022. There is limited information about young peoples’ experiences of healthcare services when seeking sexual health testing, treatment and/or information in WA. Research was conducted to examine these experiences, to help improve patient pathways for this priority population. An online survey was administered to youth living in WA (aged 16-25 years). The survey covered 10 domains and various descriptive statistics were generated. Eighteen qualitative interviews were conducted with young people to better understand the barriers identified. Only 51% had previously sought sexual health information, testing or treatment from a healthcare professional. Negative experiences were found to hinder patient pathways for young people. Improvement of telehealth options, text-based services for reminders and results, and step-by-step resources were recommended by the young people. Youth voices also highlighted the importance of practitioner attitudes. Health practitioners must have compassion for young people, affirm diverse identities and cultural backgrounds, and understand their right to confidentiality and autonomy. These strategies are recommended to encourage safer sexual practices, and support young people to seek quality information, testing and treatment.

20. EmbraceU - Trans and Gender Diverse sexual health. Whittle, 2022. Implemented as a pilot project, EmbraceU aimed to identify and reduce barriers to accessing STI and BBV services, increase knowledge and perceptions of risk, and increase testing pathways for trans, gender diverse and non-binary people. The project was run through a partnership between Sexual Health Quarters, WAAC and Transfolk of WA, and community consultation informed project development. Consultation involved 11 steering committee meetings and a stakeholder reference group meeting. A total of 251 participants completed five surveys and a focus group to shape the project and gain insight into the needs of trans and gender diverse people in WA. This informed the development of the EmbraceU website housing several resources, including a letter template for appointments, language guide for professionals, sexual health testing video, a list of support services in WA, and a sexual safety quiz providing suggestions on how often to get tested. Consumer evaluation suggested visitors felt affirmed when navigating the EmbraceU website, noting the design, layout, language, and photography creating a sense of belonging, and reflecting the community. Community consultation and meaningful involvement is recommended for interventions which are inclusive and accessible when addressing STIs and BBVs in gender and sexuality diverse groups.

21. FIFO sexual health project. Whittle, 2022. There is a lack of evidence, resources, and support for fly-in-fly-out (FIFO) workers with regards to their sexual health. Currently a pilot project run by Sexual Health Quarters is in development, which will aim to increase access to STI and BBV prevention methods, testing and treatment for FIFO workers, minimise the stigma and discrimination associated with STIs and BBVs, and reduce transmission rates amongst this population. The pilot project will involve health promotion campaigns, health education sessions, workforce development and training, and STI and BBV testing services and referral pathways. Strategies are needed to address STIs and BBVs in emerging priority populations.

22. The structural and systematic factors that drive HIV and COVID-19 transmission. Beltran, 2022. With COVID-19 at the forefront of the public health agenda, progress towards the HIV response has faltered. Thus, there is a critical need to understand how structural and systemic factors impact the transmission of HIV in the context of COVID-19. A scoping review was conducted, resulting in 125 articles included in data synthesis. Structural and systematic factors have widened the inequalities faced by priority populations during the pandemic, having impacted determinants that are strongly associated with vulnerability to infectious diseases (such as economic stability, neighbourhood and built environment, education, and access to quality healthcare). Importantly, structural racism has left certain racial groups vulnerable to both COVID-19 and HIV. Investment in more just and equitable public health infrastructure and social safety net that meets the needs of already marginalised communities is needed now more than ever.

23. How do we balance tensions between COVID-19 public health responses and stigma mitigation? Learning from HIV research. Logie, 2022. There are many similarities between the stigmatisation of people living with HIV and COVID-19. Lessons from HIV stigma research suggest that community-based approaches and community engagement with those most affected by stigma generates solidarity and assists people to reclaim their identity. Stigma mitigation must also tackle facilitating factors contributing to marginalisation such as persistent social inequities including racism and xenophobia. There is a tension between the immediate work of providing services during a pandemic and long-term investment in reducing social inequities highlighting the need for strengthened risk communication, building enabling environments, community engagement and social justice-oriented policies. Furthermore, there is a need for evidence-based, multi-level and intersectional stigma reduction interventions.

24. mhealth in a time of COVID-19: A case study evaluation of a mobile application for people who inject drugs. Reeves et al., 2022. This research aimed to evaluate the ACE (Access, Care and Empowerment) mobile application developed for people who inject drugs (PWID). A paper-based and online cross-sectional survey was administered at five needle syringe program (NSP) service provider sites in WA in August 2021 and May 2022. An online survey was also administered via social media and direct email to 180 pharmacies and other services accessed by PWID, and via the ACE app. Survey questions sought to understand knowledge, attitudes and behaviours relating to the ACE app and mHealth. Interviews were also conducted with three metropolitan NSP service providers. Findings highlighted that although app awareness is low, acceptability appears reasonable and has value in its confidentiality, discretion and utility as a ‘one-stop-shop’. The difficulty of low-tech literacy, access to technology and ability to build trust and safety of mHealth for participants pose potential barriers to uptake. Research findings also suggest that research can be a viable mode of outreach and intervention.

25. Taking it to the streets: genuine peer involvement increases access to HCV testing and uptake of HCV treatments. Jeffrey et al., 2022. Peer Based Harm Reduction WA’s (PBHRWA) unique Nurse Practitioner-led health team delivers hepatitis C virus (HCV) education, testing, treatment, and case management in outreach settings with populations that mainstream services often consider ‘difficult-to-reach’ such as people who inject drugs. Barriers to accessing, testing and treatment of HCV include conflicting priorities perceived to be greater than HCV, and previous negative experiences of discrimination in healthcare settings. To address these barriers, a range of peer worker projects have been implemented since 2017, including an HCV treatment support program, outreach to deliver testing and treatment in consumers’ homes, HCV peer education program, and peer workers trained to perform phlebotomy and HCV rapid testing. These peer-led approaches have built rapport and trust, significantly increasing engagement and uptake of testing and treatment with target populations, and reducing fear, stigma and discrimination.

26. Peer harm reduction education: Valuing that which we cannot measure. Gava et al., 2022. The Hepatitis C Peer Harm Reduction Education project recruited and trained peer-educators to teach peers about HCV and develop referrals to HCV testing and treatment services delivered by PBHRWA. The project involves peer-workers sharing experiences of HCV treatment, credibly addressing misunderstandings, and introducing peers to a non-judgemental service for testing and treatment. The peers reached by this service consistently stated first-hand information received from someone they know is more trusted than the same information received from a healthcare professional. Peer education is a model that is deemed preferable, more appropriate, safe, effective and trustworthy for people who inject drugs.

27. A qualitative investigation of Western Australian service providers' experiences prescribing pre-exposure prophylaxis (PrEP). Coci et al., 2022. The 18-month WA Pre-Exposure Prophylaxis for HIV Implementation Trial (PrEPIT-WA) commenced in November 2017 involving provision of PrEP for people at substantial risk of HIV at four diverse clinic sites. Service providers involved in PrEPIT-WA participated in an evaluation to explore barriers and enablers to PrEP provision. Qualitative data from service providers were collected over 18 months via in-depth semi-structured interviews, focus groups and a workshop. Findings suggest enhancing PrEP prescribing by GPs, including on-demand PrEP, will require identifying support mechanisms for GPs, service delivery reform with greater utilisation of nurses, and succinct prescribing guidelines. Furthermore, in response to COVID-19, GPs could utilise telehealth as a cost- and time-efficient way to engage existing and new patients in PrEP provision.