PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS

HIV-related knowledge and practices among Asian and African migrants living in Australia: Results from a cross-sectional survey and qualitative study. Vujcich et al. Collaboration for Evidence, Research and Impact in Public Health. The Migrant Blood-Borne Virus and Sexual Health Survey represented the first attempt to build the national evidence base regarding HIV knowledge, risk behaviours, and testing among migrants in Australia. Knowledge of pre-exposure prophylaxis was low, and condom use at last sexual encounter was reported by more than half of respondents engaging in casual sex and respondents reporting multiple sexual partners. Less than one third of respondents reported testing for any sexually transmitted infection or blood-borne virus in the previous two years. The findings identify policy interventions and service improvements critically needed to reduce widening disparities regarding HIV in Australia. 

Support for school-based relationships and sexual health education: A national survey of Australian parents. Hendriks et al. Collaboration for Evidence, Research, and Impact in Public Health. This research aimed to examine Australian parents’ attitudes towards school-based relationships and sexuality education (RSE). The results from this research suggested that Australian parents are overwhelmingly supportive of school-based RSE. Beyond widespread support for RSE, parents endorsed schools to address a diverse range of topics within this education. Findings from this overview challenge the currently overstated assumption that parents do not support RSE in schools.

Increasing Aboriginal women’s engagement with antenatal care services to prevent congenital syphilis in Western Australia: Stories of success and lessons learned.  D’Costa et al. Collaboration for Evidence Research and Impact in Public Health. This report presents the findings of a qualitative research study commissioned by the Department of Health, WA in 2021 as part of the response to the ongoing syphilis outbreak in Australia. The purpose of the research was to collect data that would support improved engagement of Aboriginal women in antenatal and postnatal care to prevent congenital syphilis. Five key areas for action are recommended based on findings.

REPORTS

The 7th National Survey of Australian Secondary Students and Sexual Health 2022. Australian Research Centre in Sex, Health and Society, La Trobe University. The National Survey of Australian Secondary Students and Sexual Health (SSASH) is a periodic survey, which reports on a range of issues related to sexual identity and experiences, STI and HIV prevention, and relationships and sexuality education for secondary students in Australia. 

Approaches and Best Practice Models of Care for Advancing the Quality of Life for People with HIV in Australia 2023. Health Equity Matters and National Association of People with HIV Australia. This report focuses on the practical approaches and best practice models of care for advancing the quality of life for PLWH, and for staff working at AIDS councils and organisation in Australia. The paper considers protective factors in HIV care and support to help promote improved quality of life. In addition, considerations were made for workers providing peer support, health services, social and community services, and health promotion. 

Monitoring HIV pre-exposure prophylaxis (PrEP) uptake in Australia, Issue 8. Kirby Institute. This report uses data extracted from every PrEP prescription supplied in Australia through the Pharmaceutical Benefits Scheme (PBS). Data are presented on the total number of people who have ever initiated PBS-subsidised PrEP, as well as the number of people dispensed PrEP within the past 12 months.

PrEP Product Awareness, Preferences, and Past Experiences among Transgender Women and Men Who Have Sex with Men in Asia and Australia: The PrEP APPEAL Study. Kirby Institute. PrEP APPEAL was a cross-sectional survey of transgender women in 11 countries and MSM in 16 counties and territories. The survey examined preferences for various aspects of existing and potential future types of PrEP, and used a discrete choice experiment including cost, type of PrEP, and service delivery models. 

Australian NSP Survey National Data Report 2018-2022. Kirby Institute. The Australian Needle Syringe Program Survey (ANSPS) provides serial point prevalence estimates of HIV, HCV and sexual and injecting risk behaviour among PWID in Australia. This report presents national and state/territory data for the period 2018 to 2022.

Guidance for National Strategic Planning (NSP): Health Sector Response to HIV, Viral Hepatitis, and Sexually Transmitted Infections 2023. World Health Organization. This guidance report provides countries with the key elements of strategic planning for HIV, viral hepatitis and sexually transmitted infections.

Western Australian Syphilis Action Plan 2023-2025. Government of Western Australia Department of Health. This Plan was developed to help guide the priorities and activities for the Western Australian Syphilis Outbreak Response Group across the state.

PODCASTS

A vaccine against gonorrhoea: Is it more than an aspiration? BMJ STI Podcast. This episode provides further information on the development gonococcal vaccines, with some inclusion of current research. 

IAS 2023 – Doxy PEP. Well, Well, Well. In this podcast, Cal Hawk talks to Dr Chase Cannon about some of his work investigating the efficacy of using Doxycycline to prevent the acquisition of STIs such as chlamydia, gonorrhoea, and syphilis. 

Bacterial vaginosis and partner treatment. Well, Well, Well. Lenka Vodstrcil speaks about her presentation panel, Sharing microbiomes: Bacterial vaginosis and the importance of partner treatment in this podcast.

Breaking the science from IAS 2023. HIV unmuted podcast. This episode takes a deep dive into the breaking science released at the IAS conference 2023. The podcast explains why these breakthroughs are important for people living with and affected by HIV. 

JOURNAL ARTICLES

AIDS and Behavior
National surveillance of home-based HIV testing among Australian gay and bisexual men, 2019-2020: Uptake after commercial availability of HIV self-tests. Zhang et al. This study aimed to measure the uptake of home-based HIV testing among Australian gay and bisexual men (GBM). Using national cross-sectional data from the Australian Gay Community Periodic Surveys, the authors assessed trends in home HIV testing among non-HIV positive GBM between 2018 and 2020. Analysis suggested at-home testing was more likely among non-HIV-positive GBM who were born overseas and recently arrived in Australia, at higher risk of HIV, and infrequent HIV testers. The study recommended increased access to HIV self-testing to enhance uptake in men at higher risk of HIV, recent migrants, and infrequent testers.

Identifying patterns of discontinuing and recommencing pre-exposure prophylaxis in the context of sexual behaviour among gay and bisexual men in Australia. Philpot et al. This study mapped GBM’s patterns of using PrEP over time and explored sexual behaviour as PrEP use changed. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centred on accurate perceived changes to HIV risk. Condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognise changing circumstances of risk and when to recommence PrEP.

Culture, Health, & Sexuality
Sexual and reproductive health and rights decision-making among Australian migrant and refugee youth: A group concept mapping study. Napier-Raman et al. Young people from marginalised group such as migrants and refugees, are vulnerable to compromised sexual and reproductive health and rights. This study aimed to identify socioecological factors influencing migrant and refugee youth sexual and reproductive health decision making and to compare perspectives of youth with key stakeholders. The study involved participants brainstorming statements about how migrant and refugee youth make sexual and reproductive health decisions. The most important clusters were healthy relationships and safe sex practices. Youth rated healthy relationships more important than stakeholders did. This study reveals factors informing migrant and refugee youth’s decision-making. Future policy should go beyond biomedical constructions of sexual and reproductive health and to incorporate emotional and relational factors, which young people consider to be equally important and beneficial to their agency. 

Yarning as a method for building sexual wellbeing among urban Aboriginal young people in Australia. Bryant et al. This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. Participants reported a strong desire to stay safe and healthy in their sexual relationships and relied heavily on oral communication and yarning strategies to achieve this. Communication was viewed as a way to gain or give advice, assess the acceptability and safety of potential partners, negotiate consent with partners, build positive relationships, and to get themselves out of unhealthy relationships. Self-talk was also discussed as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people’s positive views of self and as deserving of respectful and safe sexual relationships. The findings suggest that future programs and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy that Aboriginal young people already use to build positive relationships and identities.

Harm Reduction
Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework. Cama  et al. The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for BBVs and STIs for Aboriginal and Torres Strait Islander Australians. This research used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions. Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access. The employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, as it enabled workers to build trust, which encouraged clients to undertake screening. The data emphasised the need for interventions to be adaptable and flexible, tailoring elements of the program to suit local and community needs. The findings have been used to develop tools so that the learnings from DLM can be shared with others. 

Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program’s ‘cascade of care’ across nine sites in New South Wales, Australia. Cama  et al. This paper presents routinely collected data across nine sites on the ‘cascade of care’ progression of Aboriginal and Torres Strait Islander clients through the Deadly Liver Mob program: hepatitis C education, screening, returning for results, and recruitment of peers. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive and safe programs led by, and for Aboriginal and Torres Strait Islander peoples. However, the data also indicates points at which clients ‘fall off’ the cascade, underscoring the need to address remaining barriers to care. Future implementation could focus on addressing potential barriers to participation in the program, such as co-location of services and transportation. 

International Journal of STD & AIDS 
Clinicians’ perspectives on why young Aboriginal people are not testing for sexually transmissible infections in Western Sydney. Mate et al. This study sought to understand accessibility barriers faced by Aboriginal peoples with local sexual health services from the perspective of local clinicians within Western Sydney. Clinicians believed the involvement of Aboriginal peoples in service delivery would contribute to greater inclusion and more culturally competent services. Clinicians identified that Aboriginal young people were concerned about their privacy when accessing services, and that barriers could be reduced by greater community engagement in service delivery design and quality improvement initiatives. The themes in the study provide guidance for service providers about approaches that may enhance the access, participation, and cultural safety in sexual health services for Aboriginal clients. 

Barriers to adherence to antiretroviral therapy: identifying priority areas for people with HIV and healthcare professionals. Cama  et al. The objective of this paper is to identify barriers to antiretroviral therapy (ART) adherence that are relevant to HIV care from the perspective of people living with HIV (PLHIV), HIV related healthcare and social service professionals. The study utilised an online survey which asked participants to rate the importance of 100 areas for HIV care. Areas endorsed by both groups included drug cost coverage, challenging material circumstances, HIV stigma and privacy concerns, affect, motivation, beliefs, acceptance of HIV, comorbidity, side effects, and demands and organisation of daily life. 

Sexual Health
Trends and associated factors in HIV testing among heterosexual men and women in Melbourne, Australia, 2011-2020. Tieosapjaroen et al. This paper investigated the trends and factors associated with HIV testing behaviours among heterosexuals. The authors analysed the trend and proportion of heterosexuals attending the Melbourne Sexual Health Centre for the first time, who had ever tested for HIV in the last 12 months and the median number of months since their last HIV test. They identified the factors associated with HIV testing behaviours. Results suggested HIV testing was low among heterosexuals, and that individuals who engaged in condomless sex and had another STI were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are suggested. 

Syphilis in pregnancy: a qualitative investigation of healthcare provider perspectives on barriers to syphilis screening during pregnancy in south-east Queensland. Warzywoda et al. Suboptimal syphilis screening during pregnancy has been identified as a key contributing factor to the resurgence of congenital syphilis. This study aimed to explore, from the perspective of multidisciplinary healthcare providers, the barriers to optimal screening during the antenatal care pathway. Barriers were found to occur at the system level of antenatal care, through difficulties in patient engagement in care, limitations in the current model of health care delivery and limitations in the communication pathway across health care disciplines. Additionally, barriers were found at the individual healthcare provider level, through healthcare provider knowledge and awareness of epidemiological changes in syphilis in south-east Queensland, and adequately assessing patient risk. The paper suggested it is imperative that the healthcare systems and healthcare providers involved in antenatal care address these barriers to improve screening. 

Understanding the health care needs of transgender and gender diverse people engaging with rural Australian sexual health centres: a qualitative interview study. Del Tufo et al. The purpose of this study was to understand what health and wellbeing means to trans people in a regional or rural community and identify their health needs and experiences. Participants reported experiences of stigma and discrimination, reduced employment opportunities and limited social interactions, which led to feelings of isolation and loneliness. However, they also reported high quality of care, particularly with the specific sexual health centres which supported the research. The findings challenge the perception that rural trans people experience only poor health outcomes and shows the difference that key health services such as sexual health centres can make in supporting trans health.  

Sexually Transmitted Infections
Effect of COVID-19 pandemic restrictions on chlamydia and gonorrhoea notifications and testing in Queensland, Australia: an interrupted time series analysis. Dalmau et al. This paper sought to investigate trends in testing and notifications of chlamydia and gonorrhoea during the COVID-19 pandemic in Queensland, Australia. All three study outcomes, chlamydia notifications, gonorrhoea notifications, and combined chlamydia and gonorrhoea testing declined directly after COVID-19 restrictions were introduced. By the end of the study, only monthly gonorrhoea notifications showed a continuing decline. There was a difference between the immediate and sustained impact of the COVID-19 pandemic on reported chlamydia and gonorrhoea notifications and testing in Queensland. The study suggested possible explanations for the findings including an interruption or change to healthcare services during the pandemic, reduced or changed sexual practices or changed disease transmission patterns due to international travel restrictions. 

Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in the UK: a qualitative study to inform public health guidance and messaging. May et al. This study examined knowledge, attitudes, and perceptions of mpox among a sample of gay, bisexual, or other men who have sex with men during the 2022-2023 outbreak in the UK, including facilitators for and barriers to the uptake of public health measures. Measures that aligned with existing sexual health practices and norms were considered most acceptable. Connections to gay, bisexual, or other men who have sex with men networks and social media channels were found to increase exposure to sexual health information and norms influencing protective behaviours. This study suggested there are differential needs, preferences, and experiences of gay, bisexual, and other men who have sex with men that limit the acceptability of some mitigation and prevention measures. The study recommended that future public health interventions and campaigns should be co-designed in consultation with key groups and communities to ensure greater acceptability and credibility in different contexts and communities. 

Sexually Transmitted Diseases
Trends in testing and self-reported diagnoses of sexually transmitted infections in gay and bisexual men in Australia, 2017 to 2021: analysis of national behavioural surveillance surveys. Chan et al. This study assessed trends in STI testing and diagnoses among gay, bisexual, and men who have sex with men in Australia. Between 2017 and 2020, frequent comprehensive STI testing decreased among HIV-negative gay, bisexual and men who have sex with men on PrEP, and declined further in 2021. Frequent comprehensive STI testing declined in 2021 among non-PrEP users and HIV-positive participants. The study suggested that many gay, bisexual and men who have sex with men do not meet Australian STI testing guidelines that recommend quarterly testing. The study recommended further evaluation of whether this recommendation is realistic or necessary to reduce STIs among this group of people. 

How much do young Australians know about syphilis compared with chlamydia and gonorrhea? Findings from an online survey. Bittleston et al. This study suggested that little is known about young Australians’ perceptions and knowledge of syphilis. This study asked participants if they were aware of syphilis, their personal risk perceptions, and perceived severity of infection. These results were compared with similar findings for chlamydia and gonorrhoea. Older participants and gay and lesbian participants were more likely to have heard of syphilis, including those who were non-Aboriginal, sexually active, and had a school-based sex education. Syphilis knowledge was also lower than chlamydia/gonorrhoea knowledge. Most young Australians in this study were aware of syphilis, but few had comprehensive knowledge about the infection relative to chlamydia/gonorrhoea. Considering increasing heterosexual transmission, the study recommends syphilis health promotion campaigns should expand their focus.