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Evidence Update Issue 13, 2019| February 8, 2019 |
These emails provide bite-size summaries of the latest evidence from key sexual health and blood-borne virus journals and reports with relevance to the Australian setting. We hope that these emails will save you time and help keep you on top of the latest evidence in your interest areas. SiREN regularly Tweets new research articles and reports, so follow us on Twitter.
If you or your organisation publish a report or journal article, let us know and we will share it as part of these emails. And don’t forget, if you are unable to access any journal articles or reports you can email us at firstname.lastname@example.org and we will send you a copy.
Publications from the SiREN Team and Members
Declining Condom Use among Sex Workers in Western Australia. This study involved an environmental scan of the sex industry in WA, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews. It found an apparent increase in sex workers reporting condomless penetrative sex with clients in WA compared to a previous study. An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors.
‘Everyone knows everyone’: youth perceptions of relationships and sexuality education, condom access and health services in a rural town. This study undertook interviews with young people to explore their experiences and perspectives accessing relationships and sexuality education and sexual health services in a small rural Australian town. It found that targeting youth sexual health interventions at an individual level while failing to address organisational and community socio-ecological threats and weaknesses will limit effectiveness. Working closely with young people may allow greater opportunity for the improved provision of rural sexual health services and relationships and sexuality education.
Needle Syringe Program National Minimum Data Collection Report 2018. This report presents national and state/territory Needle and Syringe Program (NSP) data for the period 2017/18, with comparisons to past reporting periods. It provides a descriptive overview of NSP services across Australia and summary data including agency data, service provision and needle and syringe distribution data.
Global State of Harm Reduction 2018. This report maps harm reduction policy adoption and program implementation globally. The data gathered for this report provides a critical baseline against which progress can be measured in terms of the international, regional and national recognition of harm reduction in policy and practice.
HIV, Health and Development Annual Report 2017-2018. This report includes an overview of the United Nations Development Program's HIV and health portfolio, and how they support countries to turn innovations into scalable and sustainable solutions to deliver results on reducing inequalities and exclusion that drive HIV and poor health; promoting effective and inclusive governance for health, and; building resilient and sustainable systems for health.
SpeakEasy: 2018 it’s a wrap. This episode wraps up the year for the SpeakEasy podcast reflecting on the 2018 discussions with key spokespeople and researchers from areas such as harm reduction, HIV, Hepatitis C, peer education and more. The podcast also highlights key achievements for the sexual health/harm reduction space across 2018.
AIDS and Behaviour (Volume 23, Issue 1)
Factors Associated with Sexual Risks and Risk of STIs, HIV and other Blood-Borne Viruses among Women Using Heroin and Other Drugs: A Systematic Literature Review. This systematic literature review identified factors associated with sexual risks related to STIs, HIV and BBVs among women using heroin and other drugs. Factors identified were: socio-demographics; gender roles and violence against women; substance use; transactional sex; partner characteristics, partner’s drug use, and context of sex; preferences, negotiation and availability of condoms; HIV status and STIs; number of sexual partners; love and trust; reproductive health and motherhood; and risk awareness and perception of control.
Experiences of the HIV Cascade of Care among Indigenous Peoples: A Systematic Review: This systematic review assessed the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand and the United States. The findings affirm that significant gaps remain in achieving universal engagement in HIV care among Indigenous peoples. It is essential that social and structural barriers that continue to impede Indigenous peoples from engaging all along the HIV cascade of care, including stigma and racism, trauma experiences, and intersecting health concerns, are taken into account in healthcare settings.
Trends in Attitudes to and the Use of HIV Pre-exposure prophylaxis by Australian Gay and Bisexual Men, 2011-2017: Implications for Further Implementation from a Diffusion of Innovations Perspective. This study analysed trends related to HIV pre-exposure prophylaxis (PrEP) use in Australian gay and bisexual men (GBM). New scales were constructed assessing reduced concern about HIV among PrEP users and non-users. The analysis of PrEP users vs non-users indicated that PrEP users were more sexually active than non-users, more likely to live in NSW or VIC and were more likely to be in social networks featuring larger numbers of HIV-positive men and other PrEP users. Theory suggests that future PrEP users may be less adventurous and require greater reassurance about PrEP’s efficacy and legitimacy, to sustain rollout and address current disparities in uptake.
Predictors of Daily Adherence to HIV Pre-exposure Prophylaxis in Gay/Bisexual Men in the PRELUDE Demonstration Project. This study identified predictors of daily PrEP adherence among GBM in their first 12 months on PRELUDE (a PrEP demonstration project in NSW). It found that retained study participants maintained high adherence to daily PrEP over 12 months, confirmed by two biological and two self-reported measures. Facilitated recall to clinicians is a suitable measure for assessing PrEP adherence in populations engaged in care where there is established trust and rapport with patients.
International Journal on Drug Policy (Volume 63)
Chemsex behaviours among men who have sex with men: A systematic review of the literature. This review synthesises the published research on the antecedents, behaviours and consequences associated with chemsex behaviours among MSM. It found a minority of MSM appear to engage in chemsex behaviours but they are at risk of this negatively impacting on their health and well-being. There are potentially multiple consequences associated with chemsex behaviour although this remains an under researched area. Further research is required to examine high risk chemsex behaviours, impact of chemsex on psycho-social well-being and if chemsex influences uptake of PrEP, PEP and sexual health screening.
Perceptions and self-reported competency related to testing, management and treatment of hepatitis C virus infection among physicians prescribing opioid agonist treatment: the C-SCOPE study. This study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opiod agonist treatment (OAT) in Australia, Canada, Europe and USA. It found that physicians treating HCV infection among people who inject drugs (PWID) attending OAT clinics recognised the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.
Journal of Medical Internet Research (Volume 21, Issue 1)
Assessing the Impact of a Social Marketing Campaign on Program outcomes for Users of an Internet-Based Testing Service for Sexually Transmitted and Blood-Borne Infections: Observational Study. This study evaluated the impact of a Canadian social marketing campaign by the promotional venue on the use and diagnostic test results of the internet-based STI and BBV testing service. They found that: 22% of users who created an account completed testing; the overall cost was Can$188 per account created and Can$533 per test; and web-based venues with high click-through rates may not always have a high conversion to service use, which is ultimately the desired outcome of social marketing campaigns. Developing mechanisms to track individuals from Web-based exposure to social marketing campaigns to outcomes of internet-based health services permits greater evaluation of the yield and cost-effectiveness of different promotional efforts.
Sex Education (Online)
Australian students' experiences of sexuality education at school. This paper presents findings related to sexuality education from the Fifth National Survey of Secondary Students and Sexual Health. Findings from the study highlight students’ own perceptions of their school-based sexuality education and provide valuable insight for designing and implementing school-based sexuality education based on students’ opinions and needs. In this study, students’ overall low HIV, STI and HPV knowledge scores show a distinct lack of awareness in these areas, which may be a reflection of students’ inadequate sexuality education. The study also highlighted how gender made a contribution to both STI and HPV knowledge. The findings indicate that students have diverse sexuality education needs, and that content delivered varies widely depending on school context. To better young people’s sexual health knowledge, it is necessary to provide sexuality education that is nuanced to the differing needs of young people.
Sexual Health (Volume 16, Issue 1)
A systematic review of the geospatial barriers to antiretroviral initiation, adherence and viral suppression among people living with HIV. This systematic review explores antiretroviral therapy (ART) and Treatment as Prevention (TasP) and how adherence and viral suppression have the potential to reduce TasP effectiveness despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation. The review explores these barriers by using Geographic Information Systems (GIS) with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Findings highlight geospatial variation in ART success and inequitable distribution of HIV care and the utility and current limitations of using GIS to monitor health outcomes related to ART. Findings call for careful planning of resources with respect to the geospatial movement and location of people living with HIV.
Personal and reported partner pornography viewing by Australian women, and association with mental health and body image. This study aimed to improve the understanding of the effects of pornography on mental health and body image, particularly among young people. A large portion of the women sampled reported having viewed pornography. In this study, pornography had a minor effect on mental health and body image . Further understanding of the effects of pornography on body image, particularly among vulnerable individuals, is needed.
Sexually Transmitted Infections (Volume 95, Issue 1 and online)
Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention. This study aimed to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined Indication Condition (IC)-guided HIV testing. The electronic prompt was the factor most closely associated with HIV test requests. A significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres.
Trichomonas vaginalis and HIV infection acquisition: a systematic review and meta-analysis. This systematic review assessed the association of Trichomoniasis and HIV-1 acquisition. It found that infection with T. vaginalis augments HIV acquisition with 50%. Diagnosis and treatment of T. vaginalis infection in both high-risk and low-risk individuals may be a potential tool to reduce new HIV infections.
Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates. This systematic review identified costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. It found differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. The review highlights how as patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients.
Sex with a transgender or gender diverse person among patients attending a sexual health centre in Melbourne, Australia. This study assessed whether males and females attending the Melbourne Sexual Health Centre had had sex with a transgender or gender diverse (TGD) person using computer-assisted self-interviewing (CASI) and whether this was associated with STI risk. TGD partners were most commonly reported among males. There was no association between chlamydia positivity and sex with a TGD person. When a question on TGD partners is asked as part of routine sexual history using CASI, the majority of responses could be verified. These findings underscore the value of asking patients about sex with TGD partners.
Dried blood spot and mini-tube blood sample collection kits for postal HIV testing services: a comparative review of successes in a real-world setting. This is a comparative review between using dried blood spot (DBS) and mini-tube (MT) HIV sampling kits as part of an online STI postal testing service. This comparative analysis suggests that in this community setting, the use of postal HIV DBS kits resulted in a significantly improved request-to-result ratio (RRR) compared with MT. The RRR provides a different unit of measure for postal HIV and STI kit services which can be objectively used to compare how system changes and service delivery models can affect overall kit performance.
Lancet HIV (Volume 6, Issue 2)
Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs. This review summarised recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among people who inject drugs (PWID). Effective HIV prevention strategies include mobile NSPs, PrEP, supervised injection facilities, and, to a lesser extent, some behavioural interventions. A combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Social and political advocacy will be needed to overcome barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.
Journal of Viral Hepatitis (Volume 26, Issue 2)
Improving hepatitis C direct‐acting antiviral access and uptake: A role for patient‐reported outcomes and lived experience. This commentary provides an overview of the population‐level impact of direct-acting antiviral (DAA) treatment, highlighting the need for further understanding of the impact of treatment on behaviour, health and wellbeing through lived experience and more sensitive patient‐reported outcome measures. This commentary calls for more sensitive patient‐reported outcome measures, directly informed by qualitative research. The authors encourage such work to better understanding the personal benefits of treatment can inform simple and direct health promotion messaging about hepatitis C treatment, screen participants for adherence based interventions and inform value‐based care models.
Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis. This study analysed the cost‐effectiveness of an increased access screening program of PWID (increased screening using rapid antibody saliva tests and DBS tests) was analysed through a decision tree screening model combined with the outputs of a Markov treatment model. The results showed an increased access screening program that uses tests which are better suited to the PWID population to be more cost‐effective, due to the increased uptake that rapid antibody saliva and DBS tests generate.