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Evidence Update Issue 14, 2019| April 9, 2019 |
Publications from the SiREN team
HIV Diagnoses In Migrant Populations In Australia - A Changing Epidemiology. This study conducted a detailed analysis of trends in new HIV diagnoses in Australia by country of birth. It found the epidemiology of HIV in Australia is changing, with an increase in HIV diagnosis rates attributed to male-to-male sex amongst men born in Asia and the Americas. Tailored strategies must be developed to increase access to, and uptake of, prevention, testing and treatment in this group.
“I Couldn’t Imagine My Life Without It”: Australian Trans Women’s Experiences of Sexuality, Intimacy, and Gender-Affirming Hormone Therapy. This study aimed to provide an exploration of trans women’s negotiation of the psycho- and physiosexual shifts which result from Gender-Affirming Hormone Therapy (GAHT). The final analysis identified four themes: overall experiences, physiological changes, psychological changes, and shifts in experiences of orgasm. The findings from this study findings highlight the dearth of medical knowledge in the area of sexual function and pleasure for trans women undergoing GAHT and provide an impetus for a systematic reimagining of how clinical practitioners might negotiate their treatment of a transgender client.
Service Provider Recognition Of The Significance Of Animal Companionship Among Trans And Cisgender Women Of Diverse Sexualities. This article explored the benefits of healthcare providers recognising the potential significance of interspecies companionship for the health of trans and cisgender women of diverse sexualities. It considered some of the contextual challenges for such recognition to occur in service provision. Suggestions are then offered in relation to how providers might think about service provision which is both inclusive of all women and takes into account close connections with animal companions.
Gonorrhoea Gone Wild: Rising Incidence Of Gonorrhoea And Associated Risk Factors Among Gay And Bisexual Men Attending Australian Sexual Health Clinics. A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017. The strongest predictors of infection were having more than 20 sexual partners in a year, using injecting drugs, being HIV positive and being aged less than 30 years old. Enhanced prevention efforts, as well as more detailed, network-driven research are required.
Reports & Briefs
AFAO Research Brief 01: Late HIV Diagnosis. Australian Federation of AIDS Organisations. This research brief summarises selected research about late HIV diagnoses in Australia.
Australian Trachoma Surveillance Report 2017. The Kirby Institute. This report is compiled by the National Trachoma Surveillance and Reporting Unit and covers trachoma program coverage, screening coverage, clean face prevalence, trachoma prevalence, antibiotic distribution and coverage, trachoma‑related trichiasis and health promotion activities.
Women and HIV — A spotlight on adolescent girls and young women. World Health Organization. This report calls for the provision of HIV services and the protection of the rights of adolescent girls and young women to be stepped up and draws on current statistics concerning adolescent girls and young women still being disproportionally affected by HIV.
S04 SpeakEasy: 2019 "Not my family, never my child" - an interview with Tony Trimingham. In this episode Annie and Carla speak with Tony Trimingham, CEO of Family Drug Support, founder of Damien Trimingham Foundation and co-founder of Harm Reduction Australia, about supporting families affected by alcohol and other drug issues.
AIDS and Behaviour (Volume 23, Issue 2 & 3)
What’s Sleep Got To Do With It?: Sleep Health and Sexual Risk-Taking Among Men Who Have Sex With Men. This study tested associations between a range of sleep health indicators and sex outcomes in an online sample of men who have sex with men (MSM). Among MSM, poor sleep health and increased sexual risk-taking are connected, even when adjusting for depression and drug use. These findings highlight the importance of addressing sleep health to prevent HIV risk among MSM.
Self-Stigma Reduction Interventions For People Living With HIV/AIDS And Their Families: A Systematic Review. This systematic review evaluated the impact of HIV/AIDS-related self-stigma reduction interventions among people living with human immunodeficiency virus (PLWHA) and their families. The review identified five types of interventions to reduce HIV/AIDS-related self-stigma among PLWHA and their families. Overall, this article suggests a general trend of promising effectiveness of these interventions for PLWHA and their family members.
Comparisons of New HIV Rapid Test Kit Performance. This study reported on the sensitivity and specificity of HIV tests when included on multi-disease test kits. The two HIV kits which used oral fluid instead of blood performed well. This study can assist health care providers and testing sites in developing protocols for their use among high-risk clients.
Promoting ‘Equitable Access’ to PrEP in Australia: Taking Account Of Stakeholder Perspective. This study conducted interviews with key stakeholders in the Australia HIV response, before federal support for a subsidised access scheme was achieved. It showed a degree of complexity in the way that Pre-Exposure Prophylaxis (PrEP) was viewed and understood. Achieving equity in PrEP access will require continuing discussion about who constitutes a suitable candidate for PrEP and which key groups in need are being missed.
Which Gay and Bisexual Men Attend Community-Based HIV Testing Services in Australia? An Analysis of Cross-Sectional National Behavioural Surveillance Data. This study compared the socio-demographic and behavioural characteristics of gay and bisexual men (GBM) whose last HIV test was conducted at a community-based service, to GBM whose last test was at a traditional clinical setting. It found that non-HIV-positive GBM who attended community-based services were largely similar to men attending clinic-based settings. This study showed that community-based services are likely to play a critical role in improving access to HIV testing.
BMC Health Services Research (Volume 19)
Point-Of-Care Testing (POCT) For HIV/STI Targeting MSM In Regional Australia At Community ‘Beat’ Locations. This project aimed to establish proof of concept for POCT via a mobile van clinic at community ‘beat’ locations. The study found a mobile van clinic in a regional area may be feasible, however it is resource and time intensive. HIV self-testing is acceptable and could be more cost-effective for dispersed regional populations.
Culture, Health & Sexuality (Volume 21, 2019)
PrEP Indicators, Social Capital And Social Group Memberships Among Gay, Bisexual And Other Men Who Have Sex With Men. This study examined social capital items and social group membership in association with PrEP outcomes. Men who reported community group participation were more likely to be aware of PrEP compared to those who did not. Men in chosen families associated with a family name were least likely to be aware of and willing to take PrEP compared to those not in any other social groups. Social group membership is a potential social capital indicator for assessing HIV prevention among men.
Optimising HIV Programming For Transgender Women In Brazil. This study gathered trans women’s perspectives on combination HIV prevention approaches. Several social and contextual factors inhibited participants’ access to HIV prevention and treatment. Participants recommended HIV prevention interventions which combined socio-structural interventions with biomedical interventions. Participants expressed a preference for programmes and interventions that emphasised a gender-affirmative approach, promoted autonomy and aimed to reduce stigma and discrimination in public health services.
Harm Reduction (Online)
Hepatitis C Services At Harm Reduction Centres In The European Union: a 28-Country Survey. This study determined service providers’ understanding of the current services in their respective countries in the European Union (EU) and the barriers experienced by People Who Inject Drugs (PWID) in accessing hepatitis C virus (HCV) testing, care and treatment services in their country. Not all EU member states have harm reduction services that provide HCV tests, many do not have established referral systems with treatment providers and there are issues involving the inability of addiction specialists to prescribe HCV treatment. Discrepancies were noted between the available HCV services and stakeholders’ knowledge about their availability.
Evidence-Based And Guideline-Concurrent Responses To Narratives Deferring HCV Treatment Among People Who Inject Drugs. This study explored why some people who inject drugs (PWID) and have HCV have not sought HCV treatment or decided against starting it. These narratives were compared to evidence-based and guideline-concordant information to better enable stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.
International Journal on Drug Policy (Volume 66 & 67)
Priorities And Recommended Actions For How Researchers, Practitioners, Policy Makers, And The Affected Community Can Work Together To Improve Access To Hepatitis C Care For People Who Use Drugs. This paper summarises a roundtable discussion that identified key priority areas and recommended actions for improving hepatitis C prevention and care for PWID.
The Projected Costs And Benefits Of A Supervised Injection Facility In Seattle, WA, USA. This study used a model to assess the impact of a hypothetical supervised injection facility (SIF). The analysis suggested that a SIF program in Seattle would save lives and result in considerable health benefits and cost savings. These results may be useful to other jurisdictions currently considering similar public health interventions throughout North America and beyond.
The Experiences Of People Who Inject Drugs Of Skin And Soft Tissue Infections And Harm Reduction: A Qualitative Study. This study examined the lived experience of PWID who have had soft tissue infections (SSTI). It found the experience of SSTI can cause strong negative feelings and there was limited knowledge of SSTI prior to firsthand experience. To deliver SSTI harm reduction, peer based support, improved needle and syringe exchange program (NSP) provision and medically supervised injecting facilities are recommended.
‘This About Bloody Time’: Perceptions Of People Who Use Drugs Regarding Drug Law Reform. This study gathered the opinions and preferences of people who use drugs about the current or alternative models of drug laws, in addition to how they think drug laws could be changed. Opinions were diverse and there was no consensus on a preferred model. Participants shared pessimistic views of the drug laws ever changing. The study highlights that the experiential knowledge of the affected community could be utilised to inform drug law reform campaigns.
Journal of Medical Internet Research (Volume 4, Issue 4)
Quality Of HIV Websites With Information About Pre-Exposure Prophylaxis or Treatment as Prevention for Men who have Sex with Men: Systematic Evaluation. This study reviewed existing HIV websites that include information about PrEP or treatment as prevention for MSM. It found existing websites failed to provide adequate content, as well as present that content to users in an interactive and audience-conscious way. Future eHealth interventions should attempt to rectify these deficiencies to successfully engage and educate MSM at high risk for HIV.
Quantification Of HIV-1 RNA Among Men Who Have Sex With Men Using An At-Home Self-Collect Dried Blood Spot Specimen: Feasibility Study. This study aimed to assess the feasibility of at-home blood self-collection and laboratory quantification of HIV-1 RNA viral load (VL) to report laboratory-based VL outcomes and compare self-reported and laboratory-reported VL. Home collection of dried blood spot (DBS) samples from HIV-positive MSM is feasible and has the potential to support clinical VL monitoring. Most participants were willing to use an at-home DBS kit in the future, signalling an opportunity to engage high-risk MSM in long-term HIV care activities.
Journal of Viral Hepatitis (online)
Clinical Effectiveness, Cost Effectiveness And Acceptability Of Community-Based Treatment Of Hepatitis C Virus Infection: A Mixed Method Systematic Review. This study assessed clinical effectiveness, cost effectiveness and acceptability of community-based hepatitis C virus (HCV) treatment models. The review could not find any studies on the cost effectiveness of community-based models and there was a lack of studies on re-infection rates. It concluded that support for health care providers and patients is critical in the development of community-based models.
Durable Control Of Hepatitis C Through Interferon-Free Antiviral Combination Therapy Immediately Prior To Allogeneic Haematopoietic Stem Cell Transplantation. This study reports the course of two paediatric patients with chronic HCV infection who have received a full course of directly acting antivirals prior to allogeneic haematopoietic stem cell transplantation (HSCT). They achieved and maintained viral eradication throughout transplantation until complete immune recovery. This provides support for treatment with the novel regimens prior to transplantation. More systematic studies are needed to fully assess outcomes in allogeneic HSCT recipients with chronic HCV infection.
Role Of Soluble Inflammatory Mediators And Different Immune Cell Populations In Early Control Of Symptomatic Acute Hepatitis C Virus Infection. This study analysed a large panel of soluble inflammatory mediators, immune cell frequencies and phenotypes using peripheral blood samples from patients with symptomatic acute HCV infection from a controlled randomised clinical trial. The study found that patients with a spontaneous early HCV control demonstrated a distinct expression pattern of various soluble immune mediators. The data indicated that the immune cell composition and cytokine pattern varies considerably in patients with symptomatic acute HCV infection. Natural killer cell–mediated killing of CD4+ T cells might affect early control of HCV infection.
Sex Education (Volume 19, Issue 2)
Association Between Receipt Of School-Based HIV Education And Contraceptive Use Among Sexually Active High School Student – United States, 2011-2013. This study explored the association between HIV education and contraceptive methods among a nationally representative sample of US high school students. Students who received HIV education were more likely than students who did not to use a condom and any contraceptive method. School-based HIV education may be important for promotion of adolescent condom and contraceptive use.
Sexual Health (Online)
Effect Of An Express Testing Service For Gay And Bisexual Men On HIV Testing Frequency In Sydney, Australia: A Cohort Study. This study assessed the effect of introducing the Xpress (a fast-track screening model) clinic on repeat HIV testing in high-risk gay or bisexual men (GBM) in Sydney, Australia. Among high-risk GBM, HIV retesting increased. This study consistently showed that introducing express clinics was able to increase HIV testing frequency in high-risk GBM and should be adopted more widely.
New Digital Media Interventions For Sexual Health Promotion Among Young People: A Systematic Review. This review showed there is significant scope for these technologies to interact in real time with participants and create customised programs to facilitate networking among participants and health specialists and to reach large numbers at times and places convenient to the individual. High-quality, evidence-based content that engages with individual participants is essential. An important challenge for public health is that the rapidity of change may outpace the currency of evaluation and publication, creating a space for many interventions to flourish without solid evidence and for effective interventions to lose relevance.
Acceptability Of Self-Collecting Oropharyngeal Swabs For Sexually Transmissible Infection Testing Among Men And Women. Men and women were asked to provide self-collected oropharyngeal specimens for STI testing. Most reported the collection of the swab was ‘easy’ or ‘very easy’ to use; even more were willing to test for STIs at home in the future. Self-collecting oropharyngeal swabs for STI testing may prove acceptable among men and women. Future research should test the effect of self-collecting pharyngeal swabs on STI testing behaviours and results.
Sexually Transmitted Infections (Volume 95, Issue 2)
Differences In Experiences Of Barriers To STI Testing Between Clients Of The Internet-Based Diagnostic Testing Service GetCheckedOnline.com And An STI Clinic In Vancouver, Canada. This study compared experiences of testing barriers between STI clinic clients to clients of GetCheckedOnline.com (GCO), an internet-based STI testing service. Compared with clinic clients, the GCO clients were more likely to be older MSM, be testing routinely and have experienced more barriers to testing. The authors concluded an internet-based testing service effectively engaged individuals experiencing testing barriers, highlighting the importance of internet-based STI testing services to increasing test uptake.
Post-Test Comparison Of HIV Test Knowledge And Changes In Sexual Risk Behaviour Between Clients Accessing HIV Testing Online Versus In-Clinic. This study assessed the HIV test knowledge and sexual risk behaviour of clients testing for HIV through GetCheckedOnline. The study found no evidence of decreased HIV test knowledge or decreased condom use following HIV testing through GetCheckedOnline. The findings suggest that with careful design and attention to educational content, online testing services may not lead to missed opportunities for HIV education and counselling.
Inconsistent Condom Use With Known HIV-Positive Partners Among Newly Diagnosed HIV-Positive Men Who Have Sex With Men Interviewed For Partner Services In New York City, 2014. This study describes factors associated with inconsistent condom use with known HIV-positive partners prior to participants’ diagnosis with HIV. Feelings of love/emotional attachment as a reason for having sex was the only significant predictor of inconsistent condom use. These findings showed there is a need for HIV prevention programmes to take into account relationship context, specifically the desire for intimacy, in their messaging.
Does Infection With Chlamydia trachomatis Induce Long-Lasting Partial Immunity? Insight From Mathematical Modelling. This study used a population-based mathematical model to explore whether the existence of long-lasting partial immunity against reinfection with Chlamydia trachomatis is necessary to explain C. trachomatis prevalence patterns by age and sexual risk. The results were suggestive of a strong natural immune response against C. trachomatis infection, which upon exploration of its detailed biological mechanisms, may have implications for vaccine development.
AIDS Acquired Immune Deficiency Syndrome
DBS Dried Blood Spot
EU European Union
GBM Gay and Bisexual Men
GAHT Gender-Affirming Hormone Therapy
GCO Get Checked Online
HBV Hepatitis B
HCV Hepatitis C
HIV Human Immunodeficiency Virus
HSCT Haematopoietic Stem Cell Transplantation
MSM Men who have Sex with Men
NSP Needle and Syringe Program
PrEP Pre-Exposure Prophylaxis
PWID People Who Inject Drugs
PLWHA People Living With HIV/AIDS
RNA Ribonucleic Acid
STI Sexually Transmitted Infection
SSTI Soft Tissue Infections
SIF Supervised Injection Facility