REPORTS

ASHM COVID-19 Taskforce report on sexual health services in Australia and New Zealand during the COVID-19 pandemic. ASHM. This report is designed to provide clinicians with an update on changes in sexual health clinic services around Australia and in New Zealand, and to raise awareness around the likely increased needs around STI testing and treatment during the COVID-19 pandemic. Of note, general practitioners will play a vital role in the ongoing care of people with STIs.

Rights in the time of COVID-19 - Lessons from HIV for an effective, community led response. UNAIDS. This report identifies the key learnings from the global HIV response that are critical in ensuring an evidence-informed and effective response to the COVID-19 pandemic. An empowerment approach, and human rights in the context of a pandemic is discussed.

What people living with HIV need to know about HIV and COVID-19. UNAIDS. People living with HIV are recommended to take measures to prevent infection of the virus that causes COVID-19. Four pillars have been identified to do so in this report, these are: Stay informed, be prepared, support yourself and people around you, and stop stigma and know your rights. 

We've got the power - Women, adolescent girls and the HIV response. UNAIDS. This publication marks the 25th anniversary of the Beijing Declaration and Platform for Action, and discusses the worldwide progression of achieving equality for women. The HIV pandemic is spotlighted as a reflection of the inequality that women and girls still face, and empowerment is recommended to combat this inequality.

PODCASTS

Positive Impact for HIV: Nursing on the frontline. The Sydney Sexual Health Centre is a community-oriented sexual health centre offering specialist expertise in STIs and HIV. Their podcast aims to educate and share stories of people who have made a positive impact for people living with HIV in Australia. This edition features Vickie Knight and Lizzie Griggs, two nurses who have been working in the HIV/AIDS sector since the 1980s. 

Extra Easy Ep1: COVID-19 & Harm Reduction Special. UNSW Centre for Social Research. In this podcast, hear from Charles Henderson, the Deputy CEO of NSW Users and AIDS Association discuss the most recent harm reduction info and advice for people who are using drugs in the current COVID-19 climate.

Sector Briefing: BBVs and STIs and COVID-19. Australian Federation of AIDS Organisations (AFAO). Hear from Darryl O'Donnell, CEO of AFAO and other leaders in the Australian BBV and STI sector. The briefing provides information on COVID-19 from scientific, clinical, and public health perspectives, with a focus on what COVID-19 means for communities. You can also view the question and answer resource which was developed from the podcast. 

JOURNAL ARTICLES 

AIDS and Behavior (Volume 24, Issue 5)
Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining. In this study, the researchers piloted a nurse-led pre-exposure prophylaxis (PrEP) clinic in an STI clinic and had nurses refer patients during sexually transmitted infection (STI) follow-up. PrEP offers, declines and clinic uptake were recorded, and reasons for declining PrEP was analysed based on patient responses. It was found that patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless “other”. This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.

Low PrEP Awareness and Use Among People Who Inject Drugs, San Francisco, 2018. This study examined PrEP awareness and use among people who inject drugs (PWID) through survey data.  of the respondents not known to be HIV positive, slightly more than half of had heard of PrEP, and slightly less than half y knew that PrEP can prevent HIV transmission from sharing injection equipment. Findings from this study suggest there is a need to improve messaging on PrEP’s effectiveness for PWID and to tailor ways of engaging PWID in PrEP programs.

Gay Men’s Relationship Agreements in the Era of Pre-exposure Prophylaxis: An Analysis of Australian Behavioural Surveillance Data. Using  surveillance data, this study explored trends in relationship agreements and casual sex among HIV-negative and untested gay and bisexual men who had regular partners during 2013–2018. A large increase in agreements that allowed condomless sex with casual partners, particularly by PrEP users in relationships, was found. PrEP use was independently associated with having agreements permitting condomless sex with casual partners, recent condomless sex with casual partners, having greater numbers of male partners, recent post-exposure prophylaxis use, having an HIV-positive regular male partner, and recent condomless sex with regular male partners. The findings show a shift away from relationship agreements in which condomless sex was only sanctioned between regular partners. The authors recommend  clinicians and educators should support open, non-judgemental communication between partnered men to facilitate agreements that accommodate PrEP, the discussion of acceptable sexual practices, and whether condomless sex with casual partners is expected or allowed.

Project Moxie: Results of a Feasibility Study of a Telehealth Intervention to Increase HIV Testing Among Binary and Nonbinary Transgender Youth. Project Moxie tested the feasibility of an intervention that provides home-based HIV self-testing coupled with video-chat counselling. A sample of  binary and nonbinary transgender youth (TY) received either the intervention or home-based HIV self-testing. Half of intervention participants opted to use the video-chat counselling and reported high levels of satisfaction. This research shows the ability to recruit TY online and provide them with access to home HIV testing. More research is needed into online interventions for TY who do not wish to receive counselling through video-chat formats.

Sheroes: Feasibility and Acceptability of a Community-Driven, Group-Level HIV Intervention Program for Transgender Women. The researchers piloted ‘Sheroes’, a peer-led group-level intervention for transgender women of any HIV status emphasising empowerment and gender affirmation to reduce HIV risk behaviours and increase social support. Study participants were randomised to either Sheroes, attending 5 weekly group sessions topics on topics such as sexuality and coping skills, or a control group where participants attended 5 weekly group movie sessions. At follow up, HIV-negative and unknown status Sheroes participants reported reductions in condomless intercourse and improved social support compared to control, demonstrating effectiveness of this model of intervention. 

Culture, Health & Sexuality 
Structural and syndemic barriers to PrEP adoption among Black women at high risk for HIV: a qualitative exploration. This study explored Black women’s interest in, and barriers to adopting PrEP over 6 months. Black women who experienced multiple substance use, violence and HIV-related syndemic factors were interviewed four times over a 6-month period. Results demonstrated that experiencing intimate partner violence, substance use, community violence and other structural factors all acted as barriers to PrEP adoption. Future research should consider multi-level interventions that include methods such as media campaigns and implementing PrEP adherence programmes and interventions in support group settings.

#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign. This study aimed to address the literature gap on evaluation of public responses to PrEP campaigns, by exploring negative responses to Chicago’s PrEP4Love campaign. The researchers  found stigmatisation of racial minorities, general anti-Lesbian, Gay, Bi, Trans and Queer (LGBTQ)  comments and the sexually explicit nature were recurrent themes among others. More PrEP social marketing is needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies and effectiveness.

International Journal of Drug Policy
Injecting drug use during sex (known as “slamming”) among men who have sex with men: Results from a time-location sampling survey conducted in five cities, France. The study aimed to investigate the prevalence of men practicing 'slamming' and to identify factors associated with this practice, using data from a survey conducted in France. From the sample of 2646 men who have sex with men (MSM), a very low number reported slamming at least once during their lifetime. However, the study found vulnerability of this sub-group is high enough to justify development of harm reduction measures and specific care, and should be considered in future practice. 

Destabilising the ‘problem’ of chemsex: Diversity in settings, relations and practices revealed in Australian gay and bisexual men's crystal methamphetamine use. The Crystal, Pleasures and Sex between Men study conducted interviews with gay and bisexual men and found that men used crystal  methamphetamine in a variety of settings and relations, which mediated their sexual practices and patterns of use. The findings indicate that researchers should remain open to the variability and contingency of settings, relations and practices in gay and bisexual men's different networks when recommending public health responses to their engagement in drug-enhanced sexual activity. 

Examining risk behavior and syringe coverage among people who inject drugs accessing a syringe services program: A latent class analysis. The study investigated patterns of substance use among  participants newly enrolled in a syringe services program in Florida. The study identified behaviours associated with different types of substance use, for example heroin/cocaine users were more likely to report homelessness, sharing works, unprotected sex, public injection, and to be HCV positive. It was concluded that targeted preventive interventions and need-based syringe distribution policies are needed to further reduce HIV and HCV risk among various PWID populations.

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs. This study explored the prevalence of public injecting in Scotland and associated risk factors, and estimated the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections. A survey was administered to current PWID, and it was found that public injecting was associated with an increased risk of HIV infection, current HCV infection, overdose and skin and soft tissue infections. The need to address the harms associated with PWID in public places is highlighted, and the research suggests safer drug consumption environments are needed.

Perceptions and concerns of hepatitis C reinfection following prison-wide treatment scale-up: Counterpublic health amid hepatitis C treatment as prevention efforts in the prison setting. 
Semi-structured interviews were undertaken with men in prison following HCV treatment completion. Participants identified a number of challenges of meaningful HCV ‘cure’ in the absence of increased access to prevention strategies (e.g., opioid agonist therapy and prison needle syringe programs) along with concerns that ‘cure’ was only temporary whilst incarcerated.  Interventions in prison must address the whole person and the circumstances in which they live, not just the illness.

Journal of Medical Internet Research (Volume 8, Issue 4)
Efficacy of a Mobile Texting App (HepTalk) in Encouraging Patient Participation in Viral Hepatitis B Care: Development and Cohort Study. The study aimed to assess the efficacy of a newly developed mobile texting app (HepTalk) in overcoming barriers to health care access and improving patient engagement and health care access among HBV-infected and non-immune individuals. Engagement was assessed over a 6-month period, and it was suggested that HepTalk or similar texting apps could potentially be used in interventions by easing access of health care providers to patients. 

Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study. The aim of this study was to analyse the patterns of use, benefits, and perceived obstacles in electronic health (eHealth) among people living with HIV and their caring physicians at hospitals, through the use of a questionnaire. It was found that participants were either enthusiastic, skeptic or viewed eHealth as beneficial. This research highlights the diverse viewpoints of eHealth users, and can inform future electronic health methods.

Journal of Viral Hepatitis 
Maternal hepatitis B or hepatitis C virus carrier status and long‐term infectious morbidity of the offspring: A population‐based cohort study. The objective of the study was to investigate the long-term effects of maternal hepatitis B virus (HBV) or HCV carrier status on the long-term infectious morbidity of their offspring. . It was found that maternal HBV carrier status is an independent risk factor for long-term infectious morbidity of the offspring, particularly for gastrointestinal and respiratory infections. This study adds to the literature aiming to understand the effects of HBV and HCV status on childbirth.

Journal of Adolescent Health (Volume 66, Issue 4)
How Are Transgender and Gender Nonconforming Youth Affected by the News? A Qualitative Study. The aim of this study was to understand how transgender and non-conforming (TGNC) youth react to news stories about TGNC and other gender and sexual minority identifying persons, through the use of semi-structured interviews. Participants described frustration associated with inaccurate portrayals of the TGNC community in the news; however, with increased visibility, there is also a growing sense of shared community and opportunity for acceptance of TGNC people. TGNC youth may benefit from increased support to promote resilience when interpreting the news.

Sexual Health (Volume 17, Issue 2)
High levels of engagement with testing for HIV and sexually transmissible infection among gay Asian men in Sydney and Melbourne: an observational study. The study aimed to evaluate, through a survey, current levels of engagement with HIV and sexually transmissible infection (STI) testing services and to identify factors associated with service engagement in gay and other men who have sex with men of Asian background (GAM). The results demonstrate an association between high levels of male-to-male sexual activity and engagement in frequent and comprehensive HIV and STI testing. Factors driving service engagement were self-perceived notions of risk and reliance on gay community organisations, which will help inform future testing initiatives. Increasing engagement with testing initiatives beyond GAM who self-identify as being at high HIV and STI risk will require the use of novel routes by which to disseminate this information.

Perceptions of sexually transmissible infection pre-exposure prophylaxis: a qualitative study of high-risk gay and bisexual men in Sydney, New South Wales. Interviews were conducted with  high-risk gay and bisexual men (GBM) residing in Sydney, Australia to gain qualitative data on perceptions and use of sexually transmissible infection pre-exposure prophylaxis (STI-PrEP). Perceptions were largely based on knowledge of regular PrEP, and knowledge of  STI-PrEP benefits influenced used. The researchers suggest future studies should focus on concerns regarding side effects and monitoring antibiotic resistance, as well as considering the acceptability and potential for stigmatisation of STI-PrEP consumers.

Prevalence of sexually transmissible infections and HIV in men attending sex-on-premises venues in Australia: a systematic review and meta-analysis of observational studies. A systematic review and meta-analysis was utilised to assess HIV and other STI prevalence in men tested at sex-on-premise venues (SOPV), and to describe testing services.  The results showed a high prevalence of STIs in patrons that attended SOPV, and that PrEP use and resultant condomless sex may influence STI prevalence. Further research is needed to determine the effect of PrEP on the STI prevalence among SOPV patrons. 

How should we refer to people attending sexual health services; patients, clients, users or customers? Through a survey, this study sought to determine whether ‘client’, ‘customer’ and ‘user’ are replacing the previously acceptable collective noun, ‘patient’, and if it's use is important to the individuals attending a HIV and sexual health care clinic. The most preferred collective noun was 'patient' which is in line with other published data. This research supports the use of 'patient' to describe attendees in sexual health care services. 

Contextual and behavioural risk factors for sexually transmissible infections in young Aboriginal people in central Australia: a qualitative study. This qualitative study explored behavioural and contextual risk factors for STIs in young Aboriginal people in central Australia. The study identified that casual relationships between young people are common and that there is a strong association between travel, alcohol and casual sex, highlighting the ongoing need for comprehensive sexual health programs that are tailored to the specific social, cultural and interpersonal circumstances of young people in this setting.

Sexually Transmitted Infections
Social network strategy as a promising intervention to better reach key populations for promoting HIV prevention: a systematic review and meta-analysis. This study aimed to investigate the effects of social network strategy (SNS) on HIV prevention among key populations affected by HIV, through a systematic review and metal-analysis of research published between January 1999 and May 2019. The results showed that SNS was associated with less unprotected intercourse and sex with multiple partners, reduced HIV seroconversion, improved HIV testing uptake and promoted participant retention among key populations. This review provides evidence that SNS can reach key populations who are currently not being reached, and can deliver HIV interventions through social networks, which decreases HIV sexual risk behaviour and HIV incidence and increases HIV testing uptake and participant retention.