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Evidence Update Issue 22, 2020| June 30, 2020 |
PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS
Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia. Authored by Roanna Lobo, Josephine Rayson, Jonathan Hallett and Donna Mak, and published in Communicable Disease Intelligence. This study was conducted in response to the rise of notification rates of gonorrhoea in heterosexual young adults in Australia, to inform appropriate action. Findings of this study support public health interventions that focus on communication between sexual partners, shifting of risk perceptions in sexual health education programs and ensuring accessibility of quality sexual health information and condoms.
Australian Gay and Bisexual Men Who Use Condoms, PrEP or Rarely Practise HIV Risk Reduction with Casual Sex Partners: An Analysis of National, Behavioural Surveillance Data, 2017–2018. Authored by Timothy Broady, Benjamin Bavinton, Limin Mao, Garret Prestage and Martin Holt, and published in AIDS and Behavior. This study explored the use of different risk reduction strategies and compared characteristics of men who rarely use strategies with those who regularly use condoms or PrEP using data from the Gay Community Periodic Surveys in Australia.Men who infrequently use HIV risk reduction strategies should be encouraged to test for HIV more regularly and to utilise prevention strategies that align with their infrequent high-risk behaviour.
Characteristics of gay and bisexual men who rarely use HIV risk reduction strategies during condomless anal intercourse: Results from the FLUX national online cohort study. The study aimed to identify the characteristics of a minority of Australian gay and bisexual men (GBM) who do not consistently use a strategy to protect themselves from HIV, using a survey. GBM who never or rarely used HIV risk reduction strategies were largely similar to other Australian GBM. Analysis of the data found that HIV prevention interventions should focus on younger, less socially engaged and less educated GBM, as well as men who prefer receptive anal intercourse to promote the use of effective HIV risk reduction strategies.
Australian Research Centre in Sex, Health and Society Strategic Plan 2020-2023. La Trobe University. ARCSHS is the largest research centre in Australia investigating the health and wellbeing of lesbian, gay, bisexual, transgender, intersex and queer communities. This report outlines their strategic direction for the next three years, which focuses on advancement of new knowledge and learning, maximise research impact and enhancing the capacity for world-class research.
Australian Research Centre in Sex, Health and Society Annual Report 2019. La Trobe University. The 2019 annual report provides a comprehensive summary of the research projects, collaborative efforts, awards, achievements, events and research outputs by the ARCSHS, and provides a strategic direction for 2020 and beyond.
Overview of Aboriginal and Torres Strait Islander Health Status 2019. Australian Indigenous Health InfoNet. This report provides a comprehensive summary of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people. Areas include: the context of Aboriginal and Torres Strait Islander health; social determinants including education, employment and income; the Aboriginal and Torres Strait Islander population; and measures of population health status including births, mortality and hospitalisation.
Sexual Health Matters - Clinical Podcast. Shine SA has developed this podcast that broaches the uncomfortable conversations necessary to ensure client safety and sexual/reproductive well-being. This edition in the series discusses contraception access and provision during COVID-19.
HEP C 101. Hear from the Pacific Hepatitis C Network based across the pond in British Colombia, Canada as they cover the basics of hepatitis C, harm reduction, stigma and more in this quick and friendly series of podcasts.
AIDS and Behavior
A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM. The study aimed to explore racial disparities in Pre-Exposure Prophylaxis (PrEP) use among cis-gender men who have sex with men (cisMSM) aged 15–24 years in New Orleans, Louisiana, and Los Angeles, California. After analysis of cross-sectional data, it was found that the odds of PrEP use among African American adolescents were considerably lower than White adolescents in New Orleans only. The findings highlight the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among African American adolescent cisMSM.
Examining Correlates of Pre-ART and Early ART Adherence to Identify Key Factors Influencing Adherence Readiness. This study examined correlates of multiple adherence readiness measures, as well as electronically measured early ART adherence, to identify variables most important for readiness to adhere well at the start of treatment. Education level, recency of HIV diagnosis and knowledge and commitment to adherence were found to be associated with both ART readiness and early ART adherence. These findings suggest that resources to support adherence readiness should target more experienced HIV patients, and strive to bolster knowledge and attitudes that reinforce commitment to adherence..
Identifying Implementation Strategies That Address Barriers and Facilitate Implementation of Digital Interventions in HIV Primary Care Settings: Results from the Pilot Implementation of Positive Health Check. This study used the 1-month pilot implementation of Positive Health Check, a brief web-based video counseling intervention that supports patients with HIV attending HIV primary care clinics, to exemplify how studying implementation strategies earlier in the evidence-generation process can improve implementation outcomes in later pragmatic trials. The authors identified how implementation strategies were operationalised and the barriers and facilitators these strategies addressed using multiple data sources, including adapted implementation procedures and weekly structured interviews. It was concluded that identifying the link between strategies, barriers, and facilitators will help plan for larger intervention trials in the future.
BMC Public Health
The safe use of dating applications among men who have sex with men: a study protocol for a randomised controlled trial to evaluate an interactive web-based intervention to reduce risky sexual behaviours. This paper outlines the protocol for a proposed study to develop and evaluate the effectiveness of an interactive web-based intervention in improving the sexual health of men who have sex with men (MSM) dating app users in Hong Kong. Chinese MSM dating app users will be recruited and randomly allocated into either the intervention or control group. The findings will aid development of culturally relevant health promotion programmes aimed at minimising the potential harm of dating app use and promoting the sexual health of MSM dating app users.
Culture, Health & Sexuality
How current and potential pre-exposure prophylaxis (PrEP) users experience, negotiate and manage stigma: disclosures and backstage processes in online discourse. To understand how stigma affects current and potential users of PrEP, the study analysed blog posts from the “My PrEP Experience” website, as well as reader comments on those posts, and information available through hyperlinks in the posts and comments. Findings revealed a number of active seeking and sharing of strategies for coping with and challenging stigma, including the creative re-appropriation of negative labels and calls for advocacy. These strategies identified can inform future efforts to reduce stigma and encourage PrEP uptake.
Transgender men’s fertility preservation: experiences, social support, and the quest for genetic parenthood. Four transgender men were interviewed about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option as part of a larger study on fertility preservation. After interview analysis, it was found that social support from social circles including parents, siblings, partners and peers was favourable, and aided in enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men’s experiences of fertility preservation.
Perceived risks and amelioration of harm in research using mobile technology to support antiretroviral therapy (ART) adherence in the context of methamphetamine use: a focus group study among minorities living with HIV. This study interviewed men who have sex with men living with HIV to understand their thoughts on the risks of participating in smartphone-based research to promote ART adherence in the context of methamphetamine use. Participants provided feedback after receiving probes for HIV medication adherence, mood, and substance use. Confidentiality was found to be a main concern, and it was found that the target group were likely to participate if studies include appropriate protections against risks to confidentiality and experimental harm and are designed to offer future benefit to themselves and other people living with HIV.
Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD. This study examined the association between sexual minority status by identity and behavior, structural vulnerability, and HIV risk among a sample of street-based female sex workers, through the use of a survey. Sexual minority status by identity was associated with increased odds of injection drug use, binge drinking, homelessness, physical intimate partner violence, and being a minor at sex work entry. Sexual minority status by behavior was associated with increased odds of binge drinking, homelessness, ever having a pimp, and being a minor at sex work entry.The study indicates disproportionate structural vulnerability and heightened HIV risk among sexual minority female sex workers, as compared to their heterosexual counterparts. Findings suggest a need for nuanced interventions tailored to these populations.
Motivations, facilitators and barriers to accessing hepatitis C treatment among people who inject drugs in two South African cities. Semi-structured interviews were implemented in a group of participants living with hepatitis C virus (HCV) recruited at harm reduction service sites. Despite routine experiences of being stigmatised by the healthcare system in the past, most participants indicated a desire to attend their appointments. Attendance motivators included the desire to be cured, fear of dying and the wish to assist the research project. Perceived barriers to appointment attendance included fear of again experiencing stigmatisation and concerns about waiting periods and drug withdrawal. Perceived facilitators included the knowledge they would be treated quickly, and with respect and access to opioid substitution therapy. In the end, very few participants went to their appointment. Actual barriers to attendance included lack of finances, lack of urgency and forgetting and fatalism about dying. Psychosocial support prior to initiating referrals that focuses on building and maintaining a sense of self-worth and emphasising that delayed treatment hampers health outcomes is needed.
International Journal of STD & AIDS
Comparing sexual behaviours and knowledge between domestic students and Chinese international students in Australia: findings from two cross-sectional studies. Domestic and Chinese international students were recruited for separate online surveys exploring sexual behaviours and knowledge. After analysis, it was found that there were a number of differences in sexual behaviour and knowledge, such as domestic students reporting more use of the oral contraceptive pill. These results suggest domestic and Chinese international students need targeted sexual health promotion.
Journal of Medical Internet Research
The Effectiveness of Electronic Health Interventions for Promoting HIV-Preventive Behaviors Among Men Who Have Sex With Men: Meta-Analysis Based on an Integrative Framework of Design and Implementation Features. This study aimed to assess the effectiveness of eHealth technology–based interventions for promoting HIV-preventive behaviours among MSM, and to determine effectiveness predictors. A literature review was conducted, and from 46 articles it was found that features of treatment content and eHealth technology might best predict the intervention effects on HIV testing. Intervention adherence played an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.
Using Social Media and Technology to Communicate in Pediatric HIV Research: Qualitative Study With Young Adults Living With or Exposed to Perinatal HIV. The study aimed to describe participants’ perceptions and use of social media and technology in their personal lives, in the context of participating in longitudinal paediatric HIV research, and to further describe any implications in this context. Focus groups were conducted with young adults living with Perinatal HIV, and with young adults who had perinatal HIV exposure but were uninfected. Participants’ willingness to use technology and social media platforms varied due to fears of HIV stigma and inadvertent disclosure. However, it was found that trusting relationships with clinical staff positively impacted their willingness to use these platforms, which can be considered in technology based intervention development.
Journal of Viral Hepatitis
Determinants of stigma among patients with hepatitis C virus infection. To explore how stigma acts as a barrier to HCV treatment and elimination, a study among patients with a history of HCV infection at outpatient clinics in Philadelphia was conducted. A stigma scale was used to identify demographic, behavioural, and clinical determinants. Most participants experienced stigma associated with HCV diagnosis, and stigma scores were similar between HCV‐monoinfected and HIV/HCV‐coinfected participants. Understanding how experiences of stigma differ between HCV‐monoinfected and HIV/HCV‐coinfected patients may aid in the development of targeted interventions to address the HCV epidemic.
Detection, stratification and treatment of hepatitis C–positive prisoners in the United Kingdom prison estate: Development of a pathway of care to facilitate the elimination of hepatitis C in a London prison. This paper is a study of a pathway of care within a London prison to diagnose, stratify and link HCV‐positive prisoners into care. New arrivals to the prison were offered BBV screening, and those with an active infection were reviewed at a weekly hospital‐based multidisciplinary team meeting to determine management. Over the evaluation period, linkage to care was improved. Elimination of HCV in prisons requires local service configuration to ensure high uptake of testing, with all HCV‐positive cases then offered treatment during custody or referral on to treatment after release.
Barriers to syphilis testing among men who have sex with men: a systematic review of the literature. A systematic review was conducted to assess proportions of syphilis testing among MSM and to identify social, structural, and individual barriers to syphilis testing. A number of socioeconomic factors and community/interpersonal factors were identified as barriers to testing. such as mental health factors, age, education level and disclosure of sexual behaviour both to partners and healthcare providers. It was recommended that Improving overall routine utilisation of healthcare services is an especially important focal point in testing promotion.
Psychological wellbeing facilitates accurate HIV risk appraisal in gay and bisexual men. This study focuses on the role of psychological wellbeing in determining perceived HIV risk in a sample of GBM in the UK. A survey was utilised to gain demographic information, and measures of engagement in sexual risk behaviours, diagnosis with a sexually transmissible infection in the past 12 months, frequency of HIV testing and more. It was found that psychological wellbeing facilitates the development of a strong and robust lesbian, gay, bi-sexual and transgender (LGBT) identity, which can be displayed to others, and that a strong LGBT identity in turn facilitates accurate HIV risk appraisal in GBM. A focus on enhancing psychological wellbeing in people at risk of HIV is recommended.
Sexually Transmitted Infections
Investigating the effects of COVID-19 on global male sex work populations: a longitudinal study of digital data. This study examined the effects of coronavirus (COVID-19) on male sex work globally and investigated how men who sold sex responded to and engaged with the virus in the context of work. Data was analysed from an existing database of deidentified data extracted from online profiles maintained by male sex workers on a large, international website. Only a small proportion of profiles explicitly referenced COVID-19 and risk reduction strategies, with some profiles downplaying the seriousness. It is evident that COVID-19 has dramatically impacted the sex industry and targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies.