PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS

Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review. Daniel Vujcich, Sonam Wangda, Meagan Roberts, Roanna Lobo, Bruce Maycock, Chanaka Kulappu Thanthirige, Alison Reid. PLOS One. This scoping review collated information about how sexual health and blood-borne virus (SHBBV) surveys have been administered in migrant populations, and the effect that mode of administration has on data quality, reliability and other practical considerations. Most studies were missing other information including method of recruitment, consent procedures and whether incentives were offered. Guidelines to inform future SHBBV survey research in migrant populations are presented.

Sex workers as peer researchers – a qualitative investigation of the benefits and challenges. Roanna Lobo, Kahlia McCausland, Julie Bates, Jonathan Hallett, Basil Donovan, Linda Selvey. Culture, Health & Sexuality. Sex worker peer researchers reflected on their involvement in the Law and Sex Worker Health study (LASH 2) through semi-structured interviews. It was found that the majority of peer researchers were motivated to participate in the research by the possibility of future changes to sex work-related legislation, and support for sex workers based on the research findings. Research partnerships with peer researchers that offer employment throughout the research process, including co-authorship of journal articles and opportunities for leadership roles can increase research impact.

REPORTS

Report on the PrEP in NSW Transition Study 2018-2020. The Kirby Institute. This report outlines the findings of the PrEP in NSW Transition Study. The study explored how people transitioned out of a PrEP implementation trial to receiving PrEP through general practice and standard-of-care prescribing, and associated changes in behaviour, attitudes or engagement with sexual health. An overview of the methods, results, and discussion of the study findings and importance is presented.

Viral Hepatitis Mapping Project Report. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. This report provides a summary of the 2018 - 2019 period of the project, which aims to assess geographic variations in the prevalence of viral hepatitis and disparities in access to care, in order to identify priority areas for response. A national snapshot, as well as geographic trends, is provided for both hepatitis B and hepatitis C. The report is concluded with a summary of data sources and methodology. 

Australian NSP Survey 25 Year National Data Report 1995–2019. The Kirby Institute. The Australian Needle Syringe Program Survey is conducted in all states and territories and provides serial point prevalence estimates of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibody prevalence, HCV ribonucleic acid prevalence and sexual and injecting risk behaviour among people who inject drugs (PWID) in Australia. This special report presents national and jurisdictional findings over the 25-year period from 1995 to 2019. Findings highlight the benefits of investing in robust sentinel surveillance to monitor trends in drug use, sexual and injecting risk behaviour, treatment uptake and prevalence of blood-borne viral infections among people who inject drugs (PWID).

Viral Hepatitis: Annual Report of Trends in Behaviour. This report is centered on viral hepatitis and highlights the contributions made to the changing landscape of HCV infection in Australia by The Kirby Institute. An overview of current studies and strategies are provided.

The INTO? Study: Report of Results. The INTO? study was a cross-sectional survey of gay and bisexual men (GBM) in Australia conducted between December 2019 and March 2020. INTO? examined recent sexual and drug use events, with a focus on how biomedical HIV prevention methods may affect the negotiation of sex and drug use practices. Methods, results and a discussion is presented in this report. 

PODCASTS

World Hepatitis Day 2020: Elimination of Hep C. Sydney Sexual Health Centre. Hear from the Sydney Sexual Health Centre as they discuss the cure for Hepatitis C, elimination goals and barriers to these goals in Australia. A World Hepatitis Day special edition in this sexual health podcast series. 

Distance is No Obstacle. Rural Health West. This podcast series provides clinical education and information targeted to rural health professionals. Topics include sleep science, health education in rural WA, mental health conditions among youth, drug and alcohol misuse and mental health conditions, screening and treating sexually transmitted infections and more. 

JOURNAL ARTICLES

Aids and Behavior
Shared Decision Making Between Patients and Healthcare Providers and its Association with Favorable Health Outcomes Among People Living with HIV. The study investigated patient-provider communication in HIV care using data from the Positive Perspectives Survey of people living with HIV (PLHIV) from 25 countries. It was found that one-third of PLHIV with salient treatment-related concerns reported feeling uncomfortable when discussing HIV with providers. Recently diagnosed individuals were found to be the most interested group in being involved with decisions about their HIV treatment but reported less understanding of their treatment compared with those reporting the longest duration. To continue to identify and address unmet treatment needs among PLHIV, providers need to ensure that there is ongoing open dialogue.

Increases in HIV Testing Frequency in Australian Gay and Bisexual Men are Concentrated Among PrEP Users: An Analysis of Australian Behavioural Surveillance Data, 2013–2018. The study examined trends in HIV testing frequency among non-HIV-positive men to determine demographic  and behavioural factors differentiating preexposure prophylaxis (PrEP) users and non-PrEP users. National data from surveys of Australian GBM over 6 years were examined. It was found that the proportion who tested at least annually increased overtime. Further, recent risk behaviour was common. Efforts are needed to encourage frequent testing and PrEP use among non-PrEP-users who are at higher-risk.

Assessing the HIV Prevention Needs of Young Gay and Bisexual Men in the PrEP Era: An Analysis of Trends in Australian Behavioural Surveillance, 2014–2018. National surveillance data was analysed to identify similarities and differences between young gay and bisexual men (YGBM) aged 16–24 and older GBM aged 25–49, in order to quantify risks and identify gaps in HIV prevention. The analysis was conducted using surveillance data. There were similar rates of condomless anal intercourse with casual partners in both age groups, YGBM had lower rates of HIV testing and PrEP use but also fewer male partners. The results suggest most YGBM have lower HIV risk than older GBM but a minority still need testing and prevention efforts.

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 GBM whose last HIV test was conducted at a community-based service, to GBM whose last test was at a traditional clinical setting. Behavioural surveillance data were collected from participants in seven states and territories during 2016–2017. Non-HIV-positive GBM who were younger, born in Asia, more socially engaged with other gay men but who had not recently used PrEP were more likely to attend community-based services for their last HIV test. This study highlights the success of community-based HIV testing services in Australia as a way to attract subgroups of GBM at potentially higher risk of HIV. 

The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review. A literature search was conducted to identify the current state of the PrEP care cascade in PWID. A decline in engagement throughout the stages of the PrEP care cascade was found. High awareness and willingness to use PrEP was identified, yet PrEP uptake was relatively low. The researchers suggest that more efforts are needed to identify and screen PWID for PrEP eligibility for interventions and to link and maintain them with appropriate PrEP care.

Culture, Health & Sexuality 
Talking About Sex With Friends: Perspectives Of Older Adults From The Sex, Age & Me Study In Australia. This study explored the barriers and facilitators to sexual communication between older adults and friends. Women and men aged 58 and older were interviewed about their intimate relationships and sexual behaviours and attitudes. Findings indicated that talking about sex with friends played an important role in providing support and sharing information. The privacy of the topic meant that trust and confidentiality were paramount before sexual conversations occurred. By exploring sexual communication outside of the healthcare context, the findings highlight diverse methods to support the sexual health and well-being of older adults.

How Current And Potential Pre-Exposure Prophylaxis (Prep) Users Experience, Negotiate And Manage Stigma: Disclosures And Backstage Processes In Online Discourse. This study investigates how current and potential users of PrEP discuss their experiences of stigmatisation, in addition to their anticipation, preparation, and management of stigmatising encounters. Blog posts from the “My PrEP Experience” website, reader comments on those posts, and information available through hyperlinks, were extracted for analysis. Strategies to cope with stigma were identified, including the creative re-appropriation of negative labels and calls for advocacy. The discussion considers how these strategies can be used to inform future efforts to reduce stigma and encourage PrEP uptake.

Harm Reduction Journal 
“They Look At Us Like Junkies”: Influences Of Drug Use Stigma On The Healthcare Engagement Of People Who Inject Drugs In New York City. Interviews were conducted to gain perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care in New York City, USA. Study participants reported at least one instance of stigma related to healthcare system engagement. two-thirds of participants reported positive experiences at SSPs. It was found that stigmatizing experiences contributed to negative attitudes toward seeking healthcare in the future. Future research recommendations include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.

Providing Reproductive Health Services For Women Who Inject Drugs: A Pilot Program. In this study, the researchers designed, implemented, and evaluate the provision of reproductive health services within one syringe exchange program's existing wound and primary care program. Patient and staff satisfaction with the new services, service uptake, and barriers and facilitators to continued service provision were investigated through client feedback and staff interviews. Clients and staff noted a high unmet need for trauma-informed, accessible reproductive health care. It is concluded that integrating reproductive health care into an NSP’s clinical services is feasible and can be a source of low-barrier preventive care for women unable to seek care elsewhere.

Journal of Medical Internet Research 
Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis. A systematic review and meta-analysis were conducted to assess the impact of digital communication technology on HIV testing uptake among MSM and Transgender Women (TW). A total of 13 studies were reviewed. Factors related to greater impact were identified, including delivery through mainstream social media–based platforms, were interactive, and involved the target group in the design process. These findings support the integration of technology with existing approaches to promote and facilitate HIV testing among MSM and TW. 

Journal of Acquired Immune Deficiency Syndromes
HIV Preexposure Prophylaxis Cascades to Assess Implementation in Australia: Results From Repeated, National Behavioral Surveillance of Gay and Bisexual Men, 2014–2018. In this study, two PrEP cascades for GBM were developed to help monitor the implementation of PrEP. Data was used from the Gay Community Periodic Surveys and PrEPARE Project. Trends over time were assessed. PrEP eligibility, awareness and use increased rapidly during the period of study. Analyses indicated that PrEP coverage was affected by geographical availability, education level, employment, and willingness to use PrEP. The cascades effectively identify disparities in uptake by eligible men as a result of socioeconomic factors and PrEP's acceptability.

Journal of the International AIDS Society
Impact Of Male Circumcision On Risk Of HIV Infection In Men In A Changing Epidemic Context – Systematic Review And Meta‐Analysis. A review and analysis of the impact of circumcision on the risk of HIV infection among heterosexual men were conducted in this study. Observational studies and randomized controlled trials were included for review. Efficacy of medical male circumcision on HIV incidence from randomized controlled trials was supported by effectiveness from observational studies in populations with diverse HIV risk and changing epidemic contexts. Voluntary Medical Male Circumcision remains an important evidence‐based intervention for control of generalized HIV epidemics..

A Review Of HIV Pre‐Exposure Prophylaxis (PrEP) Programmes By Delivery Models In The Asia‐Pacific Through The Healthcare Accessibility Framework. A literature search was conducted to identify published evidence that had evaluated the outcomes of PrEP‐related projects in the Asia‐Pacific. Literature was classified by delivery models and assessed with a healthcare accessibility framework. PrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia‐Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed.

Disparities In The PrEP Continuum For Trans Women Compared To MSM In San Francisco, California: Results From Population‐Based Cross‐Sectional Behavioural Surveillance Studies.The objective of this study was to examine PrEP disparities between transgender women and men who have sex with men (MSM) in the United States and to compare individual, social and structural factors that influence differences between the two populations along the PrEP continuum. Data were analysed from two population‐based studies, one with trans women and the other with MSM. Key indicators of the PrEP continuum were evaluated. It was found that PrEP disparities exist for trans women compared to MSM and that there is a need for differentiated implementation strategies to meet the specific PrEP barriers trans women face. 

Journal of Viral Hepatitis
Sharing The Cure: Building Primary Care And Public Health Infrastructure To Improve The Hepatitis C Care Continuum In Maryland. Sharing the Cure (STC) was an intervention of services that aimed to enhance information technology and public health infrastructure, primary care provider training and practice transformation to address HCV in Maryland, USA. HCV clinical outcomes were documented among individuals who presented for care at sites and met criteria for HCV testing. Findings show HCV RNA testing among HCV antibody‐positive people increased among STC providers. Primary care practices can effectively serve as HCV treatment centres to expand treatment access. 

PLOS One
The Impact Of Universal Access To Direct-Acting Antiviral Therapy On The Hepatitis C Cascade Of Care Among Individuals Attending Primary And Community Health Services. In this study, data were analysed from primary care clinics providing services targeted towards PWID to explore hepatitis C (HCV) testing. The testing time frame was within the three-year period immediately prior to and following universal access to DAA treatments in 2016. Improvements in the cascade of HCV care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.

Sex Education
‘Half The Time It’s Just Guessing’: Youth Worker And Youth Service Manager Experiences Of Sexual Health Training In The Pilbara, Remote Western Australia. In this study, youth workers and youth service managers working in the Pilbara participated in interviews to share their experiences and the impact of sexual health training on their work. Data were thematically analysed, with the results suggesting current training is not meeting the needs of the workers. Participants felt under equipped to address sexual health topics with young people. Suggestions are made to improve youth workers’ and youth service managers’ access to effective sexual health training.

Learning From Pornography: Results Of A Mixed Methods Systematic Review. A mixed-methods review of research on pornography use for sexual learning in young people was conducted. The findings suggest pornography use can offer useful information about the mechanics of sex, and this is particularly pertinent for young gay men. Young people are often aware of the shortcomings of pornography as a source of information and guidance, and improvements to sex and relationships education are recommended.

Sexual Health
Young Aboriginal People’s Sexual Health Risk Reduction Strategies: A Qualitative Study In Remote Australia. This study aimed to understand young Aboriginal people’s individual and more collective sexual health risk reduction practices using qualitative methods. Interviews with young Aboriginal women and men aged 16–21 years in two remote Australian settings were conducted, and subject to thematic analysis. Participants reported individual and collective STI and pregnancy risk reduction strategies. Findings broaden the understanding of young Aboriginal people’s sexual health risk reduction strategies in remote Aboriginal communities. The need for multisectoral STI prevention and sexual health programs driven by young people’s existing harm minimisation strategies and cultural models of collective support is recommended.

Understanding The Challenges Faced In Community-Based Outreach Programs Aimed At Men Who Have Sex With Men In Urban Indonesia. The study aimed to understand how outreach workers (OW) worked as part of existing HIV testing and treatment efforts, and what knowledge they possess that may contribute to the development of improved community-based responses for MSM in Indonesia. Focus groups were conducted with OW from one community-led MSM outreach organisation in Jakarta. Challenges faced when conducting HIV outreach for MSM were described from the focus groups. The important role of OW in developing community responses to HIV is highlighted, as they are well placed to assist HIV programs. 

Characteristics Of Clients Newly Diagnosed With HIV In Central Sydney In 2016–17: A Retrospective Audit Comparing A Community-Based Testing Site And A Clinical Sexual Health Service. The study aimed to identify the characteristics of patients newly diagnosed with HIV. Comparisons were made using data from a community-based testing site and a traditional clinical service in Sydney, NSW. Compared with the clinical service, clients diagnosed at the community-based site were more likely to be diagnosed at their first visit and report no prior HIV test. The findings indicate that in central Sydney, community-based HIV and STI testing is a service model that reaches a higher proportion of MSM who are first-time testers and born overseas compared with the traditional, clinic-based service model. A tailored approach is needed for culturally and linguistically diverse populations, and investigation into populations who have never tested before is needed.

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. Studies that measured syphilis testing in a sample of MSM were included. In the final review, it was found that the largest difference in syphilis testing proportions was based on hospital or clinic-based sampling compared with venue/community-based and online sampling. It is concluded that barriers to syphilis testing among MSM include socioeconomic factors, healthcare-related factors and community/interpersonal factors. Improving overall routine utilisation of healthcare services is recommended.

International Students’ Views On Sexual Health: A Qualitative Study At An Australian University The views and experiences of international students with regard to their sexual health and wellbeing were investigated through interviews. Understanding of sexual consent, misinformation about the consequence of reporting sexual misconduct on their privacy and visa status, and lacking skills to navigate sexual health information and to access relevant support were key themes found. These findings are important for understanding the experiences of international students at Australian universities, and should be considered when implementing future sexual health education and support programs.

Sexually Transmitted Infections
Utilisation Of Pharmacy-Based Sexual And Reproductive Health Services: A Quantitative Retrospective Study. The study objective was to explore the utilisation of pharmacy-based sexual and reproductive health services (SRHS) in order to optimise delivery and identify barriers to access. Data was collected from Umbrella, a sexual health provider in the United Kingdom, from patient records and online patient questionnaires over 3 years. Data was used to analyse uptake, user characteristics and attendance patterns according to day of the week. The results identified the most common and least common requested services by patient demographic characteristics. It was concluded that a wide range of pharmacy-based services were accessed by a diverse range of people, suggesting that pharmacies are a suitable provider of many SRHS.

Enhancing Help-Seeking Behaviour Among Men Who Have Sex With Men At Risk For Sexually Transmitted Infections: The Syn.Bas.In Randomised Controlled Trial. This study investigated the impact of an intervention, where MSM attended at the STI outpatient clinic in Amsterdam. Participants were randomly assigned to receive either tailored, face-to-face feedback and help-seeking advice on mental health screening, or no feedback and no help-seeking advice, and were followed trimonthly for a year. Participants completed a set of questionnaires that discussed several mental health-related domains. There were no significant differences in self-reported or confirmed help-seeking behaviour between the intervention and the control group. There were also no differences in STI incidence and condomless anal sex acts between the two groups. Other interventions are needed to tackle the high burden of mental disorders among MSM.

Undetectable Equals Untransmittable (U = U): Awareness And Associations With Health Outcomes Among People Living With HIV In 25 Countries. The study investigated the percentage of PLHIV who ever discussed U=U with their main HIV care provider, and associations with health-related outcomes. The impact of whether the U=U message varied between those who heard it from their healthcare provider (HCP) vs from elsewhere was also evaluated. Data were analysed from the 25-country 2019 Positive Perspectives Survey of PLHIV on treatment. HCP discussion of U=U with PLHIV was associated with favourable health outcomes. However, missed opportunities exist since a third of PLHIV reported not having any U=U discussion with their HCP. U=U discussions with PLHIV should be considered as a standard of care in clinical guidelines.