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Evidence Update Issue 24, 2021| May 5, 2021 |
PUBLICATIONS FROM THE SIREN TEAM AND MEMBERS
Sex Worker Health Outcomes in High-Income Countries of Varied Regulatory Environments: A Systematic Review. McCann, Crawford & Hallett. International Journal of Environmental Research and Public Health. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status. Eight scholarly databases were searched, which yielded 95 articles eligible for review. Findings from the review suggested that sex workers in legalised and decriminalised countries demonstrated greater health outcomes, including awareness of health conditions and risk factors. Further, fndings from this review support decriminalisation of sex work to improve sex worker health outcomes.
Lessons learned from the implementation of the Young Deadly Free peer education programme in remote and very remote Australian Aboriginal communities. D'Costa, Lobo & Ward. Sex Education. The Young Deadly Free youth peer education programme trained Aboriginal young people in 15 remote/very remote communities as peer educators to deliver sexual health education to other young people. Interviews were conducted with the project team and regional coordinators to understand the barriers and enablers to implementing peer education in remote communities. Analysis of the interviews identified barriers, enablers, and seven implications for policy and practice to increase the efficacy and long term-impacts of youth peer education.
Socioecological Factors Influencing Sexual Health Experiences and Health Outcomes of Migrant Asian Women Living in ‘Western’ High-Income Countries: A Systematic Review. Gray, Crawford, Maycock & Lobo. International Journal of Environmental Research and Public Health. This systematic review explored socio-ecological factors influencing sexual health experiences and health outcomes of migrant Asian women living in “Western” high-income countries. Findings are discussed at each level of Bronfenbrenner's socioecological model. The authors suggest that the public health policy, practice, and research to improve the sexual health of migrant women requires greater consideration of the intersecting factors of gender, culture, and the migration process.
Lessons learned from Australian case studies of sex workers engaged in academic research about sex worker health, wellbeing and structural impediments. Lobo, McCausland, Bates, Selvey, Jones, Jeffreys, Dean & Fitzgerald. Peer Research in Health and Social Development, International Perspectives on Participatory Research. The Law and Sex Worker Health Study 2.0 involved sex workers as peer-researchers to assist in evaluating the sexual health outcomes and well-being of sex workers in Western Australia. This book chapter reflects on the lessons learned from the study and makes recommendations for future research involving peer-researchers.
Increasing Aboriginal Peoples’ Use Of Services That Reduce Harms From Illicit Drugs Project Final Report: April 2021. Sexual Health and Blood-Borne Virus Applied Evaluation and Research Network. This report presents the methodology, findings and implications from a Western Australian project which aimed to co-design intervention strategies to reduce harms from illicit drugs among Aboriginal peoples.
Legal and Policy Trends Impacting People Living with HIV and Key Populations in Asia and the Pacific 2014–2019. UNAIDS. This report highlights key trends and developments in laws affecting people living with human immunodeficiency virus (HIV) and key populations in Asia and the Pacific over the five-year period 2014–2019. A summary of the findings is presented, and an overview poster is also available.
Annual Report of Trends in Behaviour 2020: HIV and STIs in Australia. UNSW Centre for Social Research in Health. This report presents the data on behavioural trends of HIV and Sexually Transmissible Infections (STIs) for the year 2020. Prevention, care and treatment cascades for HIV and STIs are presented. Key studies that respond to the National Blood-Borne Viruses and Sexually Transmissible Infections Strategies 2018-2022 are also summarised.
Australia’s Progress Towards Hepatitis C Elimination. Burnet Institute and Kirby Institute. This is the second national report on progress towards Hepatitis C (HCV) elimination in Australia. The report brings together national data from across the sector, to give an overview of the progress made towards eliminating HCV, gaps in the current knowledge base and recommendations for future directions of Australia’s HBV elimination response.
Impact of COVID-19 and associated restrictions on people who inject drugs in Australia: Findings from the Illicit Drug Reporting System 2020. The Illicit Drug Reporting System, UNSW. The Coronavirus Disease (COVID-19) pandemic and restrictions on travel and gathering have likely had major impacts on drug supply, use and harms, and there have been significant challenges with the delivery of drug treatment and harm reduction services. This report presents data on people’s experiences during COVID-19, collected from 884 interviews conducted across Australia with people who use drugs.
End Inequalities. End AIDS. Global AIDS Strategy 2021 - 2026. UNAIDS. The Strategy sets out evidence-based strategic priority actions and targets to enable every country and every community to end Acquired Immune Deficiency Syndrome (AIDS) as a public health threat by 2030. This Strategy is the result of extensive analysis of HIV data and an inclusive process of consultation with member states, communities, and partners.
The Hep-Cast. World Hepatitis Alliance and Gilead Sciences. The Hep-cast is a podcast series about the people working to eliminate HCV. Each episode features doctors, policymakers, and advocates in the field as they explore the impact of HCV, and discuss what can be done to eliminate the virus.
Tell Me About It: HIV Conversations in the Community. AIDS Map. This podcast is inspired by the conversations that people living with HIV often find themselves having with those unaware of the many new and life-changing developments in HIV prevention and treatment. The podcast shares accurate and trustworthy information about HIV and sexual and reproductive health in a friendly and open way.
In Conversation With... The Lancet Gastroenterology & Hepatology. This podcast series accompanies The Lancet Gastroenterology & Hepatology, by exploring the articles published in the journal with journal authors. In this installment, Matthew Akiyama from the Montefiore Medical Center and Albert Einstein College of Medicine, USA discusses a review on HCV elimination among people incarcerated in prisons.
The Future of Sex Education. Curtin University. The Future Of is a podcast where experts share their vision of the future and how their work is helping shape it for the better. This episode features Dr. Jacqueline Hendriks, sexology expert and Lecturer of Health Promotion and Sexology at Curtin University, as she discusses topics that feature in Australia’s sex education curriculum and what changes could be made to promote more respectful and meaningful sexual relationships.
HIV Prevention Among Cisgender Men Who have Sex with Transgender Women. Poteat et al. To explore perspectives on HIV prevention strategies, 19 interviews were conducted with men who have sex with transgender women in 4 southern USA cities. Interviews were analysed thematically, and several strategies to reduce HIV risk were identified: condoms, frequent HIV testing, communication about HIV status with partners, and limiting the types of sex acts performed. While condom use was inconsistent, it was found to be preferred over pre-exposure prophylaxis (PrEP), in part due to medical distrust. HIV self-testing was generally viewed unfavourably. HIV prevention interventions are recommended to be inclusive of the needs and experiences of men who have sex with transgender women.
Reviewing PrEP’s Effect on STI Incidence Among Men Who Have sex with Men—Balancing Increased STI Screening and Potential Behavioral Sexual Risk Compensation. Kumar et al. A literature search of studies assessing sexual risk compensation or STI screening among men who have sex with men (MSM) before and after PrEP initiation was conducted. Sixteen studies were identified for review. Only fourteen publications examining individual-level sexual risk compensation after PrEP initiation were found in the literature and results were inconsistent. The review highlights the scarcity of literature examining all types of sexual risk compensation. Further monitoring of trends in sexual risk compensation and STI screening is recommended by the authors to understand PrEP’s effects on STI burden.
BMC Public Health
“It is not an acceptable disease”: A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. Ziersch et al. This study aimed to explore HIV-related stigma and discrimination (HSD) in ethnically diverse communities in South Australia and the impact on health and wellbeing. Interviews and focus groups were conducted with 10 individuals living with HIV from ethnically diverse backgrounds, 14 ethnically diverse community leaders, and 50 service providers. Data were analysed thematically. Findings indicated that HIV is a highly stigmatised condition in ethnically diverse communities due to fear of moral judgment and social isolation, and experiences of HSD were damaging to health and wellbeing. Actions addressing the impacts of HSD on people from ethnically diverse backgrounds are recommended.
Culture, Health & Sexuality
‘I love my job…it’s more the systems that we work in’: the challenges encountered by rural sexual and reproductive health practitioners and implications for access to care. Malatzky & Hulme. This study aimed to develop greater insight into contemporary sexual and reproductive health care delivery challenges for rural practitioners, and the implications for sexual health and wellbeing. To do so, the researchers examined the practice experiences and role-related challenges encountered by sexual and reproductive health practitioners working in three rural regions of Victoria, Australia, through interviews conducted with sexual and reproductive health General Practitioners (GP) and nurses from the region. Organisational and structural barriers were identified. Adapting organisational cultures and how sexual and reproductive health is structured within the health system are highlighted as critical to improving access for rural residents.
Social and emotional wellbeing of indigenous gender and sexuality diverse youth: mapping the evidence. Soldatic et al. Using a scoping review methodology, this paper aimed to map existing research on the intersections of youth, gender and sexuality diversity, Indigeneity and wellbeing in Australia, as part of a project co-designed and guided by a Youth Advisory Group and Aboriginal co-researchers with the lived experience of being young, gender and sexuality diverse and Aboriginal. Twelve studies were included for analysis. Robust conclusions were difficult to draw on, as the review found little published evidence. Therefore, more targeted research that focuses specifically on young peoples’ perspectives, needs, and lived experiences is recommended.
Women’s views on communication with health care providers about pre-exposure prophylaxis (PrEP) for HIV prevention. Jackson et al. This study aimed to identify the role of patient-provider communication in PrEP decision-making among women considering PrEP. Interviews were conducted with 41 PrEP-eligible women in Philadelphia and New York City, USA. A thematic analysis of the responses was conducted, and a conceptual model developed and confirmed as analysis continued. Lack of provider knowledge about PrEP, perceived health care provider stigma about their drug use and sexual activity, and lack of care continuity were identified as barriers to effective communication. The study findings can inform future interventions to enhance patient-provider communication about PrEP and increase PrEP uptake among women.
Considering treatment-as-prevention scale-up for Australian prisons: a qualitative sub-study of expert stakeholders from the Australian ‘surveillance and treatment of prisoners with hepatitis C’ project (SToP-C). Rance et al. The Australian ‘Surveillance and Treatment of Prisoners with Hepatitis C’ project (SToP-C) is the world’s first trial of HCV treatment-as-prevention in prison. This study sought to determine the factors that may enable future scale-up of the project. Interviews were conducted with 19 HCV experts working across key policy, advocacy, research and clinical dimensions of the Australian HCV response. Data were coded and analysed. A number of considerations, both external and internal to the prison system, were identified as key to the response. The challenges to implementation were found to be are considerable, however, the authors argue that prisons remain an obvious setting for treatment scale-up, not only for prevention and potential elimination benefit, but for the treatment opportunities they provide for a socially disadvantaged and underserved population.
Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries. Chang et al. A rapid review was conducted to explore peer involvement in harm reduction services in low and middle-income countries. After an academic database search and, 48 papers were reviewed. The analysis found that peer involvement in this context is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. It is recommended that efforts to study peer involvement need to develop theory and methods to evaluate the complex factors that have an impact on this issue. The authors further recommend the expansion of peers in this context of research, to embrace the capacities and expertise of people who use drugs.
Health Promotion Journal of Australia
Comparing Australian health worker and student attitudes and concerns about providing care to people living with hepatitis B. Brener et al. In this study, health workers and students completed an online survey investigating attitudes towards people living with Hepatitis B (HBV), comfort with providing care for these clients, and concerns they have about working with them. Results from the survey found that health students expressed less comfort and reported more concerns about working with people with HBV than qualified health workers. HBV workforce development is therefore recommended to be included in undergraduate and postgraduate training programs as well as in continuing professional education. This will assist the health workforce to develop competency in the treatment of people living with HBV, with the ultimate aim of providing best quality, non‐judgemental care to all people living with HBV.
The female condom: What do Australian women say?. Botfield et al. This study was undertaken to explore the views and experiences of female condoms in women living in New South Wales. After trying the female condom, participants were invited to complete an online survey and/or interview with the research team. Four broad themes were identified, with the most prominent being concerns around accessibility (including cost and availability). The overall findings suggest the female condom may be an acceptable option for many women in Australia. To support the choice of method and promote uptake, it will be important to increase the accessibility of the female condom by raising awareness and addressing the issues of cost and availability.
Journal of Acquired Immune Deficiency Syndrome
The PrEP Cascade in a National Cohort of Adolescent Men Who Have Sex With Men. Moskowitz et al. In this study, PrEP-related attitudinal and behavioural data from a US national cohort of over 1000 adolescent men who have sex with men (AMSM) were analysed to explore progression from PrEP awareness to uptake and adherence. Attitudes and behaviours were mapped using the Transtheoretical Model of Change. Factors associated with reaching later stages of the model of change were being older, being out to parents, and engaging in previous HIV/STI testing. Overall, the study found AMSM PrEP use falls short of recommended levels. PrEP campaigns are recommended to raise awareness by targeting key AMSM subgroups that underestimate the appropriateness of use. Parents and health providers of AMSM are recommended to serve educational roles to help facilitate potential PrEP uptake, by motivating adolescents and giving them the skills needed to request, fill, and adhere to a prescription.
Journal of Viral Hepatitis
A qualitative exploration of enablers for hepatitis B clinical management among ethnic Chinese in Australia. Xiao et al. This study aimed to identify enablers to engagement in chronic Hepatitis B (CHB) clinical management among ethnic Chinese people attending specialist care. Interviews were conducted with Chinese identifying people who received specialist care of CHB clinical management at a Melbourne clinic. Data were transcribed and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long‐term clinical management were the main enablers. The findings indicate that to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. Further, there is a need for public health programmes directed to communicate CHB‐related complications; availability of effective and cheap treatment; and that long‐term engagement with clinical management and its benefits.
Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care. Harney et al. The study sought to improve HCV care among people with severe mental illness, by evaluating a nurse‐led program established in a co‐located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses in the program, with support provided on‐site from a GP and remotely from an infectious disease and hepatology specialists. Data were extracted from clinical records and statistically analysed. The data suggested that the nurse‐led model of care to improve HCV diagnosis and treatment among people with severe mental illness was a success in achieving high treatment uptake and cure. Further implementation work is needed to improve treatment uptake and to improve follow‐up testing.
Training programmes for practitioners in sexual health promotion: an integrative literature review of evaluations. Begley et al. A literature review was conducted, with a focus on evaluation studies exploring sexual health promotion preparation programmes aimed at professionals with a sexual health promotion remit. After a database search and article screening, 27 relevant studies were identified and thematic analysis were conducted. The types of programmes and evaluation approaches were diverse, which made direct comparison between them challenging. The authors recommend future development of core outcome impact measures for sexual health education programmes in the areas of knowledge, comfort, skills, and changes to practice, to allow for more direct comparison in future evaluation studies.
Can you design the perfect condom? Engaging young people to inform safe sexual health practice and innovation. Cook et al. This paper describes the process of engaging young people in a user-centred, co-design strategy to define their perfect condom. The research aimed to find a way to destigmatise discussions about sexuality and contraception and to explore what characteristics a perfect condom might embody for adolescents through a series of arts-based workshops for young people aged 15–25 years in Wollongong, Australia. Discussions by workshop participants were analysed by the research team. Findings from the condom mapping workshops highlighted the value of humour, pleasure, and the condom being produced and marketed in a way that embraced the fun aspects of sex. The study findings are a precursor to decreasing stigma related to condoms, making condoms universally socially and culturally acceptable for young people in Australia.
Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians. Smith et al. This study investigated the challenges that have emerged for PrEP-providing clinicians after public subsidy for PrEP was introduced in Australia in 2018. Interviews were conducted with 28 PrEP providers in two Australian states, and data were analysed thematically. The authors found sexual health services have been reconfigured to meet changing patient demands. Supporting ways for patients without Medicare to access PrEP inexpensively, advocating for nurse-led PrEP, and developing guidelines adapted to general practice consultations could ensure that PrEP is delivered more effectively and equitably. Additionally, PrEP providers require encouragement to build confidence in providing on-demand PrEP.
Barriers and facilitators to pre-exposure prophylaxis among African migrants in high income countries: a systematic review. Mwaturura et al. This review aimed to explore acceptability, barriers, and facilitators to PrEP use among African migrants in high-income countries. Three online databases, abstracts from key conferences and reference lists of relevant studies articles published in a 1 year-period were searched. A narrative synthesis was performed on quantitative data and thematic synthesis performed on qualitative data. Several common barriers to PrEP use, including stigma, health literacy. risk perception and cost were identified. Findings were limited as there was no published data on uptake found. Additional work is needed to understand PrEP acceptability and uptake among African migrants.
‘I think they might just go to the doctor’: qualitatively examining the (un)acceptability of newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Queensland, Australia. Blondell et al. This study explored the (un)acceptability, barriers and facilitators to newer HIV testing approaches among Vietnamese-born migrants in greater-Brisbane, Australia. Interviews were conducted, from which key approaches were identified. Approaches included provider-initiated testing and counselling, HIV rapid testing and HIV self-testing. Several factors were identified that either facilitate or act as barriers to newer HIV testing approaches, including privacy, cost of (accessing) HIV testing, comfort, convenience and more. Further, the findings from this study show a preference for doctor-centered HIV testing, due to enhanced privacy, accuracy and support. There is a need to understand migrants’ HIV testing preferences if poorer HIV-related outcomes are to be overcome.
Demedicalisation of HIV interventions to end HIV in the Asia–Pacific. Janamnuaysook et al. In this study, the researchers aimed to explore the demedicalisation of HIV interventions. Demedicalisation is where medical discourse is shifted from a disease-focused to a people-centered approach. To do so, the researchers applied a demedicalisation approach into three frameworks and reviewed each by assessing HIV intervention examples from countries in the Asia–Pacific. The study focused on HIV interventions specific to key populations in the Asia-Pacific, including MSM, transgender women and sex workers. After review of the frameworks, they were found to be fit-for-purpose and an integral part of demedicalisation. This research supports demedicalisation as a strategy to increase acceptability and accessibility of HIV interventions in the key populations.
A rapid review of pre-exposure prophylaxis for HIV in the Asia–Pacific region: recommendations for scale up and future directions. Haldar et al. To help inform PrEP rollout in the Asia-Pacific region, a rapid review of published literature was conducted to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines. For the latter, an expanded Internet search was conducted. A total of 36 PrEP-related studies conducted among MSM, female sex workers, and transgender women were included. Most studies had addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. A scarcity of published information was available about national PrEP policies and guidelines. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. Newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.
Sexually Transmitted Infections
Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men. Wong et al. This study investigated sexual behaviours associated with incident anal High-risk Human Papillomavirus (HRHPV) in an observational cohort study of gay and bisexual men (GBM) in Sydney, Australia. Detailed information on sexual practices in a 6-month period, including receptive anal intercourse and non-intercourse receptive anal practices, were collected. Anal human papillomavirus (HPV) testing was performed at the baseline and three annual follow-up visits. Statistical analysis were performed. The findings indicate GBM living with HIV and those who reported receptive anal intercourse were at increased of incident anal HRHPV. Given the substantial risk of anal cancer and the difficulty in mitigating the risk of acquiring anal HRHPV, HPV vaccination should be considered among sexually active older GBM.
Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials. Berendes et al. The study sought to assess the effectiveness of mobile health interventions for preventing STIs and promoting preventive behaviour. Seven databases and reference lists of 49 related reviews were searched, and experts in the field were contacted. A meta-analysis was conducted. The data indicated that smartphone application messages increased STI/HIV testing. The effects on other outcomes or of social media or blended interventions were uncertain due to low or very low certainty evidence. Further research is recommended to determine the feasibility of mobile technology for sexual health interventions.
‘It’s literally giving them a solution in their hands’: the views of young Australians towards patient-delivered partner therapy for treating chlamydia. Layton et al. In this study, the researchers sought to investigate the views of young people regarding patient-delivered partner therapy (PDPT) for chlamydia. Telephone interviews were conducted with young Australian men and women aged 18-30 years old. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Data were analysed thematically. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Though PDPT is unlikely to fully replace partners’ interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.
Going beyond ‘regular and casual’: development of a classification of sexual partner types to enhance partner notification for STIs. Estcourt et al. This study aimed to create a useable classification of sexual partners to improve the targeting of partner notification (PN) for STIs. To do so, the researchers conducted a 4-step process involving a scoping review, qualitative interviews with the public, patients, and health professionals, a pilot of a revised classification in sexual health clinics, and an application of the Theoretical Domains Framework to identify index patients’ willingness to engage in PN for each partner type. The study resulted in an evidence-informed useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Additional studies are needed to determine the utility of the classification to improve the measurement of its impact.