Evidence Update Issue 4, 2017

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Reproductive and sexual health, Aboriginal and Torres Strait Islander, education

The Strong Family Program: an innovative model to engage Aboriginal and Torres Strait Islander youth and Elders with reproductive and sexual health community education. P. Duley.

What they did: Evaluated the Strong Family Program which was developed to deliver reproductive and sexual health education to Aboriginal communities in New South Wales.

What they found: Improvements were seen in reproductive and sexual health knowledge and attitudes. Participants perceived the information provided to be useful and relevant.

Policy and practice implications: Reproductive and sexual health promotion in Aboriginal communities should be based on community consultations and carried out within a culturally appropriate framework to promote greatest success.

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Hepatitis C, direct acting anti-viral’s

Hepatitis C in Australia — a role for general practitioners? M. L. van Driel.

What they did: Evaluated the role of new Direct Acting Anti-Viral’s (DAA) for increasing GP management of hepatitis C.

What they found: The availability of new antiviral agents opens the way for increasing GP involvement in the management of hepatitis C.

Policy and practice implications: Universal access to DAA therapies will require concerted efforts of general practitioners to improve rates of diagnosis, assessment, treatment and follow-up in the community.

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HIV, gay and bisexual men

In Australia, Most HIV Infections Among Gay and Bisexual Men are Attributable to Sex with ‘New’ Partners. I. Down.

What they did: Asked Australian GBM recently diagnosed with HIV to describe their relationship to the person they believed to be the source of their infection.

What they found: The majority of GBM recently diagnosed with HIV ascribed their infection to a casual partner.

Policy and practice implications: In the Australian context, negotiated safety appears to have minimised infections between regular but not casual partners.

Psychosocial intervention, BBV, STI, PWID

A Systematic Review and Meta-analysis of Psychosocial Interventions to Reduce Drug and Sexual Blood Borne Virus Risk Behaviours Among People Who Inject Drugs. G. Gilchrist.

What they did: Systematic review and meta-analysis of psychosocial interventions designed to control interventions aimed at reducing BBV risk behaviours in people who inject drugs (PWID).

What they found: Psychosocial interventions appear to reduce: sharing of needles/syringes compared to education/information or HIV testing/counselling; sharing of other injecting paraphernalia and unprotected sex compared to interventions of a lesser time/intensity, however, moderate to high heterogeneity was reported.

Policy and practice implications: Psychosocial interventions could be included with other harm reduction approaches to prevent BBV transmission among PWID.

Young people, MSM, HIV, substance use

Effects of Parental Monitoring and Knowledge on Substance Use and HIV Risk Behaviours Among Young Men Who have Sex with Men: Results from Three Studies. B. Mustanski.

What they did: Examined the relationship between parenting practices, substance use and HIV risk behaviours among young men who have sex with men (YMSM).

What they found: Participants reported significantly higher scores for parental knowledge of general activities than parental knowledge of gay-specific activities. Monitoring was associated with less drug use and less condomless sex.

Policy and practice implications: Findings support the need for further research on the influences of parents on YMSM health risk behaviours. 

HIV, intimate partner violence, women

An Integrated HIV Risk Reduction Intervention for Women with a History of Intimate Partner Violence: Pilot Test Results. M. Mittal.

What they did: Tested the feasibility, safety, and preliminary effects of an integrated intimate partner violence (IPV) sexual risk reduction intervention for abused women.

What they found: The intervention group had a higher number of safer sex conversations with their steady partner, fewer episodes of IPV, improvements in sexual relationship power and in several hypothesised antecedents of HIV-risk behaviour.

Policy and practice implications: These encouraging preliminary findings suggest the need for a larger clinical trial.

Sex workers, health-seeking behaviours, health services

The Socio-Ecological Model Approach to Understanding Barriers and Facilitators to the Accessing of Health Services by Sex Workers: A Systematic Review. P. H. X. Ma.

What they did: Explored the health-seeking behaviours of sex workers and their access to health care services using the socio-ecological model.

What they found: A wide range of barriers and facilitators at multiple levels could influence sex workers' utilisation of health care services, such as health or service information; stigma; social support; quality of health care; available, accessible and affordable services; and healthcare policy.

Policy and practice implications: Health services or future intervention studies should take the facilitators and barriers identified in this review into account to improve the health of sex workers.

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HIV, STI, screening, young people, MSM

An Intervention Using Gamification to Increase Human Immunodeficiency Virus and Sexually Transmitted Infection Screening Among Young Men Who Have Sex With Men in California: Rationale and Design of Stick To It. C. M. Mejia.

What they did: Described the methodology of anincentive-based intervention that will use elements of gamification to increase routine HIV/STI screening among young MSM in California.

What they found: The authors describe the formative research phase and the implementation phase. Initial results are expected in the late 2017.

Policy and practice implications: Results from this research will provide preliminary evidence about the potential effectiveness of using gamification to amplify health-related behavioural change interventions.

HIV, self-management, technology, phone apps

The Relationship Between Individual Characteristics and Interest in Using a Mobile Phone App for HIV Self-Management: Observational Cohort Study of People Living With HIV. R. J. Lucero.

What they did: Examined the association between individual characteristics of people living with HIV (PLWH) and level of interest in using a free mobile phone app for HIV self-management.

What they found: Overall, 85.5% of respondents were interested in using a free mobile phone app that supports HIV self-management. Participants expressed the highest interest in app functions that facilitate communication with health care providers or help to identify relevant health care services.

Policy and practice implications: Findings can inform the development of mobile phone apps that support effective HIV self-management.

HIV testing, technology, transgender women, MSM

Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men. B. A. Koblin.

What they did: Explored development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen.

What they found: Intention to self-test was positively associated with comfort in testing by a friend or a partner at home, and stigma or fear as a reason not to test and negatively associated with higher social support and having health insurance. Intention to test at a clinic was positively associated with self-efficacy for HIV testing and social support, and negatively associated with a lifetime history of incarceration. Intention to test by couples, HIV testing and counselling was negatively associated with higher educational level.

Policy and practice implications: These findings can inform the development of interventions to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen.

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HIV, STI, syphilis, PrEP

High HIV incidence in men who have sex with men following an early syphilis diagnosis: is there room for pre-exposure prophylaxis as a prevention strategy? N. Girometti.

What they did: Undertook a service evaluation of a London sexual health clinic. Estimated the incidence of bacterial STI in MSM diagnosed with early syphilis according to their HIV status and estimated the incidence of HIV infection in HIV-negative MSM, following a diagnosis of early syphilis.

What they found: In this clinic, early syphilis was identified as a risk factor for HIV acquisition in MSM, and MSM with early syphilis had high rates of subsequent bacterial rectal STI and syphilis reinfection, irrespectively of HIV status.

Policy and practice implications: A diagnosis of early syphilis carries a high risk of consequent HIV seroconversion and should warrant prioritised access to prevention measures such as PrEP and regular STI screening to prevent HIV transmission.

HIV acquisition, MSM

High-risk sexual behaviours among gay and bisexual men: comparing event-level casual sex encounters among seroconverters and non-seroconverters. I. Down.

What they did: Using findings from the Australian HIV Seroconversion Study and the Pleasure and Sexual Health Study, the authors compared accounts of condomless anal intercourse with casual partners (CLAIC) that resulted in HIV transmissions and similar occasions when HIV transmission did not occur.

What they found: Both groups of men engaged in CLAIC, how they engaged in CLAIC differed, and the context in which they did so was different. 

Policy and practice implications: A generic measure of CLAIC conceals the critical elements of HIV risk, particularly the role of receptive CLAIC, among GBM that distinguish those who seroconverted and those who did not. Detailed information about the context and nature of the practise of CLAIC is required for a more complete understanding of HIV risk among GBM.

MSM, substance use

Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need. A. Bourne.

What they did: Reviewed patterns of substance use among gay, bisexual and other MSM.

What they found: The limited existing research indicates a higher prevalence of illicit drug use among MSM compared with their heterosexual counterparts, although the same is not necessarily true of alcohol. A sense of belonging, coping with everyday problems and the enhancement of pleasure, all feature in motivations for alcohol and drug use.

Policy and practice implications: The relationships between substance use and sexual risk behaviour among MSM are poorly understood. A focus on substance use and sexual risk may have served to mask the impact of alcohol and drug use on the broader health and well-being of MSM.

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Harm minimisation,
young people, substance use

Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people’s harm minimization strategies. E. K. Jenkins.

What they did: Present data from the Researching Adolescent Distress and Resilience (RADAR) study, which used an ethnographic approach to bring youth voice to the literature on mental health and substance use.

What they found: Young people’s individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, as were ad hoc harm minimisation strategies utilised.

Policy and practice implications: Harm reduction approaches need to be contextually relevant and responsive to the lived experiences of youth.

Health promotion, methamphetamine, illicit drugs

“Just not all ice users do that”: investigating perceptions and potential harms of Australia’s Ice Destroys Lives campaign in two studies. C. H. Douglass.

What they did: Investigated perceptions and harms of Ice Destroys Lives campaign among adults with a history of injecting drugs and young people.

What they found: Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign reinforced negative stereotypes and did not encourage help seeking

Policy and practice implications: Alternative evidence-based strategies are required to reduce crystal methamphetamine related harms.

PWID, HCV, respondent-driven sampling

Hepatitis C bio-behavioural surveys in people who inject drugs—a systematic review of sensitivity to the theoretical assumptions of respondent driven sampling. R. Buchanan.

What they did: Systematically reviewed studies that use respondent-driven sampling (RDS) in PWID to measure the prevalence of HCV, and compared each study against the STROBE-RDS checklist to assess their sensitivity to the theoretical assumptions underlying RDS.

What they found: RDS can be used to estimate a population prevalence of HCV in PWID and estimate the PWID population size.

Policy and practice implications: Future studies should report operational conduct of each survey in accordance with the STROBE-RDS checklist to indicate sensitivity to the theoretical assumptions underlying the method.

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Syphilis, MSM, screening

Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection. M. Chen.

What they did: Editorial that discusses increasing syphilis rates among men who have sex with men in various countries and complications such as ocular syphilis and neurosyphilis.

What they found: Greater efforts for promoting frequent syphilis screening of higher risk men are required. This should include serological testing for syphilis every time HIV testing is undertaken and each time HIV viral load testing is performed in HIV-positive MSM.

Policy and practice implications: Systems-based approaches tailored to particular contexts should be explored, evaluated and, if shown to be effective, implemented.

Aboriginal and Torres Strait Islander, health services, testing, gonorrhoea, chlamydia

Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services. M. E. Harrod.

What they did: Analysed gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services.

What they found: Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test.

Policy and practice implications: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.

HCV, HIV, DAA

Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database. R. Puhr.

What they did: Factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia were assessed before access to DAA.

What they found: HCV treatment uptake and sustained virological response have been relatively low in the era of interferon-containing regimens, in Australian HIV/HCV co-infected patients. With new and better tolerated DAA, treatment of HCV is likely to become more accessible.

Policy and practice implications: Identification and treatment of HCV in co-infected patients should become a priority.

Young GBM, HIV, STI

Partnership agreements less likely among young gay and bisexual men in Australia – data from a national online survey of gay and bisexual men’s relationships. J. Kolstee.

What they did: Assessed differences in partnership agreements among GBM.

What they found: Younger men were more likely to report having a monogamous partnership. In regards to their primary regular partner, younger men were less likely to have a partnership agreement and less likely to report condomless anal intercourse.

Policy and practice implications: Due to less communication with partners about sexual agreements, young GBM may be at an increased risk of HIV and other STI.

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Sexuality education, teachers, professional standards

Could Australia have its own teacher professional standards for teaching relationships and sexuality education? C. A. Collier-Harris.

What they did: Explored the potential to develop professional standards for relationships and sexuality education for Australian teachers, by comparing the competencies in the prospective USA preparation standards with those in the existing Australian teacher standards at graduate level.

What they found: There are common areas of suitability, competencies, and effectiveness that could help identify benchmarks for the teaching of timely and comprehensive relationships and sexuality education.

Policy and practice implications: Information may be useful for teachers and educators wishing to generate professional standards for the teaching of relationships and sexuality education in Australia.

Family relationships, sexuality

Deciding to reveal sexual information and sexuality education in mother-daughter relationships. T. A. Coffelt.

What they did: Interviewed nine mothers and their 18 or 19-year-old daughters to understand privacy rule foundations that influence their decisions to reveal or conceal sexual information.

What they found: Mothers may have many motivations to talk to their daughters, whereas daughters are motivated to discuss sex with a trusted source. Mothers’ perceived risks of talking about sex included judgement from other parents, and daughters were concerned about disappointing their parents. Additionally, a privacy rule emerged during joint mother–daughter interviews that stipulated ‘we talk about everything but the details’, and mothers volunteered their privacy rule acquisition of talking about sex with daughters differently from the ways their mothers talked to them.

Policy and practice implications: Findings add to sex education research by showing how mothers and daughters who talk about sex assess their decisions to do so.

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HCV, DAA, treatment

Shift in disparities in hepatitis C treatment from interferon to DAA era: A population-based cohort study. N. Z. Janjua.

What they did: Evaluated the shift in the characteristics of people who received interferon-based HCV treatments and those who received recently introduced DAA in Canada.

What they found: People with HIV co-infection, cirrhosis, decompensated cirrhosis, diabetes, history of injecting drug use and opioid substitution therapy were significantly more like to receive DAA. Those socioeconomically marginalised were less likely to access DAA.

Policy and practice implications: There is a shift in prescription of new HCV treatments to those previously excluded, although gaps remain for the socio-economically marginalised populations.

HCV, testing

Understanding patient perceptions and risk for hepatitis C screening. S. Grannan.

What they did: Identified specific themes and barriers to HCV testing to determine if testing rates increased when patients self-identify their risk factors. Participants were offered testing in Wyoming.

What they found: Testing incidence did not increase when patients self-identified risk and were offered testing. Many participants did not identify risk.

Policy and practice implications: Lack of risk identification is a barrier to HCV testing along with concerns about cost and comfort in the clinical setting.

HBV

Hepatitis B surface antigen loss and clinical outcomes between HBeAg-negative cirrhosis patients who discontinued or continued nucleoside analogue therapy. C. H. Hung.

What they did: Investigated the incidence and predictors of post-treatment HBV relapse and hepatitis B surface antigen (HBsAg) loss.

What they found: HBeAg-negative patients with cirrhosis who discontinued nucleoside analogue treatment might have a higher rate of HBsAg loss and their risk of developing hepatocellular carcinoma did not increase compared with those who continued entecavir treatment.

Policy and practice implications: The end-of-treatment HBsAg level was a useful predictor of post-treatment HBV relapse in HBeAg-negative patients with cirrhosis. This study suggests that it is worthwhile to discontinue nucleoside analogue therapy in HBeAg-negative patients who achieve a low end-of-treatment HBsAg, even if the patients have cirrhosis.

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Gay men, HIV

Abjection. Objection. Subjection: rethinking the history of AIDS in Australian gay men’s futures. G. W. Dowsett.

What they did: Article discusses the history of AIDS and Australian gay men’s futures.

What they found: Since the term 'post-AIDS' was coined some 20 years ago, gay men are having increasingly different experiences. These divergent trajectories have been influenced by age and generation; the ascendancy of the biomedical and the technosexual; and the supremacy of neoliberal politics (including sexual politics).

Policy and practice implications: The author asks: “Are we finally returning to the original gay liberation agenda of the eradication of difference, or simply being traduced (seduced?) by our success at intimate citizenship?”