ORCID Profile
0000-0002-4116-4250
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UNSW Australia
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Médecins Sans Frontières
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Public Health and Health Services not elsewhere classified | Social and Cultural Anthropology | Public Health and Health Services | Urban Sociology and Community Studies |
Cultural Understanding not elsewhere classified | Social Structure and Health | Men's Health
Publisher: Elsevier BV
Date: 08-2020
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18161
Publisher: Springer Science and Business Media LLC
Date: 2020
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19175
Abstract: Background Novel sexually transmissible infection (STI) prevention strategies are needed to combat increasing bacterial STI incidences alongside decreasing condom use among gay and bisexual men (GBM) in Australia. Sexually transmissible infection pre-exposure prophylaxis (STI-PrEP) using regular doxycycline is one such strategy that is the subject of ongoing research. However, a lack of qualitative data regarding the conceptualisation, perceived risks, perceived benefits and preferred dosing strategies of STI-PrEP may impede future research and implementation efforts. Methods: Semistructured in-depth interviews were conducted with 13 high-risk GBM residing in Sydney, Australia. Interviews were audio recorded, transcribed verbatim and then analysed thematically. Results: STI-PrEP was largely conceptualised using pre-existing knowledge of HIV-PrEP. The perceived benefits, including a reduced incidence of STIs, destigmatisation and a ‘peace of mind’, often outweighed the perceived risks, including side effects, antibiotic resistance and stigmatisation of consumers. A daily dosing regimen was preferred unanimously by participants when compared with event-driven or episodic strategies. Conclusions: Participants of this study were cautiously optimistic regarding the concept of STI-PrEP. The findings suggest that, in addition to examining the effectiveness of STI-PrEP, future implementation studies should also focus on concerns regarding side effects and monitoring antibiotic resistance, as well as considering the acceptability and potential for stigmatisation of STI-PrEP consumers.
Publisher: Springer Science and Business Media LLC
Date: 14-04-0001
Publisher: JMIR Publications Inc.
Date: 23-09-2016
DOI: 10.2196/JMIR.5707
Publisher: Springer Science and Business Media LLC
Date: 23-01-2021
DOI: 10.1186/S13643-021-01591-Y
Abstract: Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none has focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era. A scoping review focusing on sexual health and COVID-19 will be conducted. We will search (from January 2020 onwards) CINAHL, Africa-Wide Information, Web of Science Core Collection, Embase, Gender Studies Database, Gender Watch, Global Health, WHO Global Literature on Coronavirus Disease Database, WHO Global Index Medicus, PsycINFO, MEDLINE, and Sociological Abstracts. Grey literature will be identified using Disaster Lit, Google Scholar, governmental websites, and clinical trials registries (e.g., ClinicalTrial.gov , World Health Organization, International Clinical Trials Registry Platform, and International Standard Randomized Controlled Trial Number Registry). Study selection will conform to the Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Only English language, original studies will be considered for inclusion. Two reviewers will independently screen all citations, full-text articles, and abstract data. A narrative summary of findings will be conducted. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., content and thematic analysis) methods. Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap. Systematic Review Registration: Open Science Framework osf/io/PRX8E
Publisher: JMIR Publications Inc.
Date: 08-08-2019
DOI: 10.2196/13625
Abstract: Passive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. The aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. ACCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of in iduals tested and retested, test yield, positivity, and incidence. To date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory reporting of indicators will occur in 2019 with publication to follow. The ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. DERR1-10.2196/13625
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20128
Abstract: Sex workers confront unique challenges in the face of COVID-19. Data from an international sex work website popular with cisgender men and transgender men and women suggest that, after a period of physical distancing, many sex workers are returning to in-person work: from May to August 2020, active sex work profiles increased 9.4% (P & 0.001) and newly created profiles increased by 35.6% (P & 0.001). Analysis of sex work and COVID-19 guidelines published by five community-based organisations found that they focused on altering sexual practices, enhancing hygiene and pivoting to virtual work. To capitalise on these guidelines, funding and research for implementation and evaluation are needed to support COVID-19 risk reduction strategies for sex workers.
Publisher: JMIR Publications Inc.
Date: 17-04-2018
Abstract: ay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs), yet opportunities for sexual health testing of this population are often missed or incomplete in general practice settings. Strategies are needed for improving the uptake and completeness of sexual health testing in this setting. he goal of the research was to evaluate the impact of an intervention centered around integrated decision support software and routine data feedback on the collection of sexual orientation data and sexual health testing among gay and bisexual men attending general practice. study using before/after and intervention/comparison methods was undertaken to assess the intervention’s impact in 7 purposively s led Australian general practice clinics located near the urban centers of Sydney and Melbourne. The software was introduced at staggered points between April and August 2012 it used patient records to prompt clinicians to record sexual orientation and accessed pathology testing history to generate prompts when sexual health testing was overdue or incomplete. The software also had a function for querying patient management system databases in order to generate de-identified data extracts, which were used to report regularly to participating clinicians. We calculated summary rate ratios (SRRs) based on quarterly trends and used Poisson regression analyses to assess differences between the 12-month preintervention and 24-month intervention periods as well as between the intervention sites and 4 similar comparison sites that did not receive the intervention. mong 32,276 male patients attending intervention clinics, sexual orientation recording increased 19% (from 3213/6909 [46.50%] to 5136/9110 [56.38%]) during the intervention period (SRR 1.10, 95% CI 1.04-1.11, P .001) while comprehensive sexual health testing increased by 89% (305/1159 [26.32%] to 690/1413 [48.83%] SRR 1.38, 95% CI 1.28-1.46, P .001). Comprehensive testing increased slightly among the 7290 gay and bisexual men attending comparison sites, but the increase was comparatively greater in clinics that received the intervention (SRR 1.12, 95% CI 1.10-1.14, P .001). In clinics that received the intervention, there was also an increase in detection of chlamydia and gonorrhea that was not observed in the comparison sites. ntegrated decision support software and data feedback were associated with modest increases in sexual orientation recording, comprehensive testing among gay and bisexual men, and the detection of STIs. Tests for and detection of chlamydia and gonorrhea were the most dramatically impacted. Decision support software can be used to enhance the delivery of sexual health care in general practice.
Publisher: Routledge
Date: 20-03-2021
Publisher: Wiley
Date: 04-2018
DOI: 10.1002/JIA2.25109
Publisher: BMJ
Date: 30-01-2012
DOI: 10.1136/SEXTRANS-2011-050312
Abstract: To investigate willingness to use HIV pre-exposure prophylaxis (PrEP) and the likelihood of decreased condom use among Australian gay and bisexual men. A national, online cross-sectional survey was conducted in April to May 2011. Bivariate relationships were assessed with χ2 or Fisher's exact test. Multivariate logistic regression analysis was performed to assess independent relationships with primary outcome variables. Responses from 1161 HIV-negative and untested men were analysed. Prior use of antiretroviral drugs as PrEP was rare (n=6). Just over a quarter of the s le (n=327 28.2%) was classified as willing to use PrEP. Willingness to use PrEP was independently associated with younger age, having anal intercourse with casual partners (protected or unprotected), having fewer concerns about PrEP and perceiving oneself to be at risk of HIV. Among men who were willing to use PrEP (n=327), only 26 men (8.0%) indicated that they would be less likely to use condoms if using PrEP. The likelihood of decreased condom use was independently associated with older age, unprotected anal intercourse with casual partners (UAIC) and perceiving oneself to be at increased risk of HIV. The Australian gay and bisexual men the authors surveyed were cautiously optimistic about PrEP. The minority of men who expressed willingness to use PrEP appear to be appropriate candidates, given that they are likely to report UAIC and to perceive themselves to be at risk of HIV.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Publisher: Informa UK Limited
Date: 04-2013
DOI: 10.1080/00224499.2012.760189
Abstract: Understandings of male sex workers (MSWs) shift with technological, conceptual, and social changes. Research has historically constructed MSWs as psychologically unstable, desperate, or destitute victims and their clients as socially deviant perverts. These perceptions, however, are no longer supported by contemporary research and changing societal perceptions of the sex industry, challenging how we understand and describe "escorts." The changing understandings of sexuality and the increasing power of the Internet are both important forces behind recent changes in the structure and organization of MSWs. The growth in the visibility and reach of escorts has created opportunities to form an occupational account of MSWs that better accounts for the dynamic and erse nature of the MSW experience in the early 21st century. Recent changes in the structure and organization of male sex work have provided visibility to the increasingly erse geographical distribution of MSW, the commodification of race and racialized desire, new populations of heterosexual men and women as clients, and the successful dissemination of safer sexual messages to MSWs through online channels. This article provides a broad overview of the literature on MSWs, concentrating its focus on studies that have emerged over the past 20 years and identifying areas for future research.
Publisher: BMJ
Date: 04-2020
DOI: 10.1136/BMJOPEN-2019-032876
Abstract: In the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, s ling methods, data collection and analyses of the TURNNT (‘Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour’) study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention. TURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate in idual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably in idual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation. The TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population’s health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2012
DOI: 10.1007/S10461-012-0313-Z
Abstract: We assessed attitudes to medicines, HIV treatments and antiretroviral-based prevention in a national, online survey of 1,041 Australian gay men (88.3% HIV-negative and 11.7% HIV-positive). Multivariate analysis of variance was used to identify the effect of HIV status on attitudes. HIV-negative men disagreed with the idea that HIV drugs should be restricted to HIV-positive people. HIV-positive men agreed and HIV-negative men disagreed that taking HIV treatments was straightforward and HIV-negative men were more sceptical about whether HIV treatment or an undetectable viral load prevented HIV transmission. HIV-negative and HIV-positive men had similar attitudes to pre-exposure prophylaxis but ergent views about 'treatment as prevention'.
Publisher: Springer Science and Business Media LLC
Date: 06-12-2018
DOI: 10.1007/S10461-018-2353-5
Abstract: Adequate adherence to pre-exposure prophylaxis (PrEP) is critical to prevent HIV infection, but accurately measuring adherence remains challenging. We compared two biological [blood drug concentrations in plasma and peripheral blood mononuclear cells (PBMC)] and two self-reported measures (facilitated recall to clinicians and self-report in online surveys) and identified predictors of daily PrEP adherence among gay and bisexual men (GBM) in their first 12 months on PRELUDE, an open-label, single-arm PrEP demonstration project in New South Wales, Australia. 327 participants were enrolled 263 GBM attended their 12-month follow-up visit (81% retention). Overall, 91% of blood s les had plasma drug concentrations indicative of taking 7 pills/week, and 99% had protective drug concentrations (≥ 4 pills/week). Facilitated recall to clinicians identified 99% of participants with protective adherence as measured by PBMC drug concentrations. Daily adherence measured by facilitated recall was associated with behavioural practices including group sex (aOR 1.33, 95% CI 1.15-1.53, p < 0.001). Retained participants maintained high adherence to daily PrEP over 12 months, confirmed by four different measures. Facilitated recall to clinicians is a suitable measure for assessing PrEP adherence in populations engaged in care where there is established trust and rapport with patients. Trial registration: ClinicalTrials.gov NCT02206555.
Publisher: JMIR Publications Inc.
Date: 06-11-2018
DOI: 10.2196/10808
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16191
Abstract: Background Among gay and bisexual men (GBM), ‘serosorting’ is common and involves restricting sex, or at least condomless sex, to partners of the same HIV status. The prevalence of men conveying their serosorting preferences regarding partners they meet online remains unclear. Methods: This study reviewed 57 178 Australian online profiles obtained directly from a popular gay website. Logistic regression was used to identify factors associated with preferences for meeting HIV-positive partners. Results: Men could indicate their preferences from a list of 22 types of partners 4358 profiles (7.6%) indicated an interest in meeting HIV-positive men. There were 1959 profiles (3.4%) listing a preference for 21 of the 22 types of men, including 1498 men (2.6%) that specifically excluded HIV-positive men. Men who specifically excluded HIV-positive men on their profiles were younger (mean age 34.7 years), less likely to identify as gay (25.6%) and more likely to always prefer ‘safer sex’ (55.3%) than those who specifically included them (mean age 39.6 years 62.8% gay-identified 30.9% preferred safer sex P 0.001). Men who specifically excluded HIV-positive partners on their profiles were also more likely to live outside major capital cities (P 0.001). Conclusions: Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. These factors may reflect lower social and community engagement with the gay community. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.
Publisher: Springer International Publishing
Date: 2018
Publisher: BMJ
Date: 02-09-2016
DOI: 10.1136/SEXTRANS-2016-052578
Abstract: Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers. From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis. These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19062
Abstract: Objectives The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a s le of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a s le of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11–9.99, P & 0.001), drug use during sex (aOR 3.92, 95% CI 1.79–8.60, P & 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31–6.12, P & 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09–7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07–15.51, P & 0.001). Stress and incarceration produced a dose–response effect for each association similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18097
Abstract: Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. Results: The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P& .001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P& .001) and rectum (6.6–14.8/100 PY, P& .001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7–2.2), using injecting drugs (HR=1.7, 95%CI: 1.4–2.0), being HIV positive (HR=1.4, 95%CI: 1.2–1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2–1.6). Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
Publisher: JMIR Publications Inc.
Date: 18-02-2019
Abstract: assive surveillance is the principal method of sexually transmitted infection (STI) and blood-borne virus (BBV) surveillance in Australia whereby positive cases of select STIs and BBVs are notified to the state and territory health departments. A major limitation of passive surveillance is that it only collects information on positive cases and notifications are heavily dependent on testing patterns. Denominator testing data are important in the interpretation of notifications. he aim of this study is to establish a national pathology laboratory surveillance system, part of a larger national sentinel surveillance system called ACCESS (the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance). ACCESS is designed to utilize denominator testing data to understand trends in case reporting and monitor the uptake and outcomes of testing for STIs and BBVs. CCESS involves a range of clinical sites and pathology laboratories, each with a separate method of recruitment, data extraction, and data processing. This paper includes pathology laboratory sites only. First established in 2007 for chlamydia only, ACCESS expanded in 2012 to capture all diagnostic and clinical monitoring tests for STIs and BBVs, initially from pathology laboratories in New South Wales and Victoria, Australia, to at least one public and one private pathology laboratory in all Australian states and territories in 2016. The pathology laboratory sentinel surveillance system incorporates a longitudinal cohort design whereby all diagnostic and clinical monitoring tests for STIs and BBVs are collated from participating pathology laboratories in a line-listed format. An anonymous, unique identifier will be created to link patient data within and between participating pathology laboratory databases and to clinical services databases. Using electronically extracted, line-listed data, several indicators for each STI and BBV can be calculated, including the number of tests, unique number of in iduals tested and retested, test yield, positivity, and incidence. o date, over 20 million STI and BBV laboratory test records have been extracted for analysis for surveillance monitoring nationally. Recruitment of laboratories is ongoing to ensure appropriate coverage for each state and territory reporting of indicators will occur in 2019 with publication to follow. he ACCESS pathology laboratory sentinel surveillance network is a unique surveillance system that collects data on diagnostic testing, management, and care for and of STIs and BBVs. It complements the ACCESS clinical network and enhances Australia’s capacity to respond to STIs and BBVs. R1-10.2196/13625
Publisher: Informa UK Limited
Date: 04-09-2012
DOI: 10.1080/13691058.2012.714799
Abstract: Racialised language is a salient and contested aspect of contemporary sexual cultures, particularly in the online domain. This paper explores the ways in which gay men in Australia employ race-related language when using online sex/dating websites. Using inductive content analysis, descriptive categories were developed to identify recurrent patterns in the racialised language employed by website users. A coding framework was then constructed to identify the 'subject' (self, other or concept) of each piece of race-related content, its 'purpose' (marketing, negative or positive discrimination, commentary) and the 'position' adopted (defensive, normalised or critical). Descriptive and comparative analyses revealed differences in the ways in which members of racial groups employed racialised language online. These differences are reviewed in relation to broader discourses on Whiteness and race in Australia, as well as recent community-produced anti-racism c aigns.
Publisher: Oxford University Press (OUP)
Date: 09-11-2018
Publisher: BMJ
Date: 29-03-2021
DOI: 10.1136/SEXTRANS-2020-054896
Abstract: The COVID-19 pandemic has exposed and exacerbated existing socioeconomic and health disparities, including disparities in sexual health and well-being. While there have been several reviews published on COVID-19 and population health disparities generally—including some with attention to HIV—none has focused on sexual health (ie, STI care, female sexual health, sexual behaviour). We have conducted a scoping review focused on sexual health (excluding reproductive health (RH), intimate partner violence (IPV) and gender-based violence (GBV)) in the COVID-19 era, examining sexual behaviours and sexual health outcomes. A scoping review, compiling both peer-reviewed and grey literature, focused on sexual health (excluding RH, IPV and GBV) and COVID-19 was conducted on 15 September 2020. Multiple bibliographical databases were searched. Study selection conformed to Joanna Briggs Institute (JBI) Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. We only included English-language original studies. We found that men who have sex with men may be moving back toward pre-pandemic levels of sexual activity, and that STI and HIV testing rates seem to have decreased. There was minimal focus on outcomes such as the economic impact on sexual health (excluding RH, IPV and GBV) and STI care, especially STI care of marginalised populations. In terms of population groups, there was limited focus on sex workers or on women, especially women’s sexual behaviour and mental health. We noticed limited use of qualitative techniques. Very few studies were in low/middle-income countries (LMICs). Sexual health research is critical during a global infectious disease pandemic and our review of studies suggested notable research gaps. Researchers can focus efforts on LMICs and under-researched topics within sexual health and explore the use of qualitative techniques and interventions where appropriate.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2021
DOI: 10.1186/S12889-021-12011-0
Abstract: HIV self-testing was proved as an effective tool for increasing testing frequency in gay and bisexual men at high risk of infection. Questions remain about understanding why HIVST encouraged testing and how such success can be translated to programmatic implementation. We conducted a qualitative investigation of how FORTH participants experienced and perceived HIVST. Stratified s ling was used to recruit gay and bisexual men participating in the FORTH HIVST intervention to take part in interviews, focusing on infrequent testers and those who had received inaccurate HIVST results. Our analysis identified several prominent themes organized into two overarching domains from the 15 interviews: (i) aspects of HIVST contributing to HIV testing frequency, and (ii) sustaining HIVST into the future. Participants also believed that their use of HIVST in the future would depend on the test kit’s reliability, particularly when compared with highly reliable clinic-based testing. HIVST increases the frequency of HIV testing among gay and bisexual men due, in part, to the practical, psychological, and social benefits it offers. To capitalize fully on these benefits, however, strategies to ensure the availability of highly reliable HIVST are required to sustain benefits beyond the confines of a structured research study.
Publisher: Oxford University Press (OUP)
Date: 13-04-2017
DOI: 10.1093/CID/CIX326
Abstract: Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91% Ptrend < .0001) and HIV-positive MSM (42% to 77% Ptrend < .0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend < .0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend < .0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend < .0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend = .030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend < .0001), while secondary infections decreased from 45% to 26% (Ptrend = .0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87 P = .005) or frequency (r = -0.93 P = .001). Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
Publisher: Wiley
Date: 18-02-2019
DOI: 10.5694/MJA2.50006
Abstract: To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia. Retrospective cohort analysis of routinely collected longitudinal data from 44 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) program. Patients diagnosed with HIV infections, January 2004 - June 2015. Commencement of antiretroviral therapy within 6 months of HIV diagnosis (early treatment) demographic, clinical, and risk group characteristics of patients associated with early treatment trends in early treatment, by CD4 917 people were diagnosed with HIV infections, their median age was 34 years (interquartile range [IQR]: 27-43 years), and 841 (92%) were men the median CD4 The proportion of people newly diagnosed with HIV in sexual health clinics in Australia who received treatment within 6 months of diagnosis increased from 17% to 53% during 2004-2015, reflecting changes in the CD4
Publisher: Informa UK Limited
Date: 17-09-2019
Publisher: AMPCo
Date: 29-08-2019
DOI: 10.5694/MJA2.50322
Abstract: To estimate rates of HIV infection, chlamydia, gonorrhoea, and infectious syphilis in transgender men and women in Australia to compare these rates with those for cisgender people. Cross-sectional, comparative analysis of de-identified health data. We analysed data for 1260 transgender people (404 men, 492 women, 364 unrecorded gender), 78 108 cisgender gay and bisexual men, and 309 740 cisgender heterosexual people who attended 46 sexual health clinics across Australia during 2010-2017. First-visit test positivity for sexually transmitted infections (STIs), stratified by patient group and year demographic and behavioural factors associated with having STIs. 14 of 233 transgender men (6.0%) and 34 of 326 transgender women (10%) tested during first clinic visits were chlamydia-positive nine transgender men (4%) and 28 transgender women (8.6%) were gonorrhoea-positive. One of 210 tested transgender men (0.5%) and ten of 324 tested transgender women (3.1%) were diagnosed with infectious syphilis 14 transgender men (3.5%) and 28 transgender women (5.7%) were HIV-positive at their first visit. The only significant change in prevalence of an STI among transgender patients during the study period was the increased rate of gonorrhoea among transgender women (from 3.1% to 9.8%). Compared with cisgender gay and bisexual men, transgender men were less likely (adjusted odds ratio [aOR], 0.46 95% CI, 0.29-0.71 P = 0.001) and transgender women as likely (aOR, 0.98 95% CI, 0.73-1.32 P = 0.92) to be diagnosed with a bacterial STI compared with heterosexual patients, transgender men were as likely (aOR, 0.72 95% CI, 0.46-1.13 P = 0.16) and transgender women more likely (aOR, 1.56 95% CI, 1.16-2.10 P = 0.003) to receive a first-visit bacterial STI diagnosis. The epidemiology of STIs in transgender people attending Australian sexual health clinics differs from that of cisgender patients. Gender details must be captured by health data systems to facilitate appropriate delivery of sexual health care.
Publisher: SAGE Publications
Date: 17-07-2017
Abstract: Research shows that some heterosexually identified men engage in sex with men however, they remain largely hidden and little understood. Despite long-standing scholarly recognition that sexual identity and orientation do not always neatly coincide, the culturally normative heterosexual/homosexual binary tends to shape mainstream perceptions of such men as well as render them invisible in sexual health systems reliant on stable sexual identity categories. This invisibility, in turn, perpetuates the fiction of the binary. We explore perspectives on heterosexually identified men who have sex with men, drawing on recent research literature and on qualitative interviews with “key informants” in the Australian sexual health field who have frontline knowledge of these men. We consider the limitations of inventing a label to “encapsulate” these erse men but also the significance of finding a language that meaningfully acknowledges their sexual realities and highlights heterosexuality as more varied and fluid than social attitudes and traditional sexual identity categories permit.
Publisher: Elsevier BV
Date: 08-2019
Publisher: Springer Science and Business Media LLC
Date: 07-07-2015
DOI: 10.1007/S10508-015-0487-3
Abstract: Sexual racism is a specific form of racial prejudice enacted in the context of sex or romance. Online, people use sex and dating profiles to describe racialized attraction through language such as "Not attracted to Asians." Among gay and bisexual men, sexual racism is a highly contentious issue. Although some characterize discrimination among partners on the basis of race as a form of racism, others present it as a matter of preference. In May 2011, 2177 gay and bisexual men in Australia participated in an online survey that assessed how acceptably they viewed online sexual racism. Although the men s led displayed erse attitudes, many were remarkably tolerant of sexual racism. We conducted two multiple linear regression analyses to compare factors related to men's attitudes toward sexual racism online and their racist attitudes more broadly. Almost every identified factor associated with men's racist attitudes was also related to their attitudes toward sexual racism. The only differences were between men who identified as Asian or Indian. Sexual racism, therefore, is closely associated with generic racist attitudes, which challenges the idea of racial attraction as solely a matter of personal preference.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Informa UK Limited
Date: 05-01-2022
Publisher: Elsevier BV
Date: 12-2022
Publisher: SAGE Publications
Date: 16-04-2016
Abstract: Sexual racism can be thought of as a specific form of racial prejudice enacted in the context of sex and dating. It is a contentious issue among gay and bisexual men looking for partners online. This study draws upon 14 in-depth interviews conducted between August and October 2012 with gay and bisexual men of colour in Australia. Data were thematically analysed to identify interpretations and experiences of, and reactions to sexual racism online. Understandings of online sexual racism were erse, ranging from clear ideas about racist and non-racist practices to more ambiguous and contextual interpretations. Nevertheless, all participants described experiences of sexual racism while seeking partners online, which were, in some cases, largely indistinguishable from generic forms of racism. Most described experiences of subtle racism, but there were also cases of blatant and aggressive racial prejudice. Finally, men reacted in a range of ways when confronted with online sexual racism, with strategies ranging from disconnection to adaptation through to confrontation. Our findings highlight that sexual racism – as an expression of racism generally – is an ongoing issue for men who seek out other men online, and that men engage in a range of strategies for mitigating the negative effects of racial prejudice in this domain.
Publisher: Informa UK Limited
Date: 16-03-2020
Publisher: Public Library of Science (PLoS)
Date: 21-07-2021
DOI: 10.1371/JOURNAL.PONE.0253589
Abstract: Transgender and gender erse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender erse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of ‘gender insensitivity’, which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender erse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4 p .001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p .001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,-0.03, p = 0.007). Given the high rates of HIV and other STIs among trans and gender erse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.
Publisher: Mary Ann Liebert Inc
Date: 08-2022
Publisher: Springer Science and Business Media LLC
Date: 28-05-2020
Publisher: Springer Science and Business Media LLC
Date: 05-04-2021
DOI: 10.1007/S10461-021-03249-1
Abstract: The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017–January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) in idual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.
Publisher: Informa UK Limited
Date: 09-2013
Publisher: SAGE Publications
Date: 29-05-2019
Abstract: To understand the HIV epidemic among men who have sex with men who engage in transactional sex (MSM-TS) in Paris, France, we sought to examine the association between engagement in transactional sex and HIV risk behaviors among MSM in Paris, France. Users of a geosocial-networking application in Paris were provided an anonymous web-based survey ( N = 580), which included questions about transactional sex and behavioral risk factors for HIV along with sexually transmitted infection (STI)/HIV status. Multivariate analyses showed that engagement in transactional sex was associated with condomless receptive and insertive anal intercourse (adjusted relative risk [aRR] = 1.34, 95% confidence interval [CI] = 1.04–1.72 and aRR = 1.41, 95% CI = 1.04–1.91, respectively). MSM-TS were more likely to have engaged in substance use before or during sex (aRR = 1.35, 95% CI = 1.13–1.62), to have participated in group sex (aRR = 1.37, CI = 1.13–1.62), and to have had an STI during the last year (aRR = 1.68, 95% CI = 1.16–2.45). Transactional sex was not associated with HIV status. MSM-TS in Paris engaged in higher HIV risk behaviors, however, did not have higher rates of HIV infection. Sexual health interventions should continue to target MSM-TS however, future studies should characterize the social, cultural, and structural factors that interact with in idual behaviors to elevate HIV risk for MSM-TS.
Publisher: Oxford University Press (OUP)
Date: 14-02-2018
Publisher: Springer Science and Business Media LLC
Date: 18-07-2019
Publisher: BMJ
Date: 17-10-2020
DOI: 10.1136/SEXTRANS-2019-054107
Abstract: Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity. Data (2011–2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests. From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend .001 urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006 and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend .001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33 95% CI 1.27 to 1.38) than at urogenital (OR 1.06 95% CI 1.02 to 1.10) and anorectal (OR 1.16 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p .001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p .001), injecting drug use (p .001), anogenital symptoms (p .001) and HIV-positive status (p=0.050). Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18181
Publisher: Springer Science and Business Media LLC
Date: 24-03-2015
Publisher: Mary Ann Liebert Inc
Date: 03-2020
Publisher: JMIR Publications Inc.
Date: 20-11-2018
DOI: 10.2196/11028
Publisher: JMIR Publications Inc.
Date: 24-06-2020
DOI: 10.2196/16757
Abstract: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link in idual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures. The aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance. Although ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs. Sensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches. This study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
Publisher: Springer Science and Business Media LLC
Date: 28-03-2020
Publisher: Wiley
Date: 19-04-2021
DOI: 10.1111/HIV.13102
Abstract: To evaluate the impact of government HIV strategies that aimed to increase HIV testing uptake and frequency among gay and bisexual men (GBM) in New South Wales (NSW), Australia. We analysed HIV testing data from existing passive and sentinel surveillance systems between 2010 and 2018. Six indicators were measured: (1) state‐wide total HIV laboratory tests (2) number of GBM attending publicly‐funded clinics (3) 12‐monthly testing uptake (4) annual testing frequency (5) HIV testing with a STI diagnosis and (6) HIV positivity. Mathematical modelling was used to estimate (7) the proportion of men with undiagnosed HIV. Indicators were stratified by Australian vs. overseas‐born. Overall, 43,560 GBM attended participating clinics (22,662 Australian‐born, 20,834 overseas‐born) from 2010‐2018. Attendees increased from 5,186 in 2010 to 16,507 in 2018. There were increasing trends (p .001 for all) in testing uptake (83.9% to 95.1%) testing with a STI diagnosis (68.7% to 94.0%) annual HIV testing frequency (1.4 to 2.7) and a decreasing trend (p .01) in HIV positivity (1.7% to 0.9%).Increases in testing were similar in Australian‐born and overseas‐born GBM. However, there were decreasing trends in the estimated undiagnosed HIV proportion overall (9.5% to 7.7%) and in Australian‐born GBM (7.1% to 2.8%), but an increasing trend in overseas‐born GBM (15.3% to 16.9%) (p .001 for all).
Publisher: Oxford University Press (OUP)
Date: 16-10-2018
DOI: 10.1093/CID/CIX905
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Elsevier BV
Date: 10-2021
Publisher: Mary Ann Liebert Inc
Date: 12-2018
Publisher: Oxford University Press (OUP)
Date: 28-02-2019
DOI: 10.1093/CID/CIZ164
Abstract: Human immunodeficiency virus (HIV)–positive gay and bisexual men (GBM) in Australia are well engaged in care. The World Health Organization’s (WHO) hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030 may be reachable ahead of time in this population. We predicted the effect of treatment and behavioral changes on HCV incidence among HIV-positive GBM up to 2025 using a HCV transmission model parameterized with Australian data. We assessed the impact of changes in behavior that facilitate HCV transmission in the context of different rates of direct-acting antiviral (DAA) use. HCV incidence in our model increased from 0.7 per 100 person-years in 2000 to 2.5 per 100 person-years in 2016 and had the same trajectory as previously reported clinical data. If the proportion of eligible (HCV RNA positive) patients using DAAs stays at 65% per year between 2016 and 2025, with high-risk sexual behavior and injecting drug use remaining at current levels, HCV incidence would drop to 0.4 per 100 person-years (85% decline from 2016). In the same treatment scenario but with substantial increases in risk behavior, HCV incidence would drop to 0.6 per 100 person-years (76% decline). If the proportion of eligible patients using DAAs dropped from 65% per year in 2016 to 20% per year in 2025 and risk behavior did not change, HCV incidence would drop to 0.7 per 100 person-years (70% reduction). Reaching the WHO HCV elimination target by 2025 among HIV-positive GBM in Australia is achievable.
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: BMJ
Date: 05-06-2019
DOI: 10.1136/SEXTRANS-2018-053801
Abstract: Key strategies to control chlamydia include testing, treatment, partner management and re-testing. We developed a diagnosis and care cascade for chlamydia to highlight gaps in control strategies nationally and to inform efforts to optimise control programmes. The Australian Chlamydia Cascade was organised into four steps: (1) annual number of new chlamydia infections (including re-infections) (2) annual number of chlamydia diagnoses (3) annual number of diagnoses treated (4) annual number of diagnoses followed by a re-test for chlamydia within 42–180 days of diagnosis. For 2016, we estimated the number of infections among young men and women aged 15–29 years in each of these steps using a combination of mathematical modelling, national notification data, sentinel surveillance data and previous research studies. Among young people in Australia, there were an estimated 248 580 (range, 240 690–256 470) new chlamydia infections in 2016 (96 470 in women 152 100 in men) of which 70 164 were diagnosed (28.2% overall: women 43.4%, men 18.6%). Of the chlamydia infections diagnosed, 65 490 (range, 59 640–70 160) were treated (93.3% across all populations), but only 11 330 (range, 7660–16 285) diagnoses were followed by a re-test within 42–180 days (17.3% overall: women 20.6%, men 12.5%) of diagnosis. The greatest gaps in the Australian Chlamydia Cascade for young people were in the diagnosis and re-testing steps, with 72% of infections undiagnosed and 83% of those diagnosed not re-tested: both were especially low among men. Treatment rates were also lower than recommended by guidelines. Our cascade highlights the need for enhanced strategies to improve treatment and re-testing coverage such as short message service reminders, point-of-care and postal test kits.
Publisher: No publisher found
Date: 2018
DOI: 10.1071/SH17183
Publisher: Mary Ann Liebert Inc
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: JMIR Publications Inc.
Date: 21-10-2019
Abstract: he Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link in idual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures. he aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system’s integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance. lthough ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs. ensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches. his study’s findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS.
Publisher: BMJ
Date: 26-06-2020
DOI: 10.1136/SEXTRANS-2020-054550
Abstract: Recommendations of ‘social distancing’ and home quarantines to combat the global COVID-19 pandemic have implications for sex and intimacy, including sex work. This study examined the effects of 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. This study made use of an existing database of deidentified data extracted from the online profiles maintained by male sex workers on a large, international website. Website engagement metrics were calculated for the periods before (September to December 2019) and during COVID-19 (January to May 2020) Poisson regression analyses were used to assess changes over time before and after, while a content analysis was undertaken to identify modes of engagement with the virus. Data were collected from 78 399 profiles representing 19 388 in iduals. In the ‘before’ period, the number of active profiles was stable (inter-rate ratio (IRR)=1.01, 95% CI 0.99 to 1.01, p=0.339) but during COVID-19 decreased by 26.3% (IRR=0.90, 95% CI 0.89 to 0.91, p .001). Newly created profiles also decreased during COVID-19 (59.4% IRR=0.71, 95% CI 0.69 to 0.74, p .001) after a period of stability. In total, 211 unique profiles explicitly referenced COVID-19 185 (85.8%) evoked risk reduction strategies, including discontinuation of in-person services (41.2%), pivoting to virtual services (38.9%), COVID-19 status disclosure (20.9%), enhanced sanitary and screening requirements (12.3%) and restricted travel (5.2%). Some profiles, however, seemed to downplay the seriousness of COVID-19 or resist protective measures (14.7%). These findings support the contention that COVID-19 has dramatically impacted the sex industry globally, male sex workers may be facing considerable economic strain. Targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies. Those involved with the sex industry must have access to state-sponsored COVID-19 financial and other aid programmes to support in idual and public health.
Publisher: JMIR Publications Inc.
Date: 11-05-2018
Abstract: ew biomedical prevention interventions make the control or elimination of some blood-borne viruses (BBVs) and sexually transmissible infections (STIs) increasingly feasible. In response, the World Health Organization and governments around the world have established elimination targets and associated timelines. To monitor progress toward such targets, enhanced systems of data collection are required. This paper describes the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). his study aims to establish a national surveillance network designed to monitor public health outcomes and evaluate the impact of strategies aimed at controlling BBVs and STIs. CCESS is a sentinel surveillance system comprising health services (sexual health clinics, general practice clinics, drug and alcohol services, community-led testing services, and hospital outpatient clinics) and pathology laboratories in each of Australia’s 8 states and territories. Scoping was undertaken in each jurisdiction to identify sites that provide a significant volume of testing or management of BBVs or STIs or to see populations with particular risks for these infections (“priority populations”). Nationally, we identified 115 health services and 24 pathology laboratories as relevant to BBVs or STIs purposive s ling was undertaken. As of March 2018, we had recruited 92.0% (104/113) of health services and 71% (17/24) of laboratories among those identified as relevant to ACCESS. ACCESS is based on the regular and automated extraction of deidentified patient data using specialized software called GRHANITE, which creates an anonymous unique identifier from patient details. This identifier allows anonymous linkage between and within participating sites, creating a national cohort to facilitate epidemiological monitoring and the evaluation of clinical and public health interventions. etween 2009 and 2017, 1,171,658 in idual patients attended a health service participating in ACCESS network comprising 7,992,241 consultations. Regarding those with unique BBV and STI-related health needs, ACCESS captured data on 366,441 young heterosexuals, 96,985 gay and bisexual men, and 21,598 people living with HIV. CCESS is a unique system with the ability to track efforts to control STIs and BBVs—including through the calculation of powerful epidemiological indicators—by identifying response gaps and facilitating the evaluation of programs and interventions. By anonymously linking patients between and within services and over time, ACCESS has exciting potential as a research and evaluation platform. Establishing a national health surveillance system requires close partnerships across the research, government, community, health, and technology sectors. ERR1-10.2196/11028
Publisher: Springer Science and Business Media LLC
Date: 31-07-2019
DOI: 10.1007/S10461-019-02618-1
Abstract: We assessed in idual and collective responses to HIV pre-exposure prophylaxis ('PrEP') among a network of male sex workers and clients. From 2011 to May 2017, keyword searches on an online discussion forum identified 668 posts that referenced PrEP. We conducted four analyses: (i) discourse analysis identifying reactions to PrEP, (ii) thematic analysis constructing rhetorical strategies, (iii) content analysis comparing discursive positions and rhetorical strategies, and (iv) longitudinal analyses assessing trends over time. Forum posts adopted one of three discursive positions (reluctance, interest, advocacy), drawing upon four non-exclusive strategies (deference to experts and evidence, acknowledging personal and shared experiences, establishing philosophical arguments, engaging in speculation). Posts from sex workers were more likely than clients to be supportive of PrEP (96% vs. 42% χ
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-10-2020
DOI: 10.1097/OLQ.0000000000001086
Abstract: In recent years, gonorrhea notifications have increased in women in Australia and other countries. We measured trends over time and risk factors among Australian Aboriginal and Torres Strait Islander (“Aboriginal”) and non-Aboriginal women. We conducted a cross-sectional analysis of data from 41 sexual health clinics. Gonorrhea positivity at each patient's first visit (first-test positivity) during the period 2009 to 2016 was calculated. Univariate and multivariate analyses assessed risk factors for first-test positivity in Aboriginal and non-Aboriginal women. Gonorrhea positivity decreased among Aboriginal women (7.1% in 2009 to 5.2% in 2016, P 0.001) and increased among non-Aboriginal women (0.6%–2.9%, P 0.001). Among Aboriginal women, first-test positivity was independently associated with living in a regional or remote area (adjusted odds ratio [aOR], 4.29 95% confidence interval [CI], 2.52–7.31 P 0.01) and chlamydia infection (aOR, 4.20 95% CI,3.22–5.47 P 0.01). Among non-Aboriginal women, first-test positivity was independently associated with greater socioeconomic disadvantage (second quartile: aOR, 1.68 [95% CI, 1.31–2.16 P 0.01] third quartile: aOR, 1.54 [95% CI, 1.25–1.89 P 0.01]) compared with least disadvantaged quartile: recent sex work (aOR, 1.69 95% CI, 1.37–2.08 P 0.01), recent injecting drug use (aOR, 1.85 95% CI, 1.34–2.57 P 0.01), and chlamydia infection (aOR, 2.35 95% CI, 1.90–2.91 P 0.01). For non-Aboriginal women, being aged 16 to 19 years (aOR, 0.62 95% CI, 0.49–0.80 P 0.01) compared with those ≥30 years was a protective factor. These findings highlight 2 different epidemics and risk factors for Aboriginal and non-Aboriginal women, which can inform appropriate health promotion and clinical strategies.
Publisher: Informa UK Limited
Date: 04-2013
Publisher: MDPI AG
Date: 30-05-2019
Abstract: Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). In idual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, s ling methods, data collection, data management methods, and preliminary findings of the ongoing ‘Neighborhoods and Networks (N2) Cohort Study’. Methods/Design: N2 employs a prospective longitudinal design. The s le includes Black MSM participants in Chicago recruited via respondent-driven s ling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a erse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a erse population of Black MSM as we work toward HIV elimination in the U.S.
Publisher: Informa UK Limited
Date: 03-01-2020
Publisher: Springer Science and Business Media LLC
Date: 19-12-2018
DOI: 10.1007/S10461-017-2012-2
Abstract: We assessed trends in HIV testing outcomes during a period of clinic-based initiatives introduced to increase HIV testing among gay and bisexual men (GBM) attending sexual health clinics (SHCs) in New South Wales (NSW). A cohort of 25,487 HIV-negative GBM attending 32 SHCs in NSW (2009-2015) was classified into six sub-groups each year based on client-type (new/existing), risk-status (low/high-risk), and any recent HIV testing. Poisson regression methods were used to assess HIV testing outcomes in sub-groups of GBM. HIV testing outcomes and the sub-groups with greatest statistically significant annual increases were: in iduals attending (26% in high-risk existing clients with recent testing) testing uptake (4% in low-risk existing clients with no recent testing) testing frequency (6% in low-risk existing clients with no recent testing and 5% in high-risk existing clients with recent testing) and total tests (31% in high-risk existing clients with recent testing). High-risk existing clients with recent testing had a 13% annual increase in the proportional contribution to total tests. Our findings show improved targeting of testing to high-risk GBM at NSW SHCs. The clinic-based initiatives should be considered for translation to other similar settings.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12179
Abstract: Background Research indicates that the incidence of hepatitis C (HCV) among HIV-positive men who have sex with men (MSM) is increasing. Although injecting drug use remains the predominant means of transmission of HCV in the developed world, there is evidence of sexual transmission of HCV among MSM. Stigma associated with HCV has been shown to negatively impact HCV testing and health-seeking behaviour. There is little research that addresses attitudes towards HCV testing among this population. Methods: The current exploratory study focussed on HCV knowledge, HCV testing, sexual practices, perceptions of HCV risk and attitudes towards people with HCV among Australian MSM. The s le consisted of 590 men who completed an online survey. Results: The findings suggest that attitudinal factors related to HCV were associated with HCV testing behaviour. The more negatively respondents felt about people with HCV, the less likely they were to have ever had an HCV test. Behavioural risk factors related to sexual practices (i.e. is condom use and sexual risk activities) were not associated with HCV testing. Testing for HCV was associated with HIV-positive status, more knowledge about HCV and a greater likelihood of ever having injected drugs. Conclusions: The attitudes of MSM towards those who inject drugs are negative, mirroring that of society more generally. Furthermore, these attitudes, coupled with a lack of knowledge of the risk of sexual transmission of HCV among gay men, especially those who are HIV-positive, may act to prevent routine HCV testing among some MSM at potential risk of acquiring HCV.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1007/S10508-018-1308-2
Abstract: We investigated the racial or ethnic partner preferences among Australian gay and bisexual men (GBM) as part of a large study of sexual preferences among GBM, to identify whether racial bias was a factor in how GBM expressed their partner preferences. We surveyed 1853 Australian GBM about their partner preferences and preferred sex practices. We used logistic regression to identify whether factors such as age, gay social engagement, or men's own ethnicity or race were associated with ethnic and racial partner preferences. Mean age was 34.8 years. Ethnic or racial background included: white or "Caucasian" (86.6%), Australian Aboriginal (2.7%), and Asian (6.6%). Mean attraction scores were highest for "Caucasian" men, and lowest for Aboriginal and Asian men. Under half (41.6%) were attracted to all racial or ethnic types 7.7% were only attracted to "Caucasian" men. Being older and lower homonegativity scores were independently associated with finding all ethnic and racial types attractive. Being attracted only to "Caucasian" men was associated with younger age. Mental health was not associated with ethnic or racial partner preferences. Although men more commonly found most racial or ethnic types attractive, racial biases in partner selection were more evident among younger men, and among those who were less comfortable with their own sexuality. Addressing anti-gay stigma and broader exposure to gay community subcultures may be as important in countering racial bias.
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.00597
Abstract: To examine the impact of the national human papillomavirus (HPV) vaccination program (available to girls and women [12-26 years] since 2007 and to boys [12-15 years] since 2013) on the number of diagnoses of genital warts in Australian Aboriginal and Torres Strait Islander (Indigenous) people. Analysis of routinely collected data from patients attending 39 sexual health clinics (SHCs) in the Genital Warts Surveillance Network for the first time.Major outcome: The average annual proportion of Indigenous and non-Indigenous SHC patients diagnosed with genital warts during the pre-vaccination (2004-2007) and vaccination periods (2008-2014), stratified by age group and sex. 7.3% of the 215 599 Australian-born patients with known Indigenous status and seen for the first time at participating SHCs during 2004-2014 were Indigenous Australians. The average proportion of female Indigenous patients diagnosed with warts was lower during the vaccination period than during the pre-vaccination period (in those under 21, summary rate ratio [SRR], 0.12 95% CI, 0.07-0.21 P < 0.001) in 21-30-year olds: SRR, 0.41 95% CI, 0.27-0.61 P < 0.001) there was no significant difference for women over 30 (SRR, 0.84 95% CI, 0.51-1.36 P = 0.47). The proportion of male Indigenous heterosexual SHC patients under 21 diagnosed with warts was also lower during the vaccination period (SRR, 0.25 95% CI, 0.12-0.49 P < 0.001), with no significant changes among older Indigenous men over 30. There were marked declines in the proportions of diagnoses of genital warts in young Indigenous women and men attending SHCs after the introduction of the HPV vaccination program. If high levels of HPV vaccine coverage are sustained, HPV-related cancer rates should also decline.
Publisher: Oxford University Press (OUP)
Date: 04-02-2021
DOI: 10.1093/AJE/KWAB014
Abstract: Ambitious World Health Organization targets for disease elimination require monitoring of epidemics using routine health data in settings of decreasing and low incidence. We evaluated 2 methods commonly applied to routine testing results to estimate incidence rates that assume a uniform probability of infection between consecutive negative and positive tests based on 1) the midpoint of this interval and 2) a randomly selected point in this interval. We compared these with an approximation of the Poisson binomial distribution, which assigns partial incidence to time periods based on the uniform probability of occurrence in these intervals. We assessed bias, variance, and convergence of estimates using simulations of Weibull-distributed failure times with systematically varied baseline incidence and varying trend. We considered results for quarterly, half-yearly, and yearly incidence estimation frequencies. We applied the methods to assess human immunodeficiency virus (HIV) incidence in HIV-negative patients from the Treatment With Antiretrovirals and Their Impact on Positive and Negative Men (TAIPAN) Study, an Australian study of HIV incidence in men who have sex with men, between 2012 and 2018. The Poisson binomial method had reduced bias and variance at low levels of incidence and for increased estimation frequency, with increased consistency of estimation. Application of methods to real-world assessment of HIV incidence found decreased variance in Poisson binomial model estimates, with observed incidence declining to levels where simulation results had indicated bias in midpoint and random-point methods.
Publisher: Routledge
Date: 20-03-2021
Publisher: Routledge
Date: 20-03-2021
Publisher: Wiley
Date: 2021
DOI: 10.1002/JIA2.25655
Abstract: The human immunodeficiency virus 1 (HIV‐1) pandemic is characterized by numerous distinct sub‐epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. We used HIV‐1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV‐1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences s led between 2004 and 2018 in combination with global sequence data and NSW‐specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi‐Square statistics. We identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a 2‐fold increase in the number of NSW‐specific CRF01_AE clades over time. Subtype B clusters were associated with in iduals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection ( p 0.01). CRF01_AE infections clusters were associated with infections among in iduals diagnosed during the early stage of infection ( p 0.05) and CRF01_AE singletons were more likely to be from infections among in iduals reporting heterosexual transmission ( p 0.05). We found six subtype B clusters with an above‐average growth rate ( .5 sequences / 6‐months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time ( year) between infections and may be indicative of intermediate transmissions via undiagnosed in iduals. The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE.
Start Date: 2017
End Date: 09-2019
Amount: $197,000.00
Funder: Australian Research Council
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