ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

The injecting drug population in Australia contribute to 90% of newly diagnosed HepC, making health professionals working in the Drug and Alcohol sector pivotal to the health care outcomes of this community.  From a public health perspective better healthcare post diagnosis would reduce the the advanced progress of the disease by encouraging early thus reducing commodities.

We now have effective treatments that cure.

A discussion on what it is like to live with HepC and the past experiences with older injectable treatment V's new oral treatments, with highly successful cure rates was most insightful into the progression of the treatment journey for individuals diagnosed. Those individuals diagnosed who had experienced the older treatments with severe side effects and no success of clearing the virus, moved to using the new treatments with next to no side effects and had clearance of the infection within 12 weeks.

In 2016 reported cases of of HepC in Australia was 230,000. High risks groups need a holistic approach to care taking into account behavioral and social aspects. However recommendations are to treat first and deal with other lifestyle and behavioral issues later. This way we keep the client engaged in services

A great resource for health practitioners www.gesa.org.au (HepC treatments and Genotypes)

Interactive polling was used during this presentation to determine the group knowledge of testing and treatments for HepC.

 

Challenges in the care of Refugee women living with HIV in a  regional town

This talk was presented as part of the HIV&AIDS symposium "Who is left behind in a virtual elimination of HIV" 

I found this talk, presented by Lauren Coelli , (Sexual Health Coordinator at the Gateway Health clinic , Wodonga) very inspiring , providing a great example of how to provide care for refugee women living with HIV in regional Australia which could be translated/adopted to similar clinics and settings

The Gateway Health clinic in Wodonga was established  in 2014

The clinic is a general practice clinic set in a community health service, 

one of it's focus areas includes meeting needs of refugees 

largely from the Democratic Republic of Congo (DRC), Bhutan and Nepal

The clinic currently looks after 12 women and one child living with HIV

all the 12 women acquired HIV as a result of rape

According to the DRC family code (444) " a wife owes her obedience to her husband"

marital rape is not criminal act

The women attending the service described high levels of anxiety about their HIV diagnosis, including fear of death and worry about children's future 

Bottle feeding their babies may identify the mother as being HIV positive, and feeding therefore often takes place in private

In addition, they reported fear of transmission, disclosure to community and ostrerisation by their community if their HIV status was disclosed

These concerns and fears have contributed to reluctance to join support organisations, fear of meeting other African people working at the clinic and distrust of phone interpreters

Some of the strategies employed by Gateway Health to overcome these barrier and improve patient care and outcomes have included gaining trust and building rapport with the women, providing a flexible, walk-in model, close collaboration with other local health care providers and up-skilling clinic staff (eg undertaking s100 prescriber training) to provide care within the service for the women rather than having to refer the women to multiple external service providers.

 

 

Presented by Dr Ayden Scheim, Division of Global Public Health, University of California, San Diego, USA 

Overview

1.       Trans populations are incredibly diverse

2.       Trans women disproportionately impacted by HIV globally

3.       A “global” picture obscures context & knowledge gaps

4.       Trans people face multi-level HIV /STI vulnerabilities and protective factors

5.       We must make trans people visible in HIV & sexual health

6.       A trans sexual health agenda is needed

Trans populations are diverse

Trans and gender diverse identities

-          Trans women/ trans feminine & trans men / trans masculine

-          Non- binary

-          Two Spirit

-          Sistergirl/ Brotherboy

0.6 % of US adults (~ 1 in 160) are trans gender compared 1.2 % of NZ high school students

Gender Identity

Non Binary people counted 35 %, while 33 % of Transgender women and 29 % of Transgender men with the least proportion is Crossdressers, only 3 %

Medical Transition (hormones and / or surgeries)

Almost a quarter already had completed transition and next quarter is still in process. Other half include; Planning but not begun, not planning to and not sure group as well as concept does not apply group

Ø  Trans women face a disproportionate HIV burden globally

-          Based on paper from Baral et al, Lancet Infectious Disease 2013, the pool HIV prevalence was 19.1 % in 11066 transgender women worldwide.

Trans men

Qualitative data is very limited and Lab confirmed HIV + varies from 0 - 4 % while self reported presented from 0 – 10 %

Choosing the right denominator

-          2/3 of trans men identify as gay, bi, queer but only 1/3 of those had sex with cis men

Trans MSM seem a lot like other MSM; however countervailing risk & protective factors shown as below are unavoidable

-          Sexual abuse, stimulant use, depression, syndemics predict risk behaviour

-          But are distinct in consequential ways

-          Exclusion from gay communities

-          Less anal intercourse

-          Changes to genital mucosa

Therefore, Trans people are not MSM….. except for when they are

-          Include trans MSM alongside other MSM

-          Who will be accountable to trans women ?

Summary

A trans sexual health agenda based in access to gender affirming care including hormones and surgery, reproductive care, HIV / STI prevention, screening and treatment in a context of gender recognition and rights protection

 

Normal 0 false false false EN-US JA X-NONE

 

Dr. Alena Simonis presented an interesting presentation on Labiaplasty which is a surgical procedure which aims to change the appearance of the labia majora and or labia minora and surrounding skin.

 

I was surprised to hear that Female Genital Cosmetic Surgery (FGCS) can be performed by anyone with a medical degree, as it stands there is no formal training. In the US, Labioplasty is the 4th most requested cosmetic procedure with similar trends in most of the developing world.

 

Dr. Simonis talked through a GP based survey she was involved in which included 443 GPs. The two figures that stuck out for me were as follows;

- 50% of the GPs had been asked about FGCS

- 35% of which were under 18 years of age

The survey highlighted that most women asking about FGCS were also in an emotional and vulnerable state. In response to the increasing FGCS demand, the RACGP has developed the useful guidelines  which also identifies the various reasons women of many ages are requesting FGCS;

 

Normal 0 false false false EN-US JA X-NONE

https://www.racgp.org.au/download/Documents/Guidelines/Female-genital-cosmetic-surgery-toolkit.pdf

This whirlwind run with two enthusiastic and knowledgeable presenters reinforced that implementation of Evidence Based Medicine means clinicians need a basic understanding of how the data is being collected, sifted and analysed to provide treatment recommendations.  I’ve just completed (with some difficulty!) an introductory biostatistics university course and was looking forward to consolidating the knowledge.

First, Professor Matthew Law gave a rundown of the basics of statistical inference.  His Key Points:

      5% of all studies with a significant finding have occurred by chance – thinking of all the studies in all the journals in all the world, this is a sobering perspective!

      Look at confidence intervals to get an idea of how precise this estimate is – narrower is better, but crossing the ‘no difference’ value negates significant p-values.

      Failure to reject a null hypothesis doesn’t mean the null hypothesis is true.

      One tailed tests suggest mathematical jiggery-pokery and should be approached with caution!

Next, an explanation of what the different types of models and tests all mean, by A/Prof Kathy Petoumenos.   She ran through the differences in variable types, model types, and how to interpret reported calculations such as relative risk, odds ratios and hazard ratios.

Her (very reassuring) Key Point: Ask a friendly statistician!

 

 

In this era of information galore, KPIs and rapidly evolving evidence base, we as clinicians should consider basic statistics knowledge for ourselves mandatory, and biostatisticians part of our multidisciplinary team.

RT @hepqld: Curing #hepatitis C is easy, and no longer needs a specialist to prescribe treatment. Community doctors play a pivotal role in…

ASHM ASHM