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.

Elizabeth Pearce

Elizabeth Pearce

I'm a registered nurse with over 10 years nursing experience. I've worked in the UK, Singapore and Australia in the transplantation setting, Emergency Care and now HIV and Sexual Health.

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Associate Professor David Whiley, Principle Research Fellow, Pathology QLD and the University of QLD, Australia looked at the different Neisseria Gonorrhoeae (NG) genotypes within NSW and in particular the genotypes associated with MSM and the heterosexual community.  David’s team collected samples over a period of time and applied NG genotyping and whole genome sequencing to the NG isolates, using MassARRAY iPLEX technology. Amongst many interesting findings the majority of isolates collected from female patients of all ages belonged to 1-5 clusters.

 

Having an understanding of the NG genotypes is fascinating, especially in the face of antibiotic resistance. Following on from Davids presentation, Dr. Eric Chow, senior research fellow, Melbourne Sexual Health Centre, VIC, Australia then presented an interesting session on Risk Factors for NG in heterosexuals. As it stands NG is the second most prevalent STI, which has been attracting a lot of media attention due to the first line antibiotic resistant strains.

 

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Dr. Chow looked at a number of risk factors associated with the increase. The risk factors included condom use, dating apps, bisexual sex, alcohol use and international travel. Increased International travel seemed to be the most feasible risk associated with the increase. The take home message from this; always ask clients about overseas travel and to educate them on safe sex abroad. 

 

 

 

 

 

Lynda Carlye is a sex and relationship therapist and director of the Society of Australian Sexologists, Australia. Lynda has over 10 years experience in the field and presented a very engaging talk which looked at why 27.3% of women do not enjoy sex (Australian study of Health and Relationships)

Lynda kicked off her talk by going through the pathological and non-pathological reasons of vulvodynia which is a pain in one area of the vulva. Lynda established the importance of understanding the 237 reasons people have sex from the YSEX survey under the following four subcategories; physical, emotional, goal attainment and insecurity.

At a clinical service level, it is important that once organic causes have been ruled out, appropriate referrals are made within the multidisciplinary team which should include a solution focused psychosexual management/ treatment within a counselling framework for the individual and/or couple.  

Amongst many, Lynda recommended Dr. Anita Elias’s practical assessment and management tool that helps patients understand the connection between their thoughts emotions and physical sexual response.

Certainly psychosexual therapy is invaluable although public funding for this is limited and therefore a barrier for many. 

 

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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;

 

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

Trans Rights, Sexual Health, and HIV: The View from Canada. Dr Ayden Scheim whom currently works in San Diego, USA delivered an interesting presentation on the global trans gender community.

 

The trans gender community is diverse and have low rates of access to health and HIV services. Dr. Scheim contributed this to a number of issues including violence, legal barriers, stigma and discrimination.

 

As a global health agenda and key population group, the overwhelming message Dr. Scheim highlighted was the lack of inclusive research/ data in this field which mainly comes from the US.

 

At a clinical service level Dr. Scheim recommended that we need to firstly understand the basic epidemiology of the trans community and we should be asking the following questions;

 

-       What sex where you assigned at birth?

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-       Which best describes your current identity? (which can included up to 33 possible answers)

Psychosocial Complexity in HIV care. Senior Psychologist, Ruth Hennessy presented a snap shot of data from a 65 participant audit collected in 2009 and again in 2016. The audit identified the increasing complexity of psychosocial issues among HIV clients.

 

The focus of the data identified the increase use of crystal use, increase in social isolation and mental health issues associated with HIV positive clients and thus the importance of a complexity of care model to identify risk. The data also represented the increasing level of clinical comorbidity in clients presenting for psychological therapy at an inner Sydney public health HIV clinic. This increase in comorbidity often equates to an increase in clinical complexity, and the need for an expert interdisciplinary team of clinicians to effectively manage their care in a holistic way.

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Dr Adam Bourne, Associated Professor, Australian Research Centre in Sex, Health and Society, Latrobe University, Melbourne VIC, Australian delivered an interesting talk on global PrEP use within the MSM community and the stigma associated with taking PrEP called  "sl*t shamming". To tackle this perception, Dr. Bourne highlighted the importance of a "good sex life" within the MSM community and mentioned various lived experience PrEP studies, one found that 76% of the PrEP participants since taking PrEP are now happier with there sex life. At a clinic level this reminds us that a "good sex life" is a key motivator and if discussed with every client will help increase PrEP use and help address the associated “sl*t Shamming” stigma associated with PrEP.  

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