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.

Fiona Taylor

Fiona Taylor

Registered Nurse for 29 years, worked in a variety of areas, including Intensive Care, Midwifery and most recently school based youth health nursing (9 years) where a passion for inclusive, sex positive, sexuality education developed. Completed Graduate Certificate in Sexual Health in 2014 and am currently employed (on contract) as Clinical Nurse/Clinical Trials coordinator at Sexual Health and HIV Service, Roma Street Brisbane. It is a busy clinic with a large cohort of HIV and SH clients. I am currently busy with Qprep trial but also responsible for a number of other trials, ie START, Cease and Long Term Non progressors. Have been a member of the Sexual Health Society of Qld for a number of years and attend regular PD in the area of SH and HIV.

The symposiusm on Trans-inclusion in clinical care was stimulating discussion with a diverse and representative panel facilitating the talk. 

Discussion started with the gender experience rather than identity and the identification of the trans-gendered women, trans-gendered men and non binary people who seek health care.  Important points raised included highlighting the need for education and upskilling of health professionals, if you are unsure, ask...ask about pronouns; ask "are you enjoying the sex you are having?", ask about the body parts used.  There is decreased sexual health literacy in this group as they feel they "aren't part of the conversation".

In relation to HIV, the concern was that they are "not seen as a target group" by some, and yet trans women who have sex with men have higher rates than MSM groups.

Another important point around health for trans people raised was that there is not one group who takes the lead for Trans Health Care and this needs to happen - a Mandate for Trans Health!  Normalised Health Care with GPs who are comfortable rather than care by endocrinologists is the way forward.  

 

 

In the plenary session on Wednesday morning, I was able to see Prof. Andrew Grulich from the Kirby Institute present information about maximising the population-level impact of PrEP.  Initially he spoke about where we have come with PrEP from 2010 with the results from iPrEx study released through to 2012 US FDA approval, 2015 results from Ipergay and Proud studies and 2016 TGA approval in Australia.  The PROUD and Ipergay studies show 86% efficacy in adherent individuals, research shows that adherence issues when measured in rectums is more forgiving than in vaginal mucosa where daily adherence to PrEP is more important - but notes no studies have been done in women.  

PrEP Activism has highlighted what an important individual and population based intervention PrEP is, and education, demand building and advocacy for widespread availability has lead to @70% uptake in eligible high risk men in NSW and similarly in San Francisco.  San Francisco has reported a 50% decrease in new diagnoses (not incidence).

Challenges continue to be in equitable access to PrEP, and identified young people and ethic minority groups being not well represented in PrEP uptake cohorts.  

Increases in STIs are counterbalanced by increased testing and shorter duration of infection.

 

This talk inspires me to get back to work and recruit more clients to the QPrEP trial in Brisbane.

The speakers presented a range of sessions around PrEP uptake and use in Gay and MSM.

Most use has been in the well connected, educated, white clients.  Why are some gay and bisexual men eligible for PrEP but not taking it suggested that many see others at more risk than themselves.  The flux cohort research suggested that there is increasing use of Meth and Viagra, adding Truvada into the mix for HIV protection, MTV. 

Other risk reduction strategies include serosorting, strategic positioning and negotiating safety.  A lot of PrEP users have decreased or stopped using condoms but there is an increasing awareness of the importance of undetectable viral loads.  The final session discussed the lack of Indigenous health promotion material and lack of uptake/knowledge of, in this priority group. 

If they were using it was probably in those "well integrated with the main stream MSM communities". Big positives for prep were that it is promoting disclosure and discussion with the Gay MSM community.

 

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