Day 2: Rapid Fire Session Sexuality and Reproductive Health:

Tim Chen – Asian Gay Men’s Project Officer ACON NSW ‘A Changing Sexual Landscape of Gay Asian Men in Sydney: Implications for HIV/STI Prevention’.

Tim discussed the results from a survey conducted between September 2015 and June 2016 for Asian gay and bisexual men.  The survey was printed in English and Thai languages and conducted at sexual health services (including a[test]), sex-on-premises venues, forums, workshops and through partnership networks.  Some similar research had been conducted in 1999 and 2002 and it was decided there was a need to repeat this survey due to the rising incidence of HIV and STIs among Asian MSM. 

The survey this time round was more ethnically diverse than previous years .  Although the overall number of Chinese respondents did increase compared to previous years, the proportion of Chinese respondents decreased and a greater proportion of Thai, Indian and Filipino guys completed the survey.  

HIV and STI testing rates had increased but less guys were testing at GPs with increased rates of testing observed at community-based testing sites (eg a[test]) and hospitals.

In regards to condoms use, guys reported less anal sex with their regular partners but similar levels of condoms use with these regular partners.  More anal sex with casual partners was reported than in previous years with more condomless anal sex.

In conclusion, sexual practices and health-seeking behaviours have changed among Asian MSM in recent years with an increasing rate of condomless anal sex with casual partners (it is worth noting that this study took place before the commencement of the EPIC PrEP trial in NSW).

Community-based testing sites were also shown to be of great importance in ensuring high rates of HIV/STI testing in this population.

Day 2 Rapid Fire Sessions: Health Promotion and Education

Carolyn Murray (on behalf of Gemma Hearnshaw) – NSW STI Programs Unit (STIPU):  "No Question Too Awkward: Nurse Nettie, the Online Sexual Health Nurse".

Nurse Nettie is a confidential, virtual online sexual health nurse created to allow young people to email questions they may have about their sexual health/sexuality and receive an answer from a sexual health professional within 24 hours (although Nurse Nettie does have weekends off!)  Nurse Nettie was created to address the concern that young people may be too embarrassed or afraid to ask a Doctor/Nurse or parent/caregiver questions about sexual health.

Nurse Netttie does not provide diagnosis online but instead refers on to the most appropriate service where indicated.

Nurse Nettie commenced in April 2014 and the data presented was up until March 2016. In this time Nurse Nettie had received 761 questions with 77.4% of these being from people aged <30yrs.  Approximately 52% were from NSW and 17% were from abroad. 

Common question categories are listed in order below:

STI/HIV risk – 14%

Anatomy – 12%

Symptoms – 11%

STI/HIV testing – 10%

Contraception – 8%

In conclusion, Nurse Nettie has been shown to allow large numbers of young people to receive information about their sexual health in a confidential, personal and specific manner.

Nurse Nettie can be accessed at: https://playsafe.health.nsw.gov.au/ask-nurse-nettie

Day 3 – Joint Symposium Session: Prevention of Anal Cancer in gay and Bisexual Men: The Current State-of-Play and Future Directions.

“What should we be doing for our patients now?”  Dr Jason Ong, Monash University, The Alfred – Melbourne Sexual Health Centre, VIC, Australia

Dr Ong acknowledged the HPV vaccine as a game-changer in the prevention of HPV-associated anal cancer however there is still a cohort of males who remain unvaccinated and therefore will continue to be at risk of anal cancer for many years to come.

Many ask the question: if screening for cervical cancer using the PAP smear works so well in early detection of cervical pre-cancerous lesions, then why can’t we take this methodology and apply it to anal screening of MSM for pre-cancerous lesions (aka ‘CHAP smears’)?

Some similarities and differences between anal and cervical anatomy and lesions were described:

Similarities:

-       Both have transformational zones

-       HPV responsible for a significant proportion of pre-cancerous changes

-       Pre-cancerous lesions are histologically similar

Differences:

-       The anal canal is a much larger area to swab (approx. 5cm tube)

-       It is more difficult to visualise anal lesions

-       Natural history of lesions between each site is different (up to 30% of anal smears are positive for abnormal changes)

-       Progression of changes is different as many more anal intraepithelial neoplasia (AIN) resolve over time compared to cervical intraepithelial neoplasia (CIN)

-       Different referral rates (only approx. 3% of cervical PAP smear result in onward referral for colposcopy but up to 60% of men undergoing anal screening would need referral due to the increased rate of high grade anal lesions.  This has implications for the workforce as it does not have the capacity to deal with such a large volume of referral for anoscopy or further investigation). 

High-grade anal intraepithelial neoplasia (HGAIN) regress at a rate of 36/100 person years so if left alone, many would disappear.

In answering the question of whether we should screen for early anal cancer, Dr Ong explained that the best annual screening tool for MSM would be the digital anorectal examination (DARE).  As approx. 50% of anal cancers are externally visible and approx. 2.9cm in size, and due to the fact that many HGAIN resolve spontaneously over time without intervention, DARE is a most cost-effective and simple early detection technique.

In another study, Dr Ong also explored the acceptability of a DARE for men with favourable findings.  82% of men felt relaxed during the procedure and 99% were willing to have another DARE in a years time.

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As a side note, Dr Ong will be conducting a teaching session on Friday 16^th Nov from 10:30am-11:00am using his plastic bum segment for this wishing to perfect their DARE technique …sadly I will miss out!

Khadija was born in Sierra Leone and arrived in Australia in 2001. There is an impressive list of projects and organisations in which she is heavily involved including her long-standing involvement with ShineSA and No FGM Australia - a not-for-profit Australian organisation where she is currently the Executive Director.

She gave the opening address at the 2016 Australasian Sexual Health Conference in Adelaide and also provided a second presentation titled 'Sexuality and Female Genital Mutilation - The Psycho-Social Impact of Sexual Dysfunction due to Female Genital Mutilation'.  

Today she kindly spoke with me about FGM in the context of health settings with a particular focus on sexual health clinics.  It is with her generous permission, and that of ShineSA, that this audio interview is able to be shared.

Due to the size of this 12 minute audio file, it is hosted on the external link below:

https://soundcloud.com/user329177428/khadija-gbla

For more information on FGM and FGM in the Australian context see the following link: http://www.nofgmoz.com 

Monday 14/11/16 – Day 1: Jan Edwards Trainee Session

Dr Danae Kent, Senior Registrar at Adelaide’s Clinic 275: ‘Testing for Rectal Chlamydia in Women – Is It Worth It?’

In short the answer was yes…and no! 

Rectal chlamydia infections in women have the potential to result in significant morbidity and enhanced HIV transmission. 

Few other Australian studies have looked at this topic.  The estimated rectal CT positivity rate in women is 5-27% (variable depending on population eg. higher in sex workers and sexually adventurous females).  Awareness of site of CT infection is important as this has implications for choice of treatment (rectal CT treated with Doxycycline vs genital CT treated with Azithromycin).

Method:

This South Australian retrospective study looked at women who received anal CT testing if they reported anal sex and/or anal symptoms.

Results:

Overall CT positivity rate = 8.5%

Young women less likely to have anal CT testing done but more likely to have positive anal CT result (of those with a CT positive result, 16% of women <20yrs were positive for anal CT)

Isolated rectal infections:

70% were found to have urogenital AND anal CT

19% were found to have rectal CT only

11% were found to have urogenital CT only

Therefore urogenital testing alone would miss 1 in every 5 cases of chlamydia confirming the value of testing for anal CT where a women reports anal sex and/or anal symptoms.  These findings are not generalizable to settings outside the sexual health clinic. 

Interesting food for thought and also a timely reminder of the importance of a thorough sexual history for the female client including enquiry about anal sex practices.