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.

Geraldine Dunne

Geraldine Dunne

Geraldine has a strong background in Paediatric Nursing in both Australia and the UK, completed her paediatric training at Great Ormond Street Hospital in London and holds a degree in Child Health as well as a post graduate diploma in Child Development. She has worked at both major Paediatric hospitals in Sydney.


Sydney Children’s Hospital is a tertiary referral centre and is part of the Sydney Children’s Hospital network.


Her current role as Clinical Nurse Consultant, Infectious disease and Immunology, involves caring directly for children and their families affected by HIV in a tertiary Children’s hospital. Services include all aspects of HIV treatment, prevention, counselling, advocacy, case management and, education, as well as participation in research. These services are provided to Children who are HIV positive but also to infants born to HIV positive women. Sydney Children’s Hospital has a successful pMTCT service which means the CNC is responsible for coordinating across several services throughout Sydney and NSW. In conjunction with the HIV teams social worker, she Co-ordinates ‘Camp Goodtime’ and ‘Positive Kids’ camps annually, which are camps for families, children and adolescents affected by HIV.


She coordinates continuing education activities for health professionals in Australia and New Zealand and assist in the development of local and national guidelines on paediatric HIV prevention and care. Geraldine participates in national surveillance of peri natal exposure and transmission coordinated by Australian Paediatric Surveillance Unit (APSU).

This series of talks about the rise in gonorrhea in young people across Australian capital cities was fascinating and resulted in ample discussion and questions.

As Christopher  Fairley said, before we can control the increase in gonorrhea, we must first understand why it has occurred.

Risk factors are thought to be overseas travel from Australian cities to countries of high prevelance I.e. Indonesia, Vietnam and Thailand, bisexual men engaging in sex while OS and also perhaps the continual imported cases of gonorrhea from people of various countries of origin.

Another interesting suggestion was the type of sex education that is received  from people who reside in Australia as students and the gap in their education around condom use.

a discussion also occurred about the possibility of a strain of gonorrhea being more likely to cause infection in women than men, which may account for the high infection rate Moungst women now.

A very diverse group of talks which provided much food for thought. 

This iseries of interviews was captured across 2 groups of people who grew up queer in the context of a Catholic education. Group one attended school in the 1970's and group 2 in the 1990's.

Overall, in both groups, sex education was very brief and functional and included straight sex only. The only exception to this was when disease was discussed. 

Both groups sought their information from other sources such as porn, cleo magazine, dolly magazine and then the Internet, once available. 

A common theme in both decades was  that people growing up queer,  felt there was no place for them.

This presentation was a summary of the results of a survey undertaken by a group of GP's , following an increase in requests for labioplasty.

The procedure of labioplasty can vary but in general, involves trimming of the labia minora and possibly trimming of the clitoral hood.

Long term research has not yet been achieved in terms of the long terms effects of this procedure, particularly in relation to post menopausal women. 

The presenter indicated that in many women, the labia minora extended beyond the labia majora and was therefore normal but women who sought this surgery believed that they were abnormal. What was often unknown by the women seeking the surgery is that 'more tissue=more sensory availability' . 

Psychological drivers for seeking the surgery have often been overlooked, hence the GP survey that was undertaken, with 443 GP completing the survey. Alarmingly 35% of the GP's had experience of this request from women/ girls  less than 18 years of age. 

Factors that were useful to consider in talking to patients about their concerns were various and included perception of normal versus desirable /influence of  pornography/ choice of underwear I.e. G strings and their comfort level and so on. 

The take home message is that this surgery appears to be unnecessary for physical reasons in many cases and that the long term effects are unknown. 

 

 

Leah Williams walked us through the ways in which her service created small changes to their service that resulted in greater outcomes for vulnerable groups.

The most vulnerable people living with HIV:- those 10% not on treatment or linked into services were identified and then the barriers to them accessing health care were identified , such as the need for a GP referral and the restrictions surrounding Activity Based Funding which means they can be discharged from a service if they do not attend 2 successive appointments. 

Flexible service provision is the key to accessing these hard to reach groups: - drop in clinics and small but important changes such as assistance from administrative assistants/ reception staff when vulnerable changes to attend.

The  take home message was : Tweak your service to meet the needs of vulnerable groups rather than asking those patients to access care that seems inflexible to them. 

This was an interactive session and panel discussion based on various case studies that may be met within the clinical area of working with people living with HIV.

The backdrop to various discussions was some information indicating indicating the link between HIV, discrimination and legal issues. This is further complicated by recent changes in legislation in NSW as well as the disparity in legislation throughout Australia, with potential for further confusion due to lack of uniformity across the states.

currently, it appears to be abundantly clear for example that sexual transmission of HIV with an undetectable viral load does not occur. Not as clear however is what precautions a person must take when having a sexual relationship with a person who does not have ZhIV, even in the e end of an undetectable viral load. 

various case presentations highlighted some of the ethical issues around transmission of HIV and overall, supported the clinicians need to support their patients by engaging well with them, using research evidence to provide up to date information but also being aware that medical advice is not the same as legal advice. Various situations may occur therefore that medical advice requires back up with advice and input  from agencies such as those that care for refugees or  legal organisations for people living with HIV. 

 

The session provided plenty of 'food for thought' for conversations within the clinical setting. 

The talk was by Ruth Hennessy who is a clinical psychologist based at the Albion centre in Sydney.

Although relevant to any area of HIV care, I was interested due to my work with children and young people living with HIV as well as my work with women living with HIV and prevention of transmission of HIV to their infants where I experience a high level of psychosocial needs. 

The speaker, Ruth stated that people living with HIV have higher incidence of mental health issues and then went onto highlight that marginalised groups are affected by HIV. It has been established that Psychosocial issues affect access to care and care outcomes and therefore treatment of psychococial issues can remove obstacles to care.

The psychology team at the Albion centre collected data around presenting psychosocial issues in their client group and compared the data over a number of years. 

Age range was 23-68 years with a high proportion of men. 44 % of sample were born OS. 

An  overall increase in issues around depression, self harm, welfare issues, alcohol and drug misuse was found. Interestingly, a reduction in adherance issues was found, which is encouraging.  This probably reflects the relatively simple medications increasingly available now to treat HIV.  The data collected overall supported the teams belief that their clients psychosicial needs  had increased in complexity.

What might help in the future to support this client group?

it was  suggested that having 'Complexity predictors' and interdisciplinary intensive support would assist in identifying which clients who may need extra  support. It was also suggested that Establishing standards for psychological support for adults living with HIV would assist in providing appropriate care. 

In the paediatric population within Australia, HIV is largely not a sexually transmitted disease and is further complicated by issues such as adoption,history of trauma and of course  the child or young person may not know ( or understand) their diagnosis and must, at some stage, learn of it and how it was contracted. The availability of complexity predictors could be a useful resource in assisting and supporting families and their children living with HIV. Despite more simple and available drug formularies, psychosocial issues are a large part of care required it seems across many age groups and therefore require further attention. 

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

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