Janelle Small

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.

Janelle Small

Janelle Small

I started my nursing career in 1996, working in a number of hospitals around Sydney. Left Sydney in 2001 to work in rural and remote areas of Central Australia and Kimberley region of Western Australia. I loved the Aboriginal culture, people, their communities as well as the challenges and complexities of living and working in them.


Most of my nursing had been in ED/ICU as well as Paediatrics. In 2004 had a career change and moved in to the world of sexual and reproductive health, working for a NGO in Canberra for a period of time before moving to the NSW Mid North Coast in 2007.


This is where I am currently based as a Clinical Nurse Specialist in Sexual Health/HIV/Viral Hepatitis and work in an Outreach clinic for Hunter New England LHD, covering both Taree and Forster as a single nurse lead clinic. There is a large Aboriginal community as well as other high risk/at risk groups that I work with and enjoy being an advocate for. Also the challenges faced being in a rural area where there is stigma and isolation, and access to care and treatment that is continually improving.

Becoming Serodiscordant: The Seroconversion Study Interviews. Steven Philpot, Kirby Institute. 

 

In this study participants were interviewed between 2009-2014, and the aim was to gain knowledge of perspectives of those recently diagnosed with HIV. Topics discussed included: The seroconversion event, sexual practices prior to diagnosis, reactions to and management of diagnosis, post-seroconversion sexual practices, attitudes towards treament for HIV and viral load. Most participants in the study identified as gay, with some bisexual and queer also, with a mixture of ages, ethnicity and various relationship status.

 

Steven presented the analysis of response from 41 participants of which 25 were men in serodiscordant relationship, 6 single men who were previously in relationships but their relationship ended once HIV diagnosis made, and 10 were single who discussed previous serodiscordant relationships in which they were the HIV negative partner. 

 

In these relationships, renegotiating sex with regards to infectiousness, responsibility and intimacy were discussed. Also, reaffirming relationships with regard to love, support and strength. Various narratives were shown and were certainly wide and varied in their individual experiences. Some relationships suffered or ended as a result of thr new HIV diagnosis, some relationships became stronger and provided an opening of communication between partners, though couples within an established relationship when diagnosis made grappled with chages within their intimate relationships.

 

It will be interesting to see what lived experiences will now occur withinin serodiscordant relationships and a new HIV diagnosis in the day of UVL for prevention and the introduction of PrEP, as this study predates these changes.

 

Dr Eric Chow. Senior Research Fellow, Melbourne Sexual Health Centre.

Risk factors for gonorrhoea in heterosexuals.

 

Eric looked looked at various factors as to providing reasons for the increased incidences of gonorrhoea infections in heterosexuals in Australia. The risk factors explored were: 

Change in partners/ condom use

Dating Apps

Travel

Drug and or Alcohol use

Bisexual men

 

In Eric's research the biggest risk factor was travellers, bisexual men and also people using Dating Apps such as Tinder. 

It seems that there are much larger numbers of people travelling overseas, particularly to high prevalence countries and having unsafe sex. There was a higher proportion of travellers from Western Australia, which may explain partly the very high increase in gono notifications in heterosexuals there in recent years.

 

With the revolution of Dating Apps, the incidence of gono notifications in heterosexuals has also increased and linked to this is bisexual men who may be having the best of both worlds in dating apps such as Tinder and Grindr and passing infection to hetero females.

 

It's an interesting and changing world we live in both in the digital world and the real world and sexual partners are more accessible in a variety of settings which is resulting in changes in notifications and the demographics of notifications are changing.

NSW HIV Diagnosis and Care Cascade: Meeting the UNAIDS 90-90-90 Target. Phillip Keen, Kirby Institute 

 

Phil discussed the HIV care cascade plan launched in 2014 by UNAIDS to have 90% of PLHIV diagnosed, 90% of people diagnosed with HIV to be on ART, and 90% of those on ART to achieve viral suppression by the year 2020. 

 

In relation to this, where are we now with these targets in various countries and in particular what has been achieved in NSW. Sweden was the 1st country to achieve these targets.

 

 Through increased testing and treating, treating sooner and more aggressively has resulted in NSW to achieve 90-90-90 in 2016. To help meet these targets the way ART was prescibed was changed to not be influenced by factors such CD4 count or symptomatic HIV. So more people commenced on ART that previously had not been, and commencing newly diagnosed HIV on ART within 6 weeks. Also the ways and means of people accessing HIV testing and treatment has increased.

 

 To increase the accuracy of data so as to be considered 'high quality' according to Granich criteria, data surveillance and collection was revised and improved. Now NSW Health has raised the bar in the NSW 2016-2020 HIV Strategy aiming for 95% of people diagnosed with HIV to be on ART and 90% of people newly diagnosed with HIV to be on ART within 6 weeks.

Dr Klausner discussed  using various innovative ways to increase HIV and STI testing, treatment, adherence, and prevention via the use of technology-based and online methods. The aim was to reach the hard to reach, in a way that was accessible and individuals not feel judged.

 

Testing occurred in various ways including in community based settings at places accessible to our frequented by hard to engage individuals such as sex workers, injecting drug users, homeless. A walk-in self testing service was set up where12,500 people per month accessed this service. The self- testing facility would allow people to go in and fill in an electronic risk assessment, print identification labels, then dispense the appropriate swabs for the self collected samples. A result would then be given in 2 hours.

 

Online ordering of in-home HIV and STI testing kits, and Outreach voucher programs were other ways to make testing more accessible.

 

To increase adherance to PrEP or ART individuals can go to online program and customise how and when they get reminders to take there medication and reminders for testing through patient engagement software. Also was noted that PLWHIV could check their CD4 counts and VL and found that there was increased medication compliance in this experience.

 

With regards to prevention of HIV and STI's condom vending machines were widely distributed to areas to increased accessibility to condoms. Online ordering and initiation of PrEP is an option too where individuals can go online and answer questions regarding their history and risk factors. Appropriate pathology testing would be ordersd including HIV and Hepatitis B serology. Once results are available if person is eligible to commence PrEP they are prescibed medication and it is sent to them. All done without having a face to face consult with a doctor.

 

 

 

Presented by Clara Brown.

As we are aware there are people living with HIV who are also co-infected with Hepatitis C. In Australia approximately 1 in 8 people living with HIV are also co-infected with HCV. 

Clara discussed how there is a disparity between those that are mono- infected and those that are co-infected and the number of those that have initiated early administration of ARV's for HIV. The rates of co-infected initiating or are on ARV's are much lower, despite the change in recommendations of early initiation of ARV's for HIV.

There are significant unmet needs for those that are co-infected with HCV. Often this minority population may have chaotic lives, not engage in health services, have financial difficulties, and may have difficulty with medication compliance. Clara discussed issues surrounding the need for wider Alcohol and Other Drugs services, Primary Care services, Allied Health services, as well as the ongoing issues surrounding stigma.

It is hoped that we can help this minority of a minority group improve their health outcomes and quality of life.

Tagged in: HIVAIDS2015

Paul Kidd is the Chair of the Victorian HIV Legal Working Group. 

In this session, Paul discussed the definitions of laws in Victoria which involve Human Endangerment and PLWH. POAR Guidelines are in place to intervene to protect Public Health. The focus of these guidelines are to achieve behavioural changes to protect human rights. The problem Paul stated is that once a HIV positive individual has had allegations of Human Endangerment made against them, their privacy is lost forever, and they are publicly shamed.

Paul discussed prosecution when intent and HIV transmission occurs. For ths to happen, it has to be shown that sex occurred, there was appreciable danger and HIV was subsequently transmitted. 

Unfortunately HIV is stigmatised as a "Dread" disease and unfortunately stigmatism is alive and well in the Courts. Jurors ignore scientific evidence because of stigma in the media. Stigma drives stigma.

The key points taken from this session are that we may be winning the battle with HIV for effective treatment and prevention, but not for stigma. Policy changes are needed for more just and compassionate treatment of people with HIV before the Law Courts.

Tagged in: HIVAIDS2015

This symposium was a very interesting one presented by Prof. Brian Gazzard. 

Prof. Gazzard discussed different types of HIV client care, of which he advocates Patient Centred Options and discussed barriers to comliance of HIV clients taking and adhering to ART medication regimes.

Following this, Jenny Brockie convened a discussuion between a panel of a HIV doctor, HIV nurse, and the audience. Three Scenarios A or Scenario B of ART choices were presented and the audience had to choose which scenario they think their HIV client would choose. One scenario was having the choice of ART which needs o be taken with food, or ART which does not need to be taken with food. A choice of ART which induces slow CD4 increase and causes no diarrhoea, or ART which induces fast CD4 rises but causes diarrhoea.

Interesting discussions and rationales for different decision making were heard from a variety of doctor, nurse, and patient perspectives.

Some of the key points taken from this symposium in regard to ART perspectives were;

-HIV clients need to be the centre of their own care

-ART and clinical care needs to be cost effective

-Single dose regimes are the way to go if possible

-Interactions and toxicities of ART are important factors

-Patient advocacy needs to include understanding how ART impacts a PLWH day to day life

Last but not least be honest with your patients, and know more about ART than your patients so they can make informed decisions.

Tagged in: HIVAIDS2015

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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