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.

Paul Esplin

Paul Esplin

I have been working in the HIV Outreach team for the last 4.5 years. Previously I had been working within the homeless sector in the inner city of Sydney and in hospitals for many years.


I am current studying a Masters of Public Health/International Health at the University of NSW (UNSW) which has opened my world up considerably. My Nursing and Career aspirations are to assist in bringing health and healing to marginalised and poor communities in need, social justice and equity and equality for all. 

Looking at inequity and qualitative care data measures in UK for People Living with HIV min 2015, in the UK.

HIV – 98% diagnosed retain in care.

5-6 thousand new diagnosis yearly. 3,000 are gay men. 3,000 heterosexuals (people that acquired HIV abroad or late diagnosis, mostly new arrivals/immigrants).  

Most linked to care in first year of diagnosis

An early diagnosis in a high resourced country, shows similar lengths of life expectancy as the general population.

Many people feel (or experience) stigma and discrimination around social gatherings and settings.

Dental and Healthcare/GP’s are 2 areas the people living with HIV avoided.

 

Dr Gail Matthews, Sydney. HEP C Updates –

200,000 to 300,000 people living with HEP C in Australia.

2-3 thousand people living in Australia co-infected with Hep C and HIV.

Since the new Hep C Treatment begun 12% of the Hep C population.                             40,000 (20% of this Hep C population) expected to be treated by the end of 2016. Predominately genotype 1. Genotype 3 (less).

Updates to Census Guidelines for Hep C – 2016.

Gastroenterologists (Specialist) treatment rates have fallen to 50% with other Dr’s/Prescribers accounting for an increasing amount in March to June, 2016.

Possible Risk of HBV reactivation on DAA therapy. The risk levels are unclear. Prescribers can discuss with Specialist about Serology or treatment concerns.

 

CLOSING PLENARY - looking towards 2020!

President Elect Donald Trump accession in US and Global politics was discussed, with unanimous concerns of the possible impacts on marginalised groups, such as people living with HIV.

PEPFAR – is a major global initiative, assisting those with HIV/AIDS. It was thought funding may be less sustainable and diminished under Trump Presidency.

PrEP – Pharmaceutical Benefit Scheme - (PBS) Australia, hopefully rolled out next year. Need to target Aboriginal people, CALD Communities.                                                         There is an over-representation of ABSTI with HIV.                                                                     STI rates are climbing.  Condom use needs to remain as valued!

Partner with Aboriginal lead services to effect better outcomes for ABSTI Communities. Need high level engagement to focus on ABSTI chronic health conditions, mental health, HIV, STI’s and long term future funding arrangements.

ABSTI community lead primary healthcare in partnerships/collaboration with agencies.

Need better national co-ordination. Invite all stake-holders to assist in managing – Treatment as Prevention (PrEP) collectively.

Equitable care

Develop greater sense and involvement with communities.

Challenge the ‘spitting law’ that is been brought up by 3 states. This is NOT Evidence based practice. A motion agreed by all was held at the end of the Conference today.

Focus now needs to be on other priority populations, such as Woman and heterosexual males to be seen as a priority populations.

Develop internationally agreed best policy – basic guidelines of care and treatment.

There is a lack of engagement with governments and communities. This needs to change NOW!

Speak up and challenge funding cuts. We need to INVEST MORE.

Non-Aboriginal people to ‘speak up and be a voice’ for ABSTI plight and their needs.  

Migrants Medication and medical needs to be covered.  

Collaborate with local communities. How do we reach out to others less engaged?

What resources do we have and how can we mobilize them better?

Look towards Aboriginal Medical Service (AMS) for leadership in Primary Care delivery.  

Globally, The United Nations (UN) is under threats by been constantly undermined by States with vested interests.  

Next step in HIV care and treatment is a vaccine. Injectable is expected 4 + years away.

 

See you all in Canberra, ACT in November 2017 J

 

 

 

 

 

      

 

 

 

                           

 

 

 

         

 

 Aboriginal & Torres Strait Islander Health (ABSTI) – HIV & STI’s in the Australian ABSTI health context.

 Presented by A.Prof. James WARD and Prof. Gracelyn Smallwood and other eminent panellist discussed these contemporary health issues with Australia’s ABSTI people.

 HIV – double the rate of Non- Aboriginal people

                   With 60 % - Men that have sex with Men (MSM)

                             20% - Injecting drug users

                             20% - Heterosexual     

                                                                                                                                                               Please note that  -  20 % of HIV Diagnosis are Women and 12% live in remote and rural & communities.                                                                                                                                                                                                                                                       33% late diagnosis with 21 % having advanced HIV. In the general Population – 90% are diagnosed.

MEDICATION and adherence and co-morbidities are a huge burden.                               Mental Health/ depression – 12% report feeling depressed, with 9.6% of the general population report this.

The social determinates of health – ABSTI have poorer general health with unique challenges in addressing ABSTI HIV care and treatment. Medication burden.             Complex health.

 the effects of ongoing racism and discrimination.

 Feel “SHAME” and their spirits is low.

 Stigma from HIV.                                                                                                                                                                             Need to trust clinicians and respect for clients confidentially is utmost important.  

  

Needle Syringe Program (NSP) – 

ICE/Crystal has become a big issue.  

We can’t wait for an outbreak to occur, so we need to increase access to NSP services, such as in outreach programs.  

 Health and Community Partners/organisation to work with the community needs, in culturally appropriate ways, including not driving it (program & service health delivery) with experts  without consulting, involvement & input from respected key community stakeholders.

Partner’s organisations needs to ask local people to teach cultural norms. 

PANEL DISCUSSION –

90 % of the general population know HIV Status

80% of the ABSTI know their status (20% don’t!).

Reduced life expectancy (estimates 20 years compared to non-aboriginal Australia people).

need a grass roots approach, need to empower the local people by using their knowledge and expertise about their own local communities and support solutions at local levels.

Funding been cut by Governments with 75 % of Funding is going to non-grass roots, such as University Research & government bureaucracy.  

3% population in jail, 

                                                                                                                                          

food prices are increasing in local and remote communities 

Poor sanitation

No jobs, lack of career pathways

 

Cairns Doctors advised that the syphilis epidemic came first, then linked with HIV.  

Recently 1 female and 4 males (MSM) aged from 18-25 years HIV +                                  young mobile, homelessness (is a major barrier), couch surfing, staying with Aunties, not taking medication as forgets due to constant moving. Finances - Centrelink – cut off.

 Aboriginal Medical Service (AMS) – Aboriginal controlled services across Australia -      there can be an issue of taking blood in ABSTI Peoples.                                                          Non-Aboriginal Health care workers need to provide better cultural translations -           explanations as to why blood is needed (MEDICALLY) to be taken.

With young people there is a better acceptance of outreach programs that deliver rapid testing for Syphilis.  

Issues in screening STI’s in prisons

Aboriginal Community Health Workers – not getting paid and recognised properly.

Some Clinicians can be uncomfortable offering a HIV Test.

Clinicians needs to be flexible in care delivery. Work to ‘hold confidence’ with Clients.

How can Services be friendlier to ABSTI Peoples?

Building good working and trusting relationships is everything. Keeping rapport and people engaged.

Service providers need to become more effective!

Burden of disease/s, reluctant in accessing care, complex family dynamics, isolation.

Family worries, social issues, turning up for appointments and reminders.

Shame aspect – needs to be taken out of HIV. Of not having housing, which prevents people from becoming stable and stay on treatment.

 

 

 

 

 

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A.Prof. James. WARD - Aboriginal Health Perspectives.

A Predicted divergence of what is happing in Aboriginal and Torres Straits Islanders community’s in relation to HIV and STI’s.

  

New diagnosis of HIV in remote communities due to young mobile population.

Risk Behaviours such as sharing NSP Equipment, with a background of increasing prevalence of STI’s.

 Failure to engage Treatment as Prevention (PrEP) as need to take other medication (pill burden) for multiple health conditions/comorbidity.

 10-24 years age group, increasing Chlamydia and Gonorrhoea -                                                                  This highlights the inequities and lack of access to care.

 

Hep C – mostly transmitted through injecting drug use (IDU).  

Hep C has increased 43 % in 2011 – 2015.  

It effects the youngest 15-24 years old.

Hep C has 8 times the incidence in Aboriginal people (than non-Aboriginal People).

 

Rural and Remote Communities – need more access to Aboriginal Primary healthcare for testing and treatment and treatment as prevention (PrEP).

HIV in Cairns, QLD – young Aboriginal & Torres Straits Islander men in 2014-2016 had 50 % increase in HIV. This also effects bi-sexual men and men that don't dentify as gay.

NO access to NSP. Difficulties in approach to NSP and harm minimisation.

(Treatment as Prevention) TASP.

Prof. Ward said that we could learn from Canada’s first nation’s people in Saskatchewan that have a background of unresolved grief & intergenerational trauma. 

Increased of IDU and STI’s = HIV !

We need to prevent an outbreak occurring in our rural and remote Aboriginal and Torres Strait Islander (ABSTI) Communities. Health services are already limited and they would also not be able to cope with a major outbreak occurs. This would devastating to these communities.

ABSTI – vulnerability of population.

Need to increase the workforce in meaning work and career options

Need timely surveillance data, to be able to respond quickly    

Medicare to cover costs

Need to advocate ‘outside and ‘raise our voices’ (to Governments and the Australian people to increase awareness and be able to act/prevent). Especially non-Aboriginal People need to stand up and raise their voices about concerns and issues of our ABSTI People.

Increase the current low testing rates for HIV.                                                                                                                                                             Use a diversity/combination of strategies include - strengthen Aboriginal and cultural appropriate Primary care.

 Currently on 32% of people with STI’s are offered HIV Test. This needs to be offered 100%.

 Community itself needs to be interested and engaged.

 

 

 

Professor Gracelyn Smallwood 'Aunty' delivered a highly emotional discussion about the realities faced by many Aboriginal People and Communities across Australia.

Most of the Closing the Gap money (75%) is not going to grassroots level of the people.

it is been swallowed up by university research, and provides jobs to non-aboriginal people.

Gracelyn said that poverty is widespread and needs to be cleaned up.

Many don't have running water and sanitation is poor. 

Food is marked up 200%

Most are unemployed and on Centrelink benefits.

ICE/ substance/drug use is high, including injection.

Concerns about HIV reaching remote and rural communities.

High rate of imprisonment  

Aboriginal Health & Community Services need culturally appropriate programs.

Non-Aboriginal people involved in programs deliver need to go into communities before and consult and talk with keys players/stakeholders and elders. 

Local grass root program delivery don't have to cost lots of money,                                                             such as the 'deadly program' and 'grog kills skills' delivered on a  shoe-string budget. 

Gracelyn talked about her us of the (world famous) Condom man.

This health promotion/prevention strategy was used successful and widely as a healthy alternative to the scary 'grim reaper' advertisements to assist combating HIV/AIDS. 

 Non-Aboriginal People need to speak out more and advocate for ABSTI People by keeping it on the agenda.

Australia needs to reconcile with the past and the ongoing injustices against Aboriginal and Torres Strait Islanders People's. 

Please read Gracelyn thesis which she addresses these multilevel issues in Australia's Indigenous People. http://www.atsiwlsnq.org.au/reports/Gracelyn_Smallwood_2011_thesis.pdf

Thankyou Aunty, your inspirational presentation. It was the highlight of the conference for me and together we can all individually and collectively help to improve the health and lives of Australians Aboriginal and Torres Strait Islanders People. 

 

 

 

In today's presentations a strong theme came across that we need more data for sexual health services & the effectiveness of STI's in teenage programmes.

HIV is increasing in some populations.

Professor Mark Hayter, UK, talked about the importance of integrating a multidisciplinary approach         in Sexual Health.

That substance use is often predictor in context of higher risk sexual activity/practices/behaviours. 

Alcohol remains to the most significant driver, which equates to more sexual partners.

Evidence has shown that Clinicians need to identify higher risk individuals and interactions around substance use need to be more substantial, such as motivational behaviours skills. We may also need to consider bring in a Specialist in Drug and Alcohol/addiction, or refer on to another service if the expertise is not available in the service delivery model. 

 

CHEMSEX - MSM sexually disinhibiting drugs use, often with Viagra. 

Potential sexual Partners meet on line, App's - meeting up sites. 

Increased numbers of partners. STI’s risks increased 

PrEP is available option, but also need to address chemsex behaviour. 

Behaviour modification interventions such as education and prevention can reduce changes in behaviour, in drug use and unprotected sex & which reduces the risks of considerable harm. 

Evaluating 1 stop shops for (sexual health clinics) and the effects on staff. Research has shown mixed results of this. 

Need to build research into service design and evaluation with partnerships with Universities. 

 

Reaching out to Schools - Sex Education & relationships:

Nursing is best suited to deliver this care in outreach setting such as schools.

Nurse lead sexual health, mental health and substance use & care delivery to schools children and adolescents, is better delivered and protective under a broader health objectives, as a sexual health clinic at schools will become political. 

 

 

 

Associate Professor Rebecca Guy gave the Gallows Lecture.

The theme was new technologies for STI prevention and adult health checks with the target populations

- Aboriginal and Torres Straits Islanders People, 

- Gay men, 

- Mental health 

 

Resources and Notification of Partners. SMS technology is preferred. 

23% notified partner/s

Only 1/5 followed up in a clinic 

www.letthemknow.org.au

www.thedramadownunder.info

HOW is this going to change and effect my PRACTICE?

I will incorporate more IT into my clinical practice, as the Research has shown that clients and patients prefer SMS technology.  I have found this to be more effective approach in contacting those less engaged and harder to reach Clients, as it appears to be less intrusive means of contact & provides people the choice of when they want to make contact.

 

Other presentations on sexual health - Chlamydia 

Discussed health seeking behaviour. 

Focus on Adolescents

Low testing rates, 20 % people became re-infected in 1 year.

Issues are PID, infertility.

Gay men, increase risk HIV 

www.access-study.org

 

 

 

FAMSACA - is Forensic & Medical Sexual Assault Clinicians Australia. 

www.famsaca.org.au

Today commenced with FAMSACA breakfast which was very well attended.

The organisation is small group nationally and meets up every 2 years. It welcomes new members and provides clinical educational updates. 

The Australian media has increased its reporting on Domestic Violence (DV) in Australia.

DV has become a major topic and focus nationally, especially since Rosie Batty education campaigns and advocacy.

FAMSACA presenters discussed 4 different and highly complex Client cases.

Physical Assessment of Woman and Girls after an assault can be re-traumatising.

There is clear Pathways to E.D and Medically investigation. 

FAMILY PLANNING - Copper IUD is 1 of the most effective form of contraception. 

New Emergency Contraception Pill, Ulipristal acetate is 99% effective. Ideally to be administered ASAP and within 4 days of an event. After this time it's efficiently declines rapidly. Cost is approximately $50.00 AUD and will become available over the counter in 2017. Please refer to  www.ellaone.com 

Reporting Violence to Police and relevant Authorities in relation to Children.

We spoke about the potential difficulties of reporting if the victim refuses to consent in providing this information and requests confidentiality. 

Woman may often feel unsafe reporting to Police due to fears of retribution from men/boys. This can include threats to their children. Victims dislike reporting directly to the Police, an option would be to report this on-line, but the Police require the victim (witness) to provide details, otherwise they lack powers to investigate. 

Other challenges to services and clinicians are re-current presenters. This often presents in context of people with an Intellectual Disability or mental health, with a history of childhood sexual abuse. It is hard to establish safety with ongoing abuse. 

Under age children/young people with abuse, even under Guardianship present particularly difficult challenges. When they become of legal age of sexual consent the police are not so interested. 

Drugs and Alcohol are frequently seen but it’s also can be common not remember things/details. 

Clinicians need to celebrate small changes to cope and manage working in this area of trauma. 

It is important for Clinicians and Community Workers to know where to refer Clients and Patients to these Specialised Services. 

 

 

 

 

 

 

 

 

 

Day 1/ Monday 14/11/2016 - Highlights from day 1:

Today was full of diversity in Sexual Health Field.

It was amazing to see so many people come together to listen to each of the incredible presenters and discuss, debate and learn.

My main contributions today where through regular 'tweets' on my Twitter account.

Please check them out at Twitter @paulafe2

 

 

 

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

ASHM ASHM