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.

Rebecca Bosworth

Rebecca Bosworth

Rebecca Bosworth is a PhD candidate at the National Drug and Alcohol Research Centre, UNSW. Rebecca's doctoral thesis focuses on harm reduction in prisons globally. She also works as a Registered nurse for Justice Health. Her research interests include prisoner health, harm reduction and HIV/hepatitis prevention among drug injecting prisoners.

Joint Symposium: Are we there yet? Reaching global goals for HIV in Asia and Pacific Regions

HIV response in PNG. Are key populations being reached?

Dr Angela Kelly-Hanku, Senior Research Fellow, Papua New Guinea Institute of Medical Research /Kirby Institute, UNSW, Sydney Papua New Guinea

An interesting discussion around whether key populations are being reached in terms of the HIV response within Papua New Guinea (PNG).

Dr Kelly-Hanku explained we need to ‘unpack’ the term key population and posed the question of exactly ‘who’ are the key populations.

Sexual identity: How one claims their sexual identity is changing in PNG. From bisexual to gay to men who have sex with men (MSM), to men of diverse sexualities.

Attraction: Who one is attracted to; only women, only men or mostly women for example, however this does not mean they are having sex with who they are attracted to.

Sexual behaviour: Who did they last have sex with? Male, female and so on.

These complexities around sexual identity may indeed be the reason why some key populations are not being reached in PNG, claiming the picture is far more complicated than people wanted to know.

Dr Kelly-Hanku suggests we learn how to work with it, through the different layers of diversity, attraction and ethnicity. Much more work needs to be done in order to reach the global targets for HIV and increase levels of testing and treatment, however PNG is up for the challenge, showing it can be done, where some financial donors have said no!

Health vulnerabilities, human rights and the war on drugs in the Philippines.

Joint Symposium: Are we there yet? Reaching global goals for HIV in Asia and Pacific Regions

Health vulnerabilities, human rights and the war on drugs in the Philippines.

Jonas Bagas, Programme Officer, Asia Pacific Council of AIDS Service Organisations, Bangkok, Thailand

The focus of this session was to discuss how our neighbours are meeting global goals for HIV, in terms of leaving no one behind in the aids epidemic.

The ongoing fight to end the public health threat of AIDS concerns all of us. The epidemic does not respect borders, whether it be new migrants that have acquired AIDS overseas and settle in Australia or tourists visiting overseas and returning with an acquired infection.

The Philippines in particular has one of the most explosive HIV epidemics in the Asia and Pacific Region. High levels of discrimination and stigma towards key populations such as men who have sex with men (MSM) continue to exist.

Are the Philippines there yet, will they meet the Fast-track target of 90-90-90 by 2020? No, Jonas informs. In fact, targets are way off with 260 000 new HIV infections in 2016 alone.

141% increase in HIV infections was reported since 2010, particularly among key populations and young MSM. Gay men are suffering and dying in silence, fearful of accessing healthcare.

Barriers hindering progression towards targets include; poor knowledge, increase prevalence of STIs, chem sex and low-level condom use.

Prevention targets are also not being met. ½ of MSM, people who inject drugs and sex workers are not even aware of their HIV status. Treatment targets are also off track.

The Philippines are not there yet, Jonas states they will not get there by 2020 or by 2030.

Why? Political struggles, human rights violations and the war on drugs are all key contributors that need urgent attention. Politics are core of the response.

Take home message was we need to work towards zero discrimination, uphold human rights and continue the fight to ends aids for all.

Self-Perceived Problematic Relationship with Drugs and the Use of Alcohol and Other Drug (AOD) Services among Gay and Bisexual Men

Self-Perceived Problematic Relationship with Drugs and the Use of Alcohol and Other Drug (AOD) Services among Gay and Bisexual Men

Professor Adam Bourne

Statistics show drug use, including cannabis, cocaine, ecstasy and methamphetamine for example, is up to three times higher among the Gay and Bisexual male population, nationally and globally.

Drug related harms occur from risky drug use, increasing the risk of disease transmission. For example, methamphetamine use and erectile dysfunction has been reported to increase the odds of HIV infection among this population.

Other drug related harms among Gay and Bisexual males have been observed from the use of GHB and crystal meth. Of concern is the increased mortality rates attributed to GHB overdoses in London, with one death reported every 12 days between 2014 and 2015 in addition to poor ART adherence secondary to crystal meth use.

The Flux study aimed to understand how drug use is situated among gay and bisexual men. How comfortable are they engaging with alcohol and other drug (AOD) services? What are the barriers? One point of note was that there was a fear of judgement and the perceived lack of understanding from AOD services in terms of the synthetic types of drugs being used and the different ways Gay and Bisexual men use the drugs compared to other populations.

A comment from the audience triggered the response that a move forward may be to try to meet the needs of people who are sexually active and who chose to use crystal meth, exploring ways of how to use it safely.

The overall aim is to reduce disease transmission and improve engagement with AOD services for all, but in particular for those who believe their drug use is problematic.

Sexual Health from an Indigenous Perspective

Sexual Health from an Indigenous Perspective

Professor Gracelyn Smallwood

Prof. Smallwood, a Professor of Nursing and Midwifery at Central Queensland University lead an inspiring session, capturing the audience’s attention not only with her outstanding achievements on a global level but her strong presence, proud ties to her Indigenous heritage and great sense of humour.

Coming from a family of 19 children, Prof. Smallwood’s rise to success has been remarkable. As a young Indigenous female, stating “I want to be a doctor and I want to buy a pair of shoes” her parents ensured she strived towards what they called “a white education” to achieve her goals. Progressing through the world of academia from Midwifery to Masters and later PhD and even meeting Nelson Mandela, Prof. Smallwood has excelled as a global leader in sexual health.

“Name a disease, you name it, they’ve got it”, referring to her people, seemed to be an inspiration for her efforts to achieve greater health outcomes for Indigenous communities.

While Prof. Smallwood has worked on many International projects, what stood out the most was her success in designing and implementing a culturally appropriate program “Condoman”, as an alternative to the famous 1997 Grim Reaper HIV campaign. Pushing barriers, Prof. Smallwood recruited a young, fit Indigenous footy player to dress up as Condoman in a tight lycra outfit to roll out their campaign and it was an absolute hit! Their aim was to promote the use of condoms to minimise disease transmission in Indigenous communities. The impact of the campaign was recognised on a global scale, attracting International attention and support from the World Health Organization.

A take home message was that her people are not after ‘Equality’, they are after ‘Equity’. We need to empower Indigenous communities, increase their access to health care, educate and uphold their human rights.

“Acceptability and Feasibility of an Integrated HIV Self-Testing (HIVST) Service Delivery Model in Queensland”

Sara Bell from the University of Queensland discusses on-line HIV self-testing kits.

As a means of encouraging more Australians to get tested for HIV and increase testing frequency, providing access to self-testing kits is a convenient step in the right direction. However, self-testing in not currently available in Australia. It has been proven that the demand is there, with data showing Australians are already conducting internet searches seeking self-test kits from overseas. While this shows a willingness to self-test, caution must be taken as seeking kits from unknown sources presents a certain level of risk, with the possibility of overseas test kits being substandard.

Sara and her team conducted a pilot in Queensland, with the aim of assessing whether an integrated HIV self-testing service delivery model would be accepted and how feasible the service would be in a peer-led Queensland community setting. A particular target population included men who have sex with men (MSM) living in regional, remote or rural areas.

630 test kits were ordered, including 87 from non-Queensland locations. Although eligibility was such that the participant was required to live in Queensland, data showed that there is a demand nationally.

An important finding showed 32% of MSM and bisexual males in Queensland reported never being tested for HIV. While we know there are many reasons why people choose not to engage with health care providers, what we do know is that while HIV related stigma and discrimination continues to exist, the chance of a person stepping forward for testing is decreased. Therefore, self-testing kits may break this barrier due to convenience self-test kits provide.

The interest shown in this pilot demonstrates that this form of on-line technology is indeed effective in increasing HIV testing among key populations such as MSM and bisexual males. It also shows that advertising on social media, dating apps and other websites is an effective platform to engage hard to reach populations.

This project aligns well with the UNAIDS 90-90-90 target and will be one to follow in the future.

“When will it ever end?” The Provision of Regulated Injecting Equipment to Australian Prisoners.

Professor Michael Levy, Australian National University, ACT, Australia

Within this session, Professor Michael Levy discussed harm minimisation strategies within the prison environment, including the controversial provision of a needle exchange program in Alexander Maconochie Centre (Prison), Australian Capital Territory (ACT), Australia and achievements in reaching global targets for hepatitis C treatment.

Prof. Levy, a tireless advocate for prison needle and syringe programs, led us through the session by providing a background on the situation and the barriers encountered.

His passion was clear as he spoke about the frustrations of being so close yet so far from achieving the ultimate goal of implementing a needle exchange program in the ACT. Prof. Levy expressed the challenges faced in getting Corrective Services to share the same enthusiasm.

The event that occurred in 1990 in New South Wales, Australia where a detainee living with HIV used a blood-filled syringe to stab an Officer who subsequently died still remains a major barrier to moving forward in the harm reduction response. This case, he states, is nested within Professor Kate Dolan’s PhD thesis on HIV transmission in Australia. Since this time, agitation among Corrective Services has remained.

While Switzerland is recognised as the leader, commencing the first needle exchange program in prison in the world, various other countries have progressed, implementing programs since. However, this progression is yet to follow in Australia, where we sadly lag behind other countries in the global response.

The ACT had an aspirational plan to comply with the human rights of prisoners, advocating for the equivalence of healthcare by recommending a needle exchange pilot to minimise the transmission of disease, however their efforts were to no avail.   

While there is Government commitment from the Greens, the ACT Human Rights Commission, the Australian Medical Association and Public Health Association, the battle continues. While harm minimisation programs such as needle exchange services are yet to be implemented, other strategies such as therapeutic prevention, such as hepatitis C treatment, have been adopted as an alternative to managing the within prison risk behaviours of the sharing of syringes.

Prof. Levy discusses the remarkable achievements in reaching global targets of a reduction in hepatitis C prevalence. From a HCV Ab prevalence of 48% in 2010, to 20% in October 2016, an impressive reduction was achieved in just 18 months.

What we can be assured of is that while passionate leaders in global health such as Prof. Levy continue to be at the forefront, striving for improved public health outcomes, there is still hope. The dream may one day become a reality, where we see prison needle exchange programs, achieving universal health for all as we know ‘good prison health is good public health’.

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