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 Wiig

Rebecca Wiig

Rebecca completed her medical degree in Ireland and graduated from the Royal College of Surgeons in 2005 with a Bachelor of Medicine and Surgery. She has worked in Australia since 2006 in various hospital positions, including Obstetrics and Gynaecology as well as eight years as a registrar in Sexual Health Medicine at Royal North Shore Hospital. She went on to do General Practice training,completing this in 2014. Rebecca has a particular interest in Sexual health, Women’s health and contraception.

This presentation was given by Associate Professor Suzanne Belton from the Menzies School of Health Research.

A/Prof Belton presented data from the study using quantitative and qualitative data to capture clinical process and outcome data from a telehealth abortion provider, Tabbot telehealth service.

She explained that access to abortion in Australia is limited by several factors, especially in regional, rural and remote areas.

Since the TGA approval of medical abortion in Australia, only 1.5% of registered medical practitioners have obtained certification to prescribe.

Telehealth models of care have been found to work well internationally. The study looked at whether telehealth abortion was a safe, effective and acceptable option in Australia.

The study aimed to provide information to health managers and policy makers which can be used to inform a responsive reproductive health care system.

The clinical outcomes included efficacy and safety , and process outcomes included acceptability by women using the service.

The data showed that one quarter of women chose not to proceed with a telehealth abortion, but for whose who did, clinical outcomes were very good. No adverse events were reported.

Interestingly, of the 717 women in the study, only 8 (1%) and 2 (<1%) of women registering with the Tabbot telehealth service were from remote or very remote areas respectively. 296 (41%) of women were from major cities and 318 (44%) from inner regional areas.

The women interviewed reported high levels of satisfaction, privacy, quality of care and levels of support.

In conclusion, telehealth abortion is safe, effective and acceptable to Australian women who experience limited reproductive health service options.

A/Prof Belton also presented a comparison of three telehealth abortion services available in Australia. These included the Tabbot Foundation, Cairns Doctors and Marie Stopes. The Tabbot Foundations provided the cheapest option for patients at $250 (no medicare rebate). Aside from cost, the three services were found to be similar in the way they are set up and run and in terms of patient requirements.

The presentation provided some valuable insights into access issues for medical abortion in Australia, and innovative ways to help provide women with choices and improved access.

 

I attended this great talk given by Kevin McGeechan on Wednesday 8/11.

 

Kevin McGeechan is a senior lecturer in Biostatistics at the School of Public Health, University of Sydney and acts as a consultant statistician for Family Planning NSW.

The topic of abortion law in NSW was presented and discussed in further detail the following day at the symposium addressing "Abortion:2017 and Beyond" with several other excellent presentations on the topic. 

A bit of background to start:

Abortion remains a crime in the NSW Crimes Act 1900, punishable by up to 10 years jail. However, as a result of case law, abortion can be provided legally, but only to protect the life or health of the woman. Abortion law reforms have taken place in all other Australian jurisdictions except NSW and Queensland. This leaves women in these states vulnerable to prosecution.

 

In September 2015 , The Greens NSW commissioned a community survey to inform development of an abortion law reform bill.

This bill was introduced to the NSW Parliament in May 2017 and was debated but defeated.

The survey was conducted anonymously online by a market research company.

1015 male and female adult residents of NSW participated

Of these, 76% were unaware that abortion is a crime in NSW.

73% thought it should be decriminalised and regulated as a healthcare service.

These results were consistent across gender, age groups, metropolitan/regional and rural areas as well as all levels of education.

There was also strong support for women seeking abortion to be protected from harassment (89%) and for protest exclusion zones around abortion clinics (81%)

Support for decriminalisation and protection of women seeking an abortion was higher amount regional/rural residents than Sydney based respondents.

I found it interesting to learn about the differences across Australian jurisdictions regarding abortion law. In addition, it is surprising how many people are unaware of the law pertaining to this in NSW. I think as a medical practitioner it is important to be aware of these issues and what barriers this may pose to women wanting to access abortion services in NSW or Queensland. 

 

                                    

 

This talk was presented by Udesha Chandrasena, Policy Officer, Scarlet Alliance, Australian Sex Workers Association, Australia

Udesha spoke about the results from a study conducted by the Scarlet Alliance, involving an online survey that was distributed to sex workers including members of the Scarlet Alliance. The survey looked at potential implications of HIVST 

Sex workers in Australia have low rates of HIV infection despite laws that stigmatise and discriminate against them. This is largely due to the success of peer eduction, outreach services, and safer sex information practices.

Benefits of HIVST may include providing testing options that are private and confidential and that take place outside of a clinical setting 

The risks of such testing , however, may include a higher rate of false reactive results due to sex workers being a low prevalence population 

In addition, there is no opportunity for pre and post test counselling 

In the event of a reactive result this may be considered evidence of HIV infection as per the National Policy on HIV testing, which could have consequences for the sex workers due to current laws and policies that are in place 

It is important to ensure that if HIVST was carried out, sex workers are supported and that information is available regarding what to do in the case of forced or coerced testing. Privacy rights also need to be protected

In addition, clear information regarding the risks of false reactive test results and the need for confirmatory testing needs to be in place

The sex workers who completed the survey generally welcomed HIVST, however they were concerned about the legal implications and other possible drawbacks as mentioned above

Challenges in the care of Refugee women living with HIV in a  regional town

This talk was presented as part of the HIV&AIDS symposium "Who is left behind in a virtual elimination of HIV" 

I found this talk, presented by Lauren Coelli , (Sexual Health Coordinator at the Gateway Health clinic , Wodonga) very inspiring , providing a great example of how to provide care for refugee women living with HIV in regional Australia which could be translated/adopted to similar clinics and settings

The Gateway Health clinic in Wodonga was established  in 2014

The clinic is a general practice clinic set in a community health service, 

one of it's focus areas includes meeting needs of refugees 

largely from the Democratic Republic of Congo (DRC), Bhutan and Nepal

The clinic currently looks after 12 women and one child living with HIV

all the 12 women acquired HIV as a result of rape

According to the DRC family code (444) " a wife owes her obedience to her husband"

marital rape is not criminal act

The women attending the service described high levels of anxiety about their HIV diagnosis, including fear of death and worry about children's future 

Bottle feeding their babies may identify the mother as being HIV positive, and feeding therefore often takes place in private

In addition, they reported fear of transmission, disclosure to community and ostrerisation by their community if their HIV status was disclosed

These concerns and fears have contributed to reluctance to join support organisations, fear of meeting other African people working at the clinic and distrust of phone interpreters

Some of the strategies employed by Gateway Health to overcome these barrier and improve patient care and outcomes have included gaining trust and building rapport with the women, providing a flexible, walk-in model, close collaboration with other local health care providers and up-skilling clinic staff (eg undertaking s100 prescriber training) to provide care within the service for the women rather than having to refer the women to multiple external service providers.

 

 

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