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.

"There has probably never been a population both more heavily impacted and less discussed at scientific meetings than the transgender population around the world" Dr.Tonia Poteat CROI 2016

TGD are being recognised as a high risk population (WHO 2015)

Nineteen percent of Trans women world wide are HIV (+ve). Limited evidence about HIV among trans males is available due to the lack of data/evidence.

ACCESS (Kirby Institute 2017) Data shows out of 696 people 5.2% were HIV (+ve); 8.9% were trans women and 4.5% trans men. Trans women were more likely to report sex work

Barriers to Prevention: Methodological, cultural, social and system, geographical and under representation

Legal Barriers: Pathologisation and legal sex recognition

Trans and Gender Diverse people are a community of interest in UNAIDS/HIV elimination program.

They are not included in the National HIV strategy or included in STI/HIV reporting. This misses the opportunity to collect data of behaviors and STI/HIV testing among the TGD population

In a STI/HIV testing service a research project was produced to collect Sentinel Surveillance data via surveys that demonstrated the importance of the data collected

Three surveys were set up to collect the data between 2013-2017

The 3rd (2017) survey asking gender identity and sex assigned at birth: Of 1220 surveyed, 88 (7.2%) reported to be TGD, of which 61 of those reported to have a gender identity that was different to the one designed at birth 

Thirty nine has tested more than once at the service

* Take home: Simple changes to data collection based on community consultation had a considerable impact on the utility of surveillance to help guide STI/HIV prevention and care for TGD people

Posted by on in Public Health and Prevention

Presentation by Professor Monica M Lahra

Monica gave a fascinating and thorough summary of global concerns relating to anti microbial resistance [AMR]. Resistance is predicted to be a big problem by 2050, and is considered to threaten health and health care provision.

AMR is essentially a problem of overuse. Bacteria which come into contact with antibiotics, but are not killed have various means of developing resistance. Resistant organisms are now global and endemic in some countries. Some organisms have become resistant to last line antibiotics. AMR presents a threat to medical procedures and treatment, including chemotherapy, complex surgery and transplants.

Factors leading to resistance include:

  • Mass food production. Antibiotics are needed to control disease, particularly where large numbers of stock are raised in minimal space as happens with large scale fish and pig farming. This is considered a major contributing factor.
  • Large scale antibiotic dumping by manufacturers.
  • Inappropriate prescription /overuse where antibiotics are not necessary /availability of non prescription antibiotics. The latter uncontrolled use is estimated to be even greater than current studies indicate as many countries do not collect data on non-prescribed supply.
  • Travel. Global travellers are colonised with resistant bacteria which they bring home with them. (here Monica threw in a comment that we should avoid eating pastry or ice cream when travelling ).
  • Lack of data. Inadequate surveillance has led to an inadequate understanding and response to the problem.

Peak global health organisations see AMR as a real threat as evidenced by a 2016 UN high level meeting on the subject and subsequent global planning to stem resistance. WHO have released a list of priority organisms and these have been categorised according to their threat level as urgent, serious, or concerning.

Responses required for tackling the problem include:

  • Improved knowledge and awareness of the issue at all levels. This should include building awareness amongst industries such as food production.
  • A solid global and national policy response, including workable frameworks and accountability.
  • Optimisation of antibiotic use through stewardship, and reduction of antibiotic use through lowering infection rates.
  • Investment in research and development.

Monica argued that now was not a time for complacency. We need to be careful about how we use this precious commodity. We need a workable road map of what to do, and commitment from business, which is likely to require strong governmental policy. 

At a clinic level, it raised questions for me about the wisdom of contact treatment where risk is low, and the contact indicates their willingness and ability to abstain from sex until results are received. We currently advise contact treatment, so is it too controversial to wait?

It also raises questions about any rollout of antibiotic prophylaxis for high risk groups

The presentation was a confident and engaging call to action.

On the throw away line regarding the risks of global dining, a friend who I informed about the presentation commented “deliciously infected by an Italian Gelato”.

 

 

 

 

Posted by on in Public Health and Prevention

One of the biggest challenges facing health now and into the future is that of antimicrobial resistance, and Monica Lahra from the WHO did a fantastic job at outlining the issue.

Almost 40 years ago the specialty of infectious diseases seemed almost dead as it looked as if mankind had won the battle against microbes. However this was short lived as natural selection ensured antibiotics were no longer our golden bullet. 

Though to some degree antimicrobial resistance is an inevitable consequence of antibiotic use, antibiotic abuse has certainly led the problem to explode throughout the world.  Inappropriate use in hospital, community health facilities, pharmacies and pharmaceutical companies (dumping in water ways) and agricultural practices (fish farms and livestock) have all been the major of drivers of this. Furthermore travel has ensured these organisms are spread throughout the world. For example Poor antibiotic practices have ensured the subcontinent is riddled with ESBL enterobacteriaceae. A survey of Swedish travelers stools before and after returning from the subcontinent showed extremely high carry rates of ESBL after returning to Sweden, often persisting for months. It's tragic to hear now Colistin resistance is being widely seen, particularly in livestock.

So how do we tackle this growing problem? Not easily. Improving awareness and education to healthcare providers so they rationalize and appropriately prescribe antibiotics is key. Restricting over the counter purchasing of antibiotics must accompany this. Increased surveillance and research is also a key to understanding the patterns, distribution and resistance profiles of such organisms. And finally better hygiene practices must continue to be promoted. 

 

HIV quality of life with stigma and treatment adherence has been well established

Quite often we see poor mental health, isolation and co-morbidities associated with stigma and discrimination.

(WHO) declared 90% diagnosed, 90% on treatment and 90% with viral suppression by 2020. We should look at adding another 90% Good health and quality of health.

Overall health testing should be offered at regular intervals in HIV care with the individual referred onto other services as needed, to improve the quality of health

A PoZ QoL survey was developed with 4 domains that included 13 questions about health*

*Psychological, Social, Functional and Health Concerns. with the survey results/outcomes being higher than expected. 

 

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

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