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.

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Day 1 ASHM HIV & AIDS Conference 2017 - Canberra

 

Day one, it's wet. Bring an umbrella. It is worthwhile to mention to the conference bag from SEW Conference bags, made by women in Tanzania living with HIV, they are made from recycled wheat flour sacks. It's a fair trade set up where employees are paid a fair wage, which is fantastic as well. They're pretty funky, I tried looking up their website but the domain expired a couple of weeks ago, so hoping it's only temporary. 

First up is the Opening plenary with Martin Holt and Denise Kraus chairing.

Acknowledgement of the Ngunnawal people on whose lands we meet with a welcome to country by Wally Bell, a Ngunnuwal man. Wally reminds us that if you take care of the land, the land takes care of you. I can't agree more with that sentiment.

A welcome from the government from Senator Richard Di Natale was next with a reflective Senator considering his own previous work in public health and HIV prevention in India prior to his career in politics. Senator Di Natale then spoke to how Australia was once leading in many ways for it's response to the emergence of HIV, the care and dedication of healthcare workers and how early implementation of Needle Syringe Programs helped stem infection rates. However we have more work to do as a nation, with examples given specifically as the still anticipated approval by the PBAC for PrEP on the PBS and that of our collective position as a leader in our region from a funding and policy standpoint with ending HIV. A final sobering example was given; the disparity between the Indigenous population and non-Indigenous persons. Among other indicators, preventable disease being five times greater in the ATSI population compared to the people not of indigenous background remains a stark reminder that we have far to go.

The Acting CEO of ASHM Scott McGill followed with his opening remarks and paying respects to Levinia Crooks who recently passed, who will be sorely missed. Later, In memoriam of Levinia Crooks will be conducted by Edwina Wright at the end of this session.

Dr Bridget Haire, President of Australian Federation of AIDS Organisations AFAO also welcomed us with again further reminders that work is yet to be done across the nation, highlighting that "Best practice depends on where you live". City to country, we have large gaps within our reach as clinicians despite the hard work we all do. A few take home messages for me, that advances in the field of HIV treatment, prevention and screening are not always technology based (such as the advent of home testing), but community based programs can be of even greater significance. Also, that we need to ensure equitable action to ensure proper prevention, screening and treatment.

The last welcome of the morning was from Cipri Martinez, President of the National Association of People with HIV Australia (NAPWHA). The important news that undetectable viral loads in people living with HIV means it is sexually untransmissible. This still has not resonated across society and the stigma associated with HIV still remains, to quote "letting go of our fears and the modern reality of U equals U".

I will end this post with Cipri's last quote, "People deserve our care, and our best. Thank you for continuing to care and welcome to ASHM 2017".

 

 

Day 1: SARAH Bell - Research Officer, University of Queensland

 It is interesting to know of such a project in Queensland:  HIV Self Testing (HIVST) service.

 The aim of the service is to pilot and evaluate the efficacy of the program, determining if it increases access to HIVST particularly for gay and other men who have sex with men (MSM), infrequent and new testers and those in regional and remote areas. A model was formulated which includes recruitment pathways through dating apps, word of mouth, gay apps and social media sites; all designed to engage those mentioned population. Ordering of the HIVST kit along with a completed survey were all done on-line. They receive and return the kit. Once test was done, they receive a follow-up phone call giving contacts to organizational support if test was reactive and an option for test reminders if non-reactive.

 As of 30 September 2017, 630 kits were ordered of which 516 are from Queensland and the rest are from different states. Main reason stated for availing of the service was unprotected sex and test access convenience.

These are the preliminary results from the targeted population:

  • 71.9% reside in Major QLD city compared to only 1.4% from remote or very remote QLD.
  • 65% of gay and other MSM used the service.
  • 38.3% are those that have never had any form of HIV testing
  • 23.9% those who have had HIV tests done >12 months

In the light of these findings, it can be said that the service will be a success if rolled out state-wide or nationally mainly because of its dicreteness and test accessibility. However more should be done to somehow tap those in remote places and to also target Aboriginal and TSI populaion. These findings will inform further improvements to better the service and provide more access to marginalized population.  

 

 

The talk was by Ruth Hennessy who is a clinical psychologist based at the Albion centre in Sydney.

Although relevant to any area of HIV care, I was interested due to my work with children and young people living with HIV as well as my work with women living with HIV and prevention of transmission of HIV to their infants where I experience a high level of psychosocial needs. 

The speaker, Ruth stated that people living with HIV have higher incidence of mental health issues and then went onto highlight that marginalised groups are affected by HIV. It has been established that Psychosocial issues affect access to care and care outcomes and therefore treatment of psychococial issues can remove obstacles to care.

The psychology team at the Albion centre collected data around presenting psychosocial issues in their client group and compared the data over a number of years. 

Age range was 23-68 years with a high proportion of men. 44 % of sample were born OS. 

An  overall increase in issues around depression, self harm, welfare issues, alcohol and drug misuse was found. Interestingly, a reduction in adherance issues was found, which is encouraging.  This probably reflects the relatively simple medications increasingly available now to treat HIV.  The data collected overall supported the teams belief that their clients psychosicial needs  had increased in complexity.

What might help in the future to support this client group?

it was  suggested that having 'Complexity predictors' and interdisciplinary intensive support would assist in identifying which clients who may need extra  support. It was also suggested that Establishing standards for psychological support for adults living with HIV would assist in providing appropriate care. 

In the paediatric population within Australia, HIV is largely not a sexually transmitted disease and is further complicated by issues such as adoption,history of trauma and of course  the child or young person may not know ( or understand) their diagnosis and must, at some stage, learn of it and how it was contracted. The availability of complexity predictors could be a useful resource in assisting and supporting families and their children living with HIV. Despite more simple and available drug formularies, psychosocial issues are a large part of care required it seems across many age groups and therefore require further attention. 

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Dr Adam Bourne, Associated Professor, Australian Research Centre in Sex, Health and Society, Latrobe University, Melbourne VIC, Australian delivered an interesting talk on global PrEP use within the MSM community and the stigma associated with taking PrEP called  "sl*t shamming". To tackle this perception, Dr. Bourne highlighted the importance of a "good sex life" within the MSM community and mentioned various lived experience PrEP studies, one found that 76% of the PrEP participants since taking PrEP are now happier with there sex life. At a clinic level this reminds us that a "good sex life" is a key motivator and if discussed with every client will help increase PrEP use and help address the associated “sl*t Shamming” stigma associated with PrEP.  

The Multicultural HIV and Hepatitis Service (MHAHS) has launched a multilingual communication communication toolkit… https://t.co/eXa72MaSv2

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#ASHMResource HIV Management in Australasia is a ‘living resource’ for health practitioners managing people with HI… https://t.co/yKj1D4aCrE

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