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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Lynda Carlye is a sex and relationship therapist and director of the Society of Australian Sexologists, Australia. Lynda has over 10 years experience in the field and presented a very engaging talk which looked at why 27.3% of women do not enjoy sex (Australian study of Health and Relationships)

Lynda kicked off her talk by going through the pathological and non-pathological reasons of vulvodynia which is a pain in one area of the vulva. Lynda established the importance of understanding the 237 reasons people have sex from the YSEX survey under the following four subcategories; physical, emotional, goal attainment and insecurity.

At a clinical service level, it is important that once organic causes have been ruled out, appropriate referrals are made within the multidisciplinary team which should include a solution focused psychosexual management/ treatment within a counselling framework for the individual and/or couple.  

Amongst many, Lynda recommended Dr. Anita Elias’s practical assessment and management tool that helps patients understand the connection between their thoughts emotions and physical sexual response.

Certainly psychosexual therapy is invaluable although public funding for this is limited and therefore a barrier for many. 

The talk was presented by Dr Jeffrey D Klausner, Professor of Medicine, Department of Infectious Disease, University of California, Los Angeles, USA

Outline

·         What is self – testing?

·         How is self – testing Adopted?

·         What is the fidelity of self – testing?

·         Where can self – testing can be disseminated?

Self – Testing for HIV Infection

Only US FDA approved in Home HIV testing kit which used similar technique of Western Blot

Used by over a million consumers and same device used by health care professionals recently

The technique is simple oral swabs, no blood, and results will be in 20 minutes

24 bilingual customer phone support and details product website offering information, referrals to care, product usage instructions and more

Higher consumer satisfaction

Self – testing adoption

Influenced by user’s perception of costs, benefits, personal need and convenience.

Users greatly prefer painless oral testing over finger stick or venepuncture

Additional benefits include increased confidentially, privacy and reduced social stigmatization

Self – testing Fidelity

Original studies by manufacturer < 2 % failure

-          Limited by use of select population (MSM)

-          US adult vs trained providers ( Sensitivity 92.9% vs 99.3 % )

Singapore, error rate 0.6 %

Atlanta, 9 % error rate

China (non – Oraquick) 10 % difficulty swabbing, 17.5 % difficulty reading results

In NYC young MSM and transgender women reported concerns of anxiety, test correct use and instructions

Self – testing Dissemination – Los Angeles

-          Vending machines

-          Vouchers

-          US Priority mail

-          Online

Vending Machines in sex clubs which are located at private areas with self – contained unit that can be monitored remotely as well as posted instruction how to use the kit

Initial Concerns for Vending Machines

·         Cost of HIV home test kits

·         Emptying the vending machine

·         Conflict with existing testing programs

·         Home test kit window period

·         Result anxiety

Results summary over 7 weeks, in 2014

-          1176 hours and 312 tests for Vending machines versus 64 hours with 58 tests for traditional testers with clinicians

Providing Vouchers for the free test kit that can available at Pharmacy is also very positive outcome 

Social Medical Promotion commenced since 2014 through Periodic advertisements

In General, among three choices; vouchers, vending machine, priority mail to home 

Approximately 2/3 used Mail services and 1/3 of other consumers accessed through free vouchers, 67 % and 30 % respectively. Only 3 % used vending machine to get the self – testing kit  

Linkage to care for community

HIV Self- test added as a reported element in HIV Surveillance and also follow up management goes through by receiving the positive test kit photos taken by consumers

STD Self – Testing

·         Self -collection urine send via mail for STD testing

·         Self – referral syphilis lab testing

·         Commercial home – based collection and shipping

·         True home – based collection and self – testing.. .. not yet but coming soon.

Among all, using Mail for screening is the most cost effective method

Summary

·         HIV self – testing is desirable, safe and effective – WHO recommended

·         Need more evidence on outcomes, impact and cost effectiveness

·         STD home – specimen collection and self – referral options

·         True STD home – based self – testing …. Coming soon and waiting approval from FDA

Presented by Dr Ayden Scheim, Division of Global Public Health, University of California, San Diego, USA 

Overview

1.       Trans populations are incredibly diverse

2.       Trans women disproportionately impacted by HIV globally

3.       A “global” picture obscures context & knowledge gaps

4.       Trans people face multi-level HIV /STI vulnerabilities and protective factors

5.       We must make trans people visible in HIV & sexual health

6.       A trans sexual health agenda is needed

Trans populations are diverse

Trans and gender diverse identities

-          Trans women/ trans feminine & trans men / trans masculine

-          Non- binary

-          Two Spirit

-          Sistergirl/ Brotherboy

0.6 % of US adults (~ 1 in 160) are trans gender compared 1.2 % of NZ high school students

Gender Identity

Non Binary people counted 35 %, while 33 % of Transgender women and 29 % of Transgender men with the least proportion is Crossdressers, only 3 %

Medical Transition (hormones and / or surgeries)

Almost a quarter already had completed transition and next quarter is still in process. Other half include; Planning but not begun, not planning to and not sure group as well as concept does not apply group

Ø  Trans women face a disproportionate HIV burden globally

-          Based on paper from Baral et al, Lancet Infectious Disease 2013, the pool HIV prevalence was 19.1 % in 11066 transgender women worldwide.

Trans men

Qualitative data is very limited and Lab confirmed HIV + varies from 0 - 4 % while self reported presented from 0 – 10 %

Choosing the right denominator

-          2/3 of trans men identify as gay, bi, queer but only 1/3 of those had sex with cis men

Trans MSM seem a lot like other MSM; however countervailing risk & protective factors shown as below are unavoidable

-          Sexual abuse, stimulant use, depression, syndemics predict risk behaviour

-          But are distinct in consequential ways

-          Exclusion from gay communities

-          Less anal intercourse

-          Changes to genital mucosa

Therefore, Trans people are not MSM….. except for when they are

-          Include trans MSM alongside other MSM

-          Who will be accountable to trans women ?

Summary

A trans sexual health agenda based in access to gender affirming care including hormones and surgery, reproductive care, HIV / STI prevention, screening and treatment in a context of gender recognition and rights protection

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.

RT @hepqld: Curing #hepatitis C is easy, and no longer needs a specialist to prescribe treatment. Community doctors play a pivotal role in…

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