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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The Implications of HIVSTI on Sex Workers

Udesha Chandrasena - Policy Officer at Scarlet Alliance, Australian Sex Workers Association

This was an very interesting session focusing on the accessibility of "self-test" HIV test kits that are currently available online and that have been made available to people in rural areas of Australia. With the changes and increase in availability of technologies that will allow for fast results, with some accuracy, to determine someone's HIV status, Udesha presented that this has potential to impact positively and negatively on sex workers.

The ability to have people attend tests at non-clinical locations can have great potential benefit in allowing for confidential testing in a private setting but can also have potential for significant issues.

Sex workers in Australia have been shown across Australia to have lower rates of HIV than the general population and also when compared to rates of sex workers overseas. This has been made possible through strong peer group programs in Australia and can only be measured in this population as a success, something that should be recognised. However this is not new data and across Australia every state and territory has it's own legislation regarding sex workers and a persons HIV status. This has potential to impact this population at risk with emerging new technologies that laws may not be keeping up with.

The advent of technologies with the ability to test a person on site or that need to be sent elsewhere for results may lead to an increase in the number of people tested but could also open workers up to potentially dangerous practices in their workplace. This could lead to bullying within brothels to be tested, to have workers be coerced by other workers, clients or brothel owners or managers to test in their presence. This has potential to impact on the workers safety, ability to work or force people to change practices or even be stopped from working. With differences between testing kits, techniques and potential technical issues with these technologies, this could lead to issues with false negative outcomes which would be managed differently in a clinical setting or with more "traditional" testing techniques.

Udesha argues that the current high rates of voluntary testing among the sex worker population be acknowledged and that changes to legislation across the country be made to ensure safety for workers.

In conclusion, there is potential for an increase in the numbers and scope of testing, however this can also negatively impact on sex workers. Changes in legislation across Australia is necessary to accompany this new technology.

We came to this meeting in part to hold a round table discussion about the role of DBS sample collection. Excitingly for us, further exploration of DBS, including through multi-centre collaborations made it onto the list of 4 priorities coming from the meeting.

Dry Blood Spots are a simple way to collect a biological sample for analysis in the laboratory. You use a lancet to pierce the finger-tip and drip blood onto one or more target sites on a sheet of blotting paper. This sample is then dried, sent to the lab (through the mail or easily transported at room temperature) and then analysed in the lab. The spot is punched out of the blotting paper and eluted The lab can test for any number of things including the presence of antibody, molecular, and serological tests. Labs can use their own tests or test which are marketed through diagnostics companies using a variety of analysers.

In order to be approved (and rebated), a DBS claim needs to be made by a producer/supplier when the product is registered. This has been something which has held back DBS sample collection for some time. As tests became more sophisticated and analysers more mechanised, the operator-involved steps in processing a DBS sample probably seemed overwhelming.

But there are many factors which place a DBS sample in good light. Transportablity, durability and stability are all excellent in remote, hard to reach or poorly serviced areas. They also appear to provide an alternative for people who are, for whatever reason, avoiding testing through conventional means.

Two posters which also looked at DBS, both its use in one of the larger format analysers, and as an acceptable sample collection technique for consumers are below.

Validation of the GEN-PROBE® APTIMA® HIV-1 RNA Qualitative Assay for use with Dried Blood Spots.pdf

Diminishing Return on Increasing DBS Sample Quantity.pdf



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