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.

Monday 14/11/16 – Day 1: Jan Edwards Trainee Session

Dr Danae Kent, Senior Registrar at Adelaide’s Clinic 275: ‘Testing for Rectal Chlamydia in Women – Is It Worth It?’

In short the answer was yes…and no! 

Rectal chlamydia infections in women have the potential to result in significant morbidity and enhanced HIV transmission. 

Few other Australian studies have looked at this topic.  The estimated rectal CT positivity rate in women is 5-27% (variable depending on population eg. higher in sex workers and sexually adventurous females).  Awareness of site of CT infection is important as this has implications for choice of treatment (rectal CT treated with Doxycycline vs genital CT treated with Azithromycin).

Method:

This South Australian retrospective study looked at women who received anal CT testing if they reported anal sex and/or anal symptoms.

Results:

Overall CT positivity rate = 8.5%

Young women less likely to have anal CT testing done but more likely to have positive anal CT result (of those with a CT positive result, 16% of women <20yrs were positive for anal CT)

Isolated rectal infections:

70% were found to have urogenital AND anal CT

19% were found to have rectal CT only

11% were found to have urogenital CT only

Therefore urogenital testing alone would miss 1 in every 5 cases of chlamydia confirming the value of testing for anal CT where a women reports anal sex and/or anal symptoms.  These findings are not generalizable to settings outside the sexual health clinic. 

Interesting food for thought and also a timely reminder of the importance of a thorough sexual history for the female client including enquiry about anal sex practices.

 

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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