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 2 of the conference was informative, fun and interactive. Opportunities to use smartphone technology to interact using live polls added to the experience. Here are my key GP take home messages from day 2.

1. Hepatitis C is curable and can be eradicated! At present only 1% of people with Hepatitis C are offered treatment. There is an urgent need for more community prescribers. The new DAA should be PBS listed by the end of this year. These drugs offer 8 week treatment times, are well tolerated, and have minimal drug interactions. Regimens will be interferon free. These drugs are highly effective (over 90-95% cure rates, even in advanced cirrhotics and HIV/Hep C coinfected populations).

GPs will play a major role in the eradication of Hep C. Treatment needs to be accessible and affordable globally.

2. Integrase inhibitors should now be first line agents of choice for ARV naive patients. They have outperformed EFV, DRV, ATV and just about everything else. They are well tolerated, suppress viral load rapidly, have few drug interactions and have a good metabolic profile. They are also increasingly available in 'one pill daily' regimens.

3. We need to include the transgender community in our sexual health campaigns and research (see my blog "PASH" 17/9/15)

4. We should be open to HIV self testing, in the US HIV self testing kits were well received by patients, and available by voucher, post, sex on premises venues, and even from vending machines in car parks! Patients who tested positive did link in with care, and these tests offered a convenient, out of hours testing opportunity, potentially reducing barriers to HIV testing.

Looking forward to day 3!

Congratulations to Teddy Cook (ACON) and Jeremy Wiggins (VAC) for an important talk today about PASH, the Peer Advocacy network for the Sexual Health of trans masculinities. 

It took me a long time browsing through the ASHM program to find any content or posters addressing sexual health in the Trans community.

Trans MSM are often assumed to have low risk of STI's although this group are more likely to practice condomless receptive anal sex than other men. Trans MSM are often not included, and often deliberately excluded from research projects. During data collection the Trans community are often misgendered or expected to tick a 'transgender' box when they may identify as male, female, or non binary. Trans women are often misgendered as 'gay men'.
 
So it's not surprising that we have a lack of data about STI and HIV prevalence in Trans MSM. PASH aims to educate health practitioners, promote inclusive research, and provide health promotion and resources for transmen who have sex with other men. 

As health providers we need to lift our game and take action to prevent further discrimination and negative health outcomes for this often neglected group.

A great presentation, informative and concise. Thanks!

Teddy Cook and Jeremy Wiggins gave a talk on the inclusion of transgender men in the HIV response, which provided much food for thought for healthcare practitioners and a call to action for health policy makers.

The presenters raised concerns that trans men generally report significant HIV risk, yet are overlooked in the HIV response. They highlighted some issues in data collection that may have resulted in trans people not being accurately represented in HIV data.

Particularly, they made the enlightening statement that "Transgender is not a gender identity". Trans men have very different experiences from trans women, and have different health requirements, including different sexual health requirements. 

Also, health data collection does not accurately capture data on transgender people. For example, the Victorian Department of Health HIV notification form gives the gender options of "male", "female" and "transgender". By lumping trans men, trans women and genderqueer people into the same category, health data loses nuances that are important for informing health policy and health promotion.

Also, they highlighted some case studies illustrating how this simplistic gender categorisation has resulted in miscategorisation of trans people in HIV statistics. One case described a non-binary trans masculine person who was assigned female at birth who has sex with men, who was categorised as a heterosexual female on her HIV notification form. Obviously, in order to develop an appropriate public health response to address HIV risk in the transgender community, we need data that accurately reflects what is happening in the trans community.

The presenters suggested the following two-question gender classification in order to overcome some of these issues.

  • Question 1: What is your gender
  • Question 2: What gender were you assigned at birth

On a lighter note, Jeremy pointed out that a recent HIV testing campaign from Victoria did include a trans man. It's a fun campaign, so have a look at the video below: