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.

I attended this great talk given by Kevin McGeechan on Wednesday 8/11.

 

Kevin McGeechan is a senior lecturer in Biostatistics at the School of Public Health, University of Sydney and acts as a consultant statistician for Family Planning NSW.

The topic of abortion law in NSW was presented and discussed in further detail the following day at the symposium addressing "Abortion:2017 and Beyond" with several other excellent presentations on the topic. 

A bit of background to start:

Abortion remains a crime in the NSW Crimes Act 1900, punishable by up to 10 years jail. However, as a result of case law, abortion can be provided legally, but only to protect the life or health of the woman. Abortion law reforms have taken place in all other Australian jurisdictions except NSW and Queensland. This leaves women in these states vulnerable to prosecution.

 

In September 2015 , The Greens NSW commissioned a community survey to inform development of an abortion law reform bill.

This bill was introduced to the NSW Parliament in May 2017 and was debated but defeated.

The survey was conducted anonymously online by a market research company.

1015 male and female adult residents of NSW participated

Of these, 76% were unaware that abortion is a crime in NSW.

73% thought it should be decriminalised and regulated as a healthcare service.

These results were consistent across gender, age groups, metropolitan/regional and rural areas as well as all levels of education.

There was also strong support for women seeking abortion to be protected from harassment (89%) and for protest exclusion zones around abortion clinics (81%)

Support for decriminalisation and protection of women seeking an abortion was higher amount regional/rural residents than Sydney based respondents.

I found it interesting to learn about the differences across Australian jurisdictions regarding abortion law. In addition, it is surprising how many people are unaware of the law pertaining to this in NSW. I think as a medical practitioner it is important to be aware of these issues and what barriers this may pose to women wanting to access abortion services in NSW or Queensland. 

 

                                    

Becoming Serodiscordant: The Seroconversion Study Interviews. Steven Philpot, Kirby Institute. 

 

In this study participants were interviewed between 2009-2014, and the aim was to gain knowledge of perspectives of those recently diagnosed with HIV. Topics discussed included: The seroconversion event, sexual practices prior to diagnosis, reactions to and management of diagnosis, post-seroconversion sexual practices, attitudes towards treament for HIV and viral load. Most participants in the study identified as gay, with some bisexual and queer also, with a mixture of ages, ethnicity and various relationship status.

 

Steven presented the analysis of response from 41 participants of which 25 were men in serodiscordant relationship, 6 single men who were previously in relationships but their relationship ended once HIV diagnosis made, and 10 were single who discussed previous serodiscordant relationships in which they were the HIV negative partner. 

 

In these relationships, renegotiating sex with regards to infectiousness, responsibility and intimacy were discussed. Also, reaffirming relationships with regard to love, support and strength. Various narratives were shown and were certainly wide and varied in their individual experiences. Some relationships suffered or ended as a result of thr new HIV diagnosis, some relationships became stronger and provided an opening of communication between partners, though couples within an established relationship when diagnosis made grappled with chages within their intimate relationships.

 

It will be interesting to see what lived experiences will now occur withinin serodiscordant relationships and a new HIV diagnosis in the day of UVL for prevention and the introduction of PrEP, as this study predates these changes.

 

Dr Eric Chow. Senior Research Fellow, Melbourne Sexual Health Centre.

Risk factors for gonorrhoea in heterosexuals.

 

Eric looked looked at various factors as to providing reasons for the increased incidences of gonorrhoea infections in heterosexuals in Australia. The risk factors explored were: 

Change in partners/ condom use

Dating Apps

Travel

Drug and or Alcohol use

Bisexual men

 

In Eric's research the biggest risk factor was travellers, bisexual men and also people using Dating Apps such as Tinder. 

It seems that there are much larger numbers of people travelling overseas, particularly to high prevalence countries and having unsafe sex. There was a higher proportion of travellers from Western Australia, which may explain partly the very high increase in gono notifications in heterosexuals there in recent years.

 

With the revolution of Dating Apps, the incidence of gono notifications in heterosexuals has also increased and linked to this is bisexual men who may be having the best of both worlds in dating apps such as Tinder and Grindr and passing infection to hetero females.

 

It's an interesting and changing world we live in both in the digital world and the real world and sexual partners are more accessible in a variety of settings which is resulting in changes in notifications and the demographics of notifications are changing.

This iseries of interviews was captured across 2 groups of people who grew up queer in the context of a Catholic education. Group one attended school in the 1970's and group 2 in the 1990's.

Overall, in both groups, sex education was very brief and functional and included straight sex only. The only exception to this was when disease was discussed. 

Both groups sought their information from other sources such as porn, cleo magazine, dolly magazine and then the Internet, once available. 

A common theme in both decades was  that people growing up queer,  felt there was no place for them.

Background

·         Gay and bisexual men’s sexual practices have evolved throughout the HIV Epidemic

·         Protective strategies (e.g. condoms) have often been community led/ generated

·         Every technological innovation in HIV testing, treatment and prevention has prompted shifts in practice

·         Australian GBM’s practices have been monitored by the Gay Community Periodic Surveys since 1996

·         What follows is a review of trends in selected practices since 2000

( national;unadjusted;7 states / territories, > 6000 participants per year; only NSW & VIC in 2017 )

Findings

Overall, partner numbers have declined over time, except in 2016 – 2017

Majority of men in relationship have condomless sex with their regular partners. This became more common after 2010 which is around 60 % in 2017 

Regarding HIV status, 30- 40 % of HIV Negative partners with similar status while both partners positive observed just under 10 %

HIV negative relationship more common after 2010

Condom use was primary prevention strategy, with casual partners and Anal sex has become gradually more common with casual partners.

 

 

Risk reducing strategies frequently used during condomless sex with casual partners

-          HIV positive men who had CAIC  ( Condomless Anal Intercourse ); 2011 – 2017 counted Undectable viral load 80 % whose partners are on PrEP around 40 %

-          HIV Negative men who had CAIC represented around 50 % whose partners on PrEP approx. 40 %

 

Summary

·         Up until recently, Gay / Bi men were reporting fewer male sex partners over time

·         Since 2000, condomless sex has become more common

-          First emphasising serosorting ( matching HIV status )

-          Now harnessing PrEP and treatment as prevention

·         In the last 5 years,

-          HIV positive men have switched from serosorting to undetectable viral load as their primary strategy during condomless sex with casual partners

-          HIV negative men have rapidly embraced PrEP and many continue to serosort

·         The vast majority of GBM continue to minimise HIV transmission risk, using an increased range of strategies

 

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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