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.

Transactional sex in MSM: How common is it? Who does it? What are the risk factors?

This presentation looked a cohort of MSM from Vancouver. Canada, to examine prevalence, trends and risk factors of transactional sex and ultimately if transactional sex constitutes an increased risk of HIV transmission.

The study design was a prospective cohort study with respondent driven sampling of approximately 700 MSM aged over 16 years. 201 participants were HIV positive. Participants used a computer assisted questionnaire with the main outcome was an exchange of money/drugs/goods or services for sex. The data was analyzed with a multivariate logistic regression model.

Transactional sex was found to be rare in this cohort (between 1-3%).

Transactional sex was more likely with the following factors:

1) partner was met online

2) a lower incomes

3) a lower level of education

4) identification as bisexual

5) having an older sexual partner and

6) having a partner who uses either crystal methamphetamine, GBL or GBH

Partner substance use was most strongly associated with transactional sex, No significant associations with HIV risk behaviour.

Tagged in: 2017 IAS Conference

This morning I watched a presentation by Joshua Rosenberger (USA).Examining the role of STI prevention among MSM using mobile applications.

He was discussing a study that was conducted in a American city with a population of about 1 million people. Looking at how many MSM that logged into a particulat Geospactial networking app within a 24 hour period.

And where these men lived in relation to the Sexual health and HIV services that were available in the city. 

In a 24 hour period 5000 men logged into the Application. Most of the men being of white or Hispanic background and living in the inner city and downtown area. There was a population of African-American background that lived further on the outskirts of the city. The peak time for log on being 2000 through till 2300.

Using this information and location of the men that logged in they could see the centres for access (their clinics were all located in the city area). Which was great for the small population of white men that lived in that area. But not so for the rest of the population. Especially there most at risk men of African-American background. 

The clinic hours extended until 1730 at the latest. So how could they use this information for health promotion and to allow for better access to the rest of the population at greatest risk for STI/HIV prevention and education?

 

My Take HOME MESSAGE:

Harnessing the use of mobile application services is a great way to ascertain where the target population are living and using the platforms for advertising "Health Promotion".

In Australia and especially in NSW we have embraced Mobile Social Applications such as GRINDR to deliver Health promotion activites. But can we better utilise the data to look at where we need to direct outreach services to capture the proportion of the population that do not live in "The bubble" of the innner city - where a lot of our Sexual Health and HIV services are located. 

Recruiting people into HIV services
Panus Na Nakorn

The breakout session PA_9 was entitled, 'Innovative HIV testing, prevention and care service delivery models' with the first speaker Dr. Panus Na Nakorn presenting a session entitled, 'Recruiting people into HIV services: ebooking'. He told us that this model of care was Thailand-based where their 90-90-90 figures were 82-72-79 in 2014. The 90-90-90 is an indicator of how well countries are providing HIV treatment. It represents the percentage of people diagnosed-the percentage of those people on treatment-the percentage of those who are virally suppressed. He broke those figures down for MSM and they were poor reading as 19-37-65.

The speaker then discussed the Thai national strategic framework to end AIDS. He discussed current (offline) interventions where peer to peer and social networks are the most common way of trying to get get people to attend for testing. The speaker highlighted an interesting fact about internet use in Thailand - MSM and TransFemales spent more time on the Internet than other groups. To capitalise on this, a MSM specific site was created called 'Adam's Love Site'. This site was very well accessed and resulted in 20000 visitors to clinics for HIV and STI testing. This result showed that the internet could be a way of reaching MSM and getting them tested and into treatment. Dr. Nakorn explained how the ebooking system worked. After logging into the website, the client took a quick survey about any risk taking behaviours. If any were highlighted, they would be offered a test at a centre of their choosing and at a time/date convenient to them. The client filled out a form online and this gave the client a unique code. This code was sent to the centre they had chosen so when the client attended the centre already knew why they were there. Confidentiality was therefore maintained throughout. 
Dr. Nakorn completed his session by saying that ICT and social media needs to be embraced as way to reach key populations in this age of technology.

This sentiment has also been echoed by DR. Chris Beyrer who in a discussion session yesterday said (not verbatim) '...services need to go where the people are. Thats where the outreach principle came from. People now live in a virtual world. That's where the services need to go.'

Wise words.

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Tagged in: APACC 2017

As a nurse who has repeatedly encounter negative attitudes to PLWHA, by nursing students, I was looking forward to this presentation.

David Pickles presented research on the socio-cultural influences on the perceptions of nursing students toward caring for the people living with HIV/AIDS: Implications for Nursing Education.

Negative attitudes of nurses impacts patients. With the increasing number of overseas student, studying nursing in Australia, they bring with them beliefs from their home countries.

The interviews with the undergraduate students showed fear of transmission, myths & misconception, homophobia, responsibility and disparity. The quotes from the participants made it clear, some couldn't overcome their prejudice even with sound knowledge of HIV and its transmission.

The discussion afterwards was even more interesting, as different people spoke about how they had managed prejudice. Suggestions given included- calling out the prejudice, having PLWHA speak to students and having strong role models.

I agree with all the suggestions in the study and by the audience, but having worked in HIV for 20 years, I find it disappointing that we are still encountering this prejudice. When will the tide turn?

 

 

I chose to review these two posters, as they both concern women, the first is about empowering through employment, the second is identifying the barriers to accessing services.

 

SEW Tanzania: Showcasing the Resilience of HIV+ Women in Tanzania. Lead author: Lees, N.

 

S.E.W. stands for Supporting Empowering Women, which is a social enterprise in Tanzania, which provides employment to HIV positive women.

 

The participants make conference bags from recycled wheat sacks and are provided with fair prices for their products. This shows them to be resilient, industrious and capable. By providing this work, S.E.W. seeks to end the stigma associated with HIV.

 

Examining the benefits to women living with HIV of a community organisation led research project. Lead author: Boughey, A.

 

Positive Women Victoria’s membership is increasingly becoming women born in Africa and the Western Pacific. They tend to be diagnosed later and often during their reproductive years.

 

The needs and preferences of this growing, culturally diverse population have not been effectively identified. With further research needed to identify the barriers to accessing services for the group.