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.

The talk was by Ruth Hennessy who is a clinical psychologist based at the Albion centre in Sydney.

Although relevant to any area of HIV care, I was interested due to my work with children and young people living with HIV as well as my work with women living with HIV and prevention of transmission of HIV to their infants where I experience a high level of psychosocial needs. 

The speaker, Ruth stated that people living with HIV have higher incidence of mental health issues and then went onto highlight that marginalised groups are affected by HIV. It has been established that Psychosocial issues affect access to care and care outcomes and therefore treatment of psychococial issues can remove obstacles to care.

The psychology team at the Albion centre collected data around presenting psychosocial issues in their client group and compared the data over a number of years. 

Age range was 23-68 years with a high proportion of men. 44 % of sample were born OS. 

An  overall increase in issues around depression, self harm, welfare issues, alcohol and drug misuse was found. Interestingly, a reduction in adherance issues was found, which is encouraging.  This probably reflects the relatively simple medications increasingly available now to treat HIV.  The data collected overall supported the teams belief that their clients psychosicial needs  had increased in complexity.

What might help in the future to support this client group?

it was  suggested that having 'Complexity predictors' and interdisciplinary intensive support would assist in identifying which clients who may need extra  support. It was also suggested that Establishing standards for psychological support for adults living with HIV would assist in providing appropriate care. 

In the paediatric population within Australia, HIV is largely not a sexually transmitted disease and is further complicated by issues such as adoption,history of trauma and of course  the child or young person may not know ( or understand) their diagnosis and must, at some stage, learn of it and how it was contracted. The availability of complexity predictors could be a useful resource in assisting and supporting families and their children living with HIV. Despite more simple and available drug formularies, psychosocial issues are a large part of care required it seems across many age groups and therefore require further attention. 

Posters; PrEPX findings, and mobile apps

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BBetween sessions I had an opportunity to view some posters highlighting excellent research from around the world. I was happy to see some findings from PrEPX in Victoria:

 

Sexually transmissible infections as HIV risk markers at baseline in PrEPX, a large Australian PrEP trial – An analysis of formal eligibility criteria; Dr Vincent Cornelisse (Prahan Market Clinic, Melbourne) concluded that participants who were enrolled despite not meeting eligibility criteria still had substantial prevalence of STI’s (7.1%) which suggests that someone requesting PrEP is likely to be at considerable risk of HIV, even if they do not meet the eligibility criteria.

Comparison between HIV risk reported by clinicians and HIV risk reported by participants at enrolment in PrEPX, a large Australian HIV pre-exposure prophylaxis study; a finding of this analysis showed that patients may over-report CLAI with HIV + receptive sexual partners to their PrEP providing clinicians, but under-report methamphetamine use and CLAI with casual partners.

There were 2 interesting posters on smartphone app use to reach target populations. This research builds on what we learned earlier in the day’s plenary sessions about utilising low cost technologies where possible in resource poor environments:

Understanding the Impact of Smartphone Applications on Sexually Transmitted Infections (STI) and HIV prevention among Men who Have Sex with Men (MSM) in the EU/EEA, highlighted that smartphone apps are currently under-utilised and that realising their potential requires support, engagement, and coordination from EU stakeholders and engagement with the private sector.

Harnessing the Power of Smartphone Dating Apps and Online Tools to Increase MSM testing in Europe and Central Asia through a Community, Business and Public Health Partnership, described a partnership between 3 smartphone apps (Hornet, Grindr and PlanetRomeo), the ECDC and European HIV/Hepatitis Testing Week where the apps provided free advertising to promote a site with information about testing sites across Europe and Central Asia (European Test Finder). The app pushed out information to millions of users in 40 local languages in 53 countries resulting in 65,614 hits. This demonstrates the power of partnerships between public health and private sector business in improving access to education about testing for HIV.

 

Tagged in: EACS 2017

Prof Nicola Gardini teaches Italian at Oxford University and is a researcher of renaissance texts, a translator, author and poet. He gave an erudite and thoughtful paper on "illness" in literature, his interest in this started when he translated Virginia Woolf's essay "on Being Ill " and developed further when exploring the writings of AIDS Sufferers. In his opinion whether we are living or dying is a linguistic construct. He pointed out that as doctors we are engaged in narratives as we diagnose and that in this we are similar to an author developing the plot of a novel.

He describes AIDS literature as initially being all about dying and loss, but now about infection and disease. He used the seminal work by Edward White "A Farewell Symphony" 1997 as an example. In his opinion literature can be an antidote to bias and stigma. It gives a voice and expression to gay men and AIDS sufferers. He made an interesting observation that literature is kind to TB compared AIDS with its attendant decline in body and lack of "spiritual lifting up."

His recent novel: "La vita non vissuta" (The Unlived Life) describes the story of a man leaving his wife for a male lover, only to be infected by him with HIV. It describes his coming to terms with his infection and "being ill" he ended his lecture with the point that it is possible to be "I'll" but still healthy in mind and body.

 

 

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. 

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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