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.

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) ' 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.



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.


Stigma and discrimination in Timor Leste - Ines Lopes, Executive director, Estrela+, Timor Leste.


·      Timor leste  a catholic, spiritual and ‘moral’ based society.   

·      631 cases of HIV. 231 on treatment (75 deaths) – considered low prevalence

·      ESTRELA+ Aims to allow people living with HIV to live with dignity/respect free from discrimination  through community based teaching in response to challenges faced due to conservative nature. HIV taboo, cannot mention sex, ‘moral’ attitude promoting immoral attitude to those living with HIV. This leads to people living with HIV not disclosing status to healthcare/ employer

·      ESTELA+ fund misinformation was widespread with media playing a significant a role in perpetuating this. It was found that Stigma could be extreme and revolved around HIV being seen as an ‘immoral’ or ‘bad’ disease. Some stigmatising behaviour included being called ‘dirty’/ shouted at/ violent threats/ forced to move/ rejected by family/ medicine thrown away by family/ prevented to visit healthcare/ baby removed by family.   

·      People living with HIV had concerns with regards to lack of confidentiality and differential treatment in health care. This meant people living with HIV were more likely to use free foreign clinic as they felt that they had better treatment and confidentiality was respected.

·      Change continues to take place through solidarity and support, lobby the government  with regards to labour rights. Community groups have worked with the church to promote tolerance and work  has been done at a community level to disseminate evidence based information and community training.


Perceived stigma is associated with non adherence to ART; a case study of a community- based sms reminders campaign - Limin Mao


·      Trial of 6-week intervention of community driven sms reminder/ congratulatory sms to assist with ART adherence. It comprised three groups:  G1- 2 way sms 3/wk, G2 - 2 way sms 2/wk, G3 - 2 way sms 1/wk.

·      Valid responses – roughly split between 3 groups.

·      Characteristics included 85% Gay men, 25% outside metro area. Many lived alone without a partner pointing towards an otherwise isolated cohort.

·      34 with CD4 >500  - 11 increased, 2 decreased, 18 stayed same  (no statistical significance found)

·      During intervention (last week) 100% adherence. And adherence increased across all groups throughout the intervention.

·      Participants felt no stigma from non-adherence but  did report stigma related to: HIV status (31%), sexual orientation (27%), drug use (11%).

·      Participants reported majority of support came from  HIV clinician and HIV support groups.

·      Participants liked a community based reminder/ congratulatory message when adherent as it made them feel supported. They preferred receiving a message from the community as felt clinicians too busy and fear of letting clinician down if non-adherent. It was noted most already had strategy in place to assist adherence 

·      Sustained ART adherence is required, PLWH want community based support.

·      Future studies would need to look at if SMS reminders would be tolerate on a long term basis or more suited to initiation of therapy/ if having difficulty being adherent.


Development of a national monitoring system of stigma among people living with HIV in Australia - Carla Treloar


·      The stigma indicators project  - was a brief indicator of stigma and measure of stigma over time including the mirror of stigma/ attitudes of healthcare professionals over last 12 months.

·      Results 200 ppl (>50/male/ gay /1% ATSI/ 5% CSW/35% PWID)

·      Almost all disclosed status to healthcare/family – fewer to employer/colleague.

·      Stigma most frequently experienced in media, amongst healthcare workers not paramedics and sexual partners.

·      Internalised stigma observed in 25%-50% - proving a significant experience for those surveyed.

·      1/3 – 3/4 reported they had been told by others that they had felt stigma from sexual partners.

·      In conclusion the preliminary data from ‘The stigma indicators project’ includes – stigma and discrimination most common sexual partners health worker and media.

·      Future work will covariate i.e. mental health and develop qualitative work with CSW and HBV and feed these results back to the national strategy.


ART use, stigma and disclosure changing attitudes among PLHIV 1997-2015 - Jennifer Power.


·      FUTURE study

·      PLHIV Self reported physical health–good/excellent, general wellbeing good/excellent and this is consistent.

·      However, attitudes toward relationships and disclosure showed increase in concern over disclosing status, a consistently high preference for sero-sorting and a reduction in fear of virus transmission reduced,

·      FUTURE STUDY also revealed High rates of diagnosed mental illness (>50%), with 30% taking medication in last 6 months this mainly consisted of the 45-59 age group.  There was no sig difference between men and women.

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·      In conclusion, wellbeing study for PLHIV requires more than purely medical treatment and issues of stigma persist despite improved health/ viral suppression.

Day 2: A Changing Sexual Landscape of Gay Asian Men in Sydney: Implications for HIV/STI Prevention

 Day 2: Rapid Fire Session Sexuality and Reproductive Health:

Tim Chen – Asian Gay Men’s Project Officer ACON NSW ‘A Changing Sexual Landscape of Gay Asian Men in Sydney: Implications for HIV/STI Prevention’.

Tim discussed the results from a survey conducted between September 2015 and June 2016 for Asian gay and bisexual men.  The survey was printed in English and Thai languages and conducted at sexual health services (including a[test]), sex-on-premises venues, forums, workshops and through partnership networks.  Some similar research had been conducted in 1999 and 2002 and it was decided there was a need to repeat this survey due to the rising incidence of HIV and STIs among Asian MSM. 

The survey this time round was more ethnically diverse than previous years .  Although the overall number of Chinese respondents did increase compared to previous years, the proportion of Chinese respondents decreased and a greater proportion of Thai, Indian and Filipino guys completed the survey.  

HIV and STI testing rates had increased but less guys were testing at GPs with increased rates of testing observed at community-based testing sites (eg a[test]) and hospitals.

In regards to condoms use, guys reported less anal sex with their regular partners but similar levels of condoms use with these regular partners.  More anal sex with casual partners was reported than in previous years with more condomless anal sex.

In conclusion, sexual practices and health-seeking behaviours have changed among Asian MSM in recent years with an increasing rate of condomless anal sex with casual partners (it is worth noting that this study took place before the commencement of the EPIC PrEP trial in NSW).

Community-based testing sites were also shown to be of great importance in ensuring high rates of HIV/STI testing in this population.


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