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.

Notes from talk:

The most recent syphiils outbreak in northern Australia highlights the vulnerability of this community due to isolation, reduced access to services and poor engagement with the health communities. 

Advances in HIV treatment in Australia has created an obvious divide with increased HIV diagnosis in ATSI communities. While non ATSI HIV diagnosis are mainly in men who have sex with men, this only accounts for 50% of the case load in ATSI communities.

Increased IV drug use appears to be fueling this with reduced access to programs such as needle exchange.

Canadian modeling is sobering if we continue on this same path.


2.30 pm session Wednesday 16th November

In her session entitled 'Holding space for those who hold doubts', Christy Newman presented her qualitative research referred to as the 'ARV uptake study'.  Based on interviews with 27 people living with HIV around Australia who were not taking treatment, she explored their reasons for not starting nor taking it.  She found they had varied and usually well-considered reasons for not using ART, including difficulty access treatment due to immigration status, housing issues, having a 'cautious doctor', concerns about long term side effects, for instance. One participant had experienced a range of unpleasant side effects and had elected to stop treatment at the time of the study.

I believe this type of research is critical and we need more of it. In my experience too, people who choose not to take or to delay treatment are often ridiculed and begin to feel alienated, even from their own communities, as Christy also found in this small study.  She noted one person saying he felt 'invalidated' (by the HIV positive community) because he was not on treatment. But many are making a considered choice/decision, even if healthcare workers disagree with that decision; they may still require support, and should not be dismissed by services.

As Christy Newman noted in her presentation, 'taking a hard line on treatment can rupture shared points of connection' between health are workers and people living with HIV who are not on treatment.  I look forward to hearing more about this work.

Day three of the Australasian Sexual Health Conference 2016


Professor Alan McKee sparked an interesting debate today around sex education with his lecture ‘What we can learn from Pornography?...

Healthy sexual development is part of becoming a well-adjusted adult, right? …but what is 'healthy sexual development'? Is there such a thing and if there is, can it be taught and incorporate the beautifully diverse nature of sexuality and sexual identity?

Studies have shown that sex education can’t be left to families alone and calls for health and education to collaborate to improve sex education and incorporate themes such as pleasure as well as the well-trodden path of sexual risk – could it be possible that we might learn something from pornography in this regard?

 In Angela Davies’s lecture yesterday we learned that young people are already watching porn for a more detailed and pleasurable form of sex education. However, the overall impact of pornography is unclear. Some young people describe this experience as positively impactful in terms of preventing risk behaviour and normalising taboos and others report resulting harmful attitudes. The impact of pornography on body image can be positive or negative and In some cases young people report pornography had no impact at all.


Is there a role for picture books detailing the story and diversity of vulvas? flaccid penises? erect penises? Menstrual fluid? Ejaculation? so that young people get a sense that there really is no such thing as normal or perfect. 

One attendee pointed out that showing young people pictures of genitals in the context of sex education could contradict child protection programs where young people are taught that their genitals are private,  however, the overriding feeling was – pictures of genitals for sex education could be ok if in an appropriate and safe context.

Personally, I think we have a bigger battle - forgetting porn for a second, young people are constantly bombarded with expectations of whats 'normal' outside of school, Advertising prohibits any hint or curve of a labia. Are we to implicated in these built up expectations? After all how diverse are the drawings of genitals in our anatomy/ biology text books?

Maybe we can take example from the Netherlands  where young people having a later sexual debut, the vast majority use contraception the first time they have sex and describe there first experience as 'being ready'. These healthy and positive sexual experiences follow a  ‘comprehensive' sex education that starts at 4 years old and educates parents too.  In fact, ‘sex education’ is termed ‘sexuality education’ and incorporates young peoples rights and responsibilities leaving them more assertive and better communicators compared to there counterparts around the world.  

Take home messages

  • Young people are curious about sex (and always have been)
  • Some young people (regardless of gender identity) watch pornography which more often than not has an impact, and that impact is not necessarily negative.
  • Sex education is incredibly important, especially around issues of body image, but needs to go beyond sexual risk to meet young peoples needs.


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Associate Professor Rebecca Guy gave the Gallows Lecture.

The theme was new technologies for STI prevention and adult health checks with the target populations

- Aboriginal and Torres Straits Islanders People, 

- Gay men, 

- Mental health 


Resources and Notification of Partners. SMS technology is preferred. 

23% notified partner/s

Only 1/5 followed up in a clinic

HOW is this going to change and effect my PRACTICE?

I will incorporate more IT into my clinical practice, as the Research has shown that clients and patients prefer SMS technology.  I have found this to be more effective approach in contacting those less engaged and harder to reach Clients, as it appears to be less intrusive means of contact & provides people the choice of when they want to make contact.


Other presentations on sexual health - Chlamydia 

Discussed health seeking behaviour. 

Focus on Adolescents

Low testing rates, 20 % people became re-infected in 1 year.

Issues are PID, infertility.

Gay men, increase risk HIV




Professor Mark Hayter University of Hull

"Stronger Than The Sum Of Our Whole"


  • The one stop shop can be a great opportunity to offer comprehensive care for clients with multiple needs.
  • Great chance to consider combining sexual health and reproductive health, sexual health and drug and alcohol services.
  • Colocation within schools may be useful and a great chance to "be where the market is". Evidence points to importance of need for concominnent quality sexual health education as well as branding as "health" service rather than "sexual health " service to reduce stigma.
  • May not apply to all markets, ie gay men appear to prefer traditional GUM/Sexual Health services.

Personal reflections:

My question is, isn't the GP in the perfect position for this? I wonder if there are GP's similar to myself who feel strongly to be able to step up and provide these levels of services. 

Currently this reflects my own practice however I wonder if there are other GP's who have similar passions.

Will these services limit communication between teams and loss of some patients to primary care?


Twitter response: "Could not authenticate you."