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.

Posted by on in Social and behavioural research

Day 2 of the conference and there have been more thought provoking sessions. The afternoon "Drug and Alcohol Session" raised a number of issues for clinical practice and for future research and confirmed what I have been noticing in patient presentations over time, with more individuals reporting regular use of methamphetamine.

Mo Hammoud, Project Manager of the Flux study (Kirby Institute) and his talk on "Highs and Lows of Methamphetamine Use among Gay and Bisexual Men" referred initially to data from the HIM study with odds ratios for risk of HIV seroconversion being: 1.8 with methamphetamine use, 4.1 with erectile dysfunction medication (EDM) use, and 8.1 with both methamphetamine and EDM use.

In the Flux study, examining the relationship between EDM and methamphetamine use, Mo indicated that many men are using EDM for pleasure, that this may not be associated with erectile dysfunction, that EDMs were more commonly being obtained from outside the health system (online), and that men who use EDM are more likely to engage in condomless sex, group sex, and to use methamphetamine. The implication of this is that it highlights key indicators for HIV risk behaviours and transmission.  

In their research looking at methamphetamine use they found that over 80% smoked while around 30% injected, 30% used monthly, 13% weekly and 4% every day. When asked about reasons for methamphetamine use the top response was "for fun" (around 70%). The reported "highs" of methamphetamine use were ranked 1) had better sex (60%), 2) I felt happy, 3) had some great parties, 4) gained more confidence, 5) met new friends, and 6) brought me closer to people (40%). Conversely, the reported "lows" of methamphetamine use included a number of responses but with the top response (around 50%) being "had unsafe sex". Overall the men reported more highs than lows in their reasons for methamphetamine use. The research also found that condomless sex was significantly more likely with recent methamphetamine use.

Studies such as Flux are highlighting important isues to consider in targeting HIV transmission in certain groups but also possible aspects to focus on in working with individuals when trying to address methamphetamine use, providing better understanding of the likely reasons for use as well as the downsides of use. 

In my job as a clinical neuropsychologist assessing HIV positive individuals for possible cognitive impairment I am increasingly seeing people present with a mixture of contributing factors for cognitive impairment and with crystal meth use becoming more of an issue over the last few years. The session today focussed on use of methamphetamine and risk behaviours and provides important information to consider. Over time it would be great to see more research on the longer term impact of methamphetamine use by HIV positive individuals and also more funding and services to enable ready access to treatment for those seeking to reduce or cease methamphetamine use.  

Tagged in: HIVAIDS2015

Jeffery Klausner provided an excellent talk on new methods in the US and around the world.

Jeff spoke about the need to utilise modern media eg YouTube to better engage with people; it seems the days of brochures and information sheets are soon to go.

The internet now can provide condom delivery within an hour in most big capital cities.

There is the ability now to have your HIV Status verified by medical companies on gay websites to prove that you are telling the truth. You can also allow blood results to be verified so that you can prove you have an undetectable viral load.

The younger generation all seem to like gaming and there are now Apps which emphasise Playing it Safe and promoting condom usage and increasing adherence to taking your medications.

I know in Adelaide we have very little like these education initiatives and you usually get handed a brochure.

In regards to testing Jeffery discussed the importance of status awareness and that San Francisco had the highest on the world for this.

It seems in Australia we have been very slow to even introduce rapid testing, but thankfully now this is happening.

We should also be considering the HIV self test, thus creating more options for people

In San Francisco they placed self tests in Sex Clubs, Saunas and provide vouchers to get free self test kits at pharmacies.They also provided the means to order a free self test kits online thus creating even more status awareness.The utilisation of these test kits was good and seemed to encompass the people who would not or could not get to a testing centre.

A hugely interesting talk outlining the need for us to utilise new methods in educating and engaging with people

New technologies include:

  • SmS weekly messages about adherence and testing
  • Geo mapping of current outbreaks of STIs
  • Home PCR for testing of STIs and HIV and providing Tele Health for PreP

A hugely interesting talk!!!

 

Tagged in: HIVAIDS2015

Posted by on in Social and behavioural research

 

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What a start to the conference!

 

The theme of harnessing HIV and STI prevention opportunities rang throughout the hall during the plenary sessions - and continued to echo throughout the presentations.

 

Of particular note (for me) was the Causal Interactions Session - specifically the ‘Mega Model’ session presented initially by Marissa Becker and later by James Blanchard. At the base of these talks were the Mega Model diagram and a central concept of fluidity in program design approach. He asks us to specifically consider population transmission dynamics and individual risk, namely looking at biology, behaviour and networks when planning research and developing projects. Blanchard illustrated his ideas through asking the group: why do populations that look similar often have very different HIV epidemics?

 

The mega model helps address this. In part, this diagram takes a look at how we can modify our approach to problems and adjust our actions along what is occurring in a group or individual’s time line. Without getting too complicated, his argument is that for every phase in a timeline, we should be examining what is actually happening for people during each phase or ‘window’ of the continuum. This is done by considering each phase by analysing 1. Behaviours of groups/individuals 2. Networks that affect group/individual decision making and 3. Biological influences that impact on health changes/disease processes during each window.

 

An example might be a woman is sexually active at age 14, has casual partners for 2 years, commences sex work in a brothel for 4 years and then ceases sex work. In addition to larger influences, say limited access to education or gender violence, these timeline windows or phases can be examined for influences. Behaviour might include early sexual debut, Networks she interacts within might be intergenerational relationships and Biologically, an immature cervix and high levels of inflammation play significant roles on the trajectory of her timeline.  Different influences at each window will be affecting her individually but they can also change how a program or intervention might be aimed.

 

By examining the nuances of individual and group timelines, you can negotiate and recognise the smaller differences that can greatly influence group outcomes.

 

Essentially, we should be approaching problems in a flexible manner that considers all angles of influence for a group or individual PRIOR to instituting a program. This would help stop a ‘one size fits all’ approach while recognizing and accounting for variables that have previously gone unrecognized or acknowledged in program or study development. This will allow us to closely examine the influence of individual or group variables more fully.

It is much simpler than it sounds! Of course, everyone has their favourite method but I saw this as a thoughtful approach to research and project development.

Tagged in: HIVAIDS2015
MSM: The Global Perspective session began with a study examining testing behaviour in Thai MSM by Tim Holtz. This was followed by a presentation outlining the historical disparities in HIV incidence in Black MSM living in King County by Galant Au Chan. Ashley Grosso spoke about the potential issues associated with exclusion and inclusion of MSM aged under 18 years in epidemiological research. And finally Christen Khosropour and my colleague, Ben Bavinton spoke about seroadaptive behaviours in MSM in Seattle and in Australia, Brazil, and Thailand respectively.
 
Some findings of this session were:
- Only about one fifth of individuals attending a busy MSM clinic in Bangkok, Thailand met the current Thai national guidelines for HIV testing (every 6-12 months) Messages to improved repeat testing are needed.
- Historical examination of trends in HIV incidence showed HIV incidence increased in birth cohorts from 1940s to 60s then declined 65% but has since plateaued. These trends have been the same in both black and white MSM, and there is evidence of significantly higher incidene in black MSM almost since the beginning of the epidemic. Disparities and absence of progression in recent birth cohorts in concerning
- A significant proportion of MSM reported having had sex with a man under the age of 18yrs across different settings in Africa, estimates ranged from 15-65%. Most also reported non-disclosure of orientation to family and stigma experienced as a result of family members knowing their orientation suggesting that parental consent for <18 years of age is unlikely to encourage participation in this setting. We may be overlooking an important group of MSM in our epidemiological research, innovative ways of involving MSM under the age of 18 while considering ethical considerations in this group are required. 
-There is evidence that HIV testing frequency and ART use impacts sexual behaviour decision-making among MSM in Seattle. Results on incidence are not conclusive as there were few seroconversion however there was some suggestion  effects of this nuanced behaviour may lead to protection from HIV.
- HIV-ve MSM were twice as likely to have condomless anal sex when they perceived their partners viral load was undetectable in Australia, but not in Thailand or Brazil. Optimism about TasP were found to be associated with condomless anal sex in all three settings. 
 
Tagged in: IAS2015

I’ve just had the privilege of attending the stream this morning on Community & Social Research – Preventing Viral Hepatitis.  All of the sessions were very valuable, however, I particularly enjoyed the session titled “Peer Link”, this was presented by Yvonne Samuels, Yvonne presented on behalf of Fiona Poeder who was unable to be present. 

Yvonne was a vibrant and passionate presenter who succinctly and clearly made the point that, while often overlooked, peer education is a powerfully effective tool for fighting viral hepatitis in injecting drug using communities. 

Peerlink, is a program run by NUAA (NSW Users and Aids Association).  It is a peer education project which has been developed and is delivered by people who use drugs.  It has recently been delivered in Nowra, Toronto and Mt Druitt.  The model is a holistic model that tackles Hepatitis C via education and prevention. It is based on the view that each individual community knows its own needs and own also contains the strategic information that that community needs for prevention.
 
Compellingly, Yvonne quoted, when you arrive in a community,  “What you do …. is shut up….You never arrive in a community with any ideas.”  Rather you need to arrive in the community ready to learn what the community needs.
 
The Peerlink program has three phases.
 
Phase 1
Making contact with the community, find a core group of people who use drugs and who are interested in being trainers in their own community (peer recruitment).  In this phase service partners are also identified and recruited.  In this phase there is initial training, the project outlined and planned.
 
Phase 2
In this phase Peerlink peer educator activities take place with individual contacts of the peer educator and also in groups.  If appropriate refresher training takes place. There are also health promotion activities and collaboration with service partners.  There is ongoing peer facilitator training.
 
Phase 3
Is working out how to withdraw the peer-link program while sustaining the gains that have been made.
 
The results have been impressive. In Mt Druitt there were 10 peer educators. In two years NUAA expected 800 peer education interactions. In actual fact, there were over 7,000  peer interventions.  In Toronto, there were seven peer educators.  It was expected that 800  interactions would occur in two years.  In actual fact over 9,000 conversations took place. In Nowra, there were nine Peer Educators. It was expected that in two years there would 400 interactions.  However, in two years there were more than 6,000 total peer interventions.
 
In summary, it was concluded that Peerlink demonstrates effectiveness in disseminating education to communities and reducing Hepatitis C.
 

 

 

Tagged in: VH 2014

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