"There has probably never been a population both more heavily impacted and less discussed at scientific meetings than the transgender population around the world" Dr.Tonia Poteat CROI 2016

TGD are being recognised as a high risk population (WHO 2015)

Nineteen percent of Trans women world wide are HIV (+ve). Limited evidence about HIV among trans males is available due to the lack of data/evidence.

ACCESS (Kirby Institute 2017) Data shows out of 696 people 5.2% were HIV (+ve); 8.9% were trans women and 4.5% trans men. Trans women were more likely to report sex work

Barriers to Prevention: Methodological, cultural, social and system, geographical and under representation

Legal Barriers: Pathologisation and legal sex recognition

Trans and Gender Diverse people are a community of interest in UNAIDS/HIV elimination program.

They are not included in the National HIV strategy or included in STI/HIV reporting. This misses the opportunity to collect data of behaviors and STI/HIV testing among the TGD population

In a STI/HIV testing service a research project was produced to collect Sentinel Surveillance data via surveys that demonstrated the importance of the data collected

Three surveys were set up to collect the data between 2013-2017

The 3rd (2017) survey asking gender identity and sex assigned at birth: Of 1220 surveyed, 88 (7.2%) reported to be TGD, of which 61 of those reported to have a gender identity that was different to the one designed at birth 

Thirty nine has tested more than once at the service

* Take home: Simple changes to data collection based on community consultation had a considerable impact on the utility of surveillance to help guide STI/HIV prevention and care for TGD people

Trans gender and diverse (TGD) population are of high priority for STI/HIV according to (WHO) last year.

TGD are of greater risk for discrimination, stigma and neglect.

Currently TGD are not mentioned in the National or State and Territory STI/HIV strategies. They need to be included for the collection of data and future research

*What should inclusive Clinical care look like for TGD population?

Many have to access multiple services to have healthcare needs met. There is no particular one-stop-shop.

Shared care is needed with client involvement in all aspects of their care, keeping it open and empowering.

TGD people need sexual health care amalgamated with their hormone therapy reviews. It brings them to test more regularly if needed.

Not all TGD medically transition.

National standards of care differ around the world.

EQUONOX Victoria supplies a one-stop-shop and uses the Informed Consent model. It has Psychological practitioners through to a GP Prescriber which improves access to care with less waiting time.

Good access to care improves health quality

TGD have a higher risk of suicidality, as much as 50%

Research is needed to help provide best practice.

GP'S need to be up-skilled in the area instead of passing people on by referral due to ignorance.

How can this be done? Certainly through Med School training, but also practicing GPs

We need to change registration forms and Notification forms to start collecting data and build better relationships with workforce development

A good resource video "PrEP 4 Trans"

Nurse Practitioners began evolving in Australia in 2000 with Health Practitioners continuing to prescribe treatments for clients.

With advanced nursing roles, the NP needed to evolve and develop novel innovative care.

In Primary Care, NP model  to be successful needed: Organisational support, Funding, develop a plan for the model in collaboration and present a business plan.

A supportive navigator needed to drive the plan, was key to success

MBS item numbers then developed (82200,82205, 82210 and 82215 which made the model financially sustainable.

Nurse Practitioner's Scope of Practice needed to be updated and approved through APRAH. It looked at inclusion/exclusion criteria, autonomous and collaborative practices, updating the scope of practice.

IVDU is the most frequent mode of HIV transmission globally

In Australia, Clean Needle Exchange Programs have reduced the risk

Comparison of IVDU V's no IVDU in the Australian Observational Database showed

IVDU  had 40 new diagnosis

IVDU with MSM had 56 new diagnosis

IVDU population had a higher risk of loss to follow up and mortality and viral suppression took longer than those whose risk was MSM only.

The IVDU with MSM group had the highest risk of virological failure and the highest risk of being lost to follow up

HIV quality of life with stigma and treatment adherence has been well established

Quite often we see poor mental health, isolation and co-morbidities associated with stigma and discrimination.

(WHO) declared 90% diagnosed, 90% on treatment and 90% with viral suppression by 2020. We should look at adding another 90% Good health and quality of health.

Overall health testing should be offered at regular intervals in HIV care with the individual referred onto other services as needed, to improve the quality of health

A PoZ QoL survey was developed with 4 domains that included 13 questions about health*

*Psychological, Social, Functional and Health Concerns. with the survey results/outcomes being higher than expected. 

Looking at PrEP and HIV/ART treatments as prevention in the 6 months prior to the 2016-17 Gay and Periodic Survey, showed an increase of casual sex being reported by those using medical prevention.

There was a decline in the use and frequency of condom use 39% (2016) - 32% (2017) and a reported increase in casual anal intercourse (CAIC) 22% (2016) - 27% (2017) as more MSM joined in the uptake of PrEP.

Socioeconomic demographics showed PrEP users were more likely to be Uni educated, in full- time employment and engaged with Gay men networks

PrEP users reported to be more sexually active than when they were not taking it and more likely to engage in condomless sex due to reduced anxiety of HIV risk.

The Periodic Survey in Melbourne ans Sydney reported PrEP users had 11% more partners and 11% less condom use.

* PrEP users becoming more sexually active reflects the successful targeting of PrEP

The injecting drug population in Australia contribute to 90% of newly diagnosed HepC, making health professionals working in the Drug and Alcohol sector pivotal to the health care outcomes of this community.  From a public health perspective better healthcare post diagnosis would reduce the the advanced progress of the disease by encouraging early thus reducing commodities.

We now have effective treatments that cure.

A discussion on what it is like to live with HepC and the past experiences with older injectable treatment V's new oral treatments, with highly successful cure rates was most insightful into the progression of the treatment journey for individuals diagnosed. Those individuals diagnosed who had experienced the older treatments with severe side effects and no success of clearing the virus, moved to using the new treatments with next to no side effects and had clearance of the infection within 12 weeks.

In 2016 reported cases of of HepC in Australia was 230,000. High risks groups need a holistic approach to care taking into account behavioral and social aspects. However recommendations are to treat first and deal with other lifestyle and behavioral issues later. This way we keep the client engaged in services

A great resource for health practitioners www.gesa.org.au (HepC treatments and Genotypes)

Interactive polling was used during this presentation to determine the group knowledge of testing and treatments for HepC.