RELATIONSHIPS AND COMMUNICATION

These words were repeated today in all sessions I attended.

What is a relationship for gay men?

How successfully do gay men communicate with each other? And why is this important for HIV and STI prevention?

The session today titled Gay Men, Sex and HIV Prevention thoroughly explored the various combinations spoken of relationships that gay men talk about in the Monopoly study. Different aspects such as Agreement whether formalised or implied, which cohort of gay men are more likely to make these agreements and why or how are they broken or bended?

What did I learn today?

WORDS words Words!!

In USA they use " steady" instead of "regular" and the chasm between regular and casual is very wide in relation to what the researchers say gay men are negotiating.In Australia the fallaback option is monogamy,  so if it is not then what is it? According to one researcher about three quarters of men in the study said they had a regular partner , but only 40% of the men also stated that they were in a relationship;  so men are often in a relationship with a fuckbudy, where does this behaviour get discussed in relation to HIV transmission risk? Typical consultations may miss these types of relationships if prior knowledge of regular partners is known.

Relationships according to how old a gay man is was then explored, with the aversge age of gay men in the Monopoly study being mid thirties , the question was posed do young gay men behave or think they behave the same way?

Generally the evidence was that young gay men had fewer explicit agreements, it was surmisec that they assume monogomy until it wasn't! Young gay men were less likely to discuss HIV risk reduction and relationships were of shorter duration. However somewhat surprising engaging in condomless sex was relative similar despite the age.

The use of the term now condomless instead of unprotected sex was discussed, this term accurately describes the act of sex, however, any person may have taken other steps into reduce the risk of HIV and STIs by choosing who to have sex with, know the Viral load status of themselves and sexual partner or even take PrEP.

This was discussed by Martin Holt who presented results that HIV positive men, HIV negative men both took other measures to reduce the risk of HIV transmission, with knowing their undetectable  viral load as the most commonly practiced method. A question from the floor added about what do we know about those who are unknown or not tested; it was thought that these men assumed they were negative.

Then onto the lively session on PrEP

In a  nutshell: IT WORKS, IT IS REASONABLY SAFE, GAY MEN WANT TO USE IT, SOME GREAT GPS ARE CREATIVE IN SUPORTING CLIENT CHOICE AND ACCESS AND DEMAND IS GROWING. WHAT WE NEED IS ACCESS SOONER THAN LATER AND RESEARCH INTO THE LONG TERM EFFECTS.

DAY 5 for me as an atendee of both conferences.

Brisbane reminded us that it can rain and rain it has today. 

BE BRAVE BE courageous Was a theme I heard from two very different aspects of the issues up for discussion today.

Presentations discussing how best to harness the power, energy and wisdom of young people towards HIV health promotion engagement, were diverse and interesting. From the voices of young Ugandans, or Australian First Nation youth or same sex attracted young men already somewhat engaged in advocacy the take home messages were; get them interested, ask them what they know now, then ask them to come on board and  lead the way in working out how to engage their peers.But most of all do what they suggest- follow through.

This afternoons BINGO session about Targets for HIV policy once again drew out different opinions on the usefulness and relevance of  targets, one panelsit alluded to the meaning of random numbers anyway.

We heard plausible argument for inspirational targets that can push governing bodies or agencies for visionary levels or can be motivational for aspirations to be more tha "usual practice". Other arguments lauded that aspirational targets miss the current climate of resource limitations and allocation challenges; therefore the setting of targets must be effective. Effectiveness may mean targets based on developed modelling that mobilises resources to areas of most need, regardless of settings. Questions from the floor were thought provoking; what is the alternative? And what about those vulnerable people who do not have a voice to advocate for their issues to be considered.

This is where courage and bravery comes in advocates may need to be the voice of the vulnerable, health professionals may have to be in competition for the same dollars -which disease is more worthy?

Do we teach coleagues , students, managers to take lesons in political health as part of public health advocacy?

 

A great ending to a stimulating day of excellent information.

 

 

STI AND HIV IN PREGNANCY

Yes well done Cuba.

Natholie Broutet from WHO guided us through that country's journey of strategies implemented to achieve this wonderful milestone.We were Iinvited to take away the published booklet from WHO , that sets out the criteria and process for validation.

The session reiterated previous evidence of the global scale of  the prevalence and impact of STI's on people particularly vulnerable populations. Pregnant women are a significant population of vulnerable persons, this was highlighted by the next speaker .Dr John Kinuthia presented on current practices,  limitations of resources for optimal screening tests, diagnostics and time to treat if positive. He discussed the current guidelines of syndromic treatment, whilst is effective in poorly resourced services it misses the asymptomatic clients and sexual partners. One discussion related to the acceptability of partner delivered treatment, which in one study in Kenya appeared to be well accepted by the women and their male partners.

POINT OF CARE testing and treatment has ben widely discussed during the World STI/HIV conference and continued today in relation to STI  testing and treatment for women who are pregnant in rural and remote areas.Dr Andrew Vallely informed us about the research that has yet to commence recruitment in PNG, which they will attempt to provide the evidence that these new technologies will have a positive impact in reducing the burden of disease of STI's in pregnant women.