The talk was presented by Brent Clifton, Manager – Gay Men’s Sexual Health, ACON, NSW, Australia

ü  Peer = Peer Educator who trained for point of care and

ACON submitted a proposal to the Ministry of Health to support the implementation and roll – out of the EPIC – NSW Study and lead education and community awareness of PrEP

EPIC enrolment and peer educators

Peer educators provided with EPIC – NSW and PrEP training

Amended process and updated IT Systems to get a [ TEST ] partners to develop

Currently, there are two clinics that clients can attend and discuss regarding PrEP

Ø  RPA sexual health – PrEP Clinic

-          Nurse and Peer Led

-          Monday and Thursday evenings

-          Group education pre – enrolment

-          PrEP dispensed onsite

-          Follow up visits

-          Average 20 people in one evening

-          Over 650 enrolled quickly 

Ø  Sydney Sexual Health Clinic /a [TEST]

-          Nurse and Peer led

-          Wednesday and Thursday – Surry Hills

-          By appointment at Oxford Street

-          PrEP Dispensed onsite

-          Follow up visits by appointment

-          Over 300 people enrolled through an a [TEST] site

-          Over 700 men can access follow up visits through Oxford Street

The peer experience

·         Less anxious about sex

·         What will the side effects be?

·         More STI conversations

·         Undetectable Viral Load

·         EPIC- NSW

·         “I am not high risk enough but still want PrEP”

More importantly…… The sex is better 

Increasingly, trans and gender diverse people are being identified by global organisitions as a population in need of HIV resources, however as often as they are identified they are still not included in meaningful ways.

"There has probably never been a population both more heavily impacted and less discussed at scientific meetings the the transgender population around the world" (Poteat, 2016).

Decades of joint advocacy has ensured the inclusion of trans and gender diverse people at ASHM. The task ahead is to ensure sustainable and equitable strategies for these communities and that they are led by tans and gender diverse people. 

Globally, the prevalence data shows that 19.15 of trans women worldwide are estimated to be living with HIV (Baral et al, 2013). There is limited empirical evidence about prevalence among trans men, and no data about HIV among non-binary people. The "absence of evidence due to lack of resource allocation and or proper research is usually considered as 'evidence of absence', naturalizing the gaps in data collection and analysis" (IRGT, 2016). Less than 40% of countries report that their national HIV/AIDS strategies address trans and gender diverse people (Poteat et al, 2016).

There is a lack of data across countries, with the majority of data sitting in the global north. Often, sampling often includes only very particular populations.

In terms of the Australian experience, the Kirby Institute's analysis of ACCESS data (Callender et al, 2017), of 696 patients recorded as transgender, 29% were women, 32% were men and 40% did not have their gender identity captured. Of these patients, 5.2% were HIV positive. Prevalence among trans women was 8.9% and trans men 4.5%. Taylor Square Private Clinic reported prevalence as 4.5% among trans women and 0% among trans men (Pell, Prone and Viahakis, 2011). The Private Lives 2 Study found 1.4% of trans women live with HIV (Leonard et al, 2011).

The most comprehensive data of HIV prevalence among trans women (8.9%) is probably not accurate because of inadequate data collection methods.

HIV risk factors for these populations:

• Receptive vaginal sex can pose a different level of risk for trans women (Cornelisse et al, 2017)
• Stigma, discrimination, social exclusion from employment and education (Poteat et al, 2014)
• Trans women more likely to report sex work (13%) than other cisgender patient groups (9%) and are more likely to report injecting drug use than gay and bisexual men (7% vs 4%) (Callander et al, 2017)
• By contrast, trans men were no more likely than other groups to report sex work or injecting drug use (3%) (Callander et al, 2017)
• HIV risk among tans men is similar to HIV risk for cisgender men (CSRH, 2016)
• Research into trans women's experiences in Australian's men's prisons found that incarceration increases risk factors of HIV including physical and sexual violence (Wilson et al, 2016)

For transgender and gender diverse sex-workers, there are other intersecting social and cultural factors that impact upon their risk of contracting HIV.

Barriers to prevention include invisibilising methodological approaches, a lack of cultural competence, social and systemic barriers, geographical barriers, under representation in targeted health promotion strategies and legal barriers that perpetuate pathologisation. There is a low workforce literacy and systemic barriers (particularly legal) that exacerbate narrow clinical models and ultimately leads to entrenched mistrust among trans and gender diverse people.

"Other barriers to health and health care are the numerous socioeconomic determinants of health that legally, economically, and socially marginalize trans people. These include discrimination in employment, education, housing, and relationship recognition; police harassment, often as a result of actual or assumed association with sex work; and identity document policies that deny many trans people legal recognition in their true gender. They also include aspects of structural violence such as racism, violence against women, and poverty" (Open Society Foundation, 2013).

Both policy and legal environments need to be opened up and there needs to be a continuance of critique of systems that perpetuate structural violence.

Globally we are at a crossroads, with significant progress made towards the virtual elimination of new HIV transmissions in Australia by 2020. Success is characterised by collaboration and strong partnerships between community-based organisations, research, policy and (some) affected communities. Combination prevention strategies have been enhanced through peer-education and harm reduction programs, condom usage, PrEP, PEP and TasP. Also, there has been a focus on increasing the quality of life for PLHIV. 

In Australia, the sector is well positioned to achieve the UNAIDS global targets of 90-90-90.

But is this enough?

There are persistent issues for people of culturally and linguistically diverse communities. Late diagnoses are an ongoing issue, in particular with Aboriginal and Torres Strait Island communities, as well as South East Asian populations. For Aboriginal and Torres Strait Islander people, the rate of HIV is more than double that for non-Indigenous Australians, exacerbated by a completely unique set of transmission drivers. Criminalisation is still impacting negatively on sex-workers and their access to services. Data on key populations, such transgender and culturally and linguistically diverse populations is incomplete. Stigma and discrimination, barriers to health literacy, shame and machismo are having a continued impact on progress.

From a moral and human rights perspective it is imperative that on one is left behind!

Over the period of  the epidemic we have amassed a great deal of evidence and a good blueprint of what works well to enable the sector to move forward, but action needs to be taken now to:

• Enable equitable access to new HIV testing technologies and harm reduction strategies
• Reduce barriers to accessing treatment and care
• Increase health literacy among the sector workforce and throughout communites
• Enhance the meaningful opportunities to involve affected communities
• Improve the framing and reach of health promotion efforts
• Advance shared care models and dedicated services for key populations
• improve date and surveillance, research and evaluation strategies
• Continue to invest in partnerships

What is our response?

Are grass-roots efforts like we saw in the 80s and 90s needed or even achievable? We need to assess what things are different now and ask what support is needed by affected communities today to give them a voice. As well, we need to better understand what role other key stakeholders (policy-makers, funders, practitioners and researchers) collectively play - we need better funding models and more visibility of the issues.

How do we coordinate our efforts for efficiencies and synergy ti ensure no one is left behind?

Young, Deadly and Syphilis free is an aspect if the Young Deadly and Free campaign focused on improving STI infection rates amongst young Aboriginal and Torres Strait Islander people living in remote Australian communities. The outcomes are to:

• Increase age specific syphilis testing among young people in remote communities affected by the syphilis outbreak
• Increase awareness  and understanding of syphilis, its transmission, testing and outcomes among young people
• Improve awareness of the syphilis outbreak among clinicians and understandings of syphilis testing for remote clinicians

The components of the campaign include a media strategy involving television commercials, radio advertisements and other media; supporting posters and multi-media education materials; a social media campaign for peer to peer delivery of key messages about syphilis, and; a health service engagement strategy towards testing promotion. The media strategy also includes messaging local languages and Kriol.

Using analytics for Facebook, the platform where the majority of resource sharing is taking place, it is apparent that the videos developed for the campaign are having the most reach. This is followed by image-based resources. It is difficult to measure the extent of links being shared as Facebook's analytics do not prioritise accounting for these. Instagram is being used although currently the account only has 54 followers.

Unfortunately, getting info to really remote areas is still proving difficult.

Moving forward, the campaign is investigating the use of online ambassadors who would be paid to guide others in their social networks towards information.

To develop the literacy capabilities of clinical service providers, an electronic newsletter sent via email is sent fortnightly to over 350 health service staff. These act as reminders about campaign services, the outcomes of the campaign, key messages and stories from health services highlighting strategies for testing On average, about 38% of these are opened which is on par with other forms of electronic newsletter clinicians may receive. .

Young Deadly and Free is a culturally responsive campaign, targeted to combat the prevalence of STIs amonst Aboriginal and Torres Strait Islander youth. The campaign has been developed by the Aboriginal Health Team at the South Australian Medical Research Institute. The rationale for the campaign is based on increasing rates of STIs experienced by Aboriginal and Torres Strait Island people and strategies toward providing appropriate educational tools. Recent findings from the Kirby Report released 6 November 2017, indicates a 33% increase in diagnoses of HIV amongst Aboriginal and Torres Strait Island people between 2011 and 2016. In Aboriginal and Torres Strait Islander communities, young people and women feature prominently in STI infection data. 

Young Deadly and Free is an attempt to enhance the knowledge, awareness and skills surrounding sexual health literacy, with a focus on Aboriginal and Torres Strait Islanders aged between 16 and 29, living in remote and very remote Australia. The components of the campaign include:

• Clinician resources
• Animations, infographics and fact sheets for young people
• People of influence resources
• Peer education

In terms of Clinician resources, the campaign has developed a resource audit to help clinics ascertain the things that work and find gaps in service provision. As well, new knowledge-bases have been built to help clinicians feel more confident in their approaches to testing for opportunistic infections and skills in talking to young people about blood-borne viruses. Resources for young people have been developed for visual appeal and utilise forms of communication that young Aboriginal and Torres Strait Islander can relate to. Enlisting people of influence within communities enables strength-based ways of sharing knowledge within communities. Peer education strategies pay young Aboriginal and Torres Strait Islander youth to facilitate peer education programs, with between 4 and 8 sixteen to twenty-four year olds facilitating at different sites throughout Australia.

http://youngdeadlyfree.org.au/

Mycoplasma Genitalium: Should we look and how can we treat it?

Dr. Tim Read

Mycoplasma Genitalium (MG) is the bug that has all of a sudden made day-to-day testing and treatment in a sexual health service complicated.  No longer can we just test the heterosexuals for chlamydia and everyone else for everything else - MG has raised questions and have had sexual health clinicians almost at logger-heads with what to do about it - who to test, asymptomatic or only symptomatic; what to do if found - straight treatment or reduce the bacterial load first and then treat specifically?

Dr Read showed information from Melbourne Sexual Health regarding the prevalence of infection in both asymptomatic and symptomatic men who have sex with men.  He concluded that if we look we will find!  But is is not clear how a MG in an asymptomatic man might affect that man or his partners. 

It is known that MG causes the same spectrum of infection as Chlamydia and it is known that untreated CT is thought to be problematic in both men and women due to the inflammation it causes - leading to possible scaring, infertility and pelvic infection etc.  But not enough is known about the long term sequelae of MG.

Treatment is complex and MSHS is using long course treatment (doxy/azithro or doxy/moxi) -   However they have also utilised 'resistance-guided' therapy using a PCR  test that not only detects MG but informs the clinician if that particular sample has macrolide resistance. (2/3 of samples in this research were macrolide resistance).  Using this technique they had a 90% cure rate using doxy to lower the bacterial load.

The recommendation he gives for MG are as follows -

Treat NGU with doxy pending MG test

consider reducing the azithro when coinfection with MG likely

base therapy on known of likely macrolide resistance

do not screen asymptomatic people for MG

need more data on prevelence in heterosexuals.

Dyspareunia - understanding sexual pain

Lynda Carlyle

This is an important component of the sexual health work done at the Townsville Sexual Health Unit - unlike other sexual health services there is not many others that have the capacity, capability or willingness to talk about sexual function, pain and good sex with their clients.  Townsville works within a sexual 'health' model - a wellness model - and therefore having an enjoyable sex life is just as important as ensuring that the client is disease free.

Dyspareunia is a major issue with many women (and men) and the 'pyscho-sexual' issues can be overwhelming for some people who suffer pain with sex.  Learning how to help people with sex pain isvital for sexual health practitioners - there are no sex therapists  in the regional and remote areas (generally) - there are none that I know of in Townsville.  It was therefore really important for sexual health clinicians to  learn from the 4 speakers and the chair of this session on Wednesday (8th Nov).

one area that struck a cord with me was the model of bad sex  and how it can be reversed.  Many clients have sex out of 'duty' which leads to anxiety, tension, lack of arousal and painful sex.  As a clinician giving the client 'permission' to say no to sex for a time frame where some pain relief strategies can be in place or developed with the client and their partner was really important.  Many clients may not

This presentation was given by Associate Professor Suzanne Belton from the Menzies School of Health Research.

A/Prof Belton presented data from the study using quantitative and qualitative data to capture clinical process and outcome data from a telehealth abortion provider, Tabbot telehealth service.

She explained that access to abortion in Australia is limited by several factors, especially in regional, rural and remote areas.

Since the TGA approval of medical abortion in Australia, only 1.5% of registered medical practitioners have obtained certification to prescribe.

Telehealth models of care have been found to work well internationally. The study looked at whether telehealth abortion was a safe, effective and acceptable option in Australia.

The study aimed to provide information to health managers and policy makers which can be used to inform a responsive reproductive health care system.

The clinical outcomes included efficacy and safety , and process outcomes included acceptability by women using the service.

The data showed that one quarter of women chose not to proceed with a telehealth abortion, but for whose who did, clinical outcomes were very good. No adverse events were reported.

Interestingly, of the 717 women in the study, only 8 (1%) and 2 (<1%) of women registering with the Tabbot telehealth service were from remote or very remote areas respectively. 296 (41%) of women were from major cities and 318 (44%) from inner regional areas.

The women interviewed reported high levels of satisfaction, privacy, quality of care and levels of support.

In conclusion, telehealth abortion is safe, effective and acceptable to Australian women who experience limited reproductive health service options.

A/Prof Belton also presented a comparison of three telehealth abortion services available in Australia. These included the Tabbot Foundation, Cairns Doctors and Marie Stopes. The Tabbot Foundations provided the cheapest option for patients at $250 (no medicare rebate). Aside from cost, the three services were found to be similar in the way they are set up and run and in terms of patient requirements.

The presentation provided some valuable insights into access issues for medical abortion in Australia, and innovative ways to help provide women with choices and improved access.

I attended this great talk given by Kevin McGeechan on Wednesday 8/11.

Kevin McGeechan is a senior lecturer in Biostatistics at the School of Public Health, University of Sydney and acts as a consultant statistician for Family Planning NSW.

The topic of abortion law in NSW was presented and discussed in further detail the following day at the symposium addressing "Abortion:2017 and Beyond" with several other excellent presentations on the topic. 

A bit of background to start:

Abortion remains a crime in the NSW Crimes Act 1900, punishable by up to 10 years jail. However, as a result of case law, abortion can be provided legally, but only to protect the life or health of the woman. Abortion law reforms have taken place in all other Australian jurisdictions except NSW and Queensland. This leaves women in these states vulnerable to prosecution.

In September 2015 , The Greens NSW commissioned a community survey to inform development of an abortion law reform bill.

This bill was introduced to the NSW Parliament in May 2017 and was debated but defeated.

The survey was conducted anonymously online by a market research company.

1015 male and female adult residents of NSW participated

Of these, 76% were unaware that abortion is a crime in NSW.

73% thought it should be decriminalised and regulated as a healthcare service.

These results were consistent across gender, age groups, metropolitan/regional and rural areas as well as all levels of education.

There was also strong support for women seeking abortion to be protected from harassment (89%) and for protest exclusion zones around abortion clinics (81%)

Support for decriminalisation and protection of women seeking an abortion was higher amount regional/rural residents than Sydney based respondents.

I found it interesting to learn about the differences across Australian jurisdictions regarding abortion law. In addition, it is surprising how many people are unaware of the law pertaining to this in NSW. I think as a medical practitioner it is important to be aware of these issues and what barriers this may pose to women wanting to access abortion services in NSW or Queensland. 

Barriers And Facilitators Relevant To An HIV-Testing Clinic Model Among Chinese And Thai MSM At Sydney Sexual Health Centre (SSHC)

Dr Mcnulty talked about a decrease in HIV diagnosis in Australian born MSM but with no change in non-Australian MSM. She stated the Sydney Sexual health center is increasing its testing options which are free, far from being judgemental with expert staff who are confidentiality conscious. The center introduced the express clinic to overcome waiting times. They complete a number of questions on the computer with a brief encounter with a nurse.It attracted a hard to reach people born overseas although she was quick to explore more testing options with emphasis on confidentiality, free and non-judgemental services.

Lymphogranuloma Venereum in the era of PrEP: are we heading for another epidemic?

Professor David Templeton. Normal 0 false false false MicrosoftInternetExplorer4

Professor Templeton presented a paper on the transmission dynamics of rectal LGV.  He gave information regarding the prevalence of infection being significantly more prevalent in gay and bisexual men (GBM) and even more significantly higher in HIV positive men.  He posed the question ‘Is it all behaviour or does immunodeficiency play a role?’

The research he had looked at suggested a differing theory of CT transmission (including the LGV serovars) this being the role of ano-oral transmission from gut reservoirs of infection passed through faecal-oral contamination.  In comparison to the thinking that it might be past via rimming and fisting. CT can be transmitted from the urethra of men into the throat of their partners, it then is carried through the gut (the gut with it’s down-regulation of inflammatory responses allows CT to survive), it then infects the rectal mucosa and sets up a persisting infection (that then might lead to symptomatic or asymptomatic carriage of LGV or CT.)

This has been suggested by several authors that I found in the reference list of the paper Professor Templeton was quoting –  The Enigma of Lymphogranuloma Venereum Spread in Men Who Have Sex With Men: Does Ano-Oral Transmission Play  a Role? de Vries, Sexually Transmitted Diseases 43, 7, 2016.  Some of the work is based on animal models – where animal CT and ‘LGV – like’ infections occur and persist in the GIT and are not cleared with macrolide treatments.  

There are some studies by one author who looked at  infection in babies at risk of CT infection at birth and how long it took for the infection to get to the anus of the baby and the vagina of the baby girls – postulating that the infection had to travel through the gut and then through feacal contamination enter the vagina. (for further information read  Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection Rank & Yeruva, Infection and Immunity 2014 ;82 :4,  1362–1371.

In practice this has implications for testing and treatment as rectal CT and LGV are vastly different to uro-genital infection.  Therefore non-sexual health clinicians must ask about sexual practices (or just test every orifice in both men and women), GBM with proctitis or procto-colitis who get sent to Gastro-enterologist must have an anal swab first (symptomatic LGV can present as Crohns Disease for example and be missed) and any GBM with ano-rectal CT infection should have their sample sent for LGV serovar testing.  The research is suggesting that heterosexual transmission of LGV is very unusual however continuing vigilance and surveillance is needed to detect shifts in infection dynamics within our community.

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Are we there yet? Reaching global goals for HIV in Asia and Pacific Regions

Treatment approaches should also be within context of a country’s culture. Any approaches for it to work must be culturally appropriate. HIV and drug use are indeed global issues but unfortunately, successful approaches in first world countries does not automatically translate to the same level of success in third world countries. Take the Philippines as an example. MSM is an issue that is still taboo in many places, particularly in very remote places; therefore, collecting accurate data will remain questionable. Studies will always be one sided for not all views will be collected. Drug program and HIV intervention as mentioned, are treated separately for the reason stated above. Are we there yet? Certainly not. But until culturally appropriate treatment strategies could be devised, HIV will always remain a stigma and the 90-90-90 target will remain a long way from achievement.

Presentation by Ruth Hennessy showed a study in a Sydney based HIV clinic.  This demonstrated a higher level of mental health issues, depression, anxiety, suicide, alcohol and IV drug use, social isolation in people who are HIV positive.

It was also found that these client has issues compliance to treatment in general thereby mitigated against optimal care

 Considering this complex association between HIV and mental health illnesses it is suggested that;

-          A multidisciplinary intensive specialist care should be adopted in caring for people with HIV

-          Establishing guidelines for identifying patients who will require extra supports and appropriate referrals will ensure adequate care for people living with HIV

Wonderful talk by Prof. Gracelyn Smallwood who brought in her wealth of experience and activism to elucidate the sexual health burdens faced by the indigineous populations resulting from inequities in health care due to unfavorable governmental policies that has long disadvantaged the ATSI

Everyone will agree that for equity in health care to be achieved in the country as a whole, governmental policies has to be aligned to carter for the disproportionate distribution of social determinant of health which includes; social/physical environments, education, access to health services, health literacy, housing and employment amongst the ATSI

Mark Bloch elucidated several advantages of rapid self-testing which includes

1.      Privacy

2.      Convenience

3.      Short time interval to obtain result

4.      Less anxiety period prior to knowing test result

5.      Easy to use in remote communities with little or no access to health care

Results of the NSW study demonstrated a high uptake and usability of people performing a  rapid self-testing and also correctly following all the steps.

 Clinicians are still concerned about commencing treatment based on results of this self-tests which is also self-reported by patient.

 Example, after a patient self-tests, how will a clinician have documented evidence of test result in patients chart prior to commencement of therapy or even referrals to a specialist

In addition, after a positive self-testing and a patient fails to present for treatment, how can one ensure follow ups.

The Atomo device would undoubtedly improve access to HIV testing but much work has to be done regarding guidelines to clarify concerns as above to make it universally acceptable

I enjoyed the talk given by Natalia Edmiston on predictors of unplanned admissions.

It was surprising to note that studies have shown that most unplanned admissions amongst HIV infected people were due to multi-morbidity rather than HIV specific factors.

Natalie, also demonstrated that recommendations from the NSW studies is in keeping with other international studies such as National Institutes for Health and Care (NICE) guidelines.

Recommendations:

-          Clinicians should consider a mult-morbidity approach to care in treating people with HIV

-          Obtain a CIRS score at entry to care and update this annually

-          CIRS score is a very strong predictor of hospital admissions in HIV positive individuals

Prof Georg Behrens discussed the impact of co-morbidities in HIV patients.

This is relevant in every area of care in people with HIV but I was particularly interested in the pathophysiology of HIV and co-morbid conditions.

The speaker stated that HIV infections is associated with varieties of co-morbid conditions including; Hepatitis B virus, Diabetes, Cardiovascular diseases, Myocardial infarctions, Osteoporosis and Cancers.

These co-morbidities are as a result of chronic inflammation which stems from the virus infection

Keeping these in mind, a whole patient approach is important in the care of people with HIV.

In addition to treating the virus, attending to the co-morbid conditions is necessary for optimal management of HIV patients.

Commencing antiretroviral drugs early (“Starting early”) will lead to immune re-construction and a fall in CD4 counts and further improve life expectancy in HIV patients

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PrEP Implementation

Brent Clifton is the Manager of Gay Men’s Sexual Health Programs. He has taken us to the journey of PrEP implementation. They developed 2 models: Nurse led, and Peer led.

He described how on the early days, PrEP medications can be accessed through import from doctors and from reputable medical sites

That all changed on December 2015, when then Health Minister Jillian Skinner announced a landmark clinical trial on PrEP in NSW named Epic NSW ("Expanded PrEP Implementation in Communities"). A proposal was then sent from ACON to: support the implementation and rollout of the Epic-NSW Study; lead the education and increase community awareness of PrEP. These proposals included a PrEP mailing list, a full-time staff position to lead the community education of PrEP, holding community forums (9 in total were held), community awareness during Mardi Gras Festival and the development of the campaign “Is PrEP right for You?”

They have 2 clinical partners RPA Sexual Health and SSHC. Both centres deliver Nurse and Peer led programs. One of the key services offered was dispensing of PrEP medications on site. This program saw a substantial increase in enrolment within a month.

Some of the peer experiences  they had were feeling less anxious about sex, what will be the possible side effects? they had more conversation about STI, undetectable viral load and some comments like “I’m not high risk enough but still want PrEP.

Some of the take home notes are If we have enough support and education on marginalized population we will be able to eliminate HIV. The availability of PrEP is very crucial in HIV elimination.

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Associate Professor David Whiley, Principle Research Fellow, Pathology QLD and the University of QLD, Australia looked at the different Neisseria Gonorrhoeae (NG) genotypes within NSW and in particular the genotypes associated with MSM and the heterosexual community.  David’s team collected samples over a period of time and applied NG genotyping and whole genome sequencing to the NG isolates, using MassARRAY iPLEX technology. Amongst many interesting findings the majority of isolates collected from female patients of all ages belonged to 1-5 clusters.

Having an understanding of the NG genotypes is fascinating, especially in the face of antibiotic resistance. Following on from Davids presentation, Dr. Eric Chow, senior research fellow, Melbourne Sexual Health Centre, VIC, Australia then presented an interesting session on Risk Factors for NG in heterosexuals. As it stands NG is the second most prevalent STI, which has been attracting a lot of media attention due to the first line antibiotic resistant strains.

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Dr. Chow looked at a number of risk factors associated with the increase. The risk factors included condom use, dating apps, bisexual sex, alcohol use and international travel. Increased International travel seemed to be the most feasible risk associated with the increase. The take home message from this; always ask clients about overseas travel and to educate them on safe sex abroad. 

By Lauren Coelli.

Refugees from DRC

Client Experiences -

Torture and trauma

Many women have been exposed to HIV through rape and may have witnessed the murder or rape of family members.  Many have fled without their children to safety or experienced the trauma of their children being kidnapped.  

Attitudes to HIV

Highly anxious about the diagnosis, fear of death, fear of transmission, fear of disclosure, discrimination, worry of children's futures and difficulty understanding the need for monitoring and management processes.

Living with HIV-

Confidentiality

Anxiety about attending for monitoring and medication especially if other people from their community or culture are also there.  Distrust of phone interpreters.

Pregnancy

Bottle feeding identifies the mother as having HIV.  Fear of disclosure during pregnancy, anxiety about family and case workers finding out during the monitoring processes.  Baby requiring ART and repeated blood tests being potentially identifying.

Strategies

Build trust and rapport, use a flexible walk-in model and spend time upskilling clinical staff.  Work arounds to avoid identifying HIV status - use of immunocompromised on medical files to reduce risk of disclosure. 

Education needs to include health professional, community, WLWHA and the Men from DRC.