Judith Dean

Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men

Background To assess the prevalence and increase awareness of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men, a screening program was conducted at three inner-city homosexual entertainment venues and one community function. Study Design Each venue was accessed twice over a 3-month period between March and June 2000. First-catch urine specimens were collected for analysis by polymerase chain reaction (PCR), and throat swabs were collected for culture and PCR. Results A total of 202 men were tested during the 7 screening nights, including 16 who were tested more than once. From the 186 men tested for the first time, 184 urine specimens were collected, of which 8 (4.3%; 95% CI, 1.9–7.8%) were PCR–positive for C trachomatis and 1 (0.5%; 95% CI, 0–2.1%) was PCR–positive for N gonorrhoeae. Of the 161 throat swabs collected, none were positive for C trachomatis or N gonorrhoeae. Conclusions C trachomatis is a potentially significant pathogen in this population of urban homosexual men. Screening programs such as these are valuable as health-promotion exercises.

Hepatitis B Knowledge, Testing, and Vaccination Among Chinese and Vietnamese Adults in Australia

Hepatitis B is a significant public health challenge within some subpopulations in Australia, including Chinese and Vietnamese migrants. There has been limited research on hepatitis B knowledge and actions in these communities. The authors conducted a self-administered survey among 442 Chinese and 433 Vietnamese in Brisbane. Generally, the knowledge is best described as “moderate.” One in 2 could not identify the sexual transmission risk and less than one third knew that sharing foods or drinks did not spread the disease. The majority of Vietnamese (80%) and 60% of Chinese respondents indicated prior testing. Vaccination was reported in 60% of the Vietnamese and in 52% of the Chinese. Knowledge was better among Chinese people who had been tested and vaccinated compared with those who were nontested and nonvaccinated. Only 3.5% of the Chinese, but 11.6% of the Vietnamese, indicated having a positive test result hepatitis B virus. This study helps identify strategies for programs targeting both communities and practitioners.

Hidden yet visible: methodological challenges researching sexual health in Sudanese refugee communities

Research addressing sensitive topics with people from small, minority, ethnic communities can present challenges that are difficult to address using conventional methods. This paper reports on the methodological approach used to explore sexual health knowledge, attitudes and beliefs among the Sudanese community in Queensland, Australia. The multiphase, mixed-method study involved young people 16 to 24 years of age participating in a written survey and semi-structured interview and focus-group discussions with the broader Queensland Sudanese community members. Community collaboration, the key factor to the success of this research, optimised the development of a research environment that built trust and facilitated access and subsequent understanding. Research conducted in partnership with the target community can address methodological challenges and produce meaningful information when researching sensitive topics with small but ‘highly-visible’ populations.

HIV Testing in Men who have Sex with Men: A Follow-up Review of the Qualitative Literature since 2010

The landscape of HIV testing has changed significantly in recent years following the rise in importance of the ‘treatment as prevention’ strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.ResumenEl panorama de las pruebas para VIH ha cambiado significativamente en los últimos años por la creciente importancia del “tratamiento preventivo” como estrategia y los avances tanto en nuevas pruebas como en tecnologías preventivas. Esta revisión es una síntesis de hallazgos en estudios cualitativos publicados desde 2010 acerca de las preferencias y prácticas de hombres homosexuales (HH), en relación con pruebas de VIH en clases sociales de altos ingresos. Los hombres homosexuales son uno de los grupos más difíciles de abordar con pruebas de VIH standard o convencionales. Es necesario entender las preocupaciones, barreras y facilitadores de este grupo en particular para desarrollar estrategias alternativas de testeo. Esta revisión actualizada aportara valiosa información para mejorar programas actuales y diseñar nuevos servicios de pruebas de VIH para HH.

Intergenerational variation in sexual health attitudes and beliefs among Sudanese refugee communities in Australia

Abstract The aim of this study was to develop intergenerational understanding of the factors perceived to be influencing the sexual health and wellbeing of young Sudanese refugees in Queensland, Australia. Data from 11 semi-structured, face-to-face interviews exploring sexual health knowledge, attitudes and behaviours with young people aged 16 to 24 years, and five focus groups with adults from the broader Queensland Sudanese community, were compared and contrasted. Findings indicate that sexual health-related knowledge, attitudes and beliefs, along with patterns of sexual behaviour, are changing post-resettlement and this creates considerable intergenerational discord and family conflict. Study findings provide an understanding of how the interplay between traditional cultural gender, parenting and relationship norms and perceived normative Australian beliefs and patterns of behaviour influence the construction of both young people’s and their parents’ attitudes to sexual health post-arrival. We suggest that sexuality education programmes adapted to the specific cultural- and age-related contexts need to be introduced early within the resettlement process for both young people and their families.

Implications of the on-line market for regulation and uptake of HIV self-testing in Australia.

ABSTRACT Self-Testing for HIV (HIVST) is widely recognised as a feasible and effective means of increasing rates of testing and detection of HIV, particularly in non-testing and infrequent testing populations. Currently in Australia, the only means of accessing this technology is to purchase unregulated products on-line. A search of available on-line distributers was purposefully performed from the perspective of an English-speaking individual, with no clinical background or specific understanding of HIV testing practices, seeking to determine their HIV status. Purchased kits were assessed against a structured extraction tool based on the Australian Therapeutic Goods Administration (TGA) HIV testing clinical performance guidelines. In total, eight HIVST kits were purchased from seven different distributers. Analysis of the purchased kits and linked websites revealed that none met the TGA’s requirements for HIV testing kits intended for home use; none also conformed to the additional recommendations for information, quality and links to services developed from this study’s review of HIVST associated literature. People seeking HIVST kits are able to purchase sub-standard products that ill-serve their needs, and do so at a time of great personal vulnerability. The fact that Australians are willing to purchase and use these sub-standard products indicates HIVST is in demand. Health policy and models of service are needed in order to ensure people have access to a safe and effective registered device at prices that enable equity of access to all Australians, particularly those most at risk of HIV. Other countries awaiting access to regulated HIVST devices also need to consider the potential implications. Collaboration between manufacturers, distributers, regulatory bodies, service providers and the community is needed globally in order to ensure HIVST is embedded into testing methods in a manner that does not disrupt but rather safely and effectively increases HIV testing rates.

Sexual Risk Taking in a Community Sample of International Backpackers Visiting Brisbane, Australia

We sought to examine correlations between international backpackers’ alcohol consumption and sexual behaviors and determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoea in this population. A cross-sectional study design consisting of a convenience sample (N = 168) of non-treatment-seeking international backpackers visiting Brisbane, Australia was recruited. Participants were asked to self-complete a questionnaire on sexual behavior and to undertake a urine-based polymerase chain reaction test for C trachomatis and N gonorrhoea. Since arriving in Australia, 73.2% reported having had sex, with a median number of 2 different sex partners (range = 0-21). Most participants had consumed alcohol (53.7%) and used condoms (46.3%) the last time they had sex. In our sample, there was a 4.3% prevalence of C trachomatis and a 0% prevalence of N gonorrhoea. This study identified a variable pattern of risk among backpackers, with those spending longer periods in the country more likely to have sex with Australians.

Sexual health knowledge and behaviour of young Sudanese Queenslanders: a cross-sectional study

Background Forced migration is associated with sexual vulnerability. However, little is known about the sexual health literacy and needs of refugee-background youth post resettlement. METHODS Conducted in partnership with the Queensland Sudanese community, this study used a cross-sectional survey to explore the sexual health knowledge, attitudes and behaviours of a convenience sample of 16- to 24-year-old Sudanese-background youth in Australia (n=229). RESULTS Sexually transmissible infection (STI) and HIV knowledge scores were generally low, although they were found to significantly improve the longer participants had lived in Australia (P<0.001). Female participants reported significantly higher levels of both STI and HIV knowledge compared with the male cohort (P<0.001). The aggregated sexual risk behaviour score suggests generally low levels of risk-taking behaviour. However, of the 140 sexually active participants, 3.1% reported a STI diagnosis, 9.0% reported sex leading to a pregnancy and 33.1% reported they had experienced unwanted sex. Participants also reported engaging in behaviours such as anal sex (33%) and sharing injecting drug equipment. CONCLUSIONS Patterns of sexual behaviour among this predominately refugee-background group are not dissimilar to those of other young Australians. Nonetheless, the self-reported patterns of risk behaviour combined with the low and inaccurate levels of sexual health knowledge suggest this group of young people remain sexually vulnerable, particularly early within their resettlement experience. Culturally and contextually informed sexual health interventions are needed early within the resettlement experience.

Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia

BackgroundThe success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing.MethodsService data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed.ResultsIn 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme.ConclusionsRAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration.

Integrated HIV self-testing (HIVST) service delivery in Queensland for policy and service development: study protocol

ABSTRACT This study aims to pilot and evaluate an integrated model for HIV self-testing (HIVST) service delivery in a peer-led Queensland community setting to increase access to HIVST, particularly for men who have sex with men (MSM) living in regional, remote and rural areas. It seeks to provide evidence that would overcome some of the key objections previously raised to HIVST. Recruitment strategies have been designed to engage hard to reach MSM populations in testing. Awareness of the trial will be generated through advertising on social media platforms, including dating applications, word of mouth and HIV related websites. Participants will access an HIVST online ordering system hosted by a HIV community organisation. This system: (1) enables on-line informed consent; 2) gives clients the choice to accept verbal pre-test information from a trained peer test facilitator or not; and (3) allows for ordering of the HIVST kit after completion of an online survey (with demographic information and testing history etc.). Clients receive the kits via the post; and at 2 weeks receive a follow-up phone-call and SMS link to a post-test survey. If the test is non-reactive, clients can opt for test reminders. If reactive, referral to clinical services, peer navigation and support systems are provided. This study addresses important gaps in understanding of acceptable and feasible methods to integrate HIVST into an existing peer-led testing service and into the broader suite of HIV testing options and services. The findings will inform the actions needed to enhance access to HIVST for MSM wishing to use this technology in Australia and elsewhere, especially those who have never tested and infrequent testers.