Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible MSM

Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men

Australian and New Zealand Journal of Public Health

Anysha M. Walia, Christopher K. Fairley, Catriona S. Bradshaw, Marcus Y. Chen, Eric P.F. Chow

First published: 31 August 2020
https://doi.org/10.1111/1753-6405.13029
Abstract:

Objectives: Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men (MSM) in Melbourne, Australia.

Methods: We conducted a retrospective, cross‐sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare‐eligible and Medicare‐ineligible MSM.

Results: We included 5,085 Medicare‐eligible and 2,786 Medicare‐ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare‐eligible compared to Medicare‐ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare‐eligible and Medicare‐ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare‐ineligible MSM were more likely to have anorectal chlamydia compared to Medicare‐eligible MSM (10.6% vs. 8.5%; p=0.004).

Conclusions: Medicare‐ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high‐risk behaviour.

Implications for public health: Scaling up access to HIV and STI testings for Medicare‐ineligible MSM is essential.

Sex and gender: modifiers of health, disease, and medicine

The Lancet, Volume 396, Issue 10250, 22–28 August 2020, Pages 565-582
Mauvais-Jarvis, F., et al

Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men’s and women’s health.

 

Impact of COVID-19 on Migrant and Refugee Women and Children Experiencing DFV

Women’s Safety NSW, Published: July 31, 2020

Whilst research on the prevalence of violence against migrant and refugee women is limited, what is known is that cultural, language and systemic barriers serve to reduce access to safety and support for this group of women, and they are at higher risk of domestic homicide. (AIC 2020)

This also corresponds with lower rates of reporting amongst migrant and refugee women experiencing domestic and family violence, as distrust for authorities, limited knowledge of rights and services and concerns about both material and cultural ramifications can serve as insurmountable barriers to accessing the supports needed. (AIFS 2018)

What has not yet been investigated is the specific impact of COVID-19 on migrant and refugee women experiencing domestic and family violence. This report from Women’s Safety NSW offers the experiences and professional observations of multicultural domestic and family violence specialists supporting hundreds of these very women at this critical time. What they’ve reported is that migrant and refugee women who are experiencing domestic and family violence are at higher risk than they have ever been before and that urgent action is needed if we are going to save lives.

Sexual and reproductive health a COVID-19 priority (Statement)

Burnet Institute, 28 May, 2020

Burnet Institute is a member of a consortium of Australian-based non-governmental organisations (NGOs) and academic institutes concerned about the detrimental effects of the COVID-19 pandemic on the sexual and reproductive health and rights of women and girls globally.

The International Sexual and Reproductive Health and Rights Consortium, which includes Save the Children, Family Planning NSW, CARE Australia, The Nossal Institute for Global Health, and Médecins Sans Frontières Australia, is calling on the Australian Government to prioritise the needs of women and girls in its response to COVID-19.

Collectively, the consortium works across 160 countries to champion universal access to sexual and reproductive health and rights.

It’s concerned that women and girls across the globe are struggling to access critical sexual and reproductive health care, citing evidence that COVID-19 lockdowns are likely to cause millions of unplanned pregnancies.

In the Pacific, travel to rural and remote areas have been curtailed, and physical distancing requirements have forced the cancellation of most group training on sexual and reproductive rights.

A recent UNFPA report determined that a six-month lockdown could mean 47 million women and girls globally cannot access contraception, and seven million will become pregnant.

The consortium has issued a joint statement setting out priorities to ensure Australia’s global response to COVID-19 meets the critical needs of all women and girls, including:

  • Recognise and respond to the gendered impacts of the pandemic, and the increased risk to women and girls from gender-based violence and other harmful practices
  • Improve the supply of contraceptives and menstrual health products which are being impacted by the strain and disruption on global supply chains
  • Increase flexibility in delivering sexual and reproductive health services during lockdown using innovative health delivery models such as task-sharing, tele-health and pharmacy distribution
  • Support sexual and reproductive health workers and clinics to continue delivering services sagely with access to personal protective equipment as well as training on how to refer, test or diagnose COVID-19.

 

COVID-19 Impact and Response for Sex Workers

Scarlet Alliance, 2020

STATEMENT OF IMPACT

Sex workers throughout Australia have been devastatingly hit by the impact of coronavirus. As a workforce, sex workers are predominantly a mixture of precarious workers and the self-employed, being independent contractors who work in or for sex industry businesses, or sole traders who work independently for themselves. As such sex workers are particularly marginalised in terms of the impact of the coronavirus and many will still be excluded from the stimulus packages announced by the government.

While we welcome the announcement that from 27 April 2020 sole traders are included in the government’s Economic Response to the coronavirus, many sex workers will still be left without financial support.

Read more here

Intersex people and COVID-19

Intersex Human Rights Australia, 12 April 2020

COVID-19 can infect any individual, irrespective of age or health but its impact exacerbates existing inequalities. All populations that suffer health inequalities are disproportionately affected, and people with intersex variations are no exception.

Current health is determined to some extent by biological factors.