Updated Guidelines: Australian STI & HIV Testing Guidelines 2019 for Asymptomatic MSM

Sexually Transmissible Infections in Gay Men Action Group (STIGMA), September 2019

Most sexually transmitted infections (STIs) are asymptomatic. Testing and treatment of asymptomatic men who have sex with men (MSM) is the most effective method to interrupt transmission and reduce the burden of illness. In particular, syphilis is increasingly common, is often asymptomatic, and can cause significant morbidity.

The main barriers to STI control are insufficient frequency of testing in MSM, and incomplete testing. For example, chlamydia and gonorrhoea tests should be performed at all three sites (swab of oropharynx and anorectum, and first
pass urine), and syphilis serology should be performed every time a HIV test or HIV treatment monitoring is performed.

HIV is now a medically preventable infection. All men who are eligible under the Australian HIV Pre-Exposure guidelines should be actively offered PrEP: www.ashm.org.au/HIV/PrEP All people with HIV should be advised to commence treatment and, where possible, have an undetectable viral load.
These guidelines are intended for all MSM, including trans men who have sex with other men .

This current version is endorsed by the Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine, Australasian Sexual Health Alliance, Australasian Chapter of Sexual Health Medicine of the Royal Australasian College of Physicians and is approved as an accepted clinical resource by the Royal Australian College of General Practitioners.

A community perspective: On Human Papillomavirus (HPV)-related cancer among women and, trans and gender diverse people

Positive Life NSW & Femfatales, April 2019

Authors: Liz Sutherland, Lance Feeney, Katya Samodurov

Human papillomavirus (HPV) is a common virus which can be passed through skin to skin contact during sexual activity. Evidence to date shows that women living with HIV are 3 to 6 times more likely to develop cervical cancer than the general female population. They are also at greater risk of developing anal, vaginal, oropharyngeal and vulvar cancers.

There are other groups who may have a higher but preventable risk because they are often left out of the conversation about HPV and related cancers. Trans men are less likely to be up-todate with Pap tests to screen for cervical cancer. Furthermore, several studies have highlighted that trans and gender diverse people, and lesbian and bisexual cis-gendered women are often disregarded as not being at risk.

Positive Life and Femfatales developed a cross-sectional study to:

• Assess awareness and knowledge of HPV infection and risk for 4 HPV-related cancers (cervical, vaginal, vulvar, and anal) among women and, trans and gender diverse people in Australia;

• Assess the knowledge gaps to inform the development and implementation of population-specific educational resources to increase community and healthcare professional awareness of HPV and related cancers;

• Assist with the prevention of morbidity and mortality by increasing screening, early detection and treatment of HPV-related cancers, and;

• Assess rates of HPV vaccination in women and, trans and gender diverse people

KEY FINDINGS:

1. The results from this survey highlighted a lack of awareness of risk, prevention,
symptoms, and early detection of HPV-related vaginal, vulvar, and anal cancers.

2. Approximately 28% of HIV-positive respondents were unaware that a vaccination
against HPV exists and 71% of HIV-positive respondents had not been vaccinated
against HPV.

3. Over half (60%) of HIV-positive respondents believe their risk of anal cancer was either‘about the same’, ‘lower’, or ‘much lower’ than the general female population’s risk.

4. While all HIV-positive respondents had screened for cervical cancer at some point in
their lives, 91.7% had never had an anal examination for anal cancer.

5. Among HIV-positive and HIV-negative but immunocompromised respondents who had undergone staging or treatment for either cervical, vaginal, or vulvar cancer, none had ever screened for anal cancer.

6. Of the HIV-positive respondents who do not receive screening reminder notifications, none were aware of the new 3 yearly National Cervical Screening Guidelines and changes.

7. Qualitative responses indicated that respondents generally preferred having clinician-initiated conversations with female doctors or nurses who were non-judgemental, non-dismissive, clear, and made them feel comfortable.

8. In an open-ended short-answer question, more than 25% of qualitative respondents felt that more awareness and normalising talking about HPV in the public realm would help increase their chance of detecting HPV-related cancer early.

SHINE SA and FPAA condemn Alabama law to ban abortions (media release)

On 17 May 2019, Family Planning Alliance Australia (FPAA) released a statement condemning a new law in Alabama which makes abortion a crime in almost all cases. This is the most restrictive abortion law in the United States and follows a wave of anti-abortion laws in 2019¹.

FPAA state:

“The restrictive and extreme abortion ban violates women’s reproductive rights and penalises health care practitioners for providing basic health care. As an organisation committed to empowering reproductive choice and improving access to health care, we find this law disturbing and unjust.”

Natasha Miliotis, SHINE SA’s Chief Executive Officer said that:

“SHINE SA supports the FPAA statement and recognises that access to safe abortion services reduces the mortality and morbidity that occurs as a result of dangerous and illegal abortion. This is evidenced by a higher frequency of abortion-related deaths in countries with restrictive abortion laws than in countries with less restrictive laws².

SHINE SA, a member of FPAA, advocates for reproductive freedom and for provision of legal, safe, affordable and accessible abortion in Australia and worldwide. We recognise that trans, gender diverse and intersex people may also need access to abortion, but also that measures such as this disproportionately affect women.

SHINE SA believes that both medical and surgical abortion are safe and effective health interventions and that abortion is a private medical decision that should not be politicised.”

To read the FPAA statement visit this link. For further information contact Tracey Hutt, Director Workforce Education and Development via email. 

 

¹ https://www.theguardian.com/world/2019/may/17/we-have-to-fight-alabamas-extreme-abortion-ban-sparks-wave-of-activism

² https://www.researchgate.net/publication/26677181_Unsafe_Abortion_Unnecessary_Maternal_Mortality

Smoking and HIV: what are the risks and what harm reduction strategies do we have at our disposal?

AIDS Res Ther. 2018 Dec 12;15(1):26. doi: 10.1186/s12981-018-0213-z.

Abstract

The World Health Organization estimates that smoking poses one of the greatest global health risks in the general population. Rates of current smoking among people living with HIV (PLHIV) are 2-3 times that of the general population, which contributes to the higher incidence of non-AIDS-related morbidity and mortality in PLHIV.

Given the benefit of smoking cessation, strategies to assist individuals who smoke to quit should be a primary focus in modern HIV care.

Tobacco harm reduction focuses on reducing health risk without necessarily requiring abstinence. However, there remains uncertainty about the safety, policy and familiarity of specific approaches, particularly the use of vaporised nicotine products. Evidence suggests that vaporised nicotine products may help smokers stop smoking and are not associated with any serious side-effects. However, there is the need for further safety and efficacy data surrounding interventions to assist quitting in the general population, as well as in PLHIV specifically.

In addition, official support for vaping as a harm reduction strategy varies by jurisdiction and this determines whether medical practitioners can prescribe vaporised products and whether patients can access vaporised nicotine products. When caring for PLHIV who smoke, healthcare workers should follow general guidelines to assist with smoking cessation.

These include: asking the patient about their smoking status; assessing the patient’s readiness to quit and their nicotine dependence; advising the patient to stop smoking; assisting the patient in their attempt to stop smoking through referral, counselling, pharmacotherapy, self-help resources and/or health education; and arranging follow-up with the patient to evaluate their progress.

Drug and alcohol report uncovers burden in regional Australia

ABC Central West, 15/03/2019

A report from the Australian Institute of Health and Welfare (AIHW) has revealed alarming statistics about drug and alcohol use in regional Australia, and the difficulties faced by those seeking treatment.

The report found a 41 per cent increase in drug-induced deaths in regional and remote areas in the decade to 2017, compared to a 16 per cent spike in major cities.

Researchers said this could be attributed to opioid overdoses.

The report found there was a higher rate of people seeking drug and alcohol treatment in regional and remote communities in 2016–17, but they were likely to travel one hour or more to receive treatment.

It also said people in country areas were more likely to smoke, drink heavily, use drugs, and avoid exercise.

New Family, Domestic, and Sexual Violence Statistics Directory

Australian Bureau of Statistics (ABS), 19 December 2018

For the first time, sources of family, domestic and sexual violence statistics have been collated into a central directory by the Australian Bureau of Statistics (ABS).

The new ‘Directory of Family, Domestic, and Sexual Violence Statistics’ aims to improve the awareness and utilisation of family, domestic, and sexual violence statistics by providing an integrated repository of national and state and territory data sources.