COVID-19: A Gender Lens – sexual & reproductive health and gender inequality

UN Population Fund (UNFPA), March 2020

Disease outbreaks affect women and men differently, and pandemics make existing inequalities for women and girls and discrimination of other marginalized groups such as persons with disabilities and those in extreme poverty, worse. This needs to be considered, given the different impacts surrounding detection and access to treatment for women and men.

Women represent 70 percent of the health and social sector workforce globally and special attention should be given to how their work environment may expose them to discrimination, as well as thinking about their sexual and reproductive health and psychosocial needs as frontline health workers

Multiple factors explain why middle-aged heterosexuals with new sexual partners don’t use condoms

nam/aidsmap

New strategies and approaches are needed to address the sexual health needs of middle-aged heterosexuals starting new relationships, research published in Sexually Transmitted Infections suggests.

The UK study involved men and women aged between 40 and 59 years with, or considering, new sexual partners after the break-up of a long-term relationship. In-depth interviews showed that beliefs about sexual risk were frequently based on past rather than current circumstances and that individuals often felt that existing sexual health services were geared towards the needs of younger people.

Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

Public Cervix Announcement campaign

Thorne Harbour Health, September 2019

Cancer Council Victoria, November 2019

As more research reveals concerning health outcomes for lesbian, bisexual and queer (LBQ) identified women, it is encouraging that there is a shift in focus towards improving health for LBQ women from both mainstream and LGBTIQ health organisations. As part of Women’s Health Week (September 2 – 6) we thought we’d take you through one of our campaigns which was created to raise awareness around cervical screening.

The reasons why these groups don’t screen as often as they should include people thinking they don’t need to screen, feeling embarrassed or frightened and fearing homophobia or transphobia. The fact is, all LGBTIQ people with a cervix between the ages of 25 and 74, need cervical screening every five years to reduce their risk of cervical cancer, no matter who they have had as a sexual partner.

Working with Cancer Council Victoria, Thorne Harbour Health created the ‘Public Cervix Announcement’ campaign. This campaign was created to raise awareness around cervical cancer and debunk some of the myths around who should be screened.

PCA postcard

 

 

 

Australian-led PCOS guideline an international first

Medical Journal of Australia, Published online: 22 November 2019

An Australian-led international and multidisciplinary collaboration of health professionals and consumers has produced the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS) with an unprecedented international translation program, summarised today in a supplement published by the Medical Journal of Australia.

Led by Professor Helena Teede, Director of the National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, the collaborators took 2 years to write the guideline, which includes an integrated translation program incorporating resources for health professionals and consumers.

PCOS affects 8–13% of reproductive age women, with around 21% of Indigenous women affected.

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.