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.

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia: A Retrospective Cohort Study

Authors

Denton Callander, PhD,*† Hamish McManus, PhD,* Rebecca Guy, PhD,* Margaret Hellard, PhD,‡ Catherine C. O’Connor, DrPH,*§¶ Christopher K. Fairley, PhD,||** Eric P.F. Chow, PhD,||** Anna McNulty, MM,†† David A. Lewis, DA, PhD,‡‡§§ Christopher Carmody, MB, BS,¶¶ Heather-Marie A. Schmidt, PhD,|||| Jules Kim,*** and Basil Donovan, MD*††

From the *The Kirby Institute, †Centre for Social Research in Health,
UNSW Australia, Sydney, NSW; ‡Burnet Institute, Melbourne, VIC;
§RPA Sexual Health Clinic, Community Health, Sydney Local Health
District; ¶Central Clinical School, University of Sydney, Sydney, NSW;
||Melbourne Sexual Health Centre, Alfred Health; **Central Clinical
School, Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, VIC; ††Sydney Sexual Health Centre,
Sydney Hospital, Sydney; ‡‡Western Sydney Sexual Health Centre,
Parramatta; §§Marie Bashir Institute for Infectious Diseases and
Biosecurity & Sydney Medical School-Westmead, University of
Sydney, Sydney; ¶¶Liverpool Sexual Health Centre, Liverpool; ||||
New South Wales Ministry of Health; and ***Scarlet Alliance, Australian
Sex Worker Association, Sydney, NSW, Australia

Abstract:

Background: Female sex workers in Australia have achieved some of the lowest documented prevalences of human immunodeficiency virus (HIV) and other sexually transmissible infections globally but rates overall are increasing in Australia and warrant closer investigation.

Methods: We constructed a retrospective cohort using repeat testing data extracted from a network of 42 sexual health clinics. Poisson and Cox regression were used to determined trends in incidence and risk factors for HIV, chlamydia, gonorrhoea, and infectious syphilis among female sex workers.

Results: From 2009 to 2015, 18,475 women reporting sex work attended a participating service. The overall incidence of urogenital chlamydia was 7.7/100 person years (PY), declining by 38% from 2009 to 2013 before increasing by 43% to 2015 (P < 0.001); anorectal chlamydia incidence was 0.6/100 PY, and pharyngeal was 1.9/100 PY, which increased significantly during the study period (P < 0.001, both). For gonorrhoea, the urogenital incidence was 1.4/100 PY, anorectal incidence was 0.3/100 PY, P < 0.001), and 3.6/100 PY for pharyngeal; urogenital incidence doubled during the study period, anorectal increased fivefold, and pharyngeal more than tripled (P < 0.001, all). Incidence of infectious syphilis was 0.4/100 PY, which remained stable from 2009 to 2015 (P = 0.09). There were seven incident infections of HIV among female sex workers (0.1/100 PY). Inconsistent condom use with private partners, higher number of private partner numbers, recent injecting drug use, younger age, and country of birth variously predicted sexually transmissible infections among female sex workers.

Conclusions: Although infectious syphilis and HIV remain uncommon in female sex workers attending Australian sexual health clinics, the increasing incidence of gonorrhoea across anatomical sites and increasing chlamydia after a period of decline demands enhanced health promotion initiatives.

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