Using mathematical modelling to help explain the differential increase in HIV incidence in New South Wales, Victoria and Queensland: importance of other sexually transmissible infections

Sexual Health ◽  
2008 ◽  
Vol 5 (2) ◽  
pp. 169 ◽  
Author(s):  
Alexander Hoare ◽  
David P. Wilson ◽  
David G. Regan ◽  
John Kaldor ◽  
Matthew G. Law
Keyword(s):  
New South ◽  
New South Wales ◽  
Fold Increase ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Biological Data ◽  
Biological Factor ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Sex With Men

Background: Since 1999 there has been an increase in the number of HIV diagnoses in Australia, predominantly among men who have sex with men (MSM), but the magnitude of increase differs between states: ~7% rise in New South Wales, ~96% rise in Victoria, and ~68% rise in Queensland. Methods: Epidemiological, clinical, behavioural and biological data were collated into a mechanistic mathematical model to explore possible reasons for this increase in HIV notifications in MSM. The model was then used to make projections to 2015 under various scenarios. Results: The model suggests that trends in clinical and behavioural parameters, including increases in unprotected anal intercourse, cannot explain the magnitude of the observed rise in HIV notifications, without a substantial increase in a ‘transmission-increasing’ factor. We suggest that a highly plausible biological factor is an increase in the prevalence of other sexually transmissible infections (STI). It was found that New South Wales required an ~2-fold increase in other STI to match the data, Victoria needed an ~11-fold increase, and Queensland required an ~9-fold increase. This is consistent with observed trends in Australia for some STI in recent years. Future projections also indicate that the best way to control the current rise in HIV notifications is to reduce the prevalence of other STI and to promote condom use, testing for HIV, and initiation of early treatment in MSM diagnosed during primary infection. Conclusions: Our model can explain the recent rise in HIV notifications with an increase in the prevalence of other STI. This analysis highlights that further investigation into the causes and impact of other STI is warranted in Australia, particularly in Victoria.

Differing trends in sexual risk behaviours in three Australian states: New South Wales, Victoria and Queensland, 1998-2006

Sexual Health ◽  
2008 ◽  
Vol 5 (2) ◽  
pp. 125 ◽  
Author(s):  
Iryna B. Zablotska ◽  
Garrett Prestage ◽  
Andrew E. Grulich ◽  
John Imrie
Keyword(s):  
Hiv Risk ◽  
New South ◽  
New South Wales ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Risk Behaviours ◽  
Gay Community ◽  
South Wales ◽  
Behavioural Surveillance ◽  
Hiv Serostatus

Background: In Australia, the HIV epidemic is concentrated among gay men. In recent years, the number of new diagnoses stabilised in New South Wales (NSW), but increased in other states. We reviewed the trends in sexual behaviours to explain this difference. Methods: We used the Gay Community Periodic Surveys in NSW, Victoria and Queensland during 1998–2006 and restricted analyses to the 30–49 year olds who contribute most of the HIV cases. We used the χ2-test for trends in unprotected anal intercourse with casual partners (UAIC) and regular partners, number of partners, type of relationships, knowledge of HIV serostatus and its disclosure. We compared behaviours of HIV-positive and -negative men and men across states using logistic regression adjusted for the year of report. Results: Trends in behaviours differed across the states: following a period of increase, UAIC prevalence declined in NSW since 2001, but continued to increase in Victoria and Queensland. There were other changes in NSW that were not observed in Victoria and Queensland: a decline in factors increasing HIV risk (the proportions of men with multiple sex partners and men engaging in UAIC and not knowing or not disclosing HIV serostatus) and an increase in behaviours reducing it (the proportions of men in monogamous relationships and men disclosing HIV serostatus while having UAIC). Conclusion: There were patterns of declining HIV risk behaviours in NSW, and increasing risk behaviours elsewhere, that mirrored recent changes in HIV case notifications in Australia. These data suggest that behavioural surveillance can predict changes in HIV epidemiology.

Sexual risk assessment in general practice: evidence from a New South Wales survey

Sexual Health ◽  
2007 ◽  
Vol 4 (1) ◽  
pp. 1 ◽  
Author(s):  
Asaduzzaman Khan ◽  
David Plummer ◽  
Rafat Hussain ◽  
Victor Minichiello
Keyword(s):  
Risk Assessment ◽  
Sexual Risk ◽  
New South ◽  
New South Wales ◽  
Sexual History ◽  
History Taking ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Sexual History Taking ◽  
Sexual Histories

Background: Physicians’ inadequate involvement in sexual risk assessment has the potential to miss many asymptomatic cases. The present study was conducted to explore sexual risk assessment by physicians in clinical practice and to identify barriers in eliciting sexual histories from patients. Methods: A stratified random sample of 15% of general practitioners (GP) from New South Wales was surveyed to assess their management of sexually transmissible infections (STI). In total, 409 GP participated in the survey with a response rate of 45.4%. Results: Although nearly 70% of GP regularly elicited a sexual history from commercial sex workers whose presenting complaint was not an STI, this history taking was much lower (<10%) among GP for patients who were young or heterosexual. About 23% never took a sexual history from Indigenous patients and 19% never elicited this history from lesbian patients. Lack of time was the most commonly cited barrier in sexual history taking (55%), followed by a concern that patients might feel uncomfortable if a sexual history was taken (49%). Other constraints were presence of another person (39%) and physician’s embarrassment (15%). About 19% of GP indicated that further training in sexual history taking could improve their practice. Conclusions: The present study identifies inconsistent involvement by GP in taking sexual histories, which can result in missed opportunities for early detection of many STI. Options for overcoming barriers to taking sexual histories by GP are discussed.

What proportion of sexually transmissible infections and HIV are diagnosed in New South Wales’ public sexual health services compared with other services?

Sexual Health ◽  
2013 ◽  
Vol 10 (2) ◽  
pp. 119 ◽  
Author(s):  
Chris Bourne ◽  
Debbie Allen ◽  
Katherine Brown ◽  
Stephen C. Davies ◽  
Anna McNulty ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
New South ◽  
New South Wales ◽  
Large Contribution ◽  
Geographical Variations ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Geographical Regions ◽  
High Risk Populations

Background: In New South Wales (NSW), publicly funded sexual health services (PFSHSs) target the populations at greatest risk for important sexually transmissible infections (STIs) and so may make a large contribution to the diagnosis of notifiable STIs. We aimed to determine the proportions of STIs diagnosed in PFSHSs and notified to the NSW Ministry of Health in 2009, and describe geographical variations. Methods: The number of notifiable STIs (infectious syphilis, gonorrhoea, HIV and chlamydia) diagnosed in 2009 was obtained for each Area Health Service (AHS) and each PFSHS. The proportion of diagnoses made by PFSHSs was calculated at the state and AHS level according to five geographical regions: inner and outer metropolitan, regional, rural and remote. Results: The overall proportions of diagnoses made by NSW PFSHSs were syphilis, 25%; gonorrhoea, 25%; HIV, 21%; and chlamydia, 14%. Within each zone, the proportions of these STIs were (respectively): (i) inner metropolitan: 32%, 26%, 21% and 13%; (ii) outer metropolitan: 41%, 24%, 43% and 9%; (iii) regional: 62%, 15%, 23% and 10%; (iv) rural: 8%, 29%, <5% and 20%; and (v) remote: <5%, 43%, <5% and 29%. There was considerable variation in proportions of STIs between and within AHSs (<5–100%). Conclusions: NSW PFSHSs contribute a large proportion of diagnoses for syphilis, gonorrhoea and HIV, but less so for chlamydia. Across AHSs and zones, there was considerable variation in the proportions. These data support the role of PFSHS in identifying and managing important STIs in high-risk populations.

Australian men's sexual practices in saunas, sex clubs and other male sex on premises venues

Sexual Health ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. 186 ◽  
Author(s):  
Anthony Lyons ◽  
Anthony M. A. Smith ◽  
Jeffrey W. Grierson ◽  
Henry von Doussa
Keyword(s):  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Sexual Practices ◽  
Anal Sex ◽  
Sexually Transmissible Infections ◽  
Younger Men ◽  
Receptive Anal Sex ◽  
Risky Sexual Practices ◽  
Sexual Encounters ◽  
Sex With Men

Background: Sex on premises venues (SOPVs) where men have sex with men have been implicated in the spread of sexually transmissible infections, but few studies have described men’s sexual encounters in SOPVs, particularly the degree to which men from different backgrounds engage in risky sexual practices. Methods: Interviewer administered surveys were conducted with 186 Australian men who have sex with men (MSM) within 48 h of visiting an SOPV. They reported their sexual practices, the characteristics of their partners and other circumstances surrounding their sexual encounters. Results: All analyses were based on the number of sexual encounters (n = 430). Oral sex was the most common practice, occurring in 74.9% of encounters, followed by massage, frottage or kissing (53.7%), solo or mutual masturbation (36.3%), and anal sex (32.1%). Multivariate analyses revealed age as a significant factor for having protected anal sex (P = 0.001), insertive anal sex (P = 0.004) and receptive anal sex (P < 0.001). These practices were more frequent in encounters among younger men, while masturbation (P = 0.03) was more frequent among older men. When men’s sexual partners were affected by alcohol, encounters were less likely to involve unprotected anal intercourse (P = 0.006) and more likely to involve massage, frottage or kissing (P = 0.009). Men disclosed their HIV status in only 7.7% of encounters. Conclusions: With the likelihood of risky sexual practices varying according to background, results from this study should be used to guide interventions aiming to promote safer sex in SOPVs.

scholarly journals Azithromycin-resistant Neisseria gonorrhoeae spreading amongst men who have sex with men (MSM) and heterosexuals in New South Wales, Australia, 2017

2018 ◽  
Vol 73 (5) ◽  
pp. 1242-1246 ◽  
Author(s):  
David M Whiley ◽  
Ratan L Kundu ◽  
Amy V Jennison ◽  
Cameron Buckley ◽  
Athena Limnios ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
New South ◽  
New South Wales ◽  
South Wales ◽  
Sex With Men

scholarly journals Are printed sexually transmissible infection materials for patients appropriate? A physician perspective

Sexual Health ◽  
2008 ◽  
Vol 5 (3) ◽  
pp. 307 ◽  
Author(s):  
Asaduzzaman Khan ◽  
David Plummer
Keyword(s):  
General Practitioners ◽  
New South ◽  
New South Wales ◽  
Postal Survey ◽  
Physician Perspective ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Information Materials ◽  
Sexually Transmissible Infection ◽  
Transmissible Infection

The data from a postal survey of 409 general practitioners (GPs) practicing in New South Wales are analysed to explore GPs’ concerns, if any, about available printed information materials on sexually transmissible infections (STI) for patients. Just over half (55%) of GPs considered the materials for patients to be inadequate and/or inappropriate with 18% considering the materials as too technical for many patients and 13% considering the materials mostly out of date. Over a fifth reported that either STI materials were not available in their clinic or they did not know where to get those materials.

Corrigendum to: What proportion of sexually transmissible infections and HIV are diagnosed in New South Wales’ public sexual health services compared with other services?

Sexual Health ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 290
Author(s):  
Chris Bourne ◽  
Debbie Allen ◽  
Katherine Brown ◽  
Stephen C. Davies ◽  
Anna McNulty ◽  
...  
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
New South ◽  
New South Wales ◽  
Large Contribution ◽  
Geographical Variations ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Geographical Regions ◽  
High Risk Populations

Background: In New South Wales (NSW), publicly funded sexual health services (PFSHSs) target the populations at greatest risk for important sexually transmissible infections (STIs) and so may make a large contribution to the diagnosis of notifiable STIs. We aimed to determine the proportions of STIs diagnosed in PFSHSs and notified to the NSW Ministry of Health in 2009, and describe geographical variations. Methods: The number of notifiable STIs (infectious syphilis, gonorrhoea, HIV and chlamydia) diagnosed in 2009 was obtained for each Area Health Service (AHS) and each PFSHS. The proportion of diagnoses made by PFSHSs was calculated at the state and AHS level according to five geographical regions: inner and outer metropolitan, regional, rural and remote. Results: The overall proportions of diagnoses made by NSW PFSHSs were syphilis, 25%; gonorrhoea, 25%; HIV, 21%; and chlamydia, 14%. Within each zone, the proportions of these STIs were (respectively): (i) inner metropolitan: 32%, 26%, 21% and 13%; (ii) outer metropolitan: 41%, 24%, 43% and 9%; (iii) regional: 62%, 15%, 23% and 10%; (iv) rural: 8%, 29%, Conclusions: NSW PFSHSs contribute a large proportion of diagnoses for syphilis, gonorrhoea and HIV, but less so for chlamydia. Across AHSs and zones, there was considerable variation in the proportions. These data support the role of PFSHS in identifying and managing important STIs in high-risk populations.

Chlamydia trachomatis infection in the family planning clinical setting across New South Wales

Sexual Health ◽  
2006 ◽  
Vol 3 (1) ◽  
pp. 15 ◽  
Author(s):  
Deborah J. Bateson ◽  
Edith Weisberg ◽  
Harpreet Lota
Keyword(s):  
Family Planning ◽  
Chlamydia Trachomatis ◽  
New South ◽  
New South Wales ◽  
Oral Contraceptive Pill ◽  
Chlamydia Trachomatis Infection ◽  
The Past ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
The Family

Background: Following a small pilot study in 2003, a study was set up to determine the prevalence of genital Chlamydia trachomatis infection in young women presenting to Family Planning NSW centres across New South Wales and to evaluate the characteristics of those infected. Methods: A cross-sectional survey of 621 consecutive women aged from 16 to 24 years was carried out over a 3-month period in 2004 at five Family Planning NSW centres. Urine samples were tested for C. trachomatis using the polymerase chain reaction (PCR) method. Women with a positive result were reviewed and treated. Results: Of 925 eligible clients, 621 (67%) were recruited to the study. Chlamydia trachomatis was detected in 35 of the 621 recruits (5.6%, 95% CI 3.8–7.4). The prevalence at the Hunter centre was significantly higher than the combined prevalence at the other four participating centres (9.7% compared with 3.9%; P = 0.008). Two characteristics were identified as independent predictors of infection in this study: ‘reporting a recent change of partner in the past three months’ (crude odds ratio (OR) 3.33, 95% CI 1.67–6.64) and ‘reporting three or more partners in the past year’ (crude OR 3.69, 95% CI 1.83–7.46). Reported condom use, a history of one or more sexually transmissible infections and current combined oral contraceptive pill use were not associated with infection in this study. Conclusions: The prevalence of C. trachomatis infection is sufficiently high to support targeted testing of 16–24-year-old women in the Family Planning NSW setting and informs the development of a national screening strategy.

Changing pattern of sexually transmissible infections and HIV diagnosed in public sexual health services compared with other locations in New South Wales, 2010–14

Sexual Health ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 366 ◽  
Author(s):  
Christopher Bourne ◽  
Meeyin Lam ◽  
Christine Selvey ◽  
Rebecca Guy ◽  
Denton Callander
Keyword(s):  
Young People ◽  
Sexual Health ◽  
New South ◽  
New South Wales ◽  
People Living With Hiv ◽  
Bisexual Men ◽  
South Wales ◽  
Sexually Transmissible Infections ◽  
Annual Proportion ◽  
Priority Population

Background In Australia, testing and treatment for HIV and other sexually transmissible infections (STIs) is usually managed in general practice, while publicly funded sexual health clinics (PFSHC) attract people at higher risk for infection. The proportion of HIV and STI diagnoses in New South Wales (NSW) occurring in PFSHC stratified by priority population was investigated. Methods: From 2010 to 2014, NSW notification frequencies for chlamydia, gonorrhoea, infectious syphilis, and HIV were compared with the number of diagnoses in PFSHC. The annual proportion of diagnoses at PFSHC was calculated and Wilcoxon rank-sum tests assessed trends. Diagnoses from PFSHC were also organised by priority population, including gay and bisexual men (GBM), people living with HIV, Aboriginal and Torres Strait Islander people, people who use injecting drugs, sex workers and young people. Results: The annual proportion of HIV and STIs diagnosed at PFSHC increased (all P < 0.001): chlamydia from 12% to 15%, gonorrhoea 23% to 38%, infectious syphilis 21% to 40% and HIV 22% to 30%. Overall, the majority of all infections diagnosed at PFSHC were among GBM, with the proportional distribution of chlamydia increasing from 32% to 46% among GBM (P < 0.001) and decreasing among young people (50% to 40%; P < 0.001). There were no other significant changes by population or infection at PFSHC. Conclusions: Increasing proportions of STI and HIV are being diagnosed at NSW PFSHC, mostly among GBM. PFSHC reorientation to priority populations continues to make a large and increasing contribution to STI and HIV control efforts in NSW.

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