2013 Participant Summaries

PDF
Study:

The inside story - physicians' views on digital ano-rectal examination for anal cancer screening of HIV positive men who have sex with men

Researchers:

Ong J, Chen MY, Temple-Smith M, Hoy J, Woolley I, Grulich AE, Fairley CK                 

Publication:

Journal of Medical Screening 2013, 20(4): 188-191

Summary:

The practice of digital anal rectal examination (DARE) for cancer screening among HIV physicians, and identification of any barriers for using DARE as a method for anal cancer screening was explored. A questionnaire was completed by 36 physicians from a sexual health centre, 2 tertiary hospital infectious diseases outpatient clinics, and 2 general practices. Most physicians (86%) thought that anal cancer screening was important, but only 22% were currently screening. Reasons for not screening were the absence of guidelines (87%), lack of time (47%) and concern about patient acceptability of DARE (32%). Whilst 67% of physicians felt confident in performing a DARE, only 22% were confident in recognizing anal cancer using DARE. Although HIV physicians were aware of the need for anal cancer screening among the HIV positive MSM population, few were routinely screening. If DARE were to be included into routine HIV care, guidelines recommending screening and up-skilling of HIV physicians to recognize anal cancer are needed.


 

Study: 
The potential of metatranscriptomics for identifying screening targets for bacterial vaginosis
 
Researchers:
Twin J, Bradshaw CS, Garland SM, Fairley CK, Fethers K, Tabrizi SN     

Publication: 
PLoS ONE 2013, 8(9): e76892
 
Summary: 
No single germ has been identified yet as the cause of bacterial vaginosis (BV), and BV is now generally considered to be caused by more than one germ. The introduction of sophisticated molecular-based screening methods has increased our capability to characterise and give us a better understanding of the germs in human clinical samples. A sample collected from a woman with bacterial vaginosis (BV) was analysed to determine which active germs were present and to identify potential targets for use in further screening. The most common bacteria found were Prevotella (predominately P. amnii) (36%), followed by Megasphaera (19%), Leptotrichia/Sneathia (8%) and Fusobacterium (8%). The presence of P. amnii was screened for in a larger pool of samples of 90 sexually active women. This bacterium was found to be strongly associated with BV among the 90 women. Prevotella amnii was chosen as an example target, being the most metabolically active germ present in women with BV. Our limited findings reinforce that P.amnii may be an important BV-associated germ.


 
Study:
The burden of bacterial vaginosis: women’s experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis
 
Researchers: 
Bilardi JE, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Fairley CK,  Chen MY, Bradshaw CS
                                  
Publication: 
PLoS ONE 2013, 8(9): e74378
 
Summary: 
Bacterial vaginosis (BV) is common and causes an abnormal vaginal discharge and/or odour in up to 50% of sufferers. BV reoccurs often in many women following recommended treatment. This study explored the experiences and impact in women with reoccurring BV on their self-esteem, sexual relationships and quality of life. Thirty five women with male and/or female partners participated in interviews either face-to-face or by telephone. Some women reported reoccurring BV had little impact on their lives but most reporting BV had a moderate to severe impact. The degree to which BV impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and how severe their symptoms. Women commonly reported that symptoms of BV made them feel embarrassed, ashamed, ‘dirty’ and were very concerned that others may notice the strong smell and discharge. The biggest impact of reoccurring BV was on women’s self-esteem and sex lives, with women regularly avoiding sex, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing reoccurring BV and frustrated at their lack of control over recurrence.


 
Study:
Provision of HIV rapid testing within a health service and the frequency of HIV testing among men having sex with men: a randomised controlled trial
 
Researchers:
Read TRH, Hocking JS, Bradshaw CS, Morrow A, Grulich AE, Fairley CK, Chen MY
                                  
Publication:
BMJ 2013, 347: f5086
 
Summary: 
A rapid HIV finger prick test was compared to the HIV test using standard blood collection in men who have sex with men attending a health service to see if using the rapid test would boost the frequency of HIV testing over an 18 month period.  Men were included if they reported having a male sexual partner within the previous year and had tested HIV negative within the previous two years. Men attending the service between September 2010 and March 2011 were divided equally between the 2 test groups for the study period. In the rapid test arm, 200 men had 1.6 tests a year, and in the standard test arm 200 men had 1.4 tests a year. The initial rate of HIV testing did increase by a third in the rapid test group, but providing access to the rapid test did not increase testing compared to HIV testing using the standard blood collection over the study period.  In the study questionnaire the majority of men said they preferred rapid tests to the standard tests because getting results was quicker and the anxiety less while waiting for results.


 
Study:
Facilitating partner notification through an online messaging service: Let Them Know
 
Researchers:
Huffam S, Fairley CK, Chung M, Sze JK, Bilardi J, Chen MY
                                  
Publication: 
Sexual Health 2013; 10: 377 - 379
 
Summary:
Let Them Know (www.letthemknow.org.au) is an Australian internet based service designed for individuals with an STI to send either named or anonymous text or email messages to sexual partners to inform them they may be at risk of a particular STI. The message recommends that they go for STI testing and directs them to the website for more detailed information A review of users of the website was performed. Between March 2010 and March 2011, there were 13,024 website visits and 4,863 (37%) text messages sent. From December 2010 users were asked if they were more likely to let a partner know because of the website and out of 1,383 users, 963 (70%) answered that they were more likely to contact a partner because of the website. Misuse of the service is identified and controlled, and measures are in place to monitor for and prevent abuse. Web-based notification systems encourage partner notification for individuals who may be uncomfortable to do this in person.


 
Study: 
Acceptability of Digital Anal Cancer Screening Examinations in HIV-positive Homosexual Men
 
Researchers:
Read TRH, Grulich AE, Vodstrcil L, Farmer C, Bradshaw CS, Tabrizi SN, Hocking JS, Anderson J, Fairley CK
                                  
Publication: 
HlV Medicine, 2013 14 (8): 491 - 496
 
Summary:
Anal cancer (squamous cell carcinoma) is more common in HIV-positive gay men than in the general population and outcomes worsen with increasing tumour size. Medical records were reviewed between 1992 and 2010 from a hospital radiotherapy unit and major centre for HIV care, in Melbourne, Australia. Of 128 cases with anal cancer, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were visible and the average size was 36mm in size (29mm in HIV-positive and 38mm in HIV-negative patients). The most frequent symptoms were bleeding (43%) and pain (36%). Symptoms were present for around 22 weeks ranging from 1 to 104 weeks. Physical examination may detect many of the tumours before patients seek medical care, meaning that screening high-risk groups by anal inspection is possible.


 
 
Study:
Gay and bisexual men’s views on rapid self-testing for HIV
 
Researchers: 
Bilardi JE, Walker S, Read T, Prestage G, Chen MY, Guy R, Bradshaw C, Fairley CK
                                  
Publication:
AIDS & Behaviour 2013, 17(6): 2093 - 2099
 
Summary:
Thirty-one gay and bisexual men were interviewed for their views on HIV rapid tests for home use in Australia. The main reasons men gave for not getting tested more often for HIV were because: they believed themselves to be at low risk, particularly if they were in a regular relationship; it was inconvenient and impractical to visit health services for testing during working hours, particularly given lengthy waiting times and repeat visits for results; or due to laziness or procrastination. The majority of men supported the introduction of quick and easy, painless self-testing home tests and would be likely to use the tests. Most reported they would use them for interim testing and not to replace blood testing at health services because they could not detect other sexually transmitted infections or provide the professional expertise and support provided at health services. The frequency with which they would use rapid home tests would largely depend on the cost. Details about the accuracy and reliability of the test and the window period with access to 24 hour helpline could be useful.


 
 
Study:
Women’s experiences of pelvic inflammatory disease: Implications for health care professionals
 
Researchers:
Newton, D, Bayly C, Fairley CK, Chen M, Keogh L, Temple-Smith M, Williams H, McNamee K, Fisher J, Henning D, Hsueh A, Hocking J
                                  
Publication:
Journal of Health Psychology (Oct 2013)
 
Summary:
This study interviewed 23 women diagnosed with pelvic inflammatory disease about their health-care experiences. Many women felt more empowered about their health after being diagnosed. A smaller number reported becoming hyper aware of their symptoms. The possibility of infertility was the greatest concern for these women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively even when doctors were unable to provide exact information. The findings highlight the need for community education emphasizing the importance of safe sex practices and encouraging early presentation for the treatment of pelvic pain. There is also the need for health practitioners to provide adequate good quality verbal and written information that could reduce the level of psychological distress and confusion for some women with pelvic inflammatory disease.


 

Study:
Sex workers talk about sex work: six contradictory characteristics of legalised sex work in Melbourne, Australia
 
Researchers:
Begum S, Hocking JS, Groves J, Fairley CK, Keogh LA
                                   
Publication:
Culture, Health and Sexuality 2013, 15(1): 85–100
 
Summary:
Group interviews were held with 14 female sex workers in Victoria for their views on the good and bad experiences of legal sex work and if they viewed their work as being accepted by the general public. Women saw legal sex work as safer than illegal sex work, but sex work was still not socially accepted by the general public. They also described six conflicting sides to sex work. The money is rewarding yet entrapping because you get used to earning and spending more money than if you worked in regular mainstream jobs. The money is liberating and emotionally empowering yet disrespectful attitudes from clients lead to one feeling bad and demoralised about oneself. The work provided some opportunity to do other work in the sex industry like reception work or starting their own business, but at the same time the job severely limited opportunities outside the sex industry because of the stigma associated with sex work. Freedom to work when you choose is a huge benefit, but the mental pressure of providing the best service to clients, performing sexually and looking good are seen as hard work. Workmates were supportive and good to discuss certain issues about bad clients or experiences, but could also become competitive and nasty if one worker was getting less clients than another. Most of the participants left their families in the dark about their work to protect them but felt guilty about having to live a ‘double life.’  While legalisation has improved the safety of sex work, stigma and discrimination still persist.



 
Study:
Key informant perceptions of youth-focused sexual health promotion programs in Australia.
 
Researchers:
Newton D, Keogh L, Temple-Smith, M, Fairley CK, Chen M, Bayly C, Williams H, McNamee K, Henning D, Hsueh A, Fisher J, Hocking J
                                   
Publication:
Sexual Health 2013, 10 (1): 47 - 56

Summary:
Thirty-three sexual health professionals working in funding of or in delivering Australian sexual health promotion programs or working in sexual health clinics were interviewed to get their views on what the reasons are for sexual health programs not working effectively in young people in Australia. The reasons mentioned were: young people are not taking part in the planning of the programs; the programs do not run for enough time to be effective; and that it is not easy to test programs to show that the program is working. Other views mentioned that prevent health promotion programs from working effectively were: programs do not tackle differences in levels of knowledge, language spoken or reading skills for Aboriginal and young people coming from different cultures; and stigma and shame associated with sexual health. The views expressed of what could be effective approaches for sexual health promotion programs were: to find out what the needs are of the community being targeted by the program; use peer groups for education; work with Aboriginal health organizations to deliver the right programs for Aboriginal and young people of different cultures and languages; share information gained through reports; and publish and promote information about programs to reduce repeating programs at different places.



Study: 
Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women
 
Researchers:
Walker J, Fairley CK, Bradshaw CS, Tabrizi SN, Twin J, Chen MY, Taylor N, Donovan B, Kaldor JM, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden FJ, Gunn J, Pirotta M, Gurrin L, Harindra V, Garland SM, Hocking JS
                                   
Publication: 
Clinical Infectious Diseases 2013, 56 (8): 1094-1100
 
Summary:
Mycoplasma genitalium (MG) is a sexually transmitted infection (STI) that is associated with pelvic inflammatory disease and inflammation of the cervix in women. This study aimed to estimate how common MG is and how effective our treatment is for MG. 1110 women aged 16–25 years were recruited from primary care clinics in Australia. Women were tested for MG at their first visit, 6 months later, and then again after 12 months. The rate of MG was 2% and was higher among women who reported having 3 or more sex partners in the last 12 months. There were 3 cases who were reinfected and another 3 cases who failed treatment with azithromycin but were successfully treated with moxfloxacin. The amount of organisms found were higher in cases who failed treatment than in those who were successfully treated.


 
Study:
Recurrence of bacterial vaginosis is significantly associated with post-treatment sexual activities and hormonal contraceptive use
 
Researchers:
Bradshaw CS, Vodstrcil LA, Hocking JS, Law M, Pirotta M, Garland SM, De Guingand D, Morton AN, Fairley CK
                                   
Publication:
Clinical Infectious Diseases 2013, 53(6): 777-786.
 
Summary:                 
Bacterial vaginosis (BV) is common genital infection in women but often returns after treatment. What causes this high recurrence rate is unknown. This study looked at behaviours of women with symptoms of BV to see if any of their behaviours could play a part in returning episodes of BV. All 450 participants received oral treatment with metronidazole for 7 days as well as a vaginal pessary with either vaginal clindamycin, lactobacillus-vaginal probiotic or vaginal placebo. At 1, 2, 3, and 6 months, participants self-collected vaginal smears and completed questionnaires. After a 6 month time period, 28% of the women had BV again after treatment. Risk of BV recurrence was increased in women who had the same sexual partner before and after treatment and in women who did not consistently use condoms but was halved among the women using estrogen-containing contraceptives.



Study: 

Prevalent and incident bacterial vaginosis are associated with sexual and contraceptive behaviours in young Australian women
 
Researchers: 
Bradshaw CS, Walker J, Fairley CK,  Chen MY, Tabrizi SN, Donovan B, Kaldor JM, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden F, Garland S, Pirotta M, Gurrin L, Hocking JS
                                   
Publication:
 PLoS ONE 2013, 8(3): e57688
 
Summary:     
This study looked at the rate of bacterial vaginosis (BV) and what the risks were to acquiring BV among young sexually-active Australian women attending primary health care.  A questionnaire was completed every 3 months and vaginal smears were self-collected at 6 months and 12 months by 1093 women aged 16–25 years. At their first recruitment visit 129 women had BV (12%). The women with BV were more likely to have had a recent female partner and no tertiary-education. Women who used an oestrogen-containing contraceptive had a lower risk of acquiring BV. There were 82 women (9%) who developed BV during the study and this was connected to having a new male partner. The results of the study support the theory that sexual activity is strongly associated with the development of BV.



 
Study:
What do young women think about having a chlamydia test? Views of women who tested  positive compared with women who tested negative.
 
Researchers:
Walker J, Walker S, Fairley CK, Bilardi J, Chen MY, Bradshaw CS, Urban E, Pirotta M, Donovan B, Kaldor J, Gunn J, Hocking JS, Hocking JS.
                                  
Publication:
Sexual Health 2013, 10 (1): 39 - 42
 
Summary:     
The experience of women testing positive for chlamydia was compared to the experience of women testing negative in this study. The women completed a questionnaire about their future sexual behaviour and testing. The questionnaire was completed by 872/1116 (78%) women including 67 women who tested positive. Many women (75%) felt anxious about having a chlamydia test but the women who tested positive were: less concerned about their future health (61% versus 81%); were less concerned about their partner(s) reactions (62% versus 79%); and were more likely to discuss their diagnosis with other people (57% versus 36%). The participants in the study were pleased to have been tested and supported a screening program. Women who tested positive were less concerned about having a positive result than women who tested negative anticipated they might be. Having a chlamydia test may cause anxiety in young women and should be addressed for a chlamydia screening program to be successful.