Study: Evaluation of Health Map: a patient centred web based service for supporting HIV infected patients
Researchers: Gamage DG, Sidat M, Read T, Cummings R, Bradshaw CS, Howley K, Fehler GF, Chen MY and
Publication: Sexual Health 2011; 8 194 - 198
Summary: Our aim was to describe the use of and responses to a self-management website, ‘Health Map’, established to address the key chronic health issues of HIV-positive people. Health Map assessed health issues against current commendations for: treatment adherence, monitoring CD4 counts and viral load, psychological health and physical activity, vaccination, cholesterol, fasting blood sugar, blood pressure, alcohol consumption, smoking, body mass index, and cervical screening for women and sexually transmissible infection (STI) screening for men who have sex with men (MSM). A total of 552 people, with a mean age of 37 years, completed the full ‘Health Map’ program, of whom 536 (97%) were Australian, 425 (77%) were male, including 268 (63%) MSM. Online responses to several health indices were of concern: 49% missed at least one dose of antiretroviral therapy per month and only 41% had had an HIV viral load test in the 4 months prior. Only 43% reported regular physical activity, and 49% and 61% reported vaccination for hepatitis A and B. The proportion tested within the recommended periods for fasting cholesterol (40%), fasting blood sugar (35%) and cervical screening (43%) in women or STI screening for MSM (53%) were low. A substantial proportion of individuals completing the online survey reported information that would suggest their HIV and more general health care is suboptimal. These data are consistent with community surveys and indicate the need for improvement in the chronic management of HIV.
Study: Effects of periodic presumptive treatment (PPT) on three bacteria sexually transmitted infections
and HIV among female sex workers in Port Moresby, Papua New Guinea
Researchers: Bruce E, Bauai L, Masta A, Rooney PJ, Paniu M, Sapuri M, Keogh L, Kaldor J, and Fairley CK
Publication: Sexual Health 2011; 8: 222- 228
Summary: To determine if 3-monthly periodic presumptive treatments (PPT) would reduce the prevalence of STIs in female sex workers (FSW) in Port Moresby, Papua New Guinea between November 2003 and September 2004. FSW were enrolled, counselled and interviewed. Informed consent was obtained. Testing for Chlamydia trachomatis (Ct), Neisseria gonorrhoeae (Ng) and Trichomonas vaginalis (Tv) and serology for HIV were performed at baseline and final follow-up visits. Each FSW received 3-monthly oral amoxicillin, probenecid, a combination of amoxicillin and clavulanic acid, and azithromycin on 4 occasions. Tinidazole was administered once. The cohort consisted of 129 FSW at baseline and 71 at final follow-up visit. There was a significant decline in the proportion with positive Ct from 38% to 16% (P = 0.001), Ng from 56% to 23% (P = <0.001) and Tv from 62% to 30% (P = <0.001) between baseline and the final follow-up visit. HIV prevalence increased from 15% to 21% (P = 0.125). PPT was effective in reducing STI but rates rebounded rapidly. Several new HIV infections occurred. If PPT is to be effective in FSW where the prevalence of STIs is so high, then 100% condom use with clients and regular sexual partners (RSP) and high rates of notification of RSP are required to reduce incidence and prevalence of STIs.
Study: Maximising retention in a longitudinal study of genital Chlamydia trachomatis among young women in
Researchers: Walker J, Fairley CK, Urban E, Chen MY, Bradshaw CS Walker S, Donovan B, Tabrizi SN, McNamee K, Currie M, Pirotta M, Kaldor JK, Gurrin LC, Birden H, Harindra V, Bowden F, Garland SM, Gunn J, Hocking JS
Publication: BMC Public Health; 2011: 11:56
Summary: The Chlamydia Incidence and Re-infection Rates Study (CIRIS) was a longitudinal study of Australian women aged 16 to 25 years recruited from primary health care clinics. They were followed up via the post at three-monthly intervals and required to return questionnaires and self collected vaginal swabs for chlamydia testing. The protocol was designed to maximise retention in the study and included using recruiting staff independent of the clinic staff, recruiting in private, regular communication with study staff, making the follow up as straightforward as possible and providing incentives and small gifts to engender good will. The study recruited 66% of eligible women. Despite the nature of the study (sexual health) and the mobility of the women (35% moved address at least once), 79% of the women completed the final stage of the study after 12 months. Loss to follow up was associated with a lower education level, recruitment from a sexual health centre as opposed to a general practice clinic and previously testing positive for chlamydia. No other factors such as age, numbers of sexual partners were associated with loss to follow up. The methods used were considered effective for recruiting and retaining women in the study.
Study: The difference in determinants of Chlamydia trachomatis and Mycoplasma genitalium in a sample of
young Australian women
Researchers: Walker J, Fairley CK, Bradshaw CS, Tabrizi SN, Chen MY, Twin J, Taylor N, Donovan B, Kaldor JK, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden F, Gunn J, Pirotta M, Gurrin L, Harindra V, Garland S and Hocking JS
Publication: BMC Infectious Diseases; 2011: 11:35
Summary: A cohort of 16 to 25 year old Australian women were recruited from primary health care clinics to determine chlamydia and MG prevalence and incidence using vaginal swabs collected at recruitment. Among 1116 participants, chlamydia prevalence was 4.9% and MG prevalence was 2.4%. Younger women were more likely to have a chlamydia infection, and younger age was not associated with MG infection. MG was associated with vaginal discharge, but chlamydia showed no associations with any reported symptoms. Having two or more partners in the last 12 months was more strongly associated with chlamydia than MG. Unprotected sex with three or more partners was less strongly associated with chlamydia than MG These results demonstrate significant chlamydia and MG prevalence in Australian women. The differences in strengths of association between numbers of sexual partners and unprotected sex for infection with chlamydia and MG may be due to differences in the transmission dynamics between these infections.
Study: HIV knowledge, risk perception and safer sex practices among female sex workers in
Port Moresby, Papua New Guinea
Researchers: Bruce EA, Bauai L, Sapuri M, Kaldor JM, Fairley CK, Keogh LA
Publication: International Journal of Women’s Health; 2011:3: 53–61
Summary: The study explored the extent to which knowledge of HIV and perception of risk influence safer sex practices among female sex workers (FSWs) in Port Moresby, Papua New Guinea. FSWs. Qualitative data were collected using semistructured interviews with 142 FSWs through focus group discussions and 32 individual interviews. Despite some common misperceptions, most FSWs were basically aware of the risks of HIV and informed about transmission and prevention. Most reported using condoms ‘sometimes’ (79%), and 15% ‘never’ used condoms. Only 6% always used condoms with clients, and none used condoms with their regular sexual partners (RSPs). Among these FSWs, being knowledgeable about the risks, transmission and prevention of HIV did not translate into safe sex. The findings suggest that there are barriers to safer sex practices that could heighten HIV vulnerability and possibly be responsible for infection in FSWs. Specific interventions that focus on improving condom self-efficacy in FSWs and simultaneously target clients and RSPs with safer sex messages are recommended.
Study: Low Incidence of bacterial vaginosis in cohort of young Australian women
Researchers: Fethers KA, Fairley CK, Morton A, Hocking JS, Fehler G, Kennedy LJ, Bradshaw CS.
Publication: Sexually Transmitted Diseases 2011; 38(2): 124-126
Summary: The study was conducted in women aged between 17 and 21 years attending the University of Melbourne. This population has a low prevalence of BV of 4.7%. Women with no previous history of BV could participate in the 12-month cohort study. A questionnaire and study kit to self collect vaginal samples was posted to participants every 3 months for 12 months. Women who developed incident BV during the 12 month study period were no longer included in the cohort. The study showed that incident BV was uncommon in young women from a low prevalence population who had low numbers of sexual partners, and importantly, was absent in women reporting no sexual activity. These data should provoke further interest in the association between BV and sexual activity and inform the debate about possible sexual transmission of BV.
Study: The job satisfaction of female sex workers working in licensed brothels in Victoria, Australia
Researchers: Bilardi JE, Miller A, Hocking JS, Keogh L, Cummings R, Chen MY, Bradshaw CS and Fairley CK
Publication: J Sex Med 2011; 8:116–122
Summary: The job satisfaction levels and standards of living of sex workers in licensed brothels in Victoria were compared with Australian women. Survey data was compared with identical questions from the Households, Income and Labour Dynamics, Australia Survey. A structured survey was undertaken with sex workers attending sexual health services at Melbourne Sexual Health Centre. Of 112 sex workers who agreed to participate in the study, 85 (76%) completed the survey. The average number of years women had been working as sex workers was three (range 1 month – 18y). The main reasons women started sex work was because “they needed the money” (69%), 44% were attracted to the flexible hours and 43% had a particular goal in mind. The two biggest concerns women had about sex work were their safety (65%) and the risk of sexually transmitted infections (65%). Women reported that they primarily do sex work for financial gain although a significant minority preferred sex work to other work that they would be likely to do.