Volume 14 Number 3 2017
SH16013Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis
This is the first systematic review and meta-analysis to exame the prevalence of HIV among Australian Aboriginal and Torres Strait Islander people. Although our study suggests the prevalence of HIV is low, the potential for HIV to increase exists especially among Aboriginal gay men and Aboriginal people who inject drugs. More community-based studies that are designed and implemented by Aboriginal people are needed that include Aboriginal people at risk and Aboriginal women. These studies need to exmine effective prevention messages, promote regular testing of at risk individuals to identify new infections early and trial culturally appropriate community and clinical strategies and support programs for Aboriginal people living with HIV.
SH16177Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic
Women living in regional Queensland have limited access to medical termination of pregnancy (MToP) services. Abortion also remains in the Queensland Criminal Code leading to the potential criminal prosecution for both the woman and the provider. However, Cairns Sexual Health Service has been providing MToP services for 10 years demonstrating that this service can be safely and successfully integrated into a primary health care setting. This paper documents the clinical practice, the characteristics of the women undergoing the procedure and the outcomes over the past 5-year period at Cairns Sexual Health Service.
SH16131Psychometric properties of the Female Sexual Function Index in the visual analogue scale format
The FSFI-VAS has internal consistency, construct validity, discriminant validity and reproducibility adequate to assess female sexual dysfunction in young women.
On a large gay website, we investigated factors associated with excluding or including HIV-positive men as potential sex partners among 57 178 Australian profiles. Being younger, living outside major cities, not identifying as gay, always preferring safer sex and being of either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.
SH16150Exploring the role of sex-seeking apps and websites in the social and sexual lives of gay, bisexual and other men who have sex with men: a cross-sectional study
This study examined the social and sexual factors associated with online sex seeking in a sample of 774 gay and bisexual men recruited using respondent-driven sampling. Results indicate that men who used apps and websites to seek sex were not significantly less likely to participate in the gay community and, in fact, were less likely to be socially isolated from other gay men. However, these men exhibited lower emotional attachment to the gay community and differing patterns of seroadaptive risk management with their recent sexual partners.
SH16165Outcomes following detection of low level plasma HIV RNA in HIV-infected patients previously virologically suppressed on antiretroviral therapy: a retrospective observational study
Almost a quarter of HIV patients managed at the Alfred Hospital had an episode of detectable viral load between 20 and 200 copies/mL. Of these, half were an isolated viral blip, and only 7% of those with persistent low level viremia progressed to virological failure. Clinician management of low level viremia was generally conservative.
SH16135Sexuality-related attitudes significantly modulate demographic variation in sexual health literacy in Tasmanian university students
Previously demonstrated differences in sexual health literacy among university students by birthplace and religion were robust to adjustment for demographics and sexual education. Using factor analysis, three constructs for attitudes regarding sexual morality were generated, corresponding to sexually conservative attitude, more sexually libertine attitude, and negative attitudes toward persons with HIV. These three attitudinal constructs were able to account for much of the differences in sexual health literacy by birthplace and religion which adjustment for sexual education could not. These results indicate the potent impact of attitude and belief on sexual health literacy and support cultural framing in the design of sexual education programs.
SH16171Sexual health knowledge and behaviour of young Sudanese Queenslanders: a cross-sectional study
This study explored the sexual health knowledge, attitudes and behaviours of young Sudanese Queenslanders (n = 229). Patterns of sexual behaviour among this predominately refugee-background group are not dissimilar to those of other young Australians. However, the self-reported patterns of risk behaviour combined with relatively low levels of sexually transmissible infection and HIV knowledge suggest this group of young people remain sexually vulnerable. These findings support the need for sexual health education and interventions that address the contextualised needs for this group of young people, particularly early within their resettlement experience.
SH16137Chlamydia retesting and retest positivity rates: results from a state-wide laboratory data linkage study in Tasmania, 2012–13
In this whole-of-state, population-level data linkage study, chlamydia retesting rates and retest positivity rates were measured in individuals aged 15 to 29 years. Retesting rates were low, and retest positivity was high, reinforcing the importance of promoting safer sex practices to prevent re-infection, partner notification and treatment, and retesting to minimise the risk of long-term sequelae.
SH16202Utility of risk-based chlamydia testing in primary care: analysis of retrospective surveillance data among women in Melbourne, Australia
The present study used retrospective surveillance data to estimate chlamydia incidence rates and identified risk factors for infection among women. Chlamydia incidence declined with age; however specific risk behaviours were associated with infection among older women. Chlamydia control remains a challenge, with uncertainty about the best approach; testing among older women at least, should be informed by risk.
SH16123Patient, staffing and health centre factors associated with annual testing for sexually transmissible infections in remote primary health centres
In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009–10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of annual re-testing was determined, along with the associated patient, staffing and health centre factors.
SH16181Increasing yield of pharyngeal Chlamydia trachomatis among male gay and bisexual clinic attendees in Sydney: an observational study
Among 5445 Chlamydia trachomatis (CT) testing occasions during a 4-year study period, we observed a significant increase in yield of pharyngeal CT testing, although yield of anogenital CT testing remained stable. Without pharyngeal CT testing, over a quarter of pharyngeal CT infections and almost 5.0% of all CT infections would not have been treated.
SH16036Managing two decades of visceral leishmaniasis and HIV co-infection: a case report that illustrates the urgent research needs in the field
This case report highlights the challenges of diagnosis, monitoring and treatment in a visceral leishmaniasis and HIV co-infected patient. This patient developed multiple complications including renal and liver failure, pancytopenia with recurrent sepsis as well as anal cancer, depression and poor quality of life. Urgent research specific to this cohort is needed, with an emphasis on accessible and affordable treatment options.
SH16087First four failures of cefathiamidine to treat urogenital gonorrhoea in Guangzhou, China, 2014–15
Four patients residing in China with urogenital gonorrhoea firstly failed to treat with 1000 mg cefathiamidine intramuscular. Ceftriaxone is still an effective treatment option for gonorrhoea in China. Continued monitoring of Neisseria gonorrhoeae susceptibility to cefathiamidine as well as ceftriaxone is imperative.
Data from the Second Australian Study of Health and Relationships (ASHR2) was used to ascertain the associations between sex education and sexual health outcomes, including history of sexually transmissible infection (STI), early pregnancy, contraception use at first sex and level of STI knowledge. A total of 19 836 Australians provided information on sex education and these data were analysed using logistic regression. After adjusting for age, education and non-English-speaking background, the odds of using contraception at first sex and a high level of STI knowledge were increased in respondents reporting sex education that included information on condoms and contraception.
SH16102Undiagnosed hepatitis B and C infection is rare in Sydney gay and bisexual men attending a community HIV testing site
This study assessed the acceptability of cervicovaginal self-sampling among Portuguese women. Most of the participants considered self-sampling a well-accepted method and felt no pain, no discomfort and no complexity. The willingness to repeat self-sampling was also reported by the majority of participants. Comparing self-sampling with physician-sampling experiences, women found the former less embarrassing, more comfortable or pleasant, less painful and considered it as the preferred method.
The peer-reviewed and edited version of record published online before inclusion in an issue
SH16164Attitudes to sexual health in the United States: results from a national survey of youth aged 15–25 years
Data from a large panel survey show that American youths’ attitudes to sexual health fit well with global sexual health definitions. Survey respondents believed dimensions of sexual health such as emotional fulfilment, pleasure, and mutual benefits in relationships were important components of overall sexual health. Increasing belief in the importance of sexual health was associated with sexual activity and also condom use and health care use.
SH16207Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001–2013: a population-based cohort study
This large data-linkage study of Western Australian women found significant increases in both chlamydia and gonorrhoea testing using nucleic acid amplification tests between 2001 and 2013. During this same period, chlamydia positivity remained highest in young Aboriginal women, at around 15%, with little change observed between overtime and despite increases in positivity in young non-Aboriginal women. Further gonorrhoea positivity was at least 10 times greater in young Aboriginal women than their non-Aboriginal counterparts. More effective prevention strategies and continued surveillance of chlamydia and gonorrhoea testing, positivity by age and risk groups are needed to address these disparities.
SH16190Analysis of transmitted HIV drug resistance from 2005 to 2015 in Victoria, Australia: a comparison of the old and the new
This study outlines HIV-1 transmitted drug resistance to HIV-1 protease, reverse transcriptase and integrase inhibitors in Melbourne, Victoria from 2005 to 2015. During this time, there was a statistically significant decline in the prevalence of mutations at codons M41, K103 and T215 in the reverse transcriptase gene, but none for the protease. The presence of integrase inhibitor resistance mutations was assessed from 2010 to 2015 and found to be negligible.
SH17068Rates of advertised condomless sex in the online profiles of private sex workers: a cross-sectional study
This study assessed the rate of condomless sex advertised in the online profiles of private sex workers in Sydney. None advertised condomless anal or vaginal sex and 50% advertised condomless oral sex. Age less than 25 years was associated with advertised condomless oral sex.
SH16046Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services
In this retrospective study, routine records on gonorrhea testing at four Aboriginal community controlled health services in Australian urban and regional settings were analysed. The proportion of patients aged 15–29 who were tested each year increased over time, and results were more often positive in people who also had chlamydia. Overall positivity was 1.6%, substantially lower than in remote communities of central and northern Australia, but high enough to justify routinely duplex testing for gonorrhea and chlamydia.
SH16076Association between sexually transmissible infection testing, numbers of partners and talking to partners and friends about sexual health: survey of young adults
This study investigated the influence of partner and friendship networks on young adults (aged 18–30) sexually transmissible infection (STI) testing. Recruiting from nightlife precincts, 167 young people self-completed a questionnaire. Talking to partners and friends about STI testing was associated with testing rates for young adults, and increased numbers of sexual partners may be associated with the promotion of STI testing among friends and partners. Understanding young adult partner and friendship networks and their influence on STI testing practices may enhance health promotion efforts to increase testing for this group.
SH17004Abortion: findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey
This study of a population sample of women and men in Australia aged 18–50 years revealed that experience of abortion is common: one in six women and one in 10 men reported experiencing or being a partner in an abortion. Women who were socially disadvantaged, reported not being comfortable negotiating contraceptive use, and men who lived in a metropolitan area were more likely to report having experienced, or being a partner in, an abortion. Reporting past experiences of sexual coercion increased the likelihood of reporting abortion among both women and men.
SH16198How partnership type and HIV seroconcordance affect HIV transmission risk in regular sexual partnerships: a cross-sectional survey of Australian gay and bisexual men
Regular sexual partnerships among gay and bisexual men who practice condomless anal intercourse have not been well characterised in terms of partnership type, HIV seroconcordance and risk of HIV transmission. Primarily sexual regular partnerships (i.e. ‘fuckbuddies’) are common among gay men, but have largely been ignored in research and HIV prevention. Condomless sex is more common among regular sexual partnerships considered to be of a romantic, committed nature. However, factors associated with such romantic or committed partnerships can also protect against HIV transmission risk. Partnerships where one or both partners’ serostatus is unknown present the greatest transmission risk, especially those of a primarily sexual nature.
SH16235Contraception – what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service
This research analysed 2438 responses from men using an online dating site on contraceptive, knowledge attitudes and beliefs. We found high contraceptive use, especially vasectomy, and a desire to be part of the decision making, especially in long term relationships. However there was low awareness of some of the more effective methods and misperceptions about method safety, especially the emergency contraceptive pill.
SH17016Effect of attitudes towards patients on sexual history taking: a survey of Iranian–American physicians in California, USA
This is the first descriptive cross-sectional survey of Iranian–American physicians, a subpopulation of physicians, as providers of sexual health care practicing in California, USA (n = 354). The experience of dual process of cultural influences (i.e. both home and the main stream cultures) are important factors affecting these physicians’ involvement in sexual history taking. This is a significant neglected area in sexual health care which highlights the need to have a greater understanding of influential factors regarding physicians who share similar conservative cultural backgrounds. These findings support the need for development of new strategies that reflect on physicians’ attitude as providers of sexual health care.
SH16146Testing for chlamydial infection: are we meeting clinical guidelines? Evidence from a state-level laboratory data linkage analysis for 15- to 29-year-olds
This data linkage study of all chlamydia tests conducted in 15-29 year olds at a state population level over a 2-year period, enables population rates of testing and test positivity to be reported. Results are compared to clinical guidelines and to the estimated testing levels required to reduce chlamydia prevalence. Chlamydia testing rates are lower than recommended levels in both males and females. This study provides a robust methodology that can meet the requirements of the Australian National Sexually Transmissible Infections Strategy by monitoring testing coverage and providing evidence to evaluate prevention and control programs.
SH16240Prospective cohort study of childhood behaviour problems and adolescent sexual risk-taking: gender matters
Externalising (delinquent, aggressive) and internalising (anxious/depressed, withdrawn) behaviour problems are common in childhood. In a population-based birth cohort (the Western Australian Pregnancy Cohort (Raine) study), this study sought to determine relationships, by gender, between childhood behaviour problems and adolescent risky sexual behaviours and substance use. Externalising behaviour problems from as early as 5 years old in boys and 8 years old in girls predict a range of risky sexual behaviours in adolescence.
SH16238Factors associated with unwanted sexual experiences of young Australian females: an observational study
Sexual abuse and paedophilia are pervasive contemporary global issues. Thus raising awareness of the associated short and long term outcomes for the abused is pertinent to making sure relevant support systems are in place. We show that sexual behaviours and mental health are associated with childhood and adolescent unwanted sexual experiences (USEs) in young Australian females, but were unable to determine the direction of these associations. Longitudinal studies should be conducted to investigate whether there are groups of individuals who are at a high risk of experiencing childhood USE, so that high quality support services can be provided to these individuals.
SH16034Prevalence and correlates of condom use among sexually active men who have sex with men in the United States: findings from the National Survey of Family Growth, 2002, 2006–10 and 2011–13
This study estimated the overall prevalence of condom use at last sex and by sexual risk behaviours among sexually active men who have sex with men (MSM) in the preceding 12 months. Approximately 31% of all MSM and 30–38% of MSM who reported at least one sexual risk behavior reported condom use at last sex. Race, recent STI diagnosis, and relationship status were associated with condom use at last sex. There was no difference in temporal trends in condom use at last sex across the three NSFG cycles. Continued promotion of consistent condom use mitigates HIV and STI risk and complements the effectiveness of new HIV prevention modalities such as pre-exposure prophylaxis.
SH17026UK healthcare professionals’ uncertainties, barriers and facilitators to the introduction of targeted human papillomavirus vaccination for men who have sex with men
Healthcare professionals’ recommendation is one of the strongest predictors of the human papillomavirus (HPV) vaccine uptake. Due to concerns about the compromised effectiveness of HPV vaccination in adult sexually active men who have sex with men (MSM), some UK healthcare professionals might be hesitant to promote the vaccine to their patients. There is an urgent need to develop guidelines on HPV vaccination for MSM, raise awareness about HPV-related diseases in MSM, and enable integrated clinic procedures on vaccinations in order to achieve optimal uptake.
Gender dysphoria is associated with significant health disparity. Although specialised interventions such as endocrine therapy and surgery are safe and effective, mortality for the transgender population remains substantially higher than the general population. Primary health care is one of the components that contribute to health discrepancy for transgender individuals, but the medical needs of transgender patients are often misunderstood. This paper addresses some of the main primary care issues for transgender populations.
SH17073Sexual risk behaviours associated with unlicensed driving among young adults in Miami’s electronic dance music nightclub scene
This study examined sexual and other risk behaviours among young adults in Miami, Florida, comparing unlicensed driving (UD) offenders and non-UD offenders. Compared with others, UD offenders were more likely to report additional sexual risk behaviours. Results suggest that locating sexual risk reduction interventions inside of the justice system would benefit UD offenders.
SH16054Partnership agreements less likely among young gay and bisexual men in Australia – data from a national online survey of gay and bisexual men
In this paper differences in partnership agreements among gay and bisexual men (GBM) were assessed. The ability to communicate with a partner about sexual agreements has important sexual health implications for GBM. Regarding the nature of their partnership with their primary regular partner, younger men were less likely to have an agreement of any sort and were less likely to have discussed it. Due to less communication with partners about sexual agreements, when young GBM engage in sexual risk behaviour they may be at an increased risk of HIV and other sexually transmissible infections.
This article reviews problems with the Safe Schools program in Australia which seeks to protect lesbian, bisexual, gay, transgender and intersex young people from bullying. The information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm because it promotes gender transitioning without expert medical advice. The great majority of children resolve gender dysphoria issues around the time of puberty.
This article discusses transgender and gender diverse (TGD) student rights in a range of Australian laws and education policies. It shows how the inclusion of TGD students, particularly in sexuality education, is reinforced in the current Australian National Curricula. Finally, it considers research on Australian TGD students’ educational attainment, experiences of transphobic abuse and violence, and experiences in contexts where they do and do not have staff (and other) support. It promotes a shift from harmful approaches of victimising TGD students, towards celebrating their resilience and social contributions.
SH16149Active syphilis and its association with HIV and sexual risk behaviours in a multicity sample of men who have sex with men and transgender women in Peru
Syphilis in Peru is heavily concentrated among men who have sex with men (MSM) and transgender women (TGW). A cross-sectional analysis was conducted to better understand the correlates of active syphilis infection using a multicity sample of over 5000 MSM and TGW in Peru. Findings support the need for combined HIV and syphilis screening among MSM and TGW populations and also indicate differing syphilis epidemics throughout the country and in populations of TGW.
Few studies have examined smoking and female sexual difficulties. Data for this study came from the Second Australian Study of Health and Relationships (2012–13), which includes a representative sample of 18 427 sexually active Australian men and women (aged 16–69 years). Current tobacco smoking was associated with sexual difficulties in both men and women. This was more evident among male heavy smokers. For women, even light smoking was associated with not finding sex pleasurable and being unable to come to orgasm.
SH16179Pregnant young women’s attitudes about microbicides: the anticipated influence of the grandmother and father of the baby on microbicide use
Pregnant young women’s attitudes about their grandmother and father-of-the-baby’s role in decision-making and involvement in microbicide use were assessed. Greater grandmother involvement in microbicide use was significantly associated with being younger, having no reproductive tract infection or contraceptive-ring-use history. Greater father involvement in use was associated with being in a relationship with him. Strategies for engaging grandmothers and fathers in microbicide use should be developed.
This study describes men’s sexual difficulties and barriers to reproductive health care in the Solomon Islands. The study included qualitative inquiry and a quantitative quasi-randomised quota sample household survey. Only a few men had ever sought professional health care for reproductive health problems, while many men preferred to use kastom medicine for sexual problems. Comorbid non-communicable diseases, low health-related quality of life and dissatisfaction with sexual relationships were independently correlated with sexual difficulties. The findings strongly suggests the need for comprehensive health services that are gender-specific and sensitive to the sexual difficulties of Islander men.
SH16162Prevalence of porA pseudogene deletion among Neisseria gonorrhoeae isolates referred to the UK
Some laboratories use porA pseudogene targeted real-time polymerase chain reactions to confirm the Neisseria gonorrhoeae status of clinical specimens, however porA negative strains have been sporadically reported. In this UK study, less than 0.4% (2/533) of gonococcal isolates examined were determined to porA-negative isolates. Low prevalence indicates that although these isolates do not present a major public health problem, microbiologists should remain vigilant.
SH16221Reporting pre-exposure prophylaxis use in Craigslist personal advertisements among men seeking sex with men in the United States
This study describes the self-reported use of pre-exposure prophylaxis (PrEP) in the personal advertisements of men seeking sex with men in the United Sates on the online classified advertisement site, Craigslist. Overall use of PrEP in personal advertisements was low. However, self-reported PrEP use was often in conjunction with other sexual risk behaviours. Findings underscore the need for increased public PrEP awareness, particularly among men seeking sex with men, as well as the importance emphasising sexually transmissible infection prevention behaviours (i.e. condom use) used in conjunction with PrEP.
SH17037Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection
With increasing rates of syphilis among men who have sex with men (MSM), strategies to increase syphilis screening of MSM that are tailored to particular contexts should be implemented.
SH16151Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database
The widespread availability of direct-acting antivirals (DAAs) is expected to drastically improve the treatment uptake and cure rate of hepatitis C virus (HCV). This paper assesses rates of and factors associated with HCV treatment uptake and cure in the HIV co-infected population in Australia before access to DAAs to establish a baseline for a new treatment era.
SH16160When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice system
Detained African American adolescent girls are particularly vulnerable to contracting HIV/STIs when compared to other adolescent populations. This study examines the heightened risk for HIV/STIs when HIV/STI knowledge is high by applying the principle of least interest to understand sexual risk-taking among a detained sample of young African American women. Although some girls had a high degree of knowledge regarding the transmission of HIV/STIs, this knowledge interacted with the endorsement of a relationship imperative to increase HIV/STI risk among this group. Risk reduction interventions are needed that acknowledge the vulnerabilities for this population and increase the opportunities for appropriate HIV/STI prevention efforts.
SH16183Disclosure of newly diagnosed HIV infection and condom use at first sex after diagnosis: a study of young Black men who have sex with men
Among 125 HIV-infected young Black men who have sex with men, 70% disclosed their HIV status to the first male partner they had sex with following diagnosis. Men not making this same disclosure were about three times more likely to report condomless sex with that first, post-diagnosis, male partner. Not disclosing HIV serostatus was associated with perceiving a greater level of partner-related barriers to condom use.
This case report demonstrates that vesicovaginal fistula can be caused by the consensual use of sex toys between same-sex partners. Increased information is needed on the connection between sex toy use and trauma.
These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.
Syndromic Management of Sexually Transmitted Infections in Resource-Poor Settings: A Systematic Review with Meta-Analysis of the Abnormal Vaginal Discharge Flowchart for Neisseria Gonorrhoea and Chlamydia Trachomatis
Kept clinical visits as scheduled in the first six months of antiretroviral treatment determine long-term treatment outcomes in people living with HIV: a large retrospective cohort study in China
Funding art for HIV-positive temporary residents in Australia prevents transmission and is inexpensive
Variability in Testing for HIV in Patients Treated with Tenofovir and Lamivudine Monotherapy for Hepatitis B Virus
Rates of advertised condomless sex in the online profiles of private sex workers: a cross sectional study.
Trends in chlamydia and gonorrhoea testing and positivity in Western Australian Aboriginal and non-Aboriginal women 2001-2013: a population based cohort study
Abortion: Findings from women and men participating in the Understanding Fertility Management in contemporary Australia national survey
Analysis of transmitted HIV drug resistance from 2005 to 2015 in Victoria, Australia: a comparison of the old and the new.
Attitudes to Sexual Health in the United States: Results from a National Survey of Youth Aged 15 – 25 Years
Developing the evidence-base for gender and age-relevant school sex education; questionnaire findings from an adolescent sample using an augmented Theory of Planned Behaviour
How partnership type and HIV seroconcordance influence HIV transmission risk in regular sexual partnerships: A cross-sectional survey of Australian gay and bisexual men
Uriswab – an effective transport medium for nucleic acid detection of Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae
The association between sexually transmissible infections testing, numbers of partners, and talking to partners and friends about sexual health: survey of young adults
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