20. SEXUAL HEALTH SERVICES & HIV PREVENTION: IMPROVING INTERVENTION OPPORTUNITIES

Abstract

Objective: This descriptive study was undertaken to determine the presence of key indicators which might alert clinicians that a Melbourne Sexual Health Centre (MSHC) client is at increased risk of HIV acquisition and, if so, lead to recommendations for changes to clinical practice.

Method: We identified and reviewed the most recent medical files of clients who received an HIV positive diagnosis and who had also received a negative result at MSHC within the preceding two years (n = 20). Quantitative epidemiological and demographic data were collected and analyzed using SPSS software. Qualitative data analysis of annotated entries both pre and post HIV diagnosis included transcription and examination for emergent themes.

Results: Quantitative data analysis revealed the following; all 20 clients were male and identified MSM behaviour. Median age at diagnosis was 34.5 years (95% CI : 28.3-37.6 years). The median number of partners in the 3 months preceding HIV diagnosis was 4 (95% CI : 3.4-9.6; p = 0.005) and in the preceding 12 months 23 (95% CI : 11.4-61.4; p < 0.05). 85% of men reported inconsistent condom use, and one reported no anal sex in the preceding 12 months. None reported a history of IDU and three men reported sex overseas in the preceding 12 months.

Qualitative analysis revealed some emergent themes which included histories of mental illness, drug and alcohol use, childhood abuse, HIV serodiscordant relationships and confusion surrounding sexual orientation.

Discussion: Clinicians have an obligation to assist clients, within their scope of practice, to remain HIV negative. Results from this study have implications for the method of identification of clients at risk and also for the utilization of intervention opportunities which impact on risk behaviour. The challenge for MSHC is to adapt our practice in order to maximize these opportunities.