Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Sexual Health

Sexual Health

Sexual Health publishes contributions on sexual health from the widest perspectives including HIV/AIDS, STIs, issues of sexuality, and reproductive health. Read more about the journalMore

Editors: Christopher Fairley and Roy Chan

Current Issue

Sexual Health

Volume 13 Number 6 2016

SH16037Is sexual content in new media linked to sexual risk behaviour in young people? A systematic review and meta-analysis

Lucy Watchirs Smith, Bette Liu, Louisa Degenhardt, Juliet Richters, George Patton, Handan Wand, Donna Cross, Jane S. Hocking, S. Rachel Skinner, Spring Cooper, Catharine Lumby, John M. Kaldor and Rebecca Guy
pp. 501-515

This is the first systematic review and meta-analysis of sexting and sexually explicit websites and young people’s sexual practices and attitudes. The meta-analysis suggests that sexual content in new media is linked to sexual risk behaviour in young people and that further longitudinal research in this area is warranted.


This is a systematic review of empirical studies on the effects of stigma on HIV disclosure to sex partners. The review indicates that studies should use precisely defined measurements in their matching context. Particular types of stigma, types of sex partners, and demographic characteristics are factors that may influence HIV disclosure.

SH15132Opportunities to increase rates of human papillomavirus vaccination in the New South Wales school program through enhanced catch-up

Christine Staples, Michelle Butler, Jennifer Nguyen, David N. Durrheim, Patrick Cashman and Julia M. L. Brotherton
pp. 536-539

Australia’s school-based human papillomavirus (HPV) vaccination program provides an ideal opportunity to reach the traditionally ‘hard to reach’ adolescent cohort. Maximising uptake of this program is important for the health of Australian adolescents into the future. This paper identifies that logistical issues with program delivery are the main reasons why HPV vaccine courses remain incomplete.

SH16061Predisposing, enabling and need-for-care predictors of adolescents’ intention to use sexual health services

Nancy F. Berglas, Katherine Hucles, Norman A. Constantine, Petra Jerman and Louise A. Rohrbach
pp. 540-548

This study examined the influence of various factors on adolescents’ intention to use sexual health services among a sample in Los Angeles (n = 600). In hierarchical regression models, predisposing and enabling factors (e.g., knowledge and beliefs, awareness of services, perceived accessibility) predicted intention to use services, but sexual experience did not. These findings underscore the need for interventions that provide information, encourage positive beliefs about health care, and promote access to sexual health services for all adolescents.


Geosocial-networking smartphone applications (apps) have been used increasingly by men who have sex with men (MSM) to meet new sexual partners. The purpose of this study was to examine associations between contexts of app use (e.g. using apps when drinking) and condomless anal intercourse among a sample of MSM who use these apps. Given that 57.5% of respondents had engaged in condomless anal intercourse in the preceding 3 months and the associations of using apps when using alcohol and other drugs with condomless sexual behaviours, these findings suggest that reductions in substance use may lead to safer sexual practices among MSM who use apps to meet sexual partners.

SH16092Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia

Jason J. Ong, Andre Landika, Christopher K. Fairley, Catriona Bradshaw, Marcus Chen, Tim R. H. Read and Eric P. F. Chow
pp. 555-559

A retrospective analysis of 40 395 consultations with men who have sex with men (MSM) attending Melbourne Sexual Health Centre showed that men who received non-occupational post-exposure prophylaxis (NPEP) were more likely to report ever having injected drugs, more than three male partners in the past 3 months and inconsistent condom use with these partners within the past 3 months, and were more likely to test positive for any sexually transmissible infection. This reinforces that MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP. Therefore, we conclude that NPEP is currently being used by MSM at higher risk for HIV and that consultations for NPEP is an opportune time for discussing other effective biomedical interventions such as pre-exposure prophylaxis for HIV.

SH16027Characteristics of gay, bisexual and other men who have sex with men testing and retesting at Australia’s first shop-front rapid point-of-care HIV testing service

Kathleen E. Ryan, Anna L. Wilkinson, David Leitinger, Carol El-Hayek, Claire Ryan, Alisa Pedrana, Margaret Hellard and Mark Stoové
pp. 560-567

A summary of the first 12 months of testing at PRONTO!; Australia’s first community-based, shop-front, peer-led rapid point-of-care HIV testing service. The service attracted gay bisexual and other men who have sex with men (GBM) with no previous testing history, and GBM reporting high risk for HIV transmission. Retesting within 6 months was observed among 23% of GBM. Service refinements are needed to increase repeat testing.

SH16025High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009–2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening

Linda Garton, Amalie Dyda, Rebecca Guy, Bronwyn Silver, Skye McGregor, Belinda Hengel, Alice Rumbold, Debbie Taylor-Thomson, Janet Knox, Lisa Maher, John Kaldor, James Ward and on behalf of the STRIVE Investigators
pp. 568-574

Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. A key strategy recommended for reducing rates of CT and NG is testing for reinfection at 3 months post treatment (re-testing). Using longitudinal laboratory testing data from 65 remote communities, we assess patterns in re-testing and levels of repeat CT and NG positivity in this priority setting.

SH16051Sexually transmissible infection and HIV prevention and treatment for young male sex workers in Vietnam: findings from the SHEATH intervention

Michael C. Clatts, Lloyd A. Goldsamt, Lê Minh Giang, Lê Quôc Báo, Gary Yu and Donn Colby
pp. 575-581

Young male sex workers (YMSW) in Vietnam have low levels of HIV and sexually transmissible infection knowledge, and limited engagement with health services. The SHEATH Intervention, derived from Harm Reduction and Sexual Health Promotion, was delivered to 919 out-of-treatment YMSW in Hanoi and Ho Chi Minh City. Results indicate that the intervention was well-received and that participants expressed high levels of intentions to visit healthcare providers in the next 6 months and disclose to these providers that they engaged in sex with other men.


Despite the remarkable advances in HIV treatment in the past two decades, people living with HIV (PLHIV) have continued to experience HIV-related stigma and discrimination by healthcare workers worldwide. We used a questionnaire to explore the prevalence and nature of stigma and discrimination experienced by PLHIV in the healthcare setting in New Zealand. A total of 100 out of the 213 PLHIV (47%) who answered the questionnaire reported that they had ever experienced HIV-related discrimination by a healthcare worker. The findings of this study show that there is a need to continue to normalise the care of HIV and increase HIV education for healthcare workers.

SH16122Seasonal variation in gonorrhoea incidence among men who have sex with men

Bin Li, Peng Bi, Eric P. F. Chow, Basil Donovan, Anna McNulty, Alison Ward, Charlotte Bell and Christopher K. Fairley
pp. 589-592

A retrospective analysis of urethral gonorrhoea diagnoses among men who have sex with men (MSM) attending the three Australian sexual health services showed that more peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. The findings suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities.

SH16124Neisseria gonorrhoeae isolated from an unexpected site

Stella Pendle and Timothy Barnes
pp. 593-594

Neisseria gonorrhoeae was isolated from a nipple piercing wound in a homosexual man with pharyngeal gonoccocal carriage. Transmission to the wound may have been by direct oral contact or auto-inoculation via saliva. Wounds can readily harbour gonorrhoea and should be considered for testing in high risk groups.


People who repeatedly present for post-exposure prophylaxis (PEP) for prevention of HIV following a high-risk sexual exposure are of concern according to the British HIV Association PEP guidelines. A retrospective review of MSM patient notes from a 5-year period at one genitourinary medicine clinic showed that 107 of 929 MSM received more than one PEP prescription. Patients need to be offered and encouraged to take up behavioural risk reduction interventions at the time of each PEP prescription.

SH16155Prevalence of oral human papillomavirus in men attending an Italian sexual health clinic

Francesco Drago, Astrid Herzum, Giulia Ciccarese and Roberto Bandelloni
pp. 597-598

In this study, a high-risk population who did not have any overt signs of human papillomavirus (HPV) infection were examined. Oral HPV prevalence found in our study (37%) was much higher than previously reported. Considering this high prevalence of oral HPV, it is important to further investigate the burden of oral HPV not only in men who have sex with men, but also in heterosexual men and in women.

Online Early

The peer-reviewed and edited version of record published online before inclusion in an issue

Published online 05 December 2016

SH16132Comparing non-occupational post-exposure prophylaxis drug regimens for HIV: insights from a linked HIV surveillance system

Anna B. Pierce, Carol El-Hayek, Damien McCarthy, Jude Armishaw, Kerrie Watson, Anna Wilkinson, Brian Price, Edwina J. Wright, Jennifer F. Hoy and Mark A. Stoové
 

Data from the Victorian NPEP Service (VNPEPS) was linked with all Victorian HIV notifications to identify HIV seroconversions in NPEP users, and potential NPEP failures. Among MSM who presented to the VNPEPS following receptive anal intercourse with a source of unknown HIV serostatus (RAIU), possible NPEP failure occurred in 13 (0.7%) who were prescribed two drug NPEP and six (2.7%) who were prescribed three drug NPEP (P<0.001). This suggests that two-drug NPEP regimens do not result in excess seroconversions compared with three-drug regimens when used following RAIU.

Published online 05 December 2016

SH16075Self-reported testing and treatment histories among older Australian men and women who may be at risk of a sexually transmissible infection

Wendy Heywood, Anthony Lyons, Bianca Fileborn, Victor Minichiello, Catherine Barrett, Graham Brown, Sharron Hinchliff, Sue Malta and Pauline Crameri
 

A cross-sectional survey of 2137 Australians aged 60+ years that involved questions on STIs and STI testing was conducted in 2015. Less than one in three reported a STI test in the past 5 years (n = 241, 30%) while 6% (n = 51) reported a STI diagnosis. Among men, lower testing rates were associated with older age, identifying as heterosexual, lower educational attainment, not using online dating and reporting one partner in the past 5 years. For women, lower rates of testing were found among those who did not use a condom at their most recent sexual encounter and those with one partner in the past 5 years.

Published online 25 November 2016

SH16100HIV testing self-efficacy is associated with higher HIV testing frequency and perceived likelihood to self-test among gay and bisexual men

Muhammad S. Jamil, Rebecca J. Guy, Benjamin R. Bavinton, Christopher K. Fairley, Andrew E. Grulich, Martin Holt, Kirsty S. Smith, Marcus Chen, Anna M. McNulty, Damian P. Conway, Phillip Keen, Jack Bradley, Darren Russell, John M. Kaldor, Garrett Prestage and
 

An eight-item question block was used to construct a single broad measure capturing confidence in one’s perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) among higher risk gay and bisexual men. Higher self-efficacy was independently associated greater likelihood to self-test, and higher self-efficacy, partner numbers, and optimism regarding the effects of HIV treatments on HIV transmission were independently associated with higher frequency of HIV testing in the past year. Improving self-efficacy by enhancing knowledge and experience may lead to higher testing frequency among gay and bisexual men. The self-efficacy measure used in the present study could be useful in identifying men likely to face difficulties with HIV testing and self-testing.

Published online 25 November 2016

SH16109Daily diary study of adult men’s and women’s event-level sexual motivations and sexual behaviour

Devon J. Hensel, Fei He, Jarek Harezlak and J. Dennis Fortenberry
 

Understanding why people have sex has long been of public health and health promotion interest. We used daily diaries to examine how adult men’s and women’s event-specific affective sexual motivations were linked to the types and combinations of sexual behaviours chosen in a given sexual event. Both wanting to have sex, or a partner’s wanting to have sex, were associated with a wider set of behaviours chosen.

Published online 11 November 2016

SH16106Screening and management of risk factors for cardiovascular disease in HIV-positive patients attending an Australian urban sexual health clinic

Sheena Kakar, Douglas Drak, Tahiya Amin, Jason Cheung, Catherine O'Connor and David Gracey
 

The medical records of 188 patients attending an inner-city sexual health clinic (SHC) between August 2013 and July 2014 were retrospectively reviewed for cardiovascular risk factors and associated screening and management practices. Cardiovascular risk factors were common among attendees of the SHC, including smoking (38%), hypertension (14%) and dyslipidaemia (11%).

Published online 11 November 2016

SH16091Trends and predictors of recent HIV testing over 22 years among a clinic sample of men who have sex with men in South Australia

Bin Li, Peng Bi, Alison Ward, Charlotte Bell and Christopher K. Fairley
 

A retrospective analysis of computerised medical records of men who have sex with men (MSM) who attended the South Australia Specialist Sexual Health (SASSH) clinic at their first visit was conducted to determine whether HIV testing had changed. The proportion of newly registered MSM who reported ever being tested for HIV declined; the proportion of MSM who returned to the clinic for HIV testing within 12 months did not change, with less than 40% of MSM returning for HIV testing. The findings suggest that HIV testing rate among MSM attending SASSH was suboptimal. New approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population.

Published online 07 November 2016

SH16143Experience of domestic violence routine screening in Family Planning NSW clinics

Tara Hunter, Jessica R. Botfield, Jane Estoesta, Pippa Markham, Sarah Robertson and Kevin McGeechan
 

This study reviewed implementation of the Domestic Violence Routine Screening (DVRS) program at Family Planning NSW and outcomes of screening to determine the feasibility of routine screening in a family planning setting and the suitability of this program in the context of women’s reproductive and sexual health. A retrospective review of medical records was undertaken of eligible women attending Family Planning NSW clinics in 2015. Of 13 440 eligible women, 41% were screened and 4.0% disclosed domestic violence. Factors associated with disclosure were clinic attended, age group, region of birth, employment status, education and disability. Although routine screening may not be appropriate in all health settings, given associations between domestic violence and sexual and reproductive health, a DVRS program is considered appropriate in sexual and reproductive health clinics and appears to be feasible in a service such as Family Planning NSW.


Funded hepatitis B vaccination is provided by the Victorian Department of Health and Human Services to at-risk groups, however uptake and impact have not been measured. Analysis of administrative data indicated that approximately 5700 courses of vaccination have been provided, most commonly to household contacts of people diagnosed with hepatitis B. The findings demonstrate that gaps still exist in the provision of immunisation to those at risk of acquisition, particularly people who inject drugs and people living with hepatitis C.


This case report presents preliminary data from two men who have sex with men who reported HIV seroconversion while using non-prescribed antiretroviral medication (ARV) for pre-exposure prophylaxis (PrEP). The men reported limited knowledge of PrEP, obtaining non-prescribed ARVs from sex partners, and engaging in multiple HIV transmission risk behaviors. The informal, non-prescribed, and non-medically supervised use of ARVs for HIV prevention may leave men unprotected against HIV transmission.

Published online 07 October 2016

SH16080The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men

Kane Race, Toby Lea, Dean Murphy and Kiran Pienaar
 

Sexualised drug use is associated with a range of problems, including sexual risk-taking dependence, mental health issues, accident and overdose. For gay men, there are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. Drug and alcohol use can be a creative or experimental response to social marginalisation – and not necessarily a problematic one in every instance. This article outlines some of the conditions most likely to mediate drug futures among gay and other men who have sex with men in the medium term.

Published online 07 October 2016

SH16141Sexual transmission of hepatitis C virus among gay and bisexual men: a systematic review

Fengyi Jin, Gail V. Matthews and Andrew E. Grulich
 

A systematic review on hepatitis C virus transmission in gay and bisexual men shows substantially higher HCV prevalence in HIV-positive than in HIV-negative men, and injecting drug use remains the major risk factors. Of longitudinal studies, the pooled incidence remains very low in HIV-negative men. Since the early 2000s, cases-series reports increasingly point to the importance of sexual transmission of HCV in mainly HIV-positive men.

Published online 23 September 2016

SH16067Human papillomavirus vaccination in men who have sex with men – what will be required by 2020 for the same dramatic changes seen in heterosexuals

Christopher K. Fairley, Huachun Zou, Lei Zhang and Eric P. F. Chow
 

This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. On the basis of published data we argue that if MSM are to have the same benefit from HPV vaccination as heterosexuals have enjoyed, boys and not adult MSM will need to be vaccinated.

Published online 02 September 2016

SH16056Enhanced use of phylogenetic data to inform public health approaches to HIV among men who have sex with men

Danielle German, Mary Kate Grabowski and Chris Beyrer
 

Using HIV phylogenetic approaches to understand and intervene within social networks at high risk for transmission is a rapidly evolving field with strong promise for informing innovative responses to the HIV epidemic among men who have sex with men (MSM). Here, we argue that viral phylogenetics could become an invaluable tool in the public health response to HIV among MSM that adds value to ongoing HIV surveillance and other public health data sources. We also highlight promising HIV phylogenetic applications for the MSM HIV epidemic and important methodological, ethical and implementation questions for the field.


The advent of pre-exposure prophylaxis (PrEP) necessitates attention to several issues associated with condom migration. One issue is the clear possibility of population-level increases in the incidence of sexually transmissible infections. A second issue pertains to how clinicians can best promote the dual use of PrEP and condoms such that both are used consistently and correctly. A third issue involves accounting for condom use in future efficacy trials of PrEP; a complex task that require intensified measurement protocols.

Published online 02 September 2016

SH16104As through a glass, darkly: the future of sexually transmissible infections among gay, bisexual and other men who have sex with men

Mark Richard Stenger, Stefan Baral, Shauna Stahlman, Dan Wohlfeiler, Jerusha E. Barton and Thomas Peterman
 

Sexually transmissible infections (STI) among men who have sex with men (MSM) appear to be increasing globally. We explore the history of STI among MSM before the emergence of HIV, how STI incidence may have decreased as a result of the HIV pandemic and discuss factors potentially contributing to recent STI increases. Looking ahead to the next decade, we conclude that STIs may continue to increase among MSM for a variety of reasons and discuss the implications for MSM sexual health.

Published online 29 August 2016

SH16072Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys

Martin Holt, Toby Lea, Limin Mao, Iryna Zablotska, Evelyn Lee, John B. F. de Wit and Garrett Prestage
 

This article describes the adaptation of a behavioural surveillance system, the Gay Community Periodic Surveys, to the introduction of HIV pre-exposure prophylaxis (PrEP) and treatment as prevention. National trends in key indicators during 2000–15 are reviewed, showing increases in HIV testing, treatment and condomless sex with casual partners. Two scenarios anticipating the effect of PrEP highlight the need to target gay and bisexual men who engage in receptive condomless sex while also sustaining condom use at a population level.

Published online 29 August 2016

SH16119Emerging models of clinical services for men who have sex with men: focused versus comprehensive approaches

Kenneth H. Mayer, Rodney Vanderwarker, Chris Grasso and Stephen L. Boswell
 

Over the past few decades, the recognition of infections that were specifically transmitted through male–male intimate contact (e.g. anal intercourse) led to the development of sexual health services that were tailored to gay and other men who have sex with men (MSM). With the spread of HIV among MSM, the need for these services to address other aspects of comprehensive care, including behavioural health, led to further refinements. Some programs have further evolved to become primary care centres for all sexual and gender minority people, including lesbians, bisexuals and transgender persons, while others have refined their model to provide more efficient sexual health services for otherwise healthy individuals. This paper will discuss some of the emerging models of sexual health care.

Published online 05 August 2016

SH16070HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

Shauna Stahlman, Carrie Lyons, Patrick S. Sullivan, Kenneth H. Mayer, Sean Hosein, Chris Beyrer and Stefan D. Baral
 

This paper reviews the recent trend in HIV incidence among men who have sex with men (MSM), which is now increasing in many low- and high-income settings with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. We discuss the risk factors that are potentiating the epidemic including individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis and antiretroviral treatment as prevention. Finally, we call for a concerted effort to integrate all evidence-based interventions to proximally decrease HIV acquisition and transmission risks, together with structural interventions to support improved coverage and retention in care.

Published online 22 July 2016

SH16038Sexually transmissible infection control programs for men who have sex with men – what will they look like in 2020?

Oliver N. Refugio, Chelsea Roberts, Richard West and Jeffrey D. Klausner
 

The resurgence of sexually transmissible infections among men who have sex with men is a concern for sexual health. Traditional strategies have relied on the promotion of condom use, regular testing, treatment, and partner management. Future sexually transmissible infection control programs must combine current prevention methods with novel approaches that target the providers, patients, and mechanisms of health care delivery.

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