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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 14 Number 1 2017

What the Future Holds for Men who have Sex with Men in 2020

SH162202020, sexually transmissible infections and HIV in gay, bisexual and other men who have sex with men

Christopher K. Fairley, Garett Prestage, Kyle Bernstein, Kenneth Mayer and Mark Gilbert
pp. 1-4

This editorial accompanies a series of papers dealing with this watershed period for HIV and sexually transmissible infections (STI) infections in gay, bisexual and other men who have sex with men (GBM). We are delighted to share with you the views of some international opinion leaders on what the future may hold and what challenges lie ahead. In this issue of the Journal, authors describe current HIV and STI incidence among GBM and predict the future.

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
pp. 5-17

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.

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
pp. 18-27

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.


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.


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.

SH16099Global travel and HIV/STI epidemics among MSM: what does the future hold?

Veronica C. Lee, Patrick S. Sullivan and Stefan D. Baral
pp. 51-58

Travel shapes the social and sexual networks and, consequently, the HIV and sexually transmissible infection (STI) acquisition risks of gay men and other men who have sex with men (MSM). Four factors associated with travel that could potentiate HIV transmission are different patterns of sexual risk behaviours during travel; the growth of online tools to meet sex partners more efficiently; the global heterogeneity of HIV strains; and the potential for diassortative mixing of men from high- and low-HIV prevalence areas. Addressing these shifting risk contexts from increased connectedness through travel and online social networking platforms requires innovation in HIV and STI prevention and treatment interventions for gay men and other MSM, and mobile applications and social networking platforms that can provide HIV-related resources and information tailored to the local risk environment and to the individual may have valuable potential.

SH16083Mental health in 2020 for men who have sex with men in the United States

Abigail W. Batchelder, Steven Safren, Avery D. Mitchell, Ivan Ivardic and Conall O'Cleirigh
pp. 59-71

In this review we illustrate mental health challenges facing men who have sex with men (MSM) primarily in the US, related to HIV and sexually transmissible infection prevention and across the HIV care cascade, including HIV diagnosis, engagement and retention in care, and antiretroviral adherence. We also describe disparities among MSM including racial and ethnic, age, and structural barriers associated with HIV prevention and treatment, as well as current interventions. As access to prevention and treatment strategies expand, and new breakthroughs continue to emerge, behavioural strategies will continue to be needed to reduce risk and increase uptake and engagement among MSM most at risk through 2020 and beyond.

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
pp. 72-79

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.

SH16081HIV testing intervention development among men who have sex with men in the developed world

Paul Flowers, Claudia Estcourt, Pam Sonnenberg and Fiona Burns
pp. 80-88

HIV testing should be the primary focus of behaviour change to reduce HIV transmission. There is a need for transparency in describing the HIV testing interventions we develop and evaluate. Interventions should detail the testing technologies they use, the specific behavioural aspects they target, and the specific populations they do and do not serve. Clarity concerning the specificity of HIV testing interventions enables diverse testing interventions to be delivered in parallel, and will limit the widening of health inequalities across men who have sex with men populations.


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.


Rapid developments in the field of HIV pre-exposure prophylaxis (PrEP) with antiretrovirals offer a promise to bring HIV transmission among gay and other men who have sex with men (MSM) to zero by 2030. This review evaluates studies, which modelled the impact of PrEP on HIV diagnoses, and discusses the progress towards PrEP implementation.


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.

SH16052Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Graham Brown, William Leonard, Anthony Lyons, Jennifer Power, Dirk Sander, William McColl, Ronald Johnson, Cary James, Matthew Hodson and Marina Carman
pp. 111-118

The potential of new biomedical technologies to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention.


Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Clinical training programs and healthcare organisations are well poised to start addressing disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for health needs of LGBT patients also involves creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.


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.

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
pp. 126-132

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.

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
pp. 133-138

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.

Online Early

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

Published online 06 February 2017

SH16013Prevalence of HIV among Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis

Simon Graham, Catherine C. O'Connor, Stephen Morgan, Catherine Chamberlain and Jane Hocking
 

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.

Published online 30 January 2017

SH16137Chlamydia retesting and retest positivity rates: results from a state-wide laboratory data linkage study in Tasmania, 2012–13

Nicola Stephens, David Coleman, Kelly Shaw, Maree O'Sullivan, Alistair McGregor, Louise Cooley and Alison Venn
 

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.

Published online 20 January 2017

SH16171Sexual health knowledge and behaviour of young Sudanese Queenslanders: a cross-sectional study

Judith Dean, Marion Mitchell, Donald Stewart and Joseph Debattista
 

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.

Published online 09 January 2017

SH16036Managing two decades of visceral leishmaniasis and HIV co-infection: a case report that illustrates the urgent research needs in the field

Melissa L. Kelly, Angie N. Pinto, Dan Suan, Debbie Marriott, David A. Cooper and Sarah L. Pett
 

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.

Published online 09 January 2017

SH16148Need for more research on and health interventions for transgender people

Yeimer Ortiz-Martínez and Carlos Miguel Ríos-González
 

This study described the distribution of transgender-related research in several databases, finding a low scientific output, especially in low-income developing countries. This is a call for more research and public health interventions for transgender people due this population is growing day by day worldwide.

Published online 09 January 2017

SH16135Sexuality-related attitudes significantly modulate demographic variation in sexual health literacy in Tasmanian university students

Steve Simpson, Christine Clifford, Michael G. Quinn, Kaz Ross, Neil Sefton, Louise Owen, Leigh Blizzard and Richard Turner
 

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.

Published online 09 January 2017

SH16077Acceptability of self-sampling in Portuguese women: the good, the bad or the ugly?

Jani Silva, Fátima Cerqueira and Rui Medeiros
 

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.

Published online 16 December 2016

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

Kiffer G. Card, Nathan J. Lachowsky, Zishan Cui, Susan Shurgold, Maya Gislason, Jamie I. Forrest, Ashleigh J. Rich, David Moore, Eric Roth and Robert S. Hogg
 

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.

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.

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