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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 13 Number 5 2016

In this edition of Sexual Health, Vallely et al. report the results of a cross-sectional prevalence survey of sexually transmissible infections (STIs) among women attending their first antenatal visit in three provinces of Papua New Guinea (PNG). This Editorial examines potential reasons for these high prevalence estimates and discusses strategies for addressing high STIs rates in PNG.

This study assessed the available peer-reviewed literature to ascertain what qualities of long-acting reversible contraception (LARC) are considered desirable or undesirable by women. Although there were many characteristics of LARC that women liked, particularly their convenience and longevity, there were also many characteristics that women didn’t like, including their often unpredictable impact on bleeding and other hormonal side effects. This information is crucial in the clinical setting as it provides practitioners with a greater understanding of the qualities women do and do not like about LARC methods. Discussion about these qualities, positive and negative, during consultations about contraception may increase rates of uptake.

SH15227Prevalence and risk factors of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other sexually transmissible infections among women attending antenatal clinics in three provinces in Papua New Guinea: a cross-sectional survey

Lisa M. Vallely, Pamela Toliman, Claire Ryan, Glennis Rai, Johanna Wapling, Carolyn Tomado, Savarina Huliafi, Gloria Munnull, Patricia Rarau, Suparat Phuanukoonnon, Handan Wand, Peter Siba, Glen D. L. Mola, John M. Kaldor and Andrew J. Vallely
pp. 420-427

Through a cross-sectional bio-behavioural survey in three sites we enrolled 765 pregnant women attending their first antenatal clinic visit. We identified high rates of sexually transmissible infectionss among this study cohort; 43% had one or more of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) infection. CT was the most prevalent STI (22.9%), followed by TV (22.4%), and NG (14.2%). Prevalences were highest among primigravid women, women aged <25 years, and among those in Central Province.

SH15240Sexting among singles in the USA: prevalence of sending, receiving, and sharing sexual messages and images

Justin R. Garcia, Amanda N. Gesselman, Shadia A. Siliman, Brea L. Perry, Kathryn Coe and Helen E. Fisher
pp. 428-435

In a national sample of 5805 single adults in the USA, the present study examines sexting attitudes and behaviours, including sending, receiving, and sharing of sexual messages and images, across gender, age, and sexual orientation. Participants’ self-reported views on the impact of sexting on reputation, coupled with the relatively high rates of unauthorised sext sharing we report, suggest a contemporary struggle to reconcile digital eroticism with real-world consequences.

SH16023Indicators of HIV-risk resilience among men who have sex with men: a content analysis of online profiles

Jaclyn M. White Hughto, Anna P. Hidalgo, Angela R. Bazzi, Sari L. Reisner and Matthew J. Mimiaga
pp. 436-443

HIV-risk resilience, or positive adaptation in the face of risk, is increasingly being recognised as an important characteristic among men who have sex with men (MSM). However, resilience in the context of online partner seeking remains underexplored among MSM. This study used content analysis methodology to identify indicators of HIV-risk resilience in the online profiles of MSM using a sexual networking website. Implications for promoting HIV-risk resilience through online interventions for MSM are discussed

SH15026A systematic analysis of the needs of people with HIV in Australia: stakeholder views of the key elements for a healthy life

Sarity Dodson, Roy Batterham, Karalyn McDonald, Julian H. Elliott, Richard H. Osborne and for the HealthMap Project Team
pp. 444-450

The HealthMap project is developing an intervention to reduce cardiovascular risk in people living with HIV. As part of the formative stages of the intervention design, we sought to understand the needs of people with HIV (PWHIV). Workshops with PWHIV and their providers, and follow-up questionnaires provided insights into what PWHIV perceive they need, to live with and manage their condition, and its impact on their life. PWHIV and HIV providers continue to report unmet needs in the areas of social justice and emerging concerns about access to aged care services.

SH16055Assortative sexual mixing patterns in male–female and male–male partnerships in Melbourne, Australia: implications for HIV and sexually transmissible infection transmission

Eric P. F. Chow, Tim R. H. Read, Matthew G. Law, Marcus Y. Chen, Catriona S. Bradshaw and Christopher K. Fairley
pp. 451-456

This retrospective cross-sectional study examined the sexual mixing patterns for age, number of partners and condom use in 1165 male–female and 610 male–male partnerships attending a sexual health service in Melbourne, Australia. Male–female and male–male partnerships have a high assortativity mixing pattern for age, number of partners and condom use. The sexual mixing pattern is not purely assortative, and hence it may lead to increased HIV and STI transmission in certain risk groups.

The Deadly Liver Mob project (DLM) is an incentive-based, peer-driven health promotion intervention for Aboriginal people, focusing on hepatitis C and, offering education and screening for sexually transmissible infections (STI) and blood-borne viruses (BBV). This study assessed the DLM effect on attendance and STI/BBV screening, describes BBV risk factors and reports infection rates among Aboriginal people attending Western Sydney Sexual Health Centre.

SH15144Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey

Catherine E. Oldenburg, Bao Le, Hoang Thi Huyen, Dinh Duc Thien, Nguyen Hoang Quan, Katie B. Biello, Amy Nunn, Philip A. Chan, Kenneth H. Mayer, Matthew J. Mimiaga and Donn Colby
pp. 465-473

Pre-exposure prophylaxis (PrEP) is a promising HIV prevention strategy for men who have sex with men (MSM) in Vietnam, but implementation programs will benefit from understanding preferences for PrEP delivery. We conducted a cross-sectional survey with members of online social networking websites for MSM in Vietnam. Approximately one quarter of participants had previously heard of PrEP, and most participants indicated a preference for rectal microbicides as their preferred PrEP modality.

Gonorrhoea disproportionately affects young people and men who have sex with men although characteristics of those infected are poorly described. Enhanced surveillance conducted across two urban health districts in Sydney, Australia identified differing risk factors and testing characteristics between men who have sex with men, heterosexual males and females. This surveillance highlighted the importance of obtaining accurate sexual histories to ensure appropriate testing.

Females who are aged ≤32 years were eligible for the free female human papillomavirus vaccination program. Unvaccinated heterosexual men who had a female partner aged ≤32 were less likely to have penile warts. This suggests men would have received herd protection from their female partners.

SH16049Self-testing for Trichomonas vaginalis at home using a point-of-care test by women who request kits via the Internet

Charlotte A. Gaydos, Mary Jett-Goheen, Mathilda Barnes, Laura Dize and Yu-Hsiang Hsieh
pp. 491-493

We offered a point-of-care test for Trichomonas vaginalis to women via the Internet to determine if it was acceptable to women to perform the test at home. Most of the 102 participants felt that it was easy to collect the specimen, follow the instructions, and read and interpret the results for the trichomonas self-testing assay.

SH16026Adherence to, and acceptability of, Listerine® mouthwash as a potential preventive intervention for pharyngeal gonorrhoea among men who have sex with men in Australia: a longitudinal study

Vincent J. Cornelisse, Christopher K. Fairley, Sandra Walker, Tameka Young, David Lee, Marcus Y. Chen, Catriona S. Bradshaw and Eric P. F. Chow
pp. 494-496

Ten men who have sex with men attending the Melbourne Sexual Health Centre were recruited in this study to examine the adherence to, and acceptability of, Listerine® mouthwash as a potential preventive intervention for pharyngeal gonorrhoea. This study found high adherence and acceptability of daily mouthwash use.

SH16041Disparities of sexual orientations by sex and urban or rural residence among youth in China

Chao Guo, Lihua Pang, Lei Zhang, Gong Chen, Zhenjie Wang and Xiaoying Zheng
pp. 497-499

This study described the distribution of sexual orientations among Chinese youth. Female youth and rural youth were found with higher odds of non-heterosexual orientation than male youth and urban youth. More efforts should be made to enhance sex education and legal protection for non-heterosexual youth in China.

Online Early

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

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 21 October 2016

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

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.

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

SH16029Exploring attitudes towards sexting of young people: a cross-sectional study

Megan S. C. Lim, Alyce M. Vella, Danielle R. Horyniak and Margaret E. Hellard

This study explored young people’s attitudes towards sexting. The majority of young people surveyed agreed that sexting was risky; despite this, 46% had engaged in sexting. One third of participants indicated they might show a sext they had received to friends.

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.

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.

Published online 07 October 2016

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

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.

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 07 October 2016

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

Francesco Drago, Astrid Herzum, Giulia Ciccarese and Roberto Bandelloni

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.

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.

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 09 September 2016

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

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.

Published online 09 September 2016

SH16124Neisseria gonorrhoeae isolated from an unexpected site

Stella Pendle and Timothy Barnes

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.

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

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

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.

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 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 19 August 2016

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

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.

Published online 11 August 2016

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

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.

Published online 11 August 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

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.

Published online 11 August 2016

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

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.

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 05 August 2016

SH16089Effects of multiple types of stigma on the probability of HIV disclosure to sex partners: a systematic review

Haochu Li, Xiaoming Li, Lei Zhang and Eric Chow

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.

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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