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Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
Table of Contents
Sexual Health

Sexual Health

Volume 15 Number 1 2018


Syndromic management of sexually transmissible infections is commonly used in resource-poor settings for the management of common STIs; abnormal vaginal discharge (AVD) flowcharts are used to identify and treat cervical infection including Neisseria gonorrhoea and Chlamydia trachomatis. A systematic review and meta-analysis was undertaken to measure the diagnostic test performance of AVD flowcharts, including both World Health Organization (WHO)- and locally-adapted AVD flowcharts.

SH16237Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive

Richard T. Gray, Jo Watson, Aaron J. Cogle, Don E. Smith, Jennifer F. Hoy, Lisa A. Bastian, Robert Finlayson, Fraser M. Drummond, Bill Whittaker, Matthew G. Law and Kathy Petoumenos
pp. 13-19

Many HIV-positive temporary residents living in Australia do not have access to subsidised antiretroviral treatment (ART). In this mathematical modelling study, we showed expanding access to subsidised ART to all HIV-positive temporary residents will substantially reduce HIV transmission to their sexual partners at little additional cost. Providing subsidised ART to people with HIV in Australia will remove inequities in the provision of HIV-related treatment and care and help Australia achieve its National HIV Strategy targets.


This study conducted a retrospective cohort study to investigate the relationship between the first 6 months clinical monitoring status of antiretroviral treatment (ART) initiation and long-term treatment adherence rate and outcomes among people living with HIV (PLHIV). The result shows those completed four scheduled clinical visits in the first six months were at lower risk of mortality and loss to follow-up compared with otherwise during the study period. Factors associated with missed clinical visits included: acquiring HIV through unsafe blood donation or unsafe drug injection, being divorced, and concurrent drug injection without receiving methadone maintenance treatment. This study concluded that enabling PLHIV to complete four scheduled clinical visits during the first 6 months of ART initiation, as recommended by the Chinese CDC, is critical.

SH17042A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India

Jessamyn Bowling, Brian Dodge, Swagata Banik, Elizabeth Bartelt, Shruta Rawat, Lucia Guerra-Reyes, Devon Hensel, Debby Herbenick and Vivek Anand
pp. 29-38

This multi-method study examined perceived health concerns for sexual minority females in Mumbai, India using an online survey and photo-elicitation interviews. Sexual minority females face obstacles in health care, mostly related to acceptability and quality of care and preventative screenings were low. Participants in photo-elicitation interviews described bodyweight issues and caretaking of family members in relation to physical health. Substance use functioned as both a protective and a risk factor for their health.


This qualitative study identified factors influencing PrEP uptake among 32 self-identified MSM from a PrEP intervention study. Low perception of HIV risk, mistrust of PrEP program, concerns of side effects, lack of main sexual partner’s support, difficulties in adherence, and the inconvenient schedules in securing the medicine were the main reasons for not wanting to use or quitting PrEP. Perceived high HIV risk, beliefs in PrEP efficacy, and worries of transmitting HIV to families were the major motives for PrEP uptake.


Despite the increasing availability of online sexually transmissible infection (STI) testing, little is known about how stigma associated with STI testing may be experienced by youth in online settings. Youth were asked about their perceptions of stigma associated with STI testing in an online testing environment in Vancouver, BC, Canada. Online STI testing could ameliorate the experiences of participants regarding the stigma associated with STI testing; however, internalised feelings of shame and stigma around testing for STI may continue to persist.

SH16219Blood-borne virus transmission in an urban, culturally diverse neighbourhood: results from a cross-sectional bio-behavioural survey using innovative outreach methods in a hard-to-reach population

Elizabeth Peach, Shelley Cogger, Kat Byron, Penny Francis, Daniel O'Keefe, Peter Higgs, Mark Stoove, Kasey Elmore, Paul Dietze and Margaret Hellard
pp. 54-60

Following a HIV outbreak among Aboriginal people in a culturally diverse inner-city suburb of Melbourne, a blood-borne virus (BBV) screening program was conducted to inform public health interventions to prevent transmission and facilitate timely diagnosis and linkage to care.

SH17087Comparisons of vaginal flora patterns among sexual behaviour groups of women: implications for the pathogenesis of bacterial vaginosis

Kristin M. Olson, Louis J. Boohaker, Jane R. Schwebke, Stella Aslibekyan and Christina A. Muzny
pp. 61-67

Among African-American women aged 19–45 years presenting to an STD clinic, women who have sex with women (WSW) and women who have sex with women and men (WSWM) were significantly more likely to have a diagnosis of BV based on Nugent score than women who have sex with men (WSM). Among women with a diagnosis of BV by Nugent score, there was no significant difference in the proportion of women with low-positive and high-positive Nugent scores by sexual behaviour group (WSW, WSWM, WSM). Women who reported participating in receptive vaginal sex within 30 days preceding study enrolment were significantly more likely to have BV.

SH17039Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians

Handan Wand, Joanne Bryant, Heather Worth, Marian Pitts, John M. Kaldor, Dea Delaney-Thiele and James Ward
pp. 68-75

Early age at sexual debut is known to be associated with high-risk sexual behaviours and school dropouts. The present study raised issues regarding the adverse effects of early age at sexual debut on low level of education as well as illicit drug use among young Indigenous men and women in Australia who are disproportionally affected by sexually transmitted infections. Our findings highlight the need for effective school and/or community-based sex education programs.

SH17083Sexual health and students: the pathways travelled by those with sexual health concerns

Georgia Freeman, Lucy Watchirs Smith, Anna McNulty and Basil Donovan
pp. 76-78

This study aimed to identify the different pathways of access to sexual health care and knowledge for university students with sexual health concerns. The Internet was identified as the most common first point of call for health information, followed by doctors. Of those who accessed the Internet, the majority subsequently went to a doctor.


A substantial increase in gonorrhoea notifications to public health units in New South Wales has been observed in recent years, but whether this relates to more frequent testing or other factors is unknown. We assessed the proportion of gonorrhoea tests that were positive and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. While the number of tests performed almost double, we observed over a 3-fold increase in the proportion of positive tests from 2.2% in 2008 to 7.1% in 2013. This was observed at all anatomical sites and in all subgroups examined, and rates were highest amongst gay men. More frequent and comprehensive gonorrhoea testing and treatment to interrupt onward transmission to sexual partners could potentially reduce high and increasing rates of gonorrhoea in the community.

SH17035Patients with HIV and coronary disease: are we meeting national guidelines?

Sam Emmanuel, James Nadel, Damien Fagan, Sirinya Teeraananchai, Matthew Law and Cameron J. Holloway
pp. 83-85

Cardiovascular disease has a higher incidence in patients with HIV infection. Our study sought to determine whether national guidelines were being met to address this issue. We found that while some targets were being met, current screening and management for this patient group falls short of guidelines.

SH17068Rates of advertised condomless sex in the online profiles of private sex workers: a cross-sectional study

Edjoni Blackledge, Caroline Thng, Ruthy McIver and Anna McNulty
pp. 86-88

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.


Previously we found that local patients were often not tested for HIV prior to commencing nucleoside/nucleotide reverse transcription inhibitor (NRTI) therapy for hepatitis B virus. We performed a national cross-sectional cohort study of physician practices via an online survey. A small majority (23/44; 52%) of participants reported always testing their hepatitis B virus patients for HIV prior to NRTI therapy, and 8/44 (18%) reported testing for HIV the majority of the time. Thirteen (30%) respondents reported testing only if risk factors were present. One physician reported a patient seroconverting to HIV while on TDF monotherapy.


In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.

SH16243Private sex workers’ engagement with sexual health services: an online survey

C. Thng, E. Blackledge, R. McIver, L. Watchirs Smith and A. McNulty
pp. 93-95

Relatively little is known about private sex workers (PSW) sexual health needs and engagement with services. We surveyed female, male and transgender PSW who advertise online and found that while all had attended a service for sexual health screening, there were issues with disclosure of sex work and the comprehensiveness of services offered. Services need to address all the sexual health care needs of private sex workers.

SH17113Evaluation of knowledge and utility of the 2014 Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men among general practitioners in Sydney

David J. Templeton, Phillipe C. G. Adam, Rajesh Varma, Phillip Read, Chistopher Bourne, Shih-Chi Kao and on behalf of the Sexually Transmissible Infections in Gay Men Action Group (STIGMA)
pp. 96-98

Men who have sex with men are disproportionately affected by sexually transmissible infections (STIs) and HIV and guidelines for general practitioners who diagnose the majority of STI/HIV in Australia are essential to ensure appropriate testing in this group. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians and found familiarity with the guidelines was associated with a range of positive outcomes on general practitioners’ clinical practice. Novel approaches are required to ensure more widespread distribution of future guidelines.

Committee on Publication Ethics