1
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Hardy C, Fairley CK, Ong JJ, Vodstrcil LA, Bradshaw CS, Snow A, Chow EPF. Drug and Alcohol Use with Condomless Anal Sex among Men Who Have Sex with Men in Melbourne, Australia: A Retrospective Data Analysis from 2011 to 2017. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2497-2507. [PMID: 34757603 DOI: 10.1007/s10508-021-01966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
Rises in condomless anal sex among men who have sex with men (MSM) have been reported over the last decade but there is less certainty about the role that drugs, alcohol, play in this change. We examined the changes in drug and alcohol use among 22,255 MSM reporting condomless anal sex at Melbourne Sexual Health Centre in 2011-2017. There was a 7% annual increase in using drugs before and/or during condomless anal sex but a 3% annual reduction in condomless anal sex while drunk. MSM taking PrEP were more likely to report condomless anal sex with drug use (AOR: 1.21; 95%CI: 1.07-1.37) and alcohol use (AOR: 1.29; 95%CI: 1.14-1.46) compared with MSM not taking PrEP.
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Affiliation(s)
- Christopher Hardy
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Anthony Snow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia.
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2
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Chow EPF, Carter A, Vickers T, Fairley CK, McNulty A, Guy RJ, Regan DG, Grulich AE, Callander D, Khawar L, Machalek DA, Donovan B. Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18. THE LANCET. INFECTIOUS DISEASES 2021; 21:1747-1756. [PMID: 34339639 DOI: 10.1016/s1473-3099(21)00071-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013. METHODS We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007). FINDINGS We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40-0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53-0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28-0·36) and male individuals (0·51, 0·43-0·61) aged 15-20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06-0·09) and male individuals (0·11, 0·08-0·15) aged 15-20 years in the gender-neutral vaccination period. INTERPRETATION The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school. FUNDING Seqirus Australia and the Australian Government Department of Health.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Allison Carter
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Simon Fraser University, Burnaby, BC, Canada.
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Anna McNulty
- School of Public Health and Community Medicine, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Rebecca J Guy
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Laila Khawar
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Dorothy A Machalek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW, Australia; Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
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3
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Donovan LC, Fairley CK, Aung ET, Traeger MW, Wright EJ, Stoové MA, Chow EPF. The Presence or Absence of Symptoms Among Cases of Urethral Gonorrhoea Occurring in a Cohort of Men Taking Human Immunodeficiency Virus Pre-exposure Prophylaxis in the PrEPX Study. Open Forum Infect Dis 2021; 8:ofab263. [PMID: 34189177 PMCID: PMC8231363 DOI: 10.1093/ofid/ofab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/20/2021] [Indexed: 12/02/2022] Open
Abstract
We aimed to estimate how often urethral gonorrhoea is symptomatic among men in the Pre-Exposure Prophylaxis Expanded Victoria study. Eighty-seven percent of 213 cases of urethral gonorrhoea were symptomatic. Ensuring men with urethral gonorrhoea both recognize and present early for treatment is critical to reduce transmission.
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Affiliation(s)
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina J Wright
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Alfred Hospital, Monash Central Clinical School, Melbourne, Victoria, Australia.,Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Mark A Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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4
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Martín-Sánchez M, Case R, Fairley C, Hocking JS, Bradshaw C, Ong J, Chen MY, Chow EPF. Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia. BMJ Open 2020; 10:e037608. [PMID: 33234617 PMCID: PMC7689083 DOI: 10.1136/bmjopen-2020-037608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW. DESIGN Repeated cross-sectional study. SETTING A sexual health centre in Melbourne, Australia. PARTICIPANTS MSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW. PRIMARY OUTCOME MEASURES Demographic characterics, sexual practices and HIV/STI positivity. RESULTS Compared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW. CONCLUSIONS MSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.
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Affiliation(s)
- Mario Martín-Sánchez
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Preventive Medicine and Public Health Training Unit, Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - Richard Case
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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5
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Phillips TR, Medland N, Chow EPF, Maddaford K, Wigan R, Fairley CK, Ong JJ, Bilardi JE. "Moving from one environment to another, it doesn't automatically change everything". Exploring the transnational experience of Asian-born gay and bisexual men who have sex with men newly arrived in Australia. PLoS One 2020; 15:e0242788. [PMID: 33216802 PMCID: PMC7678978 DOI: 10.1371/journal.pone.0242788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Asian-born gay, bisexual and other men who have sex with men (gbMSM) who are newly arrived in Australia are at a higher risk of acquiring HIV than Australian-born gbMSM. We used a social constructionist framework to explore HIV knowledge and prevention strategies used by newly-arrived Asian-born gbMSM. Twenty four Asian-born gbMSM, aged 20–34 years, attending Melbourne Sexual Health Centre, who arrived in Australia in the preceding five years, participated in semi-structured, face-to-face interviews. Interviews were recorded, transcribed verbatim and analysed thematically. Participants described hiding their sexual identities in their country of origin, particularly from family members, due to fear of judgement and discrimination resulting from exposure to sexual identity and HIV related stigma in their countries of origin, although some were open to friends. Despite feeling more sexual freedom and acceptance in Australia, many were still not forthcoming with their sexual identity due to internalised feelings of stigma and shame. Exposure to stigma in their country of origin led many to report anxiety around HIV testing in Australia due to a fear of testing positive. Some described experiencing racism and lack of acceptance in the gay community in Australia, particularly on dating apps. Fear of discrimination and judgement about their sexual identity can have a significant impact on Asian-born gbMSM living in Australia, particularly in terms of social connectedness. Additionally, HIV-related stigma can contribute to anxieties around HIV testing. Our data highlights the potential discrimination Asian-born gbMSM face in Australia, which has implications for social connectedness, particularly with regard to LGBTQI communities and HIV testing practices. Future studies should determine effective strategies to reduce sexual identity and HIV-related stigma in newly-arrived Asian-born gbMSM.
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Affiliation(s)
- Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- * E-mail:
| | - Nicholas Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jade E. Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, VIC, Australia
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6
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Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia. Epidemiol Infect 2020; 148:e240. [PMID: 32985394 PMCID: PMC7584007 DOI: 10.1017/s0950268820002265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.
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7
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Phillips T, Fairley CK, Walker S, Chow EPF. Associations between oral sex practices and frequent mouthwash use in men who have sex with men: implications for gonorrhoea prevention. Sex Health 2020; 16:473-478. [PMID: 30558710 DOI: 10.1071/sh18131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022]
Abstract
Background Rates of gonorrhoea continue to rise among men who have sex with men (MSM) in Australia and worldwide. Recently, it has been proposed that oropharyngeal gonorrhoea may play a role in its onward transmission and that mouthwash use may be an effective intervention for gonorrhoea prevention and control. The objective of this study was to determine the association between specific oral sex practices and frequency of mouthwash use. METHODS A questionnaire-based study was conducted among MSM attending the Melbourne Sexual Health Centre in Australia from March to September 2015. Logistic regression was performed to examine the association between frequent mouthwash use (i.e. daily or weekly mouthwash use) and four oral sex practices (tongue kissing, receptive fellatio with or without ejaculation, and insertive rimming) among MSM. RESULTS Of the 918 MSM included in the final analysis, 490 men (53.4%) were frequent mouthwash users. Participants aged 24-34 years were 2.13-fold (95% CI 1.52-2.98) and those ≥35 years were 2.64-fold (95% CI 1.83-3.83) more likely to use mouthwash frequently than those aged ≤24 years. The most common oral sex practice was tongue kissing (n=874; 95.2%), followed by receptive fellatio without ejaculation (n=839; 91.4%), receptive fellatio with ejaculation (n=610; 66.5%), then insertive rimming (n=356; 38.8%). No significant association was found between frequent mouthwash use and tongue kissing, receptive fellatio with or without ejaculation, or insertive rimming with regular or casual male partners in the previous 3 months. CONCLUSIONS Younger MSM are less likely to use mouthwash. There is no association between engaging in oral sex practices and frequent mouthwash use among MSM.
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Affiliation(s)
- Tiffany Phillips
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia
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8
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Walia AM, Fairley CK, Bradshaw CS, Chen MY, Chow EPF. Disparities in characteristics in accessing public Australian sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men. Aust N Z J Public Health 2020; 44:363-368. [PMID: 32865864 DOI: 10.1111/1753-6405.13029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men (MSM) in Melbourne, Australia. METHODS We conducted a retrospective, cross-sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare-eligible and Medicare-ineligible MSM. RESULTS We included 5,085 Medicare-eligible and 2,786 Medicare-ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare-eligible compared to Medicare-ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare-eligible and Medicare-ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare-ineligible MSM were more likely to have anorectal chlamydia compared to Medicare-eligible MSM (10.6% vs. 8.5%; p=0.004). CONCLUSIONS Medicare-ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high-risk behaviour. Implications for public health: Scaling up access to HIV and STI testings for Medicare-ineligible MSM is essential.
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Affiliation(s)
- Anysha M Walia
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Victoria.,Central Clinical School, Monash University, Victoria.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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9
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Martín-Sánchez M, Ong JJ, Fairley CK, Chen MY, Williamson DA, Maddaford K, Aung ET, Carter G, Bradshaw CS, Chow EPF. Clinical presentation of asymptomatic and symptomatic heterosexual men who tested positive for urethral gonorrhoea at a sexual health clinic in Melbourne, Australia. BMC Infect Dis 2020; 20:486. [PMID: 32641070 PMCID: PMC7346512 DOI: 10.1186/s12879-020-05197-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Asymptomatic screening for gonorrhoea in heterosexual men is currently not recommended in many countries including Australia, given the prevalence is relatively low in the heterosexual population. We aimed to determine the proportion of urethral gonorrhoea cases among heterosexual men attending a sexual health clinic that was asymptomatic and symptomatic, the time since last sexual contact to the onset of symptoms and the time to clinic presentation following the onset of symptoms. Methods This was a cross-sectional study that included heterosexual men aged 16 years or above attending the Melbourne Sexual Health Centre (MSHC) in Australia between August 2017 and August 2018. Gonorrhoea cases were diagnosed by nucleic acid amplification testing (NAAT) and/or culture. Descriptive analyses were conducted for all gonorrhoea cases including demographic characteristics, recent sexual practices, reported urethral symptoms and duration, sexual contact with a person diagnosed with gonorrhoea, investigations performed and laboratory results. Results There were 116 confirmed cases of urethral gonorrhoea in heterosexual men over the study period of which 6.0% (95% CI: 2.7–12.1%) were asymptomatic. Typical urethral discharge was present in 80.2% (95% CI: 71.9–86.5%) of men. The mean time between last sexual contact and the onset of symptoms was 7.0 days, and between the onset of symptoms to presentation to the clinic was 5.6 days. Conclusions A small proportion of heterosexual men with urethral gonorrhoea do not have any symptoms. Heterosexual men with urethral symptoms usually seek for healthcare within a week, prompting rapid healthcare-seeking behaviour.
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Affiliation(s)
- Mario Martín-Sánchez
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia. .,Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Barcelona, Spain. .,Public Health Agency of Barcelona, Plaça de Lesseps, 1, 08023, Barcelona, Spain.
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Georgia Carter
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia. .,Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
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10
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Chow EPF, Aung ET, Chen MY, Bradshaw CS, Fairley CK. Human papillomavirus vaccination and sexual practices among men who have sex with men in Melbourne, Australia: a cross-sectional study. Int J STD AIDS 2020; 31:312-317. [DOI: 10.1177/0956462419897514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this study was to explore the factors associated with self-reported receipt of human papillomavirus (HPV) vaccine among men who have sex with men (MSM). MSM aged 16–40 years attending the Melbourne Sexual Health Centre, Australia, for their first visit in 2016 were included in the analysis. Multivariable logistic regression analyses were performed to examine the association between self-reported HPV vaccination and sexual practices: one examining the sexual practices. A total of 1332 MSM with a mean age of 27.6 (standard error [SE] = 0.1) were included in the analysis. The mean number of reported male partners in the last 3 and 12 months was 4.0 (SE = 0.1) and 8.9 (SE = 0.4), respectively. Six percent ( n = 81) of MSM reported receiving the HPV vaccine. There was no significant association between sexual practices (the number of partners or condomless anal sex) and self-reported HPV vaccine receipt after adjusting for confounding factors such as human immunodeficiency virus (HIV) status and pre-exposure prophylaxis (PrEP). HIV-negative MSM taking PrEP were three times more likely to be vaccinated against HPV compared with HIV-negative MSM not taking PrEP in both multivariable analyses. Our findings suggest that there is no association between HPV vaccination and sexual risk practices in MSM.
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Affiliation(s)
- Eric PF Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Martín-Sánchez M, Fairley CK, Bradshaw CS, Chen MY, Chow EPF. Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia. Sex Transm Infect 2020; 96:246-250. [DOI: 10.1136/sextrans-2019-054318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 11/03/2022] Open
Abstract
ObjectiveIn 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne.MethodsThis was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit.ResultsOf the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16–25 years (adjusted OR (aOR) 1.21; 95% CI 1.08 to 1.35) or 26–35 years (aOR 1.17; 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years; were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80; 95% CI 1.56 to 2.09); had more than four male partners in the last 12 months (aOR 1.16; 95% CI 1.06 to 1.27); had male partners only (aOR 2.24; 95% CI 1.96 to 2.55); or were born overseas (aOR 1.11; 95% CI 1.03 to 1.21).ConclusionsTwo-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.
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Burrell S, Vodstrcil LA, Fairley CK, Kilner A, Bradshaw CS, Chen MY, Chow EPF. Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018. Sex Transm Infect 2019; 96:110-114. [PMID: 31346067 DOI: 10.1136/sextrans-2019-054132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne. METHODS All MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine. RESULTS Of the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28; 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A. CONCLUSION The critical vaccination threshold for hepatitis A has been estimated at >70%. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.
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Affiliation(s)
- Sam Burrell
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alex Kilner
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Williamson DA, Chow EPF, Lee D, Maddaford K, Sait M, Easton M, Ingle D, Wigan R, De Petra V, Howden BP, Fairley CK, Chen MY. Risk Factors for Asymptomatic Enteric Pathogen Detection Among Men Who Have Sex With Men. Open Forum Infect Dis 2019; 6:ofz326. [PMID: 31660405 PMCID: PMC6798250 DOI: 10.1093/ofid/ofz326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/09/2019] [Indexed: 11/15/2022] Open
Abstract
Improved knowledge of factors that promote outbreaks of enteric pathogens among men who have sex with men (MSM) could enable targeted public health interventions. We detected enteric pathogens in 57 of 519 (11%) asymptomatic MSM, and we found that enteric pathogen detection was associated with both oroanal sex (rimming) and group sex.
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Affiliation(s)
- Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Darren Lee
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Marion Easton
- Victorian Department of Health and Human Services, Melbourne, Australia
| | - Danielle Ingle
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Vesna De Petra
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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Zablotska IB, Baeten JM, Phanuphak N, McCormack S, Ong J. Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges and examples of successful health service models of PrEP implementation. Sex Health 2018; 15:481-484. [DOI: 10.1071/sh18182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) with antiretrovirals could prevent millions of infections, yet effective strategies to get PrEP delivered are just being defined. This editorial introduces a series of 17 articles which form a special issue of Sexual Health focused on the opportunities and challenges for health service providers engaged in PrEP prescribing. All pieces presented here share useful lessons from PrEP pioneers; more than that, they should serve as catalysts to accelerate PrEP implementation around the world.
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