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Phillips TR, Fairley CK, Maddaford K, McNulty A, Donovan B, Guy R, McIver R, Wigan R, Varma R, Ong JJ, Callander D, Skelsey G, Pony M, O'Hara D, Bilardi JE, Chow EP. Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study. JMIR Public Health Surveill 2024; 10:e46845. [PMID: 38767954 PMCID: PMC11148521 DOI: 10.2196/46845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 01/07/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. OBJECTIVE This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. METHODS This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. RESULTS In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. CONCLUSIONS Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.
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Affiliation(s)
- Tiffany R Phillips
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Christopher K Fairley
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Kate Maddaford
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | | | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Rebecca Wigan
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Rick Varma
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason J Ong
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
| | - Denton Callander
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Operational Centre Geneva, Medecins Sans Frontiers, Mombasa, Kenya
- SexTech Lab, The New School, New York, NY, United States
| | | | - Mish Pony
- Scarlet Alliance, Australian Sex Workers Association, Sydney, Australia
| | - Dylan O'Hara
- Vixen, Victoria's Peer Sex Worker Organisation, Melbourne, Australia
| | - Jade E Bilardi
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Eric Pf Chow
- Monash University, Clayton, Australia
- Alfred Health, Melbourne Sexual Health Centre, Carlton, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Wang J, Zhao P, Xu W, Wang C. Changing trends in Chlamydia and gonorrhea infections among female sex workers in Southern China: a surveillance data analysis spanning 2019 to 2022. J Public Health (Oxf) 2024; 46:72-82. [PMID: 38031291 DOI: 10.1093/pubmed/fdad222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Female sex workers (FSW) are particularly vulnerable to chlamydia and gonorrhea infections. However, there were few studies that detail the evolving patterns of chlamydia and gonorrhea among Chinese FSW. Therefore, our study endeavors to assess the prevalence of chlamydia and gonorrhea epidemics within FSW, investigate their changing trends and scrutinize associated factors. METHODS In 2019, China instituted a sentinel surveillance network focused on FSW in Guangdong Province. This network conducted an annual serial cross-sectional survey spanning from April to August. All analyses are predicated on surveillance data accumulated between 2019 and 2022. RESULTS The prevalence of chlamydia increased from 10.1 to 12.3%, exhibiting an annual percentage shift of 6.8%. Conversely, the prevalence of gonorrhea dwindled from 2.0 to 1.3%, marking an annual percentage decline of 13.4% (P < 0.001). After adjusting for covariates, chlamydia exhibited associations with having household registration in other provinces (adjusted odds ratio (aOR = 0.55)), displaying symptoms of sexually transmitted infections (STIs) (aOR = 1.65) and infected with gonorrhea (aOR = 5.68). In parallel, gonorrhea demonstrated associations with providing oral sex to clients (aOR = 3.74), manifesting STIs symptoms (aOR = 4.27) and those infected with chlamydia (aOR = 5.43). CONCLUSIONS Our observations underscore the imperative to implement a comprehensive intervention strategy concentrating on chlamydia, while simultaneously fortifying endeavors to expand the scope of gonorrhea prevention services.
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Affiliation(s)
- Jinshen Wang
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- Dermatology Hospital, Southern Medical University, Guangzhou 510095, China
- Southern Medical University Institute for Global Health, Guangzhou 510095, China
| | - Peizhen Zhao
- Dermatology Hospital, Southern Medical University, Guangzhou 510095, China
- Southern Medical University Institute for Global Health, Guangzhou 510095, China
| | - Wenqian Xu
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- Dermatology Hospital, Southern Medical University, Guangzhou 510095, China
- Southern Medical University Institute for Global Health, Guangzhou 510095, China
| | - Cheng Wang
- School of Public Health, Southern Medical University, Guangzhou 510515, China
- Dermatology Hospital, Southern Medical University, Guangzhou 510095, China
- Southern Medical University Institute for Global Health, Guangzhou 510095, China
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Cotter J, McManus H, Vickers T, Lee C, Davies SC. Increasing prevalence of gonorrhoea and chlamydia among female sex workers in northern Sydney, 2005-2019. Int J STD AIDS 2023; 34:869-875. [PMID: 37350164 DOI: 10.1177/09564624231173024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Recent reports indicate increasing gonorrhoea and chlamydia among female sex workers (FSWs) in Australia, with decreasing condom use for oral sex. METHODS We determined trends in prevalence and positivity of gonorrhoea and chlamydia among FSWs attending our clinic from 2005 to 2019, by analysing data from medical and pathology records. We conducted a sensitivity analysis by using an alternative prevalence definition of first test result only per calendar year. RESULTS Prevalence of gonorrhoea (all sites: pharynx, genital, rectal) increased from 1/130 (0.8%) in 2005 to 14/166 (8.4%) in 2012, to 31/257 (12.1%) in 2019; rate ratio (RR) 1.19, 95%CI 1.14-1.24, ptrend < 0.001. There were rising trends for pharyngeal (RR 1.11, 95% CI 1.05-1.17, ptrend = 0.001) and genital gonorrhoea (RR 1.17, 95% CI 1.08-1.26, ptrend < 0.001). Prevalence of chlamydia (all sites) increased from 4/130 (3.1%) in 2005 to 8/166 (4.8%) in 2012, to 20/257 (7.8%) in 2019; RR 1.05, 95%CI 1.01-1.09, ptrend = 0.006. This rise reflected predominately pharyngeal chlamydia (RR 1.16, 95%CI 1.04-1.29, ptrend = 0.004). Qualitatively similar trends with similar significant results, were seen for gonococcal and chlamydial infections in the sensitivity analyses, indicating robustness of results to potential changes in testing frequency. Gonorrhoea and chlamydia were significantly associated with FSWs born in China. Chlamydia was significantly associated with age group 18-25. In the 2015-2019 period, of 89 women with gonococcal infections, 56 (62.9%) were pharyngeal-only; of 93 with chlamydial infections, 32 (34.4%) were pharyngeal-only infections. CONCLUSIONS FSWs require screening for pharyngeal as well as genital infections. Enhanced and sustainable health promotion is required.
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Affiliation(s)
- J Cotter
- Northern Sydney Sexual Health Service, Northern Sydney Local Health District, Sydney, Australia
| | - H McManus
- The Kirby Institute, University of NSW, Sydney, Australia
| | - T Vickers
- The Kirby Institute, University of NSW, Sydney, Australia
| | - C Lee
- Northern Sydney Sexual Health Service, Northern Sydney Local Health District, Sydney, Australia
| | - S C Davies
- Northern Sydney Sexual Health Service, Northern Sydney Local Health District, Sydney, Australia
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Lee C, McManus H, Foster R, Davies SC. A survey of condom use among female sex workers in Northern Sydney; declining condom use for fellatio. Int J STD AIDS 2021; 32:1326-1337. [PMID: 34525849 DOI: 10.1177/09564624211040951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Condom use among female sex workers (FSWs) is dynamic. We conducted a survey, by anonymous questionnaire, of condom use among FSWs routinely attending our clinical service in Northern Sydney. Logistic regression models determined associations with inconsistent condom use. All 201 women approached completed a questionnaire. Chinese-born women comprised 67% of participants. The median age was 35 years. Clients requesting unprotected fellatio was reported by 95% of participants, and approximately two-thirds felt pressure to have unprotected fellatio and vaginal sex (VSI). Inconsistent condom use at work was reported by 74% for fellatio and by 24% for VSI. The strongest adjusted association with inconsistent condom use for fellatio was monetary inducement by clients (aOR = 40.7, 95% CI 4.87-340, p = 0.001). The only other significant adjusted association was age ≥ 30 years (p = 0.02). The strongest adjusted association with inconsistent condom use for VSI was also monetary inducement by clients (aOR = 56.1, 95% CI 9.26-340, p < 0.001). Other significant adjusted associations were Chinese-speaking participants (p = 0.03) and clients requesting unprotected VSI (p = 0.02). We report high levels of inconsistent condom use. Health promotion should assist FSWs, particularly those of Chinese ethnicity, develop skills in dealing with pressure for unprotected sex, particularly fellatio.
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Affiliation(s)
- Casey Lee
- Northern Sydney Sexual Health Service, 3960Northern Sydney Local Heath District, St Leonards, NSW, Australia
| | - Hamish McManus
- 2786The Kirby Institute, University of NSW, Sydney, NSW, Australia
| | - Rosalind Foster
- 2786The Kirby Institute, University of NSW, Sydney, NSW, Australia.,Sydney Sexual Health Centre, 379373South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Stephen C Davies
- Northern Sydney Sexual Health Service, 3960Northern Sydney Local Heath District, St Leonards, NSW, Australia.,Northern Clinical School, Faculty of Medicine, 198092University of Sydney, St Leonards, NSW, Australia
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Haese EC, Thai VC, Kahler CM. Vaccine Candidates for the Control and Prevention of the Sexually Transmitted Disease Gonorrhea. Vaccines (Basel) 2021; 9:vaccines9070804. [PMID: 34358218 PMCID: PMC8310131 DOI: 10.3390/vaccines9070804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) has placed N. gonorrhoeae on the global priority list of antimicrobial resistant pathogens and is urgently seeking the development of new intervention strategies. N. gonorrhoeae causes 86.9 million cases globally per annum. The effects of gonococcal disease are seen predominantly in women and children and especially in the Australian Indigenous community. While economic modelling suggests that this infection alone may directly cost the USA health care system USD 11.0–20.6 billion, indirect costs associated with adverse disease and pregnancy outcomes, disease prevention, and productivity loss, mean that the overall effect of the disease is far greater still. In this review, we summate the current progress towards the development of a gonorrhea vaccine and describe the clinical trials being undertaken in Australia to assess the efficacy of the current formulation of Bexsero® in controlling disease.
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Callander D, Meunier É, DeVeau R, Grov C, Donovan B, Minichiello V, Kim J, Duncan D. Investigating the effects of COVID-19 on global male sex work populations: a longitudinal study of digital data. Sex Transm Infect 2021; 97:93-98. [PMID: 32591488 PMCID: PMC7371479 DOI: 10.1136/sextrans-2020-054550] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recommendations of 'social distancing' and home quarantines to combat the global COVID-19 pandemic have implications for sex and intimacy, including sex work. This study examined the effects of COVID-19 on male sex work globally and investigated how men who sold sex responded to and engaged with the virus in the context of work. METHODS This study made use of an existing database of deidentified data extracted from the online profiles maintained by male sex workers on a large, international website. Website engagement metrics were calculated for the periods before (September to December 2019) and during COVID-19 (January to May 2020); Poisson regression analyses were used to assess changes over time before and after, while a content analysis was undertaken to identify modes of engagement with the virus. RESULTS Data were collected from 78 399 profiles representing 19 388 individuals. In the 'before' period, the number of active profiles was stable (inter-rate ratio (IRR)=1.01, 95% CI 0.99 to 1.01, p=0.339) but during COVID-19 decreased by 26.3% (IRR=0.90, 95% CI 0.89 to 0.91, p<0.001). Newly created profiles also decreased during COVID-19 (59.4%; IRR=0.71, 95% CI 0.69 to 0.74, p<0.001) after a period of stability. In total, 211 unique profiles explicitly referenced COVID-19; 185 (85.8%) evoked risk reduction strategies, including discontinuation of in-person services (41.2%), pivoting to virtual services (38.9%), COVID-19 status disclosure (20.9%), enhanced sanitary and screening requirements (12.3%) and restricted travel (5.2%). Some profiles, however, seemed to downplay the seriousness of COVID-19 or resist protective measures (14.7%). CONCLUSIONS These findings support the contention that COVID-19 has dramatically impacted the sex industry; globally, male sex workers may be facing considerable economic strain. Targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies. Those involved with the sex industry must have access to state-sponsored COVID-19 financial and other aid programmes to support individual and public health.
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Affiliation(s)
- Denton Callander
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia
| | - Étienne Meunier
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ryan DeVeau
- Faculty of Arts, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Basil Donovan
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - Victor Minichiello
- University of New England, Armidale, New South Wales, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jules Kim
- Scarlet Alliance, Australian Sex Workers Association, Sydney, New South Wales, Australia
| | - Dustin Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Turek EM, Fairley CK, Tabesh M, Phillips TR, Bradshaw CS, Rodriguez E, Chow EPF. HIV, Sexually Transmitted Infections and Sexual Practices Among Male Sex Workers Attending a Sexual Health Clinic in Melbourne, Australia: 2010 to 2018. Sex Transm Dis 2021; 48:103-108. [PMID: 32890334 DOI: 10.1097/olq.0000000000001283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data on HIV/sexually transmitted infection (STI) positivity and sexual practices among male sex workers (MSWs) both globally and particularly in Australia. This study aimed to explore demographic characteristics, sexual practices, and HIV/STI positivity among MSWs attending a sexual health clinic in Melbourne. METHODS We analyzed computerized medical records of all first-visit consultations with men 18 years or older who self-identified as current sex workers and attended the Melbourne Sexual Health Centre (MSHC) between 2010 and 2018. Demographic data, sexual behavior data, and laboratory results for HIV, syphilis, chlamydia, and gonorrhea were collected as part of routine clinical care at Melbourne Sexual Health Centre. RESULTS Of the 190 MSWs included in the analysis, the median age was 28 years (interquartile range, 23-30 years), 30.4% (52/171) reported having condomless penile-anal sex with their clients, and 59.6% (102/171) reported having condomless penile-oral sex with their clients since their last STI screening. Most (85.6%) MSWs had noncommercial sex partners, including 56.5% with male partners only, 30.6% with female partners only, and 12.9% with both. Approximately half of MSWs used condoms consistently with noncommercial sex partners (regardless of partner gender). The positivity for incident HIV was 1.7% (95% confidence interval [CI], 0.0%-5.0%), that for syphilis was 6.1% (95% CI, 2.6%-10.5%), that for chlamydia was 9.6% (95% CI, 5.6%-14.9%), and that for gonorrhea was 10.8% (95% CI, 4.4%-20.9%). Male sex workers who exclusively had sex with women had a lower any HIV/STI positivity (0%) compared with MSW who had sex with men (15.7%; P = 0.013). CONCLUSIONS Male sex workers fall into 2 groups: those who had male clients and/or noncommercial partners who have a relatively high HIV/STI positivity and those who only had female partners or clients whose HIV/STI positivity is low. Both have a high proportion of condomless sex with clients and noncommercial sex partners. Strategies to increase condom use during sex work are needed.
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van Liere GAFS, Dukers-Muijrers NHTM, Kuizenga-Wessel S, Wolffs PFG, Hoebe CJPA. Routine universal testing versus selective or incidental testing for oropharyngeal Neisseria gonorrhoeae in women in the Netherlands: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2021; 21:858-867. [PMID: 33444559 DOI: 10.1016/s1473-3099(20)30594-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/02/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women are not routinely tested for oropharyngeal Neisseria gonorrhoeae. At present, selective testing based on sexual behaviour or risk groups is advocated by international guidelines. Many oropharyngeal infections are asymptomatic and thus remain undetected, establishing a reservoir for ongoing transmission. Data on effectiveness of routine testing are scarce, thus we aimed to assess the optimal testing strategy for oropharyngeal N gonorrhoeae in women. METHODS In this retrospective cohort study, we used surveillance data obtained from all sexually transmitted infection (STI) clinics in the Netherlands between Jan 1, 2008, and Dec 31, 2017. We collected consultation-level data, and individual-level patient data from 2016 onwards, on sociodemographic characteristics, sexual behaviour in the past 6 months, self-reported symptoms, and STI diagnoses. We compared the prevalence of oropharyngeal N gonorrhoeae between women who attended clinics that offered routine universal testing (defined as >85% of women tested per clinic-year) and women who attended clinics that offered selective testing (defined as 5-85% of women tested per clinic-year) or incidental testing (<5% of women tested per clinic-year). We calculated the number of infections missed by selective testing by extrapolating prevalence for the routine universal testing group to that of weighted and unweighted samples of all selectively tested women. We used multivariable generalised estimating equations to identify independent risk factors for oropharyngeal N gonorrhoeae to identify the optimal selective testing strategy. FINDINGS 554 266 consultations with at least one N gonorrhoeae test were recorded, of which 545 750 consultations (including repeat visits) were included in the analyses. Of 545 750 consultations, routine universal testing was used in 57 359 (10·5%), selective testing in 444 283 (81·4%), and incidental testing in 44 108 (8·1%). The prevalence of oropharyngeal N gonorrhoeae was 1·4% (95% CI 1·3-1·5; 703 of 50 962 consultations) in the routine testing group compared with 1·4% (1·3-1·5; 1858 of 132 276) in the selective testing group (p=0·68) and 2·8% (1·9-3·9; 30 of 1088) in the incidental testing group (p<0·0001). The prevalence of oropharyngeal-only infections was 47·7% (335 of 703 women) in the routine testing group, 53·3% (991 of 1858) in the selective testing group, and 60·0% (18 of 30) in the incidental testing group. Selective testing would have missed an estimated 4363 (70%; 95% CI 69-71) of all 6221 oropharyngeal N gonorrhoeae infections. Independent risk factors for oropharyngeal N gonorrhoeae were being notified for any STI (adjusted odds ratio 2·1, 95% CI 1·5-3·0), reporting sex work (4·0, 2·3-6·7), and having concurrent genital (51·5, 34·1-77·7) or anorectal (2·6, 1·4-4·8) N gonorrhoeae. Selective testing of women notified for any STI, or who reported sex work, would have led to 5418 (27·8%) of 19 455 women being tested and would have identified 119 (55·6%) of 214 oropharyngeal N gonorrhoeae infections. INTERPRETATION Selective testing potentially misses more than two-thirds of oropharyngeal N gonorrhoeae infections in women, of whom half have oropharyngeal infections without concurrent genital or anorectal infections. Using independent risk factors for oropharyngeal infection to guide testing is a minimal testing strategy. Routine universal testing is the optimum scenario to detect the majority of infections. However, future studies are needed to assess the cost-effectiveness of routine testing and its effect on antimicrobial resistance. FUNDING Public Health Service South Limburg.
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Affiliation(s)
- Geneviève A F S van Liere
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, Netherlands.
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Turek EM, Fairley CK, Tabesh M, Phillips TR, Chow EPF. Group sex events among female sex workers in Melbourne, Australia. Sex Health 2020; 17:534-537. [PMID: 33172563 DOI: 10.1071/sh20136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022]
Abstract
Background Group sex is associated with increased risk of HIV and sexually transmissible infections (STIs), but there is limited data on group sex among female sex workers (FSW). Understanding current group sex practices among FSW may assist with understanding and addressing the rise in STIs observed among Australian FSW in the 2010s. The aim of this study was to examine the proportion of FSWs who had engaged in group sex. METHODS A cross-sectional survey was conducted among FSWs attending the Melbourne Sexual Health Centre, Australia, between March and April 2019. Females aged ≥18 years who self-reported as a sex worker were invited to participate in the survey asking whether they had had group sex in the past 3 months. Group sex was defined as sex that involved two or more sexual partners. RESULTS Of the 51 FSWs who completed the survey, the median age was 29 years (IQR 24-34). Almost half (49%; n = 25) reported having group sex in the past 3 months, with a median number of group sex events of two (IQR 1-4). Australian-born FSW were more likely to report group sex than overseas-born FSW (76% vs 42%; P = 0.02). Age, number of paid clients and injecting drug use were not associated with group sex. CONCLUSION The present study findings show that group sex is common among FSW and should be included in peer sexual health education and interventions among FSW.
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Affiliation(s)
- Evelyn M Turek
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Marjan Tabesh
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia
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11
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Phillips TR, Fairley C, Maddaford K, Trumpour S, Wigan R, Bradshaw C, Hocking JS, Chow EPF. Duration of gargling and rinsing among frequent mouthwash users: a cross-sectional study. BMJ Open 2020; 10:e040754. [PMID: 32994261 PMCID: PMC7526318 DOI: 10.1136/bmjopen-2020-040754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To examine the rinsing and gargling mouthwash practices among frequent mouthwash users to determine if there are differences in use between gender, sexual orientation and sex work status. DESIGN Cross-sectional study. SETTING Data obtained from patients attending a sexual health centre located in Melbourne, Australia. PARTICIPANTS 200 frequent mouthwash users (four or more times per week), 50 for each of the following patient groups: men who have sex with men (MSM), female sex workers (FSW), females who are not sex workers and men who have sex with women only (MSW). Participants were observed and audio recorded using mouthwash. PRIMARY AND SECONDARY OUTCOME MEASURES Descriptive analyses were conducted to calculate the median age, time rinsing and gargling, amount of mouthwash used and proportion of participants who rinsed, gargled or both, as determined from the audio files. Kruskal-Wallis H test and χ2 test were used to examine differences between the patient groups. RESULTS Median age was 28 years (IQR: 24-33). During the study, most (n=127; 63.5%) rinsed and gargled, but 70 (35.0%) rinsed only and three (1.5%) gargled only. Median time rinsing was 13.5 s (IQR: 8.5-22.0 s), gargling was 4.0 s (IQR: 2.5-6.0 s) and the median total duration was 17.0 s (IQR: 11.5-25.8 s). Median duration of mouthwash did not differ significantly between the groups (females not sex workers: 18.8 s (IQR: 12.5-24.5 s); FSW: 14.0 s (9.0-22.0 s); MSM: 22.3 s (13.0-26.5 s); MSW: 15.8 s (12.0-25.0 s); p=0.070) but males used mouthwash longer than females (median 20.3 s compared with 15.5 s; p=0.034). The median volume of mouthwash used was 20 mL (IQR: 15-27 mL). And most (n=198; 99.0%) did not dilute mouthwash with water. CONCLUSION Over a quarter of frequent users do not gargle mouthwash at all (35%) and used it for a substantially shorter period of time than it was used in the randomised trial (1 min) where it was shown to be effective at inhibiting Neisseria gonorrhoeae growth. Our findings suggest that many frequent mouthwash users do not follow the manufacturer instructions for using mouthwash and may not use mouthwash in a way that was shown to reduce the growth of oropharyngeal gonorrhoea.
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Affiliation(s)
- Tiffany Renee Phillips
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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12
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Callander D, Guy R, Fairley CK, McManus H, Prestage G, Chow EPF, Chen M, Connor CCO, Grulich AE, Bourne C, Hellard M, Stoové M, Donovan B. Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics. Sex Health 2020; 16:457-463. [PMID: 30409244 DOI: 10.1071/sh18097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. METHODS A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. RESULTS The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P<0.001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P<0.001) and rectum (6.6-14.8/100 PY, P<0.001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7-2.2), using injecting drugs (HR=1.7, 95%CI: 1.4-2.0), being HIV positive (HR=1.4, 95%CI: 1.2-1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2-1.6). CONCLUSIONS Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
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Affiliation(s)
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, 580 Swanston Street, Melbourne, Vic. 3000, Australia
| | - Hamish McManus
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | | | - Eric P F Chow
- Melbourne Sexual Health Centre, 580 Swanston Street, Melbourne, Vic. 3000, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, 580 Swanston Street, Melbourne, Vic. 3000, Australia
| | | | | | | | - Margaret Hellard
- Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3000, Australia
| | - Mark Stoové
- Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3000, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
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13
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Kirkcaldy RD, Weston E, Segurado AC, Hughes G. Epidemiology of gonorrhoea: a global perspective. Sex Health 2020; 16:401-411. [PMID: 31505159 DOI: 10.1071/sh19061] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022]
Abstract
Although understanding the local epidemiology of gonorrhoea is critical for local efforts, understanding the multinational epidemiology may support development of national and international prevention and control policies and strategies. In this paper, current epidemiology of gonorrhoea is reviewed through an international lens and with a focus on selected populations. The World Health Organization (WHO) estimates that ~87 million new gonococcal infections occurred among people aged 15-49 years in 2016. Gonorrhoea rates are rising in many countries. Gay, bisexual and other men who have sex with men, racial or ethnic minorities, Indigenous populations and sex workers appear to bear disproportionate burdens of gonorrhoea. International travel can facilitate spread of gonorrhoea, including resistant strains, across international borders. Critical gaps in epidemiological knowledge are highlighted, including data on gonorrhoea among transgender persons and the burden of extragenital gonorrhoea. Even as further data are gathered, action - informed by currently available data - is needed now to confront this growing international threat.
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Affiliation(s)
- Robert D Kirkcaldy
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA; and Corresponding author.
| | - Emily Weston
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Aluisio C Segurado
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil
| | - Gwenda Hughes
- Faculty of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, 01246-903 São Paulo-SP, Brazil; and HIV & STI Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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14
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Phillips TR, Fairley CK, Chen MY, Bradshaw CS, Chow EPF. Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007-17. Sex Health 2020; 16:508-513. [PMID: 31203836 DOI: 10.1071/sh19027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. METHODS Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. RESULTS The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46-12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30-5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39-4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77-2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14-1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). CONCLUSIONS There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.
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Affiliation(s)
- Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Vic. 3053, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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15
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Chow EPF, Fairley CK. Oro-anal sexual practice among female sex workers in Melbourne: implication for extragenital gonorrhoea and chlamydia transmission. Sex Health 2020; 17:296-298. [PMID: 32564778 DOI: 10.1071/sh19219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022]
Abstract
Background The prevalence of sexually transmissible infections has been low among female sex workers (FSWs) in Melbourne, Australia. However, the prevalence of gonorrhoea and chlamydia, especially at extragenital sites, has increased since the mid-2010s. Oro-anal sex (i.e. rimming) has been identified as a risk factor for extragenital gonorrhoea and chlamydia. However, rimming has rarely been studied among the FSW population. The aim of this study was to examine the proportion of FSWs who had had rimming with their male clients. METHODS A cross-sectional survey among FSWs attending the Melbourne Sexual Health Centre in Australia in March 2018 was conducted. All females aged ≥18 years and self-reported as a sex worker were eligible. The survey included questions related to the number of insertive and receptive rimming partners with their male clients in an average working week. RESULTS Forty-five FSWs completed the survey; five (11.1%; 95% CI: 3.7-24.1%) FSWs had had insertive rimming and 19 (42.2%; 95% CI: 27.7-57.8%) had had receptive rimming with their male clients in an average working week. The median number of insertive rimming partners was two (interquartile range (IQR) 1-5) and the median number of receptive rimming partners was one (IQR 1-3). CONCLUSION Insertive rimming is more commonly practiced than receptive rimming among FSWs with their male clients in an average working week.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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16
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Charleson FJ, Fairley CK, Hocking JS, Vodstrcil LA, Bradshaw CS, Chow EPF. Age, ethnic and travel-related disparities in kissing and sexual practices among heterosexual men in Melbourne, Australia. Sex Health 2020; 17:279-287. [DOI: 10.1071/sh19230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
Background The kissing practices of heterosexual men are not well understood, despite the potential of kissing to be a significant risk factor for gonorrhoea transmission. This study aimed to explore kissing and sex practices among heterosexual men. Methods: A cross-sectional survey among heterosexual men attending the Melbourne Sexual Health Centre in 2016–2017 was conducted. Men were asked to report their number of kissing-only (in the absence of sex), sex-only (in the absence of kissing) and kissing-with-sex partners in the last 3 months. The mean number of each partner type was calculated, and multivariable negative binomial regression was used to investigate associations between the number of different types of partners and demographic characteristics. Results: Of the 2351 heterosexual men, men reported a mean of 2.98 kissing-only, 0.54 sex-only and 2.64 kissing-with-sex partners in the last 3 months. Younger men had a mean higher number of kissing-only partners than older men (4.52 partners among men aged ≤24 years compared with 1.75 partners among men ≥35 years, P < 0.001). Men born in Europe had the most kissing-only partners (mean: 5.16 partners) and men born in Asia had the fewest kissing-only partners (mean: 1.61 partners). Men recently arrived in Australia, including travellers from overseas, had significantly more kissing-only partners (adjusted incidence rate ratio (aIRR): 1.53; 95% CI: 1.31–1.80) than local men. Conclusions: This study provides novel data about kissing practices of heterosexual men. Studies assessing oropharyngeal gonorrhoea should include measurements of kissing until studies can clarify its contribution to transmission risk.
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17
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Zappulla A, Fairley CK, Donovan B, Guy R, Bradshaw CS, Chen MY, Phillips TR, Maddaford K, Chow EPF. Sexual practices of female sex workers in Melbourne, Australia: an anonymous cross-sectional questionnaire study in 2017-18. Sex Health 2020; 17:53-60. [PMID: 31928612 DOI: 10.1071/sh19037] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022]
Abstract
Background Sexually transmissible infections (STIs) are rising among female sex workers (FSW) in Australia. The rise might be explained by changes in sexual practices; however, there is limited behavioural data available. This study aimed to explore the current sexual practices among FSW in Melbourne. METHODS This cross-sectional study was conducted among FSW at Melbourne Sexual Health Centre between September 2017 and March 2018. Participants were asked about current sexual practices with male clients in an average working week. The frequency and proportion of each sexual practice was calculated. RESULTS There were 180 questionnaires included in the analysis. The median age of the FSW was 28 years (interquartile range [IQR]: 25-34). Most FSW (80.6%) worked in brothels. In an average working week, FSW had a median of 10 (IQR: 7-20) male clients. The most common sexual practices included: vaginal sex (98.3%), fellatio (97.2%), cunnilingus (92.2%) and tongue-kissing (83.7%). FSW had a median number of 10 (IQR: 6-18) vaginal, 10 (IQR: 5-18) fellatio, 7 (IQR: 2-10) cunnilingus and 6 (IQR: 2-10) tongue-kissing clients. Consistent condom use with all clients was highest for vaginal sex (97.1%), followed by anal sex (92.3%), then fellatio (78.9%). Only 3.1% used dental dams consistently for cunnilingus. CONCLUSION Consistent condom use with all clients was high among FSWs, especially for vaginal and anal sex. However, one-fifth of FSW had condomless fellatio during an average working week. Tongue-kissing was more common than previously published. Peer-led sexual health education on safe sex practice for FSW is of high importance.
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Affiliation(s)
- Annalisa Zappulla
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, High Street, Kensington, NSW 2052, Australia; and Sydney Sexual Health Centre, Sydney Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, High Street, Kensington, NSW 2052, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
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Jelocnik M. Chlamydiae from Down Under: The Curious Cases of Chlamydial Infections in Australia. Microorganisms 2019; 7:microorganisms7120602. [PMID: 31766703 PMCID: PMC6955670 DOI: 10.3390/microorganisms7120602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
In Australia, the most researched and perhaps the most successful chlamydial species are the human pathogen Chlamydia trachomatis, animal pathogens Chlamydia pecorum and Chlamydia psittaci. C. trachomatis remains the leading cause of sexually transmitted infections in Australians and trachoma in Australian Indigenous populations. C. pecorum is globally recognised as the infamous koala and widespread livestock pathogen, whilst the avian C. psittaci is emerging as a horse pathogen posing zoonotic risks to humans. Certainly not innocuous, the human infections with Chlamydia pneumoniae seem to be less prevalent that other human chlamydial pathogens (namely C. trachomatis). Interestingly, the complete host range for C. pecorum and C. psittaci remains unknown, and infections by other chlamydial organisms in Australian domesticated and wildlife animals are understudied. Considering that chlamydial organisms can be encountered by either host at the human/animal interface, I review the most recent findings of chlamydial organisms infecting Australians, domesticated animals and native wildlife. Furthermore, I also provide commentary from leading Australian Chlamydia experts on challenges and future directions in the Chlamydia research field.
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Affiliation(s)
- Martina Jelocnik
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs 4557, Australia
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19
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Foster R, McCormack L, Thng C, Wand H, McNulty A. Cross-sectional survey of Chinese-speaking and Thai-speaking female sex workers in Sydney, Australia: factors associated with consistent condom use. Sex Health 2019; 15:389-395. [PMID: 30131098 DOI: 10.1071/sh17205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
Abstract
Background Previous studies have described inconsistent condom use in Chinese- and Thai-speaking female sex workers in Sydney, Australia. In the present study, we describe the demographics and safe sexual practices in the Chinese- and Thai-speaking female sex workers attending the Sydney Sexual Health Centre (SSHC) in 2014-15. METHODS A self-completed 60-item anonymous questionnaire, adapted from previous surveys conducted in 1993 and 2003, was translated into Chinese and Thai and administered to female sex workers attending the SSHC or seen on outreach. RESULTS In all, 488 surveys were distributed, of which 435 were returned; 43% in Chinese and 57% in Thai. Most women did not plan on sex work before their arrival in Australia. Compared with Chinese-speaking women, Thai-speaking women rated themselves higher on English language literacy, had better knowledge of the transmission of HIV and sexually transmissible infections (STIs) and were more likely to practice 100% condom use. Overall, 72% of the sex workers surveyed reported consistent condom use for vaginal sex at work. CONCLUSIONS Consistent condom use for vaginal sex at work among Chinese- and Thai-speaking female sex workers has decreased slightly from that reported in a similar survey conducted by the SSHC in 2003, when 85% of sex workers reported consistent condom use. There are significant differences between Chinese- and Thai-speaking sex workers in terms of both knowledge and safer sex practices. Ongoing health promotion efforts should focus on providing culturally appropriate education around STIs and safe sex practices not only to workers, but also to parlour owners, managers and consumers.
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Affiliation(s)
- Rosalind Foster
- Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia
| | - Lynne McCormack
- Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia
| | - Caroline Thng
- Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia
| | - Handan Wand
- Kirby Institute, The University of New South Wales, Sydney, Kensington, NSW 2052, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, PO Box 1614, Sydney, NSW 2001, Australia
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20
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Lewis DA. Disentangling the tangled web of Neisseria gonorrhoeae transmission: how important are oropharyngeal infections? Sex Transm Infect 2019; 95:395-396. [PMID: 31289109 DOI: 10.1136/sextrans-2019-054030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/23/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia .,Westmead Clinical School & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.,Division of Medical Virology, University of Cape Town, Cape Town, Western Cape, South Africa
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21
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Chow EP, Williamson DA, Fortune R, Bradshaw CS, Chen MY, Fehler G, De Petra V, Howden BP, Fairley CK. Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015-2017: need for oropharyngeal testing. Sex Transm Infect 2019; 95:398-401. [PMID: 31113904 DOI: 10.1136/sextrans-2018-053957] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Victorian legislation requires sex workers to have quarterly screening for genital chlamydia and gonorrhoea, but screening for oropharyngeal infection is not mandatory in Victoria, Australia. In 2017, oropharyngeal screening for gonorrhoea and chlamydia was added as part of the routine quarterly screening for sex workers attending the Melbourne Sexual Health Centre (MSHC). The aim of this study was to examine the prevalence of oropharyngeal gonorrhoea and chlamydia among female sex workers (FSW). METHODS We included females who (1) self-identified as sex workers or were attended MSHC for a sex work certificate and (2) had tested for any STI or HIV, between March 2015 and December 2017. The prevalence of HIV, syphilis, chlamydia and gonorrhoea was calculated. RESULTS There were 8538 FSW consultations among 2780 individuals during the study period. There was a twofold increase in genital gonorrhoea (from 0.5% (95% CI 0.3% to 0.9%) to 1.1% (95% CI 0.8% to 1.5%); ptrend=0.047) and a 1.5-fold increase in genital chlamydia (from 2.2% (95% CI 1.6% to 2.8%) to 3.2% (95% CI 2.6% to 3.8%); ptrend=0.031) during the period. Overall, the prevalence of HIV (0.2% (95% CI 0.1% to 0.3%)) and syphilis (0.1% (95% CI 0.0% to 0.2%)) remained low and did not change over time. In 2017, the prevalence of oropharyngeal gonorrhoea was 2.0% (95% CI 1.6% to 2.6%) and oropharyngeal chlamydia was 2.1% (95% CI 1.6% to 2.7%). Among FSW who were tested positive for gonorrhoea and chlamydia, 55% (n=41) and 34% (n=45) only tested positive in the oropharynx but not genital for gonorrhoea and chlamydia, respectively. CONCLUSION The prevalence of oropharyngeal gonorrhoea and chlamydia is similar to the prevalence at genital sites and is often independent of genital infection. It is important to test the oropharynx and genital site for chlamydia and gonorrhoea among FSW.
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Affiliation(s)
- Eric Pf Chow
- Central Clinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, 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, Victoria, Australia
| | - Ria Fortune
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Marcus Y Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Glenda Fehler
- 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, Melbourne, Victoria, 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, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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22
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Selvey LA, Hallett J, McCausland K, Bates J, Donovan B, Lobo R. Declining Condom Use Among Sex Workers in Western Australia. Front Public Health 2018; 6:342. [PMID: 30547024 PMCID: PMC6278845 DOI: 10.3389/fpubh.2018.00342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction: Since the emergence of the HIV pandemic in the 1980s, high rates of condom use for penetrative sex have been reported among sex workers in Australia. The sex industry in Australia and elsewhere has changed over the previous decade with increasing proportions of sex workers working privately and lower proportions of sex workers working in brothels. There has also been some evidence of reductions in condom use, particularly during penetrative oral sex. We therefore decided to investigate sex workers' use of condoms during penetrative sex with clients. Methods: This was a cross-sectional mixed methods study of sex workers in Western Australia. The study involved an environmental scan of the sex industry in Western Australia, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews. Results: We surveyed 354 male, female, and transgender sex workers in Western Australia. We found unexpectedly low rates of reported condom use with clients for all forms of penetrative sex. Of respondents who reported providing this type of service, 33% reported that all clients used condoms during oral sex, 69% during vaginal sex and 59% during anal sex. High levels of client demand for condomless sex was also reported, with 42% of sex workers reporting that all or most clients requested condomless oral sex. Increasing client demand, fear of losing clients and the ability to charge more for condomless sex were reported reasons for providing this service. Conclusions: There has been an apparent increase in sex workers reporting condomless penetrative sex with clients in Western Australia compared to a previous cross-sectional study. An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors.
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Affiliation(s)
- Linda A Selvey
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Kahlia McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Julie Bates
- Urban Realists Planning & Health Consultants, Sydney, NSW, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
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23
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Callander D, Moreira C, El-Hayek C, Asselin J, van Gemert C, Watchirs Smith L, Nguyen L, Dimech W, Boyle DI, Donovan B, Stoové M, Hellard M, Guy R. Monitoring the Control of Sexually Transmissible Infections and Blood-Borne Viruses: Protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). JMIR Res Protoc 2018; 7:e11028. [PMID: 30459142 PMCID: PMC6280029 DOI: 10.2196/11028] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 01/20/2023] Open
Abstract
Background New biomedical prevention interventions make the control or elimination of some blood-borne viruses (BBVs) and sexually transmissible infections (STIs) increasingly feasible. In response, the World Health Organization and governments around the world have established elimination targets and associated timelines. To monitor progress toward such targets, enhanced systems of data collection are required. This paper describes the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). Objective This study aims to establish a national surveillance network designed to monitor public health outcomes and evaluate the impact of strategies aimed at controlling BBVs and STIs. Methods ACCESS is a sentinel surveillance system comprising health services (sexual health clinics, general practice clinics, drug and alcohol services, community-led testing services, and hospital outpatient clinics) and pathology laboratories in each of Australia’s 8 states and territories. Scoping was undertaken in each jurisdiction to identify sites that provide a significant volume of testing or management of BBVs or STIs or to see populations with particular risks for these infections (“priority populations”). Nationally, we identified 115 health services and 24 pathology laboratories as relevant to BBVs or STIs; purposive sampling was undertaken. As of March 2018, we had recruited 92.0% (104/113) of health services and 71% (17/24) of laboratories among those identified as relevant to ACCESS. ACCESS is based on the regular and automated extraction of deidentified patient data using specialized software called GRHANITE, which creates an anonymous unique identifier from patient details. This identifier allows anonymous linkage between and within participating sites, creating a national cohort to facilitate epidemiological monitoring and the evaluation of clinical and public health interventions. Results Between 2009 and 2017, 1,171,658 individual patients attended a health service participating in ACCESS network comprising 7,992,241 consultations. Regarding those with unique BBV and STI-related health needs, ACCESS captured data on 366,441 young heterosexuals, 96,985 gay and bisexual men, and 21,598 people living with HIV. Conclusions ACCESS is a unique system with the ability to track efforts to control STIs and BBVs—including through the calculation of powerful epidemiological indicators—by identifying response gaps and facilitating the evaluation of programs and interventions. By anonymously linking patients between and within services and over time, ACCESS has exciting potential as a research and evaluation platform. Establishing a national health surveillance system requires close partnerships across the research, government, community, health, and technology sectors. International Registered Report Identifier (IRRID) DERR1-10.2196/11028
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Affiliation(s)
- Denton Callander
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
| | | | - Carol El-Hayek
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Caroline van Gemert
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | - Wayne Dimech
- National Reference Laboratory, Melbourne, Australia
| | - Douglas Ir Boyle
- Research Information Technology Unit, Health and Biomedical Information Centre, Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia
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24
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Selvey LA, Lobo RC, McCausland KL, Donovan B, Bates J, Hallett J. Challenges Facing Asian Sex Workers in Western Australia: Implications for Health Promotion and Support Services. Front Public Health 2018; 6:171. [PMID: 29951477 PMCID: PMC6008381 DOI: 10.3389/fpubh.2018.00171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Asian sex workers are a significant part of the Australian sex industry. Criminal laws, racism, isolation, poor English language skills and stigma and discrimination combine to increase the vulnerability of Asian sex workers in Australia. To inform service delivery and potential legislative reform, we undertook a study of sex worker health and safety in Western Australia with a focus on Asian sex workers. Methods: This was a mixed methods study in which peer researchers played an essential role. We undertook a survey (available online and in paper form and translated into three languages other than English), semi-structured interviews with sex workers, and interviews with key advisors. Results: In our study, Asian sex workers were older, had lower levels of education, more likely to have sex work as their main source of income, work longer hours and work exclusively in a shop-front massage parlor compared to their non-Asian counterparts. The vast majority of Asian sex workers in our study said they had poor English language skills and the greatest proportion spoke Chinese languages. Sex work had a positive impact on the well-being of many respondents, and their level of psychological distress was similar to the general Australian population. Stress and “bad clients” were common negative impacts of sex work. Asian study participants were less likely than their non-Asian counterparts to smoke, undertake risky drinking or use illicit drugs. A similar proportion of Asian sex workers reported being assaulted compared to their non-Asian counterparts. Discussion/Conclusion: The major challenges facing Asian sex workers in WA seem to be stigma and discrimination, stress, social isolation, and confusion about their legal standing leading to a fear of authorities, particularly the police. Our findings support the need for enhanced targeted peer-based health promotion outreach services for Asian sex workers, increased Asian language services in sexual health clinics and decriminalization of sex work.
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Affiliation(s)
- Linda A Selvey
- Division of Disease Prevention and Control, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Roanna C Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Kahlia L McCausland
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
| | - Julie Bates
- Urban Realists Planning and Health Consultants, Sydney, NSW, Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, WA, Australia
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