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Background: Telemedicine, which involves utilising technologies for remote health care delivery, proved useful to continue offering certain health services during the coronavirus disease 2019 (COVID-19) lockdown. However, the extent of its effectiveness in delivering pre-exposure prophylaxis services for HIV prevention remains underexplored from the viewpoint of health care providers. Therefore, this study aimed to assess the experiences of health care professionals in Mexico who utilised telemedicine for delivering pre-exposure prophylaxis services during the COVID-19 contingency. Methods: A qualitative study was performed: 15 virtual interviews with health care professionals were conducted, transcribed and coded in ATLAS.ti. Results: The results indicate that telemedicine effectively mitigated COVID-19 exposure, facilitated users' access to pre-exposure prophylaxis counselling, minimised waiting times and enhanced health care professionals' perceived control during sessions. While implementing remote services, certain organisational challenges, which were somewhat latent before the pandemic, became more apparent: colleagues recognised the necessity for more formal communication channels to disseminate information effectively. Additionally, there was a recognised need for electronic patient files to streamline data-sharing processes. An optimal approach would involve a blend of face-to-face and virtual services, contingent upon the availability of essential infrastructure, well-defined implementation protocols and comprehensive training programs. Conclusions: Telemedicine streamlined certain processes, garnered positive acceptance from healthcare professionals and holds promise as a valuable post-pandemic tool for improving retention among pre-exposure prophylaxis users. Telemedicine, involving the use of technologies for remote healthcare services, was used by health care providers in Mexico to facilitate access to HIV prevention services, including pre-exposure prophylaxis. From their experiences, it became evident that telemedicine improved access to HIV-prevention counselling and enhanced time management for providers; at the same time, they struggled with inadequate infrastructure and concerns about privacy. They advocated for clear guidelines to establish procedures and provide support when delivering pre-exposure prophylaxis services remotely. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods: We conducted an online survey (July–September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results: Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12 months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5 years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions: BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women. Bacterial vaginosis is the most common cause of vaginal discharge in reproductive age women, yet little is known about it in postmenopausal women. This survey of Australian postmenopausal women found that women continue to report bacterial vaginosis after menopause, it affects their quality of life, and it is associated with sexual activity. Women of all ages are susceptible to bacterial vaginosis, research should not be limited to younger women, and developing an appropriate testing method should be a research priority. [ABSTRACT FROM AUTHOR]

This editorial, by the retiring Editors Christopher Fairley and Roy Chan, tells the story of the founding of Sexual Health in 2004 and its journey. They express their gratitude for privilege they have enjoyed as Editors-in-Chief of the journal. [ABSTRACT FROM AUTHOR]

HIV testing is a 'gateway' technology, enabling access to treatment and HIV prevention. Biomedical approaches to prevention, such as pre-exposure prophylaxis and treatment as prevention, require accurate and regular HIV test results. HIV testing also represents a powerful 'teachable moment' for behavioural prevention. An increasing range of HIV tests and the emergence of self-managed diagnostic technologies (e.g. self-testing) means there is now considerable diversification of when, where and how results are available to those who test. These changes have profound implications for intervention development and, indeed, health service redesign. This paper highlights the need for better ways of conceptualising testing in order to capitalise on the health benefits that diverse HIV testing interventions will bring. A multidimensional framework is proposed to capture ongoing developments in HIV testing among men who have sex with men and focus on the intersection of: (1) the growing variety of HIV testing technologies and the associated diversification of their pathways into care; (2) psychosocial insights into the behavioural domain of HIV testing; and (3) better appreciation of population factors associated with heterogeneity and concomitant inequities. By considering these three aspects of HIV testing in parallel, it is possible to identify gaps, limitations and opportunities in future HIV testing-related interventions. Moreover, it is possible to explore and map how diverse interventions may work together having additive effects. Only a holistic and dynamic framework that captures the increasing complexity of HIV testing is fit for purpose to deliver the maximum public health benefit of HIV testing. [ABSTRACT FROM AUTHOR]

Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM's access to and use of these technologies. At the personal level, stigma can affect individual gay men's sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM's incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma. [ABSTRACT FROM AUTHOR]

Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources. [ABSTRACT FROM AUTHOR]

Background The aim of this review is to explore acceptability, barriers, and facilitators to PrEP use among African migrants in high-income countries.Methods: A systematic review was conducted to explore reasons that contribute to low PrEP uptake in this population. Three online databases, abstracts from key conferences and reference lists of relevant studies articles published between the 2 July 2018 and 3 March 2019 were searched. Narrative synthesis was performed on quantitative data and thematic synthesis was performed on qualitative data.Results: Of 1779 titles retrieved, two cross-sectional studies (United States (US) (n = 1), United Kingdom (UK) (n = 1)) and six qualitative studies (US (n = 2), UK (n = 3), Australia (n = 1)) met inclusion criteria. PrEP acceptability was reported in one cross-sectional article and two qualitative articles. Cross-sectional studies measured acceptability and willingness to use PrEP; in one study, 46% of African migrant men found PrEP use acceptable, and following PrEP education, another study categorised 60% of participants as willing to use PrEP if it were cost-free. Qualitative studies reported mixed acceptability, with higher acceptability reported for serodiscordant couples. Barriers and facilitators to PrEP use were coded into five themes: cultural aspects of stigma; knowledge gap in health literacy; risks unrelated to HIV transmission; practical considerations for PrEP use; and the impact of PrEP use on serodiscordant couples.Conclusions: Several common barriers to PrEP use, including stigma, health literacy and risk perception and cost, were identified. Findings were limited by there being no published data on uptake. Additional work is needed to understand PrEP acceptability and uptake among African migrants. [ABSTRACT FROM AUTHOR]

This Collection highlights some recent publications in Sexual Health on using technology to optimise sexual health. By leveraging innovations such as rapid diagnostic tools, mobile health (mHealth), selftesting and artificial-intelligence-powered tools, we can empower individuals to take control of their sexual health, reducing risks and enhancing accessibility. [ABSTRACT FROM AUTHOR]

Syphilis control strategies are old, but interventions have changed and there is now a more scientific approach to evidence of effectiveness. We searched PubMed using 'syphilis control' to identify papers that measured the effectiveness of interventions. We also included novel approaches and comprehensive responses to outbreaks. Few papers used high-quality research methodology and fewer evaluated impact on prevalence or incidence; most assessed intermediate outcomes. Syphilis can often be controlled by a combination of case finding, treatment and education. However, outbreaks are unique and ongoing evaluation is needed to see if interventions are producing intended intermediate outcomes at reasonable costs. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains an ongoing global public health challenge. This disease causes damage not only to the respiratory system, affecting the normal physiological function of the lungs, but also to other vital organs, such as the heart and testicles. Existing studies have shown that co-expression of angiotensin-converting enzyme 2 and transmembrane serine protease 2 is the main mechanism by which SARS-CoV-2 invades host cells. Angiotensin-converting enzyme 2-expressing cells are widespread in the corpus cavernosum, reproductive tract and testis of men, which has raised concerns. Furthermore, abnormal sex hormone levels and decreased semen parameters were observed in coronavirus disease 2019 patients. This study comprehensively assessed the effects of SARS-CoV-2 infection on the testis, semen parameters, sex hormone levels and erectile function, and discussed possible transmission routes during sexual intercourse and the effect of vaccination on male fertility. Since the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in December 2019, coronavirus disease 2019 (COVID-19) has already had a widespread impact on fertility. This study comprehensively assessed the effects of SARS-CoV-2 infection on the testis, semen parameters, sex hormone levels and erectile function, and discussed possible transmission routes during sexual intercourse and the effect of vaccination on male fertility. It provides a reference for maintaining male reproductive health under the background of normalised prevention and control of COVID-19. [ABSTRACT FROM AUTHOR]

Background: When demand for counselling in community-based clinics exceeds capacity, waiting lists are typically formed. Determining allocation priority solely on wait time can overlook client risk factors that can elevate priority. We undertook to rigorously adapt the only existing validated counselling triage tool, to better fit the sexual health setting. Methods: Sexual health counsellors were surveyed about aspects of client presentations that flagged increased priority. The revised Client Priority Rating Scale (CPRS-R) was created through systematic analysis and decision making, informed by survey results and literature review. Four expert sexual health counsellors independently rated the priority of 14 hypothetical clinical vignettes using the CPRS and CPRS-R. Results: Criterion (concurrent), content and face validity are evidenced in the revised scale. Average interrater agreement was higher on the CPRS-R (28%) than the CPRS (11%); however, this difference was marginal (P = 0.06). According to Gwet's Agreement Coefficient (AC) and Krippendorff's Alpha, both the CPRS and the CPRS-R demonstrate comparable interrater reliability, substantial and moderate, respectively. Kendall's W indicates the CPRS yielded higher reliability. However, the difference is not substantial. Conclusions: The CPRS-R is a triage tool designed for the sexual health counselling setting. This tool has demonstrated criterion, content and face validity, as well as moderate to substantial inter-rater reliability. It can be used in sexual health settings to inform assessments about client priority, along with clinical judgement and peer consultation. Effective client triage is essential when demand for counselling exceeds capacity. We adapted an existing counselling triage tool to better fit the sexual health setting. Psychometric scales are useful tools in patient assessment and care, however, are best applied in combination with clinical judgement and peer consultation. [ABSTRACT FROM AUTHOR]

Background: International research consistently indicates that women-who-have-sex-with-women (WSW) are less likely to engage in cervical screening than heterosexual women. In the main, studies have explored rates of engagement and highlighted some reasons for non-engagement. This study extends on this work by exploring perceptions among sexual minority women (WSW) for lower rates of engagement among WSW more generally and is the first study on this topic undertaken in Aotearoa New Zealand. Methods: A sample of 177 self-identified WSW domiciled in New Zealand completed an online survey about their engagement in cervical screening, reasons for engaging (or not) in cervical screening, and perceptions of why SMW might be less likely to engage in cervical screening. Results: Fewer than half of participants had engaged in cervical screening every 3 years as recommended, with women who had only ever had sex with other women being significantly less likely to have engaged in screening. A lack of clear information about risk relative to sexual history, heteronormativity, and the invasive nature of screening were the dominant reasons for lower engagement among WSW. Conclusions: A legacy of misinformation, and endemic heteronormativity in public health messaging around cervical screening is a significant barrier to engagement in screening for WSW. To increase engagement in screening among WSW, public health information needs to specifically address the needs of WSW. International research suggests that lesbians and other women-who-have-sex-with-women (WSW) are less likely to engage in cervical screening than are heterosexual women. This study explored engagement in cervical screening and reasons for engaging (or not) among WSW in New Zealand finding lower levels of engagement due to a legacy of misinformation and endemic heteronormativity in health care. Findings of the study highlight the need to ensure that publicity around cervical screening specifically addresses WSW. [ABSTRACT FROM AUTHOR]

Background: Knowing levels and determinants of partnership acquisition will help inform interventions that try to reduce transmission of sexually transmitted infections (STIs) including HIV. Methods: We used population-based, cross-sectional data from 47 Demographic and Health Surveys to calculate rates of partner acquisition among men and women (15–49 years), and identified socio-demographic correlates for partner acquisition. Partner acquisition rates were estimated as the total number of acquisitions divided by the person-time in the period covered by the survey. For each survey and by sex, we estimated age-specific partner acquisition rates and used age-adjusted piecewise exponential survival models to explore whether there was any association between wealth, HIV status and partner status with partner acquisition rates. Results: Across countries, the median partner acquisition rates were 30/100 person-years for men (interquartile range 21–45) and 13/100 person-years for women (interquartile range 6–18). There were substantial variations in partner acquisition rates by age. Associations between wealth and partner acquisition rates varied across countries. People with a cohabiting partner were less likely to acquire a new one, and this effect was stronger for women than men and varied substantially between countries. Women living with HIV had higher partner acquisition rates than HIV-negative women but this association was less apparent for men. At a population level, partner acquisition rates were correlated with HIV incidence. Conclusions: Partner acquisition rates are variable and are associated with important correlates of STIs and thus could be used to identify groups at high risk of STIs. How people acquire new sexual partners is an important determinant of sexually transmitted infections (STI) transmission, including HIV. This analysis uses a new way of measuring partner acquisition and found that this new measure was related to people's age, sex, wealth, partnership status and HIV status. This measure could be used to help identify population groups at high risk of STIs. [ABSTRACT FROM AUTHOR]

Background: Emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) fixed-dose combination (FTC/TDF) is generally well-tolerated, although treatment-related adverse events have been reported. Methods: We report two cases of persons using FTC/TDF PrEP who had acute neuralgia in a Chinese PrEP demonstration trial. Results: Neurological symptoms subsided upon treatment discontinuation. Symptoms were reported as similar to one case's previous experiences with dolutegravir (DTG) + FTC + tenofovir alafenamide (TAF) (for PEP), leading to permanent discontinuation of PrEP. Conclusion: Acute facial neuralgia appears to be a rare idiosyncratic adverse event to FTC/TDF. HIV PrEP is widely recommended as a crucial measure for HIV prevention. In a demonstration trial in China, this article highlights two cases where facial neuralgia emerged as an unexpected side effect of PrEP medication, not previously mentioned in official prescribing information. These findings deepen our understanding of the potential side effects of emitricitabine/tenofovir disoproxil fumarate use and provide empirical evidence to enhance PrEP implementation further and address the challenges that may arise during its utilisation. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). Methods: We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019–February 2020. Women aged over 45 years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. Results: A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Conclusions: Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician–patient discourse regarding these important issues should be explored. Women living with HIV are a minority in Australia. They present unique healthcare challenges, particularly relating to sexual and reproductive health. Evidence shows higher rates of unplanned pregnancy and lower rates of long-acting-reversible contraception use among women living with HIV. We highlight gaps in care at an Australian metropolitan centre and suggest contraceptive options used by women living with HIV may be changing in the era of modern HIV treatment. We suggest changes in care provision to meet demand, including use of 'women-centred' models of care. [ABSTRACT FROM AUTHOR]

Background: Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. Methods: We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis. Results: Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk. Conclusions: The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand. This study aimed to provide a deeper understanding of transgender women's experiences of pre-exposure prophylaxis (PrEP) uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. We interviewed 20 young transgender women and 10 health care providers from two HIV clinics in Bangkok, Thailand. Our findings deepen the current understanding of barriers to PrEP use, and inform the development of effective interventions to promote PrEP use. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSWs) contribute disproportionately to HIV transmission in Uganda, and pre-exposure prophylaxis (PrEP) is effective in preventing HIV among cisgender women. Psychological factors are important for PrEP uptake, but few studies have examined psychosocial changes due to PrEP use in Uganda. Methods: In 2021, we recruited 524 FSWs in three Trans-African Highway towns and four fishing communities in south-western Uganda. We conducted structured interviews among women who were attending routine PrEP follow-up visits in six health units. Bivariable and multivariable modified regression using a robust covariance matrix estimator were used to identify factors associated with experiencing increased sexual pleasure and less worry about HIV because of PrEP. Results: Overall, 80.9% participants reported that sex was more pleasurable because of taking PrEP. There were statistical trends for sex being more pleasurable when taking PrEP or when having condomless sex with casual paying partners (aPR = 1.19, 95% CI = 1.07–1.32, P = 0.001). Almost three-quarters of the participants (76.3%) were less worried about getting HIV because of PrEP. Condomless sex with casual paying partners (aPR = 1.17, 95% CI = 1.05–1.31, P = 0.032, P = 0.003) and being On PrEP for the past 1–2 years (aPR = 1.18, 95% CI = 1.00–1.38, P = 0.032) was significantly associated with HIV-related worry (aPR = 1.17, 95% CI = 1.05–1.31, P = 0.032, P = 0.003) Conclusions: We found a positive impact of PrEP in Ugandan FSWs on two key psychosocial dimensions: (1) more pleasurable sex; and (2) less worry about acquiring HIV. Interventions aiming to increase PrEP uptake may find it useful to focus on psychosocial dimensions. There is more to pre-exposure prophylaxis (PrEP) other than the health benefits. Usually, the important social benefits are less considered yet they could reveal much more. As interest intensifies, the social benefits should be incorporated more to tell us what we are missing about PrEP, that could be important globally in the use of this drug. Being less worried about a drug and enjoying sex without worry means 'confidence' about a drug that could be vital for future uptake. [ABSTRACT FROM AUTHOR]

Background Recently, lesbian, gay, bisexual, and transgender (LGBT) scientific production is growing, but transgender (TG) people is less considered in the LGBT-related research, highlighting the lack of representative data on this neglected population.Methods: To assess the current status of scientific production on TG population, a bibliometric study was performed using the articles on TG people deposited in five databases, including PubMed/Medline, Scopus, Science Citation Index (SCI), Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Health Sciences Literature (LILACS).Results: The PubMed/Medline search retrieved 2370 documents, which represented 0.008% of all articles recorded in Medline. The Scopus search identified 4974 articles. At SCI, 2863 articles were identified. A search of the SciELO database identified 39 articles, whereas the LILACS search identified 44 articles. Most papers were from the US (57.59%), followed by Canada (5.15%), the UK (4.42%), Australia (3.19%), The Netherlands (2.46%) and Peru (1.83%). These six countries accounted for 74.6% of all scientific output.Conclusions: The findings indicate that the TG-related research is low, especially in low-income developing countries, where stigma and discrimination are common. More awareness, knowledge, and sensitivity in healthcare communities are needed to eliminate barriers in health attention and research in this population. [ABSTRACT FROM AUTHOR]

This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. The reproductive rate for HPV infection in heterosexuals is not well established, but 70% vaccination coverage in women has resulted in a fall of more than 90% in genital warts and HPV types 16/18 in young women and 80% fall in young men indicating that the critical vaccination threshold has been exceeded for this group. Published data on the three elements of the reproductive rate for HPV infection (i.e. transmission probability per sexual partnership, rate of partner change and duration of infectiousness) suggest they are higher in MSM than heterosexuals. This indicates that the reproductive rate for HPV will be higher in MSM and hence the critical vaccination threshold will also be higher. But while vaccinating 70% of girls protect 70% of sexual partnerships in heterosexuals, vaccinating 70% of boys protect more than 70% of partnerships in MSM. Only 9% (30% by 30%) of sexual partnerships in MSM are not protected with 70% coverage. Therefore vaccinating 70% of boys will protect 91% of sexual partnerships in MSM. However the efficacy of the HPV vaccine is much lower when sexually active MSM are vaccinated rather than boys. We argue that if MSM are to have the same benefit from the HPV vaccine that heterosexuals had, boys and not adult MSM will need to be vaccinated. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) in Australia has largely been targeted at gay, bisexual and other men who have sex with men. In the context of HIV elimination, the aim of this qualitative study was to explore PrEP prescribing for Australian cisgender women from the provider's perspective. Methods: Semi-structured interviews were held with Australian prescribers in 2022. Participants were recruited through relevant clinical services, newsletter distribution and snowball sampling. Interviews were audio-recorded, transcribed and analysed thematically. Results: Seventeen prescribers participated, of whom 9 were sexual health physicians and 10 worked in New South Wales. All reported limited clinical experience prescribing PrEP for women. Potential enablers to PrEP prescribing to women included education for women and clinicians, easily identifiable risk factors, individualised risk assessment and expansion of existing services. Barriers were limited PrEP awareness among women and prescribers, difficulties with risk assessment and consult and service limitations. The type of service recommended for PrEP provision varied among participants. Conclusions: Clinician experience of PrEP prescribing to Australian cisgender women is limited, with substantial barriers to access perceived by prescribers. Targeted education to PrEP prescribers, updated national PrEP guidelines to include women as a distinct group and further research regarding women's preferred model of PrEP access are required. Clarity of clinical ownership over PrEP implementation for women and, more broadly, women's sexual health, is essential in order to achieve HIV elimination in Australia. Pre-exposure prophylaxis (PrEP) is used widely by men who have sex with men in Australia to prevent HIV; however, it has not been prescribed to many cisgender women. Through interviews with PrEP prescribers, we found the barriers to PrEP for women are low patient and clinician awareness, difficulties with HIV risk assessment and service limitations. Further targeted education for prescribers, inclusion of women in national PrEP guidelines and research exploring women's access preferences will facilitate PrEP provision to women at risk. [ABSTRACT FROM AUTHOR]

Background: Australia, like many high-income countries, is experiencing a resurgence of infectious syphilis in pregnancy and congenital syphilis. Evaluations of public health notifications and clinical records suggest that healthcare systems may not be providing optimal care to women and their neonates. This study aims to explore the barriers to optimal management of syphilis in pregnancy and congenital syphilis to identify key areas for improvement. Methods: Between 2021 and 2022, 34 healthcare workers (HCW) practicing in south-east Queensland (SEQ) Australia were recruited to complete semi-structured interviews regarding their perceptions towards management of syphilis in pregnancy and congenital syphilis. Interviews were analysed thematically. Results: Thematic analysis identified four themes related to the management of syphilis in pregnancy. These included poor communication between disciplines, services, and teams from delivery through to management and post-delivery, lack of formal internal and external referral pathways, unclear and often complex maternal and congenital syphilis management procedures, and limited HCW knowledge of infectious syphilis in pregnancy and congenital syphilis. Conclusion: As congenital syphilis numbers continue to rise in SEQ, it is imperative that healthcare systems and HCWs identify and address gaps in the provision of health care. Syphilis in pregnancy can have life-long health impacts for mothers and babies and is on the rise in many high-income countries such as Australia. Healthcare providers are vital in improving outcomes for mothers and babies, but our findings show optimal management is hindered by poor communication, unclear guidelines, and knowledge deficits. To improve the provision of care offered it is important for healthcare systems address this multi-faceted issue. [ABSTRACT FROM AUTHOR]

Background: Traditional school-based sexuality education has a myriad of problems with its successful delivery, including access to comprehensive sexuality curricula, access to trained facilitators, and community and parental fears. As an alternative form of sexuality education, The Sex Wrap podcast is released in weekly episodes of about 20–45 min, providing listeners with diverse, evidence-based sexual health information. Methods: Participants in a larger mixed-methods study evaluating The Sex Wrap were invited to participate in qualitative in-depth interviews to explore their experiences with sexuality education, including The Sex Wrap , and how they relate to information received through the podcast. Seventeen interviews were conducted with listeners of The Sex Wrap , aged 20–25 years old. Results: One core category and three axial codes were identified in the interview data. The core category is: sexuality education is an ongoing process that includes learning and unlearning. The three temporally related axial codes are: (1) experiences with formal and informal sexuality education (mostly negative) drove participants to seek more information about sex, (2) participants use The Sex Wrap as a way of exploring and personalising information about sexuality, and (3) participants equipped with comprehensive sexuality education are empowered to educate their peers. Conclusions: This study suggests that podcast-based interventions, such as The Sex Wrap , can play a key role in young people's process of sexuality education and should be considered for incorporation into other forms of sex education. Sex education is critical to young peoples sexual development, yet traditional school-based sex education is often limited and non-inclusive. The present study explores young peoples' perceptions of a podcast-based sex education intervention, The Sex Wrap , and finds that young people listeners actively sought out comprehensive, inclusive sexual health information to inform their ongoing process of sex education. This study suggests that podcasts can be a powerful tool for sex education and their effectiveness should be further studied. [ABSTRACT FROM AUTHOR]

Background: China is one of the countries that set the goal to eliminate mother-to-child transmission (EMTCT) of syphilis by a target date. Active screening for syphilis among pregnant women, followed by effective treatment of maternal syphilis, is critical for achieving the goal. The China health authority issued national implementation protocols to guide EMTCT practice in health facilities. Methods: Within a cohort of infants born to mothers infected with syphilis, we obtained the data of regimens used for treatment of maternal syphilis from the National Information System of Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B, and analysed the physician's treatment behaviour and its associated factors in a public hospital in Suzhou of China. Results: A total of 450 pregnant women who were positive for treponemal or non-treponemal antibody, or had previous infection with syphilis were included into the study for analysis. Of them, 260 (57.8%) were positive for both treponemal and non-treponemal antibodies (syphilis seropositivity), and 353 (78.4%) were treated for syphilis according to the protocol in which 123 (34.8%) were treated with two courses. Non-adherence to treatment recommended by the protocol for maternal syphilis was significantly associated with antenatal visits in the third trimester (AOR 6.65, 95% CI 2.20–20.07, P = 0.001), being positive only for a treponemal test (AOR 5.34, 95% CI 3.07–9.29, P < 0.001) or having a syphilis infection before the pregnancy (AOR 2.05, 95% CI 1.14–3.69, P = 0.017), whereas the uptake of treatment for two treatment courses was associated with attending antenatal care in 2020 or before (AOR 3.49, 95% CI 1.89–6.42, P < 0.001), being positive for treponemal and non-treponemal tests (AOR 5.28, 95% CI 2.78–10.06, P < 0.001) or having non-treponemal antibody titre of ≥1:8 (AOR 3.71, 95% CI 1.77–7.78, P = 0.001). Conclusions: Implementation of the current recommendation to offer a universal treatment for syphilis among all pregnant women who are shown to be positive for a treponemal test alone is challenging in some clinical settings in China. To meet the WHO goals for elimination of congenital syphilis by 2015, the Government of China incorporated a nationwide prevention of mother-to-child transmission program for HIV, syphilis and hepatitis B into the existing maternal and child healthcare system followed by issuing the Protocol for Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B in 2011, which was updated in 2015 and 2020. This study reported the adherence to the treatment recommendation for maternal syphilis in Suzhou, China. The findings have important implications for updating our knowledge on treatment of maternal syphilis for prevention of mother-to-child transmission of syphilis. [ABSTRACT FROM AUTHOR]

Background: Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM) are significantly less likely than white MSM to initiate pre-exposure prophylaxis (PrEP). A peer-driven intervention (PDI) may be an effective approach to addressing this disparity. In this study, we explored community member perspectives of a PDI to promote PrEP uptake among B/AA and H/L MSM. Methods: We conducted semi-structured interviews with B/AA and H/L HIV-negative MSM between August 2018 and October 2019 in Rhode Island, USA. Participants reported their perspectives and recommendations for a PDI. Data from participant responses were thematically analysed. Results: Of 15 MSM, the median age was 25 years (interquartile range: 22, 33). The majority identified as B/AA (53.3%), H/L (66.7%), and having a college education or above (53.3%). Most participants viewed a PDI positively and were willing to learn and promote PrEP among their peers. Participants identified and supported several potential intervention components, such as education about the benefit of PrEP, emphasising prevention-effective dosing, and clarifying no prevention effect towards other sexually transmitted infections. They preferred in-person meetings to electronic communication. Preferred characteristics of peer educators included compassion, good communication skills, and enthusiasm about PrEP. Conclusions: This in-depth qualitative interview suggested that a PDI approach is promising in promoting PrEP uptake, as it could deliver culturally appropriate education and encourage PrEP uptake via peer influence among B/AA and H/L MSM. Peer approach is effective in promoting health among hard-to-reach populations. This study aims to explore the feasibility of implementing a peer approach for improving pre-exposure prophylaxis (PrEP) use among Black/African American (B/AA) and Hispanic/Latino (H/L) men who have sex with men (MSM). Study findings will be used to develop a peer approach for a real-world implementation. Participants were interviewed for their perspectives on such a peer approach, including willingness to disseminate PrEP knowledge and potential barriers to initiating PrEP. [ABSTRACT FROM AUTHOR]

Background: Stigma and discrimination experiences attributable to multiple intersecting facets of the self (e.g. intersectional stigma) pose substantial challenges to accessing health services, including HIV prevention. While there have been theoretical advances in understanding multiple co-occurring stigmas, there are few psychometric instruments available to assess intersectional stigma. We have developed an approach to assessing intersectional stigma that conceptualises an intersection in geometric terms, defined as the line that connects points on two (or more) stigma dimensions and calculates scores derived from the geometric definition of intersecting lines. Methods: Following pilot studies to derive items and response formats, we administered newly developed enacted stigma (24-items) and anticipated stigma (17-items) scales with attributions to race and sexual minority status for stigma experiences to a sample of 422 Black sexual minority men at risk for HIV recruited through social media platforms. Results: The enacted and anticipated intersectional stigma scales, including subscales representing discrimination, interpersonal and felt stigma demonstrated evidence for reliability and construct validity. The enacted stigma scales were associated with medical mistrust, whereas the anticipated stigma scales predicted perceived barriers to using pre-exposure prophylaxis for HIV prevention. Conclusions: The intersectional stigma scales offer greater specificity in measuring stigma experiences attributed to race, sexual minority status and the intersection of racial–sexual minority status. Stigma and discrimination experiences attributable to multiple intersecting facets of the self (e.g. intersectional stigma), including sexual orientation, pose substantial challenges to accessing health services, including HIV prevention. We report a novel approach to assessing intersectional stigma that conceptualises intersections in geometric terms. The geometric intersectional stigma scales were found reliable and valid, offering greater specificity in measuring stigma experiences attributed to multiple intersecting dimensions. [ABSTRACT FROM AUTHOR]

Background: Strengthening sexually transmissible infection (STI) management in general practice is prioritised in Australian STI strategy. Digital interventions incorporating clinical decision support offer a mechanism to assist general practitioners (GPs) in STI care. This study explored clinicians' views towards a proposed digital intervention for supporting STI care in Australian general practice as a first step in the tool's design. Methods: Semi-structured one-to-one interviews were conducted during 2021 with sexual health physicians (n = 2) and GPs (n = 7) practicing in the state of Victoria, Australia. Interviews explored views on a proposed STI digital intervention for general practice. We applied the Theoretical Domains Framework (TDF), a behaviour change framework to our analysis. This involved: (1) directed content analysis of transcripts into TDF domains; and (2) thematic analysis to identify sub-themes within relevant TDF domains. Subthemes were subsequently categorised into enablers and barriers to the use and implementation of a STI computerised clinical decision support system (CDSS). Results: All interviewees viewed a digital intervention for STI care favourably, expressing confidence in its potential to improve care and support management. Within the relevant TDF domains (e.g. environmental context and resources), subthemes emerged as barriers (e.g. lack of sensitivity to patient context) or enablers (e.g. clear communication and guidance) to the use and implementation of a STI CDSS in primary care. Multiple subthemes (e.g. time constraints) have the potential to be a barrier or an enabler, and is largely dependent on end-user needs being met and clinical context being appropriately addressed. Conclusions: A digital intervention incorporating clinical decision support was viewed favourably, indicating a possible role for such a tool in Australian general practice. Co-design with end-users and prototype evaluation with health consumers is recommended to ensure relevance and usefulness. Digital interventions may offer a mechanism to assist general practitioners (GPs) in optimising care for sexually transmissible infections (STIs). We interviewed GPs and sexual health physicians, who viewed the concept of digital intervention for STI care favourably and with potential to improve STI processes, contingent on its design being considerate of the time-pressured general practice environment, the clinician and patient context, and integration of key evidence-based resources. A prototype digital tool for STI care informed by these insights is in development. [ABSTRACT FROM AUTHOR]

Background: Young cisgender heterosexual men in Australia are the least likely population group to undergo testing for sexually transmissible infections (STI) and ensuring barrier method use during casual sex with cisgender women who have sex with men, with rates of STIs increasing among this group. This research examines how these men navigate sexual health conversations and practices during casual sexual encounters. Methods: A total of 30 semi-structured interviews with young cisgender heterosexual men living in Australia during 2021 were conducted. Participants were asked questions about their dating and sexual practices, including sexual health knowledge, how they learned to have sex, and navigating sexual health conversations with partners, such as STI testing, and barrier method and hormonal contraceptive use. Findings were analysed using reflexive thematic analysis techniques. Results: Findings note that men use various strategies of avoidance including sustaining the erotic moment, and assuming women's responsibility. Participants also noted limited relationality, in which they highlighted individualised concerns for their own sexual health wellbeing but not that of their partners. Conclusions: This research highlights that despite increased awareness and promotion of STI prevention and contraceptive responsibility, young cisgender heterosexual men continue to forego their responsibilities regarding their own and other's sexual health during casual sexual encounters. Findings highlight a need to include gender transformative approaches to sexual health promotion and practice to address continuing gender inequities. Young cisgender heterosexual men in Australia are the least likely population group to ensure barrier method use during casual sex. There is limited information about how these young men might be navigating sexual health conversations with potential partners, whereby findings note that they choose to avoid the discussion or expect women to take responsibility. There is need to focus on educating young men concerning their responsibility for sexual health in casual sex encounters. [ABSTRACT FROM AUTHOR]

Background: Factory workers are a key population for HIV transmission in China, as they often engage in sexual risk behaviours. This study aims to evaluate sexual risk behaviours and associated factors among factory workers in Shenzhen, China. Methods: A cross-sectional study was conducted by using multi-stage stratified cluster random sampling. Full-time workers aged ≥18 years were eligible to participate in the study. A self-administered questionnaire was used to collect information. Univariate and multivariable logistic regression were applied to assess factors associated with sexual risk behaviours. Results: A total of 2029 factory workers were included. Mean age was 37.2 (±4.4) years; 48.5% were men. Two-thirds (64.9%) had had vaginal intercourse. Their sexual risk behaviours included condomless sex with casual partners in the last sex episode (23.6%), multiple sex partners (11.5%) and engaging in commercial sex (8.4%), in the past year. Having HIV/AIDS knowledge (adjusted odds ratio (AOR) 0.41, 95% confidence interval (CI) 0.24–0.70) and using a condom at sexual debut (AOR 0.08, 95% CI 0.05–0.13) were factors associated with condomless sex with casual partners in the last sex episode. Males (AOR 3.03, 95% CI 1.96–4.69 and AOR 2.19, 95% CI 1.33–3.60), local workers (AOR 2.11, 95% CI 1.01–4.42 and AOR 3.42, 95% CI 1.63–7.21), being single (AOR 2.04, 95% CI 1.39–3.01 and AOR 2.49, 95% CI 1.61–3.87), having sexual debut aged <18 years (AOR 5.98, 95% CI 3.28–10.89 and AOR 3.34, 95% CI 1.74–6.39), and substance use (AOR 2.01, 95% CI 1.38–2.93 and AOR 4.43, 95% CI 2.85–6.87) were associated with both having multiple sex partners and engaging in commercial sex in the past year. Conclusions: Sexual risk behaviours were prevalent despite most participants having basic HIV/AIDS knowledge. Future workplace-based prevention programs should target factory workers and there should be a focus on enhanced sexual education to reduce HIV transmission in China. Sexual transmission has been the main mode of HIV transmission, and data on sexual risk behaviours among factory workers from various industries are scarce in China. Sexual risk behaviours that showed associations with certain characteristics and experience of sexual debut were prevalent among factory workers in Shenzhen, China. There are massive labour forces in China, indicating an urgent need to strengthen sexual health education and promote safer sexual behaviours among factory workers. [ABSTRACT FROM AUTHOR]

Background: Increasing rates of syphilis in pregnancy (SiP) in Australia and other high-income countries, has led to the resurgence of congenital syphilis. Suboptimal syphilis screening during pregnancy has been identified as a key contributing factor. Methods: This study aimed to explore, from the perspective of multidisciplinary healthcare providers (HCPs), the barriers to optimal screening during the antenatal care (ANC) pathway. Semi-structured interviews conducted with 34 HCPs across multiple disciplines practising in south-east Queensland (SEQ) were analysed through a process of reflexive thematic analysis. Results: Barriers were found to occur at the system level of ANC, through difficulties in patient engagement in care, limitations in the current model of health care delivery and limitations in the communication pathways across health care disciplines; and at the individual HCP level, through HCP knowledge and awareness of epidemiological changes in syphilis in SEQ, and adequately assessing patient risk. Conclusion: It is imperative that the healthcare systems and HCPs involved in ANC address these barriers to improve screening in order to optimise management of women and prevent congenital syphilis cases in SEQ. Over the past decade, the rates of syphilis in pregnancy and congenital syphilis are continuing to rise in south-east Queensland (SEQ). Screening for syphilis during antenatal care is an important factor for prevention. In our study, SEQ healthcare providers identified system-level and individual-level barriers that prevent adequate screening. It is important that these barriers be identified and addressed to improve screening to promote maternal health and prevent congenital syphilis in SEQ. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018–July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit. Zero new HIV infections could become a reality if HIV pre-exposure prophylaxis (PrEP) programs are successfully implemented but the World Health Organization recognises that large-scale roll out is challenging. We used implementation science research tools in novel ways to evaluate one of the world's first national PrEP programs, to develop evidence-based recommendations for use across a range of settings to improve PrEP uptake and initiation. Adopting these recommendations could enable governments and societies to better address HIV prevention goals. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae (NG) can lead to serious reproductive and sexual health outcomes, and the annual number of NG notifications in Australia increased steadily from 10 329 in 2010 to 29 549 by 2020. Australian populations most affected are urban men who have sex with men and First Nations peoples living in remote areas, and a resurgence in urban heterosexuals has been observed since 2012. Methods: A case series analysis of Queensland NG isolates (2010–15) exploring temporal trends and antimicrobial resistance by demographic and geographic distribution and genotype was performed. Proportions describe age, sex, strain, genogroup (NG multi-antigen sequence typing), region, swab site, antimicrobial sensitivity and isolate rates per 100 000 population. Dominant genogroups were identified. Results: Among 3953 isolates, the median age was 25 years (IQR 20–34 years) and most (n = 2871/3915, 73%) were men. Brisbane city (68.8) and Far North Queensland (54.1) excluding Cairns showed the highest rates. Forty-six genogroups were documented, seven (G2992, G6876, G1415, G4186, G5, G1407 and G6937) comprised half of all isolates. The predominant male genogroup was G2992 (16%), and G6876 (20%) for females; G5 was predominantly male from 2010 to 2011, but equal in both sexes from 2012 to 2015. Conclusion: Considerable temporal, geographical and demographical diversity was observed in Queensland NG isolates, which has public health implications. Certain genogroups are more transient than others, and evidence suggests bridging from male-dominant networks to heterosexual networks. Molecular surveillance can enhance tracking the epidemiology and movement of NG in Australia, highlighting the necessity of genotyping to expose potentially prevalent strains circulating in undetected or underrepresented networks by current screening methods. Our 5-year Queensland study demonstrates the potential for molecular surveillance to track the changing epidemiology, movement and antimicrobial resistance of Neisseria gonorrhoeae in Australia. This is increasingly important, because potential prevalent gonococcal strains are not captured well by current methods, and we found evidence of bridging from male-dominant networks to heterosexual networks, which has serious implications for current public health practise. Genotyping is also necessary to monitor the transiency of dominant genogroups to allow a more targeted and tailored approach to treatment. [ABSTRACT FROM AUTHOR]

Background: This study responds to the increasing rate of HIV/AIDS and unplanned pregnancies among Chinese college students from a sociocultural perspective, and investigates the influences of sociocultural factors in shaping sex-related beliefs and acts among Chinese college students. Methods: An online survey was conducted on a purposive sample of 1286 female college students in four cities in east and west China. Results: Significant east–west disparities have emerged in the rate of sexual intercourse experience, rate of safer sex, conservative sexual values, authority sex education, unofficial sex knowledge access and HIV knowledge. A higher rate of sexual activity, but lower rate of safer sex, were found among the students in the west relative to those in the east. Conclusions: This study demonstrates that in a large country, such as China, regional disparities in economy, social development and sexual norms are salient to affect individuals' sexual behaviours. A total of 1286 female college students in China was surveyed to investigate their sexual behaviours. The results show that between those students in the east (Shanghai and Nanjing) and those in the west (Chongqing and Chengdu), their rate of sexual intercourse experience, rate of safer sex, conservative sexual values, authority sex education, unofficial sex knowledge access and HIV knowledge level were different. Compared with the eastern students, western students have a higher rate of sexual activity, but lower rate of safer sex. The regional disparities in economy, social development and culture affect individuals' sexual behaviours saliently. [ABSTRACT FROM AUTHOR]

Background: Rates of sexually transmissible infections (STIs) are increasing among older adults in many countries. Little is known about the testing and treatment histories of these populations. Correlates of testing in the past 5 years among older adults who may be at risk of a STI were examined.Methods: A cross-sectional survey of 2137 Australians aged 60+ years that involved questions on STIs and STI testing was conducted in 2015. To help inform potential education campaigns, analyses focused on those who may have been at risk of a STI (n=805, 38%).Results: Less than one in three reported a STI test in the past 5 years (n=241, 30%) while 6% (n=51) reported a STI diagnosis. Those diagnosed typically received treatment from a family doctor or general practitioner. Among men, lower testing rates were associated with older age, identifying as heterosexual, lower educational attainment, not using online dating and reporting one partner in the past 5 years. For women, lower rates of testing were found among those who did not use a condom at their most recent sexual encounter and those with one partner in the past 5 years.Conclusions: STI testing rates were low. This study indicates that consideration should be given to the way targeted education campaigns are formulated, such as emphasising the importance of STI testing to older people who are at risk, as well as encouraging healthcare professionals to discuss sexual health with their older patients. [ABSTRACT FROM AUTHOR]

The clinical knowledge that people living with HIV who maintain an undetectable viral load and therefore cannot transmit HIV sexually, known as Undetectable equals Untransmittable (U=U), has reached a critical mass of adults, but it is relatively silenced within adolescent HIV care and support. We argue that understanding the full range of opportunities enabled by viral suppression, including the elimination of transmission risk, could transform adolescents' understanding of living with HIV, incentivise optimal treatment engagement and support and sustain their positive mental health. However, the reluctance to discuss U=U with adolescents means that we are not providing them with adequate access to the information and tools that would help them to succeed. We need to recognise, value, and invest in the mediating role of building viral load literacy, illustrated by conveying U=U in ways that are meaningful for adolescents, to accelerate viral suppression. Rather than protect, rationing access to information on U=U only increases their vulnerability and risk to poor HIV and mental health outcomes. [ABSTRACT FROM AUTHOR]

Background. Thailand National AIDS Committee endorsed Undetectable=Untransmittable (U=U) as a science which needs an urgent translation into actions to address pervasive stigma faced by people living with HIV (PLHIV). We aimed at humanising and demedicalising U=U by exploring a 'people-centered value' of U=U and translate them into efficient U=U communications. Methods. During August-September 2022, in-depth interviews were conducted with 43 PLHIV and 17 partners from various background in five regions of Thailand. Focus group discussions were made with 28 healthcare providers (HCPs) and 11 PLHIV peers. Thematic analysis was used for data analysis. Results. Among PLHIV, how U=U frees them up to 'live a full life' was valued highest. A great relief from sin, immorality, and irresponsibility was mentioned by all. U=U communications allowed PLHIV and their partners to love/be loved and enjoy intimacy and sex with pleasure again. HCPs and PLHIV peers almost always refer U=U value to 'physical health'. Common concerns were around increasing sexually transmitted infections with condomless sex. The people-centered U=U values, together with dismantling of power imbalance within healthcare system and sexual health skills empowerment among providers, were used to develop a humanised and demedicalised National U=U Training Curriculum. The Curriculum was highlighted in country's planned activities to address multilevel/multi-setting stigma and discrimination. Conclusions. U=U can be successfully humanised and demedicalised in designing efficient communications. At an individual level, U=U can address one's intersectional stigmatizing attitudes. At a policy level, national endorsement can initiate and sustain tangible actions and interest around U=U across country's leaderships. [ABSTRACT FROM AUTHOR]

Background. Even with the Undetectable equals Untransmittable campaign (U=U) campaign, women living with HIV continue to experience intersecting forms of stigma. We explored how the somatic experiences of viewing a film about U=U and women could help individuals gain deeper understandings of HIV and alter learned prejudices. Methods. HIV Made Me Fabulous is a film that utilises embodied storytelling to tell the story of a trans woman living through social and historical traumas of HIV. Four online film screenings and focus group discussions took place between June 2020 and June 2021, with participants attending from Canada, Australia, South Africa, Kenya, Zimbabwe and India. Two sessions were held with women living with HIV (n = 16) and two with HIV-negative individuals (n = 12). Transcripts were analysed via thematic analysis using Lafrenière and Cox's framework to assess its impact. Results. Participants experienced strong, diverse emotional responses and sometimes physical effects from viewing the film. These somatic experiences furthered engagement with key messages in the film, including U=U, intersectional identities, and impacts of patriarchal systems. Women living with HIV commented on unique gendered risks experienced during disclosure, and the pressures of reaching an undetectable viral load. Women also commented how the film resulted in deeper reflection of their deservingness of pleasure. Regardless of HIV status, participants expressed motivation towards influencing change that included addressing biases and sharing U=U with others. Conclusions. Embodied storytelling in film is an effective method to counter both intra- and inter-personal HIV-related stigma by provoking responses that enhance compassion for oneself and others. [ABSTRACT FROM AUTHOR]

Background. Our objective was to understand what gay, bisexual, and queer men (GBQM) who had experience using pre-exposure prophylaxis (PrEP) thought about the 'Undetectable equals Untransmittable' (U=U) message and how it informed their sexual decision-making over time. Methods. We conducted annual longitudinal qualitative interviews (2020-22) with 17 current or former PrEP users as part of a mixed-methods implementation science study examining barriers and facilitators to PrEP awareness, access, and adherence. Over 3 years, 47 interviews were conducted with GBQM in Ontario, Canada. Interviews were transcribed verbatim and coded in NVivo following reflexive thematic analysis. Results. Participants' sexual health decision-making was informed by their confidence in biomedical HIV prevention and the person taking medication (i.e. themselves using PrEP versus a real/imagined person living with HIV (PLHIV)). Longitudinal narratives of U=U clustered around four overarching themes: (1) U=U confidence (i.e. increasing trust in U=U irrespective of their PrEP use); (2) PrEP confidence (i.e. accounts of self-reliance and PrEP as sufficient HIV protection); (3) combination confidence (i.e. trusting U=U and PrEP as a package); and (4) partner confidence (i.e. potential 'distrust' of U=U due to uncertainties about partners' medication adherence). Overall, men described increased sex with PLHIV over time, including some participants who, during earlier interviews, said they would 'never be comfortable' with serodifferent sexual partners. Conclusions. GBQM's use of PrEP shaped how they thought about U=U and sex with PLHIV. Although many GBQM embraced treatment as prevention/U=U as significant to their sexual lives, longitudinal analysis revealed its varied and uneven adoption across participants and time. [ABSTRACT FROM AUTHOR]

Background. The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s' agreement of and discussion with clients about U=U. Methods. We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U; and (2) discussing U=U with clients. Results. Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7 years (s.d.: 8.4). Most GPs (74.2%, n = 302) agreed with U=U, but only 33.9% (n = 138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33-9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94-0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11-3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94-1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17-3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24-0.86). Conclusion. Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed. [ABSTRACT FROM AUTHOR]

Background. The Undetectable=Untransmittable (U=U) message has been promoted since it was demonstrated that viral suppression through HIV treatment prevents sexual transmission between serodiscordant partners (HIV treatment as prevention). Our study assessed familiarity with, perceived accuracy of, and willingness to rely on U=U in a national sample of gay and bisexual men in Australia. Methods. We conducted a national, online cross-sectional survey in April-June 2021. Eligible participants were gay, bisexual and queer men and non-binary people who lived in Australia. Logistic regression was used to identify factors associated with familiarity, perceived accuracy and willingness to rely on U=U (by having condomless sex with a partner with HIV who has an undetectable viral load). Results. Of 1280 participants, most were familiar with U=U (1006/1280; 78.6%), the majority of whom believed U=U was accurate (677/1006; 67.3%). Both familiarity and perceived accuracy were higher among participants living with HIV, followed by pre-exposure prophylaxis (PrEP) users, HIV-negative participants not taking PrEP, and untested/unknown status participants. Knowing at least one person living with HIV, among other factors, was associated with familiarity and perceived accuracy of U=U; and familiarity was associated with perceived accuracy. Among participants familiar with U=U, less than half were willing to rely on U=U (473/1006; 47.0%). Familiarity with U=U and knowing at least one person living with HIV were associated with willingness to rely on U=U, among other factors. Conclusions. We found familiarity with U=U was associated with perceived accuracy and willingness to rely upon it. There is an ongoing need to educate gay and bisexual men (particularly HIV-negative men) about U=U and its benefits. [ABSTRACT FROM AUTHOR]

Background. We analysed the impact of increased antiretroviral therapy (ART) on HIV epidemiology and healthcare costs in Australia during the 'Treatment-as-prevention' and 'Undetectable equals Untransmissible (U=U)' eras. Methods. We conducted a retrospective modelling analysis between 2009 and 2019 to calculate the potential impact of early initiation of ART and treatment-as-prevention on HIV among gay and bisexual men (GBM). The model incorporates the change in the proportion diagnosed, treated, and virally suppressed, as well as the scale-up of oral HIV pre-exposure prophylaxis (PrEP) and the change in sexual behaviour during this period. We simulated a baseline and a no ART increase scenario and conducted a costing analysis from a national health provider perspective with cost estimates in 2019 AUD. Results. Increasing ART use between 2009 and 2019 averted an additional 1624 [95% percentile interval (PI): 1220-2099] new HIV infections. Without the increase in ART, the number of GBM with HIV would have increased from 21 907 (95% PI: 20 753-23 019) to 23 219 (95% PI: 22 008-24 404) by 2019. HIV care and treatment costs for people with HIV increased by $296 (95% PI: $235-367) million AUD (assuming no change in annual healthcare costs). This was offset by a decrease in the lifetime HIV costs (with 3.5% discounting) for those newly infected of $458 (95% PI: $344-592) million AUD, giving a net cost saving of $162 (95%: $68-273) million AUD (and a benefits-to-cost ratio of 1.54). Conclusions. Increasing the proportion of Australian GBM on effective ART between 2009 and 2019 likely resulted in substantial reductions in new HIV infections and cost savings. [ABSTRACT FROM AUTHOR]

Background. By reducing HIV viral load to undetectable levels, HIV treatment slows disease progression and eliminates the possibility of sexual transmission. The promotion of undetectable viral load has also been accompanied by expectations of reducing HIV-related stigma, including self-stigma. Drawing on accounts of people recently diagnosed with HIV, we explored experiences of both detectable and undetectable viral load. Methods. Between January 2019 and November 2021, semi-structured interviews were conducted with 35 people living with HIV (PLHIV) who had received an HIV diagnosis in Australia from 2016 onward. Of these participants, 24 completed follow-up interviews approximately 12months later. Interviews were transcribed verbatim, entered into NVivo (software v12), and thematically analysed. Results. Reflecting on the period in which their viral load was detectable, some participants described feeling 'dirty,' 'viral,' and 'a risk' to sexual partners. During this period, some participants minimised or ceased having sex, sometimes despite being in ongoing romantic relationships. Reaching undetectable viral load was commonly characterised as an important goal in HIV care and signalled a marker of good health and enabled a return to sexual relationships. However, the psychosocial benefits of undetectable viral load were not universally experienced, with some participants highlighting ongoing challenges of living with HIV long term. Conclusions. Increasing awareness of the benefits of undetectable viral load is an important and powerful tool for improving the health and wellbeing of PLHIV; however, the period in which one's HIV viral load is detectable can be challenging, particularly as feelings of being 'unclean' and 'a risk' may be internalised. Ensuring PLHIV are appropriately supported during periods of viral detectability is necessary. [ABSTRACT FROM AUTHOR]

Background. Undetectable=Untransmittable (U=U) first emerged in 2016 as a health information campaign to promote rigorous scientific evidence that people living with HIV (PLHIV) on effective treatment who have reached an undetectable or suppressed viral load cannot pass on the virus sexually. Within 7 years, U=U underwent transformation from a global community-led, grassroots movement into a global HIV/AIDS health equity strategy and policy priority. Methods. For this narrative review, a targeted literature search on 'history' + 'Undetectable=Untransmittable' and/or 'U=U' on Google and Google Scholar, in addition to a search of online documents on the Prevention Access Campaign (PAC) website, was conducted. The article utilises an interdisciplinary policy studies approach that recognises the roles of multi-stakeholder, especially that of the community and civil society, to effect policy change. Results. The narrative review first provides a synopsis of the scientific origination of U=U. The second section highlights the progress and leadership on U=U led by the PAC and civil society partners and efforts of the PLHIV and ally communities in advocating for the broad recognition and dissemination of the evidence, which has proven to be a game-changer within the HIV/AIDS response. The third section spotlights the recent developments of U=U within the local, national, and multilateral spheres. Conclusion. The article ends with recommendations for community and HIV/AIDS multi-stakeholders on how they can further integrate, implement, and strategically utiliseU=U as an essential and complementary HIV/AIDS pillar to the current Global AIDS Strategy 2021-2026 to end inequalities to end AIDS by 2030. [ABSTRACT FROM AUTHOR]

The World Health Organization's (WHO) global public health mandate includes a focus on expanding access to HIV testing, antiretroviral therapy (ART) and treatment monitoring to improve the clinical management of HIV, achieve sustained viral suppression, and prevent HIV-related incidence, morbidity, and mortality. This article documents key moments in research and WHO policies that have informed how ART is applied within HIV programs, including as a prevention tool with the potential to support efforts to address HIV-related discrimination. For more than 20 years, WHO has promoted the benefits of HIV treatment including as part of the approach to prevent the mother-to-child transmission (vertical transmission) of HIV. WHO guidance has followed, and continues to follow, the evolving evidence. In 2023, WHO continues to clarify that there is zero risk of sexual HIV transmission when a person living with HIV has an undetectable viral load and an almost zero or negligible risk of sexual transmission when a person living with HIV has a viral load of =1000 copies/mL - helping to evolve the focus of community campaigns and health worker training to include a focus on 'virally suppressed' while also continuing to emphasise the ultimate goal of achieving an undetectable viral load. This evolution does two things: first, it strongly reasserts the evidence around there being no chance of transmission if a person has an undetectable viral load; and second, it provides an extremely strong degree of confidence that, similarly, individuals who are virally suppressed will not pass on the virus sexually. WHO is now encouraging positive and clear messaging to highlight that the consistent use of ART prevents onwards HIV transmission. [ABSTRACT FROM AUTHOR]

Background: In August 2022, in response to a global mpox outbreak, the World Health Organization recommended the Vaccinia vaccination for at-risk people. Methods: Case study. Results: We describe a case of a HIV-negative bisexual man who developed a symptomatic mpox infection 13 weeks after completing a two-dose course of subcutaneous third-generation modified vaccinia Ankara vaccines. The case likely acquired his mpox infection in the USA; was diagnosed in Aotearoa, New Zealand; and was followed-up in Australia, as he was actively travelling during his infection. Conclusions: This case highlights the importance of maintaining clinical suspicion for mpox in people who present with consistent symptoms, even if they are fully vaccinated. Also, as he travelled around Aotearoa, New Zealand, and Australia during his infection, this case highlights how public health authorities and clinicians can cooperate across jurisdictional boundaries to support cases and minimise the risk of onward transmission. This report describes the first case (in December 2022) of mpox occurring in Aotearoa, New Zealand, and Australia in a person who had completed a two-dose course of subcutaneous vaccination using modified vaccinia Ankara. He likely acquired his infection in the USA, was diagnosed in Auckland, and was followed-up in Australia, as he was travelling. This case highlights the importance of maintaining clinical suspicion for mpox in fully vaccinated individuals who present with symptoms suggestive of mpox and who have epidemiological risk. [ABSTRACT FROM AUTHOR]

This editorial introduces the incoming co-Editors-in-Chief of the journal, and their plans to taking the journal in four directions focused on clinical impact, open science, building capacity, and improving the submission process. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3 months with high rates of asymptomatic chlamydia and gonorrhoea detected. However, there is little evidence about the effectiveness of this screening interval and there is increasing concern about antibiotic consumption and its impact on antimicrobial resistance. There have been calls to reconsider this frequent screening for chlamydia and gonorrhoea. We conducted interviews with MSM to assess their attitudes to 3-monthly chlamydia and gonorrhoea screening. Methods: Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20–62 years and had been taking PrEP for at least 6 months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. Results: Thirteen interviews were conducted in August 2021. Participants were hesitant about reducing the screening frequency and reported that testing gave them a sense of security. While MSM recognised antimicrobial resistance was a concern, it did not impact their sexual behaviour, with many participants stating they would rather continue to take antibiotics to treat infections rather than adopt preventative measures such as condom use. Positive attitudes towards screening interval changes are more likely when PrEP patients are informed about the risks and benefits of sexual healthcare recommendations. Conclusion: While MSM on PrEP were initially hesitant to changes in screening frequency, changes may be acceptable if transparent communication, presenting the benefits and harms of screening and treatment, was delivered by a trusted healthcare professional. Current sexually transmitted infection (STI) guidelines recommend that men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) should be tested every 3 months for chlamydia and gonorrhoea regardless of symptoms. However, these guidelines have not led to a noticeable reduction of gonorrhoea and chlamydia rates and there is increasing concern about antibiotic consumption among this group and its impact on antimicrobial resistance. We interviewed MSM to explore their attitudes to 3-monthly screening and how they would feel about screening less frequently. [ABSTRACT FROM AUTHOR]

Background: Age-based sexual mixing patterns in men who have sex with men (MSM) can greatly inform strategic allocation of intervention resources to subsets of the population for the purpose of preventing the greatest number of new HIV infections. Methods: Egocentric network data collected from MSM participating in annual HIV sentinel surveillance surveys were used to assess age-dependent mixing and to explore its epidemiological implications on the risk of HIV transmission risk (among those HIV-infected) and HIV acquisition risk (among those not infected). Results: Mixing in this sample of 1605 Chinese MSM is relatively age assortative (the average of values expressing the degree of preferential mixing were 2.01 in diagonal cells vs 0.87 in off-diagonal cells). Expected numbers of HIV acquisition were highest in the 20–24 years age group; those for HIV transmissions were highest among 25–29 year olds. The risk of both acquisition and transmission was highest in age groups that immediately follow the most commonly reported ages of sexual debut in this population (i.e. age 20). Conclusions: These findings suggest that combination prevention resources should be targeted at younger MSM who are at higher risk of both transmission and acquisition. Programs may also do well to target even younger age groups who have not yet debuted in order to establish prevention effects before risky sexual behaviours begin. More research on optimal strategies to access these harder-to-reach subsets of the MSM population is needed. Findings also support ongoing efforts for public health practitioners to collect network data in key populations to support more empirically driven strategies to target prevention resources. 'Who has sex with whom?' is the primary question that dictates how HIV and other sexually transmitted infections spread in populations. We used such sexual network data from a sample of Chinese men who have sex with men (to further answer, 'who transmits to whom?' Our findings – that most HIV transmission originates in men who have sex with men shortly after sexual debut – can guide the targeting of resources to the highest-need subgroups to arrest HIV spread. [ABSTRACT FROM AUTHOR]

Recent studies have provided evidence for the effectiveness of using doxycycline (Doxy-PEP) to prevent bacterial sexually transmissible infections (STI), namely chlamydia, gonorrhoea, and syphilis, among gay, bisexual, and other men who have sex with men who have experienced multiple STIs. However, there remain several unanswered questions around potential adverse outcomes from Doxy-PEP, including the possibility of inducing antimicrobial resistance in STIs and other organisms, and the possibility of disrupting the microbiome of people who choose to use Doxy-PEP. This interim position statement from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine aims to outline the current evidence for Doxy-PEP, and to highlight potential adverse outcomes, to enable clinicians to conduct evidence-based conversations with patients in Australia and Aotearoa New Zealand who intend to use Doxy-PEP. This interim position statement from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) outlines evidence for the effectiveness of doxycycline prophylaxis to prevent bacterial sexually transmitted infections (STI), namely syphilis, chlamydia and gonorrhoea, and outlines potential risks of this prevention strategy. This position statement aims to provide clinicians in Australia with the information needed to conduct evidence-based conversations with patients about this STI prevention strategy. [ABSTRACT FROM AUTHOR]

Background: Additional approaches to HIV prevention and management, such as Nudgeathons, are required to increase access to HIV pre-exposure prophylaxis (PrEP) among overseas-born men who have sex with men (MSM). Methods: In September 2021, we conducted a 4-h online Nudgeathon, wherein four teams co-designed behaviourally informed adverts to improve PrEP access and uptake for overseas-born MSM. After the Nudgeathon, eight of 17 invited Nudgeathon attendees were interviewed about their experience. We conducted a qualitative content analysis of interview data to highlight participants' experiences of the co-design process. Results: We identified three major themes: (1) what worked well; (2) group dynamics; and (3) improvement and future directions. The Nudgeathon about PrEP was a positive learning experience, with valuable contributions and overall satisfaction with the end-products. The online format was perceived as less costly than if the Nudgeathon was hosted in person, and suitable for participants from different geographical regions. In-person Nudgeathons with international attendees would require costs for flights, accommodation, function room hire and catering. Within groups, sharing personal experiences essential to co-designing concepts. However, less information on how to create nudges and more information before the Nudgeathon was preferred. Conclusion: Our evaluation finds that Nudgeathons are fast and efficient in developing potential solutions to complex issues related to HIV prevention. We evaluated a 4-h online Nudgeathon aimed to co-design a digital advertisement campaign for HIV pre-exposure prophylaxis (PrEP) among overseas-born men who have sex with men. All interviewees were satisfied with the end-product they co-designed with their group, which proved to be as productive in co-designing solutions as past Nudgeathons conducted in person, lasting 1–2 days. Online co-design workshops can be a fast and efficient option for developing potential solutions to sensitive issues, such as PrEP. [ABSTRACT FROM AUTHOR]

Background: Sexually transmissible infections (STI) are prevalent and increasing among young Australians. This study examined trends in STI testing, sexual health knowledge/behaviours, and pornography use in young people aged 15 – 29 years in Victoria, Australia between 2015 and 2021. Methods: Seven online cross-sectional surveys were conducted in a convenience sample of young people, recruiting a total of 7014 participants (67% female). Logistic regression analyses determined trends over time in binary outcomes. Results: There was a decrease in reports of lifetime vaginal sex over time, while lifetime anal sex remained stable. Among those who had ever had vaginal sex, results showed an increase in the use of long-acting reversible contraceptives on the last occasion of vaginal sex. There was no change in STI testing or condom use with all partner types. Knowledge of STIs and sexual health changed over time: the proportion knowing that chlamydia can make women infertile decreased over time, while knowledge that taking the pill does not reduce fertility increased. There was no change in pornography use after adjusting for demographic variables. Conclusions: Although uptake of long-acting contraceptives increased, STI knowledge and testing, as well as consistent condom use, remained low. Public health interventions should continue to address these critical components of STI prevention. Young people aged 15–29 years account for more than 70% of sexually transmissible infections (STIs) reported in Australia. This study surveyed self-reported STI testing, sexual behaviours, pornography use, and sexual health knowledge in samples of young Victorians over the period of 2015–21, captured through an online survey. Results provide current trends in sexual health behaviours and knowledge to help inform effective public health interventions for young people. [ABSTRACT FROM AUTHOR]