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Iryna Zablotska from NCHSR presents data from six Australian Gay Community Periodic Surveys (1998-2008) related to: - Trends in sexual heath testing; - Testing by HV serostatus and sexual practices; - Reasons for and patterns of testing; and - Issues in sexual health testing. This presentation was given at AFAO's syphilis forum in May 2009.
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National surveillance of sexual health testing practices and sexual behaviours
Dr. Iryna Zablotska, NCHSR
22 May 2009
In this presentation
Trends in sexual heath testing
Testing by HV serostatus and sexual practices
Reasons for and patterns of testing
Issues in sexual health testing
Data from six Australian Gay Community Periodic Surveys (1998-2008)
Sexual health testing in previous 12 months using any testing method
40.0
50.0
60.0
70.0
80.0
2003
2004
2005
2006
2007
2008
%
Sydney GCPS Melbourne GCPS Queensland GCPS
Any test excluding blood
Sexual health testing in previous 12 months using any testing method
40.0
50.0
60.0
70.0
80.0
2003
2004
2005
2006
2007
2008
%
Sydney GCPS Melbourne GCPS Queensland GCPS
40.0
50.0
60.0
70.0
80.0
2003
2004
2005
2006
2007
2008
%
Sydney GCPS Melbourne GCPS Queensland GCPS
Any test excluding blood Any test including blood
Sexual health testing in previous 12 months using any testing method
40.0
50.0
60.0
70.0
80.0
2003
2004
2005
2006
2007
2008
%
Sydney GCPS Melbourne GCPS Queensland GCPSAdelaide GCPS Perth GCPS Canberra GCPS
40.0
50.0
60.0
70.0
80.0
2003
2004
2005
2006
2007
2008
%
Sydney GCPS Melbourne GCPS Queensland GCPSAdelaide GCPS Perth GCPS Canberra GCPS
Any test excluding blood Any test including blood
STI testing (last 12 months)
0.0
20.0
40.0
60.0
80.0
2003 2004 2005 2006 2007 2008
%
Anal swab (sign. Increase, p<0.001)Throat swab (sign. Increase, p<0.001)Penile swab (sign. Increase, p<0.001)Urine sample (sign. Increase, p<0.001)Blood other than for HIVAny STI test
0.0
20.0
40.0
60.0
80.0
2003 2004 2005 2006 2007 2008
%
0.0
20.0
40.0
60.0
80.0
2003 2004 2005 2006 2007 2008
%
VIC
QLD
NSW
Frequency of STI testing in the past 12 mo: SGCPS
0%
20%
40%
60%
80%
100%
2005 2006 2007
%
0%
20%
40%
60%
80%
100%
2005 2006 2007
%
Anal swabs
0%
20%
40%
60%
80%
100%
2005 2006 2007
%
none once twice 3+ times
Throat swabs
Penile swabs
Sydney GCPS: STI testing (last 12 months)
0
20
40
60
80
100
2003 2004 2005 2006 2007 2008
%
Anal swab (sign. Increase, p<0.001)Throat swab (sign. Increase, p<0.001)Penile swab (sign. Increase, p<0.001)Urine sample (sign. Increase, p<0.001)Blood other than for HIVAny STI test
0
20
40
60
80
100
2003 2004 2005 2006 2007 2008
%
HIV-positive men HIV-negative men
STI testing by number of partners and HIV status: Sydney GCPS, 2008 (I)
0
20
40
60
80
100
0 1 '2-10 '11-50 more than50
HIV-negative & UK status HIV-positive
STI testing by risk practices: Sydney GCPS, 2008 (I)
0
20
40
60
80
100
Some None Some None Some None
HIV-negative & UK HIV-positive
UAIR UAIC Group sex
Service where men had their last STI test, by HIV serostatus: Sydney GCPS, 2008 (II)
HIV-positive(100%)
HIV-negative(100%)
UK status(100%)
A regular doctor 66.2 57.8 50.0
Another doctor 2.9 6.3 5.8
A sexual health clinic 23.5 30.4 36.7
A hospital 7.4 4.1 5.0
Somewhere else 0.0 1.5 2.5
Location where men had their last STI test, by HIV serostatus: Sydney GCPS, 2008 (II)
HIV-positive
men
HIV-negative
men
UK serostatus
men
Gay Sydney 64.0 39.9 21.2
Sydney suburbs 20.0 41.3 41.2
Wollongong/Newcastle 0 2.1 1.2
Rural NSW 1.3 0.7 1.2
Other states/territories 13.3 15.7 33.3
Overseas 1.3 0.4 1.8
Residential location, by HIV serostatus: Sydney GCPS, 2008 (II)
HIV-positive
men
HIV-negative
men
UK serostatus
men
Gay Sydney 34.0 29.5 23.1
Sydney suburbs 61.7 62.1 66.2
Wollongong/Newcastle 0.7 2.3 2.1
Rural NSW 0.7 1.4 1.0
Other states/territories 2.1 4.5 6.2
Overseas 0.8 0.3 1.5
Gay-friendly services and being able to talk with a doctor about sex: Sydney GCPS, 2008 (II)
63% of HIV positive and 45% of HIV-negative/UK-serostatus men reported having a gay doctor at their last visit for testing
Although most men (92%) disclose their sexual identity, there is a significant increased probability (about twice) of disclosing details of sexual practices to doctors that are gay friendly
No difference in the practices of doctors by gender and sexual identity
Reasons for being tested for STI: Sydney GCPS, 2008 (II)
HIV-pos HIV-neg HIV-ukSignificant
difference
Regular testing pattern 62.4 58.1 42.6 *
Changed partners 2.1 9.5 9.2 *
Did something risky 11.4 19.4 12.3 *
Partner asked 3.6 4.8 2.1
Partner had STI 4.3 2.7 1.5
Doctor suggested 17.7 9.0 6.2 *
Partner did something risky - 4.2 2.1
Had sex with someone he didn't trust 9.9 9.0 5.1
Saw information campaign 2.8 5.4 4.6
Had symptoms 12.1 13.9 8.7
Knowledge of prevention messages and sexual behaviours: Sydney GCPS, 2008 (II)
Predominant majority of gay men are aware of STI prevention strategies and messages, but continue to sometimes engage in risky practices
Examples:
A: 96% of men who had casual partners agreed that “using condoms for all anal intercourse with causal partners would reduce chances of an STI (apart from HIV)”,
• 28% of those who agreed indeed had UAIC in past 6 months and 38% of those who did not agree (non-significant difference)
B: 58% of men agreed that “Having more regular sexual health checks would reduce chances of an STI (apart from HIV)”,
• Similar proportions of those who agreed and disagreed had indeed a sexual health check-up in past 12 months (69% and 71%) nor was there any difference in the frequency of testing
Summary
Improvement in HIV testing, increased comprehensiveness and frequency of STI testing
Remaining issues in STI testing:• Some men are still not being tested for HIV and other STI, some are
tested for one but not the other
• Testing behaviours are associated with risk taking
• Continuing discrepancy in both the prevalence of STI and STI testing by HIV serostatus
• HIV-negative men access services of gay-friendly doctors less often. They may not be able to disclose to their doctors all information that is important for STI testing
• Although STI prevalence is higher among HIV-positive men, STI testing for HIV-negative and unknown-serostatus men should not be neglected
Remaining challenge:• Although all men (independent of serostatus) understand the risk of
STI and know how to reduce the risk, still a substantial proportion engage in risky practices
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