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Michael Atkinson, (WA AIDS Council) describes development and progress of the only peer-based sexual health screening clinic in Australia: the M Clinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
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Community Testing
M Clinic Reflections July 2010 – May 2012
Michael Atkinson
Overview
1. Rationale for M Clinic
2. What we have found
3. Implications
Rationale for M Clinic 1. Syphilis Outbreak mid 20062. At the same time - high level of asymptomatic
STIs in WAAC Sauna Clinic3. PGCPS’s show: testing poor + Increasing UAIC 4. General unmet supply of testing services 5. Seen as a way to improve ‘testing culture’ 6. WAAC survey found guys wanted peer based
service but more discrete 7. Clinic provided a tangible hook to engage men
in education
What have we found?
Clients
1. 1310 clients since July 2010
2. >85% of clients have returned at least once
3. Place of residence: 60% within 20km of CBD, 40% outer suburbs & state wide
4. Majority hear about us though word of mouth
5. Place of last test: Majority from GP, then tertiary sexual health service
6. Increasing number of HIV positive clients
Clients by age
0
100
200
300
400
500
600
Under 21 years
21 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
61 + years
Age distribution
HIV Diagnoses (22 months)
• 18 HIV diagnoses• 14/18 incident cases• Over half had co-current STIs• All but 1 contracted in Australia• 9 Overseas born• UAI main mode of transmission
HIV Yield by Age
0
10
20
30
40
50
60
Under 21 years
21 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
61 plus years
Testers %
HIV Yield %
Data provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health
HIV & Syphilis Yield by Age
0
10
20
30
40
50
60
Under 21 years
21 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
61 + years
Clients %
HIV Yield %
Infectious Syphilis Yield %
Data provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health
Interpretation
1. The sexual health service gap in WA is experienced most by younger people (21-30 years) who require convenient, fast testing
2. The older age bracket (51-60) may have decided that risky sexual practices are part of the deal as you get older.
WA HIV notifications – MSM 01 July 2011 to 31 March 2012
Diagnosing Clinic Total Total%
GPs 16 39%
M Clinic 12 29%
General sexual health clinics (n=3 clinics) 7 18%
Hospital diagnoses (n=4 hospitals) 5 12%
Private Infectious Diseases Consultant 1 2%
Grand Total 41 100%
WA Trends
Since Establishment
M Clinic has had the highest number of MSM HIV notifications from a single clinic in WA
Since November 2011
M Clinic has diagnosed 50% of new HIV diagnoses amongst gay men in WA
Compared with other settings in WA:
M Clinic clients are:
• More likely to have contracted HIV in Australia
• More likely to have been tested because of risky behaviour
• More likely to present for testing within one year of transmission
Information provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health
Implications
• Positive response from the community
• Potential to expand services to a condom-weary group
• Potential to incorporate innovations such as Point of Care testing
• Model attractive to under 30s
• Potential to develop other strategies to engage this elusive target group
• Large number of HIV diagnoses
• Model provides opportunity for a holistic and integrated response at diagnosis – thus reducing long term impact
• Potential to expand the range of services to HIV positive people
• Shift towards community based screening in WA
• Cost shifting
Implications cont…
• The model facilitates early diagnoses of HIV & STIs
• Potentially decreasing downstream infection
• Complements ‘treatment as prevention’ model
• M Clinic sees different clients to other clinics
• People prefer to talk to a peer about risk behaviour
• We are diagnosing people that may not have tested
• Rich source of data - Research potential
• Western Australian Sexual Health Services Survey – Kirby Institute
• HIV Sero-converters Study (Recent HIV Spike) – Kirby Institute
Acknowledgements
• Byron Minas, Lisa Bastian and the supportive team at CDCD, WA Department of Health
• Mark Reid, Tony Bober, Garry Kuchel, Nadine Toussaint and all the peer educators at WAAC
• Dr Lewis Marshall, Dr Paul Effler and the four other M Clinic doctors
• The gay community and clients who have embraced and supported our clinic