“We get by with a little help from our friends”: Small-scale informal and large-scale formal peer distribution networks of sterile injecting equipment in Australia

Background

In Australia, sterile needles and syringes are distributed to people who inject drugs (PWID) through formal services for the purposes of preventing blood borne viruses (BBV). Peer distribution involves people acquiring needles from formal services and redistributing them to others. This paper investigates the dynamics of the distribution of sterile injecting equipment among networks of people who inject drugs in four sites in New South Wales (NSW), Australia.

Methods

Qualitative data exploring the practice of peer distribution were collected through in-depth, semi-structured interviews and participatory social network mapping. These interviews explored injecting equipment demand, access to services, relationship pathways through which peer distribution occurred, an estimate of the size of the different peer distribution roles and participants’ understanding of the illegality of peer distribution in NSW.

Results

Data were collected from 32 participants, and 31 (98%) reported participating in peer distribution in the months prior to interview. Of those 31 participants, five reported large-scale formal distribution, with an estimated volume of 34,970 needles and syringes annually. Twenty-two participated in reciprocal exchange, where equipment was distributed and received on an informal basis that appeared dependent on context and circumstance and four participants reported recipient peer distribution as their only access to sterile injecting equipment. Most (n = 27) were unaware that it was illegal to distribute injecting equipment to their peers.

Conclusion

Peer distribution was almost ubiquitous amongst the PWID participating in the study, and although five participants reported taking part in the highly organised, large-scale distribution of injecting equipment for altruistic reasons, peer distribution was more commonly reported to take place in small networks of friends and/or partners for reasons of convenience. The law regarding the illegality of peer distribution needs to change so that NSPs can capitalise on peer distribution to increase the options available to PWID and to acknowledge PWID as essential harm reduction agents in the prevention of BBVs.

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By:  Jamee Newland, Christy Newman, Carla Treloar

Centre of Social Research in Health, UNSW Australia, John Goodsell Building, UNSW 2052 Australia 

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The impact of an automatic syringe dispensing machine in inner-city Sydney, Australia: No evidence of a 'honey-pot' effect

INTRODUCTION AND AIMS:

Needle and syringe automatic dispensing machines (ADM) aim to increase needle/syringe distribution to people who inject drugs. ADM implementation has been met with community concern about potential perceived increases in crime and drug use and that they will attract non-resident drug users-the 'honey-pot effect'. In April 2013, an ADM commenced operation in inner-city Sydney. We assessed the impact of the ADM on crime and examined its use by non-resident drug users (the honey-pot effect).

DESIGN AND METHODS:

Fixed-site needle and syringe program (n = 207) and ADM clients (n = 55) were surveyed to determine whether they lived within 1 km of the ADM. Police-recorded offences between January 2012 and March 2014 across six crime categories for the local and surrounding areas were assessed for trend to measure impact on crime.

RESULTS:

The majority (78%) of needle and syringe program clients reported residing within 1 km of the service. Most (95%) ADM users were fixed-site service clients. The 2 year trend for crime categories remained stable or decreased, except for fraud, which increased significantly (P < 0.05).

DISCUSSION AND CONCLUSION:

Automatic dispensing machine users were largely clients of the existing fixed-site service and lived locally. There was no apparent concurrent increase in crime or a honey-pot effect. It is important that services continue to be aware of community concerns and respond to them appropriate

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By:  Grau LE1, Zhan W1,2, Heimer R1.

• 1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
• 2Department of Children and Families, Hartford, USA. 
• Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12396

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Syringe Stockpiling by Persons Who Inject Drugs: An Evaluation of Current Measures for Needle and Syringe Program Coverage

Needle and syringe program (NSP) coverage is commonly used to assess NSP effectiveness. However, existing measures don't capture whether persons who inject drugs (PWIDs) stockpile syringes, an important and novel aspect of NSP coverage. 

In this study, we determine the extent of stockpiling in a sample of Australian PWIDs and assess whether including stockpiling enhances NSP coverage measures. As part of the Illicit Drug Reporting System study, PWIDs reported syringes procured and given away, total injections in the last month, and syringes currently stockpiled in 2014. We calculated NSP coverage with and without stockpiling to determine proportional change in adequate NSP coverage. We conducted receiver operating characteristic curve analysis to determine whether inclusion of stockpiled syringes in the measure improved sensitivity in discriminating cases and noncases of risky behaviors. 

Three-quarters of the sample reported syringe stockpiling, and stockpiling was positively associated with nonindigenous background, stable accommodation, no prison history, longer injecting careers, and more frequent injecting. Compared with previous measures, our measure was significantly better at discriminating cases of risky behaviors. 

Our results could inform NSP policy to loosen restricted-exchange practice, allowing PWIDs greater flexibility in syringe procurement practices, promoting greater NSP coverage, and reducing PWIDs' engagement in risky behaviors.

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By:  McCormack AR, Aitken CK, Burns LA, Cogger S, Dietze PM.

Correspondence to Professor Paul M. Dietze, Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia (e-mail:pauld@burnet.edu.au).

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Sexual health-related information delivery: Are patient information leaflets still relevant?

Background:

Patient information leaflets (PILs) are widely utilised within publically funded sexual health clinics to deliver sexual health-related information (SHRI); however, their continued value to clients in the era of social media is unclear. This study aimed to evaluate clients' opinions on three newly developed PILs and examine client views on other forms of SHRI delivery.

Methods:

An anonymous self-administered questionnaire was completed by clients attending the Western Sydney Sexual Health Centre (WSSHC) in 2012. High-risk population (HRP) vs non-high-risk population (non-HRP) views on PILs vs alternative methods of SHRI delivery were analysed by using Mann-Whitney U, Wilcoxon, McNemar and χ2 tests.

Results:

Over half (210/315; (67%)) of the consecutive clients from a culturally diverse population completed the survey. Sex workers (SW) and young people (YP) were significantly likely to have a high school education than non-HRP (P < 0.039 and P < 0.032). Overall, PILs, a clinic website and the Sexual Health Information Link (SHIL), a state-wide website and telephone line, were ranked significantly higher as a means of SHRI delivery on a Likert scale than newer technologies including Facebook (P < 0.001), email (P < 0.001), mobile phone applications (P < 0.001), TVs in waiting rooms (P < 0.001) and business cards (P < 0.001). There was no significant difference in opinion between HRP and non-HRP.

Conclusions:

This study provides evidence for the ongoing use of PILs to deliver SHRI to clinic attendees, in conjunction with other forms of SHRI delivery such as websites and SHIL. Novel methods may require additional consumer engagement and a greater understanding of specific population's needs.

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By:  Rick Varma A B, Charles Chung A, Amanda Townsend A and Melissa Power A C 

A Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, Sydney, NSW 2150, Australia. B Sydney Sexual Health Centre, Sydney Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia. C Corresponding author. Email: melissa.power@health.nsw.gov.au 

Sex Health. 2016 Feb 4. doi: 10.1071/SH15199.

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"Nowhere Line" - Voices from Manus Island, Where Australia Deports Asylum Seekers - Video

Nowhere Line: Voices from Manus Island from Lukas Schrank on Vimeo.

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Does Gender Moderate the Relationship between Polydrug Use & Sexual Risk-Taking among Australian Secondary School Students Under 16 Years of Age?

INTRODUCTION AND AIMS:

This study examines the association of alcohol and polydrug use with risky sexual behaviour in adolescents under 16 years of age and if this association differs by gender.

DESIGN AND METHODS:

The sample consisted of 5412 secondary school students under 16 years of age from Victoria, Australia. Participants completed an anonymous and confidential survey during class time. The key measures were having had sex before legal age of consent (16 years), unprotected sex before 16 (no condom) and latent-class derived alcohol and polydrug use variables based on alcohol, tobacco, cannabis, inhalants and other illegal drug use in the past month.

RESULTS:

There were 7.52% and 2.55% of adolescents who reported having sex and having unprotected sex before 16 years of age, respectively. After adjusting for antisocial behaviours, peers' drug use and family and school risk factors, girls were less likely to have unprotected sex (odds ratio = 0.31, P = 0.003). However, the interaction of being female and polydrug use (odds ratio = 4.52, P = 0.004) was significant, indicating that girls who engaged in polydrug use were at higher risk of having unprotected sex. For boys, the effect of polydrug use was non-significant (odds ratio = 1.44, P = 0.310). Discussion and Conclusions For girls, polydrug use was significantly associated with unprotected sex after adjusting for a range of risk factors, and this relationship was non-significant for boys. Future prevention programs for adolescent risky sexual behaviour and polydrug use might benefit from a tailored approach to gender differences.

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By:  Chan GC1, Kelly AB1, Hides L1,2, Quinn C1,2, Williams JW3,4,5,6.

• 1Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.
• 2Queensland University of Technology, Brisbane, Australia.
• 3School of Health and Social Development, Deakin University, Melbourne, Australia.
• 4Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Australia.
• 5Population Health Studies of Adolescents and Health Services Delivery for Adolescents, Murdoch Children's Research Institute, Melbourne, Australia.
• 6Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
• Drug Alcohol Rev. 2016 Mar 23. doi: 10.1111/dar.12394. 

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'Everyone Wants a Vagina That Looks Less Like a Vagina': Australian Women's Views on Dissatisfaction with Genital Appearance

We present a thematic discourse analysis of 94 Australian women's written comments about women's presumed dissatisfaction with their genital appearance. 

Two themes emerged: 'from natural to normal' and 'the difficulty of resistance'. In the first theme, participants discuss genital dissatisfaction with reference to hegemonic constructions of femininity and to postfeminist, neoliberal discourses that position the natural female body as inadequate, with beauty practices necessary to achieve acceptability. 

The second theme addresses the difficulty of challenging this positioning, referencing discourses that position the vagina as unpleasant and discussion of it as taboo. 

We consider implications of these constructions for women's well-being.

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By:   Moran C1, Lee C2.

• 1The University of Queensland, Australia.
• 2The University of Queensland, Australia c.lee@psy.uq.edu.au.
• J Health Psychol. 2016 Mar 23. pii: 1359105316637588. 

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The Meaning of 'Regular Partner' in HIV Research among Gay and Bisexual Men: Implications of an Australian Cross-Sectional Survey

Estimates of the proportion of HIV infections coming from within regular sexual relationships among gay and bisexual men (GBM) vary widely. Research surveys use various partner type categories, but there is little understanding of how men classify their partners. We conducted an online cross-sectional survey of Australian GBM exploring sexual relationships, including 2057 men reporting on 2566 regular partnerships. 

Just over half of the partnerships were considered 'relationships', while the remainder were non-romantic 'fuckbuddy'-style arrangements. In multivariable analysis, factors associated with considering the partnership a 'relationship' were: using a 'romantic' descriptor, partnership length, monogamous agreements, any condomless anal sex with each other, love, and commitment. The category of 'regular partner' can mask diverse partnership types, which have different meanings to GBM, associated behaviours, and HIV risks. 

Certain HIV prevention techniques may be more suited to particular types of partnerships. 'Fuckbuddy' arrangements need to be more explicitly acknowledged in HIV prevention.

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By:  Bavinton BR1, Duncan D2, Grierson J3, Zablotska IB4, Down IA4, Grulich AE4, Prestage GP4,5.

• 1Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia. bbavinton@kirby.unsw.edu.au.
• 2University of New England, Armidale, Australia.
• 3Anglia Ruskin University, Cambridge, England, UK.
• 4Kirby Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
• 5Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia. 
• AIDS Behav. 2016 Mar 12.

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Hepatitis C in Australian Prisons: A National Needs Assessment

Purpose

Hepatitis C (HCV) infections are prevalent in custodial settings worldwide, yet provision of antiviral therapies is uncommon. Approximately 30,000 prisoners are held in Australian prisons at any one time, with more than 30 per cent testing positive for HCV antibodies. Prisoners have been identified in the National Hepatitis C Strategy as a priority population for assessment and treatment. The purpose of this paper is to examine the rates of HCV testing and treatment, as well as barriers and opportunities for development of infrastructure for enhanced services. 

Design/methodology/approach

Interviews were conducted with 55 stakeholders from the correctional sector in each state and territory in Australia in two stages: service directors to gather quantitative data regarding rates of testing and treatment; and other stakeholders for qualitative information regarding barriers and opportunities. 

Findings

Of more than 50,000 individuals put in in custody in Australian prisons in 2013, approximately 8,000 individuals were HCV antibody positive, yet only 313 prisoners received antiviral treatment. The barriers identified to assessment and treatment at the prisoner-level included: fear of side effects and the stigma of being identified to custodial authorities as HCV infected and a likely injecting drug user. Prisoners who came forward may be considered unsuitable for treatment because of prevalent mental health problems and ongoing injecting drug use. Provision of specialist hepatitis nurses and consultants were the most frequently recommended approaches to how prison hepatitis services could be improved. 

Originality/value

Many personal and systems-level barriers relevant to the delivery of HCV treatment services in the custodial setting were identified. Ready access to skilled nursing and medical staff as well as direct acting antiviral therapies will allow the prison-sector to make a major contribution to control of the growing burden of HCV disease.

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By:  Mina MM1, Herawati L, Butler T, Lloyd A.

• 1Inflammation and Infection Research Centre (IIRC), School of Medical Sciences, University of New South Wales, Australia.
• Int J Prison Health. 2016 Mar 14;12(1):3-16. doi: 10.1108/IJPH-08-2015-0025. 

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A Model for Lesbian, Bisexual & Queer-Related Influences on Alcohol Consumption & Implications for Policy & Practice

Research consistently reports higher rates of problematic drinking among lesbian, bisexual and queer women than among heterosexual women, but relatively little research has identified underlying factors. 

Within this context, the aim of the present study was to qualitatively explore the sociocultural influences on alcohol consumption among lesbian, bisexual and queer women in Australia. An ethnographic study including in-depth interviews and 10 sessions of participant observation was conducted with 25 Australian lesbian, bisexual and queer women. 

Analysis of transcripts and fieldnotes focused on lesbian, bisexual and queer-related influences on alcohol consumption. Three lesbian, bisexual and queer-related factors were identified that influenced alcohol use: (1) coping, (2) connection and (3) intersections with lesbian, bisexual and queer identity. Most participants reported consuming alcohol to cope with discrimination or to connect with like-minded others. Alcohol use had positive influences for some women through facilitating social connection and wellbeing. Women with a high lesbian, bisexual and queer identity salience were more likely to seek lesbian, bisexual and queer community connection involving alcohol, to publicly identify as lesbian, bisexual and queer and to experience discrimination. National policies need to address underlying causes of discrimination against lesbian, bisexual and queer women. 

Alcohol policies and clinical interventions should acknowledge the impact of discrimination on higher alcohol consumption amongst lesbian, bisexual and queer women compared with heterosexual women, and should utilise health promotion messages regarding safe drinking that facilitate lesbian, bisexual and queer social connection.

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By:  McNair R1, Pennay A2,3, Hughes T4, Brown R5, Leonard W6, Lubman DI7.

• 1 Department of General Practice, University of Melbourne, Melbourne , Australia.
• 2 Centre for Health Equity, University of Melbourne.
• 3 Centre for Alcohol Policy Research, and Turning Point, Fitzroy , Australia.
• 4 School of Nursing, The University of Illinois at Chicago, Chicago , USA.
• 5 School of Nursing and Midwifery, Faculty of Health, Deakin University , Burwood , Australia.
• 6 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne , Australia.
• 7 Turning Point and Eastern Health Clinical School , Monash University , Fitzroy , Australia.
• Cult Health Sex. 2016 Apr;18(4):405-21. doi: 10.1080/13691058.2015.1089602. Epub 2015 Oct 14. 

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The Positive Outlook Study: A Randomised Controlled Trial Evaluating Online Self-Management for HIV Positive Gay Men

The aim of this paper was to evaluate the effectiveness of an online self-management program in improving health outcomes and well-being for gay men living with HIV in Australia. 

The online Positive Outlook Program was based on self-efficacy theory and used a self-management approach to enhance HIV-positive gay men's skills, confidence and abilities to manage the psychosocial issues associated with HIV in daily life. The 7-week program was delivered in closed groups and comprised information modules, action-planning activities, moderated discussion boards, and weekly peer-facilitated 'live chats'. 

A randomised controlled trial was conducted to establish the effectiveness of the Positive Outlook program compared to a 'usual care' control. Participants were HIV-positive gay men 18 years or older living in Australia. Primary outcomes were evaluated at three time-points (baseline, post-intervention and 12-week's post-intervention follow-up) and included HIV-related quality of life (PROQOL-HIV), outcomes of health education (HeiQ) and HIV specific self-efficacy (Positive Outlook Self-Efficacy Scale). 

A total of 132 gay men with HIV in Australia were randomly allocated to the intervention (n = 68) or usual care control (n = 64) groups. Maximum likelihood marginal-linear modelling indicated significant improvement in the intervention group on the PROQOL-HIV subscales of body change (p = 0.036), social relationships (p = 0.035) and emotional distress (p = 0.031); the HeiQ subscales of health-directed activity (p = 0.048); constructive attitudes and approaches (p = 0.015); skill and technique acquisition (p = 0.046) and health service navigation (p = 0.008); and the Positive Outlook Self-Efficacy Scale on the subscales of relationships (p = 0.019); social participation (p = 0.006); and emotions (p = 0.041). 

Online delivery of self-management programs is feasible and has the potential to improve quality of life, self-management skills and domain specific self-efficacy for gay men with HIV.

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By:  Millard T1, Agius PA2,3, McDonald K4,5,6,7, Slavin S8, Girdler S9, Elliott JH10,11,12.

• 1Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia. tanya.millard@monash.edu.
• 2Centre for Population Health, Burnet Institute, Melbourne, Australia. pagius@burnet.edu.au.
• 3Judith Lumley Centre, La Trobe University, Melbourne, Australia. pagius@burnet.edu.au.
• 4Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia. karalyn.mcdonald@monash.edu.
• 5Judith Lumley Centre, La Trobe University, Melbourne, Australia. karalyn.mcdonald@monash.edu.
• 6Jean Hailes Research Unit, Monash University, Melbourne, Australia. karalyn.mcdonald@monash.edu.
• 7Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia. karalyn.mcdonald@monash.edu.
• 8Centre for Social Research in Health, University of New South Wales, Sydney, Australia. sslavin@afao.org.au.
• 9School of Occupational Therapy and Social Work, Curtin University, Perth, Australia. sonya.girdler@curtin.edu.au.
• 10Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia. julian.elliott@monash.edu.
• 11Centre for Population Health, Burnet Institute, Melbourne, Australia. julian.elliott@monash.edu.
• 12Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia. julian.elliott@monash.edu. 

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As Good As It Gets? Retention in Care of People Newly Diagnosed with HIV at the Sydney Sexual Health Centre

A retrospective review of all new HIV positive patients attending the Sydney Sexual Health Centre in 2012 and 2013 was performed to ascertain the retention in care rates, proportion that achieved viral suppression, number of SMS reminders sent and counselling uptake. 

• Ninety-six patients had a retention rate of 66%. 
• Thirty-three patients (34%) were not retained in care, 
• 16 (17%) were knowingly attending another healthcare service with 17 (18%) categorised as lost to follow up. 
• Counselling referrals had a 74% (71/96) uptake, with SMS reminders sent in 97% (93/96) of cases. 

Overall, the clinic performed well compared with international standards but the lost to follow-up rate remains a concern

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By:  Dominic Rowley A E, Amel Ahmed A, Anna McNulty A B, Lynne Wray A C and Vickie Knight A D 

A Sydney Sexual Health Centre, Nightingale Wing, Sydney Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia. B School of Public Health and Community Medicine, University of NSW Australia, Sydney, NSW 2052, Australia. C School of Women’s and Children’s Health, University of NSW Australia, NSW 2052, Australia. D The Kirby Institute, Wallace Wurth Building, University of NSW Australia, Sydney, NSW 2052, Australia. E Corresponding author. Email: dominicrowley@hotmail.com 

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How Do Outcomes Compare between Women & Men Living with HIV in Australia?

Background: 

Gender differences vary across geographical settings and are poorly reported in the literature. The aim of this study was to evaluate demographics and clinical characteristics of participants from the Australian HIV Observational Database (AHOD), and to explore any differences between females and males in the rate of new clinical outcomes, as well as initial immunological and virological response to antiretroviral therapy.

Methods: 

Time to a new clinical end-point, all-cause mortality and/or AIDS illness was analysed using standard survival methods. Univariate and covariate adjusted Cox proportional hazard models were used to evaluate the time to plasma viral load suppression in all patients that initiated antiretroviral therapy (ART) and time to switching from a first-line ART to a second-line ART regimen. 

Results: 

There was no significant difference between females and males for the hazard of all-cause mortality [adjusted hazard ratio: 0.98 (0.51, 1.55), P = 0.67], new AIDS illness [adjusted hazard ratio: 0.75 (0.38, 1.48), P = 0.41] or a composite end-point [adjusted hazard ratio: 0.74 (0.45, 1.21), P = 0.23]. Incident rates of all-cause mortality were similar between females and males; 1.14 (0.61, 1.95) vs 1.28 (1.12, 1.45) per 100 person years. Virological response to ART was similar for females and males when measured as time to viral suppression and/or time to virological failure. 

Conclusion: 

This study supports current Australian HIV clinical care as providing equivalent standards of care for male and female HIV-positive patients. Future studies should compare ART-associated toxicity differences between ART-associated toxicity differences between men and women living with HIV in Australia.

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By:  Michelle L. Giles A B I, Marin C. Zapata C, Stephen T. Wright D E, Kathy PetoumenosD, Miriam Grotowski F, Jennifer Broom G, Matthew G. Law D and Catherine C. O’Connor C D H 

A Department of Infectious Diseases, Monash University, Clayton, Vic. 3168, Australia. B Monash Infectious Diseases, Monash Health, Clayton, Vic. 3168, Australia. C RPA Sexual Health, Sydney Local Health District, Sydney, NSW 2050, Australia. D The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia. E School of Mathematical and Physical Sciences, University of Technology, Sydney, NSW 2007, Australia. F Tamworth Sexual Health Service, Tamworth, NSW 2340, Australia. G Department of Medicine, Nambour Hospital, Nambour, Qld 4560, Australia. H Central Clinical School, University of Sydney, Sydney, NSW 2052, Australia. I Corresponding author. Email: m.giles@alfred.org.au 

Sex Health. 2016 Feb 1. doi: 10.1071/SH15124. 

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