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Type: Thesis
Title: Epidemiology, seasonal variation and factors associated with HIV testing and sexually transmitted infections among men who have sex with men and heterosexuals in South Australia
Author: Li, Bin
Issue Date: 2018
School/Discipline: School of Public Health
Abstract: Background and objectives: Sexually transmitted infections (STIs) have a profound impact on sexual and reproductive health. Despite decades of control efforts, STIs are still common in Australia and remain the major public health concern. This research was conducted within the context of increased diagnoses of STIs, control of STIs and prevention of HIV transmission in South Australia. The objectives of this research project were to: (1) explore and compare the trends in gonococcal diagnoses among heterosexuals, and investigate the plausible reasons for the gonorrhoea epidemic among heterosexuals; (2) examine the trends in gonorrhoea diagnoses among MSM and to determine whether seasonal variations in gonorrhoea diagnoses were evident in MSM; (3) determine the trends in HIV testing and examine factors associated with recent HIV testing among MSM; and (4) evaluate treatment efficacy of two treatments for rectal chlamydial infection, in order that future public health policy, clinical practice and future research are informed by the best evidence. Methods: The research project was a quantitative analysis of medical records using longitudinal clinical data. The first study was a cross-sectional and retrospective analysis to understand how the gonorrhoea trends observed in South Australia compare to those seen in other Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales). Additional analyses were undertaken to investigate factors associated with the gonorrhoea epidemic among heterosexuals in Adelaide to explore whether the observations were unique or part of an Australia-wide phenomenon. In the second project, cross-sectional study was conducted to assess whether seasonal variations in urethral gonorrhoea diagnoses were evident in MSM in three Australian states. The third study explored computerised medical records of MSM who attended the Adelaide Sexual Health Centre (ASHC) at their first visit between 1994 and 2015 to determine whether HIV testing had changed and examine factors associated with recent HIV testing among MSM. The fourth study was a retrospective analysis to evaluate treatment efficacy of two treatments for rectal chlamydial infection. Results: In the first study, a gonorrhoea epidemic has been identified between 2006 and 2010 among heterosexual men, women and female sex workers (FSWs) compared with other years; the odds of gonorrhoea were significantly associated with FSWs in the epidemic years at ASHC. No corresponding trend in gonorrhoea diagnoses was seen at Melbourne Sexual Health Centre (MSHC) and Sydney Sexual Health Centre (SSHC). It is noted that around the same time convictions against FSWs peaked in Adelaide and newspaper reports of increased police activity against FSWs where carrying condoms had been used as evidence of sex work by police. In the second study, peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney but in the second and fourth quarter in Melbourne. The third study showed the proportion of newly registered MSM who reported ever being tested for HIV declined; recent HIV testing did not change and current HIV testing increased between 1994 and 2015. The proportion of MSM who returned for HIV testing within 12 months did not change, with less than 40% of MSM returning for HIV testing. In the last study, rectal chlamydia prevalence was 6.7% and 8.1% respectively in men and women. Treatment with azithromycin was significantly associated with 3-fold higher risk of repeat rectal chlamydial infection. The significant association of treatment regimen with repeat rectal chlamydia remained after adjusting for other factors. Conclusions: The first study suggests that increased policing against sex workers may reduce access to condoms, thereby increasing rates of unprotected sex. SA government should consider legislative revisions to stop using possession of condoms as evidence of sex work. The second study finds that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services and resource allocation over the year and for the timing of health promotion activities. The third study highlights that HIV testing rate among MSM attending ASHC was suboptimal and new approaches are needed to increase the uptake and early detection of HIV infection among the high-priority MSM population. The last study identifies that azithromycin was associated with repeat rectal chlamydial infection compared to doxycycline, suggesting that doxycycline may be more effective than azithromycin in the treatment of rectal chlamydia infection in men and women. Given that STIs remain a neglected area of research and many countries observed simultaneous increases of HIV and STIs today including Australia, especially among men who have sex with men (MSM), the findings from this research project have implications for sexual health policy, clinical practice and future research in this area.
Advisor: Bi, Peng
Fairley, Christopher
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2018
Keywords: Sexually transmitted infections
men who have sex with men
rectal chlamydia
HIV testing
risk factors
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
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