Upload
xavier-bowman
View
216
Download
2
Embed Size (px)
Citation preview
STIs in Victoriawhowhy
prevention
Rebecca GuyCentre for Epidemiology and Population Health Research, The Macfarlane Burnet Institute for Medical Research and
Public Health
Why are STIs important?
• Common
• Morbidity
• Asymptomatic
• Often missed
• Associated with systemic disease
• Facilitation of HIV transmission
Chlamydia
Rising chlamydia diagnoses, Australia
0
10000
20000
30000
40000
50000
60000
91 92 93 94 95 96 97 98 99 20002001
20022003
20042005
20062007
Year
nu
mb
er
Who is affected by chlamydia?
• Most infections among heterosexuals
• High rates among MSM
• High rates among Indigenous
Australians
1. Sexual Health (2005) 2:185-192
Interpreting chlamydia trends
• As chlamydia is often asymptomatic nature, notification data underestimate chlamydia prevalence
• Testing is increasing each year
Correlation between chlamydia notifications and testing 1999-2005
50
70
90
110
130
150
170
190
210
230
500 750 1000 1250 1500 1750
Tests per 100,000
No
tifi
cati
on
s p
er 1
00,0
00
Chlamydia Prevalence in Australia
• ~4% of sexually active 18 to 24 year old women1
Victorian community survey
• ~4% of heterosexually active 16 to 29 year old men2
• ~5% in gay men• ~ 10%-15% in Indigenous Australian
populations
1. Hocking et al. ISSTDR, November 20052. ANZJPH (2007) 31(3):243-6
Youth: chlamydia risk factors
• Younger age
• Increased number of partners
• Recent partner change
Youth: knowledge & behaviours
• Big Day Out (BDO) Study• A survey of over 900 young people at the 2007
Melbourne BDO music festival• 35% had multiple sexual partner/s in the past year• 40% had new sexual partner/s in the past three months• Of those with new sexual partners, 53% always used
condoms in the past year• Of those with casual partners, 53% used condoms all the
time.
• Secondary school kids, year 10,12 (2002)– Poor levels of knowledge
Chlamydia Control issues
• No screening = many undetected infections
• Short of a vaccine – screening is the key to control
• Chlamydia is a good candidate for screening– Its complications are important health problems– It is easily diagnosed – simple urine test for men
and women– It is detectable early– It is easily and effectively treated – single dose
treatments (1g azithromycin)– Early treatment reduces the risk of complications
Screening is cost-effective
• Review of published cost-effectiveness studies found that screening was cost-effective at prevalence rates of 3.1% and over1
• Department of Health and Ageing announced $12.5 million for increased chlamydia awareness, improved surveillance and a pilot testing program.
1. STI (2002) 78:406-412
Australian screening program
• Screening likely to be based in primary health care– ~90% of young women and 70% of young men
attend a GP each year– Only 6-8% of 16-24 yr old women get tested
• Questions to be addressed– What resources/skills do GPs need to increase
chlamydia screening – Who should be screened?
• ?Age group – likely to be <25 years• Should men be screened?
– How often should people be screened?– What coverage should we aim for?
STI awareness Campaign
• Victorian government• 14 June 2007• Aimed at 18 to 25 year olds• Radio, posters
“You never know who you’ll meet” • Raise awareness of STIs & increase safe
sex behaviours, regular STI check ups
Syphilis
Infectious syphilis notifications, Victoria, 2000 to 2007
9 16 28 55 84 117
234
418
0
50
100
150
200
250
300
350
400
450
2000 2001 2002 2003 2004 2005 2006 2007
Year
Num
ber
of n
otifi
catio
ns
`
80% MSM
Source: http://www.health.vic.gov.au/ideas/surveillance
Syphilis risk factors, MSM
• HIV positive (around 50%, Sydney1, Melb)• More sexual partners1
• More frequent unprotected anal intercourse• More frequent unprotected oral sex2
• Recreational drug use1,2
• Use of sex on premises venues1,2
• Meeting sexual partners through the Internet3
1 Holt M, Jin F, Grulich A et al. Syphilis, STIs men who have sex with men in Sydney, Understanding and managing risk. National Centre in HIV Social Research, 2003
2 J Epidemiol Community Health (2002) 56(3):235-236
3 JAMA (2000) 284(4):447-449
• Annually testing recommended– Quarterly in high risk men
• The number of syphilis tests conducted per individuals is increasing1
• The proportion of MSM tested for syphilis is not increasing2
– Approx 60% (2004, 2005, 2006)
700
750
800
850
900
950
1000
07/2002
09/2002
11/2002
01/2003
03/2003
05/2003
07/2003
09/2003
11/2003
01/2004
03/2004
05/2004
07/2004
09/2004
11/2004
MonthN
umbe
r of
tes
ts
SYP Linear (SYP)
Syphilis testing, MSM
1. Allen K, Guy R, Leslie D, Goller J, Medland N, Roth N, Lewis J, Hellard M. The rise of
infectious syphilis in Victoria and the impact of enhanced clinical testing. Aust N Z J
Public Health. 2008;32:39-42
2. Hull P, Prestage G, Zablotska I, et al. Melbourne Gay Community Periodic Survey
2006: National Centre in HIV Social Research, University of New South Wales; 2006.
Source: Goller J, Guy R, Leslie D, Lewis J, Batrouney C, Fairley C, Ginge S, Hellard M.
Evaluation of a HIV and STI testing campaign targeting men who have sex with men in
Victoria 2004. 18th Annual Conference of the Australasian Society for HIV Medicine,
Melbourne, Australia, October 2006. [oral]
Syphilis campaigns
• PLHA inc– 2008– Syphilis health promotion– Encourage gay men to be tested
HIV
HIV diagnoses, Victoria 1999-2007
132
187203 211 205 206
242263 256
0
50
100
150
200
250
300
1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er o
f n
ew H
IV d
iag
no
ses
Source: http://www.health.vic.gov.au/ideas/surveillance
HIV diagnosis rates, Victoria NSW and QLD
0
1
2
3
4
5
6
7
8
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Dia
gn
os
is r
ate
pe
r 1
00
00
0
NSW QLD VIC
Unprotected anal sex with casual partners, MSM
15
20
25
30
35
40
1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
Perc
enta
ge
NSW QLD VIC
Note: the sample includes only men who had sex with casual partnersSource: NSW, VIC and QLD Periodic surveys, 1998-2006, men aged 30-49
HIV campaigns
1. Testing campaign– To increase testing
2. UAIC campaign– To increase condom use
3. High case load clinics supported
4. New clinical services provided at convenient locations – run by MSHC
Summary
• Chlamydia – youth– increased testing – prevalence still high
• All STIs - gay men– changes in sexual behaviour
• Campaigns underway
Acknowledgements
• Judy Gold– Centre for Epidemiology and Population
Health Research, Burnet Institute
• Dr Jane Hocking– NHMRC Postdoctoral Research Fellow
School of Population Health