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