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Antenatal STI and BBV testing at Aboriginal Medical Service Western Sydney

Antenatal STI and BBV testing at Aboriginal Medical Service Western Sydney

Specialist antenatal services are an integral and effective component of service delivery in many Aboriginal community-controlled health services (ACCHSs). Sexual health screenings in ACCHS-led antenatal programs has not been thoroughly documented. The new Clinical Practice Guidelines – Antenatal Care Module 1 recommend that all pregnant women be screened for syphilis, HIV, hepatitis B infection with screening for chlamydia in women aged under 25. This study examined guideline adherence in antenatal STI screening advance of an evaluation of the effectiveness, culturally appropriateness and accessibility of existing services. 

This project was undertaken as a component of the (Research Excellence in Aboriginal Community Controlled Health) REACCH collaboration. Service-wide testing for sexually transmitted and blood borne viral infections in addition to demographic information including pregnancy status was extracted via GRHANITE software. Overall STI and BBV testing and positivity in clients identified as pregnant in the system was examined. 

A total of 203 pregnant women with 229 pregnancies attended the service in the time covered in this study. The mean age of pregnant women was 23.7 (SD=5.9) with a range of 15 (the youngest age covered by this data collection) to 40. Of the 203 women, 176 (87%) were Aboriginal or Torres Strait Islander with 19 (9%) non-Indigenous and 8 (4%) not identified. Across the four years of data reported here, the percentage of clients tested for syphilis 69%, HIV 66% and Hepatitis B infection 72% and chlamydia 80%. Across all age group, 63% of clients had all recommended STI tests and 89% had chlamydia testing in accordance with guidelines. The prevalence of chlamydia was 14.4% in women aged under 25 compared to 1.2% of women aged 25 and older.
These results add to the evidence base on specialised antenatal care services within Aboriginal Community Controlled Health Services. Rates of STI testing are generally comparable to other specialist services. 

Conference: ASHM|HIV|AIDS 2013

AIDS 2013

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The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.

Complex case report that illustrates the paucity of data for long term management of Visceral Leishmania-HIV co-infection.

HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.

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Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.

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