Most Australian guidelines for clinical screening of chlamydia infection advise testing sexually active individuals aged 16-24 years. Recent research shows that age at first sex in Australia is decreasing; a recent Victorian survey showed 29% of respondents reported being sexually active before age 16 years. There is also evidence that younger age at first sex is associated with risk behavior such as unprotected sex and having multiple sex partners.
We examined three years of laboratory testing data (2008-2010) collected via the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). Data from 15 laboratories were used; five from Victoria, four each from New South Wales and Queensland, two from South Australia and one from Tasmania. Chlamydia test numbers and proportion positive were compared by age group.
In three years 286,020 tests were conducted in individuals aged 12-24 years, the majority occurring in females (3:1 ratio). Of total tests, 3.6% were in 12-15 year olds (n=10,296) compared to 32% in 16-19 year olds. The proportion chlamydia positive was highest in adolescent girls aged 12-15 years (13%) compared to 12% in those aged 16-19 years, 8% in those aged 20-24 years (p=.001) and 9% in boys aged 12-15 years (p<.001).
Chlamydia testing in 12-15 year olds was much lower than in other adolescents but this group had the highest chlamydia prevalence. This is possibly due to less routine chlamydia testing in 12-15 year olds or only testing those presenting with sexual risk. Testing young adolescents is complicated by legal policies relating to age of consent, and privacy is a potential barrier to testing. Also of concern is the sexual behaviour of younger adolescents potentially increasing their risk of infection. Research into sexual behaviours of this group is needed.
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.
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.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.