HPV causes around 90% of anal cancer, and HPV16, causes 90% of HPV-positive cases. Morbidity and mortality from HPV-related diseases are markedly higher among homosexual men. We describe the prevalence of anal HPV, the potential predictors of anal high-risk (HR) HPV and HPV16, and incidence and clearance of HPV16, in a cohort of Australian homosexual men.
The Study for the Prevention of Anal Cancer is a three-year prospective study of HIV-negative and positive homosexual men aged ≥ 35 years. Participants complete behavioural questionnaires and undergo anal canal examination. An anal swab is analysed using liquid-based anal cytology (ThinPrep®). Thinprep® medium is used for HPV genotyping by Roche Linear Array.
By March 2013, 342 participants (median age 49 years; 28.7% HIV positive) had attended a baseline visit. Almost two thirds had at least one HR genotype (64.4%) and almost a third had HPV16 (30.3%) detected. HR-HPV detection was significantly associated with positive HIV status (p=0.010), younger age (p=0.007), more lifetime (p=0.013) and recent (p=0.005) male sexual partners, more receptive anal behaviours in the last 6 months, including unprotected (p=0.001) and protected (p=0.019) intercourse, rimming (p<0.001) and fingering (p=0.004). HPV16 detection was only associated with a recent history of receptive fisting (p=0.049). The incidence of anal HPV16 infection was 5.6 per 100PY (HIV negative 3.66 vs HIV positive 10.00 per 100PY, HR 2.74, 95% CI 0.73-10.27). Clearance of HPV16 (30.67 per 100 PY ) was similar among HIV positive and negative participants (27.69 vs 32.54 per 100 PY, HR 0.91, 95% CI 0.32-2.57).
HR anal HPV was extremely common in this cohort of homosexual men. Incident HPV16 infection was more frequent among HIV positive participants, however clearance was similar among all men. Receptive anal sexual practices and recent sexual activity were important predictors of HR-HPV detection.
Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.
Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.
Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.
Based on evidence of the success of utilising online campaigns to access MSM, RPA Sexual Health, a publically funded sexual health service (PFSHS) in the inner-west of Sydney, trialled two clinic advertising campaigns over a three year period. Both campaigns were developed with community consultation, targeting MSM and were predominantly online. They were evaluated and compared to measure their success and the effectiveness of advertising a PFSHS online.
Background: Medical termination of pregnancy (MTOP) has been available and successfully used as an option for women internationally since 1988. The regimen for MTOP results in abortion in 99% of cases. Since Mifepristone’s recent availability in Australia, Marie Stopes International has performed more than 10,000 MTOP procedures in Australia since 2009. In Victoria, the Law Reform Commission removed pregnancy termination (“abortion”) from the criminal statutes in August 2008, which provided women and health care professionals with protection from criminal prosecution for their legal involvement in termination of pregnancy (TOP).
Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.