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E-Health for STI Control

E-Health for STI Control

In our Internet program www.iwantthekit.org (IWTK), women in Maryland, West Virginia, and Washington DC have been able to request home vaginal swab collection kits since 2004 via the Internet or a toll-free number. Other jurisdictions have been added over time. Beginning in 2006, men were added to the program and could requested free kits for home collection of urine and penile Self-obtained specimens were collected and mailed, and questionnaires were completed for demographics, acceptability and perceptions of use, and sexual risk history. Samples were tested using nucleic acid amplification tests. Self-collected rectal kits were made available in 2009. Infected participants were treated at participating clinics. As well, patients in our Emergency Department (ED) have been allowed to perform their own HIV test and are requesting a HIV test via an e-health kiosk. From 2008 to 2009, patients, who had completed a standard HIV oral fluid test performed by a trained healthcare professional and who were unaware of their results, were recruited to perform a rapid POC HIV test. In 2009-2110, patients were allowed to perform their own test before the standard of care HIV test.

Of 2689 female samples submitted from IWTK , 8.9% were positive for Chlamydia, 1.2% for gonorrhea and since 2006, 8.9% were positive for trichomonas. Prevalence for chlamydia in women aged 15-19 was 15.3% (11% in 20-25 year olds). High satisfaction was reported: 91% preferred self-collection; almost 97% said the collection was easy or very easy and 92% stated they would use the internet program again. Treatment was verified in all women except 4. Prevalence was higher than in family planning clinics. Of 927 men requesting kits, 29.1% mailed samples. Most (98.1%) submitted both penile swabs and urines. Chlamydia prevalence was 13.4%. Prevalence for those15-19 yr. was 20.6%, for 20-24 yr. was 18.1% and for 25-29 was 5.8%. Treatment was verified for all but 1 infected man. 93.0% of men found the instructions very easy/easy. Median age was 24 yr. Only 16.0% used condoms consistently. High satisfaction was reported: 86.7% preferred to collect his own specimen; 88.9% indicated the swab collection was easy/very easy and 87.5% stated they would use the Internet program again. In the ED HIV self test program, 478 of 564 (85%) patients receiving a standard oral fluid HIV test volunteered, with a mean age of 38-39 years. 91% of participants chose oral fluid and 9% chose blood (p<0.05). Self-test results were 99.6% concordant with health care professionals’ test results. For the self-testers, 94% of oral fluid testers and 84.4% of blood testers reported trusting the self-administered test result “very much.” 95.6% of oral fluid group and 93.3% of the blood group would “probably” or “definitely” perform a test at home, if available. A kiosk is now used in an ongoing study to recruit patients to accept an HIV test and provide an option to perform the oral fluid HIV self-test.
Self-collected samples recruited via the Internet and via an electronic kiosk approach appear to be acceptable, may remove barriers to testing, such as stigma and privacy issues, and may identify more sexually transmitted infections and cases of HIV than traditional venues if they can be more widely implemented. E-health for STI control has arrived.

Areas of Interest / Categories: Australasian Sexual Health Conference 2011

Australasian Sexual Health Conference 2011

Current Medical Treatment of Premature Ejaculation

Over the past 20-30 years, the Premature Ejaculation (PE) treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Animal and human sexual psychopharmacological studies have demonstrated that serotonin and 5-HT receptors are involved in ejaculation and confirm a role for SSRIs in the treatment of PE. Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of SSRIs in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is associated with superior fold increases in IELT compared to on-demand SSRIs.

The Sexuality Education of Australian GLBTIQ Youth: Messages, Usefulness, Recommendations

There have been many recent media debates and controversies in Australia over what sexuality education in schools should constitute. Concerns for sexual health can inform pushes for educating young people on topics such as hygiene, biology or safe sex. Yet other agendas privilege censorship, the teaching of abstinence, a focus on sexual morality or the inclusion of gay rights and other diverse perspectives. A review of the literature uncovered the key approaches to sexuality education, and 14 specific messages they offer young people about their sexuality. This presentation considers the relevance of these messages for gay, lesbian, bisexual, transgender and intersex students.

Gay men prefer partner notification by short message service (SMS) rather than e-postcards: a web-based evaluation

In 2006 two new innovative features were added to the WhyTest website; the ‘Tell them’ service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the ‘remind me’ service allowing visitors to register for a 3, 6 or 12 monthly SMS reminder for a sexual health check. We describe the usage of the new website functionality, and recognition of a health promotion campaign conducted in January-June 2007 to promote these new features.

The importance of mobility in sustaining high STI prevalence in remote indigenous communities

Despite high rates of screening and treatment in many remote Indigenous communities in Australia, diagnosis rates for sexually transmitted infections (STI), chlamydia and gonorrhoea in particular, remain alarmingly high. One contributing factor may be the high rate of temporary mobility for residents of remote communities. We use mathematical modelling to explore the impact of mobility on STI transmission within remote communities.

Lighting the fire, not filling the pail - positioning sexuality in the Australian curriculum

This symposium presentation will discuss conceptual approaches to how processes underway to develop the Australian Curriculum might link to improved sexual health outcomes. It will also explore the assumptions underpinning the ‘partnership’ between health and education sectors to uncover both the opportunities and the pitfalls for those who want to promote young people’s learning. 

Oropharyngeal carcinoma related to human papillomavirus

Human papillomavirus (HPV) induced oropharyngeal squamous cell carcinoma is a unique subtype of oropharyngeal cancer. It has a significantly better prognosis than that caused by tobacco and/ or alcohol. The incidence of HPV related oropharyngeal cancer is raising in the western countries.

Surgical Aspects of Transgender Medicine

Surgery for gender dysphoria was not routinely available prior to the 80’s, surgery and psychiatry having had an unhappy liaison. While gender dysphoria is DSM classified it’s not because it is deemed to be an illness, rather than to give guidelines as to establishing a diagnosis, and surgery is now deemed to be an appropriate activity.