Transcript headline

STIs in Victoria
who
why
prevention
Rebecca Guy
Centre for Epidemiology and Population Health Research,
The Macfarlane Burnet Institute for Medical Research and
Public Health
Why are STIs important?
• Common
• Morbidity
• Asymptomatic
• Often missed
• Associated with systemic disease
• Facilitation of HIV transmission
Chlamydia
Rising chlamydia diagnoses,
Australia
60000
50000
number
40000
30000
20000
10000
0
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
20
99
98
97
96
95
94
93
92
91
Year
Who is affected by chlamydia?
• Most infections among heterosexuals
• High rates among MSM
• High rates among Indigenous
Australians
1.
Sexual Health (2005) 2:185-192
Interpreting chlamydia trends
• As chlamydia is often asymptomatic
nature, notification data underestimate
chlamydia prevalence
• Testing is increasing each year
Correlation between chlamydia notifications
and testing 1999-2005
Notifications per 100,000
230
210
190
170
150
130
110
90
70
50
500
750
1000
1250
Tests per 100,000
1500
1750
Chlamydia Prevalence in
Australia
• ~4% of sexually active 18 to 24 year
old women1
 Victorian community survey
• ~4% of heterosexually active 16 to 29
year old men2
• ~5% in gay men
• ~ 10%-15% in Indigenous Australian
populations
1.
2.
Hocking et al. ISSTDR, November 2005
ANZJPH (2007) 31(3):243-6
Youth: chlamydia risk factors
• Younger age
• Increased number of partners
• Recent partner change
Youth: knowledge & behaviours
• Big Day Out (BDO) Study
• A survey of over 900 young people at the 2007
Melbourne BDO music festival
• 35% had multiple sexual partner/s in the past year
• 40% had new sexual partner/s in the past three months
• Of those with new sexual partners, 53% always used
condoms in the past year
• Of those with casual partners, 53% used condoms all the
time.
• Secondary school kids, year 10,12 (2002)
– Poor levels of knowledge
Chlamydia Control issues
• No screening = many undetected
infections
• Short of a vaccine – screening is the
key to control
• Chlamydia is a good candidate for
screening
– Its complications are important health problems
– It is easily diagnosed – simple urine test for men
and women
– It is detectable early
– It is easily and effectively treated – single dose
treatments (1g azithromycin)
– Early treatment reduces the risk of complications
Screening is cost-effective
• Review of published cost-effectiveness studies
found that screening was cost-effective at
prevalence rates of 3.1% and over1
• Department of Health and Ageing announced
$12.5 million for increased chlamydia
awareness, improved surveillance and a pilot
testing program.
1. STI (2002) 78:406-412
Australian screening program
• Screening likely to be based in primary
health care
– ~90% of young women and 70% of young men
attend a GP each year
– Only 6-8% of 16-24 yr old women get tested
• Questions to be addressed
– What resources/skills do GPs need to increase
chlamydia screening
– Who should be screened?
• ?Age group – likely to be <25 years
• Should men be screened?
– How often should people be screened?
– What coverage should we aim for?
STI awareness Campaign
•
•
•
•
Victorian government
14 June 2007
Aimed at 18 to 25 year olds
Radio, posters
“You never know who you’ll meet”
• Raise awareness of STIs & increase safe
sex behaviours, regular STI check ups
Syphilis
Infectious syphilis notifications,
Victoria, 2000 to 2007
Number of notifications
450
400
80% MSM
350
300
250
4 18
200
150
234
100
50
0
117
84
9
16
28
55
2000
2001
2002
2003
2004
2005
2006
2007
Year
Source: http://www.health.vic.gov.au/ideas/surveillance
Syphilis risk factors, MSM
•
•
•
•
•
•
•
HIV positive (around 50%, Sydney1, Melb)
More sexual partners1
More frequent unprotected anal intercourse
More frequent unprotected oral sex2
Recreational drug use1,2
Use of sex on premises venues1,2
Meeting sexual partners through the
Internet3
1 Holt M, Jin F, Grulich A et al. Syphilis, STIs men who have sex with men in Sydney, Understanding and managing risk. National Centre in HIV Social Research, 2003
2 J Epidemiol Community Health (2002) 56(3):235-236
3 JAMA (2000) 284(4):447-449
Syphilis testing, MSM
• Annually testing recommended
SYP
– Quarterly in high risk men
Number of tests
950
900
850
800
750
700
4
00
/2
11 04
0
/2
09 04
0
/2
07 04
0
/2
05 04
0
/2
03 04
0
/2
01 03
0
/2
11 03
0
/2
09 03
0
/2
07 03
0
/2
05 03
0
/2
03 03
0
/2
01 02
0
/2
11 02
0
/2
09 02
0
/2
07
• The number of syphilis tests
conducted per individuals is
increasing1
• The proportion of MSM tested
for syphilis is not increasing2
– Approx 60% (2004, 2005,
2006)
Linear (SYP)
1000
Month
1.
2.
Allen K, Guy R, Leslie D, Goller J, Medland N, Roth N, Lewis J, Hellard M.
The rise of infectious syphilis in Victoria and the impact of enhanced
clinical testing. Aust N Z J Public Health. 2008;32:39-42
Hull P, Prestage G, Zablotska I, et al. Melbourne Gay Community Periodic
Survey 2006: National Centre in HIV Social Research, University of New
South Wales; 2006.
Source: Goller J, Guy R, Leslie D, Lewis J, Batrouney C, Fairley C, Ginge S,
Hellard M. Evaluation of a HIV and STI testing campaign targeting men who
have sex with men in Victoria 2004. 18th Annual Conference of the
Australasian Society for HIV Medicine, Melbourne, Australia, October 2006.
[oral]
Syphilis campaigns
• PLHA inc
– 2008
– Syphilis health promotion
– Encourage gay men to be tested
HIV
HIV diagnoses, Victoria 1999-2007
300
Number of new HIV diagnoses
250
200
150
242
100
187
203
211
205
206
2001
2002
2003
2004
263
256
2006
2007
132
50
0
1999
2000
2005
Year
Source: http://www.health.vic.gov.au/ideas/surveillance
HIV diagnosis rates, Victoria NSW and QLD
Diagnosis rate per 100 000
8
7
6
5
4
3
2
1
0
1996
1997
1998
NSW
1999
2000
2001
2002
Year
QLD
2003
2004
2005
VIC
2006
Unprotected anal sex with casual
partners, MSM
40
Percentage
35
30
25
20
15
1998
1999
2000
NSW
2001
2002
Year
QLD
2003
2004
2005
2006
VIC
Source: NSW, VIC and QLD Periodic surveys, 1998-2006, men aged 30-49
Note: the sample includes only men who had sex with casual partners
HIV campaigns
1. Testing campaign
– To increase testing
2. UAIC campaign
– To increase condom use
3. High case load clinics supported
4. New clinical services provided at
convenient locations – run by MSHC
Summary
• Chlamydia – youth
– increased testing
– prevalence still high
• All STIs - gay men
– changes in sexual behaviour
• Campaigns underway
Acknowledgements
• Judy Gold
– Centre for Epidemiology and Population
Health Research, Burnet Institute
• Dr Jane Hocking
– NHMRC Postdoctoral Research Fellow
School of Population Health