In May 2022, the most widespread outbreak of sustained transmission of mpox outside of countries historically affected countries in Western and Central Africa occurred. We aimed to examine the personal and clinical experiences of international healthcare workers (HCWs) during this public health emergency. We conducted an international cross-sectional survey study between August and October 2022, examining the experiences and perceptions of HCWs clinically involved in the 2022 mpox response. Respondents were recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness; training and support at work; psychological well-being and vaccination. 725 multi-national healthcare workers across 41 countries were included in the analysis. 91% were physicians specialised in Sexual Health or Infectious Diseases; with 34% (n = 247) of all respondents involved in mpox policy. A substantial proportion of respondents (n = 296, 41%) reported working longer hours during the mpox outbreak, with no concomitant removal of other clinical responsibilities. 30% (n = 218) of respondents reported that they had never heard of mpox before the outbreak and over 25% of the respondents reported that they had misdiagnosed someone initially. This culminated in a high prevalence of moral distress at thirty percent. Less than 9% of HCWs in the region of the Caribbean, Central America and South America had been offered a vaccine as compared to almost one-third in the other regions. Where offered, there were high levels of uptake across all regions. The findings highlight a critical need for addressing the profound gaps in HCW knowledge about re-emerging diseases with pandemic potential. Strengthening the resilience of global health systems and prioritising internationally coordinated approaches to global vaccine deployment is imperative.
Objective Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time. Methods National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression. Results In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this. Conclusions Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.
Gay men and lesbian women often demonstrate unique settlement patterns, forming what have been referred to as 'gayborhoods'. This study sought to provide the first postcode-level estimates of population size and prevalence of gay and lesbian people in Australia. Data on same-gender-partnered households from the Australian Census were combined with information from six different surveys conducted from 2011 to 2017. We estimated that in 2016 there were 132,203 gay men (1.5% of adult males; 95% CI: 1.4–1.6) and 79,931 lesbian women (0.9% of adult females; 95% CI: 0.8–1.0) in Australia. While many postcodes were sparsely populated by gay and lesbian people (40.1% had prevalences of <0.1%), 24.6% were moderately populated (prevalences in the 50-95th percentile) and 2.7% were highly populated (95th percentile). By jurisdiction, the Australian Capital Territory had the highest prevalences of gay men (2.1%; 95% CI: 2.0–2.2) and lesbian women (1.5%; 95% CI: 1.4–1.6). Although the majority of highly populated postcodes were found in major cities (83.7%), some were also found in regional and remote area (16.3%). This method can be applied in other countries to enhance populate estimates. The accompanying dataset can be used to guide service delivery, conduct geographically contextualised research and develop policies relevant to gay men and lesbian women in Australia.
This study explores the perception of and readiness for hepatitis C treatment within a sample of 77 clients already participating in drug treatment, with a view to identifying likely barriers and incentives to hepatitis C treatment within a drug treatment population. Participants with hepatitis C did not demonstrate a consistent, indepth knowledge of the infection, lacked confidence in symptom recognition, and had little awareness of treatment options. Those without obvious symptoms or liver deterioration did not have a pressing interest in treatment, and many had heard concerning stories about the side effects of hepatitis C treatment. For those coping with anxiety or depression, the increased risk of a depressive episode under interferon treatment was a major barrier to treatment.
We assessed willingness to use HIV pre-exposure prophylaxis (PrEP) and current PrEP use among gay and bisexual men (GBM) in Australia.National, online cross-sectional surveys of GBM were conducted in 2013, 2015, 2017, and 2019. Willingness to use PrEP was measured on a previously validated scale. Trends and associations with key measures were analyzed using multivariate logistic regression.During 2013-2019, 4908 surveys were completed. Among HIV-negative and untested men not currently using PrEP, willingness to use PrEP increased from 23.0% in 2013 to 36.5% in 2017 (P < 0.001) but then plateaued at 32% in 2019 (P = 0.13). The proportion of current PrEP users increased significantly from 2.5% in 2015 to 38.5% in 2019 (P < 0.001). In 2019, factors independently associated with being a current PrEP user (compared with non-PrEP users who were willing to use PrEP) included having subsidized health care (Medicare), knowing HIV-positive people, being recently diagnosed with an STI other than HIV, having higher numbers of recent male sexual partners, recent condomless sex with casual and regular partners, and frequent PrEP sorting.Willingness to use PrEP has plateaued as its use has rapidly increased among GBM in Australia. PrEP use is concentrated among more sexually active men with access to subsidized health care. Free or low cost access schemes may facilitate broader access among GBM who want or need PrEP but lack access to subsidized health care.
Sexually transmitted infections (STIs) are bacteria and viruses passed from person to person during sex. Their association with sexual activity and marginalized activities (such as commercial sex work and homosexuality) means that STIs are often highly stigmatized. Public health responses continue to be hampered by gender inequalities, moral outrage, and public condemnation.
We analyzed the HIV risk reduction strategies (RRS) used by Australian gay and bisexual men with casual partners. Among 1346 men who reported any condomless anal intercourse with casual partners, 75% frequently practiced at least one RRS. The most common RRS was serosorting, frequently practiced by 55% of HIV-positive and 47% of HIV-negative participants. Condoms were frequently (but inconsistently) used by 17% of HIV-positive, 41% of HIV-negative, and 30% of untested participants. Relying on an undetectable viral load was frequently practiced by 58% of HIV-positive participants. Strategic positioning, withdrawal, and non-HIV-positive men taking antiretroviral medication were less common strategies.
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