STIs in Victoriawhowhy

prevention

Rebecca GuyCentre 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

0

10000

20000

30000

40000

50000

60000

91 92 93 94 95 96 97 98 99 20002001

20022003

20042005

20062007

Year

nu

mb

er

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

50

70

90

110

130

150

170

190

210

230

500 750 1000 1250 1500 1750

Tests per 100,000

No

tifi

cati

on

s p

er 1

00,0

00

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. Hocking et al. ISSTDR, November 20052. 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

9 16 28 55 84 117

234

418

0

50

100

150

200

250

300

350

400

450

2000 2001 2002 2003 2004 2005 2006 2007

Year

Num

ber

of n

otifi

catio

ns

`

80% MSM

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

• Annually testing recommended– Quarterly in high risk men

• 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)

700

750

800

850

900

950

1000

07/2002

09/2002

11/2002

01/2003

03/2003

05/2003

07/2003

09/2003

11/2003

01/2004

03/2004

05/2004

07/2004

09/2004

11/2004

MonthN

umbe

r of

tes

ts

SYP Linear (SYP)

Syphilis testing, MSM

1. 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

2. 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

132

187203 211 205 206

242263 256

0

50

100

150

200

250

300

1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er o

f n

ew H

IV d

iag

no

ses

Source: http://www.health.vic.gov.au/ideas/surveillance

HIV diagnosis rates, Victoria NSW and QLD

0

1

2

3

4

5

6

7

8

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Dia

gn

os

is r

ate

pe

r 1

00

00

0

NSW QLD VIC

Unprotected anal sex with casual partners, MSM

15

20

25

30

35

40

1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Perc

enta

ge

NSW QLD VIC

Note: the sample includes only men who had sex with casual partnersSource: NSW, VIC and QLD Periodic surveys, 1998-2006, men aged 30-49

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