1. 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

2. Why are STIs important? Common Morbidity Asymptomatic Often missed Associated with systemic disease Facilitation of HIV transmission

3. Chlamydia

4. Rising chlamydia diagnoses, Australia

5. 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

6. Interpreting chlamydia trends As chlamydia is often asymptomatic nature, notification data underestimate chlamydia prevalence Testing is increasing each year

7. Correlation between chlamydia notifications and testing 1999-2005

8. Chlamydia Prevalence in Australia ~4% of sexually active 18 to 24 year old women 1 Victorian community survey ~4% of heterosexually active 16 to 29 year old men 2 ~5% in gay men ~ 10%-15% in Indigenous Australian populations 1.Hocking et al. ISSTDR, November 2005 2.ANZJPH (2007) 31(3):243-6

9. Youth: chlamydia risk factors Younger age Increased number of partners Recent partner change

10. 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

11. 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

12. Screening is cost-effective Review of published cost-effectiveness studies found that screening was cost-effective at prevalence rates of 3.1% and over 1 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

13. 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?

14. STI awareness Campaign Victorian government 14 June 2007 Aimed at 18 to 25 year olds Radio, posters You never know who youll meet Raise awareness of STIs & increase safe sex behaviours, regular STI check ups

16. Syphilis

17. Infectious syphilis notifications, Victoria, 2000 to 2007 80% MSM Source: http://www.health.vic.gov.au/ideas/surveillance

18. Syphilis risk factors, MSM HIV positive (around 50%, Sydney 1, Melb) More sexual partners 1 More frequent unprotected anal intercourse More frequent unprotected oral sex 2 Recreational drug use 1,2 Use of sex on premises venues 1,2 Meeting sexual partners through the Internet 3 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

19. Annually testing recommended –Quarterly in high risk men The number of syphilis tests conducted per individuals is increasing 1 The proportion of MSM tested for syphilis is not increasing 2 –Approx 60% (2004, 2005, 2006) 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]

20. Syphilis campaigns PLHA inc –2008 –Syphilis health promotion –Encourage gay men to be tested

21. HIV

22. HIV diagnoses, Victoria 1999-2007 Source: http://www.health.vic.gov.au/ideas/surveillance

23. HIV diagnosis rates, Victoria NSW and QLD

24. Unprotected anal sex with casual partners, MSM Note: the sample includes only men who had sex with casual partners Source: NSW, VIC and QLD Periodic surveys, 1998-2006, men aged 30-49

25. 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

26. Summary Chlamydia – youth –increased testing –prevalence still high All STIs - gay men –changes in sexual behaviour Campaigns underway

27. Acknowledgements Judy Gold –Centre for Epidemiology and Population Health Research, Burnet Institute Dr Jane Hocking –NHMRC Postdoctoral Research Fellow School of Population Health