Sexual health最新文献

This integrative qualitative review examines barriers and facilitators affecting sexual health service access among Asian-born men who are gay, bisexual, or who have sex with men (GBMSM) in Australia. Despite advancements in HIV prevention, this group remains underrepresented in research and healthcare, contributing to health disparities. The analysis identified a 'socioecological cascade' where external, structural-level forces like pervasive stigma and perceived threat of health-related visa requirements are progressively internalized, culminating in individual-level barriers to care. On the positive side, a supportive attitude from the clinic's staff and the connection to the gay community improve access. Findings highlight the need for culturally sensitive outreach, clinician training, and policy reforms.

World AIDS Day 2025 arrives at a critical inflection point for the global HIV response. Four decades of scientific progress have transformed HIV into a manageable chronic condition, yet funding contractions, widening inequities, and persistent stigma threaten progress towards epidemic control. This review of the Special Collection highlights emerging challenges and opportunities across prevention, care, and social contexts, with a focus on resilience. Digital innovation, accelerated by COVID-19, is reshaping HIV service delivery through telehealth, remote engagement, and online research platforms. Studies of PrEP use across the Asia-Pacific region reveal cyclical patterns of prevention, varying preferences for long-acting and oral formulations, and the centrality of person-centred approaches. Other papers examine sexual satisfaction among people living with HIV, showing the ongoing influence of stigma even in the era of U=U (Undetectable equals untransmittable). Several contributions highlight enduring social and gendered inequities, including stigma among healthcare workers and gaps in menopause, reproductive health, and psychosocial care for women living with HIV. Evidence from humanitarian settings demonstrates how climate-related crises heighten HIV vulnerabilities, while peer-led navigation models illustrate community resilience. These papers underscore the need to integrate scientific innovation with equity, community leadership, and sustained solidarity as the global HIV movement adapts to a rapidly changing landscape.

Background: A sustained outbreak of infectious syphilis has been documented in Australia since 2011. Although treatment of syphilis with antibiotics is highly effective, the ongoing spread of this pathogen in Australia suggests that diagnosis may be suboptimal. Molecular detection of syphilis is now commonly performed; however, in many instances clinicians request separate tests for specific pathogens, which may lead to issues in failing to request testing for Treponema pallidum subspecies pallidum, the causative agent of syphilis.

Methods: In this study, we performed routine screening of 5052 samples submitted to our local pathology provider for routine herpes simplex virus (HSV) investigations. Samples were tested for the presence of T. pallidum.

Results: We identified a total of 41 samples (0.8%) which were T. pallidum positive. Of these, the majority of samples reassuringly had requests for T. pallidum testing requested; however, samples from three patients (including a pregnant female) were identified as part of this exercise, who would have otherwise remained undetected and untreated.

Conclusion: This study demonstrates the clear value in routine screening exercises such as this to improve the timely detection and management of syphilis in Australia.

Background Recovering clinical isolates of Treponema pallidum (Tp) can expedite the research on molecular epidemiology and vaccine development of syphilis. Nevertheless, obtaining numerous isolates through rabbit infectivity testing (RIT) remains unsatisfactory, particularly in secondary syphilis cases. This study re-evaluates the reliability of orchitis as a phenotypic indicator for assessing Tp clinical strains during RIT. Methods Treponemal and nontreponemal tests were used to analyze the correlation between serological titers and Tp burden. An optimal titer threshold was identified and applied to verify the maximum achievable Tp burden across different initial inoculation doses. A modified recovery protocol was developed for isolating Tp clinical strains from chancre exudates or whole blood, and its success rate was subsequently evaluated. Results We demonstrated that a Treponema pallidum particle agglutination (TPPA) titer of 1:1280 reliably indicated the peak burden of Tp Nichols strain and clinical isolates during RIT. To achieve stable recovery, the initial inoculum should be at least 105 organisms. Using this optimized protocol, we successfully recovered and maintained Tp clinical isolates from 82.69% (43/52) of syphilis patients overall. Notably, the success rate from whole blood samples of secondary syphilis cases increased markedly to 82.50% (33/40), despite many of these specimens testing negative for Tp DNA by qPCR. Conclusions This study shows that the pathogenicity of secondary syphilis blood is greater than previously recognized. Thus, monitoring TPPA titers enables the recovery of Tp clinical isolates even from specimens with extremely low bacterial burdens.

Background: Secondary distribution of HIV self-testing (HIVST) may improve HIV testing coverage and facilitate the diagnosis of people living with HIV, but whether this effect is similar among index men who have sex with men (MSM) with different HIV status is still not clear.

Methods: This study is a pooled analysis of three trials (ChiCTR1900025433, ChiCTR2000039632 and ChiCTR2200064517) conducted by our study team. These three trials aimed to evaluate the effectiveness of monetary incentives in promoting the secondary distribution of HIVST in China. MSM who participated in the three trials were grouped into four groups based on their HIV and intervention status. The control group followed a standard HIVST distribution process in which participants (defined as 'index') distributed the HIVST kits to members of their social network (defined as 'alter'), whereas the intervention group received monetary incentives for promoting altered testing.

Results: Between June 2018 and December 2023, 891 unique MSM from 68 cities in China were recruited as index participants, with 55, 54, 390 and 392 categorized into the positive control, positive intervention, negative control and negative intervention groups, respectively. A total of 1035 alters tested for HIV, including 962 motivated by 782 HIV-negative index participants and 73 motivated by 109 index participants living with HIV. The negative intervention group motivated significantly more unique alters to test than the negative control group (IRR 2.46, 95% CI: 1.85, 3.28). With intervention, index living with HIV was less likely to motivate alters for HIV testing (IRR 0.36, 95% CI: 0.23, 0.57). An interaction was not detected between intervention and HIV status. The proportion of newly tested testers among alters was 52%, 48%, 38% and 40% in the positive control, positive intervention, negative control and negative intervention groups, respectively. A total of 41 alters were diagnosed with HIV (5 motivated by index participants living with HIV).

Conclusions: The effect of monetary incentive was lower among MSM living with HIV, even though they tend to identify alters with HIV-reactive results. Integrating incentive-based HIVST secondary distribution into routine HIV prevention and care services is recommended.

Background: This study aims to explore the relationship between sexual orientation-related stigma and sleep quality in gay men, the mediating roles of depression and perceived social support in this relationship, and the moderating mediation effects of living alone and being only children.

Methods: Between April and August 2022, 528 gay men were recruited. All participants completed the Sexual Orientation-related Stigma Scale, the Chinese version of the Patient Health Questionnaire, the Multidimensional Survey of Perceived Social Support and the Pittsburgh Sleep Quality Index. Structural equation models were constructed for mediation and moderated mediation analysis.

Results: Sexual orientation-related stigma significantly impacts the sleep quality of gay men, with depression and social support playing a chain-mediated role in this relationship. Being an only child moderates the relationship between sexual orientation-related stigma and social support, whereas living alone moderates the relationship between sexual orientation-related stigma and depression.

Conclusions: The results emphasize the importance of sexual orientation-related stigma in the mental health and sleep quality of gay men. Reducing stigma, increasing social support, and considering individual differences related to family structure and living arrangements are all crucial for enhancing the mental health and sleep quality of gay men. Future research should delve deeper into these complex relationships to develop more effective interventions; thus, improving the overall quality of life and happiness of gay men.

Background: Pre-exposure prophylaxis (PrEP) use could be accelerated by offering alternatives that overcome key barriers associated with oral PrEP. This study aimed to understand willingness and preferences for long-acting injectable cabotegravir (CAB-LA) among gay men and other men who have sex with men (MSM), and transgender women (TGW) in Asia.

Methods: An online cross-sectional survey was conducted from May to November 2022 among HIV-negative or unknown status MSM and TGW aged ≥18 years across 15 and 11 Asian countries/territories, respectively. Survey items included awareness and use of PrEP and CAB-LA, willingness to use current and emerging PrEP options, and attitudes towards CAB-LA. Descriptive statistics and logistic regression were used to analyse associations with willingness to use CAB-LA.

Results: Among 11,870 MSM and 980 TGW, 21.4% (n = 2448) and 32.5% (n = 295) were aware of CAB-LA, respectively, and 17.2% (n = 2036) and 16.8% (n = 165) were willing to use it. CAB-LA was the most preferred PrEP option for 3.6% (n = 400) of MSM and 6.5% (n = 61) of TGW. Awareness and willingness varied across countries/territories and populations. Key benefits of CAB-LA included HIV protection (57.8% MSM, 46.8% TGW), no need for daily pills (42.6% MSM, 31.1% TGW) and longer-term protection (38.0% MSM, 23.6% TGW). Main concerns included cost (39.6% MSM, 22.1% TGW), side-effects (37.5% MSM, 22.2% TGW), insufficient knowledge (33.3% MSM, 20.6% TGW) and pain (21.4% MSM, 24.9% TGW).

Conclusions: Successful introduction of CAB-LA, or other new long-acting injectable PrEP options, in Asia will require strategies to raise awareness and demand-generation that responds to the perceived benefits and concerns of communities.

Background: Generous peer review is essential for scientific review, yet many researchers experience the current review culture as unkind. Harsh reviews disproportionately affect women, researchers of color, and other under-represented groups, contributing to reduced confidence, diminished job satisfaction, and delayed career progression. In contrast, generous reviewing strengthens research quality, promotes equity, and reinforces the collaborative foundations of science.

Methods and results: This article outlines four principles to guide a more generous approach to manuscript review: empathizing with authors, providing constructive criticism, focusing on areas of genuine expertise, and advocating for systemic improvements in academic publishing. Empathy encourages reviewers to recognize the emotional and professional labor behind every submission, framing feedback in a manner that supports learning rather than discouragement. Constructive criticism emphasizes specificity, actionable guidance, and a distinction between major and minor concerns. Reviewing within one's expertise enhances accuracy and protects against misplaced or misleading critique, while acknowledging limitations promotes humility and transparency. Finally, reviewers are well positioned to promote broader equity, including advocating for fair article processing charge policies, inclusive language support, and greater recognition of reviewer labor.

Conclusions: Cultivating generosity in peer review does not diminish rigor; it enhances the effectiveness, fairness, and impact of scholarly communication. By adopting these principles, reviewers can help shift the culture of peer review towards one that encourages improvement, supports diverse researchers, and advances high-quality science.

Background: Notifications of syphilis in Australia have increased since 2011, particularly among gay and bisexual men who have sex with men (GBMSM). Adherence to current late latent syphilis treatment regimen is low-moderate, which is a significant health issue. To address this treatment non-compliance, a single high-dose benzathine benzylpenicillin G regimen has been under clinical trial. This study aimed to determine which attributes of either a three-dose or single-dose benzathine benzylpenicillin G regimen for treating late latent syphilis were preferred, and which attributes were deemed most important by a sample of GBMSM in Australia.

Methods: A discrete-choice experiment survey was administered to GBMSM. This included two experiments: (1) treatment Day 1, and (2) completion of a full course. Random parameters logit model and latent class analysis were used to analyse choices of preferred attribute levels, and attributes deemed most important by respondents.

Results: A total of 309 respondents completed the survey, having a mean age of 42.35 (±15.4) years. The choices revealed respondents' preferred attribute levels that were related to the single high-dose regimen, such as one injection on Day 1, the use of a shorter and thinner needle, a single injection, and a single appointment to complete the treatment course. Respondents preferred a shorter injection time. The pain on treatment Day 1, and the total number of injection(s) and appointment(s) to complete a treatment course were of most concern to respondents.

Conclusions: The GBMSM respondents preferred one injection and one appointment for a full treatment course, which supports efforts to develop a single high-dose benzathine benzylpenicillin G regimen for late latent syphilis treatment.

This Letter reports on perimenopausal and menopausal symptoms among Chinese-speaking commercial sex workers (CSWs) attending Sydney Sexual Health Centre. Forty-six CSWs aged ≥45 years were screened using a modified Greene Climacteric Scale. Sixteen showed symptoms of oestrogen deficiency, and 31 reported vaginal dryness causing painful sex. Given the physical demands of sex work, these symptoms may impact quality of life and ability to work. Findings highlight the need for culturally sensitive, accessible healthcare services to address the menopausal health concerns of CSWs and reduce barriers to care.