Sexual health最新文献

Recent studies have demonstrated that doxycycline post-exposure prophylaxis (doxy-PEP) reduces the risk of syphilis and chlamydia in men who have sex with men and transgender women who have sex with men who are at risk of sexually transmitted infections (STIs). With several international organisations publishing guidance regarding doxy-PEP use, and substantial community and sector interest, the New Zealand Sexual Health Society drafted an interim statement and then convened a cross-sectoral meeting to discuss doxy-PEP benefits and risks, and review and revise the statement. There was strong agreement that doxy-PEP be considered as part of a comprehensive STI prevention approach to people assigned male sex at birth who have sex with men who are at risk of syphilis, primarily as an intervention to prevent syphilis. New Zealand Sexual Health Society advises that doxy-PEP be proactively offered to people assigned male sex at birth who have sex with men with a diagnosis of syphilis or two other bacterial STIs in the past 12months, and considered for others as outlined in the statement. Prescription of doxy-PEP should include counselling on the benefits and harms including side-effects and antimicrobial resistance, with users assisted to maximise the benefits of doxy-PEP while minimising overall antibiotic use. STI diagnostic considerations, and monitoring and surveillance are discussed.

Background Key populations and their sexual partners account for 98% of new HIV infections in the Asia-Pacific region. Despite increased domestic funding for HIV programs, concerns persist about the sustainability of services for key populations as external donor programs wind down, potentially reversing progress and contributing to new infections. This study aims to understand structural, political and institutional barriers to domestic funding for key population-led HIV programming in these countries through diverse stakeholder perspectives, including limitations of procurement processes, budget allocation systems and political will. Methods A mixed methods approach was utilized, with 60 participants completing an online survey and 145 participating in key informant interviews across four countries in 2022. Stakeholders were categorized according to their organization (government, key population-led, non-government (NGO), and multilateral), with 30 stakeholders per country identified. The same respondents were targeted for quantitative and qualitative data collection. Results Key informant interviews included 60 staff from government organizations, 42 from key population-led organizations, 31 from NGOs, and 12 from multilateral organizations. For the survey (n =60), responses were from key population-led (35%), government (32%), NGOs (23%) and multilateral organizations (10%). Regarding the timeline for increased domestic financing for key population-led HIV services, 45% of participants thought it would take 5-10years to expand them without reliance on external donors, 25% thought more than 10years and 5% thought between 0 and 3years. Almost all government and key population-led organization respondents in each country agreed on government funding or purchasing of community-based services across various HIV-related areas, including linkage to treatment and antiretrovirals (92%), HIV self-testing (95%), PrEP (80%), and stigma-reduction programs (92%). Although most supported the government funding community-based services/NGOs for delivering essential key population HIV services, 28.3% believed that existing laws and policies are in place for such funding, highlighting implementation gaps while knowledge and buy-in remain high. Conclusions This study underscores the importance of identifying realistic timelines with key national stakeholders when designing and deciding timelines for transitioning from international external donor support to domestic budgeting for key population-led HIV programming. It also highlights that although buy-in and understanding of key interventions is well known, there is a lack of sustained funding for these interventions that are essential to ending AIDS as a public health threat by 2030.

Background Pre-exposure prophylaxis (PrEP) uptake remains low in mainland China and Hong Kong. We examined preferences for different PrEP modalities among men who have sex with men (MSM) in mainland China and Hong Kong. Methods We conducted a cross-sectional online survey from May to November 2022 in mainland China and Hong Kong. Eligible participants were aged ≥18years, identified as MSM and self-reported HIV-negative, or unknown HIV status. Random forest models and SHapley Additive exPlanations analyses were used to identify key factors influencing preferences for and willingness to use six PrEP options: (1) daily oral, (2) on-demand oral, (3) monthly oral, (4) two-monthly injectable, (5) six-monthly injectable, and (6) implantable PrEP. Results Among 2142 participants (mainland China: 1604; Hong Kong: 538), the mean age was 28.4 (±7.0) years in mainland China and 34.7 (±9.5) years in Hong Kong. Current PrEP use was similar between mainland China and Hong Kong (18.0% vs 17.8%, P =0.93), with an additional 10.5% and 8.0% reporting past PrEP use (P =0.11), respectively. A greater proportion of participants from mainland China preferred on-demand PrEP compared to those from Hong Kong (55.7% vs 48.1%, P P =0.02). Willingness to use non-oral options was lower, with two-monthly injectable PrEP preferred by 21.1% (19.1-23.1%) in mainland China and 15.4% (12.3-18.5%) in Hong Kong (P Conclusions On-demand and monthly PrEP options remain the preferred choices, though the monthly oral option is neither proven nor available. However, the factors influencing these preferences vary, highlighting the need for tailored and targeted approaches to PrEP implementation.

Background Improving adolescent health and well-being is a key policy priority in countries with a high HIV burden, because adolescents have lower rates of treatment coverage, viral load suppression and survival compared with others. This study aimed to identify innovative ideas from young people (aged 10-30years) on how adolescent health and well-being can be improved in communities most affected by HIV. Methods We organized a global crowdsourcing open call for ideas from young people on how to improve adolescent HIV outcomes and well-being in countries with a high HIV burden. At least three independent judges assessed each submission based on prespecified criteria. We then conducted a thematic analysis of eligible submissions to identify key themes to inform HIV programming and policy. Results We received 357 submissions from 37 countries. Of 107 eligible submissions, 91 (85%) described new ideas. Seventy-one (66%) participants were aged 20-30years, and 30 (28%) were aged 10-19years. Major themes suggested that edutainment interventions linking entertainment and education could increase adolescent uptake of HIV services. Digital interventions adapted for analog cellphone users (e.g. unstructured supplemental service delivery) could increase the reach of HIV information and engage remote, rural participants. Peer-based interventions could improve feelings of social inclusion among adolescents. Conclusions Adolescents and young people in countries with a high HIV burden can create innovative and feasible ideas for improving health and well-being. Exceptional ideas were presented to senior leadership at UNICEF/WHO/UNAIDS as part of a multi-sectoral HIV strategic planning exercise.

New strategies and innovations are needed to achieve ambitious global goals for the control of HIV, hepatitis B, hepatitis C and STIs. Network-based testing (NBT) services, including partner services, social network testing, and family and household testing, are a heterogeneous group of practices in which healthcare providers support clients with STIs or bloodborne infections to offer testing and/or other services to sexual or injecting partners, biological children, or household members or contacts. Although significant evidence supports the efficacy of NBT services to identify, diagnose and link to care partners and other contacts of people with HIV, there has been less direct research about NBT for viral hepatitis or STIs, or for providing prevention services to partners. Research is needed to better understand how NBT can best be utilised for multiple infections, specific populations and to achieve maximal impact. Integrating NBT service delivery to achieve testing, treatment and/or prevention for multiple infections may be efficient, and this might include dual or multiplex testing for different populations. Self-testing or self-sampling for partners may overcome barriers to testing. Providing partners who test negative with prevention options, including PrEP or hepatitis B vaccination where appropriate, might be a powerful way to expand prevention efforts for multiple pathogens. NBT is an important tool for identifying those in need of interventions; a better understanding of how to expand and integrate this tool may help achieve cross-cutting health outcomes globally.

Background Expedited Partner Therapy (EPT) is the practice of treating sexual partner(s) of patients diagnosed with STIs without examining the partner(s) and is effective in reducing reinfection. It has been permissible in Virginia since 2020. This study aimed to assess knowledge and practices surrounding prescription of EPT at an academic medical center in Virginia before and after an online learning module. Methods Data were obtained via online anonymous RedCap surveys. The first was distributed via e-mail to providers who regularly diagnose and treat STIs at an academic medical center in Virginia. The survey assessed provider knowledge and practices regarding EPT and preference of future education. On the basis of the results, an online learning module with information on EPT was created and distributed to the same population of providers. The module contained pre- and post-module surveys evaluating participant knowledge of the legal status, methods of prescription, and attitudes surrounding EPT. Results The initial survey showed that 10% of participants were aware of the new legal status of EPT. In terms of EPT prescription, 4% always prescribed EPT, 14% prescribed it sometimes, and 61% never prescribed it. In the pre-module survey, 31% of respondents correctly identified one option for prescription of EPT. Knowledge surrounding the legal status and prescription methods was significantly improved in the post-module responses, with 100% of participants able to identify one correct prescription option. Conclusion These results show knowledge gaps surrounding the Virginia EPT provision and policy change. These gaps improved with the implementation of an online learning module. Further evaluation is needed to assess the continued implementation of EPT.

Sexual health literacy refers to the ability to find, understand, and use information and services to inform decisions and actions related to sexual health. Given the importance of sexual health literacy for improving health outcomes, it is prudent to identify sexual health literacy measures that can be used by healthcare providers, scholars and educators. To address this need, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to conduct a systematic review. This review examined 12 databases to identify existing sexual health literacy self-report scales, subscales or individual items that were available in English, developed for scale validation purposes, and published between 2002, the year the World Health Organization convened experts to provide a clear working definition of sexual health, and 2022. We conducted a risk of bias and quality assurance assessment of the nine articles that met inclusion criteria, and coded articles along the ten components of a sexual health model used as the theoretical framework. Findings revealed mixed quality of identified measures. None of the measures received positive ratings on all eight criteria assessed or addressed all components of the sexual health model. The results from this systematic review suggest the need for a culturally sensitive, valid and reliable scale to assess sexual health literacy that can be used by sexual health professionals to promote sexual health and to reduce deleterious sexual health outcomes.

Background Crowdsourcing is a process whereby a large group, including experts and non-experts, collaborate to solve a problem and then share the solution with the public. Crowdsourcing can be used to identify strategies to sustain HIV services in low-and-middle-income countries. This study aims to identify innovative adolescent and young adult (AYA) solutions through a crowdsourcing open call to sustain HIV services. Methods Building on HIV prevention services developed by AYA from an initial open call, we organized a crowdsourcing open call to identify innovative, AYA-led strategies to sustain these services through partnerships with the community. The open call question was, 'How might we sustain the 4 Youth by Youth HIV prevention services while nurturing our existing relationships, practices, procedures and services that will last in our communities?'. All submissions were assessed based on prespecified judging criteria. Qualitative data were analyzed using thematic analysis and categorized into strategies for sustaining AYA-friendly HIV prevention services in Nigeria. Results We received 102 eligible submissions from AYA. Twenty-three submissions met the mean score threshold and were qualitatively analyzed. Through this analysis, we identified four strategies for sustaining AYA-friendly HIV prevention services in Nigeria: AYA engagement and leadership in research, digital health solutions, financing and efficiency, and partnerships. Conclusion This open call highlights how strategies developed by AYA may sustain AYA-friendly HIV prevention services. Our findings offer key insights for maintaining HIV prevention services in Nigeria and other similar settings.

Community-based participatory research (CBPR) is quickly becoming an ethical standard for research, ensuring that the research processes align with the values of beneficiaries and contributes to broader social justice goals. This paper reflects on a qualitative study on HIV/STI risks in the sex work industry in Singapore that aimed to adopt a CBPR approach. The project was conducted in partnership with a local sex workers' rights group, Project X, and recruited community members to be part of the research team. The data collection phase of the project lasted for approximately 6months, involving five focus group discussions (n = 24) and 55 semi-structured interviews, the latter conducted primarily by three community interviewers. Based on an analysis of our fieldnotes and interviews with community interviewers, we found five key themes - capacity building, cultural knowledge, limited flexibility in project design, intra-community dynamics and differences in research interests. These themes reflected the project's assumptions, adaptations made, limitations and areas of tension. Despite our best efforts to align with CBPR, there were ultimately some pitfalls. This paper reflects on the lessons learned and assumptions uncovered, and advances current understandings of CBPR, particularly in settings where sex work is diverse, hierarchical and remains highly stigmatized or criminalized.