Sara Fiona Elisabeth Bell

Alcohol use has been linked to sexual risk-taking behaviour, particularly among young people in Australia, who are also substantially represented in sexually transmissible infection (STI). While research on alcohol use and sexual risk-taking among university students in Australia exists, no studies outside recent Tertiary Students Sexual and Reproductive Health Survey (TSSHS) publications have distinguished between Australian-born and overseas-born domestic students, despite evidence that migrant populations may show different alcohol use and sexual behaviour patterns. Using data from the TSSHS and a cross-sectional anonymous online survey of university-enrolled students, this study is the first to compare sexually active Australian-born domestic, overseas-born domestic, and international students on alcohol use and sexual risk-taking. Findings align with past research, with Australian-born domestic students being more likely to consume alcohol at high-risk levels than international and overseas-born domestic students. Differences in sexual risk-taking behaviours between the three enrolment groups were fully mediated by harmful alcohol use, indicating an indirect effect between group membership and sexual risk-taking. Age moderated this mediation, with the association between harmful drinking and sexual risk-taking strongest among students aged 20–24, compared with younger and older groups.

University attendance can lead to changes in sexual behaviour that place people at increased risk of negative sexual and reproductive health (SRH) experiences; however, relatively few studies have explored access to and use of SRH services by university students in Australia. A convenience sample of students (N = 4291) from five universities completed an online survey to examine barriers and facilitators to accessing SRH services. Descriptive statistics were used to analyse variations by gender, sexuality, and enrolment status. Content analyses were conducted on responses to two open-ended questions. Over half (59%, 2934) had never spoken to a health professional about SRH issues. Of the 41% (1357) who had, female, non-binary/gender diverse, and Australian-born students were significantly more likely to have done so than students identifying as male, heterosexual, or as an international student. Frequently reported barriers to use of SRH services were 'feeling embarrassed', 'being judged' and 'not knowing where to go'. LGBTQIA+ students along with international and overseas-born domestic students faced specific access barriers. Recommendations targeting student-identified barriers to access are offered, calling for universities to support student wellbeing by providing supportive, non-judgemental, and inclusive SRH promotion and health services that cater to needs of diverse student cohorts.

Background: Long-acting reversible contraceptives are recommended first-line contraception; however, intrauterine device (IUD) uptake remains low in Australia. Objectives: To describe the outcomes of an independent evaluation of the General Practitioner IUD Insertion Network (GPIIN), a project designed to address access barriers through formalized referral pathways between general practitioners (GPs) inserting IUDs and noninserters. Methods: An independent qualitative pragmatic inductive evaluation, involving 14 in-depth interviews with GPIIN members, was conducted 18 months post-GPIIN implementation in 2 Australian jurisdictions to identify and explore critical success factors and limitations of the model. Results: Local GP-to-GP IUD referral networks were considered a useful model to assist affordable and timely IUD access, improve noninserters’ IUD knowledge and inserters’ reflection on best practice. However, pathway simplification is needed to determine optimal integration of the concept into pragmatic GP-to-GP referral arrangements. Conclusions: GPIIN provides an opportunity to improve IUD access in Primary Health Care. Further consideration of organizations best positioned and resourced to facilitate sustainable delivery and coordination is necessary.

HIV self-testing (HIVST) introduces opportunities for screening in non-conventional settings, and addresses known testing barriers. This study involved the development and evaluation of a free online HIVST dissemination service hosted by a peer-led, community-based organisation with on-site, peer-facilitated HIV testing, and established referral and support programs for people newly diagnosed with HIV to determine whether this model was feasible and acceptable for engaging MSM, particularly among infrequent and naive HIV-testers, or those living in remote and rural areas. Between December 2016 and April 2018, 927 kits were ordered by 794 individuals, the majority of whom were men who have sex with men (MSM) (62%; 494), having condomless sex (50%; 392), or living outside a major city (38%; 305). Very few (5%; 39) sought the available pre-test peer contact, despite 45% (353) being naive HIV-testers. This study demonstrates that online HIVST dissemination is acceptable and feasible for engaging at-risk suboptimal testers, including those unwilling to test elsewhere (19%; 47/225). With half (50%; 403) unwilling to buy a kit, our study suggests that HIVST will need to be subsidized (cost-neutral to users) to enhance population coverage and access.

Background: The aim of this study was to compare the performance of pooled self-collected urogenital, pharyngeal and anorectal specimens to that of individual specimen results for the molecular detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) near the point of care (POC) for diagnostic sensitivity. Methods: Clients (mostly men who have sex with men) attending an urban community testing service and three sex-on-premises venues in Brisbane, Australia, were offered CT and NG testing by trained lay providers. Participants provided three self-collected specimens (urine, pharyngeal and rectal) for testing by GeneXpert (Cepheid, Sunnyvale, CA, USA). If any of the individual specimens from a participant were positive, all three specimens were pooled and retested. Results: Of the 388 participants who provided three individual anatomical specimens, 76 (19.6%) were found to be positive for CT and/or NG at one or more sites. The pooling approach failed to detect five CT rectal and four NG pharyngeal infections. The overall performance (sensitivity) of the pooling approach compared with individual specimen testing and Cohen’s κ were 90.0% and 0.86 respectively for CT and 89.7% and 0.89 respectively for NG. Conclusions: Reduced sensitivity was observed when using pooled specimens for the detection of CT and NG using GeneXpert near the POC, similar to results reported in laboratory-based CT and NG pooling studies. These data suggest specimen pooling is feasible near to the POC, potentially saving time and costs when screening at-risk populations for CT and NG. Our data also suggest a reduction in pooled urine could improve overall test sensitivity.

This study aims to pilot and evaluate an integrated model for HIV self-testing (HIVST) service delivery in a peer-led Queensland community setting to increase access to HIVST, particularly for men who have sex with men (MSM) living in regional, remote and rural areas. It seeks to provide evidence that would overcome some of the key objections previously raised to HIVST. Recruitment strategies have been designed to engage hard to reach MSM populations in testing. Awareness of the trial will be generated through advertising on social media platforms, including dating applications, word of mouth and HIV related websites. Participants will access an HIVST online ordering system hosted by a HIV community organisation. This system: (1) enables on-line informed consent; 2) gives clients the choice to accept verbal pre-test information from a trained peer test facilitator or not; and (3) allows for ordering of the HIVST kit after completion of an online survey (with demographic information and testing history etc.). Clients receive the kits via the post; and at 2 weeks receive a follow-up phone-call and SMS link to a post-test survey. If the test is non-reactive, clients can opt for test reminders. If reactive, referral to clinical services, peer navigation and support systems are provided. This study addresses important gaps in understanding of acceptable and feasible methods to integrate HIVST into an existing peer-led testing service and into the broader suite of HIV testing options and services. The findings will inform the actions needed to enhance access to HIVST for MSM wishing to use this technology in Australia and elsewhere, especially those who have never tested and infrequent testers.