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March 2017 Issue No.1

March 2017 Issue No.1. Link with ASHHNA. Inside this issue. We are very excited about the new social media presence of ASHHNA on both Facebook and Twitter.

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March 2017 Issue No.1

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  1. March 2017 Issue No.1 Link with ASHHNA Inside this issue We are very excited about the new social media presence of ASHHNA on both Facebook and Twitter. It creates a great opportunity to link with other nurse associations and get up to the minute information about sexual and reproductive health and HIV issues. Executive members Jo (Twitter) and Shannon (Facebook) manage the accounts and the content. Take a look through the newsletter to see what information is being shared via Facebook and Twitter and if you like what you see spread the work among your colleagues Search on Twitter and Facebook for ASHHNANURSES Current ASHHNA activities Member Judith Dean from Brisbane is the official ASHHNA representative on the National Sexual Health Conference organising committee Member Anne Baynes from Canberra is the official ASHHNA representative on the 2017 Australasian HIV/AIDS Conference organising committee Representing nursing and the speciality on committees such as:  Coalition of National Nursing & Midwifery Organisations (CoNNMO), Australasian Sexual Health Alliance (ASHA) , Australasian Society of HIV, viral hepatitis and sexual health medicine (ASHM)  HIV treatment guidelines committee and the ASHM National HIV Standards, Training and Accreditation Committee (NHSTAC) Opening soon: ASHHNA annual professional development scholarship to the value of $3000, keep an eye on the website for details. Sound interesting and thought provoking? Join ASHHNA http://ashhna.org.au/join/ Current ASHHNA activities New South Australian STI testing website National cancer screening register National lesbian, gay, bisexual, transgender and intersex mental health & suicide prevention strategy Watching your words article by two sexual health nurses Art of ART conference details NSW dried blood spot information

  2. The meaning of “regular partner” amongst men who have sex with men, and the significance of “fuckbuddies” In this online video Dr Vincent Cornelisse presents on his poster titled: The meaning of “regular partner” amongst men who have sex with men, and the significance of “fuckbuddies” . Dr Cornelisse is a Registrara at the Melbourne Sexual Health Centre, and a PhD candidate at Alfred Health, Monash University, Melbourne, Australia. This video contains course language so viewer discretion is advised. In the video he presents information on the study he completed looking at the meaning and significance of “fuckbuddies”. This research has also been completed in Sydney by Ben Bavington at the Kirby Institute and the results have significantce for sexual health services who provide care to men who have sex with men. See https://au.viivexchange.com/hcp/medical-education/regular-partner? token=755ec4d1-f945-4c2c-a1e5-3600bb796cde&utm_campaign=2017_FEB_POSTASHM7&utm_source=SUBSCRIBERS_REGISTERED&utm_medium=EMAIL&utm_content=Vincentvideo&seg=NA&prof=Nurse&target=No South Australia Launches its Get Checked Now website STI testing Check it out here: http://www.getcheckednow.com.au/get-checked

  3. National Cancer Screening Register delayed The Department of Health has announced a delay in the start of National Cancer Screening Register due to difficulties in assimilating the eight state and territory cancer registers into one register. This means the Register will not be ready for the publicised start dates of the National Bowel Cancer Screening Program (20 March 2017) and the National Cervical Screening Program (1 May 2017). The RACGP has supported the delay saying it is a positive indication of the Federal Government’s commitment to safe, high quality health care for Australian patients Despite these delays the PHN will continue to conduct as planned a range of education events focusing on Cancer Screening in Primary Care. Dates for these events are March 15 in Newcastle, March 28 on the Central Coast and a date to be confirmed for the North West/New England. The new test for cervical cancer to replace the current Test is contingent on a high quality register that will support the new Cervical Screening Test. As a consequence, the new MBS items for the new Cervical Screening Test will not be made available until the introduction of the register. Cancer screening (cervical, breast, bowel) is a national headline indicator for Primary Health Networks (PHNs). Hunter New England Central Coast PHN (HNECCPHN) is committed to supporting Primary Care providers involved in Cancer Screening through; facilitation of Clinician education and support to General Practice through system capacity and capability improvements. Population-based cancer screening programs are an effective means to identify cancers in people with no symptoms, allowing early treatment and a reduction in illness and mortality. Participation in screening programs is the single most important factor in achieving these outcomes. More information is available by contacting Cancer Screening Officer, Kath Duggan kduggan@hneccphn.com.au

  4. NATIONAL LESBIAN, GAY, BISEXUAL, TRANSGENDER AND INTERSEX MENTAL HEALTH & SUICIDE PREVENTION STRATEGY just released Below is a copy of the forward provided in the document by Rebecca Reynolds, the Executive Director of the National LGBTI Health Alliance. “Historically, LGBTI people and communities have been relatively invisible in mental health and suicide prevention strategies, policies and frameworks and thus excluded from program and project responses. This document aims to provide you with Strategies for Action that will ensure that targeted responses adequately and appropriately support the needs of LGBTI people and communities as a priority. This is overdue and essential if we are truly to work towards the targets we have set ourselves as a country to tackle suicide. We know that there are many nuances between the bodies, relationships genders and identities that are captured by the acronym LGBTI in an Australian context, and this strategy is based on bringing that extensive knowledge and expertise to organisations, services, Government Departments, individual practitioners and community supports so that we can all work together to reduce the incidence of self-harm and suicide”. The report can be found here and is essential reading for the Sexual Health, HIV and Reproductive Health sector. http://lgbtihealth.org.au/resources/national-lgbti-mental-health-suicide-prevention-strategy/

  5. Watching Your Words! Here Sexual Health Nurse Frances Turner talks about the importance of watching your words. I have worked in sexual health in a variety of roles since 2009 and qualified as a nurse in 2014. I immigrated to Australia from the UK in 2016 and recently began working at Sydney Sexual Health Centre as a Registered Nurse. If you ask most people what career they thought they would end up in, chances are they won't say sexual health nursing. Usually when I tell people what I do for a living I get all kinds of responses, some positive some not so much. But I am one of those very lucky few who can honestly say that I love my job. In fact, I think I've got one of the best jobs going and I'm pretty sure all of my colleagues would agree. Why? Well let me draw on my own personal experience with sexual health services to answer that. Where I grew up the sexual health service was in the one and only GP surgery in town. Now to access this clinic, you had to wait in the main waiting area with all the other patients waiting to see the GP – the same GP who had been our doctor since before I was born and knew all of my family. When you were called through by the nurse the door you went through had the blatant sign "family planning" above it. When I first accessed this clinic I was 15 and asked the nurse if I could go on the pill. I was nervous, but felt pretty proud and mature going to the clinic and taking responsibility for myself. Except the reception that I got wasn't the one that I anticipated. Rather than feeling sensible and mature I left feeling stupid and ashamed. The nurse was stony faced as she listed all the risks and hazards that sex had, and reminded me how old I was and what would my parents think? I remember feeling totally confused. Wasn't I doing what everyone had always said I should do? My mum, the educational videos at school, the teen magazine problem pages that I'd read? Surely the fact that I'd taken those messages on board was a good thing? Apparently not. I was put on the pill as I asked, but was made to feel as though I was taking a big risk and gambling with my future, with not one word of praise or encouragement uttered. After that I dreaded going to the clinic to get my repeat pill and didn’t feel as though I could ask the nurse anything. Now that I’m a nurse myself, I’m all too aware of how busy clinic can get. Regular screening, PrEP and PEP, treatments, safeguarding and everything in between can have us chasing our tails on a daily basis. When a patient who needs a little more time and attention pitches up it can be easy for any of us to forget how difficult just walking through our door might be for them. Talking about what sex a patient has had and who with is part of our bread and butter, but it’s not that way for everyone. For a patient who is nervous to come into clinic because it’s their first time testing, they’re worried about being judged or their sexual activity is at odds with their cultural values, just being in our clinic can be intimidating. Add into mix a busy nurse who is rushing to get them in and out of clinic and you get a patient who is going to feel belittled and abandoned. Taking the time to step back for a moment and empathize with my patients can make a huge difference to their experience in clinic and their future sexual health. I realize this statement might be blindingly obvious, but it’s hard sometimes, especially when it’s been a long day and all I want is a nice straightforward asymptomatic screen. But when my patients leave smiling feeling more informed and empowered – well that’s why I love my job. So whenever I see a patient in clinic, even if it’s been a long day and I’m stressed, I always try to remember how that nurse made me feel.

  6. the art of ART Meeting Secretariat E: conference@ashm.org.auP: +61 2 8204 0770 This year the art of ART Meeting will be taking place at the Pullman Albert Park, Melbourne from FRIDAY 16 JUNE - SATURDAY 17 JUNE 2017. The meeting will be comprised of a series of plenaries and interactive workshops for s100 prescribers, Nurses & Pharmacists to attend with a focus onthe Use of Antiretrovirals in the Management of Patients.This meeting is a complimentary event for prescribers, provided by ASHM, through an unconditional educational grant. Travel support and accommodation is available for eligible participants.Further information about registration, meeting themes and invited speakers will be emailed to you in the coming weeks.We look forward to welcoming you to the art of ART Meeting 2017. 2017 Conference on Retroviruses and Opportunistic Infections feedback On demand post exposure prophylaxis with doxycycline for MSM enrolled in a PrEP trial Molina J-M et al. Session O-8; Common bedfellows: PREP, STIs, and the microbiome; Abstract 91LB This prospective substudy randomised high-risk men who have sex with men from the open-label phase of the ANRS IPERGAY trial of on-demand PrEP for HIV prevention to receive PEP with Doxycycline 200mg within 72 hours after condomless sexual intercourse (maximum dosage 600mg per week; n=116) or no post exposure prophylaxis (n=116), and followed them for a median of 8.7 months. The men who received PEP had a reduced STI acquisition rate over the study period (24% vs. 38.8%; hazard ratio 0.53 [95% CI 0.33–0.85]) compared to men who did not have PEP. It specifically reduced the chlamydia and syphilis acquisition (respective hazard ratios 0.30 [0.13–0.70] and 0.27 [0.07–0.98]), but did not reduce gonorrhoea acquisition (0.83 [0.47–1.47]). Doxycycline is an effective treatment for both syphilis and chlamydia and has little known resistence profile. With a median use of about 7 pills per month (overall adherence of 83%), the incidence rates of both chlamydia and syphilis were reduced by 70%. No antibiotic resistance data are yet available, particularly for gonorrhoea; and about 10% of patients experienced doxycycline-related gastrointestinal side effects. Watch this space for further prophylaxis studies.

  7. Watching Your Words continued! Below new Sexual Health Nurse Colleen Nugent also reflects on the importance of communication in ur sector. In June 2016 I took my first position as a sexual health nurse at Sydney Sexual Health Centre. I had been a registered nurse for six years in acute care hospital settings so when I began in sexual health I was excited for the challenge this area of nursing would bring. The first focus of my training was taking a sexual history. Learning this skill allowed for great reflection on my ability to discuss sexual issues with people I have only just met. I have always been comfortable talking about sex. However, this was done with friends, where there has been a mutual level of comfort. Discussing sexual health with a stranger was very different. I quickly realised how important establishing a level of comfort with my patients was to allow them to open up and discuss their concerns freely with me. Providing a non-threatening, comfortable environment in the patient- nurse relationship is important in all areas of nursing but absolutely vital in sexual health, as commonly there is vulnerability about sex. I considered myself a skilled communicator but I found myself challenged in my communication skills.  I became acutely aware of all the subtleties of communication; choice of words, tone and volume of voice, inflections, eye contact, body language and facial expressions. I noticed the volume of my voice lowered when I ask patients about anal sex and I avoided eye contact when asking patients how many sexual partners they have had. Was I unconsciously reflecting the taboos of our society? Did my patients notice this subtle volume change and my shifting gaze and if so, how did that make them feel? I realised these expressions, although unintended, were not conducive to a good relationship with my patients. So I consciously worked at changing this behaviour. I wanted to be neutral and open, allowing my patients the space to be themselves and not feel judged. I realised early on how important a neutral and open communication style was when interacting with patients who were uncomfortable or not accepting of their own behaviour. For instance, any subtle change in facial expression, like a lift of the eyebrows could be misconstrued as judgement. This could feel hurtful to the patient and cause them to withdraw and potentially not answer the questions honestly. I first became aware of this when I was taking a sexual history from a young woman and I asked how many partners she had in the last three months. She went red, shifted in her seat and gave me a number. I remember not thinking anything of the number but unconsciously my eyebrows lifted slightly and I said “ok” in a higher tone of voice. She interpreted those expressions as a judgment on her. She shrank in her seat and referring to the number of partners she had told me, she sheepishly said “that is really bad isn’t it?” This interaction taught me how easily an unconscious or unintended expression can have a negative impact on a patient. I may not be able to change whether a patient is going to judge themselves but I certainly do not want to encourage their self-judgment in any way. As a new nurse to sexual health I was really struck by the power of this subtle communication. I had never noticed these subtleties in my previous nursing work. With reflection on my communication style and refining these skills I am continuously developing a more open, neutral and non-judgemental space for my patients to interact with me in. I have been a sexual health nurse for ten months now and already it is very clear how our interactions with our patients can have a large impact on their future sexual health. From the education we provide to their comfort level with our service to continue accessing care. It seems open and non-judgmental communication can lead to a great relationship with a sexual health service.

  8. Dried Blood Spot HIV Test Update on NSW Dried Blood Spot Testing project by Sharon Robinson My role as HIV CNC with NSW STI Programs Unit is to support the implementation of the NSW HIV Strategy 2016-2020. Much of this work involves improving access to HIV testing for our most at risk populations. I am on secondment to this role, from my usual clinical role as HIV and Sexual Health CNC at St George Hospital in Sydney’s south. It has been interesting to work with the Ministry of Health and see things from a policy perspective. At the same time, my clinical knowledge has been incredibly valuable in shaping policy implementation. I have worked in sexual health for 17 years now, first in Queensland before moving to NSW. NSW Health is committed to the bold but achievable ambition of the virtual elimination of HIV transmission by 2020 as outlined in the NSW HIV Strategy 2016-2020. To achieve this goal, very high levels of testing are required among people at risk of HIV. We know that early diagnosis and treatment of HIV, provides the best health outcomes for the individual and prevents the onward transmission of the infection to others. However, in NSW, approximately 35% of HIV diagnoses occur at a late stage of the disease. To improve testing rates, NSW Health has invested in innovative testing strategies to ensure a mix of HIV testing options are available to meet the needs of our priority populations. The Dried Blood Spot (DBS) HIV Test provides a new testing option for people at risk of HIV. The DBS HIV Test is a self-collection test, which enables people to collect a finger prick sample of blood, at home. The sample is posted to the laboratory for testing. The delivery of results and follow up care is coordinated through the Sexual Health Infolink and the relevant Local Health District. This allows people to collect samples in their own home, post back and receive results without having to attend a health service. The DBS HIV Test is highly accurate and provided free of charge to the patient. This type of testing is particularly beneficial for people concerned about known barriers to HIV testing in conventional health settings, including embarrassment, cost, transport or other logistical issues or concerns about needles or traditional venepuncture sampling. The DBS HIV Test is offered as part of a pilot project being conducted in two phases. Phase 1 of the project is currently underway. Phase 1 During Phase 1, DBS HIV testing is available to men who have had sex with men, people from countries where HIV is more common (Africa or Asia), or people who have had sexual partners from these regions. The testing kit is ordered online www.hivtest.health.nsw.gov.au and mailed in a plain express post envelope, to a preferred address. Phase 2 Phase 2 of the project will allow services within relevant settings to provide testing kits directly to people at risk. The DBS HIV Test will be available to a broader range of risk groups including people who inject drugs.It is expected that Phase 2 of the project will commence mid-2017.  For more information visit www.hivtest.health.nsw.gov.au.

  9. HIV & NURSING • The HIV epidemic has evolved in Australia, yet many nurses may have limited knowledge of HIV infection, and little experience caring for PLHIV which could impact negatively on patient care. As a Clinical Nurse Consultant (CNC) HIV Disease while providing education to recently graduated nurses, at a suburban hospital in Sydney, it became apparent to me that they had fears and limited knowledge of HIV issues and infection control. This triggered a pre-educational session quiz, which elicited some concerning results. Forty-one nurses at the end of their graduate program completed the pre-educational quiz. All had undergone infection control education and blood borne virus education at university. • Results from quiz: • • 37% stated that insects can transmit HIV; • • 17% thought HIV could be contracted from sharing a cup with a HIV positive person; • • 12% said you could tell someone had AIDS because they looked tired and ill; • • 66% were unaware of legislation related to HIV disclosure by a health worker; and • • 71% were unaware of post exposure prophylaxis (PEP) for an exposure to HIV. • Following this I completed a quality improvement activity regarding HIV with under graduate nurses on clinical placement in the community setting. It was well evaluated with 100% increasing their knowledge and they all enjoyed meeting PLHIV and hearing their stories1. The next step was to think about how nurses could access current information regarding HIV and nursing. As the nursing workforce is diverse in Sydney Local Health District (SLHD) and across many locations development of online training was considered a method to increase awareness for nurses to HIV issues relevant to them and it is anticipated that enhanced knowledge attained from the online training will also to lead to positive experience for PLHIV when accessing health services within SLHD. • Online Nursing Module • Working collaboratively with the Centre for Workforce Development we developed an online module “ HIV and Nursing” for SLHD. The main aim was to enhance nursing staff knowledge regarding HIV issues with the objectives to: • reduce fear of transmission and to improve the experience for both the nurse and patient, • Improve patient health outcomes, • improve knowledge of HIV medication issues, • improve knowledge of post exposure prophylaxis (including access), and • increase awareness of HIV issues to staff. • Content included: • Historical aspect of HIV disease • Transmission/ Infection control • First aid procedure • Access to Post exposure prophylaxis (PEP) • Maternity issues • Stigma and discrimination • Content was distributed for comment to medical and nursing staff with expert knowledge and experience working in the area of HIV in NSW and Victoria. • Continued over page …..

  10. Continued….. Positive Speakers: PLHIV are a diverse community. Since the start of the HIV epidemic many PLHIV have experienced stigma and discrimination in the health system and this has been known to stop PLHIV accessing health care 2,3. During clinical placements undergraduate nurses found meeting a PLHIV and hearing their story very beneficial. For the module we interviewed three PLHIV from the Positive Speakers Bureau who provided insights into their life including positive and negatives experiences in the health care system. It Design Many nurses are a younger generation who may not have experience with PLHIV and often digital savvy. In this case using multiple text, video and animations, interactions and quizzes was a deliberate strategy to maintain interest. The next steps: The module was launched and went live in December 2017. Now we are in the process of informing various services in SLHD such as mental health and drug health about the online module and we plan to evaluate use in 1 year. By Denise Cummins, CNC HIV Royal Prince Alfred Hospital, Camperdown Sydney. References: 1. Cummins, Denise and Muldoon, Janelle. Informing and educating undergraduates on HIV [online]. Australian Nursing and Midwifery Journal, Vol. 21, No. 9, Apr 2014: 51. Availability: < http://search.informit.com.au/documentSummary;dn=189674831043083;res=IELHEA> ISSN: 2202-7114. [cited 17 Mar 17].  2. Chambers, L.A., Rueda, S., Nico Baker, D., Wilson, M.G.,Deutsch, R., Raeifar, E.,Rourke, S. B. 2015. Stigma, HIV and health: a qualitative synthesis. BMC Public Health. 15:848 DOI: 10.1186/s12889-015-2197-0  3. Gagnon, M. 2015. Re-thinking HIV-related stigma in health care settings: a qualitative study. Journal of the Association of Nurses in AIDS Care, Vol. 26, No.6, November/December 703-719. Recent info shared on Facebook Article: reduction in genital HPV in young Aboriginal and Torres Strait Islander people. Article: gonorrhoea rates in QLD soar. Article: National sexual health crisis nobody is talking about. Article: Meet the Man Who Stopped Thousands of people Becoming HIV+. ASHM: Report from CROI. Article: Spanish Researchers patent HIV test that detects the virus within a week. Article: Australia on track to cure hep C. Article: mycoplasma genitalium a sexually transmitted superbug. Article: Western Australia PrEP trial. Article: Women are going without abortions to pay for food.

  11. Information shared via • Article- Cultural Care • Factsheet – Oral changes for PLWHIV • SWOP NSW workshop • Department of Health – ‘My Life, My Lead Implementation Plan Advisory Group Consultation’ • Article- The Story Behind the First AIDS Drug Approved 30 Years Ago’ • Article – BMJ Setting up an Asymptomatic Screening Pathway for MSM • Article – Ulipristal Acetate • Article – BMJ Barriers and Facilitators to Chlamydia Testing as GP

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