A national study of the clinical management of HIV-positive women in Australia: what are the successes and where are the gaps?
Michelle L. Giles A B U , Aleece MacPhail A , Charlotte Bell C , Catriona S. Bradshaw D E , Virginia Furner F , Manoji Gunathilake G H , Mina John I , Sushena Krishnaswamy J K , Sarah J. Martin L M , Catriona Ooi N , Louise Owen O , Darren Russell P Q , Alan Street R and Jeffrey J. Post F S TA Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, Vic. 3004, Australia.
B Department of Obstetrics and Gynecology, Monash University, 246 Clayton Road, Clayton, Vic. 3168, Australia.
C Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia.
D Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia.
E Central Clinical School, Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004 , Australia.
F The Albion Centre, 150–154 Albion Street, Surry Hills, NSW 2010, Australia.
G Sexual Health and Blood Borne Virus Unit, Centre for Disease Control, Northern Territory Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
H Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia.
I Department of Clinical Immunology, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia.
J Department of Medicine, Alice Springs Hospital, 6 Gap Road, The Gap, NT 0870, Australia.
K Monash Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, Vic. 3168, Australia.
L Canberra Sexual Health Centre, Building 5, Canberra Hospital, Hospital Road, Garran, ACT 2605, Australia.
M Australian National University Medical School, Building 4, Canberra Hospital, Hospital Road, Garran, ACT 2605, Australia.
N Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia.
O Statewide Sexual Health Service, Clinic 60, 60 Collins Street, Hobart, Tas. 7000 , Australia.
P Cairns Sexual Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia.
Q School of Medicine and Dentistry, James Cook University, 1/14-88 McGregor Road, Smithfield, Qld 4878, Australia.
R Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Parkville, Vic. 3000, Australia.
S Department of Infectious Diseases, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.
T Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
U Corresponding author. Email: m.giles@alfred.org.au
Sexual Health 16(3) 282-288 https://doi.org/10.1071/SH18070
Submitted: 6 April 2018 Accepted: 23 February 2019 Published: 6 June 2019
Abstract
Background: Women comprise ~10% of people living with HIV in Australia, so are often underrepresented in research. Methods: This study invited clinicians providing care to women living with HIV to complete an anonymous survey containing questions related to four key areas: HIV (including diagnosis, treatment and virological outcomes), reproductive health (including sexual activity, contraception, pregnancy and outcomes) and linkage and retention in care. Results: In total, 484 surveys were received, with responses from all states and territories. Most women living with HIV in Australia are on treatment (>90%) and virologically suppressed (>90% have a viral load <50 copies mL−1). Almost 75% of women have had at least one switch in treatment (with toxicity almost as common as simplification as the indication). Treatment interruption is also relatively common, but is more likely the longer a woman has been diagnosed, if she is on benefits (P = 0.007) and is the primary carer of children without a partner (P = 0.001). In Australia, women living with HIV are a diverse heterogeneous group, with over 70 different countries of birth and almost half speaking a language other than English at home. Mental health diagnosis was the most common co-morbid condition identified. A total of 21% of women were post-menopausal, with 42% reporting symptoms to their healthcare provider, but only 17% were receiving treatment for symptoms attributed to menopause. Conclusions: As well as strategies to support women vulnerable to treatment interruption, important areas for future investment in research and clinical care include co-morbid mental health and menopause symptoms and treatment.
Additional keywords: antiretroviral treatment, interruption, menopause, reproductive health, switching.
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