BACKGROUND:The population of international students (IS) in New South Wales (NSW) continues to grow post-COVID-19, with IS a key priority within NSW Health HIV and sexually transmissible infection (STI) strategies and efforts. Evidence shows gaps in sexual and reproductive health knowledge (SRH), and barriers to accessing services, including stigma, unfamiliarity with the Australian healthcare system and service cost concerns. Although the existing NSW International Student Health Hub website provides tailored information, awareness and utilisation of statewide and local sexual health preventive services remains limited. METHODS:A partnership between Sydney Local Health District and the NSW Multicultural HIV and Hepatitis Service implemented a localised, culturally responsive health promotion program. Consultations with IS and student services informed strategies to improve SRH literacy, strengthen service navigation, and enhance supportive environments. Key strategies included developing a local International Student Health Directory, peer and service capacity building, dissemination of SRH information through culturally responsive health stalls, and a mobile STI screening clinic on a university campus. RESULTS:This review describes the program delivery between January 2024 and March 2026. More than 5000 international students engaged with 28 health promotion stalls, with >2500 health directories distributed. The peer capacity-building program trained 106 student leaders, with participant sexual health knowledge increasing from 75 to 91% in pre- and post-training assessments. Campus-based STI screening tested 22 students, and identified one undiagnosed case of syphilis. CONCLUSION:A health promotion program delivering localised, multifaceted and partnership-driven activities can strengthen IS SRH literacy, service navigation and engagement with demonstrated transferability across NSW.
BACKGROUND:Although clinical trials and real-world studies demonstrate the efficacy and tolerability of dolutegravir and lamivudine (DTG + 3TC), Australian real-world evidence remains limited despite differences in access to health care and prescribing context. Here, we present the motivations for switching to DTG/3TC (a fixed-dose, single-tablet regimen) and treatment outcomes. METHODS:We performed a retrospective, observational analysis of individuals with HIV with an undetectable viral load (VL; <50 copies/mL) who switched to DTG/3TC during a 24-month inclusion window from 1 December 2020 to 1 December 2022, in nine Australian clinics. Healthcare providers completed an electronic survey using baseline demographics of people with HIV and other clinical information gathered from participant medical records. Data were collected after December 2023 to allow a 12-month follow-up. Primary endpoints were baseline demographics, clinical characteristics, and motivations for switching to DTG/3TC. Secondary endpoints included virologic outcomes and rates and reasons for DTG/3TC discontinuation. RESULTS:Overall, 276 individuals with HIV who switched to DTG/3TC were included. Most were male (97%) and White (76%), with a median (interquartile range) age of 54 (45-61) years. The most common antiretroviral therapy before DTG/3TC switch was abacavir/dolutegravir/lamivudine (54%). The most common reason for switching to DTG/3TC was clinician preference for two-drug regimen (43%). Most individuals (98%) maintained virologic suppression (VL <50 copies/mL), and none experienced virologic failure. Through Month 12, one (<1%) individual discontinued DTG/3TC. CONCLUSIONS:These real-world data support the use of DTG/3TC as a viable treatment strategy in this Australian population of individuals with HIV.
BACKGROUND:Sexual and reproductive health (SRH) services are widely available in Lusaka, Zambia but use among adolescent girls and young women remains low. This study investigated the perceptions and experiences of a sub-sample of female university students accessing clinic-based SRH services. METHODS:Thirty-four female students participated in focus group discussions in June-August 2022. Participants were recruited from a survey at a public university, where interested participants could opt-in to join focus groups discussing experiences and perceptions of SRH services. Focus groups were audio recorded, transcribed, and analysed using a line-by-line constant comparison approach in which a codebook based on the research questions was created a priori and revised as new codes inductively emerged. Key themes and illustrative quotes related to experiences and perceptions of SRH health care were identified. RESULTS:The most salient theme was widespread fear of seeking SRH services and interacting with healthcare providers. Three sub-themes included: (1) receiving moral judgement instead of health information; (2) negative clinic experiences; and (3) privacy concerns. As a result, a second theme revealed a reliance on less effective contraceptive methods, describing that these culminating experiences have led to decreased interest for SRH services. CONCLUSION:As one of the few qualitative studies on female university students in a high HIV-prevalence setting, we identified key barriers in the healthcare system that hindered the use of critical SRH services. This research contextualised the use of less effective contraceptive methods, low uptake of pre-exposure prophylaxis, and persistent suboptimal SRH outcomes in this sub-population of young women.
BACKGROUND:Many adolescents rely on digital sources for sexual and reproductive health (SRH) information; yet, online content is often inconsistent, inaccurate, or difficult to interpret. Digital knowledge translation strategies offer promising approaches to deliver accessible and youth-centred SRH education. This study aimed to explore youth perceptions, lived experiences, barriers, and facilitators to SRH education and services in Alberta, Canada. The study also sought to identify priority SRH topics, preferred communication approaches, and design features that would enhance usability and acceptability. METHODS:We used a community-based participatory research approach to recruit 15 young people aged 15-24 years from diverse backgrounds as youth partners to help guide the study, including exploring barriers to SRH education, identifying preferences for digital text-message-based SRH content, and informing the development of youth-friendly educational resources. Data were collected through semi-structured interviews. Braun and Clarke's reflexive thematic analysis approach was used to identify themes related to content priorities, messaging preferences, and implementation considerations. RESULTS:Participants emphasised the importance of accessible, non-judgemental, and culturally responsive SRH information. Content priorities included healthy relationships, consent, online safety, sexual orientation and gender identity, and communication with trusted adults. Short, clear messages delivered in a supportive tone was preferred, with links to credible resources. Youth highlighted the need for guidance in initiating conversations and addressing sensitive topics. Study results also demonstrated strong support for text messaging as a convenient and private method for receiving SRH information. CONCLUSIONS:Interactive text messaging represents a feasible and acceptable strategy for delivering youth-centred SRH education to design digital interventions that are relevantcultural appropriate, and useable,.
BACKGROUND:HIV testing is an integral component of prevention, reducing undiagnosed infection and promoting early treatment. Indigenous gay, bisexual and other men who have sex with men (GBM) are at increased risk of HIV and sexually transmitted infections (STIs), but may experience difficulties accessing clinical services. At-home blood-based self-collection may offer an alternative that bypasses such barriers. This study aimed to explore uptake of dried blood spots (DBS) among Indigenous Māori GBM in Aotearoa New Zealand. METHODS:The Sex and Prevention of Transmission Study is a national HIV bio-behavioural surveillance survey of GBM. At the end of the 2022 online questionnaire, participants were offered a mail-out at-home self-collection DBS kit for HIV, syphilis and hepatitis C. Specimens were returned using postage-paid courier bags. We assessed interest in DBS, DBS requests and DBS returns among Māori participants. We compared differences in DBS return rates by select characteristics using univariate logistic regression. RESULTS:There were 495 participants who started the survey and self-identified as Māori. Of the 77.6% (n = 384) reaching the DBS section, 66.1% (n = 246) showed an interest in DBS. Of these, 87.4% (n = 215) requested and were sent a DBS kit. Eighty-five specimens were returned, 39.4% of those sent a kit and 22.1% of those reaching the DBS question. Māori GBM reporting never testing for HIV (OR 0.37, 95% CI 0.16-0.83) were less likely to return a DBS. CONCLUSION:At-home self-collected DBS was acceptable to approximately one in five Māori GBM participants, and could complement clinic-based HIV and STI testing.
Significant disparities in the sexual and reproductive health of young people persist globally. Although previous systematic reviews and meta-analyses have largely focused on the effects of parenting practices, such as parent-child communication and parental monitoring, on sexual behaviors among young people, the effect size of parent-child connectedness (PCC) remains underexplored. The objective of this study was to explore the associations between PCC and sexual intercourse, unprotected sex, multiple sexual partners, and unintended pregnancy among young people. We searched and screened relevant literature published between January 2000 and May 2025 from six databases: PubMed/Medline, Web of Science, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, and APA PsycArticles. Eligible studies underwent quality assessment and data extraction. The meta-analysis used a multilevel mixed-effects model to calculate pooled odds ratios (OR). A total of 18 studies involving 78,284 participants were included. Meta-analysis indicated that a higher level of PCC was significantly associated with a lower risk of sexual intercourse (OR 0.72; 95% CI: 0.61-0.84), unprotected sex (OR 0.84; 95% CI: 0.74-0.96) and unintended pregnancy (OR 0.62; 95% CI: 0.43-0.91) among young people. However, its association with multiple sexual partners was not statistically significant. Higher levels of PCC are associated with lower risks of sexual-related behaviors and outcomes. However, findings should be interpreted cautiously given the high heterogeneity and limited number of included studies. Further research should explore its effects in broader populations, and incorporate prospective designs.
BACKGROUND:Honduras has the highest rates of teen pregnancy and HIV in Central America, which are disproportionately concentrated in rural, low-income communities with high school dropout rates and limited access to sexual health education. This study evaluated the 'Taking Care of You' (TCY) program, a community-based educational intervention designed to improve reproductive health knowledge and social risk awareness among adolescents aged 11-18 years in rural northwest Honduras. METHODS:We conducted a single-group, pre-post quasi-experimental study in El Rosario, Locomapa, Honduras. Eighty-seven adolescents were recruited through community leaders and school networks and participated in eight 3-h sessions from April to July 2024, covering sexual and reproductive health and social risk behaviours. A structured questionnaire with quantitative and qualitative components was administered pre- and post-intervention. McNemar tests, Wilcoxon signed-rank tests, and logistic regression models were used for quantitative analysis; descriptive-interpretive thematic analysis was applied to qualitative data. RESULTS:Before TCY, only 35.6% of participants knew about sexually transmitted infections (STIs), and fewer than half recognised risks of unprotected sex or substance use. Following TCY, there was increased knowledge on STIs, recognition of unprotected sex risks, self-assessed reproductive health knowledge, attitudes toward contraception, and comfort discussing sexual health and behaviours. Equitable gains were made across sex and age groups. Qualitative findings revealed shifts from stigma and avoidance toward openness and protective intentions. CONCLUSIONS:Knowledge and attitudinal gains were observed across sex and age groups; however, sustained behavioural change will require longer follow-up and continued structural support. Controlled trials with extended follow-up are needed to assess long-term behavioural impact.
High risks of unintended pregnancies and abortion have been reported among Chinese university students; however, their contraceptive use remains poorly understood. This study synthesised Chinese university students' contraceptive usage to inform the development of context-specific contraceptive investigations and interventions. We searched six databases from 1 January 2014 to 31 December 2024. Studies with clear definitions and comprehensive data reporting the usage of any contraceptive among Chinese university students either in China or attending universities abroad were included. Eligible studies were independently appraised by two authors. Random-effects meta-analyses were used to estimate pooled proportions of any contraceptive use. Of 6476 records identified, 34 studies were included. The proportions of any contraceptive use were reported across three important dimensions, namely, frequency of use, duration of use and at a specific time point (first/last sex). Accordingly, using any contraceptive, using any contraceptive every time and using any contraceptive at first sex among sexually experienced Chinese university students were commonly reported measurements, with pooled proportions of 74.5% (95% confidence interval (CI): 55.0-87.4%, I2 = 98.6%), 43.4% (95% CI: 33.6-53.8%, I2 = 97.5%) and 60.8% (95% CI: 51.4-69.4%, I2 = 96.8%), respectively. Subgroup analyses were performed; however, careful interpretation is required given the wide CIs, significant and unexplained heterogeneity, and the risk of bias. Findings revealed varied measurements of any contraceptive use substantiate the methodological challenges in assessing contraceptive behaviour among university populations. Future studies should adopt transparent, standardised and contextually justified measurement approaches in both global and local contexts.
BACKGROUND:Compulsive sexual behaviour disorder is recognised as a mental health disorder, characterised by the inability to control impulses and repetitive sexual behaviours, and is often associated with reduced sexual functioning and satisfaction. However, few studies have examined the associations between sexual compulsivity, sexual functioning and sexual satisfaction in non-Western populations, particularly with a gender perspective. METHODS:This study aimed to examine gender-specific patterns of these relationships in a community-based Iranian sample. Data were collected from 705 participants (81.6% male, 18.4% female) via snowball sampling and an online questionnaire. The Sexual Compulsivity Scale, the International Index of Erectile Function for men, the Female Sexual Function Index for women and the New Sexual Satisfaction Scale were used. Analyses were conducted using path analysis with observed total scores, estimated separately for each gender. RESULTS:Findings showed that in men, sexual functioning fully mediated the association between sexual compulsivity and sexual satisfaction. In women, sexual compulsivity had a direct negative association with sexual satisfaction without mediation by sexual functioning. These gender-specific patterns emphasise the importance of gender-sensitive approaches in understanding compulsive sexual behaviours. CONCLUSIONS:This study provides the first gender-specific structural evidence in the Iranian context, and suggests that clinical interventions should be performance-oriented for men and affective-relational for women.
BACKGROUND:This study aimed to systematically review and synthesize evidence on Chlamydia trachomatis prevalence in Canada, describe epidemiological patterns across populations and anatomical sites, and assess associations with prevalence. METHODS:A systematic review of Chlamydia trachomatis prevalence studies was conducted and reported according to PRISMA guidelines. Random-effects meta-analyses generated pooled mean prevalence estimates, and meta-regression analyses explored epidemiological and methodological predictors of prevalence variation. RESULTS:A total of 169 publications were included, contributing 437 prevalence measures spanning 1981-2025. The pooled mean prevalence in the general population was 4.4% (95% CI: 3.6-5.2%) for current urogenital infection and 50.3% (95% CI: 44.5-56.1%) for ever infection. Among men who have sex with men and transgender people, prevalence estimates were 1.8% (95% CI: 0.6-3.5%) for urogenital infection, 6.6% (95% CI: 3.7-10.1%) for anorectal infection and 0.7% (95% CI: 0.0-2.1%) for oropharyngeal infection. Prevalence was substantially higher among symptomatic populations, reaching 18.6% (95% CI: 9.3-30.2%) in women and 24.3% (95% CI: 13.7-36.7%) in men. Meta-regression analyses explained >40% of the observed variation in prevalence, indicating that prevalence was approximately 30% lower among individuals aged ≥25 years compared with those aged <25 years, with no significant sex differences. Prevalence declined over time at a relative rate of 3% per year. CONCLUSIONS:Chlamydia trachomatis prevalence in Canada is comparable to global levels. The ongoing persistence of infection underscores the need to enhance public health responses and expand investment in vaccine development as a cornerstone of long-term prevention and control.
BACKGROUND:Non-occupational post-exposure prophylaxis (nPEP) has been proposed as a strategic entry point for identifying candidates for HIV pre-exposure prophylaxis (PrEP). However, evidence of its ability to engage at-risk populations beyond gay and bisexual men who have sex with men remains limited. METHODS:We conducted a retrospective, real-world analysis of all individuals who accessed nPEP at a tertiary care centre in Italy between 2018 and 2025. Demographic and behavioural characteristics were evaluated to identify factors associated with PrEP initiation after nPEP. RESULTS:Among the 585 enrolled individuals, 149 (25.5%) initiated PrEP. PrEP uptake was strongly associated with being a gay or bisexual man who has sex with men and with repeated nPEP courses. In contrast, women, individuals aged <25 years, sex workers, transgender women, ethnic minorities and people using recreational drugs showed no increased likelihood of initiating PrEP. The introduction of free-of-charge PrEP did not improve engagement in these groups. CONCLUSIONS:In this real-world setting, nPEP failed to facilitate PrEP uptake among non-gay and bisexual men who have sex with men at risk of HIV infection. Alternative implementation strategies are needed to increase PrEP access for these diverse key populations.
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 Virtual Issue 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:Australia is reporting increasing notifications of sexually transmitted infections (STIs). Effective control depends on timely and equitable testing. However, evidence of testing and diagnosis patterns across diverse populations is limited. This study aimed to describe STI testing and diagnosis by different demographics in Victoria. METHODS:A 12-month online survey in Victoria, Australia recruited individuals aged 16 years and older through the Melbourne Sexual Health Centre, the Centre for Excellence in Rural Sexual Health, targeted social media advertisements, and community digital outreach. Data was collected on self-reported STI testing (blood, swab, urine, or no test) and STI diagnosis in the past 12 months. Subgroup analyses examined differences by age, residential location, and population groups. Chi-squared tests were used to compare the proportions of STI testing and diagnosis across different subgroups. RESULTS:We included 2327 participants in this analysis. Overall, 50.2% of participants reported blood testing, 39.8% swab testing, 47.3% urine testing, and 41.0% did not have any HIV/STI test in the past 12 months. In total, 17.3% reported an STI diagnosis. Participants in regional Victoria were more likely not to test (54.0%) compared with those in greater Melbourne (40.0%). The proportion with no testing was lowest among gay and bisexual cis-men (10.5%) and highest among heterosexual cis-men (57.1%). The proportion with no testing declined significantly with age from 72.7% among those aged 16-19 years to 52.4% at 20-24 years. CONCLUSION:Inequities in STI testing and diagnosis persist across age, population groups, and geography. Further research is needed to identify structural and behavioural barriers and to guide strategies that ensure equitable access to timely STI care.
BACKGROUND:Significant social, technological and medical changes highlight a need for timely and representative sexual and reproductive health surveys, while also posing challenges to their design. This paper describes methods of the Third Australian Study of Health and Relationships (ASHR3). METHODS:From March 2023 to April 2024, data were collected from people aged 16-69 years via an anonymous survey of holistic sexual and reproductive health. ASHR3 collected data via random selection of mobile phone numbers for an interviewer-administered survey and via an online probability panel for a self-administered digital survey. Potential differences between the two modes of sampling and data collection were investigated. Sample-specific design weights were applied and calibrated to the 2021 Australian Census regarding gender, country of birth, education, religion and area of residence. RESULTS:The final sample was 12,833 people: 5693 men (48.63% weighted proportion), 6984 women (49.98%), and 156 non-binary people (1.39%) from every state and territory. Telephone interviews were conducted with 7226 participants and online surveys with 5607. The survey cooperation and response rates for the telephone sample were 86.11% and 3.54%, respectively, whereas the online completion rate was 98.73%. Few participants said the survey made them feel embarrassed (10.96%) and most said they were very honest in their responses (96.54%). Comparisons with the most recent Census found the weighted ASHR3 sample was generally representative of the general population of Australia, with a mean of 1.22% difference across key sociodemographic characteristics (s.d. 2.37). There were no differences observed in sociodemographic characteristics and other responses between the telephone and online samples. CONCLUSIONS:ASHR3 compiled rich, robust, and representative data on sexual and reproductive health from a large national sample. The inclusion of an online probability panel complemented the more traditional telephone-based methods. With more than 20 years of data, ASHR is an important resource for monitoring trends in sexual and reproductive health.
BACKGROUND:Perceptions of chlamydia and gonorrhoea may influence sexually transmitted infection (STI) testing and prevention. Understanding these perceptions is essential, as many countries are considering more restrictive chlamydia testing. This study compared perceived susceptibility and severity of chlamydia and gonorrhoea among young heterosexuals in the Netherlands and explored underlying determinants and reasons. METHODS:An online cross-sectional survey (April-June 2024) among young people (16-34 year-old) was distributed via social media and sexual health clinics. Multivariable logistic regression identified determinants of perceived susceptibility and severity. Thematic analysis explored underlying reasons. RESULTS:Among participants (n = 1605), perceived susceptibility was low for chlamydia (75%) and gonorrhoea (81%), but both were considered severe (chlamydia 76%; gonorrhoea 82%). Determinants of perceived susceptibility differed by partner type. For those with steady partners, low impulsivity was associated with low perceived susceptibility, while multiple partners and low health goals were associated with high susceptibility. Among those with casual partners, multiple partners, no condom use at last sex, and low health goals were associated with high susceptibility. Perceived severity was lower among those with university education, low health goals, and multiple partners. Reasons for susceptibility related to sexual behaviour; severity to relationship concerns and STI aversion. CONCLUSIONS:Most young heterosexuals perceive chlamydia and gonorrhoea as severe, but many underestimate their personal risk, even when engaging in behaviours associated with increased risk of acquiring an STI. Misconceptions and limited awareness contribute to gaps between risk perception and preventive action. Targeted interventions and clear, infection-specific communication are needed as STI testing policies evolve.
BACKGROUND:Orgasm can be an important component of sexual wellbeing broadly and specifically in the preconception period, yet epidemiologic research on orgasm is limited. METHODS:We used cross-sectional data from Pregnancy Study Online (PRESTO), a cohort study of females attempting conception with one male partner (N = 6022; 2020-2025), to descriptively evaluate orgasm frequency, its correlates and its relationship to orgasm intensity. We used self-reported data to assess orgasm frequency (Likert scale: never/rarely to always/almost always) and intensity (0-10). Across correlates (e.g. encompassing sociodemographic, medical, behavioral factors), we calculated the absolute difference and 95% confidence interval (CI) in the percentage of participants reporting the highest versus lowest orgasm frequency within levels of each correlate, standardized relative to the difference in the full sample. RESULTS:Over half of the sample reported orgasming 'always', 'almost always' or 'most times' during sexual activity. Partner support was a strong correlate; participants whose partner 'rarely' provided love/affection and emotional support reported less frequent orgasms (standardized percentage-point differences of -11.0, 95% CI -36.7, 14.7 and -27.5, 95% CI -44.4, -10.6, respectively). Irritable bladder syndrome (standardized percentage point difference -15.4, 95% CI -25.5, -5.3), diabetes (standardized percentage point difference -5.8, 95% CI -18.2, 6.7) and depressive symptoms (highest category standardized percentage point difference -11.6, 95% CI -19.3, -4.0) were strong correlates of less frequent orgasms. Participants with lower function on other domains of sexual function reported fewer orgasms. CONCLUSIONS:Important correlates of preconception orgasm frequency spanned relational, clinical and sexual function factors. We discuss implications for conducting etiologic orgasm research.
Congenital syphilis remains a significant public health threat in Australia, warranting national efforts to reduce syphilis incidence overall, focusing on women of reproductive age. To identify priority actions to eliminate congenital syphilis, ASHM convened a national multidisciplinary roundtable with attendance from organisations, colleges, and bodies across the healthcare sector with a focus on Aboriginal and Torres Strait Islander peoples' health, sexual and reproductive health, antenatal health, primary care, pathology, and pharmacy, as well as research institutes and community organisations. This position statement outlines the immediate, short-term and long-term actions identified by roundtable participants to eliminate congenital syphilis in Australia.
BACKGROUND:Co-occurring perceived community stigmas (HIV, sexual/gender minority status and substance use) impact health behaviors and access to healthcare services, particularly in low- and middle-income countries, but there is a paucity of research among adolescents and young adults). This paper explores the associations between co-occurring perceived community stigmas (HIV, sexual/gender minority status and substance use) and their relationship to mental health and substance use outcomes among youth in Kazakhstan. METHODS:Participants were 216 (females: 116, males: 110) youth living in Almaty, Kazakhstan, who were not diagnosed with HIV. We used multidimensional latent class analyses to identify groups of youth with different combinations of perceived community stigmas. RESULTS:The four latent classes are: (1) low levels of all stigma types (26%, n = 56); (2) low levels of HIV stigma with moderate levels of substance use and sexual/gender minority status stigmas (44%, n = 95); (3) moderate levels of HIV and sexual/gender minority status stigmas with low substance use stigma (9%, n = 19); and (4) high levels of all stigma types (21%, n = 46). Adolescents and young adults in Class 4 had higher odds of self-identifying as a sexual/gender minority (OR 2.70; 95% CI: 1.09, 6.69) compared with Class 1. Youth in Class 4 had higher depression (M 13.88, s.d. 7.52) and anxiety (M 9.00, s.d. 6.82) compared with Class 1 (M 9.00, s.d. 6.01; M 5.2, s.d. 5.38, respectively). Youth in Class 2 were 2.47 times (95% CI: 1.23, 4.93) more likely to have used tobacco, and 2.06 times (95% CI: 1.05, 4.06) more likely to have used alcohol than Class 1. CONCLUSION:Discrete typologies of perceived co-occurring community stigmas are differentially associated with health outcomes, suggesting a need for interventions to address co-occurring stigmas.
BACKGROUND:The Centers for Disease Control and Prevention (CDC) has identified drug-resistant Neisseria gonorrhoeae as an urgent public health threat, highlighting the importance of antimicrobial stewardship. This study evaluated the implementation of point-of-care (POC) nucleic acid amplification (NAA) testing for chlamydia and gonnorhea among males presenting with urethritis at an urban public sexually transmitted infections (STI) clinic. METHODS:POC urine NAA testing was performed for males presenting with symptoms of urethritis and/or urethral discharge, as well as asymptomatic males reporting STI exposure. Patients with with laboratory-confirmed infections were treated according to CDC STI treatment guidelines: for chlamydia, patients were treated with doxycycline 100 mg orally twice daily for 7 days; for gonorrhea, patients were treated with a single 500-mg intramuscular dose of ceftriaxone. Patients testing negative for both infections were managed for non-gonococcal urethritis with doxycycline, or in select cases, received no empiric therapy. Reductions in antibiotic use were compared with standard syndromic management. RESULTS:A total of 385 POC tests were analysed. Gonorrhea was detected in 40 patients (10.4%), chlamydia in 29 (7.5%), and both infections in five (1.3%), while 311 (80.8%) were negative. Forty-seven patients received ceftriaxone, representing an absolute reduction of 338 doses (87.8% relative reduction). Doxycycline was dispensed to 193 patients, representing an absolute reduction of 192 doses (49.9% relative reduction). CONCLUSIONS:Implementation of POC NAA testing for chlamydia and gonorrhea in male patients presenting with urethritis improved antimicrobial stewardship by significantly reducing unnecessary empiric use of antibiotics in an urban STI clinic setting.
BACKGROUND:Social media platforms are important spaces for social and sexual networking among men who have sex with men (MSM). However, limited research has examined structural changes in MSM digital social networks or the contribution of different user roles in maintaining network connectivity. This study aims to investigate structural changes and user dynamics in an online MSM network to inform tailored digital public health interventions. METHODS:We constructed directed social networks among MSM in Zhuhai, China, using large-scale Blued platform data collected in 2021 and 2024. Users were represented as nodes, and follow relationships were represented as directed edges. Key network metrics, including degree distribution, reciprocity, assortativity, community fragmentation and attribute-based homophily, were analysed to identify weak links and structurally important users. RESULTS:The analysis included 9409 valid users in 2021 and 8890 in 2024. The network was significantly sparser and more fragmented, with edge density halving and 70.91% of detected communities containing only two users in 2024. Average degree dropped from 19.52 to 8.00, whereas degree assortativity decreased from -0.0580 to -0.1482, indicating increasing disassortative mixing. Despite reduced platform engagement, younger, versatile, and highly active boundary and common users remained important for sustaining inter-community connectivity. CONCLUSIONS:From 2021 to 2024, the MSM network on Blued became more fragmented, disassortative and heterogeneous. These changes may constrain health-message diffusion. Network-informed strategies targeting central and bridging users, while improving access for peripheral users, may enhance equitable information dissemination among MSM communities.
