National Gay Men’s Syphilis Action Plan Geoff Honnor HIV and Sexually Transmissible Infections Unit NSW Department of Health 23 October 2009

Origins and Purpose An initiative of the inter-jurisdictional Blood-Borne Viruses and STIs Sub-Committee (BBVSS) Sub-Committee of Australian Population Health Development Principal Committee, which reports through to Australian Health Ministers’ Conference In December 2008, BBVSS commits to: develop a nationally consistent approach to reducing the incidence of syphilis among gay men while allowing jurisdictions to tailor approaches specific to their individual needs; identify current gaps in policy and program development and implementation, including in the research base; and deliver a coordinated strategy in relation to reducing the incidence of syphilis.

An initiative of the inter-jurisdictional Blood-Borne Viruses and STIs Sub-Committee (BBVSS)

Sub-Committee of Australian Population Health Development Principal Committee, which reports through to Australian Health Ministers’ Conference

In December 2008, BBVSS commits to:

develop a nationally consistent approach to reducing the incidence of syphilis among gay men while allowing jurisdictions to tailor approaches specific to their individual needs;

identify current gaps in policy and program development and implementation, including in the research base; and

deliver a coordinated strategy in relation to reducing the incidence of syphilis.

Environment and context Considerable efforts to control syphilis among gay men over several years:  proportion of men testing for syphilis  frequency of testing for syphilis  protective sexual behaviours ≠ no change in apparent incidence. Doing more of what we’ve done is not certain to result in decreased incidence. So: An intensive technical review initiated to determine the order and degree of change required in transmission variables - testing rates, testing frequency, risk practice, etc – needed to achieve a new shared control goal .

Considerable efforts to control syphilis among gay men over several years:

 proportion of men testing for syphilis

 frequency of testing for syphilis

 protective sexual behaviours

≠ no change in apparent incidence.

Doing more of what we’ve done is not certain to result in decreased incidence.

So: An intensive technical review initiated to determine the order and degree of change required in transmission variables - testing rates, testing frequency, risk practice, etc – needed to achieve a new shared control goal .

Process and Governance Three phase approach: Phase A: Determining the variables/targets to underpin the goal Phase B: Developing and implementing the program response Phase C: Evaluation and review (and back to Phase A) Funding for Phase A contributed by APHDPC (all jurisdictions), with additional investment by Victoria and NSW NSW leading NSAP development on behalf of BBVSS Advisory Committee

Three phase approach:

Phase A: Determining the variables/targets to underpin the goal

Phase B: Developing and implementing the program response

Phase C: Evaluation and review (and back to Phase A)

Funding for Phase A contributed by APHDPC (all jurisdictions), with additional investment by Victoria and NSW

NSW leading NSAP development on behalf of BBVSS

Advisory Committee

Phase A Technical Working Group Associate Professor David Wilson and Professor Basil Donovan Phase A elements included: Further development of existing syphilis modelling (Victorian data), under the guidance of the Technical Working Group; Research led by A/Prof Garrett Prestage into attitudes, intentions and openness to change of gay men (and various sub-populations of gay men) in relation to syphilis / STI; Informed by National AFAO Workshop held 22 May 2009; Technical Workshop – 24 June 2009  Phase A Technical Report.

Technical Working Group

Associate Professor David Wilson and Professor Basil Donovan

Phase A elements included:

Further development of existing syphilis modelling (Victorian data), under the guidance of the Technical Working Group;

Research led by A/Prof Garrett Prestage into attitudes, intentions and openness to change of gay men (and various sub-populations of gay men) in relation to syphilis / STI;

Informed by National AFAO Workshop held 22 May 2009;

Technical Workshop – 24 June 2009  Phase A Technical Report.

Priority One - Testing Align testing rates with sexual activity - link syphilis testing to other routine testing. Test sexually active HIV+ gay men every 3 months during quarterly HIV management checks. Routinely test for both syphilis/HIV when sexually active gay men present. As a minimum, gay men who have 20+ partners per 6 months should be tested for syphilis at least twice per year.

Align testing rates with sexual activity - link syphilis testing to other routine testing.

Test sexually active HIV+ gay men every 3 months during quarterly HIV management checks.

Routinely test for both syphilis/HIV when sexually active gay men present.

As a minimum, gay men who have 20+ partners per 6 months should be tested for syphilis at least twice per year.

Priority Two – Partner Notification Increase the rate of partner notification by identifying easier/more effective ways to notify sexual partners discreetly. Link to and with clinician-led, and centralised notification models that use a variety of means and technologies. Increased education about syphilis.

Increase the rate of partner notification by identifying easier/more effective ways to notify sexual partners discreetly.

Link to and with clinician-led, and centralised notification models that use a variety of means and technologies.

Increased education about syphilis.

Priority Three – Syphilaxis Proposed syphilis chemoprophylaxis (‘syphilaxis’) trial should proceed as soon as is practical . SUPPORTING PRIORITY : Promoting condom use to maintain current high usage levels remains critical

Proposed syphilis chemoprophylaxis (‘syphilaxis’) trial should proceed as soon as is practical .

SUPPORTING PRIORITY :

Promoting condom use to maintain current high usage levels remains critical

Phase B Underway. Developing the program response. Drafting (AIDB) the National Gay Men’s Syphilis Action Plan. Second National AFAO Workshop – 23 Oct 2009. BBVSS Meeting 11 Nov 2009. Implementation/alignment with National STI Strategy. Evaluation and Review.

Underway.

Developing the program response.

Drafting (AIDB) the National Gay Men’s Syphilis Action Plan.

Second National AFAO Workshop – 23 Oct 2009.

BBVSS Meeting 11 Nov 2009.

Implementation/alignment with National STI Strategy.

Evaluation and Review.

Aims For Today Ownership of/buy in to the Plan. Identify barriers/challenges to implementation and possible solutions. Unpack education/information and ‘stigma.’ Endorsement of evaluation/monitoring framework. Consider governance arrangements .

Ownership of/buy in to the Plan.

Identify barriers/challenges to implementation and possible solutions.

Unpack education/information and ‘stigma.’

Endorsement of evaluation/monitoring framework.

Consider governance arrangements .