Michael Atkinson, (WA AIDS Council) describes development and progress of the only peer-based sexual health screening clinic in Australia: the M Clinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

1. Community Testing
M Clinic Reflections
July 2010 – May 2012
Michael Atkinson

2. Overview
1. Rationale for M Clinic
2. What we have found
3. Implications

5. Rationale for M Clinic
1. Syphilis Outbreak mid 2006
2. At the same time - high level of asymptomatic
STIs in WAAC Sauna Clinic
3. PGCPS’s show: testing poor + Increasing UAIC
4. General unmet supply of testing services
5. Seen as a way to improve ‘testing culture’
6. WAAC survey found guys wanted peer based
service but more discrete
7. Clinic provided a tangible hook to engage men
in education

6. What have we found?

8. Clients
1. 1310 clients since July 2010
2. >85% of clients have returned at least once
3. Place of residence: 60% within 20km of
CBD, 40% outer suburbs & state wide
4. Majority hear about us though word of mouth
5. Place of last test: Majority from GP, then tertiary
sexual health service
6. Increasing number of HIV positive clients

9. Clients by age
600
500
400
300
Age distribution
200
100
0
Under 21 21 - 30 31 - 40 41 - 50 51 - 60 61 +
years years years years years years

10. HIV Diagnoses (22 months)
• 18 HIV diagnoses
• 14/18 incident cases
• Over half had co-current STIs
• All but 1 contracted in Australia
• 9 Overseas born
• UAI main mode of transmission

11. HIV Yield by Age
60
50
40
30
Testers %
20 HIV Yield %
10
0
Under 21 21 - 30 31 - 40 41 - 50 51 - 60 61 plus
years years years years years years
Data provided by: Epidemiology and Surveillance Program, Communicable Disease Control
Directorate, WA Department of Health

12. HIV & Syphilis Yield by Age
60
50
40
30 Clients %
HIV Yield %
20
Infectious Syphilis Yield %
10
0
Under 21 - 30 31 - 40 41 - 50 51 - 60 61 +
21 years years years years years years
Data provided by: Epidemiology and Surveillance Program, Communicable Disease
Control Directorate, WA Department of Health

13. Interpretation
1. The sexual health service gap in WA is
experienced most by younger people (21-30
years) who require convenient, fast testing
2. The older age bracket (51-60) may have
decided that risky sexual practices are part of
the deal as you get older.

16. WA HIV notifications – MSM
01 July 2011 to 31 March 2012
Diagnosing Clinic Total Total%
GPs 16 39%
M Clinic 12 29%
General sexual health clinics (n=3 clinics) 7 18%
Hospital diagnoses (n=4 hospitals) 5 12%
Private Infectious Diseases Consultant 1 2%
Grand Total 41 100%

17. WA Trends
Since Establishment
M Clinic has had the highest number of MSM
HIV notifications from a single clinic in WA
Since November 2011
M Clinic has diagnosed 50% of new HIV
diagnoses amongst gay men in WA

18. Compared with other settings
in WA:
M Clinic clients are:
• More likely to have contracted HIV in
Australia
• More likely to have been tested because
of risky behaviour
• More likely to present for testing within
one year of transmission
Information provided by: Epidemiology and Surveillance Program,
Communicable Disease Control Directorate, WA Department of Health

19. Implications
• Positive response from the community
• Potential to expand services to a condom-weary group
• Potential to incorporate innovations such as Point of Care testing
• Model attractive to under 30s
• Potential to develop other strategies to engage this elusive
target group
• Large number of HIV diagnoses
• Model provides opportunity for a holistic and integrated
response at diagnosis – thus reducing long term impact
• Potential to expand the range of services to HIV positive people
• Shift towards community based screening in WA
• Cost shifting

20. Implications cont…
• The model facilitates early diagnoses of HIV & STIs
• Potentially decreasing downstream infection
• Complements ‘treatment as prevention’ model
• M Clinic sees different clients to other clinics
• People prefer to talk to a peer about risk behaviour
• We are diagnosing people that may not have tested
• Rich source of data - Research potential
• Western Australian Sexual Health Services Survey – Kirby
Institute
• HIV Sero-converters Study (Recent HIV Spike) – Kirby Institute

21. Acknowledgements
• Byron Minas, Lisa Bastian and the supportive
team at CDCD, WA Department of Health
• Mark Reid, Tony Bober, Garry Kuchel, Nadine
Toussaint and all the peer educators at WAAC
• Dr Lewis Marshall, Dr Paul Effler and the four
other M Clinic doctors
• The gay community and clients who have
embraced and supported our clinic