ABSTRACT
BACKGROUND: Our aim was to describe the use of and responses to a self-management website, 'Health Map', established to address the key chronic health issues of HIV-positive people. METHODS: Health Map assessed health issues against current recommendations for: treatment adherence, monitoring CD4 counts and viral load, psychological health and physical activity, vaccination, cholesterol, fasting blood sugar, blood pressure, alcohol consumption, smoking, body mass index, and cervical screening for women and sexually transmissible infection (STI) screening for men who have sex with men (MSM). RESULTS: A total of 552 people, with a mean age of 37 years, completed the full 'Health Map' program, of whom 536 (97%) were Australian, 425 (77%) were male, including 268 (63%) MSM. Online responses to several health indices were of concern: 49% missed at least one dose of antiretroviral therapy per month and only 41% had had an HIV viral load test in the 4 months prior. Only 43% reported regular physical activity, and 49% and 61% reported vaccination for hepatitis A and B. The proportion tested within the recommended periods for fasting cholesterol (40%), fasting blood sugar (35%) and cervical screening (43%) in women or STI screening for MSM (53%) were low. CONCLUSIONS: A substantial proportion of individuals completing the online survey reported information that would suggest their HIV and more general health care is suboptimal. These data are consistent with community surveys and indicate the need for improvement in the chronic management of HIV.
Subject(s)
HIV Infections/therapy , Internet , Patient Education as Topic/methods , Adolescent , Adult , Aged , Australia/epidemiology , Female , HIV Infections/psychology , Humans , Male , Middle Aged , Self Care/methods , Sexually Transmitted Diseases/psychology , Sexually Transmitted Diseases/therapy , Sexually Transmitted Diseases/virology , Young AdultABSTRACT
BACKGROUND: Syphilis continues to be a significant public health problem among HIV-positive men who have sex with men (MSM) internationally. This study aimed to determine whether the routine inclusion of syphilis serology with every blood test performed as part of HIV monitoring increases the detection of early asymptomatic syphilis among HIV-positive MSM. METHODS: We examined the effect of this intervention, implemented in January 2007, on the detection of early asymptomatic syphilis among HIV-positive MSM attending the Melbourne Sexual Health Centre, Australia, and compared this with the previous clinic policy of annual syphilis screening. RESULTS: In the 18 months before and after the intervention, the median number of syphilis tests performed per man per year was 1 and 2, respectively. The proportion of MSM diagnosed with early syphilis who were asymptomatic was 21% (3 of 14) and 85% (41 of 48) for the 2 respective periods (P = 0.006). The time between the midpoint since last syphilis serology and diagnosis of syphilis was a median of 107 days (range 9-362) and 45 days (range 23-325) for the 2 periods, respectively (P = 0.018). CONCLUSIONS: The inclusion of routine syphilis serology with every blood test performed as part of HIV monitoring in HIV-positive MSM resulted in a large increase in the proportion of men diagnosed with early asymptomatic syphilis. This simple intervention probably also decreased the duration of infectiousness, enhancing syphilis control while also reducing morbidity.
