Clinical Scorecard: Infections and Sexual Behavior Among Injecting Drug Users Attending a Sexual Health Clinic in Melbourne, Australia: A Decade of Data from 2012 to 2022
At a Glance
Category
Detail
Condition
Sexually transmitted infections (STIs) and blood-borne viruses (BBVs) among people who inject drugs (PWID)
Key Mechanisms
Injection drug use and sexual practices increase risk of HIV, syphilis, gonorrhea, chlamydia, hepatitis B (HBV), and hepatitis C (HCV) infections
Target Population
People aged 18+ who inject drugs and are sexually active, including men who have sex with women only (MSWO), gay/bisexual men who have sex with men (gbMSM), and women
Care Setting
Sexual health clinics providing free HIV/STI testing and treatment
Key Highlights
Significant increase in syphilis positivity among PWID from 0.6% in 2012/2013 to 10.0% in 2020/2021
Gay and bisexual men who have sex with men (gbMSM) had higher overall infection positivity (29.1%) compared to MSWO (19.8%) and women (17.0%)
HCV antibody positivity was 10.0% with a low testing rate of 37.6%, indicating need for increased HCV testing
Guideline-Based Recommendations
Diagnosis
Screen PWID for HIV, syphilis, gonorrhea, chlamydia, HBV, and HCV regularly
Use computer-assisted self-interview (CASI) to collect sexual behavior and drug use history for risk stratification
Management
Provide free and accessible testing and treatment services for STIs and BBVs at sexual health clinics
Implement harm reduction programs including needle and syringe programs to reduce BBV transmission
Develop targeted prevention messages addressing sexual risk practices among PWID
Monitoring & Follow-up
Conduct repeated cross-sectional surveillance to monitor temporal trends in STI and BBV positivity among PWID
Track testing rates, especially for HCV, to identify gaps in screening coverage
Risks
Injection drug use combined with condomless sex increases risk of HIV, syphilis, gonorrhea, chlamydia, HBV, and HCV transmission
Overlap with LGBTQ populations may increase vulnerability due to higher illicit drug use and chemsex practices
Patient & Prescribing Data
Sexually active PWID aged 18 and older attending sexual health clinics
High prevalence of STIs and BBVs necessitates integrated testing and treatment; increased HCV testing uptake is critical
Clinical Best Practices
Incorporate routine STI and BBV screening into care for PWID, with attention to sexual orientation and practices
Use targeted education and prevention programs tailored to subgroups such as gbMSM to address higher infection rates
Expand harm reduction services including needle and syringe programs to reduce blood-borne virus transmission
Enhance data collection on sexual behavior and drug use to inform public health interventions
